Jean-Marc Brodeur

Indicators of masticatory performance among elderly complete denture wearers

The literature on current techniques for evaluating the masticatory capacity leads to categorizing them into two groups: objective masticatory tests and questionnaires that evaluate the subject masticatory capacity. This study examines how a simple questionnaire on the reported capacity to chew certain food can predict the masticatory performance of edentulous elderly patients. The masticatory performance of 367 completely edentulous elderly persons was measured with the Swallowing Threshold Test Index and compared with their reported masticatory capacity previously measured with a questionnaire on the capacity of the individual to chew nine food items. A total of 47.4% of the individuals had a low masticatory performance. This problem was more frequent in women (51.7%) than in men (41.8%). In measuring the reported masticatory performance with seven of the nine food items listed in the questionnaire, this indicator predicted the masticatory performance with a sensitivity of 65.5% and a specificity of 81.9%. However, even though the measure of prosthesis retention/stability is related to the masticatory performance, it was not a good predictor.

How People on Social Assistance Perceive, Experience, and Improve Oral Health

Oral diseases are highly prevalent among people on social assistance. Despite benefiting from public dental coverage in North America, these people rarely consult the dentist. One possible reason is rooted in their perception of oral health and the means to improve it. To respond to this question, largely unexplored, we conducted qualitative research through 8 focus groups and 15 individual interviews in Montreal (Canada). Thematic analysis revealed that people on social assistance: (a) define oral health in a social manner, placing tremendous value on dental appearance; (b) complain about the decline of their dental appearance and its devastating impact on self-esteem, social interaction, and employability; and (c) feel powerless to improve their oral health and therefore contemplate extractions and complete dentures. Our research demonstrates that perception of oral health strongly influences treatment preference and explains low and selective use of dental services in this disadvantaged population.

Perception of dental illness among persons receiving public assistance in Montreal.

OBJECTIVES We examined rationales for behaviors related to dental care among persons receiving public assistance in Montreal, Quebec. METHODS Fifty-seven persons receiving public assistance participated in 8 focus groups conducted in 2002. Sessions were recorded on audiotape and transcribed; analyses included debriefing sessions and coding and interpreting transcribed data. RESULTS In the absence of dental pain and any visible cavity, persons receiving public assistance believed they were free of dental illness. However, they knew that dental pain signals a pathological process that progressively leads to tooth decay and, therefore, should be treated by a dentist. However, when in pain, despite recognizing that they needed professional treatment, they preferred to wait and suffer because of a fear of painful dental treatments and a reluctance to undertake certain procedures. CONCLUSIONS Persons receiving public assistance have perceptions about dental health and illness that prevent them from receiving early treatment for tooth decay, which may lead to disagreements with dentists when planning dental treatments.

Dental Caries Experience: A Two-generation Study

The life-course framework stresses the importance of social, psychosocial, and biological factors in early life on the development of later disease. From this perspective, the association between edentulousness of mothers and their children’s caries risk has not been studied. Therefore, a sample of 6303 mother-child pairs was randomly selected in Quebec (Canada). Mothers (6039 dentate and 264 edentulous) completed a self-administered questionnaire, and their children, aged 5 to 9 years, were clinically examined. Bivariate analyses and multiple logistic regressions showed that edentulous mothers’ children are more likely to experience caries on both primary [OR = 1.7 (1.3–2.3)] and permanent [OR = 1.4 (1.0–2.0)] dentitions when compared with dentate mothers’ children. These results are independent of socio-economic status, age, gender, and children’s oral-health-related behaviors. Our study is the first to show that edentulous mothers’ children constitute a group at risk of caries. It also highlights the need for a better understanding of the mother-child transmission of risk.

Ingestion of Flouride from Dentrifices by Children Aged 12 to 24 Months

The increase of dental fluorosis is largely imputable to the ingestion of dietary fluoride supplements and fluoride toothpastes. However, the toothbrushing habits of very young children is poorly documented. The purpose of this pilot study was to determine the toothbrushing habits of 12- to 24-month-old children and to estimate the quantity of fluoride ingested during toothbrushing. Fifty-nine parents completed a questionnaire regarding the toothcleaning habits of their children. When a dentifrice was used, a dental hygienist scheduled a meeting with the parents in order to observe and measure the amount of toothpaste used. Of the 36 parents who cleaned the teeth of their children, 69% used a toothpaste. Furthermore 20% of the children ingested more than 0.25 mg of fluoride per day by toothbrushing alone. Therefore the practice of toothbrushing and the use of fluoridated dentifrices are widespread among 12- to 24-month old children, and the amount of fluoride ingested from toothpaste could constitute a substantial proportion of the total daily intake of fluoride. Several measures are suggested to enhance the safe use of fluoride dentifrices.

Promoting active living among people with physical disabilities evidence for neighborhood-level buoys.

BACKGROUND People with physical disabilities are more likely to be sedentary than the general population, possibly because they have an accrued sensitivity to environmental features. OBJECTIVES This paper describes the relationship between neighborhood-level active living buoys and the active living practices of adults with physical disabilities living in a large urban area. METHODS A sample of 205 people with physical disabilities was recruited via a local rehabilitation center and its adapted fitness center. Telephone interviews were administered by senior occupational therapy students. The interview included a modified version of the Physical Activity and Disability Survey, a validated instrument that includes questions on physical activity, active transportation, and other activities of daily living. Individuals were geocoded within their census tract of residence (n=114) using their postal codes. Data on neighborhood active living potential were gleaned from systematic social observation. RESULTS Multilevel logistic regression analyses showed that the association between the presence of environmental buoys and leisure activity was significant (OR=4.0, 95% CI=1.1-13.8) despite adjustments for individual difference variables while the association with active transportation became nonsignificant (OR=2.9, 95% CI=0.7-7.7) following adjustment for these variables. CONCLUSIONS People with physical disabilities who live in neighborhoods with more environmental buoys are more likely to report involvement in leisure-time physical activity.

Eating-disorder symptoms and syndromes in a sample of urban-dwelling Canadian women: Contributions toward a population health perspective†

OBJECTIVE We estimated the prevalence of eating disorders and maladaptive eating behaviors in a population-based sample and examined the association of maladaptive eating with self-rated physical and mental health. METHOD A sample of 1,501 women (mean age = 31.2 years, SD = 6.2) were recruited using random-digit dialing to participate in a 20-min telephone interview about eating behaviors. RESULTS Weighted frequency analysis showed the prevalence of frequent binge-eating to be 4.1%, that of regular purging to be 1.1%, and that of frequent compensation to be 8.7%. Although we found none of the women to meet full criteria for anorexia nervosa, 0.6% met criteria for bulimia nervosa, 3.8% provisional criteria for binge eating disorder, and 0.6% criteria for a newly proposed entity, purging disorder. As many as 14.9% fell into a residual category representing subthreshold, but potentially problematic variants of eating disturbances. Logistic regression analyses showed that clinical-level maladaptive eating attitudes and behaviors predicted self-rated physical- and mental-health problems after sociodemographic factors were controlled. DISCUSSION This population-based survey provides prevalence estimates of BN, BED, and purging disorder that are compatible with those of recent epidemiological studies and shows that maladaptive eating attitudes and behaviors represent a substantial population burden.

Associations between school deprivation indices and oral health status.

BACKGROUND Despite an overall improvement in oral health status in several countries over the past decades, chronic oral diseases (COD) remain a public health problem, occurring mostly among children in the lower social strata. The use of publicly available indicators at the school level may be an optimal strategy to identify children at high risk of COD in order to organize oral health promotion and intervention in schools. OBJECTIVE To investigate whether school deprivation indices were associated with schoolchildren oral health status. METHODS This ecological study used a sample of 316 elementary public schools in the province of Quebec, Canada. Data from two sources were linked using school identifiers: (i) Two school deprivation indices (in deciles) from the Ministry of Education, a poverty index based on the low income cut-offs established by Statistics Canada and a socioeconomic environment index defined by the proportions of maternal under-schooling and of unemployed parents and (ii) Oral health outcomes from the Quebec Schoolchildren Oral Health Survey 1998-99 aggregated at the school level. These included proportions of children with dental caries and reporting oral pain. The relation between school deprivation indices and oral health outcomes was assessed with linear regression for dental caries experience and logistic regression for oral pain. RESULTS The mean DMF-S (mean number of decayed, missing and filled permanent teeth surfaces) by school was 0.7 (SD = 0.5); the average proportions of children with dental caries and reporting oral pain were 25.0% and 3.0%, respectively. The poverty index was not associated with oral health outcomes. For the socioeconomic environment index, dental caries experience was 6.9% higher when comparing schools in unfavourable socioeconomic environments to the most favourable ones [95% confidence interval (CI): 2.1, 11.7%]. Furthermore, the most deprived schools, as compared to least deprived ones, were almost three times as likely to have children reporting oral pain in the previous week. CONCLUSION The school socioeconomic environment index was associated with oral health outcomes, and should be studied for its potential usefulness in planning school-based oral health promotion and screening strategies.

A mixed method study of propensity for participatory evaluation

One way to increase the use of evaluation results is practical participatory evaluation (PPE), which enables non-evaluator participants to join the evaluation process in a participatory mode. We examined the propensity for PPE of health professionals by focusing on four components: learning, working in groups, using judgment and using systematic methods. We interviewed the professionals at a Haitian health institution to determine their positioning on a scale of propensity (low, medium and high) for the four components. The professionals defined each component in relation to the energy puts into them, being more or less proactive. Facilitating elements for all three levels of propensity integration included past positive experiences, external pressure and a desire for better individual and organizational performance. Impeding factors included a lack of available resources perceived responsibilities and commitments toward private patients. The reported advantages included improved organizational performance and idea sharing, and the disadvantages included availability of, difficulty implementing solutions and altered human relationships.

Migration, éthique et santé publique au Québec

Le present article analyse les enjeux ethiques de la prise en compte de l’immigration pour la sante publique du Quebec. L’objectif est double : decrire la progression de l’analyse du fait migratoire en sante publique au cours des trente dernieres annees et poser le debat ethique qu’elle souleve. La progression de l’analyse du fait migratoire a ete marquee par differentes approches : interculturelle, de l’acculturation, transculturelle et du parcours migratoire. Si ces approches ont contribue au developpement des connaissances quant a la realite de l’immigration, elles ont egalement donne lieu, bien malgre elles, a de la stigmatisation, de la discrimination et de la proliferation de prejuges. Cette prise en compte conduit a des constats qui temoignent generalement d’un rapport d’inegalite. Pour certains, s’interesser au fait migratoire entretient le rapport d’inegalite entre les groupes minoritaires et majoritaires ; pour d’autres, ne pas s’y interesser occulte ce rapport.