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  1. Che Musa MF, Bernabé E, Gallagher JE
    Int Dent J, 2016 Aug;66(4):229-36.
    PMID: 26850836 DOI: 10.1111/idj.12224
    INTRODUCTION: It is important to understand career expectations of emerging dental graduates if human resources are to be harnessed in support of oral health. The aims of this study were to explore students' career expectations and their perceived influences, and to examine variation according to student and school characteristics.

    METHODS: All final-year students registered for 2013/2014 across 11 dental schools in Malaysia were invited to participate in a self-administered questionnaire (n = 530). The instrument explored short- and long-term career expectations, influences and students' background using a mix of open- and closed-ended questions. The chi-square test was used for comparison according to student and school characteristics.

    RESULTS: Three-hundred and fifty-six (83%) students, across eight schools, completed the questionnaire. In the short term, undertaking specialist training (46%) was the most commonly cited career goal, and achieving financial stability (79%) was the greatest influence. In the long term, 59% planned to specialise (with a significant difference found according to ethnic group), and 67% considered working full-time, with men significantly more likely to do so than women (P = 0.036). More Malay students (90%) ranked childcare commitments as an important influence on the number of sessions they planned to work per week compared with Chinese students (75%) and Others (74%; P = 0.001). Work-life balance (95%) and high income/financial security (95%) were the main influences on respondents' long-term goals.

    CONCLUSION: There was a high level of interest in specialisation and a desire to achieve financial stability and work-life balance in the group of dental students who responded to the survey. Long-term career expectations varied according to student but not according to school characteristics.

  2. Musa MF, Bernabé E, Gallagher JE
    Hum Resour Health, 2015;13:47.
    PMID: 26066801 DOI: 10.1186/s12960-015-0040-4
    INTRODUCTION: Malaysia has experienced a significant expansion of dental schools over the past decade. Research into students' motivation may inform recruitment and retention of the future dental workforce. The objectives of this study were to explore students' motivation to study dentistry and whether that motivation varied by students' and school characteristics.
    METHODS: All 530 final-year students in 11 dental schools (6 public and 5 private) in Malaysia were invited to participate at the end of 2013. The self-administered questionnaire, developed at King's College London, collected information on students' motivation to study dentistry and demographic background. Responses on students' motivation were collected using five-point ordinal scales. Confirmatory factor analysis (CFA) was used to evaluate the underlying structure of students' motivation to study dentistry. Multivariate analysis of variance (MANOVA) was used to compare factor scores for overall motivation and sub-domains by students' and school characteristics.
    RESULTS: Three hundred and fifty-six final-year students in eight schools (all public and two private) participated in the survey, representing an 83% response rate for these schools and 67% of all final-year students nationally. The majority of participants were 24 years old (47%), female (70%), Malay (56%) and from middle-income families (41%) and public schools (78%). CFA supported a model with five first-order factors (professional job, healthcare and people, academic, careers advising and family and friends) which were linked to a single second-order factor representing overall students' motivation. Academic factors and healthcare and people had the highest standardized factor loadings (0.90 and 0.71, respectively), suggesting they were the main motivation to study dentistry. MANOVA showed that students from private schools had higher scores for healthcare and people than those in public schools whereas Malay students had lower scores for family and friends than those from minority ethnic groups. No differences were found by age, sex, family income and school type.
    CONCLUSION: Using CFA, this study shows that academic factors were the main motivation to study dentistry in this group of Malaysian students. There were also variations in students' motivation by students' ethnicity and school sector but not by other factors.
  3. Masood M, Sheiham A, Bernabé E
    PLoS One, 2015;10(4):e0123075.
    PMID: 25923691 DOI: 10.1371/journal.pone.0123075
    This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.
    Study name: World Health Survey (Malaysia is a study site)
  4. Che Musa MF, Bernabé E, Gallagher JE
    Int Dent J, 2020 Oct;70(5):360-373.
    PMID: 32476143 DOI: 10.1111/idj.12575
    OBJECTIVE: The dental workforce is facing unprecedented change globally as a result of multiple influences. There is a need for research informed action to map possible drivers for change at the national level and examine their potential implications in order to shape the dental workforce to serve population needs. The objective of this study was to explore key stakeholders' views on the drivers for change for the Malaysian dental workforce and their potential implications.

    METHOD: Stakeholders from key dental organisations/professions in Malaysia were purposively sampled and invited to participate in a semi-structured interview (n = 20) using a pre-tested topic guide. Interviews were recorded, transcribed verbatim and analysed using Framework Analysis.

    RESULTS: Drivers for workforce were identified across four main domains: policy-politics; trends in demography; social and economic; and, technology-scientific development. The pace of change and possible interplay between drivers, most notably government policy, liberalisation of education and health services and challenges of workforce governance, followed by Malaysian demography and health trends. Implications for the future, including possible uncertainties, particularly in relation to specialisation and privatisation were identified, together in balancing and meeting public health needs/demands with professional career expectations.

    CONCLUSION: Stakeholders' views on the high-level drivers for change broadly mirror those of high-income countries; however, specific challenges for Malaysia relate to rapid expansion of dental education and a young workforce with significant career aspirations, together with imbalances in the health care system. The impact of these drivers was perceived as leading to greatest uncertainty around specialisation and privatisation of the future workforce.

  5. Mohd Khairuddin AN, Bernabé E, Delgado-Angulo EK
    Health Qual Life Outcomes, 2021 Apr 07;19(1):115.
    PMID: 33827591 DOI: 10.1186/s12955-021-01757-1
    BACKGROUND: Most studies on social mobility and oral health have focused on movement between generations (intergenerational mobility) rather than movement within an individual's own lifetime (intragenerational mobility). The aim of this study was to investigate the association between intragenerational social mobility from early to middle adulthood and self-rated oral health.

    METHODS: This study used data from 6524 participants of the 1970 British Birth Cohort Study, an ongoing population-based birth cohort of individuals born in England, Scotland and Wales. Participants' socioeconomic position was indicated by occupational social class at age 26 and 46 years (the first and latest adult waves, respectively). Self-rated oral health was measured at age 46 years. The association between social mobility and adult oral health was assessed using conventional regression models and diagonal reference models, adjusting for gender, ethnicity, country of residence and residence area.

    RESULTS: Over a fifth of participants (22.2%) reported poor self-rated oral health at age 46 years. In conventional regression analysis, the odds ratios for social mobility varied depending on whether they were adjusted for social class of origin or destination. In addition, all social trajectories had greater odds of reporting poor oral health than non-mobile adults in class I/II. In diagonal reference models, both upward (Odds Ratio 0.79; 95% CI 0.63-0.99) and downward mobility (0.90; 95% CI 0.71-1.13) were inversely associated with poor self-rated oral health. The origin weight was 0.48 (95% CI 0.33-0.63), suggesting that social class of origin was as important as social class of destination.

    CONCLUSION: This longitudinal analysis showed that intragenerational social mobility from young to middle adulthood was associated with self-rated oral health, independent of previous and current social class.

  6. Mohd Yani AAB, Marcenes W, Stansfeld SA, Bernabé E
    Dent Traumatol, 2023 Apr;39(2):173-178.
    PMID: 36409280 DOI: 10.1111/edt.12806
    BACKGROUND/AIM: Recent reviews of case reports have pointed out a potential connection between non-suicidal self-injury (NSSI) and traumatic dental injuries (TDIs). The aim of this study was to investigate the association of a history of NSSI with TDIs in 15- to 16-year-old adolescents.

    METHODS: This study analysed cross-sectional data from the Research with East London Adolescents Community Health Survey, a prospective population survey of adolescents attending state schools in East London, England. The history of NSSI was obtained using two items from the Lifestyle and Coping questionnaire (whether they have ever engaged with self-harm and the last time they engaged in such behaviours). The presence of TDIs, increased overjet and inadequate lip coverage were determined through clinical assessments by two trained dentists. Survey logistic regression was fitted to test the association of NSSI with TDIs. Odds ratios (ORs) were adjusted for socio-demographic and clinical characteristics as potential confounders.

    RESULTS: The lifetime and last-year prevalence of NSSI were 11.9% and 6.7%, respectively, whereas the prevalence of TDIs was 16.5%. Neither the lifetime prevalence of NSSI (OR: 1.02, 95% confidence interval: 0.56-1.85) nor the last-year prevalence of NSSI (OR: 0.76, 95% CI: 0.36-1.61) were associated with TDIs in regression models adjusted for confounders.

    CONCLUSION: This study did not support an association between history of NSSI and TDIs among adolescents aged 15-16 years old in East London.

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