There is a growing population worldwide who are not able to receive dental care. The numbers and trend are increasing and the availability of providers and resources are dwindling in comparison. The dissertation starts off with an example of how the current dental healthcare system has allowed some tragic outcomes. This paper will discuss the barriers of obtaining dental care for this growing population, challenges in dental education and offer some future solutions. Using the example of a dental tragedy, we hope to be inspired as a call to action to avert further fatalities and improve the dental healthcare system. The paper reviews the issue from: 1. A Long term perspective with the current and projected statistics for special needs population nationwide and California. 2. An Expanding population perspective that focuses on patients with autism spectrum disorder. 3. A Complex needs perspective of an example of the increasing necessity of hospital dentistry care.

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La utilització de serveis sanitaris en població infantil i adolescent europea ha estat fins ara poc analitzada. Aquest treball de recerca es va centrar en l'anàlisi de la utilització de serveis sanitaris en població infantil i adolescent de la ciutat de Barcelona i d'onze països europeus, estudiant la seva associació amb necessitats en salut, característiques de la família i dels sistemes sanitaris. Concretament, es van plantejar els objectius d'examinar la utilitat de la salut percebuda com a mesura de necessitat en salut i l'existència de desigualtats socials en la utilització de serveis sanitaris. Un objectiu addicional, a nivell metodològic, va ser estudiar la participació, resposta i representativitat de les mostres dels països participants en l'estudi europeu, segons els mètodes de selecció i d'administració. Es van utilitzar les dades de l'enquesta de salut de Barcelona (ESB) de l'any 2000 de la població de 5 a 14 any i de l'estudi europeu KIDSCREEN que es va dur a terme al 2003 en població de 8 a 18 anys. La utilització de serveis sanitaris en població infantil i adolescent va mostrar-se d'acord amb els nivells de necessitat en salut, excepte en l'accés davant dels problemes de salut mental. Es van trobar desigualtats socioeconòmiques i es van identificar característiques estructurals i organitzatives dels sistemes sanitaris que semblen disminuir l'accessibilitat. Les mesures de salut percebuda van aportar informació addicional confirmant la seva validesa i utilitat en l'avaluació de serveis sanitaris per a la població infantil i adolescent. / La utilización de servicios sanitarios en población infantil y adolescente europea ha sido hasta ahora poco analizada. Este trabajo de investigación se dirigió a analizar la utilización de servicios sanitarios en población infantil y adolescente de la ciudad de Barcelona y de once países europeos estudiando su asociación con necesidades en salud y características de la familia y de los sistemas sanitarios. Específicamente, se plantearon los objetivos de examinar la utilidad de la salud percibida como medida de necesidad en salud y la existencia de desigualdades sociales en la utilización de servicios sanitarios. Un objetivo adicional, a nivel metodológico, fue estudiar la participación, respuesta y representatividad de las muestras de los países participantes en el estudio europeo, y compararlos según los métodos de selección y de administración. Se utilizaron los datos de la encuesta de salud de Barcelona (ESB) del año 2000 de la población de 5 a 14 años y del estudio europeo KIDSCREEN llevado a cabo en 2003 en población de 8 a 18 años. La utilización de servicios sanitarios resultó adecuada a los niveles de necesidad en salud, excepto en el acceso ante problemas de salud mental. Se encontraron desigualdades socioeconómicas y se identificaron características estructurales y organizativas de los sistemas sanitarios que parecen disminuir la accesibilidad. Las medidas de salud percibida aportaron información adicional confirmando su validez y utilidad en la evaluación de servicios sanitarios para la población infantil y adolescente. / Analysis of the utilisation of health care services among children and adolescents at a European level has been scarce to date. This research aimed to analyse the use of health care services in children and adolescents in the city of Barcelona and eleven European countries and to examine the correlations between use of services and health needs, family characteristics, and healthcare system factors. More specific aims were to examine the utility of perceived health as a measure of needs and to determine whether there were social inequalities in the use of health care services. At a methodological level, a further objective was to examine the sampling and administration methods used in the European study in terms of participation, response rate, and representativeness and to compare them across countries. Data used were obtained from children aged 5-15 years included in the Barcelona Health Interview Survey (BHIS), which was carried out in 2000, and from children and adolescents aged 8-18 years included in the European KIDSCREEN study carried out in 2003. We found that use of services was generally in accordance with health needs, except for access for mental health problems. Socioeconomic inequalities were found, and structural characteristics of health care systems were identified as possible correlates of a reduced access to services. Measures of self-perceived health provided information which correlated with use of services, thereby confirming their validity and usefulness for health services research in child and adolescent populations.

La ville d’Abidjan est localisée au Sud de la Côte d’Ivoire. Elle est la capitale économique depuis 1983 et la première ville du pays. Elle concentre le potentiel humain et une offre de soins dense et diversifiée répartie sur de faibles distances physiques, donnant l’impression que tout est accessible. En effet, l’État Ivoirien a consenti d’importants investissements pour construire et équiper des services de santé depuis l’émergence de la ville au début du siècle dernier pour améliorer l’accès aux soins des abidjanais. Pourtant, malgré une augmentation considérable du nombre d’infrastructures sanitaires et de leur disponibilité, les taux d’utilisations et de fréquentations des services de santé modernes dans les communes de la ville d’Abidjan restent faibles et les indicateurs de santé demeurent très préoccupants et les besoins de soins sont importants. En plus, la croissance spatiale et démographique accélérée que connaît la ville entraînent des changements rapides dans son organisation territoriale empêchant les autorités publiques chargées de la planification de suivre le rythme de sa croissance urbaine. Ils ne sont pas toujours parvenus à équiper en services urbains les nouveaux espaces au fur et à mesure de leur création et à intégrer les nouveaux citadins aux origines diverses. Cette thèse permet d’étudier, comment, dans un contexte considéré comme privilégié, se pose la problématique de l’accès et du recours aux services de santé modernes. Pour réaliser ce projet, cette étude, à partir des combinaisons d’analyses spatiales, statistiques, et d’un travail de terrain, analyse les inégalités socio-spatiales d’accès aux services de santé pour mettre en exergue le problème de l’accessibilité aux soins, tant physique, culturelle, matérielle que sociale. Elle mesure également l’adéquation de cette offre de soins moderne aux besoins de soins des populations pour identifier les zones et les populations défavorisées pour l’accès aux soins. Et enfin, cette étude analyse les pratiques citadines du recours aux soins, ainsi que les déterminants qui limitent ou facilitent l’accès aux soins dans la ville d’Abidjan. Les résultats des études montrent que les services de santé existent, ils sont denses et diversifiés, mais ils ne sont pas repartis là où il y a le plus de besoins de soins. Dans notre étude, on souligne aussi une prédominance de la prise en charge à domicile des épisodes morbides notamment à travers l’automédication et une diminution de l’utilisation des services de soins modernes. Le recours aux structures de soins se fait rare dans les quartiers où les besoins en soins de santé sont les plus importants. L’automédication ou la médecine de rue sont généralement les plus privilégiées. Les structures de soins sont sollicitées que lorsque la maladie devient très grave. Nos résultats montrent également qu’il est difficile d’attribuer à un facteur le rôle déterminant des recours thérapeutiques, car les comportements sont à la fois déterminés par les caractéristiques socio-démographiques de l’individu, de sa famille et par des paramètres contextuels, mais aussi par les caractéristiques de l’épisode morbide, par la connaissance du système de soins environnant et les attitudes vis-à-vis du système de soins. Néanmoins, nous pouvons dire qu’à Abidjan, les pratiques citadines du recours aux soins sont tributaires de la capacité économique des ménages avec le risque accru de marginaliser les personnes les plus vulnérables. / The city of Abidjan is located in the South of the Ivory Coast. It is the economic capital since 1983 and the first city of the country. It concentrates human potential and health of dense care supply modern and diversified divided on weak physical distance, giving the impression that everything is approachable. In effect, the State Of the Ivory Coast approved important investments to construct and equip services of health care since the emergence of the city at the beginning of last century to ameliorate the access to health care of abidjanais. However, in spite of a considerable increase among health facilities and among their availability, the rates of uses and company of the services of modern health care in the spaces of the city of Abidjan remain weak and the indicators of health remain very worrying and the needs in care of health are important. On top of that, the space and demographic speeded up growth which knows the city draw away quick changes in her territorial organization preventing the public authorities made responsible with planning for following the rhythm of its urban growth. They did not always manage to equip new urban spaces with timely urban services and to integrate new citizens at the various origins. This thesis allows to be studying, how, in a considered context as privileged, settle the problems of access and health care seeking in the services of modern health. To accomplish this plan, this study, from the combination of spatial analysis, statistics, and field work, analyses the socio- spatial inequality of access to the services of health to head with the problem of accessibility in care, so physical, cultural, material that social. It also measures the adequacy of health care supply at the Needs in care of health of populations to identify zones and populations discriminated for the access to health care. And finally, this study analyses the city practices in the use of health care, as well as the determinants that hinder or facilitate access to health care in the city of Abidjan. Study results show that the services of health exist, they are dense and manifold, but they did not leave again where there are most needs in care of health. In our study, they also underline a predominance of the taking care at home of morbid episodes notably across self-medication and a reduction of the use of the services of modern care. The seeking in structures of health care becomes rare in the space where the needs in care of health are the most important. Self-medication or street medicine are the most favouring in general. Structures of health care are solicited that when illness becomes very serious. Our results also show that it is difficult to allocate to a factor the role determining therapeutic seeking, because behaviours are determined at the same time by the socio-demographic characteristics of the individual, his family and by contextual parameters, but also by the characteristics of morbid episode, by the knowledge of the ambient the health care system and attitudes in relation to the health care system. However, we can say that in Abidjan, the city practices of health care seeking are dependent on the economic capacity of household with risk augmented to marginalize the most vulnerable persons.

The system of care for persons suffering from mental retardation is in a state of upheaval. Considering the mentally handicapped as holistic beings, this study explored and assessed the needs of those residing in the community of District 22 (sub-district 222), KwaZulu-Natal, thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on Maslow's hierarchy of needs theory was carried out, using 167 respondents. The study revealed that despite being mentally retarded, they were still regarded as valuable members of the community, their needs did not differ from the needs of others in the rest of the world and that mental retardation is still rated low in the prioritization of health problems, hence the lack of resources and support needed for the rehabilitation of such persons. / Health Studies / M.A. (Health Studies)

The system of care for persons suffering from mental retardation is in a state of upheaval. Considering the mentally handicapped as holistic beings, this study explored and assessed the needs of those residing in the community of District 22 (sub-district 222), KwaZulu-Natal, thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on Maslow's hierarchy of needs theory was carried out, using 167 respondents. The study revealed that despite being mentally retarded, they were still regarded as valuable members of the community, their needs did not differ from the needs of others in the rest of the world and that mental retardation is still rated low in the prioritization of health problems, hence the lack of resources and support needed for the rehabilitation of such persons. / Health Studies / M.A. (Health Studies)

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)