- Medical School
North Haugh
University of St Andrews
St Andrews, Fife
KY16 9TS
Gerry Humphris
University of St Andrews, Medical School, Faculty Member
Research Interests:
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Background. The development of dental anxiety in children is poorly understood.Aims. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other... more
Background. The development of dental anxiety in children is poorly understood.Aims. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.Design. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.Results. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.Conclusions. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.
Research Interests: Dentistry, Child Development, Paediatric Dentistry, Prospective studies, Humans, and 14 moreChild, Female, Male, Child Psychology, Dental Anxiety, Longitudinal Studies, Sex Factors, Age Factors, Parent‐child Relations, Cross Sectional Studies, Prospective Study, Cohort Studies, Avoidance Learning, and Child preschool
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Background The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. Purpose This study aimed to investigate the relationship between reassurance by... more
Background The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. Purpose This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting. Methods Nurse–child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables. Results Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior. Conclusions The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention (ClinicalTrials.gov number: NCT00881790).
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To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery.
Research Interests: Nursing, Adolescent, Critical Care, Critical Care Medicine, Anxiety, and 15 moreHumans, Female, Male, Follow-up studies, Depressive Disorder, Health Status, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, ANXIETY, Intensive Care Units, and Case Control Studies
To test a theoretical model based on Cohen's dental profession factors (training; practitioner attitudes; geography) to investigate practitioners' willingness to treat adolescents with learning disabilities (LD) in primary... more
To test a theoretical model based on Cohen's dental profession factors (training; practitioner attitudes; geography) to investigate practitioners' willingness to treat adolescents with learning disabilities (LD) in primary dental care. A sample of all 537 primary care dentists working in a mainly urban area of Northern Ireland and a more rural area of Scotland. Willingness to treat adolescents with LD. Questionnaire survey of demographic profile, undergraduate education, current knowledge, attitudes towards individuals with LD and willingness to treat this patient group. A path analytical approach (multiple meditational model) was used. Three hundred dentists participated giving a valid response rate of 61%. Undergraduate education and current knowledge (training) strengthened a social model perspective promoting positive attitudes and willingness to treat adolescents with LD. Undergraduate education and current knowledge about disability did not significantly contribute to dentists whose attitudes were underpinned by the medical model of disability. Therefore geography (rural or urban location) was not an influential factor in willingness to treat adolescents with LD. This does not exclude the possibility that area of work may have an influence as a consequence of undergraduate university attended. This model identifies the importance of undergraduate and continuing dental education with regard to modifying professional attitudes (social and clinical factors) to assist practitioners treat adolescents with LD and provide them with inclusive dental services in primary dental care.
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Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact... more
Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact of recurrence fears has been indicated in the families of cancer patients. However, there has been a lack of prospective research.Aim: To systematically examine distress and illness concerns among patient–carer dyads.Methods: A multi-centre prospective study of head and neck cancer patients and their carers (patients, n=101; carers, n=101), surveyed at two time-points following diagnosis.Results: Carers recorded higher recurrence concerns on average than the patient group (p<0.001). A predictive path model of patient and carer self-reports of distress and FORs was explored, with an excellent overall fit of the final model (χ2=15.4, df=12, p=0.22, Comparative Fit Index (CFI)=0.994, Root Mean Square Estimate of Approximation (RMSEA)=0.053).Conclusions: The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes, but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad. Future prospective dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation. Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory. Copyright © 2008 John Wiley & Sons, Ltd.
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Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah's Dental Anxiety Scale has been used extensively since the 1970s. However the scale has some flaws which led to the design of the... more
Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah's Dental Anxiety Scale has been used extensively since the 1970s. However the scale has some flaws which led to the design of the Modified Dental Anxiety Scale ...
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Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications to preschool children as part of the Childsmile initiative in Scotland. To determine a detailed behavioural profile of the EDDNs during the... more
Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications to preschool children as part of the Childsmile initiative in Scotland. To determine a detailed behavioural profile of the EDDNs during the administration of the fluoride varnish to confirm professional manner and identify differences in nurse behaviours between successful and unsuccessful application sessions. Nurse-child interactions were video recorded and nurse behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency and duration were measured and correlations were calculated. Differences in behaviour were examined between successful and unsuccessful application sessions. Three hundred and three interactions were coded out of 456 recorded application sessions. No incident occurred where nurses threatened or placed undue stress on a child. In unsuccessful, compared with successful, application sessions, nurses demonstrated higher frequency and duration of the following behaviours: &amp;amp;amp;amp;#39;permission seeking&amp;amp;amp;amp;#39;, &amp;amp;amp;amp;#39;offer of task alternative&amp;amp;amp;amp;#39;, &amp;amp;amp;amp;#39;information seeking&amp;amp;amp;amp;#39; and &amp;amp;amp;amp;#39;reassurance&amp;amp;amp;amp;#39;, controlling for length of procedure. Whereas with successful applications, &amp;amp;amp;amp;#39;praise&amp;amp;amp;amp;#39;, &amp;amp;amp;amp;#39;instruction&amp;amp;amp;amp;#39; and &amp;amp;amp;amp;#39;information-giving&amp;amp;amp;amp;#39; were used more frequently and for a longer duration, compared with unsuccessful applications. The EDDNs demonstrated a professional manner working with preschool children. They behaved differently between successful and unsuccessful application sessions. Sequential analysis is needed to examine causal effects of behaviours and its effects on delivery outcomes.
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Medline and the Social Science Index Citation databases were searched. Studies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated... more
Medline and the Social Science Index Citation databases were searched. Studies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated measures, those using proxy measures and non-dentally specific measures were excluded. Data were extracted independently using a standardised form. Validity and reliability of the questionnaires were assessed, and measures were evaluated against a theoretical framework of dental anxiety. A qualitative summary of the measures is presented. Sixty studies met the inclusion criteria. These covered seven &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;trait&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and two &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; measures of dental anxiety used to assess children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dental anxiety over the past decade. The findings from this systematic review can be used to help guide dental academics, clinicians, psychologists and epidemiologists to choose the most appropriate measure of dental anxiety for their intended use. Future work should involve evaluating the content and developmental validity of existing measures with further consideration given to the use of theoretical frameworks to develop this field.
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Patients often present in primary care with physical symptoms that doctors cannot readily explain. The process of reassuring these patients is challenging, complex and poorly understood. To construct a typology of general... more
Patients often present in primary care with physical symptoms that doctors cannot readily explain. The process of reassuring these patients is challenging, complex and poorly understood. To construct a typology of general practitioners&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (GPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) normalising explanations, based on their effect on the process and outcome of consultations involving patients with medically unexplained symptoms. Qualitative analysis of audiotaped consultations between patients and GPs. Seven general practices in Merseyside, United Kingdom. Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively, to identify types of normalising speech used by GPs. Normalisation without explanation included rudimentary reassurance and the authority of a negative test result. Patients persisted in requesting explanation and elaborated or extended their symptoms, rendering somatic management more likely. Normalisation with ineffective explanation provided a tangible physical explanation for symptoms, unrelated to patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expressed concerns. This was also counterproductive. Normalisation with effective explanation provided tangible mechanisms grounded in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; concerns, often linking physical and psychological factors. These explanations were accepted by patients; those linking physical and psychological factors contributed to psychosocial management outcomes. The routine exercise of normalisation by GPs contains approaches that are ineffective and may exacerbate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; presentation. However, it also contains types of explanation that may reduce the need for symptomatic investigation or treatment. These findings can inform the development of well-grounded educational interventions for GPs.
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The first aim of this study was to describe appearance issues in patients following surgery for oral and oro-pharyngeal squamous cell carcinoma using the Derriford appearance scale (DAS24) and the University of Washington Quality of Life... more
The first aim of this study was to describe appearance issues in patients following surgery for oral and oro-pharyngeal squamous cell carcinoma using the Derriford appearance scale (DAS24) and the University of Washington Quality of Life Questionnaire Version 4 appearance item (UWQOL v4). Another aim was to compare these two questionnaires and justify a cut-off in the UWQOL. Also the study compares the cancer group to reference data and explores associations with clinical factors. 383 alive and disease free patients and treated between 1992 and 2005 were sent the survey of which 252 (66%) responded. Age (younger patients), T stage 3 and 4 and adjuvant radiotherapy were key factors in patients reporting problems with appearance. There was excellent correlation between the two questionnaires. A cut-off of less than 75 in the UWQOLv4 appearance item captured most of the problems raised in the DAS24. The cancer cohort had similar DAS24 scores to the general population sample and had more positive scores than the clinical reference group (burns etc patient). In conclusion the UWQOL appearance domain appears to be a suitable means of screening for appearance issues in this cohort and could act as a trigger for further assessment and treatment.
Research Interests: Dentistry, Cancer, Quality of life, Face, Body Image, and 17 moreHumans, Questionnaire, Head and Neck Cancer, Female, Male, Oral Oncology, ENT, Patient Satisfaction, Social Adjustment, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Questionnaires, Mouth Neoplasms, Adult, Public health systems and services research, and Mastication
To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. Randomized controlled trial. Dental and medical waiting rooms in the North West of England. Nine... more
To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. Randomized controlled trial. Dental and medical waiting rooms in the North West of England. Nine hundred and forty nine patients from 16 practices were invited to participate. Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen. A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study). t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction. Participation rate was high (91%). Knowledge (P &lt;0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p &lt;0.05). This study supports previous findings of an immediate positive effect of an information leaflet on patients&#39; knowledge of oral cancer and willingness to accept an oral cancer screen.
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Research Interests: Marketing, Physiology, Sociology, Psychology, Cognitive Science, and 49 moreAnthropology, Early Intervention, Emotional intelligence, Personality, Mental Health, Cognition, Cancer, Human Resource Management, Attention, Cognitive Bias, Emotions, Motivation, Social Science & Medicine, Humans, Models, Smoking Cessation, Substance Abuse, Business and Management, Smoking, Correlation, Effect size, Cues, Alcoholism, Measurement, Physical Health, Psychosomatics, Personality and Individual Differences, Human Performance, Drug Addiction, Patient Compliance, Eye Movements, Metaanalysis, Cognitive processes, Meta Analysis, Association, Psychological distress, Random Effects Model, Psychosomatic, Public health systems and services research, Eye Movement, Random-Effects Models, Illicit Drugs, Cancer Patient, Correlation coefficient, Theoretical Model, Attentional Bias, Substance-Related Disorders, Diagnostic Tests, and Weighted Averaging
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Research Interests: Primary Care, Communication, Primary Health Care, General Internal Medicine, Adolescent, and 17 moreFamily Practice, Psychosomatic Medicine, Multivariate Analysis, Prospective studies, Humans, General, Female, Male, Regression Analysis, Patients, Clinical Sciences, Aged, Great Britain, Middle Aged, Psychosomatic, Adult, and General practitioner
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Background Patients with medically unexplained physical symptoms (MUS) are often thought to deny psychological needs when they consult general practitioners (GPs) and to request somatic intervention instead. We tested predictions from the... more
Background Patients with medically unexplained physical symptoms (MUS) are often thought to deny psychological needs when they consult general practitioners (GPs) and to request somatic intervention instead. We tested predictions from the contrasting theory that they are transparent in communicating their psychological and other needs. Objective To test predictions that what patients tell GPs when they consult about MUS is related transparently to their desire for (1) emotional support, (2) symptom explanation and (3) somatic intervention. Design Prospective naturalistic study. Before consultation, patients indicated what they wanted from it using a self-report questionnaire measuring patients’ desire for: emotional support, explanation and reassurance, and physical investigation and treatment. Their speech during consultation was audio-recorded, transcribed and coded utterance-by-utterance. Multilevel regression analysis tested relationships between what patients sought and what they said. Participants Patients (N = 326) consulting 33 GPs about symptoms that the GPs designated as MUS. Results Patients who wanted emotional support spoke more about psychosocial problems, including psychosocial causes of symptoms and their need for psychosocial help. Patients who wanted explanation and reassurance suggested more physical explanations, including diseases, but did not overtly request explanation. Patients’ wish for somatic intervention was associated only with their talk about details of such interventions and not with their requests for them. Conclusions In general, patients with medically unexplained symptoms provide many cues to their desire for emotional support. They are more indirect or guarded in communicating their desire for explanation and somatic intervention.
Research Interests: Primary Care, Communication, Primary Health Care, General Internal Medicine, Adolescent, and 17 moreFamily Practice, Psychosomatic Medicine, Multivariate Analysis, Prospective studies, Humans, General, Female, Male, Regression Analysis, Patients, Clinical Sciences, Aged, Great Britain, Middle Aged, Psychosomatic, Adult, and General practitioner
Objective To evaluate the effectiveness of the provision of information in the form of a rehabilitation program following critical illness in reducing psychological distress in the patients’ close family. Design Randomised controlled... more
Objective To evaluate the effectiveness of the provision of information in the form of a rehabilitation program following critical illness in reducing psychological distress in the patients’ close family. Design Randomised controlled trial, blind at follow-up with final assessment at 6 months. Setting Two district general hospitals and one teaching hospital. Patients and participants The closest family member of 104 recovering intensive care unit (ICU) patients. Interventions Ward visits, ICU clinic appointments at 2 and 6 months. Relatives and patients received the rehabilitation program at 1 week after ICU discharge. The program comprised a 6-week self-help manual containing information about recovery from ICU, psychological information and practical advice. Measurements and results Psychological recovery of relatives was assessed by examining the rate of depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms by 6 months after ICU. The proportion of relatives scoring in the range >19 on the Impact of Events Scale (cause for concern) was high in both groups at 49% at 6 months. No difference was shown in the rate of depression, anxiety, or PTSD-related symptoms between the study groups. Conclusion A high incidence of psychological distress was evident in relatives. Written information concerning recovery from ICU provided to the patient and their close family did not reduce this. High levels of psychological distress in patients were found to be correlated with high levels in relatives.
Research Interests: Rehabilitation, Depression, Family, Self Care, Stress, and 18 moreAdolescent, Anxiety, Multivariate Analysis, Post traumatic stress disorder, Humans, INTENSIVE CARE, Randomised Controlled Trial, Clinical Sciences, Intensive Care Unit, Aged, Great Britain, Middle Aged, Psychological distress, Adult, Public health systems and services research, Randomized Controlled Trial, Intensive Care Medicine, and ANXIETY
Symptomatic investigation and treatment of unexplained physical symptoms is often attributed to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; beliefs and demands for physical treatments.... more
Symptomatic investigation and treatment of unexplained physical symptoms is often attributed to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; beliefs and demands for physical treatments. To test the influential assumption that patients who present symptoms that the general practitioner (GP) considers to be medically unexplained do not generally provide the opportunity for discussion of psychological issues. Qualitative analysis of audiotaped consultations between patients and GPs. Seven general practices in Merseyside, United Kingdom. Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively to identify opportunities that patients presented for their doctors to address emotional problems or their need for explanation. All but two patients provided psychological opportunities. They described social or emotional difficulties as problems of stress or mood. They presented their need for explanation by: explicit questions; statements of concern about symptoms; suggestions that disease might be absent; or tentative references to serious disease. In general, GPs did not engage with these cues. Patients with unexplained symptoms present opportunities for GPs to address psychological needs. By taking these opportunities, GPs might be able to avoid unnecessary symptomatic intervention.
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Research Interests: Dentistry, Social Class, England, Multivariate Analysis, Humans, and 14 moreFemale, Dental Caries, Male, Dental Anxiety, Parents, Questionnaires, Dental Care, Young Children, Tooth Extraction, Socio Economic Status, Cross sectional Study, Cross Sectional Studies, Logistic Models, and Child preschool
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ObjectivesObesity and dental caries have become increasingly prevalent challenges to public health. Research results into the relationship between obesity and dental caries in children have been mixed and inconclusive. The aim of this... more
ObjectivesObesity and dental caries have become increasingly prevalent challenges to public health. Research results into the relationship between obesity and dental caries in children have been mixed and inconclusive. The aim of this review and meta-analysis was to provide evidence to quantify the relationship between obesity and dental caries in children using a systematic approach.Obesity and dental caries have become increasingly prevalent challenges to public health. Research results into the relationship between obesity and dental caries in children have been mixed and inconclusive. The aim of this review and meta-analysis was to provide evidence to quantify the relationship between obesity and dental caries in children using a systematic approach.MethodsA systematic search for papers between 1980 and 2010 addressing childhood obesity and dental caries was conducted and a random effects model meta-analysis applied.A systematic search for papers between 1980 and 2010 addressing childhood obesity and dental caries was conducted and a random effects model meta-analysis applied.ResultsFourteen papers met the selection criteria. Overall, a significant relationship between childhood obesity and dental caries (effect size = 0.104, P = 0.049) was found. When analysed by dentition type (primary versus permanent), there was a nonsignificant association of obesity and dental caries in permanent and primary dentitions, yet on accounting only for standardized definitions for assessment of child obesity using body mass index, a strong significant relationship was evident in children with permanent dentitions. Moderating for study country of origin (newly ‘industrialized’ versus industrialized) showed a significant relationship between obesity and dental caries in children from industrialized but not newly industrialized countries. Cofactors such as age and socioeconomic class were significant moderators.Fourteen papers met the selection criteria. Overall, a significant relationship between childhood obesity and dental caries (effect size = 0.104, P = 0.049) was found. When analysed by dentition type (primary versus permanent), there was a nonsignificant association of obesity and dental caries in permanent and primary dentitions, yet on accounting only for standardized definitions for assessment of child obesity using body mass index, a strong significant relationship was evident in children with permanent dentitions. Moderating for study country of origin (newly ‘industrialized’ versus industrialized) showed a significant relationship between obesity and dental caries in children from industrialized but not newly industrialized countries. Cofactors such as age and socioeconomic class were significant moderators.ConclusionsFuture analysis should investigate these confounding variables, helping shape the future of obesity management programmes and oral health interventions, through determining common risk factors.Future analysis should investigate these confounding variables, helping shape the future of obesity management programmes and oral health interventions, through determining common risk factors.
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Background.Version 4 of the University of Washington Head and Neck Cancer Questionnaire (UW-QOLv4) includes items on mood and anxiety. The aim of this study was to compare the responses to these single items with the Centre for... more
Background.Version 4 of the University of Washington Head and Neck Cancer Questionnaire (UW-QOLv4) includes items on mood and anxiety. The aim of this study was to compare the responses to these single items with the Centre for Epidemiology Studies Depression Scale (CES-D) and the Hospital Anxiety Depression Scale (HADS).Version 4 of the University of Washington Head and Neck Cancer Questionnaire (UW-QOLv4) includes items on mood and anxiety. The aim of this study was to compare the responses to these single items with the Centre for Epidemiology Studies Depression Scale (CES-D) and the Hospital Anxiety Depression Scale (HADS).Methods.A cross-sectional postal survey was undertaken in April 2003. The survey was composed of all patients treated for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 who were alive and disease free.A cross-sectional postal survey was undertaken in April 2003. The survey was composed of all patients treated for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 who were alive and disease free.Results.We distributed 306 questionnaires; there were 197 replies (65%) from 110 male and 87 female patients. Most patients reported relatively little depression, with 170 of 190 (89%) reporting a HADS depression score of less than 11. Similarly, most patients were not anxious, with 158 of 183 (86%) reporting a HADS anxiety score of less than 11. UW-QOL mood, UW-QOL anxiety, HADS anxiety, HADS depression, and CES-D scores were all moderately intercorrelated (Spearman correlations from 0.39–0.68 ignoring the signs, all p < .001). The UW-QOL mood correlated with the scores and “case-ness” categories of the HADS depression and CES-D scales, whereas the UW-QOL anxiety correlated with the scores and “case-ness” of the HADS anxiety.We distributed 306 questionnaires; there were 197 replies (65%) from 110 male and 87 female patients. Most patients reported relatively little depression, with 170 of 190 (89%) reporting a HADS depression score of less than 11. Similarly, most patients were not anxious, with 158 of 183 (86%) reporting a HADS anxiety score of less than 11. UW-QOL mood, UW-QOL anxiety, HADS anxiety, HADS depression, and CES-D scores were all moderately intercorrelated (Spearman correlations from 0.39–0.68 ignoring the signs, all p < .001). The UW-QOL mood correlated with the scores and “case-ness” categories of the HADS depression and CES-D scales, whereas the UW-QOL anxiety correlated with the scores and “case-ness” of the HADS anxiety.Conclusions.Questions on mood and anxiety can help identify significant psychological morbidity, taking a score of less than 75 for UW-QOL mood and less than 70 for UW-QOL anxiety. This could be used to trigger formal psychological assessment and with a view to possible therapeutic intervention. © 2006 Wiley Periodicals, Inc. Head Neck, 2006Questions on mood and anxiety can help identify significant psychological morbidity, taking a score of less than 75 for UW-QOL mood and less than 70 for UW-QOL anxiety. This could be used to trigger formal psychological assessment and with a view to possible therapeutic intervention. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
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Research Interests: Sociology, Primary Care, Anthropology, Doctor-patient communication, Adolescent, and 14 moreFamily Practice, United Kingdom, Social Science & Medicine, Humans, Female, Male, Aged, Great Britain, Middle Aged, Adult, Public health systems and services research, Somatoform disorders, General practitioner, and Social Science
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To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written... more
To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients&#39; oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.
Research Interests: Dentistry, Perception, Primary Health Care, Health Education, Risk, and 21 morePublic Health, Risk assessment, Adolescent, Humans, Risk Perception, Smoking, Northern Ireland, Female, Male, Oral Oncology, ENT, Aged, Middle Aged, Risk Factor, Mouth Neoplasms, Adult, Public health systems and services research, Community Dentistry, Risk Assessment, Pamphlets, and Control Group
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We tested predictions that patients with medically unexplained symptoms (MUS) want more emotional support and explanation from their general practitioners (GPs) than do other patients, and that doctors find them more controlling because... more
We tested predictions that patients with medically unexplained symptoms (MUS) want more emotional support and explanation from their general practitioners (GPs) than do other patients, and that doctors find them more controlling because of this. Thirty-five doctors participated in a cross-sectional comparison of case-matched groups. Three hundred fifty-seven patients attending consecutively with MUS were matched for doctor and time of attendance with 357 attending with explained symptoms. Patients self-reported the extent to which they wanted somatic intervention, emotional support, explanation and reassurance. Doctors rated their perception of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; influence on the consultation. Predictions were tested by multilevel analyses. Patients with MUS sought more emotional support than did others, but no more explanation and reassurance or somatic intervention. A minority of doctors experienced them as exerting more influence than others. The experience of patient influence was related to the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; desire for support. Future research should examine why GPs provide disproportionate levels of somatic intervention to patients who seek, instead, greater levels of emotional support.
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Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients&#39; dental anxiety prior to... more
Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients&#39; dental anxiety prior to commencement of treatment reduces patients&#39; state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger&#39;s state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P &lt; 0.0001). Providing the dentist with information of the high level of a patient&#39;s dental anxiety prior to treatment, and involving the patient in this, reduced the patient&#39;s state anxiety.
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Research Interests: Dentistry, Adolescent, Humans, Female, Male, and 5 moreAged, Middle Aged, Dental Anxiety, Questionnaires, and Adult
The behaviour of young children receiving mildly invasive dental preventive procedures in a community setting warrants more extensive research due to limitations in the literature.Objectives To document the behavioural profile of... more
The behaviour of young children receiving mildly invasive dental preventive procedures in a community setting warrants more extensive research due to limitations in the literature.Objectives To document the behavioural profile of preschool children undergoing a preventive oral health intervention (fluoride varnish application) and to investigate this behaviour across children with different previous experience of the procedure, ages and initial anxiety states. Nurse-child interactions were video recorded and child behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency was measured and presented diagrammatically, followed by independent sample non-parametric tests to distinguish behavioural group differences. Three hundred and three interactions were coded out of 456 recorded application sessions. &#39;Nonverbal agreement&#39; behaviour was observed most frequently compared to disruptive behaviours. Younger preschool children tended to exhibit &#39;interact with instrument&#39; behaviour more frequently than older children regardless of whether they had had previous application experience. Children who showed signs of initial anxiety were likely to display more disruptive behaviours during the later stage of the procedure compared with non-anxious children. Dental staff working with preschool children are recommended to use encouragement-centred strategies to promote nonverbal cooperative behaviours in children. In addition, procedure instruments could be considered as a tool to gain child cooperation. Evidence of an autocorrelation effect of child behaviour was found, indicating that the early presentation of child behaviour predicted the behaviour of the child at later stages.
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Research Interests:
To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire. Patients were initially screened to include only those who were dentally... more
To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire. Patients were initially screened to include only those who were dentally anxious. A pre- and post-test was planned with the completion of the Modified Dental Anxiety Scale (MDAS) questionnaire as the intervention. Two dental access centres in the North West of England. Initially, 583 patients were screened. Of these, 182 (31%) were found to be dentally anxious and were recruited into the study. State-Trait Anxiety Inventory Scale Short Form. State anxiety did not change with the completion of the MDAS questionnaire in either designated dental phobics (MDAS &amp;amp;amp;amp;gt;or=19) or those classified as non-phobics (MDAS &amp;amp;amp;amp;lt;19). The MDAS can be used to assess dental anxiety without raising anxiety in patients with or without self-reported dental phobia.
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Psychological factors, including distress and fears of recurrence, may be implicated in explaining why head and neck oncology patients continue or refrain from smoking. The aim was to determine the role of psychological factors in... more
Psychological factors, including distress and fears of recurrence, may be implicated in explaining why head and neck oncology patients continue or refrain from smoking. The aim was to determine the role of psychological factors in understanding smoking behaviour in a consecutive group of cancer patients attending a Regional Maxillofacial Unit over an assessment period of 12 months. A consecutive sample (n = 87) was assessed at 3, 7, 11 and 15 months following initial treatment. Measures of psychological distress included the Worry of Cancer Scale and the Hospital Anxiety and Depression Scale. Patient self-report assessed tobacco consumption. At follow-up, 73 patients successfully completed the four timed assessments (84% response rate). Twenty patients were consistent smokers (27%), 37 (51%) abstained, 7 (10%) returned to smoking, whereas 9 (12%) ceased to smoke by the final 15-month follow-up. Between the consistent smokers and abstainers there was a significant raised level of distress in the smoking group at each assessment after the initial baseline. Fear of recurrence was weakly related to smoking behaviour. The level of cigarette consumption at baseline was a significant predictor (adjust r 2 = 0.37) of psychological distress at 15 months in committed smokers. Previous duration of tobacco consumption prior to illness predicted psychological distress in abstainers (standardized coefficient = 0.29, n = 30, P < 0.036). In conclusion, past and current smoking behaviour is associated with psychological distress in patients with oral and oropharyngeal malignancy in their first 15 months of recovery following initial treatment. This behaviour successfully identified a psychologically at-risk group.
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Research Interests:
The aim of this article is to present the latest published material to demonstrate the service activity for the head and neck cancer team. There is a growing literature confirming the importance of many psychological issues that impact on... more
The aim of this article is to present the latest published material to demonstrate the service activity for the head and neck cancer team. There is a growing literature confirming the importance of many psychological issues that impact on the experience of the patient following diagnosis and treatment of head and neck cancer. Although there may be some recognition by some members of the multidisciplinary team to involve psychological services there is now ample evidence from the results of this literature to argue that the psychologist should feature as a full member of the multidisciplinary team. Activities would include formal assessment of psychological features of the patient and carer, interpretation of psychometric data including distress and quality of life inventories, design and implementation of interventions and supervisory support for the work pressures experienced by the multidisciplinary team. The care of the head and neck patient involves a large variety of psychosocial factors. Many of these issues require formal assessment and interpretation that the professional psychologist can input into the care programmes for these patients.
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Abstract – Objectives: To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers.Methods: Two studies were conducted. Study 1... more
Abstract – Objectives: To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers.Methods: Two studies were conducted. Study 1 examined the research question initially, and Study 2 acted as a replication and inclusion of additional secondary outcome measures. The leaflet was designed and tested in an earlier study. Knowledge of oral cancer was assessed by a previously validated 36-dichotomous-item scale. A single-item question ascertained self-reported smoking status (kappa = 0.94). Study 1 participants were drawn from 14 practices (6 medical, 8 dental). A randomised control group design was adopted. The experimental group received the leaflet on attendance to the practice and then completed the questionnaire. The control group received the questionnaire only. Complete data were collected from 739 respondents. The design of Study 2 was identical; 786 new respondents from 16 practices (7 medical, 9 dental) were collected.Results: Both studies confirmed that smokers knew less about oral cancer than nonsmokers (P < 0.05) when access to the leaflet had been denied. On receipt of the leaflet, there was no distinction in oral cancer knowledge between the smoking status categories of respondents. Evidence of reassurance about screening from leaflet exposure was supported by the second study.Conclusion: This programmed research has demonstrated an effect of a brief PIL to offset the decrement in oral cancer knowledge observed in primary care patients who use tobacco in comparison to their nonsmoking counterparts. The leaflet reduced anxiety about oral health screening in smokers.
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Fear of recurrence (FOR) following head and neck cancer is one of the most frequent concerns of patients and is associated with psychological distress. The aims of this study were, first, to report the clinical characteristics of patients... more
Fear of recurrence (FOR) following head and neck cancer is one of the most frequent concerns of patients and is associated with psychological distress. The aims of this study were, first, to report the clinical characteristics of patients selected for FOR concerns on a patient concerns inventory (PCI) and, second, to compare the degree of FOR using a FOR questionnaire of those patients expressing FOR concerns on the PCI with those who did not. Two cohorts were used. The first comprised consecutive oncology patients attending clinics from August 2007 for 9 months (N = 123). These patients completed the PCI only. The second comprised patients attending the same clinic for over 4 months from October 2008 (N = 68), and this group completed both the PCI and the FOR questionnaire. FOR was the most frequently selected issue on the PCI (42%). There were no obvious differences in selecting FOR by patient characteristics. Those who scored ‘a lot’ or ‘all the time’ for questions 1–6 in the FOR questionnaire and responses (on a 10-point scale) of 7–10 for question 7 were deemed as having ‘significant’ FOR. In those raising the issue of FOR on the PCI, 79% (15/19) had significant problems compared to 24% (12/49) if they did not. FOR is a common concern and because it is not possible to identify patients based on clinical parameters, it is important to screen for FOR to direct patients to appropriate support and intervention.
Research Interests: Fear, Cancer, Quality of life, Treatment Outcome, Humans, and 16 moreQuestionnaire, Head and Neck Cancer, Female, Male, ENT, Clinical Sciences, Ambulatory, Aged, Middle Aged, Psychological distress, Questionnaires, Fears of Cancer Recurrence, Ambulatory Care, Cohort Studies, Truth Disclosure, and Recovery of Function
Research Interests: Depression, Quality of life, Adolescent, Tooth wear, Humans, and 18 moreOral Health Related Quality of Life, Oral health, Scotland, Female, Dental Caries, Male, Depressive Disorder, Path Analysis, Health Status, Aged, Middle Aged, Dental Anxiety, Questionnaires, Psychosomatic, Adult, TOOTH LOSS, Cross Sectional Studies, and Homeless Persons
Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men... more
Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended.Methods: Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors. Inclusion criteria: participants at any stage of a cancer diagnosis, ⩾50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one–three level of evidence. Couple/carer/family interventions were excluded.Results: From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status.Conclusions: Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication. Copyright © 2009 John Wiley & Sons, Ltd.
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Study aim was to determine the influence of a patient information leaflet (PIL) on mouth cancer to improve knowledge, reduce distress and increase intention to accept a mouth screen over a 2-month period. The design was a randomised... more
Study aim was to determine the influence of a patient information leaflet (PIL) on mouth cancer to improve knowledge, reduce distress and increase intention to accept a mouth screen over a 2-month period. The design was a randomised controlled trial. Two dental practices in the northwest of England participated. Standardised multi-item scales of the three outcome measures were employed. The PIL was given to a randomised intervention group of patients in waiting room. Single sheet questionnaire was completed by both groups of patients at baseline in waiting room (immediately following leaflet administration in intervention arm of study). Repeat questionnaire completion at 8 weeks by all patients through postal system. Mann-Whitney U-tests comparing outcome variables between patients with and without access to the leaflet at baseline and 8 weeks were performed. Multiple logistic regression was used to predict re-reading of the leaflet at home. Useable replies were received from 317 patients (60% response rate). All measures showed some benefit of immediate exposure to the leaflet at follow up. Older patients, less initial knowledge, and self-reported smoking positively predicted the re-reading of the leaflet. The introduction of a mouth cancer PIL into dental practice may help to inform patients about oral cancer, moderate distress and encourage acceptance of an oral health screen.
Research Interests: Educational Measurement, England, Logistic Regression, Screening, Knowledge, and 18 moreMotivation, Humans, Smoking, Oral health, Female, Male, Follow-up studies, Standardisation, Oral Cancer, Randomised Controlled Trial, Group Intervention, Middle Aged, Psychological distress, Questionnaires, Mouth Neoplasms, Age Factors, Pamphlets, and Logistic Models
Opportunistic screening for oral cancer has been advocated as a possible beneficial procedure, especially with high-risk individuals. To assist in the identification of malignant lesions a dye has been developed which can be used... more
Opportunistic screening for oral cancer has been advocated as a possible beneficial procedure, especially with high-risk individuals. To assist in the identification of malignant lesions a dye has been developed which can be used routinely. Issues of acceptability for both patient and practitioner are raised. The adoption of this procedure for employees in a large retail chain in the UK has enabled an investigation into the use of the dye. The objective of the study was to determine the acceptability of toluidine blue in aiding the screening for oral cancer in regular attending dental patients who are at high-risk. A two-stage study design was conducted. The first stage consisted of a patient survey in which 10 patients from each of 14 stores of the retail chain were invited to complete a questionnaire. The level of embarrassment, taste and anxiety about the procedure was assessed. The second stage included a clinician questionnaire and telephone interview on the difficulties, if any, of conducting the screening procedure with the aid of the dye. The oral health screen (OHS) with OraScreen procedure was conducted in the retail store medical room. The participants consisted of 140 employees attending the routine dental examination at the store of their workplace. All employees in the survey reported that they smoked tobacco, drank alcohol and were over the age of 40 years. Fourteen dentists visited the stores to complete examinations, screening, questionnaires and telephone interview. The main outcome measures consisted of dentist and patient rating scales of acceptability developed for the study. Of the respondents 89% (n = 124) gave usable questionnaire data. The patients found the dye acceptable (for example 83% rated the oral health screen &#39;a comfortable experience&#39;) and 93% expected the examiner to give an opinion of the state of their mouths. A wish was expressed by 95% to take part in future oral health screens. The dentist-respondents were in favour of the use of the dye. In conclusion, the acceptability of toluidine blue dye to assist in the screening for oral cancer is good according to both patient and clinician. The use of this dye should now be encouraged more extensively by trained clinicians in the identification of oral cancerous and precancerous lesions.
Research Interests: Dentistry, Humans, Female, Male, Risk factors, and 6 moreMiddle Aged, Questionnaires, Mouth Neoplasms, Adult, Risk Factors, and Dentists
Research Interests: Dentistry, Turkey, Adolescent, Oral and Maxillofacial Surgery, Humans, and 16 moreFemale, Male, Young Adult, Aged, Middle Aged, Dental Anxiety, Questionnaires, Adult, Sex Factors, Tooth Extraction, Age Factors, Reproducibility of Results, Chi Square Distribution, Ambulatory Surgical Procedures, Oral Surgical Procedures, and Socioeconomic Factors
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A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise... more
A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise awareness of the importance of communication among veterinary undergraduates at all stages of the curriculum, and it allows them to role-play in acted-out scenarios. Facilitated small groups provide an environment in which students can receive feedback on their own performance and also give feedback to their colleagues. An independent evaluation suggests that the opportunity to role-play increased the students&#39; confidence in communicating with others. They were able to identify their personal strengths as communicators and gain insights into the aspects of communication they could improve. Feedback and subsequent discussions were highly valued, with the actors playing a crucial role in providing feedback from the client&#39;s perspective. Students were able to use the knowledge they acquired when consulting with real clients. Most of the students suggested that the course should continue in its current format, but with more time provided for it in the curriculum.
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To prepare an Arabic version of the Modified Dental Anxiety Scale (MDAS) and provide normative information including evidence to support the validity of the measure. The MDAS was translated into Arabic and back-translated into English.... more
To prepare an Arabic version of the Modified Dental Anxiety Scale (MDAS) and provide normative information including evidence to support the validity of the measure. The MDAS was translated into Arabic and back-translated into English. Data collection took place in Amman, Jordan from March 2009 to March 2010. One thousand and six hundred two 10th grade students took part in the study (15-16 years of age) sampled from 32 schools. Questionnaire consisted not only of the MDAS, but also (i) a single global question on dental anxiety to test concurrent validity, (ii) a question on helplessness in the dental surgery to test construct validity and (iii) demographic profile. The level of missing data was minimal for the translated scale. The internal consistency for this sample using the Arabic MDAS was 0.87 (95% confidence interval was 0.86-0.88). The measure was a one-dimensional scale. The proportion of the sample that was highly dentally anxious was 22% (&amp;amp;amp;amp;amp;amp;amp;amp;gt;/= 19 cut-off score). Expected differences between gender and self-reported dental attendance were observed. There were clear significant relationships as predicted between the Arabic MDAS and (i) a single item measure of dental anxiety and (ii) feeling helpless in the dental chair on a previous occasion. The Arabic version of the MDAS can be employed for brief assessment of dental anxiety.