Effect of remuneration on fee-for-service dental practice in a third-party payment program.
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Biomedical subjects
Publications and source records attributed to J M Brodeur.
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The incidence rate of respiratory (lung and upper respiratory tract) cancer related to the nickel industry was studied in the male population of New Caledonia over a 7-year period (1978-1984). The findings show no excess incidence of lung or upper respiratory tract (larynx, pharynx, nasal cavities) cancer cases in the population of nickel workers compared with the rest of the male population in New Caledonia. This result was corroborated by a case-control study which does not indicate any particular role of hazards specific to the nickel mining and refining industry. Our findings, which may be specific for the type of ore processed in New Caledonia, must nevertheless be confirmed by extending the study to a total of 10 years (1978-1987). The incidence rate of male respiratory cancer in New Caledonia was also compared to that of cancers of this type reported in certain regions of industrialized countries (Australia, France, U.K., USA). Such findings are very similar to those observed in New Caledonia, thereby confirming a predominant role of tobacco and alcohol consumption in a territory which, despite certain characteristics of a developing country, has life-style habits similar to those of industrialized countries.
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A method, based on the Delphi technique, for evaluating occupational risks in a quantifiable manner was devised in the course of a case-control study on respiratory cancers in the nickel mining and refining industry in New Caledonia. There were four stages in the evaluation process: identification of eleven potential carcinogenic factors in the company during the 1930-1977 period; grouping of a limited number of work-stations; evaluation of exposure levels for the different factors for each workstation; computation of the cumulative value of exposure for each subject under study. A partial validation study shows that this kind of approach may prove useful for future occupational epidemiological studies.
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Studies show that it is difficult to recruit women of low socioeconomic status as clinical research participants. Such an objective was attained though as our results demonstrate in an evaluative study of a program implemented to lower the percentage of low birthweight in four CLSCs of the Island of Montreal between 1994 and 1996. The global recruitment strategy enabled us to reach 56.2% of our goal in 1994 and 77.4% in 1996. Two conclusions can be drawn from this result: the effectiveness of the three methods of recruitment varied according to each participating CLSC, and the global strategy, combined with the mobilization of community resources, was successful in enrolling women of low socioeconomic status.
BACKGROUND: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. METHODS: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization's caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). RESULTS: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors. CONCLUSION: Comparison between Quebec and industrialized countries (United States, England and the Netherlands) shows that in adults 35 to 44, the mean number of decayed teeth is low (between 1.0 and 2.2) and the mean number of filled teeth is relatively similar (between 9.6 and 11.1); however, Quebec has a higher percentage than the United States of edentulous people. As well, in dentate adults, there are 1.6 times more missing teeth among Quebecers than among Americans.
This work was carried out as part of a community development project in North-West Haiti. The aim was to determine the prevalence of dental caries among young Haitians and to identify the principal determinants and risk factors. A total of 322 schoolchildren, all aged 12 years, participated in the study in March and April 1996. Demographic characteristics, hygiene and dietary habits were recorded. In parallel, a dentist assessed the amount of debris present on the teeth and investigated the children's history of caries. Almost two thirds of the children examined were free of caries. The mean number of decayed missing and filled teeth (DMFT index) was 0.93, which is low. However, a high-risk group was identified with a mean DMFT index of 3.8. This group is a source of some concern, particularly as the region's health services are often inaccessible resulting in dental caries frequently remaining untreated until tooth extraction is required. Logistic regression analysis showed that dental hygiene and, to a lesser extent, sugar intake, were the principal risk factors for dental caries. Adolescents who consume more than three meals per day and who, presumably, have a higher intake of cariogenic food, present more caries than those who consume less. These schoolchildren meet the objectives of the WHO for dental caries for 2000, but two courses of action are nonetheless necessary: caries prevention and improved access to dental health care. To prevent caries, techniques for increasing the resistance of teeth could be recommended, as in industrialized countries. However, such strategies would be difficult to implement in the rural context of a developing country. The addition of fluoride to drinking water, for example, is not practical as most of the inhabitants of rural areas do not have access to running water. The use of sealing agents, which protect against decay affecting the occlusal surfaces of molars, is also impractical, for financial reasons. Thus, basic measures involving the improvement of dental hygiene and reducing the intake of cariogenic foods remain the principal means of preventing caries. Increasing the accessibility of dental care, like prevention, involves a number of problems. Increasing the number of health centers, or renovating existing clinics requires resources, and possibly infrastructure, that the Haitian state may not be in a position to provide. The recently developed ART (Atraumatic Restoration Treatment) overcomes this problem. This method involves manually cleaning cavities and sealing then with glass ionomer. This product is highly adhesive, which frees dentists from the constraints of having to use rotating electrical equipment. Caries can therefore now be treated in remote areas with a minimum of dental equipment. However, although encouraging results were obtained in a three-year trial in Thailand, the mechanical quality of glass ionomer and its ability to block caries development are unclear. In conclusion, a lack of financial resources limits the possibilities of intervention in developing countries, drawing attention to the important question of the financing of health programs. Funding remains the key to any program and has been shown to be an essential issue in epidemiological studies.
The development of information and communications technologies (ICT) and Internet offers public health practitioners new tools to fulfill their missions of monitoring public health, health promotion and disease prevention, and public health protection. In recent years, new applications and practices in public health using these technologies have emerged, particularly in the area of communication among practitioners and transmission of information to the population. This article aims to give an overall view of the use of ICT in public health and to discuss the impact of these technologies on public health practices. The discussion is centred around the implications of using these new technologies: implications with regard to the new possibilities provided by these technologies, but also with regard to the difficulties involved in their use as well as issues related to unequal access and ethics. Finally, the question of the evaluation of these technologies and of their impact on public health is discussed.
This study investigates the association of dietary quality with dental caries increment of 11-year-old children. A 3-day dietary record including one weekend day was completed by the subjects and their parents. The nutritional quality was evaluated using a quality index based on the eating frequency of foods recommended in food guides and divided into 8 levels. The frequency of consumption of sugary foods, liquid and solid, at and between meals was also calculated. Two oral examinations 20 months apart were made in 1983-85; each time, the quality of oral hygiene was determined by using the simplified oral hygiene was determined by using the simplified oral hygiene index of Greene and Vermillon. the dental caries increment between the two examinations was evaluated using the DMFS index. When the subjects were distributed into 3 groups according to their nutritional quality index, the mean dental caries increment had a tendency to decrease as the nutritional quality increased for the total sample as well as for boys and girls considered separately; however, the analysis of variance did not reveal any differences of statistical significance. No association was established for children in this study between frequency of consumption of sugary foods and caries increment. No association was observed between nutritional quality and oral hygiene nor between the mother's education and the children's frequency of consumption of sugary foods. Thus, in our study, children with the highest dental caries increment are not necessarily the ones having a diet of poor nutritional quality nor the ones consuming sugary foods more frequently.
Through the fluoridation of drinking water, fluorides are becoming an increasing part of the human environment in industrialized countries. Fluoridated toothpastes are widely used in the United States and Canada. The younger a subject is, the greater proportion of toothpaste he or she tends to swallow.
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