Mike Benigeri

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.

Geographic information systems (GIS) in the health field : An opportunity to bridge the gap between researchers and administrators

This article starts by presenting some of the difficulties encountered by researchers and administrators in trying to work together. It then assesses the importance of the notion of territory in the planning and organization of health services. Last, the article presents the work achieved by the Agence de la santé de Montréal, where geographic information systems have contributed to bringing research and the field closer together.

Service Utilization by Hospitalized Suicide Attempters With Schizophrenia or Depression in Montreal

OBJECTIVE The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. METHODS This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreals Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). RESULTS Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. CONCLUSIONS The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.