Mario Brondani

Objectives: Immunocompromised individuals face heightened risks from vaccine-preventable diseases, including People Living with HIV (PLHIV), who are further vulnerable due to socio-economic and comorbidity factors, as underscored by the recent COVID-19 pandemic. This study employed a scoping review to identify barriers and facilitators to vaccination in immunocompromised individuals. It also includes a cross-sectional study focused on COVID-19 vaccines in PLHIV to highlight socio-economic and health-related factors influencing vaccine uptake and hesitancy.Methods: The scoping review was guided by the Joanna Briggs Institute’s framework encompassing studies published between January 1974 and July 25, 2022, in academic databases and grey-literature sources. Subsequently, a 34-item anonymous survey was distributed to PLHIV via e-newsletters through HIV/AIDS-related organisations in British Columbia. The survey, conducted between November 2022 and January 2023, collected information on socio-demographics, COVID-19-vulnerability factors, HIV indicators, and vaccine hesitancy scores using the validated adult Vaccine Hesitancy Scale. Descriptive (means and frequencies) and inferential statistics, including ANOVA and Binary logistic regression, were conducted to detect factors associated with COVID-19 vaccine hesitancy and vaccine uptake. Significant level (p0.05).Results: Seventy-six publications were included in the scoping review, with vaccine uptake ranging from 5.6% to 96.7%. Barriers to vaccine uptake included concerns about adverse effects, lack of physician recommendations, and younger age, while facilitators included older age, perceived disease vulnerability, higher education, prior vaccination history, and longer immunosuppression duration.ivFrom the cross-sectional study, out of 276 respondents (mean age 29.93±7.548), nearly 40% received three vaccine doses or more, and 82.2% at least one dose. Predictors of COVID-19 vaccine uptake included age , bachelor's degree , family/friends with COVID-19 , HIV viral load >500copies , belief in vaccine importance , trust in Health Canada's information , and concerns about vaccine adverse effects .Conclusions: My study highlights that immunocompromised individuals' vaccination behaviours are influenced by health-related factors, such as concerns about vaccine safety and reliance on physicians’ recommendations due to limited vaccine knowledge. These insights are pivotal in formulating effective public health policies and interventions that address safety concerns and knowledge gaps to support informed vaccination decisions, ultimately fostering vaccine uptake and maintaining an up-to-date vaccination status.

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Objectives: Undergraduate dental students at the University of British Columbia are required to interview an older adult, while optionally using the life grid, and critically reflecting on this experience. The present study undertook a scoping review to map out the applications of the life grid in oral health research and a thematic analysis to explore how the interview assignment impacted the students and their views about their future profession.Methods: The Joanna Briggs Institute’s methodology was used for the scoping review performed by two reviewers. Studies published until April 21, 2022, were searched regardless of language. Also, assignments collected from one entire cohort of students from 2021/22 academic year were analyzed thematically including an interactive coding process in a qualitative exploratory inquiry.Results: From 724 initially identified records, 22 studies were included, which used the life grid at the beginning of the interview, during the process, or at the end. This tool reduced recall bias, increased data reliability, helped establish rapport with participants, and ensured information accuracy. All the fifty-four assignments delivered in December of 2021 were thematically analyzed, in which five main themes emerged: communication, life course journey, person-centered care, social determinants of health, and access to care. A wide range of ideas emerged under each theme, with several practical suggestions to improve future practice as an oral health professional.Conclusion: Although the impact of using the life grid in dental education, in general, remains unknown, its flexibility in structure and method of use, and various perspectives on its impacts were identified. Also, the students seemed to establish effective relationships with the interviewees and provide various reflections regarding this experience and its implications for their future practice.

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Objectives: Despite teledentistry’s (TD) expanded utilization, it has yet to be fully adopted by oral health care professionals in their training and practice. The present study undertook a scoping review to explore TD incorporation in the training of oral health care providers worldwide and a survey at Canadian dental and dental hygiene programs. Methods: The Joanna Briggs Institute’s methodology was used for the scoping review performed by two reviewers. Studies published between 1989 and June 4th, 2022, were searched using “teledentistry” and “education” as initial keywords. An anonymous survey with thirty-seven questions was distributed among all ten dental and thirty-five dental hygiene programs across Canada. The survey focused mostly on TD teaching (methods employed, content taught, and barriers to implementing TD), with descriptive (frequency, maximum, minimum, mean, etc.) and inferential (Pearson chi-square for odds ratio and Fisher’s exact test) data analyses using SPSS®. A ?− value0.05 was considered statistically significant. Results: A total of 2180 documents were found; nineteen were eligible for data extraction. Didactic education and hands-on practice were the most employed training methods worldwide. All of the dental (n=10) and 68% (n=24) of dental hygiene programs responded to the survey; of the thirty-four programs, eighteen had TD content, including three dental programs. An average of 9.22± 4.86 hours was reported for teaching TD, with lecture format as the most employed approach and using TD in dental practice as the most covered topic. While 53% of the dental hygiene programs employed formative and summative assessments, only one dental program reported having an assessment for this content. Moreover, programs that dedicated less than nine hours to this content were less likely to address more than seven TD-related topics (OR=0.14).Conclusion: There is a variation in the existing TD educational programs, from content to assessment in both the scoping review and survey. Less than half of the dental hygiene and 30% of the dental programs in Canada incorporated TD content. However, the sparsity of TD educational programs emphasizes the necessity for its future planning.

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Introduction:Oropharyngeal cancer impacts quality of life negatively, has a costly treatment and a poor 5-year survival prognosis. Risk factors include tobacco, alcohol, and genetics. But in up to 28% of the cases, Human Papillomavirus (HPV) has been implicated in the development of oropharyngeal cancers. One way to prevent HPV infections, and to potentially decrease the incidence of oropharyngeal cancers, is through vaccination.Purpose:i. To investigate whether BC dentists believe administering the Gardasil® vaccine is within their scope of practice.ii. To investigate if BC dentists are willing to administer the Gardasil® vaccine within the target demographic of their practices.iii. To explore the perceptions and practices of BC dentists regarding discussing HPV in the dental practice setting.Materials & Methods:A survey was constructed consisting of 14 questions pertaining to demographics, scope of practice, barriers to discussing the HPV vaccine, willingness to engage in HPV vaccine practices, and willingness to collaborate with primary care providers in HPV vaccine practices. A partnership with the BCDA was established to disseminate a questionnaire-based survey via a URL link on April 1st, 2021, in the form of a routine bi-weekly electronic email update to enrollees. Pearson chi-squared tests of independence were conducted on the captured data with two-tailed significance determined by a P 0.05.Results:A total of 201 surveys were completed. 168 respondents (83.6%) agreed discussing the link between HPV and oropharyngeal cancer falls within the scope of practice, with agreement declining when asked about recommending (74.1%) and administering (38.8%) the HPV vaccine. Respondents reported willingness to educate (87.6%) and refer (91.5%) patients to receive HPV vaccines however remain unwilling to administer (only 53.7% willing) the vaccine within the dental office setting. Respondents were willing to educate patients on HPV and oropharyngeal cancer but were either willing or unwilling to discuss sexual history and related topics within the dental setting (p=0.02).Conclusion:Survey respondents were unwilling to administer the HPV vaccine within the dental setting as they perceived the act to fall outside their scope of practice. There remains a reluctance to engage in the inoculation effort within the dental setting.

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Objectives: The COVID-19 pandemic has caused stress on undergraduate dental students. While some stress may be protective by preparing students to manage certain challenges, overwhelming stressors can be detrimental to their mental health; coping mechanisms might be employed to deal with stressors. The present study undertook a scoping review to identify and discuss the COVID-19 pandemic-related stressors impacting dental students’ mental health across the world and a cross-sectional study exploring the coping mechanisms employed by dental students at the University of British Columbia (UBC) during the pandemic, to deal with their major stressors.Methods: The Joanna Briggs Institute’s framework for scoping reviews was used to identify systematically peer-reviewed publications reporting mental health issues in dental students from the onset of the COVID-19 pandemic until June 22, 2021. Based on findings from the scoping review, a cross-sectional study was developed and conducted at UBC. An anonymous survey with 35 questions was distributed among all 229 UBC undergraduate dental program. The survey asked for de-identified sociodemographic data and for stressors and coping strategies via the Brief-COPE inventory.Results: Fifty-five publications were included in the scoping review; dental students suffer from stress, anxiety and depression during COVID-19. Fear of contraction during patient interaction was reported to be the predominant stressor of dental students, followed by academic stressors such as transition to virtual learning and clinical skill deficits. From the 229 eligible students, 182 (79.5%) responded to the survey and 99 (54.4%) were stressed about clinical skill deficits due to the pandemic; fear of contraction was reported by 31 students (17%). Adaptive coping was significantly higher in first, second, and fourth-year students compared with third year students (p=0.001). Social isolation was a significant predictor for maladaptive coping (p0.001).Conclusions: Undergraduate dental students suffer from mental health issues related to the COVID-19 pandemic. The main cause of stress related to the COVID-19 pandemic for dental students at UBC was their clinical skills being affected. Coping strategies that students frequently use were identified. Continued mitigation efforts should be made to address students’ mental health concerns and create a supportive learning environment.

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Objectives: To map the mental health and wellness content in the curriculum of all Canadian dental schools, with a focus on the Faculty of Dentistry (FoD) at the University of British Columbia (UBC), and to investigate factors influencing resilience levels among dental students at UBC. Methods: An electronic 29-item survey was distributed to all Canadian dental schools. A situational analysis was conducted to describe the mental health content in UBC’s FoD. The Connor-Davidson 10-Item Resilience Scale was used to measure students’ psychological resilience levels among all UBC’s undergraduate dental students. Students’ de-identified demographic data were also collected. Results: Eight dental schools responded to the survey. All responding schools provided content related to resilience and used didactic sessions to deliver their content and reported having wellness committees and learning communities. None of the schools reported formally evaluating their mental health content. Two main mental health curricular components were identified in UBC’s FoD year 1 curriculum: one didactic session on stress management and one interactive workshop on resilience; 4.5 hours in total. Students who did not receive any mental health content (2020/21 year 1 students) had higher resilience scores (p= 0.043) when compared to students who received both components (2019/20 year 1 students and 2018/19 year 2 students). The multiple linear regression analysis highlighted North American/ European ethnic origins as a predictor for higher resilience levels (p = 0.008). Conclusions: The results of this study showed that all responding Canadian dental schools have at least one form of mental health content in their curricula and/or services, with UBC’s FoD mainly introducing the content over in the first two years. Ethnic origins and major life events, such as the COVID-19 pandemic, have likely affected the resilience scores. Curricular activities promoting resilience seemed to not necessarily impact students’ resilience. Further longitudinal studies are needed to further explore the curricular and non-curricular activities in dental schools and their potential influence over dental students’ mental health.

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Objectives: To evaluate family medicine residency curricula content pertaining to, and residents’ training in, infants’ oral health in Canada.Methods: Two brief self-administered online surveys were developed using Research Electronic Data Capture (REDCap). One survey targeted all the 17 Canadian family medicine training program directors, and another target the currently enrolled residents within these programs. Questions focused on training, attitudes and practices towards infant oral health. Statistical tests were performed using SPSS version 22 with a confidence interval of 95% and a significance level of 0.05.Results: A total of 11 family medicine directors and 155 family medicine residents responded to the survey. The vast majority 90% (N=10) of the directors indicated that clinical oral health screening was not incorporated into the curriculum, particularly around early childhood caries. Over half the residents (53%, n=82) reported that they did not feel their training was adequate to identify dental caries in children. As 41% (n=63) of the residents described the quality of their training in oral health-related topics during their residency to be poor, more than two thirds (62%, n=96) of them seldom performed a visual examination of the children’s teeth. Although family medicine residents felt that physicians have an important role in promoting oral health among infants and toddlers, the majority (72%, n=112) of them reported lack of knowledge and training as the main barriers to performing oral health-related practices.Conclusion: Most of the Family Physicians training programs in Canada do not include infant oral health screening in their curriculum. While the majority of family medicine residents felt that physicians have an important role in promoting oral health amongst children, the reported lack of knowledge and training were hindering them from performing various oral health-related practices.

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Objective: To assess the direct and indirect costs of non-traumatic dental visits at the Emergency Rooms (ERs) in British Columbia (BC). Methods: Services from the Canadian Institute for Health Information’s National Ambulatory Care Reporting System (NACRS) were acquired; NACRS contains data including diagnosis and procedures coded with the International Classification of Disease representing the conditions of oral cavity, salivary glands and jaws. Direct cost relates to the billing cost of non-traumatic dental patient seen at the ER as billed to the government. Direct costs from Ontario and Alberta were used to estimate the cost for BC. Indirect cost relates to loss of income in terms of time spent at the ER only. Results: Between years 2012 and 2013, the number of visits for non-traumatic dental conditions at the ERs in Ontario, Alberta and British Columbia were 135,570 (1.16% of the total number of ER visits), 69,247 (1.51% of the total number of ER visits) and 22,786 (1% of the total number of ER visits), respectively. Out of 74, the 29 reporting emergency departments in 2013 in BC showed that the majority of the visits for non-traumatic dental conditions (70%) were made by adults between the ages 20 and 64 years-old; the most common complaints were dental and periapical abscesses and dental caries. The majority (70%) of non-traumatic dental patients in BC were non-urgent. On average the patients spent around 2 hours at the ERs at a cost ranging from $185.15 to $245.51 each to British Columbians, up to $2.99 million per year. Conclusion: Although not all emergency departments in BC report data on non-traumatic dental visits, the cost to the tax payers is substantial. It was estimated to be between $185.15 and $245.51, whether using data from either Alberta or Ontario, respectively; the cost sums up to a total of $2.25 to $2.99 million per year for 29 of 74 reporting ERs. Therefore, use of emergency rooms for non-traumatic dental conditions not only adds an extra burden and contributes to overcrowding, but also makes the health care system costly.

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Objective: To determine the baseline self-reported oral health and dental service utilization of pregnant women from diverse ethno cultural backgrounds within the geographical are of the Fraser Health Authority in British Columbia, Canada. Method: A prospective 34-item cross-sectional survey was administered to all the women enrolling for a prenatal registration program between October 2012 and January 2013. For data analysis, a two-sample t-test was used, and categorical variables were tested using a chi-square test. Multivariable logistic regressions were used to estimate the odds ratio. Results: A total of 740 pregnant women filled out the questionnaire. The majority (84%) of the respondents rated their oral health as good or excellent. Fifty two percent of the women had visited dental professional during last year. Almost 1/3 of those reporting symptoms of depression rated their oral health as fair or poor. Forty-one percent reported having bleeding gums, 22% experienced tooth sensitivity, and 13% had persistent dry mouth since the beginning of their pregnancy. When asked about the beliefs associated with pregnancy, 37% of the respondents expected bleeding gums, and 34% expected tooth sensitivity. Women born in India had visited a dental professional 2.8 times more often than women who had been born elsewhere. Those with dental insurance were 6.6 times more likely to visit a dentist than those without insurance. Conclusion: The majority of pregnant women considered dental care during pregnancy to be very important and had previously visited a dental professional within the last year. However, more than 1/3 had experienced one or more oral problems while more than half held false beliefs about the effects of pregnancy upon oral health. These reported oral beliefs and problems could be addressed with patient education during routine pre-natal care and subsequent referral to a dentist if needed.

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Objectives: The objective of this study was to explore the nature of stigma experienced by dental patients who have substance use and mental health issues. Methods: Semi-structured interviews were conducted with a purposefully selected group of 13 English-speaking participants (7 males) who struggled with a variety of substance use and/or mental disorders, and lived in one of two treatment centres. An interview guide containing open-ended questions was used to discuss their experiences with dental professionals, and their perceptions of stigmatization. All interviews were audio-recorded, transcribed verbatim and analyzed using a qualitative thematic analysis. Results: Analysis of about 300 pages of interview transcripts demonstrated that participants perceived stigma in dental settings when they were viewed as “junkie” or “crazy”, were negatively stereotyped, and finally were rejected as patients or received negative attitude and substandard care from dentists who were misusing their position of power. Lack of or poor understanding and education about issues of addiction and mental health were pointed out as the origin of stigma. Positive experiences with dental professionals were characterized by empathy, reassurance and communication, which were empowering for patients. Conclusion: Individuals with substance dependence and mental health issues felt stigmatized by some dental professionals who they felt had labelled, stereotyped, and discriminated against them; making them feel disempowered. Findings of the study highlighted the need to better prepare current and future dentists to address the oral care of patients with substance dependence and mental illness in their clinical practice.

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Introduction: Oral Health Impact Profile (OHIP) is a widely used psychometric instrument or scale developed in English to measure Oral Health-related Quality of Life (OHQoL), and there has been many translations of the instrument into other languages, including Korean. Purpose: My thesis examines the validity and cultural equivalence of the English and Korean versions of the scale by answering the questions: “What methods are available to validate the cultural equivalence of psychometric instruments?” and “How culturally appropriate and valid is the Korean version of the short-form of the OHIP (OHIP-14K)?"Method: Ten Korean dental experts fluent in English and Korean independently assessed the clarity, relevance, and cultural equivalence of the OHIP-14K and offered suggestions for improving the cultural sensitivity and validity of the instrument content. The item-level Content Validity Index (I-CVI) was used to measure the validity of each item from the experts’ ratings followed by the calculation of Scale-level Content Validity Index (S-CVI) as the proportion of content valid items. Additional analyses including the average deviation index (ADM) and Kappa statistics (Kfree) were performed with the clarity index (CI), relevance index (RI) and cultural equivalence index (CEI) to measure the level of agreement between the experts.Results: The experts rated the OHIP-14K as mostly clear (S-CVI= 0.93), but they were concerned about the relevance of many items to the expected domains of the instrument (S-CVI = 0.42) and about its cultural equivalence (S-CVI = 0.50) to the English version. However, there was much disagreement between the experts as measured by the RI (Kfree = 0.19 to 1.00) and CEI (ADM = 0.36 to 0.96). Conclusion: The relevance and cultural equivalence of the OHIP-14K to the original English version of the OHIP-14 are not strong. Suggestions are offered for improving the OHIP-14K, which needs further testing within the Korean populations.

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