Development and psychometric validation of the gum health experience questionnaire.

AIM: To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts. MATERIALS AND METHODS: The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test-retest reliability among a subsample (n = 27). RESULTS: Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test-retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91-.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54-.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition. CONCLUSIONS: The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health-disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence.

Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach.

INTRODUCTION: Patients' decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. OBJECTIVES: The primary objective of the study was to identify the key processes involved in patients' experience of decision making for orthognathic treatment. METHODS: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18-66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. RESULTS: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients' decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. CONCLUSION: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients' decision-making process. The findings of this study can inform future quantitative studies. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients' decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

Structural Determinants and Children's Oral Health: A Cross-National Study.

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Scoping Review of the Role of Shared Decision Making in Dental Implant Consultations.

To what extent does dental research on implant consultations focus on the use of shared decision making? There has been an explosion in the use of implant therapies in dentistry, but very little is known about the decision-making processes involved in the provision of dental implants. The use of shared decision making (SDM) has been found to reduce undesirable outcomes and increase patient and clinician satisfaction in other health care fields. This scoping review reports on the current status of SDM in research on implant therapies. A scoping review methodology was used. Web of Knowledge, MEDLINE via OvidSP, MEDLINE via PubMed, Embase, Scopus, Cochrane, DARE, and CINAHL databases were reviewed between 1900 and December 1, 2017. The search strategy resulted in 2,289 eligible articles; 1,892 duplicated articles were deleted, resulting in a hand search of 397 titles and abstracts. These were subsequently evaluated while applying the inclusion and exclusion criteria, resulting in 48 articles for full-text evaluation. After full-text evaluation of these 48 studies, a further 27 were eliminated as not being relevant, leading to the inclusion of 21 studies for the review. No studies to date have examined how patients and dentists engage in decisions to place dental implants. Aspects that were discussed in the literature related to the decision-making process included a discussion about patients' values and discussing possible treatment options. How patients and dentists interacted during implant consultations was poorly explored. Shared decision making has been shown to improve health care quality and increase clinician and patient satisfaction. Further research concerning dental implant decisions is warranted with emphasis on evaluating patients' contributions to treatment, which is currently poorly understood. Exploring existed methods for examining the SDM process in implant consultations should facilitate improve care and consent. Knowledge Transfer Statement: The findings of this scoping review can be used by all dentists when deciding which decision-making model they wish to use when planning implant therapy. The article places special emphasis on the role of shared decision making in improving health care quality and increasing patients' and clinicians' satisfaction.

'I felt weird and wobbly.' Child-reported impacts associated with a dental general anaesthetic.

AIM: This qualitative study sought to obtain children's accounts of having dental extractions under general anaesthesia (GA). The aim was to gain greater understanding of the physical and psychological impacts from a child's perspective. METHOD: Ten children, aged 6-11 years, maintained a video diary to document their feelings and experiences before, and following their hospital admission. Two semi-structured home interviews supplemented the video diary data and analysis was guided by narrative approaches. RESULTS: This research revealed new insights into children's experiences of having teeth removed under GA. Several of the post-operative impacts correlated with those previously reported by parents/carers. These were notably nausea, bleeding and tiredness, although children used different terminology. However, additional physical and psychological outcomes, both positive and negative, emerged from the children's narratives. Negative aspects included hunger, disturbed eating, being scared/worried and experiencing discomfort from the IV cannula. Interestingly, pain was not a strong theme. Positive outcomes were also reported, such as satisfaction with the resolution of their dental problem and receipt of rewards and attention from family members. CONCLUSION: These accounts have implications for improving patient experiences and outcomes throughout the dental GA care pathway. A review of pre-operative fasting protocols should be a priority.

The effect of a domiciliary denture service on oral health related quality of life: a randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a domiciliary denture service on the oral health related quality of life (OHQoL) of older patients requiring complete dentures. DESIGN: Community based single-blind randomised controlled trial. SUBJECTS AND METHODS: 133 edentate adults aged 65 years and over referred to a community dental service for domiciliary care were assigned to study and control groups using block randomisation. Treatment to provide the study group with complete dentures commenced immediately. Treatment for the control group was deferred to the normal waiting list but in the interim participants received three home visits from the dental team. Follow up data were collected three months after dentures had been fitted in the study group. OUTCOME MEASURES: Prevalence, extent of impacts and total scores using Oral Impacts on Daily Performance (OIDP). RESULTS: The study and control groups (n = 65 and 68 respectively) had similar OHQoL at baseline. Two and five participants were lost to the study and control groups respectively. In ANCOVA and intention to treat analysis, the presence of impact, number of impacts and total scores for OIDP at follow up were predicted by group allocation (b = 0.28, b = 0.30, and b = 0.32 respectively. All p <0.001). In all cases the study group showed significantly improved OHQoL compared to the control group. CONCLUSION: A domiciliary denture service improved oral health related quality of life of housebound edentulous older people.

An exploratory qualitative study examining the social and psychological processes involved in regular dental attendance.

OBJECTIVE: This study aimed to provide a description of the psychosocial process involved in regular dental attendance. METHODS: The study design was a qualitative cross-sectional study using unstructured and semistructured interviews and observations of regular dental visits. The study participants included 12 men and 18 women attending general dental practices and six men and four women attending an emergency dental service. The data were systematically recorded and subjected to line-by-line grounded theory coding around the main concerns of those attending the dentist. RESULTS: The main concern of those attending for a regular dental visit was checking their oral health. The six-month recall was conceptualized as a checking cycle in six phases: recalling, responding, inducing (i), waiting, inducing (ii), and telling. The possible outcomes of the cycle were maintaining oral health, sustaining oral health, and a further checking cycle. Variations in checking cycles resulted from reordering and normalizing pressures within participants' lifestyles. CONCLUSIONS: The findings of this study suggest that people's patterns of dental attendance are similar to those of other chronic illnesses. An understanding of the dynamic psychosocial processes involved in frequent dental attendance may be achieved when further research into this phenomenon is conducted.

Technique and timing in the womens forward two and one half somersault pike and mens three and one half somersault pike 3m springboard dives.

The purpose of this study was to compare the forward two and one half somersault dive in a pike position (105B) performed by females (n=25) and the forward three and one half somersault dive in a pike position (107B) performed by males (n=25) to determine changes required by females to successfully perform 107B. Video data of the dives performed at the 1999 FINA World Diving Cup were captured and digitised to obtain times and postures of the divers at specific events including hurdle landing, takeoff, and entry. Estimates of hurdle flight height and mass-normalised work done on the springboard were obtained from hurdle and flight times. Females performing 105B had significantly less hip and knee flexion at landing from the hurdle than males performing 107B. It is known from simulations that the ability to land in a very flexed position without absorbing energy depends on the ability to generate large extension torques at landing. Therefore, it is likely that females need to increase strength to successfully complete 107B.

Levels of dangerousness: an analysis of Irish dentists' clinical responses to HIV-seropositive patients.

Work conducted in the mid-1980s suggested that dentists in the Republic of Ireland felt uncomfortable about treating patients who were HIV-seropositive. It seemed that with greater understanding of the behaviour of the virus, dentists' attitudes would be modified accordingly. The aim of this study was to assess the reactions of Irish dentists to the treatment of HIV-positive patients. All dentists currently on the register were sent a questionnaire to assess their knowledge, attitudes and clinical behaviours. Over 60% of dentists responded. The study highlights dentists' responses to HIV infection suggesting that they are fearful of the virus. They perceive HIV as dangerous to themselves, their other patients and their practice. The findings indicate that attitudes relating to dangerousness remain a significant obstacle in the treatment of this patient group.

Dangerousness and dentistry: an explanation of dentists' reactions and responses to the treatment of HIV-seropositive patients.

Factors which influence health professional's willingness to treat HIV seropositive patients have been explained in terms of the concept of dangerousness. Can this concept be used as a vehicle to explain dentists' responses? All dentists currently in practice in Northern Ireland (n = 664) were invited to take part in the study. A final valid response rate of 73.3% was achieved. Attitudes and behavioural aspects of dental practice were examined in relation to whether they had or had not treated and HIV seropositive patients. In addition correlation and factor analyses were conducted. The results indicated that the concept of "dangerousness' provides a useful framework to explain dentists' attitudes and behaviours with respect to the provision of dental care for this patient group.

Cytogenetics and P-glycoprotein (PGP) are independent predictors of treatment outcome in acute myeloid leukemia (AML).

Clinical and biological features have recognized prognostic significance in acute myeloid leukemia (AML). To evaluate the interaction of these variables and weighted effect on treatment outcome, prognostic variables from 96 previously untreated patients were analyzed for association with expression of the MDR1 gene product P-glycoprotein (Pgp), and effect on response to induction chemotherapy, progression-free survival and overall survival. Multivariate relationships were analyzed using six prognostic variables, including age, cytogenetic pattern, gender, CD34+ surface phenotype, AML type (de novo versus secondary) and Pgp. Univariate comparisons indicate that Pgp (P = 0.0001), cytogenetic pattern (P = 0.0004) and a Cd34+ phenotype (P = 0.0005) are predictive of primary treatment failure, whereas Pgp (P = 0.0001) had the greatest predictive value in multivariate analysis. Only cytogenetic pattern retained prognostic significance (P = 0.0143) for response to induction therapy after adjustment for Pgp. Although all variable except gender were associated with Pgp, specimens harboring the favorable karyotypic abnormalities t(15;17), t(8;21) and inv(16) exclusively lacked Pgp expression. In a multivariate model, both Pgp and cytogenetic pattern predicted response and overall survival, whereas secondary AML and cytogenetic pattern influenced remission duration. These findings indicate that cytogenetic has prognostic relevance that is independent of Pgp, and implies the presence of undefined biological mechanisms affecting chemotherapy resistance.

Dentists practising in Lothian treat HIV seropositive patients: is this a resolution of conflict or a case of Hobson's choice?

Dentists are now required to treat HIV-positive patients in their practices. Dentists working in high HIV prevalence areas treat HIV seropositive patients but what affects this treatment decision? The aim of this study is to investigate the role of conflict with regard to treatment decisions. All 371 dentists practising in Lothian were sent a questionnaire. Two hundred and fifteen questionnaires were returned giving a valid response rate of 60%. The findings of this study would support the view that dentists are able to use their scientific knowledge which reduces anxieties and assists in the resolution of their conflict with regard to the treatment of HIV seropositive patients.

Ethylene dibromide: negative results with the mouse dominant lethal assay and the electrophoretic specific-locus test.

Ethylene dibromide (1,2-dibromoethane; EDB) was tested for the induction of dominant lethal and electrophoretically-detectable specific-locus mutations in the germ cells of DBA/2J male mice. Males were treated with a single intraperitoneal injection of 100 mg/kg EDB and mated to two C57BL/6J females. In the dominant lethal assay, matings were carried out to measure the effect of EDB on meiotic and postmeiotic stages; germ cells representing spermatogonial stem cells were analyzed in the electrophoretic specific-locus test. Neither of these germ cell tests produced any evidence that EDB is a germ cell mutagen. It appears from these data and those reported in the literature that EDB, a genotoxic carcinogen that affects male fertility in some mammalian species, is not mutagenic in the germ cells of the male mouse.

Regulation of transforming growth factor-alpha mRNA expression in T3M4 human pancreatic carcinoma cells.

Cultured human pancreatic cancer cells produce transforming growth factor-alpha (TGF-alpha), a potent mitogenic polypeptide. In the present study, we investigated the regulation of TGF-alpha mRNA expression in T3M4 human pancreatic carcinoma cells. TGF-alpha mRNA levels were quantitated by densitometric analysis of autoradiographs obtained following hybridization of size-fractionated cytoplasmic RNA with 32P-labeled cRNA coding for human TGF-alpha. There was a twofold increase in TGF-alpha mRNA levels at 2 h following addition of either epidermal growth factor (EGF) or TGF-alpha. However, TGF-alpha mRNA levels declined to near basal levels by 10 h. At 2 h, one-half maximal stimulation of TGF-alpha mRNA levels occurred at 1 nM and maximal stimulation at 4 nM of either EGF or TGF-alpha. The transcriptional inhibitor actinomycin D (Act D) and the phorbol ester, 12-O-tetradecanoyl-phorbol-13-acetate (TPA), mimicked the actions of EGF and TGF-alpha. These findings indicate that the regulation of TGF-alpha mRNA expression in T3M4 cells is complex, and is mediated, in part, via the EGF receptor.

A comparative study of commercial human and bovine albumin preparations.

A number of commercial human and bovine albumin preparations were compared using seven assay procedures, to assess their suitability as reference materials for albumin and total protein assays. The results indicate that before a particular commercial albumin preparation can be used for standardisation purposes, its suitability should be checked in several assay systems which measure a different functional aspect of the protein molecule. The measurement of extinction coefficient in the range 278-280 nm does not appear to be a valid measure of protein content if the albumin preparation is to be used for standardisation of immunochemical or dye-binding assays.

Modification of a serial film changer for frontal magnification angiography.

A movable carriage was designed and built for a Franklin film changer to facilitate routine serial 2 times magnification. This simple device permits magnification angiography without major equipment purchases or room alterations.