Identifying dentists' attitudes towards prevention guidance using Q-sort methodology.

OBJECTIVE: To gain insight into the attitudes and motivating factors of dentists working in the English National Health Service (NHS) towards prevention guidance. DESIGN: Q-methodology: an established hybrid quantitative/qualitative technique used in the social sciences to categorise subjects based on their views by considering factors as part of their overall decision-making profile. SETTING: General Dental Practices offering care under an NHS contract. SUBJECTS AND METHODS: NHS dentists (n = 26) placed 36 statements about prevention guidance derived from an earlier study into a distribution grid that ranked the statements from "most agree" to "most disagree". Principal components factor analysis was applied to determine the principal patterns in the rankings of statements. RESULTS: Analysis indicated a total of six distinct profiles within the responses, of which three profiles had at least six dentists loading onto them. The first profile was strongly characterised by dentists who appear motivated to provide prevention but financial and time constraints prevent them from doing so. The second was characterised by dentists using prevention guidance but restricting its use to only certain patients. The third was characterised by dentists who appeared "health-focused". They placed importance on working to prevention guidance, but were keen to have greater patient and professional support in achieving this. CONCLUSION: In this group of dentists Q-methodology identified three main profiles to the delivery of prevention guidance

Barriers and facilitators that influence the delivery of prevention guidance in health service dental practice: a questionnaire study of practising dentists in Southwest England.

UNLABELLED: Objective: OBJECTIVE: To investigate the barriers and facilitators influencing the delivery of prevention in accordance with a national guideline (Delivering Better Oral Health, Department of Health England) in health service dental practice. DESIGN: Self-completion questionnaire. SETTING: Health service general dental practices. SUBJECTS AND METHODS: Questionnaires were sent via two mailings to all 508 dentists registered to work in health service general dental practice in Devon, South West England. RESULTS: In total 266 questionnaires were returned (52% response rate). Examples of barriers and facilitators were evident at various organisational levels of dentistry. These were principally the healthcare system, practice (dental office) arrangements and professional factors. Respondents gave positive responses to questions concerning the flexibility (53%) and benefit of the guideline (63%) and they tended to indicate that they didn't perceive problems in changing their old routines (58%). Opinion was divided among respondents on whether they felt patients followed their advice (49%). There was overall agreement that delivering prevention in practice is problematic if there are insufficient staff (68%), facilities (53%) and time (60%). Encouragingly most respondents felt adequately trained to deliver the evidence based prevention guidance (59%). CONCLUSIONS: This study has identified some barriers and facilitators to the delivery of prevention guidance in this group of health service dentists with no single factor viewed consistently as more important than any others. A further qualitative study is planned to investigate in more depth the reasons underpinning the responses given in this study

Differences by age and sex in general dental practitioners' knowledge, attitudes and behaviours in delivering prevention.

PURPOSE: To assess sex and age differences in NHS dentists' knowledge, attitudes and behaviours in providing preventive care. MATERIALS AND METHODS: A cross-sectional questionnaire survey was conducted with dentists working in North London, UK. RESULTS: The sample displayed limited knowledge in certain key aspects of prevention, but expressed generally positive attitudes towards preventive care. More female and younger dentists reported that a child should attend the dentist before the age of 3 years (p = 0.03 and p = 0.04, respectively). No other differences in knowledge or attitudes were found by age and sex. The majority of the sample reported routinely providing oral hygiene (95.7%), diet (85.4%) and smoking cessation advice (76.7%), but provision of alcohol advice was much less common (38%). A significantly higher proportion of younger dentists were more likely to give diet advice (p = 0.03) and smoking cessation support (p = 0.009) than their older colleagues. Female dentists were more likely to provide fissure sealants (p = 0.04), diet advice (p = 0.02) and smoking cessation support (p = 0.03). The main perceived barriers were related to organisational factors including insufficient remuneration (86.3%), lack of time (84%) and poor patient compliance (66%). There were no significant differences in perceived barriers by sex, but younger dentists were significantly more likely to identify poor patient compliance as a barrier (p = 0.02). CONCLUSION: Although dentists in this study may lack some core preventive knowledge, many expressed very positive attitudes towards prevention and reported to be routinely offering a range of preventive measures. Younger and female dentists tended to engage more frequently in preventive activities.National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number- PB PG 1207 14,085

Auditory Processing Disorders with and without Central Auditory Discrimination Deficits

Auditory processing disorder (APD) is defined as a processing deficit in the auditory modality and spans multiple processes. To date, APD diagnosis is mostly based on the utilization of speech material. Adequate nonspeech tests that allow differentiation between an actual central hearing disorder and related disorders such as specific language impairments are still not adequately available. In the present study, 84 children between 6 and 17 years of age (clinical group), referred to three audiological centers for APD diagnosis, were evaluated with standard audiological tests and additional auditory discrimination tests. Latter tests assessed the processing of basic acoustic features at two different stages of the ascending central auditory system: (1) auditory brainstem processing was evaluated by quantifying interaural frequency, level, and signal duration discrimination (interaural tests). (2) Diencephalic/telencephalic processing was assessed by varying the same acoustic parameters (plus signals with sinusoidal amplitude modulation), but presenting the test signals in conjunction with noise pulses to the contralateral ear (dichotic(signal/noise) tests). Data of children in the clinical group were referenced to normative data obtained from more than 300 normally developing healthy school children. The results in the audiological and the discrimination tests diverged widely. Of the 39 children that were diagnosed with APD in the audiological clinic, 30 had deficits in auditory performance. Even more alarming was the fact that of the 45 children with a negative APD diagnosis, 32 showed clear signs of a central hearing deficit. Based on these results, we suggest revising current diagnostic procedure to evaluate APD in order to more clearly differentiate between central auditory processing deficits and higher-order (cognitive and/or language) processing deficits