Social images of medicine and dentistry in Japan. An exploratory study using correspondence analysis

OBJECTIVE

To investigate social images associated with dentistry in comparison with nine other medical disciplines.

DESIGN

A questionnaire survey among members of the general public. Subjects were asked to state, in not more than five words, the images which they associated with each of the ten disciplines.

SETTING

Komaki City, Shikatsu Town and Nagoya City in Japan.

PARTICIPANTS

261 respondents from a convenience sample of 300 residents, not associated with any branch of medicine.

OUTCOME MEASURES

Frequency distribution of word images used on at least five occasions and a correspondence analysis of the responses for the ten disciplines.

RESULTS

Of the 163 coded image items, 60 were related to internal medicine, 56 to dentistry, 55 to dermatology, 51 to orthopaedic surgery, 51 to ophthalmology, 50 to surgery, 47 to obstetrics and gynaecology, 43 to otolaryngology, 40 to paediatrics and 33 to psychiatry. Correspondence analysis applied to the 163 items and 10 medical disciplines indicated that three similar paired image groups were found, namely between dermatology and ophthalmology, surgery and orthopaedic surgery, and between dentistry and internal medicine, which were the more commonly encountered disciplines across all age groups. However, compared with the other specialities, dentistry had a significantly greater association with pain, this response being four times more common than for surgery.

CONCLUSIONS

This group of members of the public in Japan perceived dentistry-associated images in a similar way to internal medicine, but the negative associations with pain need to be addressed by the dental profession and health educators alike.

Clinical and virological evaluation of the efficacy of an inactivated EHV1 and EHV4 whole virus vaccine (Duvaxyn EHV1,4). Vaccination/challenge experiments in foals and pregnant mares

Pregnant mares and young foals were vaccinated with Duvaxyn EHV1,4, an inactivated and adjuvanted vaccine containing both the EHV-1 and 4 antigens. SN and CF antibody titres were induced two weeks after first vaccination. Antibody levels were boosted after second vaccination, however they never reached the levels induced after virus challenge. Young foals were challenged with virulent EHV-1 and EHV-4 field viruses. Pregnant mares were challenged with the highly abortigenic EHV-1 strain Ab4. Vaccinated animals showed a clear reduction in clinical signs and virus excretion compared to unvaccinated control animals. Log transformed antibody levels could be correlated to duration of virus excretion. The incidence of EHV-1 induced abortions was drastically reduced in vaccinated mares. Therefore, although vaccinated animals are not fully protected against disease, Duvaxyn EHV1,4 clearly reduces clinical symptoms, the duration of virus shedding and the quantity of virus shed. It can be concluded that vaccination of foals and pregnant mares with Duvaxyn EHV1,4 significantly reduces the risk of abortions and outbreaks of respiratory disease caused by circulating field viruses.

The use of socio-demographic profiling of patients to monitor changes in the provision of care by the Community Dental Service

OBJECTIVE

To investigate the socio-demographic profile of patients using the Leeds Community Dental Service (CDS) in 1996/97 and to determine any changes in profile since 1991/92.

DESIGN

Retrospective.

SETTING

The area served by Leeds Health Authority.

SUBJECTS

A total of 8,051 patients who had used the Leeds CDS in 1996/97 together with 9,372 patients from 1991/92.

OUTCOME MEASURES

Socio-demographic profile, including age group; ethnicity; deprivation (Townsend index) and disability.

RESULTS

Of children under 16 years old using the CDS in 1996/97, 24% were of South Asian ethnic origin, much higher than the 6% reported for Leeds in the 1991 census. Over the period of the study there was a reduction in the proportion of patients aged 5-15 years (75% to 65%, P < 0.001) and an increase in those aged 16-64 years (13% to 19%, P < 0.001). Increases were also seen in the proportion of patients from districts in the two most deprived quintiles (60% to 67%, P < 0.001) and for patients with special needs (19% to 28%, P < 0.001).

CONCLUSIONS

This study indicated an increased emphasis by the CDS on targeting groups likely to be unable or unwilling to seek treatment from the GDS. Socio-demographic profiling can be useful in monitoring the progress of changes in primary dental care.

The use of clinical dental auxiliaries as examiners in caries prevalence surveys in the United Kingdom: a feasibility study

OBJECTIVE

This study investigated the use of clinical dental auxiliaries as examiners in caries prevalence surveys of 5- and 12-year-old children in the United Kingdom.

METHODS

A random sample of four therapists and four hygienists was drawn from 23 clinical dental auxiliaries employed in the Community Dental Service in Yorkshire, United Kingdom. Training and calibration were carried out according to national guidelines for caries prevalence surveys. Sixteen 5-year-old and sixteen 12-year-old children were examined in the calibration exercise. Agreement was assessed using 95% confidence intervals of mean dmft/DMFT of the group, sensitivity and specificity values, and kappa statistics on dft/DFT.

RESULTS

For 5-year-old children, a good level of agreement with the standard examiner was achieved with sensitivity scores ranging from 0.84-0.98, specificity scores from 0.93-0.97, and kappa scores from 0.80-0.89. For 12-year-old children, sensitivity scores ranged from 0.56-0.95; specificity scores from 0.93-0.99; and kappa scores from 0.66-0.83. Four examiners failed to achieve the minimum scores on all measurements.

CONCLUSION

It was concluded that clinical dental auxiliaries could be used as examiners in caries prevalence surveys of 5-year-old children. However, in order to attempt to meet the national standard for agreement in surveys of 12-year-old children, four of the eight examiners in the present study would require further training. Possible reasons for this difference are discussed.

Sedation in primary dental care: an investigation in two districts of northern England

OBJECTIVE

To determine the current provision of sedation in primary dental care and investigate the knowledge and attitudes of dental practitioners and others on the use of sedation.

DESIGN

Qualitative interviews and postal questionnaire survey.

SETTING

Health districts of Bradford (West Yorkshire) and South Durham, UK in 1996.

SUBJECTS AND MATERIALS

15 key individuals associated with NHS primary dental services were interviewed. Questionnaires were sent to all 260 NHS general dental practitioners and community dental service clinicians.

RESULTS

208 questionnaires (80%) were returned. 42% of respondents reported current sedation use, with oral administration the favoured technique (26%). Significant differences were found between districts for intravenous sedation use (7% Bradford, 41% South Durham, P < 0.001). Almost all participants agreed the value of sedation in dental care for adults and children, for nervous, phobic patients or in association with unpleasant forms of treatment and 45% of dentists felt that provision should be expanded. Training, availability of referral services, finance and patient demand were seen as encouraging factors.

CONCLUSIONS

Substantial variations in sedation provision between the two districts were associated with teaching at the nearest dental schools. Innovative use of resources could help the expansion of provision supported in this study.

The relationship between deprivation, ethnicity and dental health in 5-year-old children in Leeds, UK

OBJECTIVE

To investigate the relationship between material deprivation, ethnicity, dental health and related behaviour in the five-year-old population of Leeds.

DESIGN

Analytical survey using a stratified cluster sample of primary schools and a questionnaire to parents. Children were assigned to one of five bands according to the ranking of the Townsend deprivation index for the census enumeration district in which they lived. Standard clinical criteria were used.

SETTING

Clinical examinations were carried out in school by four trained and calibrated examiners.

PARTICIPANTS

Two thousand six hundred and seventy seven children were examined and 1881 parental questionnaires were returned (70 per cent response).

OUTCOME MEASURES

Caries experience expressed as mean dmft.

RESULTS

Caries experience increased significantly with deprivation. Deprivation gradients were found in reported dental visiting, parental dental attendance and use of the Community Dental Service. Differences in caries experience between ethnic groups were independent of deprivation score with Asian children from the most deprived districts having a higher mean dmft than their white Caucasian and Afro-Caribbean counterparts (4.80, 3.21, 2.00; P < 0.001). Muslim Asians had significantly higher (P < 0.001) caries experience (dmft = 4.63) than non-Muslim Asians (dmft = 2.08) and the difference was maintained when the effect of deprivation was controlled (P < 0.05).

CONCLUSIONS

The Townsend index is a useful indicator of dental health and related behaviour among populations but does not explain variations between ethnic groups.

The diagnostic reliability of clinical dental auxiliaries in caries prevalence surveys--a pilot study

The Nuffield Report recommended the development of further education and training for dental auxiliary personnel. The extent to which clinical dental auxiliaries might carry out oral assessments is under consideration currently. While other countries have employed clinical dental auxiliaries as examiners in national surveys, there is no evidence to suggest that they are able to perform oral assessments effectively in the United Kingdom. This study aimed to investigate the possibility of using dental hygienists or therapists as examiners in epidemiological surveys. Five dentists and three clinical dental auxiliaries were trained and calibrated together using standardised BASCD training procedures. Forty 5-year-old children in Leeds were recruited to the training and calibration exercise. Data were analysed according to BASCD recommendations. There were no differences in performance between dentists and auxiliaries. All examiners fell within 95 percent confidence limits of the group mean dt, mt, ft and dmft. Mean grouped dmft scores for the benchmark examiner, dentists and auxiliaries were 1.92, 1.84 and 1.92 respectively. Sensitivity values for dentists and auxiliaries ranged from 0.54 to 1.00 and 0.80 to 0.94 respectively. Kappa scores were 0.70 to 0.90 for dentists; and 0.82 to 0.87 for the auxiliaries. It was concluded that the dental hygienists and therapist recruited to this study could be used in epidemiological surveys of caries in 5-year-old children.

Caries experience, tooth loss and oral health-related behaviours among Bangladeshi women resident in West Yorkshire, UK

Several studies have reported high levels of caries experience among young Muslim Asian children, but there has been little corresponding information on adult dental health or related health behaviours. This paper presents the results of a questionnaire together with clinical oral findings among first generation Bangladeshi women aged over 25 years. The majority chewed betel quid with tobacco, were of rural origin, used traditional oral hygiene practices and had never visited a dentist. Of the 247 examined, only one was edentulous. A very low level of caries experience was recorded, a mean DFT score of 1.87 at 25-34 years of age, with an average of 1.05 missing teeth. Coronal caries experience was found to be independent of oral hygiene methods, including the use of fluoride toothpaste, or the frequency of betel quid chewing. It was concluded that Bangladeshi adult women have considerably lower levels of caries experience and tooth loss than United Kingdom adults as represented in recent national surveys.

The dental health of single male hostel dwellers in Leeds

Attitudes and behaviour towards oral health among 104 homeless men in Leeds were assessed at interview. Of these, 101 agreed to a subsequent dental examination. The findings confirmed a high level of normative need despite a low level of felt need. Appointments were offered at two local community dental clinics, but the majority of men failed to attend. Appropriate provision of dental care is discussed and recommendations made for future developments.

An investigation of non-response bias by comparison of dental health in 5-year-old children according to parental response to a questionnaire

Non-response bias is a potentially serious problem in studies involving human subjects. A parental questionnaire/negative consent form was used in a dental epidemiological survey of 5-year-old children in Leeds. The aim of this study was to determine whether and to what extent there was any variation in caries experience and oral cleanliness between responding and non-responding groups. 6,494 children were examined and completed questionnaires were returned for 4,069 (63 per cent). The response was higher for white children (65 per cent) than for Asian (39 per cent) and Afro-Caribbean children (45 per cent). Lower response rates were found from parents living in inner city areas associated with social deprivation. Children of non-responders had poorer oral cleanliness and higher caries experience (mean dmft). This study demonstrated that members of a non-response group are likely to be substantially different from responders.

An assessment of dental caries prevalence among Gujurati, Pakistani and white Caucasian five-year-old children resident in Dewsbury, West Yorkshire

A number of recent studies have reported higher levels of caries experience in the primary dentition of Asian when compared with white Caucasian children. However, in order to take account of the diversity of socio-cultural and religious backgrounds, an Asian 'sample' should be specified. The present study examined caries prevalence among three distinct groups of five-year-old children, Pakistani Muslim, Indian Gujurati Muslim and white Caucasian. All were resident in districts of urban deprivation in Dewsbury. Significantly more of the 200 white Caucasian children examined were found to be caries-free (50 per cent) compared with 35 per cent of the Pakistani (n = 242) and 31 per cent of the Indian group (n = 159). Extensive caries was seen far more frequently in the Asians. Only 5 per cent of the white Caucasian children had rampant caries (dmft less than/= 10), but 13 per cent of the Pakistani and 21 per cent of the Indian group were so affected. Mean caries prevalence values were also higher among the Asian children. There was little difference in the levels of disease between the two Asian groups, except for rampant caries, which was higher among Indian children. All groups had more teeth decayed than treated. However, the white Caucasian girls had the lowest mean values of caries experience and the highest proportion of f/m teeth, indicating the most favourable level of restorative care. There was extensive untreated disease in all the Asian groups. The findings show that improved prevention and treatment facilities are required for young children, especially those from these Asian communities. Health education programmes and treatment facilities must be culturally acceptable and accessible. Both developments could be co-ordinated by the community dental service, the treatment facility most frequently used by these Asian communities at present.