A survey of US early childhood caries programs: findings and recommendations.

OBJECTIVES: To identify and characterize US early childhood caries (ECC) programs. METHODS: A 39 question online survey was fielded to 245 ECC programs identified from the literature and peer programs. The 101 respondents (41 percent response rate) reported their program's geographic reach, type, areas of focus, target populations, approaches, affiliations, providers, goals, costs, and funding. RESULTS: Half of the programs affiliate with formal early childhood social service or nutrition programs. Almost all characterize their work as risk reduction, disease suppression, or arrest. In descending order, programs describe their approaches as educating parents, addressing family-level health behaviors, utilizing pharmacological approaches with fluoride varnish or silver nitrate, delivering education to health professionals, and conducting research. A majority of programs target urban, poor, and low-income populations. Although little more than a third of programs utilize a logic model, most collect evaluation data and believe their program to be "very" or "somewhat" replicable. Programs tend to depend on multiple funding sources and be largely reliant on grants with foundations as the leading source of support followed by federal grants, state/local grants, and governmental programs such as Head Start. CONCLUSIONS: Programs demonstrate attempts at ECC prevention and management through holistic approaches predicated on behavioral theory, cariology science, and public health principles. Partnerships created by these programs provide unique opportunities to promote oral health. Various strategies could potentially leverage systemic changes in the delivery of dental care for young children.

[Preliminary results of the assessment of intensity modulated radiotherapy (IMRT) for prostatic and head and neck tumors (STIC 2001)]. / Résultats préliminaires de l'évaluation de la radiothérapie conformationnelle avec modulation d'intensité (RCMI) pour le traitement des cancers prostatiques et ORL (STIC 2001).

INTRODUCTION: Between May 2002 and May 2004, eight French comprehensive cancer centres did a prospective nonrandomized study including 200 patients, 100 with cancer of the prostate and 100 with head and neck cancers. Half of each patient group was treated by IMRT and the others by RTC 3D. This clinical study was associated with an economic study and a physics study. We report here the first results. PATIENTS AND METHODS: For the clinical study, the analysis of the data of the first 88 patients irradiated for a prostatic cancer shows that 39 received RTC and 49 IMRT with a mean dose of 78 Gy at the ICRU point at 2 Gy per fraction. For H&N tumours, the preliminary analysis was done on the 87 first patients with a mean follow-up of 11.5 months (2 to 25 months) and a median of 8.4 months for the IMRT groups and 13.2 months for the RTC group. The economic study was done on the first 157 patients included during the first 18 months: 71 treated by RTC (35 for H&N and 36 for prostate) and 86 treated by IMRT (38 for H&N and 48 for prostate). The assessment of the direct costs was realized by a micro-costing technique. The physical study compared dose distributions for both techniques and has created quality control recommendations. RESULTS: Clinical studies of the acute reactions do not show any difference between groups, but we want to point out the short follow-up and the relatively high dose delivered to cancers of the prostate. The physics study demonstrates that IMRT is technically feasible in good clinical conditions with high quality assurance, a good reproducibility and precision. Dosimetric data show that IMRT could certainly spare organs at risk more than RTC for H&N tumours. The direct costs of "routine" treatments for H&N tumours were 4922 euros for IMRT versus 1899 euros for RTC and for the prostatic cancers 4911 euros for IMRT versus 2357 for RTC.