Papers by Steven Patterson
Community Dentistry and Oral Epidemiology, 2021
OBJECTIVES We examined the effect of fluoridation cessation on children's dental caries exper... more OBJECTIVES We examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated). METHODS We used a pre-post cross-sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7-8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre-cessation and early post-cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors. RESULTS The prevalence of caries in the primary dentition was significantly higher (P < .05) in Calgary (fluoridation cessation) than in Edmonton (still fluoridated). For example, crude deft prevalence in 2018/2019 was 64.8% (95% CI 62.3-67.3), n = 2649 in Calgary and 55.1% (95% CI 52.3-57.8), n = 2600 in Edmonton. These differences were consistent and robust: they persisted with adjustment for potential confounders and in the subset of respondents who were lifelong residents and reported usually drinking tap water; they had widened over time since cessation; and they were corroborated by assessments of dental fluorosis and estimates of total fluoride intake from fingernail clippings. Findings for permanent teeth were less consistent, which likely reflects that 7-year-olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent. CONCLUSIONS Our findings are consistent with an adverse impact of fluoridation cessation on children's dental health in Calgary and point to the need for universal, publicly funded prevention activities-including but not limited to fluoridation.
I was blessed during this project with collaboration from the Elders, the health director, the he... more I was blessed during this project with collaboration from the Elders, the health director, the health personnel, and members of the case community who place their trust in me and participated in this study. I am indebted to several great individuals who influenced my learning and ability to successfully conclude this research: • My supervisor, Dr. Maryam Amin, who kindly pushed me out of my comfort zone and challenged me to achieve my best. • And finally, but importantly, my wonderful family who supported and bore with me during this long journey.
Nurse Education in Practice, 2011
In exploring innovative approaches to enhanced patient care, an acute care interprofessional clin... more In exploring innovative approaches to enhanced patient care, an acute care interprofessional clinical learning unit (IPCLU) was established in a medical unit of a large metropolitan hospital in Edmonton, Alberta, Canada. Part of a larger, community based, participatory mixed method research project, this acute-care model involved several post-secondary institution health science faculties, students, academics, and other post-secondary institutions partnering with the hospital to coordinate and enhance student clinical learning and improve patient care. Pre-implementation data collected from the existing acute-care unit patient-care team, students, and faculty identified areas of strength and enhancement opportunities in interprofessional education (IPE). Interested members of several professions from the patient-care units and students constituted the working group that developed the model. This paper discusses clinical IPE and its relevance in nursing education, explains the processes and mechanisms in creating the IPCLU, details the initiatives that were developed to facilitate enhanced interprofessional care, and offers considerations in advancing IPE in an acute-care setting. The work plan included initiatives that enhance interprofessional teaching and learning culture, increase awareness surrounding interprofessional teamwork and professional roles, promote interprofessional communication and decision-making strategies, and further develop clinical reflection. Insights regarding sustainability are offered.
Canadian Journal of Public Health
Objective Community water fluoridation, because of its universal scope and passive mechanism of u... more Objective Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children’s dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated). Methods We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those ass...
European Journal of Dental Education
The behavioural sciences curriculum in dental education is often fragmented and its clinical rele... more The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.
European Journal of Dental Education
Traditional approaches to clinical education (CE) in dentistry have primarily focused on the need... more Traditional approaches to clinical education (CE) in dentistry have primarily focused on the needs and interests of students (student-centered), patients (patient-centered), or individuals receiving care (person-centered). Research has shown that giving priority to the interests of one stakeholder (e.g., students) may negatively affect the interests of others (e.g., patients, instructors, administrators). In this commentary, we discuss some limitations of traditional approaches to CE and suggest an eco-centered approach that assumes that the interests of all stakeholders must be considered when planning CE due to the interdependent relationships between stakeholders. A description of this new approach is provided, while research and innovation are encouraged to develop an ecologically informed system of CE.
BMC Oral Health
Background: Although oral health has improved remarkably in recent decades, not all populations h... more Background: Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. Methods: A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. Results: We observed significant ethnic disparities in children's oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Conclusions: Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected.
Journal of dental education, 2017
At a dental school in Canada, problem-based learning (PBL) sessions were restructured from an int... more At a dental school in Canada, problem-based learning (PBL) sessions were restructured from an integrated dental-medical model to a separate dental model, resulting in three groups of students available for study: those who had participated in the two-year dental and medical combined, the one-year dental and medical combined, the one-year dental alone, and the two-year dental alone. The aim of this qualitative study was to examine the extent to which the PBL structure affected the dental students' perceptions of the learning value of PBL in the different models. A total of 34 first-, second-, and third-year dental students participated in six focus groups in May and June 2011 (34% of students in those total classes). Semistructured questions explored their experiences in the different PBL structures. The interviews were recorded and transcribed verbatim, and thematic analysis was employed. The results showed positive and negative perceptions for both the combined dental and medic...
JBI database of systematic reviews and implementation reports, Jun 1, 2016
The objective of this review is to examine the effectiveness of entry-level education on smoking ... more The objective of this review is to examine the effectiveness of entry-level education on smoking cessation or prevention and tobacco-dependence interventions on health professional student practice in promoting client health and on client smoking cessation behaviors.The specific review question to be addressed: what is the effect of entry-level tobacco dependence education on: (1) health professional students' knowledge and skills and self-efficacy, (2) performance of tobacco prevention and cessation interventions, and (3) client smoking cessation behaviors?
Health Science students' initial involvement in learning communities through interprofessiona... more Health Science students' initial involvement in learning communities through interprofessional course is investigated. Potential means of enhancing collaborative clinical skills are identified.
Journal of the Canadian Dental Association, 1990
International Journal for Equity in Health, 2016
Background: One of the main arguments made in favor of community water fluoridation is that it is... more Background: One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socioeconomic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. Methods: We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. Results: Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. Conclusions: Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.
International Journal of Environmental Research and Public Health
The objective of this study was to perform a systematic review to examine the effectiveness of to... more The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ c...
Objectives: The purpose of this qualitative case study was to investigate the social capital of a... more Objectives: The purpose of this qualitative case study was to investigate the social capital of a First Nations community regarding their children’s oral health and to discover how the concept of social capital can be utilized by this community to generate ideas for designing and implementing community oral health initiatives for their children. Methods: Participants were purposively selected for their caregiving relationship with preschool children in a First Nations community: 7 individual interviews and two focus groups involving 18 participants. An interview guide was developed based on the Putnam’s model of Social Capital. The interviews were recorded and transcribed verbatim. Thematic analysis was based on a constant comparison method. Results: The community seemed to have a strong moral fibre and was close-knit, which encouraged members to help each other. A strong bonding social capital was also found among the community, members especially inside the clans. A need for impro...
International journal of circumpolar health, 2015
Objectives. The purpose of the study was: (a) to better understand the concept of social capital ... more Objectives. The purpose of the study was: (a) to better understand the concept of social capital and its potential role in oral health of children in a First Nations community and (b) to identify the strengths and resources in terms of social capital and a health promotion model that the community has at its disposal to address its oral health issues. Methods. In this qualitative case study, participants were purposively selected in a First Nations community: Seven individual interviews and two focus groups involving 18 parents/care givers were selected. Putnam's concept of social capital guided all the interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was employed using the NVivo software. Results. The community was close-knit and seemed to have strong moral fibre, which encouraged members to help each other. A strong bonding social capital was also found among the members, especially inside the clans (families). A need for improvement in brid...
International journal of circumpolar health, 2015
Objectives. The purpose of the study was: (a) to better understand the concept of social capital ... more Objectives. The purpose of the study was: (a) to better understand the concept of social capital and its potential role in oral health of children in a First Nations community and (b) to identify the strengths and resources in terms of social capital and a health promotion model that the community has at its disposal to address its oral health issues. Methods. In this qualitative case study, participants were purposively selected in a First Nations community: Seven individual interviews and two focus groups involving 18 parents/care givers were selected. Putnam's concept of social capital guided all the interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was employed using the NVivo software. Results. The community was close-knit and seemed to have strong moral fibre, which encouraged members to help each other. A strong bonding social capital was also found among the members, especially inside the clans (families). A need for improvement in brid...
Community dentistry and oral epidemiology, Jan 17, 2016
To examine the short-term impact of fluoridation cessation on children's caries experience me... more To examine the short-term impact of fluoridation cessation on children's caries experience measured by tooth surfaces. If there is an adverse short-term effect of cessation, it should be apparent when we focus on smooth tooth surfaces, where fluoride is most likely to have an impact for the age group and time frame considered in this study. We examined data from population-based samples of school children (Grade 2) in two similar cities in the province of Alberta, Canada: Calgary, where cessation occurred in May 2011 and Edmonton where fluoridation remains in place. We analysed change over time (2004/2005 to 2013/2014) in summary data for primary (defs) and permanent (DMFS) teeth for Calgary and Edmonton, for all tooth surfaces and smooth surfaces only. We also considered, for 2013/2014 only, the exposed subsample defined as lifelong residents who reported usually drinking tap water. We observed, across the full sample, an increase in primary tooth decay (mean defs - all surface...
Thesis (M.P.H.)--University of Washington, 1996. Includes bibliographical references (leaves [75]... more Thesis (M.P.H.)--University of Washington, 1996. Includes bibliographical references (leaves [75]-79).
Journal of the Canadian Dental Association
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Papers by Steven Patterson