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Browne AJ, Varcoe C, Ford-Gilboe M, Wathen CN, Wilson E, Bungay V, Perrin N. Using a health equity lens to measure patient experiences of care in diverse health care settings. PLoS One 2024; 19:e0297721. [PMID: 38843218 PMCID: PMC11156339 DOI: 10.1371/journal.pone.0297721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/12/2024] [Indexed: 06/09/2024] Open
Abstract
People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale-Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale-Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale-Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale-Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens.
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Affiliation(s)
- Annette J. Browne
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Vicky Bungay
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, BC, Canada
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
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Badea (Paun) AG, Bocanet VI, Badea IC, Chifor R, Duma LT, Borzan CM. Relationship between Behavior and Periodontal Health Self-Perception in Diabetic and Non-Diabetic Patients from Transylvania, Romania-A Self-Report Study, including The Desire to Use a Mobile App for Oral Care Improvements. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1419. [PMID: 37629709 PMCID: PMC10456280 DOI: 10.3390/medicina59081419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The study aimed to assess self-reported symptoms of periodontal disease (gingival bleeding, tooth mobility and halitosis) among diabetic and non-diabetic patients from Transylvania, Romania. Using statistical analysis methods, correlation between the aforementioned symptoms and diet, oral hygiene habits, stress, physical activity, and BMI (body mass index) were researched. Another secondary objective was to assess the impact of self-reported oral health, aesthetics, and halitosis on their life. Patients' willingness to use a mobile app for generating awareness of oro-dental complications, improving their knowledge of oro-dental health, and reminding them to visit the dentist based on an awareness-raising function, was also assessed. Methods: The study was based on an original self-administered questionnaire, applied to 182 subjects, in an unselected, randomized manner. A total of 110 questionnaires were applied in two dental offices and 72 questionnaires were applied in a public clinic for diabetic patients from Cluj-Napoca, Romania. Results: Warning signs and symptoms relevant to periodontal disease were identified by respondents, having statistically significant associations with the declared oral health-care habits, including interdental aids, vicious habits (nail biting, bruxism), etc. Some of these periodontal signs could be correlated with a certain lifestyle, such as the perceived stress, smoking status, practicing maintenance sports, and alcohol consumption. A total of 66% of the non-diabetics and 68% of the diabetics of the surveyed subjects consider a software application for generating awareness of oro-dental complications useful, and are willing to pay around EUR 6 for it. Conclusions: Having a medical condition such as diabetes makes patients pay more attention to dental health compared with non-diabetic patients. Patients expressed their desire to use a software application to help them to be aware of their condition and for improving their self-report capabilities, including their oral-health-related status.
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Affiliation(s)
- Ariadna Georgiana Badea (Paun)
- Department of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.G.B.); (C.M.B.)
| | - Vlad Ioan Bocanet
- Department of Manufacturing Engineering, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania;
| | - Iulia Clara Badea
- Department of Preventive Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania;
| | - Radu Chifor
- Department of Preventive Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania;
| | - Livia Terezia Duma
- Center for Diabetes, Nutrition and Metabolic Diseases, Cluj County Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania;
| | - Cristina Maria Borzan
- Department of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.G.B.); (C.M.B.)
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Goddard-Eckrich D, Henry BF, Sardana S, Thomas BV, Richer A, Hunt T, Chang M, Johnson K, Gilbert L. Evidence of Help-Seeking Behaviors Among Black Women Under Community Supervision in New York City: A Plea for Culturally Tailored Intimate Partner Violence Interventions. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:867-876. [PMID: 36479367 PMCID: PMC9712050 DOI: 10.1089/whr.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Black women involved in the legal system disproportionately experience intimate partner violence (IPV); however, current research does not satisfactorily describe the risk and protective factors associated with IPV among Black women under community supervision. METHODS We conducted a subgroup analysis of Black women (N = 128) using data from a randomized controlled trial that evaluated the feasibility and efficacy of two IPV screening and prevention programs for women under community supervision. Participants in the original study were randomized into two IPV prevention conditions-computerized or case manager Women Initiating New Goals of Safety (WINGS). In this study, we examine the effects of that study's two conditions on linkage to IPV services and secondary outcomes, specifically among Black participants who experienced physical, sexual, and psychological IPV. RESULTS Both conditions showed significant reductions in days of substance use abstinence over the 3-month period among Black women who experienced sexual or verbal IPV. Participants in the case manager arm were 14 times more likely to receive IPV services in the past 90 days-from baseline to the 3-month follow-up (adjusted odds ratio = 14.45, 95% confidence interval [CI] = 1.25 to 166.51, p = 0.032). Participants in the computerized arm were significantly more likely to report receiving social support from baseline to the 3-month follow-up assessment (regression coefficient [b] = 2.27, 95% CI = 0.43 to 4.11, p = 0.015). CONCLUSIONS Although both conditions showed significant reductions in the number of days of abstinence from substance use among this subgroup of Black women, the findings showed differential effectiveness between the computerized WINGS arm and the case manager WINGS arm in improving social support and linkage to services. These findings may indicate that different modalities of WINGS may work better for specific activities and point to the need for a hybrid format that optimizes the use of distinct modalities for delivering activities.
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Affiliation(s)
- Dawn Goddard-Eckrich
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
| | - Brandy F. Henry
- Rehabilitation and Human Services, Educational Psychology, Counseling, and Special Education, College of Education, Consortium on Substance Use and Addiction, Social Science Research Institute, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Srishti Sardana
- Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Brittany V. Thomas
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
| | - Ariel Richer
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
| | - Timothy Hunt
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
| | - Mingway Chang
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
| | - Karen Johnson
- University of Alabama, School of Social Work, Little Hall Room 2005, Tuscaloosa, Alabama, USA
| | - Louisa Gilbert
- The Social Intervention Group, Columbia University, School of Social Work, New York, New York, USA
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Patterson-Norrie T, Ramjan L, Sousa MS, George A. Dietitians' Experiences of Providing Oral Health Promotion to Clients with an Eating Disorder: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14193. [PMID: 36361071 PMCID: PMC9654250 DOI: 10.3390/ijerph192114193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Eating disorders (EDs) can seriously impact oral health, leading to irreversible dental damage. Dietitians play a key role in the care of people with an ED and are well-placed to promote oral health. However, there is currently little understanding of how dietitians perceive their role in this space. This study aimed to explore the perceptions and role of dietitians in providing oral health promotion to their clients in an ED clinical setting. (2) Methods: This descriptive qualitative study used semi-structured interviews to explore the perceptions of 14 registered dietitians practicing across seven states in Australia. Participants were recruited using a combination of purposive and snowball sampling. A hybrid thematic analysis approach was undertaken to identify and describe the key themes generated from the data. (3) Results: Generally, dietitians were insightful and knowledgeable of the oral health issues that clients with an ED may be experiencing. However, dietitians' practices across education, screening, and referrals were inconsistent. Challenges such as inadequate training, unknown referral pathways, and clear guidelines were cited as significant barriers to practice. (4) Conclusions: The results reinforce the need for education and the development of targeted strategies that address challenges to oral health promotion in dietetic practice.
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Affiliation(s)
- Tiffany Patterson-Norrie
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lucie Ramjan
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mariana S. Sousa
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- IMPACCT—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, NSW 2010, Australia
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Varcoe C, Browne AJ, Perrin N, Wilson E, Bungay V, Byres D, Wathen N, Stones C, Liao C, Price ER. EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? BMC Health Serv Res 2022; 22:1113. [PMID: 36050677 PMCID: PMC9436447 DOI: 10.1186/s12913-022-08475-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs). Methods In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention. Results Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. Conclusions The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels. Trial registration Clinical Trials.gov #NCT03369678 (registration date November 18, 2017).
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Johnson V, Brondani M, von Bergmann H, Grossman S, Donnelly L. Dental Service and Resource Needs during COVID-19 among Underserved Populations. JDR Clin Trans Res 2022; 7:315-325. [PMID: 35298308 PMCID: PMC9203663 DOI: 10.1177/23800844221083965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination. Objectives: To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services. Methods: Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed. Results: The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers. Conclusion: Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities. Knowledge Transfer Statement: This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.
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Affiliation(s)
- V Johnson
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - M Brondani
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - H von Bergmann
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - S Grossman
- Centre for Community Engaged Learning, University of British Columbia, Vancouver, BC, Canada
| | - L Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Jennings BM, Lem M, Kilborn S, Donnelly B, Acker A. Improving oral health care accessibility for homeless and vulnerably housed pet-owning populations. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:98-103. [PMID: 35811601 PMCID: PMC9236561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/08/2021] [Accepted: 11/16/2021] [Indexed: 06/15/2023]
Abstract
Individuals experiencing homelessness face unique barriers to oral health care. In collaboration with local universities in Ottawa, Canada, research was conducted to explore the experiences of Community Veterinary Outreach (CVO) clients in accessing oral health care. CVO utilizes a One Health approach, providing preventive veterinary care alongside human health care services to promote health service uptake among pet owners experiencing homelessness. Based on the results of 4 research projects, this short communication proposes recommendations for promoting accessible oral health care and increasing service uptake at One Health clinics by CVO clients experiencing homelessness. Relevant themes leading to the recommendations were 1) barriers to care, including financial and individual circumstances, and discrimination by service providers; and 2) facilitators of care, including the presence of pets, compassionate care, and care received in community settings. Recommendations to improve accessibility of oral health services for CVO clients are 1) continuation of pet-friendly services; 2) delivery of oral health care in alternative settings; and 3) reduction of discrimination through continuing education for oral health professionals. It is hypothesized that the implementation of these recommendations will improve oral health care service accessibility and uptake among clients at CVO clinics and in the community.
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Affiliation(s)
| | - Michelle Lem
- Community Veterinary Outreach, Ottawa, ON, Canada
| | | | | | - Amanda Acker
- Community Veterinary Outreach, Ottawa, ON, Canada
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Kaur K, Sculley D, Veysey M, Lucock M, Wallace J, Beckett EL. Bitter and sweet taste perception: relationships to self-reported oral hygiene habits and oral health status in a survey of Australian adults. BMC Oral Health 2021; 21:553. [PMID: 34715836 PMCID: PMC8555166 DOI: 10.1186/s12903-021-01910-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Oral health, an essential part of general health and well-being, is influenced by multiple factors, including oral hygiene habits and dietary factors. Dietary preferences are influenced by variation in taste perceptions and threshold tasting. Polymorphisms in specific genes for sweet and bitter taste receptors and bitter taste perception have been associated with dental caries. However, taste is complex with multiple receptors, each with multiple potential polymorphisms contributing to taste perception as well as social, cultural, and environmental influences. Additionally, these association studies have been conducted in restricted cohorts (e.g., children only). Furthermore, outcomes have been limited to dental caries and studies between taste perception and oral hygiene habits have not been completed. Methods A cross-sectional online survey was conducted to investigate the relationships between bitter and sweet taste perception (liking and intensity of index food items), self-reported oral hygiene habits and oral health (n = 518). Results Higher mean intensity scores for bitter (16–21%) and sweet (< 5%-60%) were seen with higher frequencies of oral hygiene habits (brushing, use of mouthwash, chewing gum and tongue cleaning). Lower mean bitter liking scores (18–21%) were seen with higher frequencies of oral hygiene habits (brushing, mouthwash use, floss use and chewing gum). Sweet liking scores varied by reported frequency of mouthwash use and flossing only, with mixed patterns of variance. Mean bitter and sweet intensity perception scores varied with the number of dental caries ((13–20% higher in those with 3 or more caries, compared to none). Conclusions While there were numerous relationships identified between liking and perception of sweet and bitter and oral health outcomes, the magnitude and direction of associations varied by outcome. The direction of the associations cannot be inferred due to the cross-sectional nature of the study. The demonstrated relationships justify further future investigations, which could help better understand if taste liking and perception is impacted by oral hygiene and health, or vice versa. This could be important in understanding the causation and progression of oral health diseases or the development of novel therapeutics for oral health. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01910-8.
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Affiliation(s)
- Kiranjit Kaur
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Ourimbah, NSW, Australia
| | - Martin Veysey
- School of Medicine and Public Health, The University of Newcastle, Ourimbah, NSW, Australia
| | - Mark Lucock
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia
| | - Janet Wallace
- School of Health Sciences, The University of Newcastle, Ourimbah, NSW, Australia
| | - Emma L Beckett
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia. .,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Ourimbah, NSW, Australia.
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Tefera AT, Girma B, Adane A, Muche A, Ayele TA, Getahun KA, Aniley Z, Ali S, Handebo S. Dental health problems and treatment-seeking behavior among special need school students in Amhara region, Ethiopia. BMC Oral Health 2021; 21:489. [PMID: 34600520 PMCID: PMC8486962 DOI: 10.1186/s12903-021-01856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Oral diseases are a public health concern with a significant impact on the quality of life of individuals. Children with special needs face significant challenges in carrying out oral hygiene due to their disability, and they are more prone to poor oral health and illnesses. This study assessed dental health problems and treatment-seeking behaviors of special needs school students in Amhara region, Ethiopia. Methods An institution-based cross-sectional study was conducted from November 2020 to April 2021, in eight special needs schools located in the Amhara Regional State, Ethiopia. A total of 443 randomly selected special needs students were included. Data were collected using a structured interview-administered questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with oral health problems and treatment-seeking behavior. A p-value of less than 0.05 was used to declare statistical significance. Results The prevalence of self-reported dental health problems and treatment-seeking behaviors among special needs school students was 46.1% (95% CI: 41.4%, 50.7%) and 60.3% (95% CI: 53.4%, 66.8%), respectively. Place of residence, grade level, religious affiliation, years lived with disability, and knowledge of dental health-related risk behaviors were associated with dental health problems. Whereas, place of residence, being hearing impaired, and having prior information about dental health problems were associated with dental treatment-seeking behavior. Conclusions A significant number of special needs students reported dental problems and about 40% of them did not seek dental treatment. Oral hygiene practice and access to dental care services are important in the prevention of dental problems. Hence, oral hygiene promotion programs focusing on oral hygiene practice and dental treatment services are needed in special needs schools. It is also strongly suggested to incorporate oral health related information in health-related academic lessons to enhance optimum oral health among special needs students.
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Affiliation(s)
- Amare Teshome Tefera
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biruk Girma
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aynishet Adane
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Muche
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of public health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Ayalew Getahun
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelallem Aniley
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Semira Ali
- Department of Special Needs and Inclusive Education, College of Education, University of Gondar, Gondar, Ethiopia
| | - Simegnew Handebo
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box-196, Gondar, Ethiopia.
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Wallace B, Rea K. Enhancing equity-oriented care in psychedelic medicine: Utilizing the EQUIP framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103429. [PMID: 34461409 DOI: 10.1016/j.drugpo.2021.103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.
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Affiliation(s)
- Bruce Wallace
- UVIC School of Social Work, Scientist, Canadian Institute for Substance Use Research (CISUR), University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Kerri Rea
- University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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Arora A, Lucas D, To M, Chimoriya R, Bhole S, Tadakamadla SK, Crall JJ. How Do Mothers Living in Socially Deprived Communities Perceive Oral Health of Young Children? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073521. [PMID: 33805307 PMCID: PMC8038038 DOI: 10.3390/ijerph18073521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
This qualitative study aims to explore and gain an in-depth understanding of the knowledge and perceptions of mothers living in Greater Western Sydney (GWS), one of Australia’s most socio-economically disadvantaged regions, regarding the factors that influence oral health of young children. Mother–child dyads (n = 45) were purposively selected from a population-based cohort study in GWS. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and subsequently analyzed using thematic analysis. Five main themes emerged from the interviews: (1) beliefs about child oral health and first set of teeth; (2) awareness and attitudes towards oral health services; (3) identification of caries risk and protective factors; (4) broader cultural and social class influences on childhood oral health practices; and (5) the influence of parental self-confidence, self-efficacy, and perceived control. Overall, mothers reported having limited knowledge and awareness on the importance of baby teeth, child’s first dental visit, and seeking oral health care. Oral health and preventative practices in children were reported to be influenced by past dental experiences, culture and social class, and parental factors. The empirical findings of this study bring our attention to the critical factors that influence child oral health and the opportunities for co-creating child oral health promotion by targeting mothers.
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Affiliation(s)
- Amit Arora
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia;
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia;
- Correspondence:
| | - Dimitri Lucas
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia; (D.L.); (M.T.)
| | - Michael To
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia; (D.L.); (M.T.)
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia;
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Sameer Bhole
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia;
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia; (D.L.); (M.T.)
| | | | - James J. Crall
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA;
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Patterson-Norrie T, Ramjan L, Sousa MS, Sank L, George A. Eating disorders and oral health: a scoping review on the role of dietitians. J Eat Disord 2020; 8:49. [PMID: 33062271 PMCID: PMC7552467 DOI: 10.1186/s40337-020-00325-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compromised nutritional intake due to eating disorder related behaviors, such as binge eating and purging, can lead to multi-system medical complications, including an irreversible impact on oral health. However, dental anxiety, fear or embarrassment may hinder individuals with an eating disorder from seeking assistance for their oral health concerns. As key health professionals in eating disorder treatment, dietitians are well positioned to provide basic dental screening, however, their capacity to perform this role in practice has not been established. The aim of this review was to identify current evidence on the role of dietitians in promoting oral health among individuals with eating disorders. METHODS A comprehensive search of eight electronic databases and the grey literature was conducted to address the following three focus areas: 1) guidelines and recommendations on the role of dietitians in oral health 2) knowledge, attitudes and practices of dietitians regarding oral health promotion and; 3) current models of oral health care and resources for dietitians. RESULTS Twelve articles were included. The review indicated that current national and international position statements encourage dietitians to conduct basic oral health screening and promote oral health in high risk populations, such as those with an eating disorder. However, no evidence was found to indicate dietitians performed oral health screening or education in populations with an eating disorder. In other population settings, dietitians were found to play a role in oral health promotion, however, were noted to have mixed knowledge on oral health risk factors, prevention and treatment and generally were not providing referrals. Some oral health promotion resources existed for dietitians working in pediatric, HIV and geriatric clinical areas however no resources were identified for dietitians working in eating disorder settings. CONCLUSION Despite current evidence showing that dietitians can play a role in oral health care, no models of care exist where dietitians promote oral health among individuals with an eating disorder. There are also no training resources and screening tools for dietitians in this area. Further research is required to develop this model of care and assess its feasibility and acceptability.
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Affiliation(s)
- Tiffany Patterson-Norrie
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery , Western Sydney University/South Western Sydney Local Health District/ Ingham Institute for Applied Medical Research, Liverpool BC, Locked Bag 7103, Sydney, NSW 1871 Australia
| | - Lucie Ramjan
- School of Nursing and Midwifery, Western Sydney University, Centre for Oral Health Outcomes & Research Translation (COHORT), Sydney, Australia
| | - Mariana S. Sousa
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Lindy Sank
- Sydney Dental Hospital, Oral Health Services, SLHD, Sydney, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/University of Sydney/ Ingham Institute for Applied Medical Research, Sydney, Australia
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Ait Addi R, Benksim A, Bahije L, Cherkaoui M. Sociodemographic Disparities and Self-reported Oral Health Problems Associated with Pregnancy: A Case-control Study in Morocco. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Donnelly LR, Martin RE, Brondani MA. Perceived oral health and access to care among men with a history of incarceration. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2019; 53:157-165. [PMID: 33240354 PMCID: PMC7533820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community. METHODS A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff members of a non-profit organization working with individuals who are involved in or at risk of involvement with the criminal justice system. All discussions were audiorecorded and transcribed verbatim. A thematic analysis was undertaken using N-Vivo 10™, a qualitative data management program. RESULTS The participants ranged in age from 29 years to 69 years, came from a variety of ethnic backgrounds, and had different prison setting experiences. Five major themes emerged: not on the radar, stigma of incarceration, being shot down, caught in the system, and institutional conditioning. CONCLUSIONS The personal backgrounds, experiences with health and dental care during prison time, and the unique challenges faced by men with a history of incarceration influenced their perceptions and their ability to access dental services. Dental professionals can help to change these perceptions and experiences by creating a safe space for these individuals to access and receive care comfortably.
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Affiliation(s)
- Leeann R Donnelly
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Mario A Brondani
- Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
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Browne AJ, Varcoe C, Ford-Gilboe M, Nadine Wathen C, Smye V, Jackson BE, Wallace B, Pauly B(B, Herbert CP, Lavoie JG, Wong ST, Blanchet Garneau A. Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics. Int J Equity Health 2018; 17:154. [PMID: 30261924 PMCID: PMC6161402 DOI: 10.1186/s12939-018-0820-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/10/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. METHODS The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. RESULTS Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. CONCLUSIONS This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.
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Affiliation(s)
- Annette J. Browne
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
- Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Beth E. Jackson
- Public Health Agency of Canada, 785 Carling Avenue, AL 6809B, Ottawa, ON K1A 0K9 Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, and School of Nursing, University of Victoria, Victoria, BC V8W 2Y2 Canada
| | - Carol P. Herbert
- School of Population and Public Health, The University of British Columbia, and Centre for Studies in Family Medicine, The Western Centre for Public Health and Family Medicine, Western University, London, ON N6A 3K7 Canada
| | - Josée G. Lavoie
- Department of Community Health Sciences and Ongomiizwin – Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB MB R3E 3P5 Canada
| | - Sabrina T. Wong
- Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Amelie Blanchet Garneau
- Faculty of Nursing, Universite de Montreal, PO Box 6128, Centre-ville Station, Montreal, QC H3C 3J7 Canada
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Durey A, McAullay D, Gibson B, Slack-Smith L. Oral Health in Young Australian Aboriginal Children. JDR Clin Trans Res 2016; 2:38-47. [DOI: 10.1177/2380084416667244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite dedicated government funding, Aboriginal Australians, including children, experience more dental disease than other Australians, despite it being seen as mostly preventable. The ongoing legacy of colonization and discrimination against Aboriginal Australians persists, even in health services. Current neoliberal discourse often holds individuals responsible for the state of their health, rather than the structural factors beyond individual control. While presenting a balanced view of Aboriginal health is important and attests to Indigenous peoples’ resilience when faced with persistent adversity, calling to account those structural factors affecting the ability of Aboriginal people to make favorable oral health choices is also important. A decolonizing approach informed by Indigenous methodologies and whiteness studies guides this article to explore the perceptions and experiences of Aboriginal parents ( N = 52) of young children, mainly mothers, in Perth, Western Australia, as they relate to the oral health. Two researchers, 1 Aboriginal and 1 non-Aboriginal, conducted 9 focus group discussions with 51 Aboriginal participants, as well as 1 interview with the remaining individual, and independently analyzed responses to identify themes underpinning barriers and enablers to oral health. These were compared, discussed, and revised under key themes and interpreted for meanings attributed to participants’ perspectives. Findings indicated that oral health is important yet often compromised by structural factors, including policy and organizational practices that adversely preclude participants from making optimal oral health choices: limited education about prevention, prohibitive cost of services, intensive marketing of sugary products, and discrimination from health providers resulting in reluctance to attend services. Current government intentions center on Aboriginal–non-Aboriginal partnerships, access to flexible services, and health care that is free of racism and proactively seeks and welcomes Aboriginal people. The challenge is whether these good intentions are matched by policies and practices that translate into sustained improvements to oral health for Aboriginal Australians. Knowledge Transfer Statement: Slow progress in reducing persistent oral health disparities between Aboriginal and non-Aboriginal Australians calls for a new approach to this seemingly intractable problem. Findings from our qualitative research identified that structural factors—such as cost of services, little or no education on preventing oral disease, and discrimination by health providers—compromised Aboriginal people’s optimum oral health choices and access to services. The results from this study can be used to recommend changes to policies and practices that promote rather than undermine Aboriginal health and well-being and involve Aboriginal people in decisions about their health care.
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Affiliation(s)
- A. Durey
- School of Dentistry, University of Western Australia, Perth, Western Australia
| | - D. McAullay
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - B. Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - L.M. Slack-Smith
- School of Dentistry, University of Western Australia, Perth, Western Australia
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