The utility of survey and administrative data to generate information for research and outcomes-based oral health services development

The aim of this research, which focused on the Irish adult population, was to generate information for policymakers by applying statistical analyses and current technologies to oral health administrative and survey databases. Objectives included identifying socio-demographic influences on oral health and utilisation of dental services, comparing epidemiologically-estimated dental treatment need with treatment provided, and investigating the potential of a dental administrative database to provide information on utilisation of services and the volume and types of treatment provided over time. Information was extracted from the claims databases for the Dental Treatment Benefit Scheme (DTBS) for employed adults and the Dental Treatment Services Scheme (DTSS) for less-well-off adults, the National Surveys of Adult Oral Health, and the 2007 Survey of Lifestyle Attitudes and Nutrition in Ireland. Factors associated with utilisation and retention of natural teeth were analysed using count data models and logistic regression. The chi-square test and the student’s t-test were used to compare epidemiologically-estimated need in a representative sample of adults with treatment provided. Differences were found in dental care utilisation and tooth retention by Socio-Economic Status. An analysis of the five-year utilisation behaviour of a 2003 cohort of DTBS dental attendees revealed that age and being female were positively associated with visiting annually and number of treatments. Number of adults using the DTBS increased, and mean number of treatments per patient decreased, between 1997 and 2008. As a percentage of overall treatments, restorations, dentures, and extractions decreased, while prophylaxis increased. Differences were found between epidemiologically-estimated treatment need and treatment provided for those using the DTBS and DTSS. This research confirms the utility of survey and administrative data to generate knowledge for policymakers. Public administrative databases have not been designed for research purposes, but they have the potential to provide a wealth of knowledge on treatments provided and utilisation patterns.

Development of a general internet attitude scale and internet self-efficacy scale

The measurement of users’ attitudes towards and confidence with using the Internet is an important yet poorly researched topic. Previous research has encountered issues that serve to obfuscate rather than clarify. Such issues include a lack of distinction between the terms ‘attitude’ and ‘self-efficacy’, the absence of a theoretical framework to measure each concept, and failure to follow well-established techniques for the measurement of both attitude and self-efficacy. Thus, the primary aim of this research was to develop two statistically reliable scales which independently measure attitudes towards the Internet and Internet self-efficacy. This research addressed the outlined issues by applying appropriate theoretical frameworks to each of the constructs under investigation. First, the well-known three component (affect, behaviour, cognition) model of attitudes was applied to previous Internet attitude statements. The scale was distributed to four large samples of participants. Exploratory factor analyses revealed four underlying factors in the scale: Internet Affect, Internet Exhilaration, Social Benefit of the Internet and Internet Detriment. The final scale contains 21 items, demonstrates excellent reliability and achieved excellent model fit in the confirmatory factor analysis. Second, Bandura’s (1997) model of self-efficacy was followed to develop a reliable measure of Internet self-efficacy. Data collected as part of this research suggests that there are ten main activities which individuals can carry out on the Internet. Preliminary analyses suggested that self-efficacy is confounded with previous experience; thus, individuals were invited to indicate how frequently they performed the listed Internet tasks in addition to rating their feelings of self-efficacy for each task. The scale was distributed to a sample of 841 participants. Results from the analyses suggest that the more frequently an individual performs an activity on the Internet, the higher their self-efficacy score for that activity. This suggests that frequency of use ought to be taken into account in individual’s self-efficacy scores to obtain a ‘true’ self-efficacy score for the individual. Thus, a formula was devised to incorporate participants’ previous experience of Internet tasks in their Internet self-efficacy scores. This formula was then used to obtain an overall Internet self-efficacy score for participants. Following the development of both scales, gender and age differences were explored in Internet attitudes and Internet self-efficacy scores. The analyses indicated that there were no gender differences between groups for Internet attitude or Internet self-efficacy scores. However, age group differences were identified for both attitudes and self-efficacy. Individuals aged 25-34 years achieved the highest scores on both the Internet attitude and Internet self-efficacy measures. Internet attitude and self-efficacy scores tended to decrease with age with older participants achieving lower scores on both measures than younger participants. It was also found that the more exposure individuals had to the Internet, the higher their Internet attitude and Internet self-efficacy scores. Examination of the relationship between attitude and self-efficacy found a significantly positive relationship between the two measures suggesting that the two constructs are related. Implication of such findings and directions for future research are outlined in detail in the Discussion section of this thesis.

Knowledge and perceptions among overweight and obese employees about lifestyle-related health benefit changes.

We investigated perceptions among overweight and obese state employees about changes to health insurance that were designed to reduce the scope of health benefits for employees who are obese or who smoke. Before implementation of health benefit plan changes, 658 state employees who were overweight (ie, those with a body mass index [BMI] of 25-29.9) or obese (ie, those with a BMI of > or = 30) enrolled in a weight-loss intervention study were asked about their attitudes and beliefs concerning the new benefit plan changes. Thirty-one percent of employees with a measured BMI of 40 or greater self-reported a BMI of less than 40, suggesting they were unaware that their current BMI would place them in a higher-risk benefit plan. More than half of all respondents reported that the new benefit changes would motivate them to make behavioral changes, but fewer than half felt confident in their ability to make changes. Respondents with a BMI of 40 or greater were more likely than respondents in lower BMI categories to oppose the new changes focused on obesity (P < .001). Current smokers were more likely than former smokers and nonsmokers to oppose the new benefit changes focused on tobacco use (P < .01). Participants represented a sample of employees enrolled in a weight-loss study, limiting generalizability to the larger population of state employees. Benefit plan changes that require employees who are obese and smoke to pay more for health care may motivate some, but not all, individuals to change their behaviors. Since confidence to lose weight was lowest among individuals in the highest BMI categories, more-intense intervention options may be needed to achieve desired health behavior changes.

Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.

BACKGROUND: Early preparation for renal replacement therapy (RRT) is recommended for patients with advanced chronic kidney disease (CKD), yet many patients initiate RRT urgently and/or are inadequately prepared. METHODS: We conducted audio-recorded, qualitative, directed telephone interviews of nephrology health care providers (n = 10, nephrologists, physician assistants, and nurses) and primary care physicians (PCPs, n = 4) to identify modifiable challenges to optimal RRT preparation to inform future interventions. We recruited providers from public safety-net hospital-based and community-based nephrology and primary care practices. We asked providers open-ended questions to assess their perceived challenges and their views on the role of PCPs and nephrologist-PCP collaboration in patients' RRT preparation. Two independent and trained abstractors coded transcribed audio-recorded interviews and identified major themes. RESULTS: Nephrology providers identified several factors contributing to patients' suboptimal RRT preparation, including health system resources (e.g., limited time for preparation, referral process delays, and poorly integrated nephrology and primary care), provider skills (e.g., their difficulty explaining CKD to patients), and patient attitudes and cultural differences (e.g., their poor understanding and acceptance of their CKD and its treatment options, their low perceived urgency for RRT preparation; their negative perceptions about RRT, lack of trust, or language differences). PCPs desired more involvement in preparation to ensure RRT transitions could be as "smooth as possible", including providing patients with emotional support, helping patients weigh RRT options, and affirming nephrologist recommendations. Both nephrology providers and PCPs desired improved collaboration, including better information exchange and delineation of roles during the RRT preparation process. CONCLUSIONS: Nephrology and primary care providers identified health system resources, provider skills, and patient attitudes and cultural differences as challenges to patients' optimal RRT preparation. Interventions to improve these factors may improve patients' preparation and initiation of optimal RRTs.

Enlightenment and mission in early nineteenth century South Africa

In the early 19th century the London Missionary Society’s activities in South Africa were the subject of great scandal and a source of disrepute. The behaviour and attitudes of the first wave of LMS missionaries had challenged, and caused outrage, to both the political and moral norms of the colony. The radical attitudes and unconventional private lives of many of the early missionaries had also clearly shocked the Directors in Europe. In these controversies, and in the manner that the Society dealt with them, there can be read a contestation about not only the character, but also the purpose of mission activity. Was the Missionary task to work for political stability, to spread European values and help prepare a compliant and educated workforce? Or was it to save ‘lost souls’ and turn people away from idolatry and sin? Or, again, was it to fight for the oppressed, to liberate slaves and oppose tyranny? These debates were framed in complex and contradictory ways by a larger discussion that was informed by the new ideas and agendas that had emerged in the 18th century, commonly referred to as ‘The Enlightenment’. This paper traces the contours of an engagement between ‘Evangelical’ values and ‘Enlightenment’ principles through an exploration of the issues of the day such as: abolitionism, women’s rights, civilization and savagery. [From the Author]

Marginal adaptation and performance of bioactive dental restorative materials in deciduous and young permanent teeth

Objective: The aim of this study was to investigate the adaptation of different types of restorations towards deciduous and young permanent teeth. Materials and Methods: Class V cavities were prepared in deciduous and young permanent teeth and filled with different materials (a conventional glass-ionomer, a resin-modified glass-ionomer, a poly-acid-modified composite resin and a conventional composite resin). Specimens were aged in artificial saliva for 1, 6, 12 and 18 months, then examined by SEM. Results: The composite resin and the polyacid-modified composite had better marginal adaptation than the glass-ionomers,though microcracks developed in the enamel of the tooth. The glass-ionomers showed inferior marginal quality and durability, but no microcracking of the enamel. The margins of the resin-modified glass-ionomer were slightly superior to the conventional glass-ionomer. Conditioning improved the adaptation of the composite resin, but the type of tooth made little or no difference to the performance of the restorative material. All materials were associated with the formation of crystals in the gaps between the filling and the tooth; the quantity and shape of these crystals varied with the material. Conclusions: Resin-based materials are generally better at forming sound, durable margins in deciduous and young permanent teeth than cements, but are associated with microcracks in the enamel. All fluoride-releasing materials give rise to crystalline deposits.

Ambitious mothers – successful daughters: Mothers’ early expectations for children’s education and children’s earnings and sense of control in adult life

Background. Mothers' expectations for their children's educational attainment are related to children's educational and occupational attainment. Studies have yet to establish, however, the long-term links between maternal expectations and offspring earnings, which are not always related to occupational attainment especially in women, or between maternal expectations and offspring sense of control and self-efficacy, which are pivotal factors in career choice and development. Aims. To explore the role of mothers' expectations for their children's educational attainment in children's earnings attainment and sense of control later in life. Method. Data from sweeps of the 1970 British Cohort Study (BCS70) were used. The study sample was those cohort members with complete information on all the variables of interest. The study sample (N = 3,285) was more educated and less disadvantaged than the whole sample. If cohort members of this type are more likely to have a mother who has high expectations, then our results are biased downwards, which suggests that we underestimate the effect of expectations on our two outcome variables. Results. Mothers' expectations at the age of 10 were positively related to daughters' sense of control at the age of 30 even after controlling for ethnicity, educational attainment, and concurrent partner, parent, and labour market participation status, as well as the following confounding variables (measured at the ages of 0–10): general ability and general ability squared, locus of control, emotional and behavioural problems and emotional and behavioural problems squared, socio-economic disadvantage, parental social class, parental family structure, and mothers' education, child-rearing attitudes, and mental health. Mothers' expectations had no effect on sons' adult outcomes. Conclusions. Given that women are particularly at risk for poor psychological and economic outcomes in adulthood, and that this study likely underestimated the effect of expectations on these two outcomes, this is an important conclusion.

The first time: young people and sex in Northern Ireland.

The sexual health of people, particularly young people, in Northern Ireland is currently poor. Yet there has been little research conducted on sexual attitudes and lifestyles. This paper is based on data from the first ever major research project in this field in Northern Ireland. Using quantitative and qualitative methods, it targeted young people aged 14-25. A combination of a self-administered survey questionnaire, focus group discussions and one-to-one interviews was found to be most suitable for the collection of sensitive data on sexuality in a country where the social and moral climate had previously prevented studies of this nature. Information was collected on sexual attitudes and behaviour generally. This paper focuses on one crucial issue: the age of first sexual encounter. It explores the attitudes of young people to that experience and the use of contraception. Many of the findings match those of similar large-scale surveys in England and Wales, including the modal age of first sexual encounter and the influence of peer pressure on decision-making about first sex. There were significant gender differences in both behaviour and attitudes. It is hoped that the research results will influence future education and health policy, which has all too often been based on ignorance.

Characterisation and evaluation of novel surfactant bacterial anti-adherent coatings for endotracheal tubes designed for the prevention of ventilator-associated pneumonia.

It is accepted that ventilator-associated pneumonia is a frequent cause of morbidity and mortality in intensive care patients. This study describes the physicochemical properties of novel surfactant coatings of the endotracheal tube and the resistance to microbial adherence of surfactant coated endotracheal tube polyvinylchloride (PVC). Organic solutions of surfactants containing a range of ratios of cholesterol and lecithin (0:100, 25:75, 50:50, 75:25, dissolved in dichloromethane) were prepared and coated onto endotracheal tube PVC using a multiple dip-coating process. Using modulated temperature differential scanning calorimetry it was confirmed that the binary surfactant systems existed as physical mixtures. The surface properties of both surfactant-coated and uncoated PVC, following treatment with either pooled human saliva or phosphate-buffered saline (PBS), were characterised using dynamic contact angle analysis. Following treatment with saliva, the contact angles of PVC decreased; however, those of the coated biomaterials were unaffected, indicating different rates and extents of macromolecular adsorption from saliva onto the coated and uncoated PVC. The advancing and receding contact angles of the surfactant-coated PVC were unaffected by sonication, thereby providing evidence of the durability of the coatings. The cell surface hydrophobicity and zeta potentials of isolates of Staphylococcus aureus and Pseudomonas aeruginosa, following treatment with either saliva or PBS, and their adherence to uncoated and surfactant-coated PVC (that had been pre-treated with saliva) were examined. Adherence of S. aureus and Ps. aeruginosa to surfactant-coated PVC at each successive time period (0.5, 1, 2, 4, 8 h) was significantly lower than to uncoated PVC, the extent of the reduction frequently exceeding 90%. Interestingly, the microbial anti-adherent properties of the coatings were dependent on the lecithin content. Based on the impressive microbial anti-adherence properties and durability of the surfactant coating on PVC following dip coatings, it is proposed that these systems may usefully reduce the incidence of ventilator-associated pneumonia when employed as luminal coatings of the endotracheal tube.

'Ancient Enmities' and Modern Conflict: History and Politics in Northern Ireland

This article investigates the role of history and historical consciousness in deeply divided societies. It looks at the case of Northern Ireland. It argues that, while the conflict here is caused by contemporary divisions, perceptions of the past have had considerable influence. Recent years have seen efforts to change historical attitudes and this has aided political accommodation. An important lesson from the conflict in Northern Ireland points to the need to challenge such historical perceptions.

Addressing diversity and inclusion in the early years in conflict-affected societies: A case study of the Media Initiative for Children – Northern Ireland

This article reports on the development and systematic evaluation of an innovative early years programme aimed at encouraging young children to respect differences within a deeply-divided society that is emerging out of a prolonged period of violent conflict. The programme, the Media Initiative for Children – Northern Ireland, has been the product of a partnership between an US-based organisation (the Peace Initiatives Institute) and NIPPA – The Early Years Organisation and has been supported by academic research and the efforts of a range of voluntary and statutory organisations. It has attempted to encourage young children to value diversity and be more inclusive of those who are different to themselves through the use of short cartoons designed for and broadcast on television as well as specially-prepared curricular materials for use in pre-school settings. To date the programme has been delivered through 200 settings to approximately 3,500 pre-school children across Northern Ireland. This article describes how the programme was developed and implemented as well as the rigorous approach taken to evaluating its effects on young children’s attitudes and awareness. Key lessons from this are identified and discussed in relation to future work in this area.

The general and specific effects of educational programmes aimed at promoting awareness of and respect for diversity among young children

This article reports the findings of a mixed-method evaluation of a pilot educational programme undertaken with 6-7 year olds in a sample of primary schools in England with the aim of increasing their awareness of and respect for diversity through theatre, workshops and related teacher-led classroom activities. The qualitative feedback from the teachers involved was extremely positive and encouraging and an analysis of the actual impact of the pilot programme on the children’s attitudes and awareness, using an experimental design, demonstrated some positive effects. In particular, the programme was found to increase the children’s general awareness of diversity and their ability to recognise instances of exclusion. While not a planned objective of the pilot programme, the evaluation also examined whether it had any effects on the children’s attitudes to specific differences, in this particular case racial differences. Interestingly, however, no evidence was found of any change in the children’s racial attitudes. With this in mind the article suggests that there is a need to distinguish between the general and specific effects of such educational programmes. The article considers the implications of this for future work in the area and also stresses the need to undertake more thorough and rigorous evaluations of such initiatives.

Cooperativism, entrepreneurship and economic development: a linking theoretical model

Cooperatives, as a kind of firms, are considered by many scholars as an remarkable alternative for overcoming the economic crisis started in 2008. Besides, there are other scholars which pointed out the important role that these firms play in the regional economic development. Nevertheless, when one examines the economic literature on cooperatives, it is detected that this kind of firms is mainly studied starting from the point of view of their own characteristics and particularities of participation and solidarity. In this sense, following a different analysis framework, this article proposes a theoretical model in order to explain the behavior of cooperatives based on the entrepreneurship theory with the aim of increasing the knowledge about this kind of firms and, more specifically, their contribution to regional economic development.

The influence of aetiology and blame on prejudice towards survivors of brain injury.

The purpose of the present work was to investigate if a hierarchy of aetiology exists which would influence attitudes towards survivors of brain injury. An independent groups design utilised four independent variables; aetiology (measured at five levels: ‘Road Traffic Accident’ (RTA), ‘Alcohol’, ‘Drug Use’, ‘Aneurism’ and ‘Recreation’), blame (blame and no-blame), group (psychology students and members of the public) and gender to explore attitudes towards survivors of brain injury. The dependent variables were measured using the Prejudicial Evaluation Scale (PES) and Social Interaction Scale (SIS). Three hundred and twenty-five participants (173 students and 152 members of the public) were randomly allocated to one of ten possible conditions. Among individuals who contributed to receiving their injury greater prejudice was displayed towards those in the ‘Drugs’ condition followed by ‘Recreation’, ‘RTA’, ‘Alcohol’ and ‘Aneurism’. Findings suggest that a hierarchy of aetiology exists, which results in prejudicial attitudes, and is influenced by issues of blame. Key words: prejudice, blame, brain injury