Using risk assessment to customize periodontal treatment.

In recent years, understanding of the multifactorial nature of periodontal disease has taken great strides. Periodontal disease is initiated and sustained by the presence of bacteria, but disease progression is significantly modified by the body's response to the bacteria. This article highlights the emerging evidence regarding which risk factors are predominant in influencing the disease process and how the incorporation of prognostic risk factors in overall diagnosis can help facilitate treatment planning. These factors appear to be smoking, genetic susceptibility, compliance, and diabetes. The first three factors mentioned are the focus of this article. Each is discussed with regard to their role in amplifying the disease process and how this information can be used in clinical practice. By acknowledging the importance of these factors, dentists can consider their patients' risk to allow for more cost-effective planning and treatment. The opportunity to identify high-risk patients and treat them more proactively is significant; the challenge rests with dentists' willingness and ability to embrace the change before them.

The social costs of inadequate contraception.

This study examines, on a per-case basis, the social costs associated with contraceptive failures and resulting term pregnancies. To combat unintended pregnancy and escalating health care costs, the public sector needs to provide greater access to highly effective methods of contraception.

PIP: This study measures the social costs resulting when specific contraceptives fail women who are eligible for federal entitlement programs and pregnancy is carried to term. Social costs were calculated for selected contraceptive methods (the copper-T IUD, the diaphragm, contraceptive implants, injectables, the male condom, oral contraceptives, and tubal ligation), which were then compared with each other and with nonuse. The three-part analysis begins with the design of an economic model to measure the social costs of a single unplanned pregnancy brought to term (state and federal government payments) per person over a five-year term. Next these data were combined with data on specific contraceptive failure rates, and, finally, the data on social cost per method were combined with data from a previous study of direct health care costs to evaluate the total costs associated with the various methods. This analysis revealed that highly effective contraceptive methods are highly cost-effective, and that the initial expenditure to provide these methods to low-income women is overwhelmingly offset by savings in medical and social programs. This finding raises the question of why those qualifying for entitlement programs have so many unintended pregnancies, and it is suggested that the answer can be found in the fact that the fiscal resources that pay for (or fail to pay for) effective contraception are different from those bearing the social and medical costs once an unplanned baby is born. It is concluded that all women should be assured of access to highly effective contraceptive methods.

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES: The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS: Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS: All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS: Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

Radiographic assessment of blunt renal trauma.

Recent reports in the urologic literature suggest that radiographic evaluation of normotensive blunt trauma patients with microscopic hematuria is no longer necessary. Several facilities, however, including the Los Angeles County-University of Southern California Medical Center continue to routinely perform intravenous pyelography in this setting. To further evaluate whether this practice is indicated, we retrospectively reviewed the records of 337 patients seen at our facility between May, 1986 and December, 1989 following blunt trauma with resultant microscopic hematuria but no shock. All patients were radiographically assessed with an intravenous pyelogram. Of the 337 studies, 30 (9%) had an abnormal result, including 28 renal contusions, 1 ureteropelvic junction (UPJ) disruption, and 1 non-functioning kidney (which on further evaluation revealed a congenitally absent kidney). A total of 1 significant urologic injury was identified. Thus, only one injury (0.3%) would have been missed if a policy of observation was followed in this group of patients. Our data support other reports in the urologic literature that radiographic staging is not necessary in managing blunt trauma patients with microscopic hematuria but no shock.