Validity and reliability of the COVID-19 Anxiety Syndrome Scale in Canadian dentists.

BACKGROUND: The COVID-19 pandemic has resulted in a high level of mental health problems for the population worldwide including healthcare workers. Several studies have assessed these using measurements for anxiety for general populations. The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a self-report measure developed to assess maladaptive forms of coping with COVID-19 (avoidance, threat monitoring and worry) among a general adult population in the United States. We used it in a prospective cohort study of COVID-19 incidence rates in practising Canadian dentists. We therefore need to ensure that it is valid for dentists in French and English languages. This study aimed to evaluate the validity of the C-19ASS in that population. METHODS: Cross-sectional data from the January 2021 monthly follow-up in our prospective cohort study were used. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. RESULTS: The results of EFA revealed a 2-factor structure solution that explained 47% of the total variance. The CFA showed a good model fit on the data in both English and French languages. The Cronbach's alpha indicated acceptable levels of reliability. Furthermore, the C-19ASS showed excellent divergent validity from the Generalized Anxiety Disorder-7 (GAD-7) scale. CONCLUSIONS: The C-19ASS is valid and reliable instrument to measure COVID-19-related anxiety in English and French among Canadian dentists. PRACTICAL IMPLICATIONS: This validated measure will contribute to understanding of the mental health impact of the pandemic on dentists in Canada and enable the dental regulatory authorities and organizations to intervene to help dentists.

Centring anti-oppressive justice: Re-envisioning dentistry's social contract.

OBJECTIVES: We re-envision dentistry's social contract and elaborate on the idea that it is not neutral and free from such things as racism and white supremacy and can act as a tool of oppression. METHODS: We critique social contract theory through examination of classical and contemporary contract theorists. More specifically, our analysis draws from the work of Charles W. Mills, a philosopher of race and liberalism, as well as the theoretical and praxis framework of intersectionality. RESULTS: Social contract theory supports hierarchies and inequities that may be used to sustain unfair and unjust differences in oral health between social groups. When dentistry's social contract becomes a tool of oppression, its practice does not promote health equity but reinforces damaging social norms. CONCLUSION: Dentistry must embrace an anti-oppression framing of equity and elevate the principle of justice to one of liberation and not just fairness. In doing so, the profession can better understand itself, act more equitably and empower practitioners to advocate for justice in health and healthcare in its fullest sense. Anti-oppressive justice supports health not as merely an obligation but as a human duty.

Chronic toxicity of shrimp feed added with silver nanoparticles (Argovit-4®) in Litopenaeus vannamei and immune response to white spot syndrome virus infection.

In recent years, the application of silver nanoparticles (AgNPs) as antibacterial compounds has been widely used in human and veterinary medicine. In this work, we investigated the effects of AgNPs (Argovit-4®) as feed additives (feed-AgNPs) on shrimp (Litopenaeus vannamei) using three different methods: 1) chronic toxicity after 28 days of feeding, 2) Effects against white spot syndrome virus (WSSV) challenged by oral route, and 3) transcriptional responses of immune-related genes (PAP, ProPO, CTL-3, Crustin, PEN3, and PEN4) following WSSV infection. The results showed that the feed-AgNPs did not interfere with the growth and survival of shrimp. Also, mild lesions in the hepatopancreas were recorded, proportional to the frequency of the feed-AgNP supply. Challenge test versus WSSV showed that feeding every 7 days with feed-AgNPs reduced mortality, reaching a survival rate of 53%, compared to the survival rates observed in groups fed every 4 days, daily and control groups of feed-AgNPs for the 30%, 10%, and 7% groups, respectively. Feed-AgNPs negatively regulated the expression of PAP, ProPO, and Crustin genes after 28 days of treatment and altered the transcriptional responses of PAP, ProPO, CTL-3, and Crustin after WSSV exposure. The results showed that weekly feeding-AgNPs could partially prevent WSSV infection in shrimp culture. However, whether or not transcriptional responses against pathogens are advantageous remains to be elucidated.

Dental and medical care visits among persons with diabetes in Ontario, Canada, who self-report oral health status.

Periodontal disease is associated with diabetes mellitus and poor overall health. While the biological underpinnings of this relationship have been identified, less is known about the extent to which this relationship is affected by dental and medical care visits. Two studies lead by the primary author (KKP) explored the likelihood of diabetes complications among persons living with diabetes in Ontario, Canada, who were followed prospectively in administrative health data. The results from both studies confirmed that poor to fair self-reported oral health was associated with a greater risk for diabetes complications, and that poor dental and medical care visiting behaviours increased this risk. In general, the findings indicate that a greater number of dental and medical visits had a protective effect on the overall health of persons with diabetes. This discovery has important implications for all health care providers interested in managing oral and systemic health.

La maladie parodontale est associée au diabète sucré et à un mauvais état de santé général. Bien que les causes biologiques de ce lien ont bien été définies, la mesure par laquelle ce lien est influencé par des visites dentaires et médicales est peu connue. Deux études menées par l'auteur principal (KKP) ont exploré la probabilité de complications diabétiques chez les personnes atteintes de diabète en Ontario, au Canada, qui ont été suivies prospectivement dans les données administratives de santé. Les résultats des 2 études ont confirmé qu'un état de santé buccodentaire autodéclaré pauvre à moyen était associé à un risque plus élevé de complications diabétiques, et que de mauvais comportements en matière de visites de soins médicaux et dentaires augmentaient ce risque. Les résultats ont généralement révélé qu'un nombre plus élevé de visites dentaires et médicales ont un effet protecteur sur la santé globale des personnes atteintes de diabète. Cette découverte a d'importantes répercussions pour tous les fournisseurs de soins de santé qui s'intéressent à la gestion de la santé buccodentaire et systémique.

What influences attitudes toward professionalism in dental students?

OBJECTIVES: To explore dental students' attitudes toward professionalism and the environmental, institutional, and student-related factors that may be associated with these attitudes. METHODS: A cross-sectional online survey, conducted in 2020, analyzed data from a convenience sample of undergraduate dental students at the Faculty of Dentistry, University of Toronto. Attitudes toward professionalism were assessed using Likert scale statements related to the American Dental Education Association professionalism values of "Fairness," "Responsibility," "Respect," and "Service-mindedness." Codes ranging from 1 to 5 were assigned for the different levels of agreement and an "attitudes toward professionalism score" (ATPS) was computed by summing the codes for all the statements. Greater agreement with the statements or a higher ATPS indicated more positive attitudes toward professionalism. Association of the ATPS with environmental, institutional, and student-related factors was investigated using non-parametric tests and linear regression. RESULTS: The survey yielded a response rate of 51.4% (n = 221). The majority of respondents agreed with all professionalism statements. Results showed that the ATPS was significantly associated with and decreased for students who viewed their future patients as consumers (ß = -3.41, 95% confidence interval [CI]: -5.21, -1.60), experienced unprofessional faculty behavior (ß = -2.45, 95% CI: -4.88, -0.01), and chose to pursue dentistry for financial benefit (ß = -2.55, 95% CI: -4.63, -0.47). CONCLUSION: This sample of dental students generally had positive attitudes toward professionalism and numerous factors were associated with these attitudes. Enhancing the instruction and reinforcement of professional attitudes may be important to students' application of professionalism in decisions regarding clinical practice.

The incidence of COVID-19 among dentists practicing in the community in Canada: A prospective cohort study over a 6-month period.

BACKGROUND: Oral health care settings carry a potentially high risk of causing cross-infection between dentists and patients and among dental staff members due to close contact and use of aerosol-generating procedures. The authors aimed to estimate COVID-19 incidence rates among Canadian dentists over a 6-month period. METHODS: The authors conducted a prospective cohort study of 644 licensed dentists across Canada from July 29, 2020, through February 12, 2021. An online questionnaire, adapted from the World Health Organization's Unity Studies protocols for assessment of COVID-19 risk among health care workers, was used to collect data on self-reported severe acute respiratory syndrome coronavirus 2 infections every 4 weeks. A bayesian Poisson model was used to estimate the incidence rate and corresponding 95% credible intervals (CIs). RESULTS: Median age of participants was 47 years; most participants were women (56.4%) and general practitioners (90.8%). Median follow-up time was 188 days. Six participants reported COVID-19 infections during the study period, giving an incidence rate of 5.10 per 100,000 person-days (95% CI, 1.86 to 9.91 per 100,000 person-days). The incidence proportion was estimated to be 1,084 per 100,000 dentists (95% CI, 438 to 2,011 per 100,000 dentists) and 1,864 per 100,000 people (95% CI, 1,859 to 1,868 per 100,000 people) in the Canadian population during the same period. CONCLUSIONS: The low infection rate observed among Canadian dentists from July 29, 2020, through February 12, 2021, should be reassuring to the dental and general community. PRACTICAL IMPLICATIONS: Although the infection rates were low among Canadian dentists, it is important to continue to collect disease surveillance data.

Ontario dentists' ease to discuss sensitive health issues with their patients: A cross-sectional study.

OBJECTIVES: With consistent calls for a more integrated approach to improve the healthcare system's effectiveness, the scope of practice for dentists has expanded; dentists are now seen to positively intervene to address several sensitive health issues among their patients. However, it is not clear how comfortable dentists feel in doing so. This study endeavored to assess self-perceived ease of dentists to discuss various sensitive health issues and if their socio-demographics influence their ease. METHODS: A self-administered online survey was sent to Ontario dentists (n = 9975) to assess their self-perceived ease in discussing five sensitive health issues with their patients: eating disorders, substance abuse, sexually transmitted infections (STIs), sexual behaviors, and physical abuse. Ordinal logistic regressions were performed along with descriptive analyses. RESULTS: The response rate was 9.3%. Over 50% of participants indicated difficulty discussing STIs, sexual behaviors and physical abuse. Younger dentists, female practitioners, dentists practicing in private settings, and those practicing in rural areas perceived more difficulty to discuss all five health issues. Place of training was also a significant predictor: internationally trained dentists perceived it easier to discuss eating disorders, substance abuse, and physical abuse while Canadian trained were more at ease to discuss STIs and sexual behaviors. CONCLUSION: This exploratory study identified that a large proportion of dentists are not comfortable discussing sensitive health issue with their patients. There are numerous opportunities for intervention in Canadian dental curriculums, continuing education programs, and communication practices to support dentists' discussions with patients about these important health concerns.

Is there a social justice to dentistry's social contract?

How should the dental profession of the 21st century frame its interactions with the society it is tasked to care for? What has this relationship looked like in the past, and what does it look like today? In this article, we examine these and other issues through the framework of the social contract, with a focus on exploring how social justice fits within the transaction of duties between the dental profession and society. We begin by describing the social contract and how this is uniquely defined within the context of dentistry; specifically, how the context of dentistry as, in part, an aesthetically driven discipline, impacts the social contract. We then consider how the nature of the profession's relationship with society, and the orientation by which it provides its services (which is sometimes critically unclear in its definitional terms), impacts the profession's contribution to ensuring social justice in oral health and oral healthcare. Through examining the nature of how the social contract has shifted (for example, by the attenuation of professional monopolies), we also ask whether this is evidence of a loss of confidence in the dental profession as an altruistic institution. We end by suggesting that the dental profession must engage with the tenets of social justice within the social contract. Failure to do so is likely to lead to erosion of dentistry as a high-status profession and societal willingness to seek solutions to oral health needs from other professional and non-professional sources.

Dentistry's social contract is at risk.

BACKGROUND: The implications of the social contract for medicine and those it serves has been debated by bioethicists, political scientists, and physicians. Far less attention, however, has been given to dentistry's social contract. METHODS: The existing literature from medicine is used to explore the social contract and the role of dentistry in today's society, focusing on several areas of interest. RESULTS: The authors' analysis discusses the history of the social contract and its implications for professionalism. The authors examine the failure of the dental profession to adequately address population needs and inequities in oral health, situating this in the context of an increasingly commodified, commercialized, cosmetically oriented, and proprietary culture in the profession. The authors highlight the important role of organized dentistry in facilitating change and renewing the social contract. CONCLUSIONS: The authors conclude that reforms are necessary for dentistry to remain a profession. PRACTICAL IMPLICATIONS: The authors' findings may inform oral health policies and underscore the need for change among dental providers and organized dentistry to maintain dentistry's professional status.

Evaluation of a new Argovit as an antiviral agent included in feed to protect the shrimp Litopenaeus vannamei against White Spot Syndrome Virus infection.

In this study, four experimental assays were conducted to evaluate the use of a new silver nanoparticle formulation named Argovit-4, which was prepared with slight modifications to enhance its biological activity against white spot syndrome virus (WSSV) in shrimp culture. The goals of these assays were to (1) determine the protective effect of Argovit-4 against WSSV, (2) determine whether Argovit-4 supplemented in feed exhibits toxicity towards shrimp, (3) determine whether Argovit-4 as antiviral additive in feed can prevent or delay/reduce WSSV-induced shrimp mortality, and (4) determine whether Argovit-4 supplemented in feed alters the early stages of the shrimp immune response. In bioassay 1, several viral inocula calibrated at 7 SID50(shrimp infectious doses 50% endpoint) were exposed to 40, 100, 200 and 1,000 ng/SID50 of Ag+ and then intramuscularly injected into shrimp for 96 h. In bioassay 2, shrimp were fed Argovit-4 supplemented in feed at different concentrations (10, 100 and 1,000 µg per gram of feed) for 192 h. In bioassay 3, shrimp were treated with Argovit-4 supplemented in feed at different concentrations and then challenged against WSSV for 192 h. In bioassay 4, quantitative real-time RT-qPCR was performed to measure the transcriptional responses of five immune-relevant genes in haemocytes of experimental shrimp treated with Argovit-4 supplemented in feed at 0, 6, 12, 24 and 48 h. The intramuscularly injected Argovit-4 showed a dose-dependent effect (p < 0.05) on the cumulative shrimp mortality from 0-96 h post-infection. In the second bioassay, shrimp fed Argovit-4 supplemented in feed did not show signs of toxicity for the assayed doses over the 192-h experiment. The third and fourth bioassays showed that shrimp challenged with WSSV at 1,000 µg/g feed exhibited reduced mortality without altering the expression of some immune system-related genes according to the observed level of transcriptional. This study is the first show that the new Argovit-4 formulation has potential as an antiviral additive in feed against WSSV and demonstrates a practical therapeutic strategy to control WSSV and possibly other invertebrate pathogens in shrimp aquaculture.

Acute and chronic diabetes complications associated with self-reported oral health: a retrospective cohort study.

BACKGROUND: Oral health is associated with diabetes, but the chances of experiencing acute or chronic diabetes complications as per this association is unknown in Canada's most populous province, Ontario. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics. METHODS: A retrospective cohort study was conducted of diabetics (n = 5183) who participated in the Canadian Community Health Survey 2003 and 2007-08. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, 2016. Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status. RESULTS: Thirty-eight percent of diabetics reporting "poor to fair" oral health experienced a diabetes complication, in comparison to 34% of those reporting "good to excellent" oral health. The odds of an acute or chronic complication among participants reporting "poor to fair" oral health status was 10% (OR 1.10; 95% CI 0.81, 1.51) and 34% (OR 1.34; 95% CI 1.11, 1.61) greater respectively, than among participants experiencing no complications and reporting "good to excellent" oral health. CONCLUSION: Self-reporting "poor to fair" oral health status is associated with a greater likelihood of chronic complications than acute complications. Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed.

Risk of complications among diabetics self-reporting oral health status in Canada: A population-based cohort study.

BACKGROUND: Periodontitis has been associated with diabetes and poor health. While clear associations have been identified for the diabetes-oral health link, less is known about the implications of poor oral health status for incident complications of diabetes. This study investigated the risk of diabetes complications associated with self-reported "poor to fair" and "good to excellent" oral health among diabetics living in Ontario, Canada. METHODS: This was a cohort study of diabetics who took part in the Canadian Community Health Survey (2003 and 2007-08). Self-reported oral health was linked to electronic health records held at the Institute for Clinical Evaluative Sciences. Participants aged 40 years and over, who self-reported oral health status in linked databases were included (N = 5,183). Cox proportional hazard models were constructed to determine the risk of diabetes complications. Participants who did not experience any complications were censored. Models were adjusted for age and sex, followed by social characteristics and behavioural factors. The population attributable risk of diabetes complications was calculated using fully adjusted hazard ratios. RESULTS: Diabetes complications differed by self-reported oral health; 35% of the total sample experienced a complication and 34% of those reporting "good to excellent" oral health (n = 4090) experienced a complication in comparison to 38% of those with "fair to poor" oral health (n = 1093). For those reporting "poor to fair" oral health, the hazard of a diabetes complication was 30% greater (HR 1.29; 95% CI: 1.03, 1.61) than those reporting "good to excellent" oral health. The population level risk of complications attributable to oral health was 5.2% (95% CI: 0.67, 8.74). CONCLUSIONS: Our findings indicate that reporting "poor to fair" oral health status may be attributed to health complications among diabetics, after adjusting for a wide range of confounders. This has important public health implications for diabetics in Ontario, Canada.

Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: the CHORAL study.

BACKGROUND: Routine application of chlorhexidine oral rinse is recommended to reduce risk of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Recent reappraisal of the evidence from two meta-analyses suggests chlorhexidine may cause excess mortality in non-cardiac surgery patients and does not reduce VAP. Mechanisms for possible excess mortality are unclear. The CHORAL study will evaluate the impact of de-adopting chlorhexidine and implementing an oral care bundle (excluding chlorhexidine) on mortality, infection-related ventilator-associated complications (IVACs), and oral health status. METHODS: The CHORAL study is a stepped wedge, cluster randomized controlled trial in six academic intensive care units (ICUs) in Toronto, Canada. Clusters (ICU) will be randomly allocated to six sequential steps over a 14-month period to de-adopt oral chlorhexidine and implement a standardized oral care bundle (oral assessment, tooth brushing, moisturization, and secretion removal). On study commencement, all clusters begin with a control period in which the standard of care is oral chlorhexidine. Clusters then begin crossover from control to intervention every 2 months according to the randomization schedule. Participants include all mechanically ventilated adults eligible to receive the standardized oral care bundle. The primary outcome is ICU mortality; secondary outcomes are IVACs and oral health status. We will determine demographics, antibiotic usage, mortality, and IVAC rates from a validated local ICU clinical registry. With six clusters and 50 ventilated patients on average each month per cluster, we estimate that 4200 patients provide 80% power after accounting for intracluster correlation to detect an absolute reduction in mortality of 5.5%. We will analyze our primary outcome of mortality using a generalized linear mixed model adjusting for time to account for secular trends. We will conduct a process evaluation to determine intervention fidelity and to inform interpretation of the trial results. DISCUSSION: The CHORAL study will inform understanding of the effectiveness of de-adoption of oral chlorhexidine and implementation of a standardized oral care bundle for decreasing ICU mortality and IVAC rates while improving oral health status. Our process evaluation will inform clinicians and decision makers about intervention delivery to support future de-adoption if justified by trial results. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03382730 . Registered on December 26, 2017.

Silver nanoparticles enhance survival of white spot syndrome virus infected Penaeus vannamei shrimps by activation of its immunological system.

The global aquaculture has shown an impressive growth in the last decades contributing with a major part of total food fish supply. However, it also helps in the spread of diseases that in turn, causes great economic losses. The White Spot Syndrome Virus (WSSV) is one of the major viral pathogen for the shrimp aquaculture industry. Several attempts to eliminate the virus in the shrimp have been addressed without achieving a long-term effectiveness. In this work, we determine the capacity of the commercial non-toxic PVP-coated silver nanoparticles to promote the response of the immune system of WSSV-infected shrimps with or without an excess of iron ions. Our results showed that a single dose of metallic silver in the nanomolar range (111 nmol/shrimp), which is equivalent to 12 ng/mL of silver nanoparticles, produces 20% survival of treated infected shrimps. The same concentration administered in healthy shrimps do not show histological evidence of damage. The observed survival rate could be associated with the increase of almost 2-fold of LGBP expression levels compared with non-treated infected shrimps. LGBP is a key gene of shrimp immunological response and its up-regulation is most probably induced by the recognition of silver nanoparticles coating by specific pathogen-associated molecular pattern recognition proteins (PAMPs) of shrimp. Increased LGBP expression levels was observed even with a 10-fold lower dose of silver nanoparticles (1.2 ng/shrimp, 0.011 nmol of metallic silver/shrimp). The increase in LGBP expression levels was also observed even in the presence of iron ion excess, a condition that favors virus proliferation. Those results showed that a single dose of a slight amount of silver nanoparticles were capable to enhance the response of shrimp immune system without toxic effects in healthy shrimps. This response could be enhanced by administration of other doses and might represent an important alternative for the treatment of a disease that has still no cure, white spot syndrome virus.

Impact of public dental care spending and insurance coverage on utilization disparities among Canadian jurisdictions.

OBJECTIVE: To investigate the role of public dental care spending and insurance coverage on dental services utilization disparities among different Canadian jurisdictions. METHODS: We utilized Canadian Institute for Health Information provincial/territorial per capita estimates for public dental care expenditure, public information on legislated dental care programs, and oral health data from the 2007-2008 Canadian Community Health Survey to make inferences regarding the relationship between dentist visits in the past 12 months and self-perceived oral health. We performed descriptive statistics and binary logistic regression analysis to determine the relationship between dentist visits and self-perceived oral health status at the provincial/territorial level and on stratified data based on three age groups - children (12-17 years), adults (18-64 years), and seniors (65 years and older). RESULTS: Overall, the presence of the "inverse care law" in dental care at the provincial/territorial level was evident. However, in the Canadian territories, which had the highest per capita public dental care expenditure, individuals with poor oral health had the highest odds of visiting a dentist compared with other jurisdictions. In jurisdictions with public dental care programs for children and/or seniors, children and seniors with poor oral health were more likely to visit dentists. CONCLUSIONS: Jurisdictions with more public spending and greater population coverage for dental care appear to better cater to those with the highest oral health care needs.

Joint effects of serum vitamin D insufficiency and periodontitis on insulin resistance, pre-diabetes, and type 2 diabetes: results from the National Health and Nutrition Examination Survey (NHANES) 2009-2010.

OBJECTIVE: Periodontitis is strongly associated with diabetes and is increasingly shown to be associated with other glycemic abnormalities. Vitamin D is postulated to have both anti-inflammatory and antimicrobial activity. Therefore, our aim was to investigate the joint effects of both serum 25-hydroxyvitamin D3 and total 25-hydroxyvitamin D with periodontitis on homeostatic model assessment for insulin resistance (HOMA-IR), pre-diabetes, and type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data from the 2009-2010 National Health and Nutrition Examination Survey, the sample was restricted to adults over 30 years of age, who were eligible for oral health examination, and had vitamin D, fasting glucose and insulin measures. The analytic sample includes those with (n=1631) and without (n=1369) type 2 diabetes. Using survey logistic multivariable regression analysis, we examined the following joint effects: (1) vitamin D insufficiency (<50 nmol/L) and moderate to severe periodontitis (VD+PD+); (2) vitamin D insufficiency and mild to no periodontitis (VD+PD-); and (3) vitamin D sufficiency ) (>50 nmol/L) and periodontitis (VD-PD+), and compared these groups with the doubly unexposed reference group (VD-PD-). RESULTS: Consistently, the joint effects of vitamin D3 insufficiency and total vitamin D insufficiency with periodontitis (VD+PD+) were significantly associated with diabetes: OR=2.83 (95% CI 1.34 to 5.96) and OR=1.98 (95% CI 1.04 to 3.76), respectively. However, the joint effects of vitamin D3 insufficiency and periodontitis were attenuated for HOMA-IR 4.17: OR=1.57 (95% CI 0.97 to 2.55). Pre-diabetes was not associated with either joint effects. CONCLUSION: In this cross-sectional, nationally representative sample, the joint effects of vitamin D and periodontitis appear to differ for HOMA-IR, pre-diabetes and diabetes.

Emergency room visits for dental problems among working poor Canadians.

OBJECTIVES: To explore the risk of visiting hospital emergency rooms (ERs) for dental problems not associated with trauma among a sample of working poor Canadians. METHODS: Data stem from a telephone survey administered between March and August 2007 of working poor Canadians aged 18-64 years. Logistic regressions were employed to determine the predictors of reporting a visit to an ER for dental problems not associated with trauma. RESULTS: Approximately 6.1 percent of the sample reported visiting an ER in the past for a dental problem not associated with trauma. Those who were publicly insured, reported poor oral health, experienced a bed day due to dental pain, had dependent children, were lone parents, had competing needs, a history of receiving welfare, a history of an inability to afford dental care, and a perceived need for dental treatment were all more likely to have reported an ER visit. When adjusting for all variables, having experienced a bed day due to dental pain and a history of an inability to afford dental care were the dominant predictors of this outcome. A higher but not significantly different prevalence of ER visits for dental problems was found among the working poor sample when compared with the general Canadian population (6.1 percent versus 5.4 percent, P > 0.05). CONCLUSIONS: Further research is needed in order to provide insight into the reasons why the working poor population is seeking dental care in hospital settings.

An observational study to assess changes in social inequality in smoking-attributable upper aero digestive tract cancer mortality among Canadian males between 1986 and 2001.

BACKGROUND: Tobacco and low socioeconomic status have been acknowledged as potential risk factors for upper aero-digestive tract (UADT) cancers in North America. In context of reducing adult male smoking prevalence (by over 50%), in the past few decades in Canada, this study tried to document changes in smoking-attributable UADT cancer mortality rates, among Canadian males of different social strata, between 1986 and 2001. METHODS: The contribution of smoking to UADT cancer mortality was estimated indirectly by using lung cancer mortality as an indicator of the accumulated mortality from smoking in a population. This method was applied to UADT cancer death rates of 35-69 year old socially stratified males. Data, stratified by neighborhood income quintile, could be obtained from Statistics Canada, for four census years, 1986, 1991, 1996, and 2001. RESULTS: A total of 2704 male deaths were analyzed. Between 1986 and 2001, UADT cancer deaths reduced by 30% (32 to 22 per 100,000) but the proportion of these deaths attributable to smoking reduced much more, by 41% (22 to 13 per 100,000). In the span of fifteen years, absolute social inequality (measured by rate difference between the highest and the lowest stratum) in smoking-attributable male UADT cancer mortality in Canada reduced by 47% and relative social inequality (measured by rate ratios) reduced by 9%. CONCLUSION: The present analyses reveal that between 1986 and 2001, smoking-attributable UADT cancer mortality rates among adult males (35-69 years) in Canada reduced in all social strata and the social inequalities in these rates have narrowed. Analysis of more current data will be of interest to confirm these trends.