A macroeconomic review of dentistry in Canada in the 2000s.

OBJECTIVES: To describe trends in expenditures on dental health care services, the number of dental health care professionals and self-reported dental visits and cost barriers to dental care in Canada from 2000 to 2010. METHODS: Data on licensed dental professionals; total expenditures on dental care, both public and private; and mean per capita amount spent on dental care were obtained from the Canadian Institute for Health Information. Information on self-reported dental visits and cost barriers to dental care were collected from the Canadian Community Health Surveys and the Canadian Health Measures Survey. To compare Canada with other countries, data from the Organisation for Economic Co-operation and Development (OECD) were used. RESULTS: From 2000 to 2010, the number of licensed dental professionals increased by 35%, with a particularly large rise in the number of dental hygienists (61%). Total real expenditures on dental care, after adjusting for inflation, increased by 56%, while the percentage of dental care expenditures paid by private insurance and through public funds decreased. Mean per capita expenditures increased from $233.94 in 2000 to $327.84 in 2010. Compared with other OECD countries, Canada ranked among the highest in mean per capita spending on dental care, but among the lowest in terms of public share. The proportion of people reporting a dental visit in the past year increased from 60.3% in 2001 to 75.5% in 2009, and those reporting cost barriers increased from 15% in 2001 to 17% in 2009. CONCLUSIONS: The dental care market appears to be growing, with increases in licensed dental professionals, total and mean per capita dental care expenditures and self-reported dental visits. However, these increases are not necessarily associated with greater effectiveness in meeting population needs and outcomes, such as equity in financing, delivery and improvements in oral health. Concerns with the financing of dental care and related issues of access may have implications for the future of dental care in Canada.

Getting on with life: positive experiences of living with a spinal cord injury.

Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.

Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer.

OBJECTIVE: To determine the reasons that motivate women in a cohort of women under intensive surveillance for breast cancer to undergo risk-reducing mastectomy (RRM). PATIENTS AND METHODS: Women with a BRCA1 or BRCA2 mutation who were enrolled in an MRI-based breast screening study were eligible to participate in this survey. A self-administered questionnaire was given to women who did, and who did not terminate annual MRI-based surveillance in order to undergo RRM. The questionnaire included information on family history, risk perception and satisfaction with screening. In addition, women were asked to provide the principal reason for their choice of having preventive surgery or not, and were asked about their satisfaction with this choice. RESULTS: 246 women without breast cancer participated in the study. Of these, 39 women (16%) elected to have RRM at some point after initiating screening. Although women who had a mother or sister with breast cancer were more likely to opt for RRM than were women with no affected first-degree relative (21% versus 10%) this did not reach statistical significance. Women who perceived their breast cancer risk to be greater than 50% were more likely to opt for RRM than were women who estimated their risk to be less than 50% (19% versus 6%). Fear of cancer was the most common reason cited for choosing to have RRM (38% of respondents) followed by having had a previous cancer, (25%), then concern over their children (16%). CONCLUSION: Among women with a BRCA mutation who are enrolled in an MRI-based screening program, a high perception of personal breast cancer risk and a history of breast cancer in a first-degree relative are predictors of the decision to have RRM.