The dental equipment needs and problems associated with the provision of dental services in remote areas.

Dental services, facilities and equipment are inseparable and interdependent. The provision of all three is influenced by socio-economic factors. Prominent among these is the powerful competition for scarce resources to meet other health needs. In planning health programmes the perception of dentists, the community and health administrators will differ. In this competitive situation the planning of dental services, and hence the choice of equipment needed, must be based upon knowledge of the oral health status of the community to be served. The community's level of interest and likely cooperation is of great importance. Unsuitable services must not be imposed but at the same time the dental profession's educational role should be maintained. Establishing a balance between treatment needs and preventive programmes will influence the provision of equipment just as much as it will determine the choice of personnel. Standards of care should not be judged on the basis of elaborate facilities and exotic equipment. The choice of equipment must be related to the level of service to be provided at its site of use. Planners must consult with the dentists concerned if the provision of inappropriate equipment is to be avoided.

The impact of selected patient characteristics on practitioners' treatment recommendations for end-stage renal disease.

Medical decision making under uncertainty was tested using an empirical study of practitioner judgments concerning the preferred treatment(s) for end-stage renal disease (ESRD) patients. Patient-specific factors were varied systematically in written case vignettes, which were mailed to physician and nonphysician practitioners who treated ESRD patients in Canada and Michigan. Respondents were asked to indicate for each vignette: a preferred treatment and all other acceptable treatments. Overall patterns of choice were analyzed; the clear preferences shown for certain treatment modalities (e.g., for continuous ambulatory peritoneal dialysis over home hemodialysis) have planning implications. The apparent receptivity to new ESRD treatments may affect the success of government policies aimed at encouraging greater use of home hemodialysis. The impact of each patient-specific variable on treatment choice was also examined. Factors such as the patient's age proved to be major determinants both of the preferred treatment modalities and of the number of alternatives considered acceptable. The research method allowed areas of medical consensus to be distinguished from those 'grey areas' in which patient characteristics alone could not explain treatment selection. The resulting 'controversy' cases are being used as the dependent variables in further studies.

Dental health of children in Australia 1977-1980.

A School Dental Scheme was commenced in Australia on July 1, 1973 in which the Commonwealth and States shared the costs of the development and operation of the school dental service. Data collected at annual examinations over the years 1977-1980 inclusive were used, from which trends, if any, could be determined on the changes that may have occurred in the dental health of the school children. From the data covering almost two million examinations, a fall in the DIMF index for children aged six to thirteen years was noted. In 1977, it was 2.97 and it reached 2.17 in 1980. Comparison with other data obtained over a longer period in the Australian Capital Territory form a useful comparison. From 1954 to 1980, the mean DIMF for twelve-year-old children was reduced from 7.17 to 2.52. The effect of fluoridation has played a major part but not the whole role in this improvement in dental health; it was introduced in Canberra in 1964 when the mean DIMF index for ten-year-old children was 4.43, and this figure was reduced to 2.16 in 1974. In 1980, the mean DIMF index was 1.56, or a fall of 27.8 per cent. A similar effect is evident in data collected from the State surveys. Included in the surveys was the development of indices for Oral Hygiene and it was found that despite a better oral hygiene index for girls it was not associated with lower caries prevalence. However, taking into account the scores for all children of twelve years of age, a clear association existed between oral debris and prevalence of carious teeth.

Fluoridation in Canberra. III. Dental caries after ten years.

The water supply of Canberra was fluoridated in eptember 1964. This report covers the period 1965 to 1974 during which children aged five to twelve years were examined. These children had lived in Canberra since fluoridation commenced. In comparison with base-line data the results showed a progressive improvement in the DMF and defindices. The reduction in the DMF index for children aged six years who were examined in 1974 was 81.0 per cent, and for children aged twelve years it was 48.5 per cent. The reduction was greatest for incisor teeth.

Triage: a working solution to over crowding in the emergency department.

Recently, emergency departments across the continent have become crowded with patients requiring non-urgent care. To alleviate this situation at The Hospital for Sick Children in Toronto, receptionists in the emergency department direct patients requiring urgent care to the emergency room and those requiring non-urgent care to a screening clinic (triage). During a two-month period, 13,551 patients visited the emergency department. The triage receptionist sent 8368 patients to the emergency room and 5183 to the screening clinic. About 45% of patients visiting the emergency room had suffered accidents and injuries, and 19% had respiratory illness; 15% of patient visits resulted in admission to hospital. In contrast to this, 49% of patients sent to the screening clinic had respiratory illness and 18% had infective disease; less than 1% of patients needed hospitalization.

Tonsillectomies: in dollars and cents.

Over the last quarter of a century, much controversy has been generated on the indications for tonsillectomy and adenoidectomy. The economic aspects of this operation have received comparatively little attention. The rate per 10,000 children 0 to 19 years of age for the whole province of Ontario for the year 1971 was 174 and ranged from a high of 307 in one county to a low of 59 in another. The total cost of these operations to the health insurance plan was 11.4 million dollars. National studies on the indications for these operations, their benefits and hazards are urgently required.