Ethnic classification in primary dental care and dental health services research: time to pause for thought.

'Ethnicity' is an important concept in dental health services research and in enabling general dental practitioners to gain insight into their patients values and expectations. Since more health services research is being undertaken in primary dental care settings it is becoming an important issue for dental professionals and researchers in primary care to be aware of. Ethnicity is thought to be related to dental health inequalities and access and is often used as a stratifying variable in many dental studies. The meaning and use of the term however differs among researchers and among the public. It is clear that researchers and professionals need to pause for thought when considering what this often bandied about term actually means and the impact of different definitions. This is illustrated using examples from the authors' own research and published papers in the medical and dental literature. There is also much debate about whether ethnicity--however defined--is an important predictor of differences in dental health in itself or is merely a marker for other factors such as social deprivation or the impact of 'place' on dental health. While the jury on this debate is out we suggest guidelines on the reporting of ethnicity should be outlined in the dental literature--perhaps updating those published in 1996 in the British Medical Journal.

Anxiety and pain measures in dentistry: a guide to their quality and application.

BACKGROUND: The authors review measures of anxiety and pain used in recent dental studies. In particular, the study identifies the reliability, validity and usefulness of the measures. TYPE OF STUDIES REVIEWED: Three computerized databases of published scientific literature were searched over a 10-year period. Only studies that included measures of anxiety or pain were included. RESULTS: Information on the reliability and validity of 15 measures of dental care anxiety and three measures of pain and pain-related behaviors is provided. Reliability and validity data for most measures are good. Corah's Dental Anxiety Scale is the most widely used measure of anxiety, although it may not be as sensitive as other measures. The McGill Pain Questionnaire is the measure of choice for the assessment of pain. CLINICAL IMPLICATIONS: The authors have summarized properties of the scales for clinicians and researchers planning to use measures of anxiety, measures of pain, or both.

Cost-effectiveness analysis of a family physician delivered smoking cessation program.

OBJECTIVES: The objectives were to present a cost-effectiveness analysis of a smoking cessation program delivered by physicians and compare results to other smoking cessation interventions. METHODS: Retrospective effectiveness figures from a previous evaluation of the smoking cessation program were supplemented with estimates based on researched assumptions. Net abstinence rates were determined for smokers, depending on their stage of readiness to quit, that is, "prepared," "contemplative," and "precontemplative," leading to an assessment of the number of smokers achieving abstinence as a result of the Smokescreen intervention. Costs were calculated from the perspectives of smokers, family physicians, organizers, trainers, and all parties combined. Assumptions were varied with a sensitivity analysis. RESULTS: Baseline costs per additional abstainer were $183 based on physicians' intervention costs at 1995 prices. This is the figure most comparable to previously conducted economic evaluations of smoking cessation interventions. Sensitivity analysis varying the perspective and under optimistic and pessimistic assumptions about effectiveness produced a wide variety of estimates. The decision to include or exclude training costs had a particularly important bearing on the estimates. However, under reasonable assumptions the cost per additional quitter compares favorably to smoking and other medical and health care interventions worldwide. CONCLUSIONS: The program appears cost-effective when compared to other smoking cessation and health promotion interventions and illustrates the potential for retrospective cost-effectiveness analysis of interventions.

Emergency support team.

The motivation for implementing the Emergency Support Team was the unique situation of being the only hospital within a resort area with limited resources for supporting families in crisis. As the program developed, broader implications for the service were identified. Educational needs became more apparent and programs were instituted to orient and educate the team members. The comfort level of the volunteers increased as they developed skills in working with families in crisis. Events such as unexpected death are difficult times for families. The support given by the team member can turn a catastrophic situation into one that is remembered by the family as a compassionate experience.