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Aloshaiby A, Gaber A, Arheiam A. The oral health care system in Libya: a case study. BMC Oral Health 2024; 24:888. [PMID: 39097699 PMCID: PMC11297658 DOI: 10.1186/s12903-024-04684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND This study aims to describe the Libyan oral health care system in terms of its structure, function, workforce, funding, reimbursement and target groups. METHODS A single descriptive case study approach and multiple sources of data collection were used to provide an in-depth understanding of the Libyan oral health care system. A purposeful sample of the key informants (Managers of oral health centers, dentists of various specialties with experience in the field, dentists, nurses, dental technicians, and officials in the affairs of medical insurance) was recruited. The case and its boundaries were guided by the study's aim. Both qualitative and quantitative analyses were conducted. Descriptive statistics were used for quantitative data. Framework analysis, informed by the study objectives, was used to analyze interviews and documents. RESULTS The analysis showed that oral health services are integrated into medical services. The provision of dental care is mainly treatment-based, in the private sector. The oral health services in the public sector are mainly emergency care and exodontia. The dental workforce included in the study were mostly dentists (89% General Dental Practitioners (GDPs), 11% specialists), with a marked deficiency in dental technicians and nurses. Around 40% of dentists work in both the private and public sectors. The government provides the funding for the public sector, but the private sector is self-funded. No specific target group(s) nor clear policies were reported. However, the system is built around primary health care as an overarching policy. Dental caries is the most common oral problem among Libyan preschool children affecting around 70% and is the most common cause of tooth loss among adults. CONCLUSION The oral health care system in Libya is mainly privatized. The public health services are poorly organized and malfunctioning. There is an urgent need to develop policies and plans to improve the oral health care system in Libya.
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Affiliation(s)
- Aisha Aloshaiby
- Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Benghazi, Libya
| | - Amal Gaber
- Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Benghazi, Libya
| | - Arheiam Arheiam
- Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Benghazi, Libya.
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Fernández-Serrano J, García-Espona E, Alarcón JA, García-Espona C, García-Espona I. Differences in the Ratios of General and Dental Specialists in Europe. Int Dent J 2024; 74:519-525. [PMID: 38228432 PMCID: PMC11123524 DOI: 10.1016/j.identj.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The European Economic Area (EEA) is composed of member states with a multitude of different regions. This study aimed to analyse the ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists in 24 European countries and to explore specific intranational differences within 2 countries: France and Germany. METHODS Available official documents and webpages from the United Kingdom and 23 of the 30 countries comprising the EEA were analysed. Data were expressed as absolute values, ratios of general dentists and dental specialists in the total of population, and percentages of dental specialists/dentists. The Mann-Whitney U test was used to clarify the main ratios that distinguish France from Germany, and cluster analysis was employed to determine similar areas. RESULTS Significant differences were found between countries, with Ireland and Austria having the lowest ratio of dentists and Romania and Greece having the highest. The Czech Republic, the Netherlands, France, and Denmark had the lowest ratios of dental specialists to the total population. Lithuania, Sweden, and Germany had the highest number of dental specialists. Orthodontists were the most numerous specialists (5.0% of dentists), followed by oral surgeons (2.7%). In France, differences between departments were pronounced and associated with the presence of dental schools and per capita income. In Germany, only the correlation between per capita income and the density of oral surgeons was significant. CONCLUSIONS Diverse ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists were discovered within the examined countries, and their maximum values were 2.5, 5.7, and 4.1 times the minimum values, respectively. Differences were even found within the same country, as was the case in France and, to a lesser extent, in Germany.
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Affiliation(s)
- Javier Fernández-Serrano
- Department of Stomatology, Section of Orthodontics, School of Dentistry, University of Granada, Granada, Spain
| | - Eugenia García-Espona
- Department of Stomatology, Section of Orthodontics, School of Dentistry, University of Granada, Granada, Spain
| | - José Antonio Alarcón
- Department of Stomatology, Section of Orthodontics, School of Dentistry, University of Granada, Granada, Spain.
| | - Cristina García-Espona
- Department of Stomatology, Section of Orthodontics, School of Dentistry, University of Granada, Granada, Spain
| | - Ignacio García-Espona
- Department of Stomatology, Section of Orthodontics, School of Dentistry, University of Granada, Granada, Spain; President of the Spanish Association of Orthodontists (AESOR), Madrid, Spain
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Davda LS, Radford DR, Scambler S, Gallagher JE. A typology of internationally qualified dentists in the United Kingdom. J Migr Health 2024; 9:100232. [PMID: 38826513 PMCID: PMC11141152 DOI: 10.1016/j.jmh.2024.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/11/2023] [Accepted: 05/05/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.
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Affiliation(s)
- Latha S Davda
- Ministry of Defence, Bulford SP4 9AD, UK
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
| | - David R Radford
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Sasha Scambler
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Jennifer E Gallagher
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
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Cebrino J, Portero de la Cruz S. Factors related to depression in adults with oral health problems in Spain (2017 to 2020). Front Public Health 2024; 12:1364119. [PMID: 38476497 PMCID: PMC10927730 DOI: 10.3389/fpubh.2024.1364119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Background The need to study the link between gender, depression, and oral health is becoming increasingly evident. This study therefore aimed to determine the prevalence and evolution over time of depression among women and men with oral health problems and to evaluate the association between depression status, lifestyle-related variables health-related variables and use of dental health services in those people. Methods We performed a nationwide cross-sectional study on 25,631 adults with oral health problems residing in Spain from the Spanish National Health Survey 2017 and the European Health Survey of Spain 2020, including as the main variable self-reported diagnosis of depression. We analysed independent variables such as lifestyle-related variables, health-related variables, and variables related to dental health services. Sociodemographic characteristics were considered as control variables. Results The prevalence of depression among adults with oral health problems in Spain was 7.81% (10.14% for women, 5.39% for men), with a notable decrease from 2017 to 2020 in women. Depressed women had a slightly higher percentage of filled or capped teeth, and had more covers (crowns), bridges or other types of prostheses or dentures, while men had more caries. Women also made more frequent, regular dental visits for check-ups and mouth cleaning, whereas men often needed extractions. Unfavourable associated factors in both genders were: perceiving their health as good, average, poor, or very poor, and having 1-2 and ≥ 3 comorbidities. Conversely, not being a current smoker was related to less likelihood of depression. In women only, not engaging in leisure-time physical activity produced more unfavourable associated factors. Conclusion The prevalence of depression among adults with oral health problems in Spain from 2017 to 2020 was 7.81%, but this figure has been steadily decreasing over time. In addition, the favourable and unfavourable associated factors could help us inform health professionals and authorities in order to prevent depression and enhance the care of this population according to gender.
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Affiliation(s)
- Jesús Cebrino
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
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Rodríguez-Fernández A, Vázquez-Cancela O, Piñeiro-Lamas M, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study. Antimicrob Resist Infect Control 2023; 12:20. [PMID: 36941734 PMCID: PMC10026418 DOI: 10.1186/s13756-023-01225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dentist play an important role in misuse of antibiotics. Identification of the dental activities linked to the misuse of antibiotics is important for improving dentists' prescribing quality. The aim of the study was to quantify the magnitude of inappropriate antibiotic prescribing by dentists in Spain and identify the characteristics, knowledge and attitudes that influence prescribing quality. MATERIAL AND METHODS We conducted a cross-sectional, questionnaire-based study on dentists in Spain, assessing prescribing quality (dependent variable) on the basis of their responses about the prescription of antibiotics in 14 clinical situations. As the independent variables, we assessed professional characteristics and attitudes (lack of knowledge, fear, complacency, scheduling problems, and economic benefit) measured on a Likert scale. Odds Ratios (OR) (95%CI) were calculated using logistic regression. RESULTS A total of 878 participants were included in the analysis. Half of all dentists displayed inappropriate antibiotic prescribing habits in more than 28.6% (10/14) of the clinical situations posed (interquartile range 57-79%). Prescribing quality increased when resistance was perceived as a public health problem (OR 0.88, 95% CI: 0.79-0.97), and decreased in response to fear (OR 1.12, 95% CI:1.07-1.18) or the pursuit of economic benefit (OR 1.07, 95% CI 1.01-1.14). Having over 30 years' experience (OR 4.58, 95% CI:1.80-12.48) and/or practising in the field of prosthodontics as opposed to endodontics (OR 2.65, 95% CI:1.26-5.71) were associated with worse prescribing quality. CONCLUSIONS Antibiotics are the most commonly prescribed drugs in dentistry, and in many cases this prescription is inappropriate. Our findings shows that modifiable factors influence prescribing quality among dentists in Spain. These may be use for designing educational and training programmes for dentists.
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Affiliation(s)
- Almudena Rodríguez-Fernández
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
| | - Olalla Vázquez-Cancela
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain.
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital, Santiago de Compostela, Spain.
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
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Eirey SM, San-Roman-Montero J, Gil de Miguel A, Rojo R, López Sánchez AF. Effect of the 2008 economic crisis on oral health in Spain: analysis of serial cross-sectional, population-based health surveys. BMJ Open 2022; 12:e061947. [PMID: 36517101 PMCID: PMC9756153 DOI: 10.1136/bmjopen-2022-061947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the economic crisis on the oral health of individuals in Spain based on variables including sex, unemployment, social class and educational level. DESIGN This was an analysis of serial cross-sectional, population-based health surveys conducted before the crisis (2003 and 2006) and during the crisis (2011, 2014 and 2017). SETTING National Health Surveys of Spain and the European Health Survey in Spain.ParticipantsA total of 189 543 participants were recruited. OUTCOME MEASURES The independent variables were sex, employment, social class and educational level. The dependent variables were related to oral health. Descriptive statistics, χ2 tests and the Cochran-Mantel-Haenszel test were performed. RESULTS The results showed that there were differences (p<0.001) in all oral health indicators before and after the crisis. Compared with the precrisis period, men had a higher probability of tooth extractions (OR 1.41, 95% CI 1.37 to 1.45), dental fillings (OR 1.30, 95% CI 1.27 to 1.34), prostheses (OR 1.04, 95% CI 1.01 to 1.07) and missing teeth (OR 1.35, 95% CI 1.31 to 1.39). Unemployed individuals were more likely to have dental caries (OR 1.08, 95% CI 1.00 to 1.16) and missing teeth (OR 1.36, 95% CI 1.27 to 1.46). Working class individuals had a higher probability of tooth extractions (OR 1.63, 95% CI 1.59 to 1.67), bleeding gums (OR 1.04, 95% CI 1.01 to 1.07), prostheses (OR 1.05, 95% CI 1.02 to 1.07) and missing teeth (OR 1.36, 95% CI 1.33 to 1.39). Participants with a basic or intermediate level of education had a higher probability of dental mobility (OR 1.13, 95% CI 1.07 to 1.19), prostheses (OR 1.11, 95% CI 1.08 to 1.14) and missing teeth (OR 1.42, 95% CI 1.38 to 1.46). CONCLUSIONS The economic crisis affected the oral health of the Spanish population, with a more significant deterioration among men, working class individuals and unemployed individuals.
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Affiliation(s)
- Silvia Méndez Eirey
- Doctoral Program in Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Jesús San-Roman-Montero
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil de Miguel
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Rosa Rojo
- Faculty of Dentistry, Universidad Alfonso X el Sabio, Villanueva de la Canada, Spain
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McAuliffe Ú, Woods N, Barrett S, Cronin J, Whelton H, Harding M, Eaton K, Burke S. Comparing oral health systems for children in six European countries to identify lessons learned for universal oral health coverage: A study protocol. HRB Open Res 2022; 5:5. [PMID: 37767201 PMCID: PMC10520513 DOI: 10.12688/hrbopenres.13458.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 09/29/2023] Open
Abstract
Background: Oral diseases have the highest global prevalence rate among all diseases, with dental caries being one of the most common conditions in childhood. A low political priority coupled with a failure to incorporate oral health within broader health systems has contributed to its neglect in previous decades. In response, calls are emerging for the inclusion of oral health within the universal healthcare domain (UHC). This protocol outlines the methodology for a cross-country comparative analysis of publicly funded oral health systems for children across six European countries, reporting on oral health status in line with the indicators for UHC. Methods: This study will follow Yin's multiple case study approach and employ two strands of data collection, analysis, and triangulation: a systematic documentary analysis and semi-structured interviews with elite participants local to each country. The countries chosen for comparison and providing a representative sample of European dental systems are Denmark, Hungary, the Republic of Ireland, Germany, Scotland, and Spain. A systematic search of five electronic databases and four additional electronic resources will be undertaken, in addition to grey literature and other publicly available sources, with the outcomes verified and further informed by local experts. The WHO Universal Health Coverage Cube will be used to guide data collection and analysis. Conclusions: This research will provide policy makers with an in-depth analysis and comparison of publicly funded oral health systems for children in Europe, including consideration of effective preventive strategies, oral health system reform, and indicators of universal oral health coverage. It is anticipated that the outcomes may help in positioning oral health on governmental health agendas and support its integration into wider health systems' reform in an accessible and affordable manner.
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Affiliation(s)
- Úna McAuliffe
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, T12E8YV, Ireland
- School of Public Health, University College Cork, Cork, Co Cork, T12K8AF, Ireland
| | - Noel Woods
- Centre for Policy Studies, Cork University Business School, Cork, Co Cork, T12EP08, Ireland
| | - Shauna Barrett
- Cork University Hospital Library, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Jodi Cronin
- Centre for Policy Studies, Cork University Business School, Cork, Co Cork, T12EP08, Ireland
| | - Helen Whelton
- College of Medicine and Health, University College Cork, Cork, Co. Cork, T12EDK0, Ireland
| | - Máiréad Harding
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, T12E8YV, Ireland
- Cork University Dental School and Hospital, Wilton, Cork, T12EYV, Ireland
| | - Kenneth Eaton
- Eastman Dental Institute, University College London, 21 University Street, London, WC16DE, UK
- University of Kent, Chatham Maritime, ME4 4AG, UK
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, D02 PN40, Ireland
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Hernández-Ruiz RE, Rosel-Gallardo EM, Cifuentes-Jiménez C, González-López S, Bolaños-Carmona MV. Gender and Leadership Positions in Spanish Dentistry. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221109970. [PMID: 35912432 PMCID: PMC9340893 DOI: 10.1177/00469580221109970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dentists in Spain reached equal gender representation in 2012 and the number of female dentists has continued to grow (until 57.3% in 2020). This study aims to increase evidence about the gender distribution on the high responsibility positions and opinion leaders of the dental profession and academia. Composition of the executive comities of the main dental institutions of Spain (regional professional associations, national dental association, and scientific societies), members of the Faculty of Dentistry of the University of Granada in 2020 and speakers of the main dental congresses of 2019 (due to the lack of congress in 2020) were recorded and analyzed by genders using chi-squared test (P < .05). Mean representation of female dentists in executive committees of professional associations was 35.6%. More than 70% of presidents and vice-presidents of professional colleges and more than 60% of these positions in scientific societies were occupied by male dentists. None of dental congresses of 2019 reached equal gender participation, being 81.3% of lecturers presenting on main auditoriums male dentists. Although dental workforce in Spain is slightly overrepresented by females, leadership positions and figures among Spanish dentists doesn’t seem to reflect the gender distribution of the collective. There is a lack of women occupying high-level positions in dentistry that proves the existence of the so-called “glass ceiling effect” on the profession. Further studies about sociodemographic aspects of dental workforce are needed to develop evidence-based policies for the collective.
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Affiliation(s)
- Rocío E. Hernández-Ruiz
- School of Dentistry of the University of Granada, Campus de Cartuja, Colegio Maximo s/n, Granada, Spain
| | - Eva M. Rosel-Gallardo
- School of Dentistry of the University of Granada, Campus de Cartuja, Colegio Maximo s/n, Granada, Spain
| | | | - Santiago González-López
- School of Dentistry of the University of Granada, Campus de Cartuja, Colegio Maximo s/n, Granada, Spain
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Cărămidă M, Țâncu AMC, Imre M, Dumitrache MA, Mihai C, Sfeatcu R. Patients' Perspective on Their Experience of Dental Treatments Covered by Public Health Insurance in Romania-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:272. [PMID: 35010534 PMCID: PMC8744563 DOI: 10.3390/ijerph19010272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Although the aims of any public health coverage are prevention, diagnosis, treatment, rehabilitation, and maintenance, dental services are hardly ever included in services. The goal of our pilot study is to assess the perspective of a group of adult patients on their covered dental treatments. The present cross-sectional study was conducted on 140 patients who reported their perception by filling in a questionnaire. All the collected data were statistically analyzed using IBM SPSS Statistics 25. Most of the subjects (40.7%, n = 57) were treatment oriented, visiting the dentist only in an emergency situation. A total of 40.7% (n = 57) of the participants stated that all the dental treatments had coverage and 22.8% (n = 13) had to split their treatment plan because of the insurance budget limit. The subjects who had chosen covered dental services because they considered it was a right they should benefit from (53.7%, n = 22) and those who had chosen covered dental services because of financial reasons (29.3%, n = 12) were more frequently unsatisfied with the types of covered dental services. The reduced level of satisfaction was associated mainly with the list of dental procedures accepted for coverage and also with younger and highly educated patients. For a more accurate description, the present study should be completed by future studies not only on a representative population at national level, but also by assessing the perspective of dental professionals.
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Affiliation(s)
- Mariana Cărămidă
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Ana Maria Cristina Țâncu
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Marina Imre
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Mihaela Adina Dumitrache
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Christina Mihai
- Department of Preventive Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania
| | - Ruxandra Sfeatcu
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
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den Boer JCL, van den Bosch LJ, van Dam BAFM, Bruers JJM. Work situation and prospects of recently graduated dentists in the Netherlands. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:837-845. [PMID: 33474782 PMCID: PMC8596787 DOI: 10.1111/eje.12663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/22/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Dentists who have graduated recently from a Dutch dental school work mainly in the Netherlands, where collaboration and differentiation are relevant factors. Furthermore, the Netherlands face regional undersupplies of dentists. The objective of this study was to describe choices and aims of recently graduated dentists for the near future. MATERIALS AND METHODS An invitation for the web questionnaire was sent by e-mail to 945 dentists who had graduated from a Dutch dental school between 2013 and 2017, of whom 230 (24.3%) participated in the survey. RESULTS Approximately three quarters (77%) of the recently graduated dentists worked as a general dentist in a practice of some else, primarily in urban areas. The choice for a practice was affected by location, earnings, and the opportunity to gain experience. Furthermore, the career choices were affected most by the desired length of the working week and financial security. The narrow majority (53%) of the recently graduated dentists believed that in 5 years they will be practice owner; 49% expected to be a differentiated dentist. Furthermore, 41% believed they will work in a smaller municipality. DISCUSSION Although recently graduated dentists seem receptive to work in smaller municipalities, the peripheral regions are conceivably less appealing. Practice ownership conceivably is an option for the near future for a narrow majority of the recently graduated dentists. CONCLUSION Recently graduated dentists have different preferences regarding their work situation in 5 years.
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Affiliation(s)
- Joost C. L. den Boer
- Department of Research & InformationRoyal Dutch Dental Association (KNMT)UtrechtThe Netherlands
- Department of Social DentistryAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Luuk J. van den Bosch
- Tandheelkundig Centrum Stad van de ZonHeerhugowaardThe Netherlands
- Tandheelkundig Centrum ObdamObdamThe Netherlands
| | | | - Josef J. M. Bruers
- Department of Research & InformationRoyal Dutch Dental Association (KNMT)UtrechtThe Netherlands
- Department of Social DentistryAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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11
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Jacob L, López-Sánchez GF, Smith L, Grabovac I. Associations between oral health and cancer in a national representative sample of Spanish adults. Eur J Public Health 2021; 31:1026-1030. [PMID: 34510199 DOI: 10.1093/eurpub/ckab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate the association between several oral health outcomes and cancer in adults living in Spain. METHODS Data from the Spanish National Health Survey 2017 were analysed. Seven oral health outcomes (dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material and missing tooth) were assessed with questions with 'yes' and 'no' options. Cancer was assessed and defined with the following yes-no question: 'Have you ever been diagnosed with malignant tumours?'. The relationship of each oral health outcome and the number of poor oral health outcomes with cancer was studied in regression models adjusted for sex, age, marital status, education, smoking and alcohol consumption. RESULTS This study included 23 089 participants aged 15-103 years [45.9% of males; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of cancer was 5.0% in the overall population. After adjusting for several potential confounding factors, all oral health outcomes except missing tooth were significantly and positively associated with cancer [odds ratios (ORs) ranging from 1.15 for dental filling to 1.48 for dental extraction]. In addition, there was a positive and significant association between the number of poor oral health outcomes and cancer (OR = 1.16, 95% confidence interval = 1.11-1.22). CONCLUSIONS On a nationally representative sample of 23 089 participants in Spain, poorer oral health outcomes were found in participants with history of cancer, with positive associations between several oral health outcomes as well as the number of poor oral health outcomes and cancer.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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12
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Alon I, Pinilla J. Assisted reproduction in Spain, outcome and socioeconomic determinants of access. Int J Equity Health 2021; 20:156. [PMID: 34229664 PMCID: PMC8259134 DOI: 10.1186/s12939-021-01438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
RESEARCH QUESTION We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. DESIGN We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. RESULTS The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. CONCLUSIONS Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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13
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López-Velasco A, Puche-Torres M, Carrera-Hueso FJ, Silvestre FJ. General anesthesia for oral and dental care in paediatric patients with special needs: A systematic review. J Clin Exp Dent 2021; 13:e303-e312. [PMID: 33680333 PMCID: PMC7920568 DOI: 10.4317/jced.57852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The objective of this study is to conduct a systematic review of the literature on the characteristics, needs and current situation of dental care for pediatric patients with special needs. MATERIAL AND METHODS An exhaustive search for literature published until June 1, 2020. It was carried out using PubMed, Web of Science, Scopus, Cochrane and EBSCO, with the following keywords: Oral Surgical Procedures and Dentistry, Operational and Anesthesia, General Y (Spanish[lang] or English[lang] ) Y (infant[MeSH] Or child[MeSH] Or adolescent[MeSH]). The research was carried out following the PRISMA research methodology. RESULTS The most common indication for general anesthesia (GA) was tooth decay in 16 studies (6.5-90.8% of patients), followed by lack of cooperation and/or fear of dental professionals performing dental procedures in 8 studies. There is a higher prevalence of treatment in the group of patients with special needs, reaching 87.7% compared to 69.9% in healthy patients. CONCLUSIONS In paediatric patients with special needs the use of GA is increasing, monitoring and preventive care are insufficient and withdrawal rates are high. Key words:Oral surgical procedures and dentistry, operational and anesthesia, general.
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Affiliation(s)
- Ana López-Velasco
- DDS. Service of Stomatology, Centro de Especialidades El Grao, Departamento Hospital clínico/Malvarrosa, Valencia; Pediatric dentistry Associate Professor Universidad European de Valencia, Valencia, Spain. Attached Dentist Center Specialties and Clinical/Malvarrosa University Hospital of Valencia. Assistant Professor Department of Pediatric Dentistry European University of Valencia, Valencia, Spain
| | - Miguel Puche-Torres
- MD, PhD. Department of Maxillofacial Surgery, Hospital Clínico Universitario de Valencia, INCLIVA. Associate Professor, Surgery Department, Facultad de Medicina y Odontología Universidad de Valencia, Valencia, Spain. Scopus Author ID: 23477898100. Department Head maxillofacial surgery service, Clinical/Malvarrosa University Hospital of Valencia. Associate Professor, Surgery Department, Faculty of Medicine and Dentistry University of Valencia, Valencia, Spain 3 PharmD. PhD. Pharmacy Service. Hospital Universitario La Plana, Villa-real (Castellón) Spain. Attached Pharmacist University La Plana Hospital of Castellón, Spain
| | - Francisco J Carrera-Hueso
- PharmD. PhD. Pharmacy Service. Hospital Universitario La Plana, Villa-real (Castellón) Spain. Attached Pharmacist University La Plana Hospital of Castellón, Spain
| | - Francisco-Javier Silvestre
- MD, DDS, PhD. Stomatology Unit. Hospital Universitario Dr. Peset de Valencia y Departamento de Estomatología Universidad from Valencia, Valencia, Spain. Attached Stomatologist Hospital Dr. Peset of Valencia. Professor Special Patiens Faculty of Medicine and Dentistry University of Valencia, Valencia, Spain
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14
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Baracco B, Ceballos L, Llorente A, Fuentes MV. Impact of COVID-19 on the work of Spanish dentists: An early response to the pandemic. J Clin Exp Dent 2021; 13:e148-e155. [PMID: 33574999 PMCID: PMC7864362 DOI: 10.4317/jced.57941] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background This study aimed to assess the quality of the information about COVID-19 that Spanish dentists felt they were provided; their opinion about the actions by Health Institutions; their perception of the risk infection at work; and the security measures implemented to prevent contagion.
Material and Methods A specific questionnaire was developed and made available online from March 18th to 20th 2020. Dentists working in Spain were invited to answer. Questions were divided in 4 sections: demographic data and professional activity; specific information on COVID-19 and opinion about the decisions taken by Dental Councils and Health Authorities; risk assessment for SARS-CoV-2 in dental practices; and implementation of new ways of working. Chi-square tests were computed (p<0.05). 873 dentists answered the survey.
Results A majority of dentists considered that Health Authorities did not take right decisions during the outbreak (86.37%), and were concerned both about getting infected at work (83.16%) and being a potential carrier to their patients (72.97%). Due to COVID-19, 59.11% of the dentists incorporated new protective measures in the dental practice, 60.17% began dealing with emergencies only and 39.18% stopped working.
Conclusions Most dentists were worried about infection in their workplaces, particularly women and dentists from the most affected regions by COVID-19. Almost 90% of the participants considered that this pandemic will change the way they provide dental care in the future. Key words:COVID-19, pandemic, disease transmission, dentists´ behavior, dental practice.
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Affiliation(s)
- Bruno Baracco
- Faculty of Health Sciences, IDIBO Research Group, Rey Juan Carlos University, Madrid, Spain
| | - Laura Ceballos
- Faculty of Health Sciences, IDIBO Research Group, Rey Juan Carlos University, Madrid, Spain
| | | | - Mª Victoria Fuentes
- Faculty of Health Sciences, IDIBO Research Group, Rey Juan Carlos University, Madrid, Spain
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15
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Urbanos-Garrido RM. Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession. Int J Equity Health 2020; 19:207. [PMID: 33183287 PMCID: PMC7658913 DOI: 10.1186/s12939-020-01317-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dental health is an important component of general health. Socioeconomic inequalities in unmet dental care needs have been identified in the literature, but some knowledge gaps persist. This paper tries to identify the determinants of income-related inequality in unmet need for dental care and the reasons for its recent evolution in Spain, and it inquires about the traces left by the Great Recession. METHODS Data from the EU-SILC forming a decade (2007-2017) were used. Income-related inequalities for three years were measured by calculating corrected concentration indices (CCI), which were further decomposed in order to compute the contribution of different factors to inequality. An Oaxaca-type decomposition approach was also used to analyze the origin of changes over time. Men and women were analyzed separately. RESULTS Pro-rich inequality in unmet dental care needs significantly increased over time (CCI 2007: - 0.0272 and - 0.0334 for males and females, respectively; CCI 2017: - 0.0704 and - 0.0776; p < 0.001). Inequality showed a clear "pro-cycle" pattern, growing during the Great Recession and starting to decrease just after the economic recovery began. Gender differences only were significant for 2009 (p = 0.004) and 2014 (p = 0.063). Income was the main determinant of inequality and of its variation along time -particularly for women-, followed by far by unemployment -particularly for men-; the contributions of both were mainly due to changes in elasticites. CONCLUSIONS The Great Recession left its trace in form of a higher inequality in the access to dental care. Also, unmet need for dental care, as well as its inequality, became more sensitive to the ability to pay and to unemployment along recent years. To broaden public coverage of dental care for vulnerable groups, such as low-income/unemployed people with high oral health needs, would help to prevent further growth of inequality.
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Affiliation(s)
- Rosa M Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, School of Economics & Business, University Complutense of Madrid, Campus de Somosaguas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Gomez-Aguilar B, Jiménez-Garcia R, Palomar-Gallego MA, Hernández-Barrera V, Carabantes-Alarcón D, López-de Andres A. Oral health status among Spanish adults with diabetes: National Health Survey, 2017. Prim Care Diabetes 2020; 14:552-557. [PMID: 32057726 DOI: 10.1016/j.pcd.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
AIMS We aim i) to describe self-reported oral health among patients with diabetes in Spain; ii) to recognize which variables (socio-demographic, lifestyle and health-related), were related to poor self-reported oral health in patients with diabetes. METHODS We used data from subjects of the National Health Interview Survey performed in 2017. Diabetes status was self-reported. One non-diabetes patient was matched by gender and age for each diabetes case. Poor self-reported oral health was defined using the answers "I have dental caries" to the following question: "What is the state of your teeth and molars?". Socieconomic, demographic, comorbidities, health status, health care-related were independent variables. RESULTS We found that the prevalence of dental caries was higher among subjects with diabetes than their matched controls (23.8% vs. 16.5%; P < 0.001). The OR of dental caries for people with diabetes was 1.45 (95% CI 1.12-1.30). Older age, having lower monthly income, obesity, periodontal disease, very poor/poor/ fair self-rated health and having public dental health insurance increased the probability of suffering caries. CONCLUSIONS Poor self-reported oral health was higher among people with diabetes compared to non-diabetes controls. Physicians and dentists should increase their awareness with their patients with diabetes, especially those with obesity, younger and with lower education.
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Affiliation(s)
- Belén Gomez-Aguilar
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Rodrigo Jiménez-Garcia
- Departamento de Salud Publica y Materno-infantil, Facultad de Medicina, Complutense University, Madrid, Spain.
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - David Carabantes-Alarcón
- Departamento de Salud Publica y Materno-infantil, Facultad de Medicina, Complutense University, Madrid, Spain
| | - Ana López-de Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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17
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Almerich-Torres T, Montiel-Company JM, Bellot-Arcís C, Iranzo-Cortés JE, Ortolá-Siscar JC, Almerich-Silla JM. Caries Prevalence Evolution and Risk Factors among Schoolchildren and Adolescents from Valencia (Spain): Trends 1998-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186561. [PMID: 32916930 PMCID: PMC7560151 DOI: 10.3390/ijerph17186561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the caries status and risk factors in the schoolchildren of Spain’s Valencia region in 2018 and to compare them to the 20-year evolution of caries indicators in the region. A cross-sectional survey was conducted with 1722 children and adolescents aged between 6 and 15 using cluster sampling. Caries status, using International Caries Detection and Assessment System II (ICDAS II) criteria, and sociodemographic variables were recorded. To ensure the comparison with previous studies using WHO caries criteria, the cut-off point was established at ICDAS II code 4. Caries prevalence was found to be 37.4% and the decayed and filled teeth index (dft) was 1.23 at 6 years for deciduous dentition (DD). In permanent dentition (PD) at 12 years, caries prevalence was 30.1% with a 0.66 decayed, missing and filled teeth index (DMFT), and at 15 years, prevalence was 44.6% and DMFT was 1.21. Socioeconomic status poses a major risk factor for caries prevalence in deciduous dentition; it is 1.8 times higher in the lowest socioeconomic group. Deciduous dentition status has worsened in the most recent eight-year period, whereas in permanent dentition the 12- and 15-year values are similar to those of the 2010 survey. Evolution analysis suggests that community dental care programs be enhanced, involving preventive activities staring at the first year and targeting disadvantaged groups.
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18
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Mazevet ME, Garyga V, Mayne C, Pitts NB, Pennington MW. 2018 French dental contracts: On the road to achieving universal dental health coverage? Health Policy 2020; 124:781-786. [DOI: 10.1016/j.healthpol.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 02/25/2020] [Accepted: 04/28/2020] [Indexed: 11/24/2022]
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den Boer JCL, van der Sanden WJM, Bruers JJM. Developments in oral health care in the Netherlands between 1995 and 2018. BMC Oral Health 2020; 20:192. [PMID: 32641034 PMCID: PMC7346473 DOI: 10.1186/s12903-020-01174-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers. Methods Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times. Results Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior. Conclusions Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.
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Affiliation(s)
- Joost C L den Boer
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Research & Information, Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands.
| | - Wil J M van der Sanden
- Department of Dentistry, Quality and Safety of Oral Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josef J M Bruers
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Research & Information, Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
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Varela-Centelles P, Seoane J, Ulloa-Morales Y, Estany-Gestal A, Blanco-Hortas A, García-Pola MJ, Seoane-Romero JM. People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain. Med Oral Patol Oral Cir Bucal 2020; 25:e455-e460. [PMID: 32388529 PMCID: PMC7338074 DOI: 10.4317/medoral.23292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/22/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. MATERIAL AND METHODS Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist. CONCLUSIONS General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer.
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Oral Health Problems and Utilization of Dental Services Among Spanish and Immigrant Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030738. [PMID: 31979248 PMCID: PMC7036804 DOI: 10.3390/ijerph17030738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 01/12/2023]
Abstract
Spanish and immigrant children and adolescents vary widely in their frequency of dental visits and occurrence of dental problems. The aims of this study were to discover the prevalence of dental problems and utilization of dental services in the Spanish and immigrant child population, identify the type of treatment received, and analyze the socioeconomic and demographic variables which are associated with dental problems and non-regular utilization of dental services, based on data from the 2017 National Health Survey in Spain. The sample consisted of 4568 children aged between 3 and 14 years old. Utilization of dental services and dental problems were assessed against socioeconomic and demographic characteristics using logistic regression models. The prevalence of caries in Spanish children was 9.29% compared with 18.58% (p < 0.001) in their immigrant counterparts. The most common reason for dental visits was a check-up (Spanish: 65.05%; immigrants: 54.94%). In both groups, from the age of 7, there was a lower probability of non-regular utilization of dental services, although this increased when the social class was lower. The probability of presenting dental problems was lower in Spanish children living in towns with over 10,000 inhabitants and was higher, in both groups, over the age of 7 and in lower social classes.
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Balenović A, Fazlić A, Mihelčić M, Hoch A, Radujković V. Sociodemographic Determinants and Common Reasons for Visiting the Emergency Dental Service in the City of Zagreb. Acta Stomatol Croat 2019; 53:247-254. [PMID: 31749456 PMCID: PMC6820444 DOI: 10.15644/asc53/3/6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective The objective of the study was to determine the sociodemographic and clinical parameters of patients who visit the emergency dental service and their most common diagnoses. Materials and Methods The data were collected on the basis of a survey filled out by patients. A total of 1730 out of 6732 patients (26%) were surveyed using a questionnaire to analyze sociodemographic status, dental visits, the description and dynamics of the symptoms. After the data collection, methods of descriptive data presentation and of inferential statistics were made in SPSS. Results Survey results show that most subjects (60.4%) came during the weekends and holidays. The subjects, 73.1% of them, stated that they had already used this type of service, and 65.8% did not visit their dentist beforehand. The largest number of subjects (62.2%) reported that they needed emergency service within a week after their problems had begun. The most common diagnoses included face and jaw abscesses (27.3%). There is a statistically significant difference between the number of patients who went to the emergency dental service and completed the questionnaire over the course of several months contrary to patients who were there in May and June (59.7%) compared to July and August (40.3%). Conclusions Most subjects had clear indications for being referred to an emergency dental service. Most of the emergency conditions were mainly due to irregular visits to the dentist. Patient education and preventive programs would probably have reduced the number of visits.
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Affiliation(s)
- Antonija Balenović
- Community healthcare center "Zagreb - Centar", Runjainova 4, Zagreb, Croatia
| | - Alem Fazlić
- Community healthcare center "Zagreb - Centar", Runjainova 4, Zagreb, Croatia
| | - Marko Mihelčić
- Community healthcare center "Zagreb - Centar", Runjainova 4, Zagreb, Croatia
| | - Andrea Hoch
- Community healthcare center "Zagreb - Centar", Runjainova 4, Zagreb, Croatia
| | - Vedran Radujković
- Community healthcare center "Zagreb - Centar", Runjainova 4, Zagreb, Croatia
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The healthcare systems and provision of oral healthcare in European Union member states. Part 10: comparison of systems and with the United Kingdom. Br Dent J 2019; 227:305-310. [DOI: 10.1038/s41415-019-0661-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rodriguez-Alvarez E, Lanborena N, Borrell LN. Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101691. [PMID: 31091780 PMCID: PMC6572320 DOI: 10.3390/ijerph16101691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022]
Abstract
This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10-1.67) and Africa (PR: 1.16, 95% CI: 1.05-1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46-2.01) and Asia (PR: 1.3, 95% CI: 1.23-1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Luisa N Borrell
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
- Department of Surgery, Medical and Social Science. University of Alcalá, 28871 Madrid, Spain.
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Lopez-de-Andrés A, Vazquez-Vazquez L, Martinez-Huedo MA, Hernández-Barrera V, Jimenez-Trujillo I, Tapias-Ledesma MA, de Miguel-Diez J, Jiménez-García R. Is COPD associated with periodontal disease? A population-based study in Spain. Int J Chron Obstruct Pulmon Dis 2018; 13:3435-3445. [PMID: 30425473 PMCID: PMC6203114 DOI: 10.2147/copd.s174898] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Periodontal disease is more prevalent and more severe among men and women suffering from chronic obstructive pulmonary disease (COPD) compared with healthy adults. The objectives of this paper were to assess the association between periodontal disease and COPD, controlling the effect of sociodemographic characteristics, oral health status, lifestyle variables, and comorbidities. Second, we identified which of the variables analyzed were independently associated with periodontal disease among COPD sufferers. Methods This descriptive study was done with data from the National/European Health Interview Surveys, conducted in years 2006, 2011/12, and 2014 in Spain. We included subjects ≥40 years of age. COPD status was self-reported. One non-COPD patient was matched by age, gender, and the year of survey for each COPD case. The presence of periodontal disease was defined using the answers "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the question: "Do you suffer of any of these dental and oral disorders or diseases?" Independent variables included demographic, socioeconomic, and health care-related variables, oral health status, and presence of comorbidities. Results The prevalence of periodontal disease was higher among COPD patients than their matched non-COPD controls (26.5% vs 22.2%; P<0.001). Adjusted odds ratio (AOR) of periodontal disease for subjects with COPD was 1.21 (95% CI: 1.12-1.30). Suffering mental disorders (AOR: 1.61; 95% CI: 1.32-1.97) was positively associated with higher risk of periodontal disease. Older age, having a private dental health insurance, and university education were variables associated with lower rates of periodontal disease. Conclusion Prevalence of periodontal disease was higher among those with COPD compared to non-COPD controls. Dentists and physicians should increase their awareness with their COPD patients, especially those who are younger, with lower education, and suffer depression and/or anxiety.
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Affiliation(s)
- Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Luis Vazquez-Vazquez
- Human Anatomy and Embryology Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Miguel A Tapias-Ledesma
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Javier de Miguel-Diez
- Respiratory Department, Gregorio Marañon General University Hospital, Medical School, Complutense University, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
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Eaton KA, Ramsdale M, Leggett H, Csikar J, Vinall K, Whelton H, Douglas G. Variations in the provision and cost of oral healthcare in 11 European countries: a case study. Int Dent J 2018; 69:130-140. [PMID: 30229884 PMCID: PMC6585721 DOI: 10.1111/idj.12437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim: To compare the provision and costs at the point of delivery of dental treatments in a sample of European Union (EU) Member States. Materials and methods: A questionnaire with open-ended questions was sent to oral health policy-makers in Denmark, England, France, Germany, Hungary, Ireland, Italy, the Netherlands, Poland, Romania, Scotland and Spain. They were asked to answer questions on the probable costs and provision of treatment in their country for a vignette presented as a pre-defined case. Results: All respondents returned answers to all questions. Wide variations were reported in: who would deliver care, cost of items of care and total cost. For example, in France, only a dentist would provide the treatment. In Denmark, England, Germany, Ireland, Italy, the Netherlands and Scotland, it was likely that the treatment would be provided by a combination of dentist, dental hygienist and dental nurse. Fees ranged from €72 in England (if treated within the NHS) to €603 in Denmark. In Italy, Spain and for most patients in Romania, all treatment costs were paid by the patient. In the other nine countries, some subsidy from public funds was available. In terms of percentage of per capita Gross National Income, the cost to the patient ranged from 0.12% in France to 1.57% in Spain. Conclusions: It was apparent that there are wide variations between EU Member States in the manner in which oral healthcare is delivered, its cost and the extent to which the cost of treatment is subsidised from state funds or through private insurance.
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Affiliation(s)
| | | | | | - Julia Csikar
- School of Dentistry, University of Leeds, Leeds, UK
| | - Karen Vinall
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Gail Douglas
- School of Dentistry, University of Leeds, Leeds, UK
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27
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Simões J, Augusto GF, do Céu A, Ferreira MC, Jordão M, Calado R, Fronteira I. Ten years since the 2008 introduction of dental vouchers in the Portuguese NHS. Health Policy 2018; 122:803-807. [PMID: 30054096 DOI: 10.1016/j.healthpol.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 06/11/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
Since the creation of the National Health Service (NHS) in Portugal, in 1979, dental care is neither provided nor funded by the NHS. Thus, most dental care is paid through out-of-pocket payments, either by patients themselves or through voluntary health insurance or health subsystems. In 2008 the government created the dental voucher targeting children, pregnant women, elderly who receive social benefits, and certain patient groups (HIV/AIDS patients and those who need early intervention due to oral cancer), to be used in private dentists who contracted with the programme. The reform was well received by the different stakeholders, especially dentists and beneficiaries, and the impact of the dental voucher in access and coverage of dental care in Portugal is positive: from May 2008 until December 2017, dental voucher reached 3.3 million NHS users in Portugal and dental care indicators have dramatically improved over the last ten years. Aiming to implement dental care provision within the NHS, the Ministry of Health has announced the foreseen integration of dentists in primary healthcare units, although the current budget constraints might hamper this possibility.
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Affiliation(s)
- Jorge Simões
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Gonçalo Figueiredo Augusto
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Ana do Céu
- National Programme for Oral Health Promotion, Directorate-General of Health, Lisbon, Portugal
| | - Maria Cristina Ferreira
- National Programme for Oral Health Promotion, Directorate-General of Health, Lisbon, Portugal
| | - Margarida Jordão
- National Programme for Oral Health Promotion, Directorate-General of Health, Lisbon, Portugal
| | - Rui Calado
- National Programme for Oral Health Promotion, Directorate-General of Health, Lisbon, Portugal
| | - Inês Fronteira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
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Suominen AL, Varsio S, Helminen S, Nordblad A, Lahti S, Knuuttila M. Dental and periodontal health in Finnish adults in 2000 and 2011. Acta Odontol Scand 2018; 76:305-313. [PMID: 29546776 DOI: 10.1080/00016357.2018.1451653] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We assessed dental and periodontal health in adults aged ≥30 years living in southern and northern Finland as part of the Health 2000/2011 Surveys (BRIF8901). MATERIAL AND METHODS Clinical findings in 2000 (n = 2967) and 2011 (n = 1496) included the presence of teeth and number of teeth with caries, fillings, fractures or periodontal pockets. RESULTS Edentulousness decreased in all age groups. The prevalence of those with no caries increased from 67% to 69% in men and from 80% to 85% in women, and of those with no periodontal pocketing from 26% to 30% in men and from 39% to 42% in women. In 2011, the mean number of decayed teeth was 0.8 in men and 0.3 in women, and the corresponding mean numbers of teeth with deepened periodontal pockets 5.6 and 3.7. The gender difference had levelled concerning edentulousness, number of teeth and DMF teeth, but still existed in the occurrence of caries and periodontal pocketing. CONCLUSION The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.
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Affiliation(s)
- Anna L. Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Public Health Evaluation and Projection Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Sinikka Varsio
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Sari Helminen
- Insurance Medicine Unit, Benefit Services, The Social Insurance Institution, Helsinki, Finland
| | - Anne Nordblad
- Department for Social and Health Services, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Satu Lahti
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland
| | - Matti Knuuttila
- Medical Research Center, Oulu University Hospital & Oulu University, Oulu, Finland
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Risk factors associated with new caries lesions in permanent first molars in children: a 5-year historical cohort follow-up study. Clin Oral Investig 2017; 22:1579-1586. [PMID: 29063383 DOI: 10.1007/s00784-017-2253-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to analyze the factors associated with the occurrence of caries in the permanent teeth (PT) and in the permanent first molar (PFM) 5 years after their eruption. MATERIAL AND METHODS Children born in 2005 and enrolled in a community dental program were included. The inclusion criteria were: age 10 years in 2015; the availability of clinical dental history (CDH) data from before eruption of the PT and a follow-up period of 5 years after eruption of the PT. A total of 206 children were enrolled. Risk factors evaluated were: caries experience in the mother, educational level of the mother, frequent drug use, systemic diseases, eating habits, brushing frequency, presence of molar incisor hypomineralization (MIH) in PT, and caries in deciduous teeth (DT). Associations between explanatory factors and the DMF-T (decayed, missing, filled teeth in PT) and DMFT-M (DMF in PFM) indexes, independently considering cavitated or cavitated and non-cavitated caries as outcomes, were evaluated by poisson regression with robust variance analysis. RESULTS In the multivariate analysis, a cariogenic diet, especially soft drinks, was associated to high DMF-T and DMFT-M scores when both cavitated and non-cavitated caries were considered. A brushing frequency < 1 a day was significantly associated to high DMF-T scores. The presence of df-t (decayed and filled temporary teeth) score > 0 and MIH conditioned high DMF-T or DMFT-M values, considering cavitated or cavitated and non-cavitated caries. CONCLUSIONS The intake of sweets and soft drinks, brushing frequency, caries in DT, and MIH in PT were the best predictors of caries in PT. CLINICAL RELEVANCE Control of risk factors in early childhood is important for preventing caries in PT.
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Elstad JI. Dental care coverage and income-related inequalities in foregone dental care in Europe during the great recession. Community Dent Oral Epidemiol 2017; 45:296-302. [DOI: 10.1111/cdoe.12288] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/12/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Jon Ivar Elstad
- NOVA, Centre for Welfare and Labour Research; Oslo and Akershus University College of Applied Sciences; Oslo Norway
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