Thesis (doctoral)--University of Göteborg, 1984. / Extra t.p. with thesis statement inserted. Includes bibliographical references.

OBJECTIVE: Within the U.S. population approximately 20 percent of individuals are diagnosed with some type of disability and another 12 percent are considered severely disabled. Many times special health care needs (SHCN) patients with one condition are burdened by more than one disability. A variety of conditions such as behavioral issues, developmental disorders, and cognitive, congenital or systemic diseases have been proven to increase the risk of oral heath disease in individuals with SHCN. These conditions may affect the ability to communicate and limit dexterity for proper oral health maintenance, which is why caregivers must become advocates for these patients to insure their oral health needs are met. By communicating effectively with caretakers, dentists will be able to establish a positive impact on patients to make dental visits easier and less traumatizing. Unfortunately studies have found that dental and hygiene students graduate without feeling adequately prepared to treat patients with SHCN. With the proper education and training, more dental students and future dentists will take on the challenges that are brought by these individuals to provide the best care possible. Establishing a strong support system could potentially decrease oral health disparity in SHCN patients and improve overall care. The goal of this study was to assess whether or not there was a positive impact on the oral health of SHCN individuals when caregivers and oral health professionals worked together in a team treatment effort to fight against oral disease. METHODS: Study used a systematic review approach of literature where a PICO question was formed and the article selection process included a review of title, abstract, and application of inclusions and exclusion criteria. Printed-text and online databases such as Pubmed/MEDLINE, Google Scholar, and Web of Science were used to conduct a review of literature where a total of 210 papers were collected. After selection process, only four papers were eligible for systematic review. Pre-determined questions were used to determine the how involved caregivers and oral health professionals were during each study followed by an assessment using a point system, which scored caregiver and oral health professionals involvement during intervention. RESULTS: Selected studies showed heterogeneity in study design and sample size but all used multidisciplinary approach, which included some degree of caregiver and oral hygiene provider (OHP) collaboration. Two out of the four studies totaled nearly perfect scores in both caregiver and oral health professional involvement, which resulted in a positive effect on oral health care of SHCN patients. Case reports that included an interdisciplinary team approach to oral care procedures on patients, showed the benefits of teamwork and how collaborative practice between dental and medical professionals increased successful patient outcomes. Results illustrated the significant role that caregiver’s play in the dental team and how their absence during intervention treatment significantly lowered study scores for the overall success of patient care. CONCLUSIONS: Results demonstrated that studies with a well-rounded dental team, which included caregivers, OHP, health care professionals accompanied by social support systems, saw the greatest success and improvements in oral health care of SHCN patients. Nevertheless, a dedicated dental team where most members were present did not guarantee intervention success if caregivers did not show a significant involvement. Caregivers alone could positively impact oral health care of a patient more than if OHP worked alone. In conclusion, we found that each member of a dental team had the ability to impact change to an almost equal degree. For this reason, it is important for caregivers, OHP, dental staff and health care professionals to work together, support one another and communicate effectively to decrease oral health disparities in SHCN patients.

Magister Scientiae Dentium - MSc(Dent) / General dentists in practice (both public and private) are often reluctant to perform interceptive orthodontic procedures on patients that present to their practices. As interceptive orthodontic treatment (IOT) can be of great benefit to some patients, it validates the need to assess the factors that influence the implementation of such treatment.

Thesis (Ph. D.)--University of Maryland at College Park, 1996. / Thesis research directed by the Dept. of Counseling and Personnel Services. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Maryland at College Park, 1996. / Thesis research directed by the Dept. of Counseling and Personnel Services. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Sömnen är en naturlig del av människans liv och sömnstörning påverkar den vakna tidens kvalité samt det allmänna välmående. För att bibehålla en god hälsa är det av stor vikt att sova utan avbrott. Obstruktiv sömnapné (OSA) är ett tillstånd som orsakar andningsuppehåll under sömn och stör därmed sömnens effekt vilket ökar risk för andra allmänna sjukdomstillstånd. Tandvården är en organisation som träffar patienter regelbundet för undersökning av den orala hälsan. Patientens egen berättelse samt intra orala markörer kan vara tecken på symtom på OSA. Det finns brist på fördjupad kunskap kring tandvårdens erfarenhet kring patienter med OSA. Syftet med studien var att beskriva legitimerad tandvårdspersonals erfarenheter av vuxna tandvårdspatienter med obstruktiv sömnapné (OSA). Resultat Resultatet visar att erfarenheter hos tandvårdspersonalen varierar vad det gäller patienter med OSA. ”Kliniska erfarenheter av OSA” med underkategorier som patientmötet, betydelsen av hälsodeklarationen, kliniska markörer samt ”Omhändertagande” med underkategorierna prevention oral hälsa och samarbete med hälso- och sjukvården, var det som speglade tandvårdspersonalens erfarenheter. Slutsats Legitimerad tandvårdpersonal har en betydande roll för den orala och allmänna hälsan. Patienter med OSA symtom kan uppmärksammas i tandvården men mer kunskap och verktyg krävs inom området för att ett samarbete med hälso- och sjukvården kan skapas.

Introdução: Profissionais da área odontológica lidam diariamente com instrumentos que emitem ruído, o que pode vir a causar alterações auditivas e efeitos negativos na comunicação e na qualidade de vida desses profissionais. Considerando o fato de que tais ruídos não podem ser eliminados, é importante que a conscientização dos futuros profissionais da odontologia seja iniciada ainda no início do curso universitário, mencionando os riscos a que estarão sendo expostos para que possam controlá-los com prevenção e tratamento, bem como obter informações consistentes a respeito do comportamento dos limiares auditivos dos cirurgiões-dentistas. Objetivo: Investigar o conhecimento de alunos do curso de graduação em Odontologia sobre saúde auditiva e caracterizar o perfil audiológico e os hábitos auditivos dos participantes da pesquisa. Metodologia: Após a aprovação do Comitê de Ética sob o processo número 045/2009, o projeto foi realizado em duas etapas. A primeira constituiu-se da aplicação de questionários aos 367 alunos dos cursos de graduação em Odontologia da Faculdade de Odontologia de Bauru FOB/USP e USC e da Faculdade de Odontologia de São Paulo FO/USP. Na segunda etapa, 25 alunos do primeiro e quarto anos de graduação das faculdades de Bauru foram convidados a realizar as seguintes avaliações: audiológica convencional, logoaudiometria, imitanciometria e a avaliação complementar (audiometria de altas frequências e emissões otoacústicas transientes e por produto de distorção). Resultados: Na primeira etapa, verificou-se que os alunos desconhecem o risco que o ambiente ocupacional e de lazer proporcionam à saúde auditiva e, desse modo, verificou-se que se faz necessária a conscientização sobre a exposição do ruído e suas consequências a fim de criar um programa de promoção e prevenção principalmente na saúde ocupacional dessa população, considerando que essa problemática interfere na qualidade de vida dos que atuam na profissão odontológica. Na segunda etapa completaram as provas 25 participantes (X= 23 anos). Apesar dos limiares se encontrarem de acordo com a normalidade para a OMS (Organização Mundial de Saúde) e também para a Portaria nº 19 do Ministério do Trabalho, houve uma entalhe na frequência de 6 kHz e 12,5 kHz em ambas as orelhas na audiometria convencional e audiometria tonal de altas frequências. A média mínima encontrada na orelha direita foi de 4,6 dB em 14 kHz e para a orelha esquerda foi de 4 dB em 1 kHz e a média máxima para a orelha direita foi de 12,4 dB em 6 kHz e para a orelha esquerda foi de 14 dB em 6 kHz. Para a logoaudiometria e imitanciometria, 100% dos participantes apresentaram exame de forma compatível com a audiometria convencional. No registro das EOE, pôde-se verificar que quanto maior o limiar de audibilidade nas frequências estudadas mais se evidencia a ausência das EOE-t e EOE-DP para ambas as orelhas, exceto na comparação do limiar de audibilidade em 1 kHz nas EOE-t, provavelmente devido à contaminação pelo ruído de fundo durante o registro das mesmas e na frequência de 3 kHz nas EOE-DP. Conclusão: Os questionários aplicados se mostraram eficientes atingindo o objetivo proposto. Quanto à caracterização do perfil audiológico foi possível concluir que o exame de emissões otoacústicas tanto transientes quanto por produto de distorção se mostraram mais eficientes como um exame complementar para identificar precocemente as alterações auditivas nessa população. / Introduction: Professionals of the dental area handle daily with noisy instruments, what may come to cause audibly alterations and negative effects at the communication and life quality of these professionals. Considering the fact that such noise can not be eliminated, it is important that the awareness of future dental professionals is initiated early on in the university, mentioning the risks to which they are being exposed so that they can control them with prevention and treatment, as well as acquire consistent information about the behavior of the auditory thresholds of surgeon dentists. Objective: To investigate the knowledge about hearing health of students of graduation in odontology, characterize the audiological profile and listening habits of the research participants. Methodology: After approval by the Ethics Committee under case number 045/2009, the project was conducted in two stages. The first consisted of questionnaires to 367 students of undergraduate courses in Odontology from the Faculty of Odontology of Bauru FOB/USP and USC and from Faculty of Odontology of São Paulo FO/USP. In the second stage, 25 students from first and fourth years of undergraduate faculties of Bauru were invited to conduct the following assessments: audiometry, speech audiometry, impedance tests and additional assessment (high frequency audiometry and otoacoustic emissions and distortion product). Results: In the first stage, it was observed that students are unaware of the risk the workplace and the leisure environment provide the hearing health and, thereby, it was verified that awareness is needed about noise exposure and its consequences, in order to create a program of promotion and prevention, especially in occupational health in this population, considering that this problem affects the quality of life of those who work in the dental profession. In the second phase 25 participants completed the tests (X = 23 years). Although the thresholds meet according to normality by the WHO (World Health Organization) and also to Ordinance No. 19 of Ministry of Labor, there was a notch in the frequency of 6 kHz and 12,5 kHz in both ears in conventional audiometry and high frequency audiometry. The average minimum found in the right ear was 4.6 dB at 14 kHz to the left ear was 4 dB at 1 kHz and the average maximum for the right ear was 12.4 dB at 6 kHz and to the left ear was 14 dB at 6 kHz. For speech audiometry and immittance, 100% of the participants presented examination consistent with conventional audiometry. In the record of EOE, it was found that the higher the threshold of audibility frequencies studied, the more evident is the lack of EOE-t and EOE-DP for both ears, except when comparing the hearing threshold at 1 kHz in the EOE-t, probably due to contamination by background noise during the registration thereof and in the frequency of 3 kHz in the EOE-DP. Conclusion: The questionnaires applied proved to be efficient, reaching the objective. As for the characterization of the audiological profile, it was concluded that, the test of both transient otoacoustic emissions and distortion product, proved more efficient as a complementary test for early detection of hearing alterations in this population.

Na história recente, o exercício da profissão de Cirurgião-Dentista tem sido alvo de inúmeras ações judiciais das mais diversificadas, impetradas por pacientes descontentes com os resultados obtidos em seus tratamentos odontológicos. Considerando os direitos inerentes à pessoa do paciente e a enorme preocupação da classe odontológica com relação às demandas judiciais originadas pela falta de informação adequada a seus pacientes, alguns aspectos importantes do Consentimento Informado bem como da própria responsabilidade civil odontológica estão abordados neste estudo, a fim de esclarecer e evitar as constantes demandas judiciais contra dentistas por falta de um termo de Consentimento Informado. A informação, seja verbal ou escrita, sobre um diagnóstico, procedimento terapêutico, ou tratamento odontológico aos pacientes ou familiares, e a forma como explicar de maneira compreensiva o que está sendo repassado é um grande conflito entre a classe odontológica nos dias atuais. O Consentimento Informado e o Termo de Consentimento Livre e Esclarecido vem ser a forma, verbal e escrita de como o cirurgião-dentista informa o seu paciente ou representante, de modo límpido, os atos e etapas, relacionados ao diagnóstico e ao seu tratamento terapêutico, esclarecendo os riscos e benefícios, vantagens e desvantagens de forma que possa, autonomamente, escolher por realizar, ou não, o possível tratamento. O objetivo deste trabalho foi realizar o levantamento e análise das decisões recursais dos Tribunais de Justiça do sul do Brasil, utilizando a Internet. Dos 102 acórdãos avaliados 30 são do Tribunal de Justiça do Paraná, 17 do Tribunal de Justiça de Santa Catarina e 55 do Tribunal de Justiça do Rio Grande do Sul. Em relação ao Consentimento Informado, Termo de Consentimento Livre e Esclarecido ou mesmo a prova da Informação, constatou-se que nos referidos acórdãos estes assuntos foram pouco citados, porém observou-se que quando mencionados serviram de subsídios consistentes para defesa do profissional. / In recent history, the profession of dental surgeon has been the target of numerous lawsuits from more diverse, filed by patients dissatisfied with the results obtained in their dental treatment. Considering the inherent rights of the patient and the dental class of great concern with respect to lawsuits stem from the lack of adequate information to their patients, some important aspects of informed consent as well as from civil liability in dentistry are addressed in this study in order to clarify and avoid the constant lawsuits against dentists by a lack of informed consent The information, whether oral or written, about a diagnosis, therapeutic procedure, or dental treatment to patients or relatives, and how to comprehensively explain what is being passed is a major conflict between the dental class nowadays. Informed Consent and the Term of Consent has to be the case, verbal and written like the dentist tells the patient or his representative, so clear, the actions and steps, related to diagnosis and therapeutic treatment, accounting the risks and benefits, advantages and disadvantages so that you can, independently, choose to perform, or not, the possible treatment. The aim of this study was to survey and analysis of appellate decisions of the Courts of Justice in southern Brazil, using the Internet. Of the 102 judgments are assessed 30 of the Court of Paraná, 17 of the Court of St. Catherine and 55 of the Court of Rio Grande do Sul. Regarding Informed Consent, Termination of Consent or even proof of Information it was found that the judgments were seldom mentioned these issues, but noted that when mentioned served as subsidies for consistent defense of the professional.

Introdução: Profissionais da área odontológica lidam diariamente com instrumentos que emitem ruído, o que pode vir a causar alterações auditivas e efeitos negativos na comunicação e na qualidade de vida desses profissionais. Considerando o fato de que tais ruídos não podem ser eliminados, é importante que a conscientização dos futuros profissionais da odontologia seja iniciada ainda no início do curso universitário, mencionando os riscos a que estarão sendo expostos para que possam controlá-los com prevenção e tratamento, bem como obter informações consistentes a respeito do comportamento dos limiares auditivos dos cirurgiões-dentistas. Objetivo: Investigar o conhecimento de alunos do curso de graduação em Odontologia sobre saúde auditiva e caracterizar o perfil audiológico e os hábitos auditivos dos participantes da pesquisa. Metodologia: Após a aprovação do Comitê de Ética sob o processo número 045/2009, o projeto foi realizado em duas etapas. A primeira constituiu-se da aplicação de questionários aos 367 alunos dos cursos de graduação em Odontologia da Faculdade de Odontologia de Bauru FOB/USP e USC e da Faculdade de Odontologia de São Paulo FO/USP. Na segunda etapa, 25 alunos do primeiro e quarto anos de graduação das faculdades de Bauru foram convidados a realizar as seguintes avaliações: audiológica convencional, logoaudiometria, imitanciometria e a avaliação complementar (audiometria de altas frequências e emissões otoacústicas transientes e por produto de distorção). Resultados: Na primeira etapa, verificou-se que os alunos desconhecem o risco que o ambiente ocupacional e de lazer proporcionam à saúde auditiva e, desse modo, verificou-se que se faz necessária a conscientização sobre a exposição do ruído e suas consequências a fim de criar um programa de promoção e prevenção principalmente na saúde ocupacional dessa população, considerando que essa problemática interfere na qualidade de vida dos que atuam na profissão odontológica. Na segunda etapa completaram as provas 25 participantes (X= 23 anos). Apesar dos limiares se encontrarem de acordo com a normalidade para a OMS (Organização Mundial de Saúde) e também para a Portaria nº 19 do Ministério do Trabalho, houve uma entalhe na frequência de 6 kHz e 12,5 kHz em ambas as orelhas na audiometria convencional e audiometria tonal de altas frequências. A média mínima encontrada na orelha direita foi de 4,6 dB em 14 kHz e para a orelha esquerda foi de 4 dB em 1 kHz e a média máxima para a orelha direita foi de 12,4 dB em 6 kHz e para a orelha esquerda foi de 14 dB em 6 kHz. Para a logoaudiometria e imitanciometria, 100% dos participantes apresentaram exame de forma compatível com a audiometria convencional. No registro das EOE, pôde-se verificar que quanto maior o limiar de audibilidade nas frequências estudadas mais se evidencia a ausência das EOE-t e EOE-DP para ambas as orelhas, exceto na comparação do limiar de audibilidade em 1 kHz nas EOE-t, provavelmente devido à contaminação pelo ruído de fundo durante o registro das mesmas e na frequência de 3 kHz nas EOE-DP. Conclusão: Os questionários aplicados se mostraram eficientes atingindo o objetivo proposto. Quanto à caracterização do perfil audiológico foi possível concluir que o exame de emissões otoacústicas tanto transientes quanto por produto de distorção se mostraram mais eficientes como um exame complementar para identificar precocemente as alterações auditivas nessa população. / Introduction: Professionals of the dental area handle daily with noisy instruments, what may come to cause audibly alterations and negative effects at the communication and life quality of these professionals. Considering the fact that such noise can not be eliminated, it is important that the awareness of future dental professionals is initiated early on in the university, mentioning the risks to which they are being exposed so that they can control them with prevention and treatment, as well as acquire consistent information about the behavior of the auditory thresholds of surgeon dentists. Objective: To investigate the knowledge about hearing health of students of graduation in odontology, characterize the audiological profile and listening habits of the research participants. Methodology: After approval by the Ethics Committee under case number 045/2009, the project was conducted in two stages. The first consisted of questionnaires to 367 students of undergraduate courses in Odontology from the Faculty of Odontology of Bauru FOB/USP and USC and from Faculty of Odontology of São Paulo FO/USP. In the second stage, 25 students from first and fourth years of undergraduate faculties of Bauru were invited to conduct the following assessments: audiometry, speech audiometry, impedance tests and additional assessment (high frequency audiometry and otoacoustic emissions and distortion product). Results: In the first stage, it was observed that students are unaware of the risk the workplace and the leisure environment provide the hearing health and, thereby, it was verified that awareness is needed about noise exposure and its consequences, in order to create a program of promotion and prevention, especially in occupational health in this population, considering that this problem affects the quality of life of those who work in the dental profession. In the second phase 25 participants completed the tests (X = 23 years). Although the thresholds meet according to normality by the WHO (World Health Organization) and also to Ordinance No. 19 of Ministry of Labor, there was a notch in the frequency of 6 kHz and 12,5 kHz in both ears in conventional audiometry and high frequency audiometry. The average minimum found in the right ear was 4.6 dB at 14 kHz to the left ear was 4 dB at 1 kHz and the average maximum for the right ear was 12.4 dB at 6 kHz and to the left ear was 14 dB at 6 kHz. For speech audiometry and immittance, 100% of the participants presented examination consistent with conventional audiometry. In the record of EOE, it was found that the higher the threshold of audibility frequencies studied, the more evident is the lack of EOE-t and EOE-DP for both ears, except when comparing the hearing threshold at 1 kHz in the EOE-t, probably due to contamination by background noise during the registration thereof and in the frequency of 3 kHz in the EOE-DP. Conclusion: The questionnaires applied proved to be efficient, reaching the objective. As for the characterization of the audiological profile, it was concluded that, the test of both transient otoacoustic emissions and distortion product, proved more efficient as a complementary test for early detection of hearing alterations in this population.

Variation in health care, whether it be in terms of the utilisation of resources, observed health outcomes, costs, quality or access to health care is a well recognised and ever present feature of the modern day health care system. Health care variations challenge basic assumptions about the nature of the health care economy and raise questions about efficiency, equity and where best to direct policy instruments in health care markets. Despite the vast literature documenting variation, and the many discussions around ways to reduce variations in health care markets, the field of dental care has received little interest, in comparison to that of general medical care. This thesis will address this gap and will analyse the variation observed in a specific dental care treatment (dental radiographs) within NHS Scotland, with particular emphasis on the contribution of both dentist and patient unobserved heterogeneity. The thesis takes its focus from two strands of the literature; the underlying theoretical aspect draws on the literature concerning the theory of incentives and physician agency, whilst the empirical component makes use of recent advances in micro-econometric methods, documented in the labour economics literature. Although the thesis is predominantly an empirical analysis, the estimation strategy combines ideas from both the theoretical and empirical literature. A matched patient provider dataset from NHS Scotland is used to conduct an analysis of the variation in dental radiographs, in the presence of, and controlling for unobserved dentist and patient heterogeneity. The results indicate that the remuneration structure alone has little or no impact on the treatment decision to provide a radiograph. When a dentist changes from being on a fixed salary contract to being paid on a fee-for-service basis, they are in fact less likely to provide a radiograph. This result changes in the presence of insurance (identified as being when patients are exempt from the patient charge) and indicates that when the self employed dentist can identify the patient as being exempt, they are more likely to provide a radiograph. This result provides some support for the theory that in the presence of insurance, financial incentives do influence the treatment decision. A final result of the study highlights the importance of accounting for unobserved patient and provider heterogeneity, a factor that has had little attention in the healthcare literature. The results suggest that patient variation, as opposed to the variation across dentists, is much more important in explaining total variation. This is a similar result to that found in both the labour and education literatures.