Identification of Unmet Healthcare Needs: A National Survey in Thailand.

OBJECTIVES: This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand. METHODS: The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. RESULTS: Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were-in descending order of frequency-insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. CONCLUSIONS: Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

Exploration of the unmet health care needs of people who inject drugs.

BACKGROUND AND PURPOSE: Access to adequate health care in the United States is often hindered by an individual's location, socioeconomic status, and lifestyle. Among those underserved are people who inject drugs (PWID), who are affected by stigma and discrimination. The purpose of this study was to describe the utilization of preventative health care services obtained by PWID. METHODS: A survey querying participants about their utilization of preventative health care services and health education over the past year was administered to PWID at 2 syringe access programs. Descriptive statistics were used to analyze the data. CONCLUSION: Of the 141 participants surveyed, 60.6% saw a provider within the past year and 62.1% indicated that their provider was aware of their drug use. Data analysis revealed that providers counseled PWID on three of nine drug-related harm reduction items. Only 30% of PWID talked with their provider about five or more items. Mean number of items discussed was significantly different between PWID whose provider was aware of their drug use and PWID whose provider was unaware of drug use (t = 10.7, p < 0.001). IMPLICATIONS FOR PRACTICE: Results indicated that PWID are not receiving adequate preventative services or harm reduction education from their primary care provider. A need for assessment of substance use, preventative vaccinations, counseling and testing for infectious diseases, and harm reduction education is essential during health care visits. Nurse practitioners and nurses have a role in screening for and educating PWID in a variety of health care settings.

Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting.

OBJECTIVE: The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. METHOD: We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress. RESULTS: The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. SIGNIFICANCE OF RESULTS: The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.

Priority and appropriateness of upper endoscopy out-patient referrals: Two-period comparison in an open-access unit.

BACKGROUND: In the early 2000s we introduced a prioritization model for referrals based on involvement of primary care physicians (PCPs) and specialists. AIMS: Assess the application of that model of prioritisation, comparing gastroscopies performed 8 years apart, with respect to priority level, appropriateness and relevant endoscopic findings (REFs). METHODS: The studies included 247 and 354 out-patients, who had undergone gastroscopy in 2006 and in 2014, respectively. To reduce interspecialists variability, both studies were performed by the same specialist as investigator. RESULTS: In both years, most patients were assigned low-priority referral by PCPs (78.6% and 75.1% respectively). The agreement PCPs versus specialist on referral priority was moderate in 2006 (0.60, Landis-Koch scale 0.41-0.60) and high in 2014 (0.81, Landis-Koch scale 0.81-1.00). In both years we observed a similar rate of inappropriateness: 27.5% and 27.1%, respectively. Due to multiple logistic regression, the odds ratio (OR) for REF increased when: (i) very high-priority referral versus nopriority referral was indicated (8.813 OR, p = 0.0012), (ii) referral followed the guidelines (9.29 OR, p<0.0001), and (iii) agreement of priority occurred (1.911 OR, p = 0.0308). CONCLUSIONS: Our findings highlighted that the issues of low-priority referrals should be addressed in order to discontinue gastroscopy overusing and reduce related operational costs.

The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings.

OBJECTIVE: Implementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings. METHOD: Data were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed. RESULT: A total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS. SIGNIFICANCE OF RESULTS: We found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

Regional Training Needs Assessment: A First Look at High-Priority Training Needs Across the United States by Region.

CONTEXT: Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains. OBJECTIVE: The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions. DESIGN: The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling. SETTING: State and local health departments. PARTICIPANTS: Respondents from state and local health departments. MAIN OUTCOME MEASURES: This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ test and Rao-Scott design-adjusted χ test. RESULTS: Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community. CONCLUSIONS: Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

Measuring the Needs of Family Caregivers of People With Dementia: An Assessment of Current Methodological Strategies and Key Recommendations.

While dementia caregivers are regarded as a population with high unmet needs, there is little consensus as to how caregivers' needs should be conceptualized and measured. This article describes how dementia caregivers' needs are currently assessed in the scientific literature with the goal of suggesting guidelines for the enhancement of future measurement of caregiver needs. A review of 26 articles identified overarching themes within measurement approaches including variation in methodological rigor, proxy indicators of need, dual needs assessment of caregiver and person with dementia (PWD), and third-party needs assessment. We recommend future research dedicate theoretical attention to the conceptualization and classification of caregivers' needs to build a stronger foundation for measurement. The measurement development process should capitalize on mixed-methodology and follow instrument development and validation guidelines set forth by measurement theory. Reliable and valid instruments are essential to developing services and policies that address dementia caregivers' needs.

Elderly and caregiver demand: proposal for a care need classification.

OBJECTIVE: To propose a care need classification for elderly people by identifying their functional demands. METHOD: Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly. RESULTS: The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver). CONCLUSION: This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.

Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?

OBJECTIVE: This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives. METHOD: A quasi-experimental pretest-posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes. RESULTS: At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items "pain", "other symptoms", "family anxiety", and the total POS score. Posttest POS scores for "wasted time" were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest. SIGNIFICANCE OF RESULTS: One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.

[Not Available]. / Sistemi per la valutazionedella complessità assistenziale a confronto:revisione narrativa della letteratura.

UNLABELLED: . Systems for the assessment of patients' complexity: a narrative review of the literature. INTRODUCTION: An effective and efficient caseload management ensures that patients receive the right care by the right person at the right time. Several systems are used in Italy to measure patients' complexity. AIM: To describe and compare the characteristics of the systems for measuring patients' complexity, used in Italy from 1994 to 2015. METHODS: A search was conducted on PubMed, CINAHL, Medline, Cochrane Library, and on Google, with the same key-words. Systems dedicated to paediatric and intensive care patients were not included. The variables used to define complexity were classified according to 4 dimensions of the Italian model of Complexity of Nursing care (autonomy/dependence, stability/instability; comprehension and choice; context). RESULTS: Eight systems were identified, each using a different set and number of variables to define patients' complexity. For 5 systems the most influential dimension on the final score was the autonomy/dependence (from 74% to 34% of the final score). The Caring professional method (MAP), the Assessment on Nursing Intensity and clinical Complexity (IACC) and the Nursing Assessment of Complexity of Care (Per.V. In.Ca.) assign an higher score to the clinical stability/instability dimension. The dimension that contributes less to the final score is the Comprehension and choice (33% for one system but no more than 11-20% for all the others) and Context (from 0 to 30%). CONCLUSIONS: The systems are evolving from an assessment of nursing activities to the assessment of patients' conditions. The informatization of these systems will offer a valuable support to the definition of the right caring mix.

A Comparison of Three Orthodontic Treatment Indices with Regard to Angle Classification.

OBJECTIVES: To calculate the agreement between the Dental Aesthetic Index (DAI) and the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need and to determine correlations between the Peer Assessment Rating (PAR) and DAI and ICON scores according to Angle classification among patients referred for orthodontic evaluation. STUDY DESIGN: This study included 457 randomly selected patients between 9 to 17 years of age. Patients were divided into four groups according to Angle classification [Class I (n=154), Class II division 1(Class II/1) (n=155), Class II division 2(Class II/2) (n=52) and Class III (n=96)]. Relationships between PAR scores and ICON and DAI scores were evaluated with the Spearman correlation test. Unweighted kappa statistics were used to analyse agreement between the ICON and DAI on the need for treatment, according to Angle classification. RESULTS: Class I malocclusions scored significantly lower than other Angle classifications in all indices. Both the ICON and DAI showed significant positive correlations with the PAR in the general study population. For Class II/2 patients, no correlation was found between PAR and DAI scores. There was significant agreement between the ICON and DAI on treatment need among Class I, Class II/1 and Class II/2 patients however, no agreement was found for Class III malocclusions. CONCLUSIONS: The ICON, DAI and PAR produce similar results and can be used interchangeably for the general orthodontic patient population. However, based on Angle classification, prominent differences exist in scoring certain occlusal features.

[The information about discharge medication: what do general practitioners need?]. / Die Informationen zur Arzneimitteltherapie im Arztbrief: Was erwarten Hausärzte?

BACKGROUND: The information about the patient's discharge medication (DM) in the discharge letter guarantees the subsequent pharmacotherapy at the interface between tertiary to primary care. International data however shows that general practitioners (GPs) receive discharge letters with a delay and relevant information about DM is lacking. The aim of this study was to assess the point of view of German GPs concerning the information about DM, since no recent data about this topic is available. METHODS AND PARTICIPANTS: In a postal survey 516 GPs in the city of Berlin were contacted and asked about the transit of discharge letters and the information about DM. Results | 117 GPs answered the questionnaire (23 %). Most frequently, the patient himself handed over the information about DM to the GP on the day of his first visit in the practice after discharge. However, more than two third of GPs wished to receive the information before the patient's first consultation (73 %). Therefore, the majority preferred the electronic communication via fax (46 %) or email (9 %). Almost half of the GPs stated that discharge letters were lacking information about changes in medication and reasons for these changes. At the same time, nearly all GPs thought that these informational aspects were important. DISCUSSION: GPs wish an early and electronic transit of the DM with information concerning changes in medication and reasons. If these wishes were considered, a continuous and thus safer pharmacotherapy at the interface could be guaranteed.

Conocimientos sobre ética asistencial de los residentes de Pediatría / Knowledge of healthcare ethics by paediatric residents

No disponible

The Spectrum of Children's Palliative Care Needs: a classification framework for children with life-limiting or life-threatening conditions.

OBJECTIVES: This paper examined the potential of a new classification framework, The Spectrum of Children's Palliative Care Needs, to facilitate identification of children with palliative care needs for the purposes of minimum data set collection and population needs assessment. METHODS: Health and social care professionals (n=50) in a range of paediatric palliative care settings applied The Spectrum to (i) clinical vignettes and (ii) consecutive children on their caseloads. They also provided confidence ratings and written comments about their experiences. Inter-rater reliability, conceptual validity, acceptability, feasibility and sustainability were examined. A subset of professionals (n=9) also participated in semistructured telephone interviews to provide further insight. RESULTS: Inter-rater reliability for the vignettes (κ=0.255) was fair. However, professionals were more confident applying The Spectrum to their caseloads, which included children (n=74) with a range of life-limiting/life-threatening conditions. The Spectrum made conceptual sense in relation to these children and was considered to offer a meaningful way to define the eligible population in service mapping. Benefits for clinical work (eg, facilitating patient review, workload management, clinical audit) and research were also identified. However, important threats to reliability were highlighted. CONCLUSIONS: Preliminary assessment of The Spectrum confirms its potential to promote consistent data set collection in children's palliative care. The results have been used to produce a revised version and user guidelines to address issues raised by participants. However, further research is required to further validate the framework and establish its relevance to families' self-defined needs.

Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale.

AIM: To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility. METHODS: All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score. RESULTS: CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76). CONCLUSIONS: The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents.

A model of job activity description for workplace accommodation assessment.

Workplace accommodations to enable employees with disabilities to perform essential job tasks are an important strategy ways for increasing the presence of people with disabilities in the labor market. However, assessments, which are crucial to identifying necessary accommodations, are typically conducted using a variety of methods that lack consistent procedures and comprehensiveness of information. This can lead to the rediscovery of the same solutions over and over, inability to replicate assessments and a failure to effectively meet all of an individual's accommodation needs. To address standardize assessment tools and processes, a taxonomy of demand-producing activity factors is needed to complement the taxonomies of demand-producing person and environment factors already available in the International Classification of Functioning, Disability and Health (ICF). The purpose of this article is to propose a hierarchical model of accommodation assessment based on level of specificity of job activity. While the proposed model is neither a taxonomy nor an assessment process, the seven-level hierarchical model provides a conceptual framework of job activity that is the first step toward such a taxonomy as well as providing a common language that can bridge the many approaches to assessment. The model was designed and refined through testing against various job examples. Different levels of activity are defined to be easily linked to different accommodation strategies. Finally, the levels can be cross-walked to the ICF, which enhances its acceptability, utility and universality.

Orthodontic treatment need for Brazilian schoolchildren: a study using the Dental Aesthetic Index.

OBJECTIVE: To determine the normative orthodontic treatment need among 12-year-old Brazilian schoolchildren, in the municipality of Juiz de Fora, Minas Gerais, Brazil, and compare with the need as perceived by the children themselves and their parents or caregivers, assessing putative associated sociodemographic factors. METHODS: Four hundred and fifty one children without a previous history of orthodontic treatment were randomly selected from a population of 7,993 schoolchildren regularly attending the public and private educational sectors of the municipality of Juiz de Fora, Minas Gerais, Brazil. RESULTS: The prevalence of normative orthodontic treatment need in 12-year-old children, assessed with the Dental Aesthetic Index (DAI) was 65.6% (n = 155). The need perceived by the caregivers was 85.6%, and by the children was 83.8%. Only the perception by the caregivers maintained a significant correlation with the normative need of treatment when adjusted to the parents' schooling and economical level (p = 0.023). CONCLUSIONS: There is a high prevalence (65.6%) of malocclusion requiring orthodontic treatment in 12-year-old Brazilian schoolchildren. The most prevalent malocclusions in the study were: Crowding, Class II molar relationship and increased overjet. There was no significant correlation between the Index of Orthodontic Treatment Need - Aesthetic Component (IOTN-AC) related to dental aesthetic perception and the normative treatment need assessed with the DAI.

Orthodontic treatment need for Brazilian schoolchildren: a study using the Dental Aesthetic Index

OBJECTIVE: To determine the normative orthodontic treatment need among 12-year-old Brazilian schoolchildren, in the municipality of Juiz de Fora, Minas Gerais, Brazil, and compare with the need as perceived by the children themselves and their parents or caregivers, assessing putative associated sociodemographic factors. METHODS: Four hundred and fifty one children without a previous history of orthodontic treatment were randomly selected from a population of 7,993 schoolchildren regularly attending the public and private educational sectors of the municipality of Juiz de Fora, Minas Gerais, Brazil. RESULTS: The prevalence of normative orthodontic treatment need in 12-year-old children, assessed with the Dental Aesthetic Index (DAI) was 65.6% (n = 155). The need perceived by the caregivers was 85.6%, and by the children was 83.8%. Only the perception by the caregivers maintained a significant correlation with the normative need of treatment when adjusted to the parents' schooling and economical level (p = 0.023). CONCLUSIONS: There is a high prevalence (65.6%) of malocclusion requiring orthodontic treatment in 12-year-old Brazilian schoolchildren. The most prevalent malocclusions in the study were: Crowding, Class II molar relationship and increased overjet. There was no significant correlation between the Index of Orthodontic Treatment Need - Aesthetic Component (IOTN-AC) related to dental aesthetic perception and the normative treatment need assessed with the DAI.

OBJETIVO: determinar a necessidade normativa de tratamento ortodôntico em escolares brasileiros de 12 anos de idade, no município de Juiz de Fora, Minas Gerais, e compará-la à necessidade percebida pelos responsáveis e crianças da amostra, avaliando potenciais fatores sociodemográficos associados. MÉTODOS: quatrocentos e cinquenta e uma crianças, sem história de tratamento ortodôntico, foram selecionadas, aleatoriamente, de uma população de 7.993 escolares matriculados na rede de ensino pública e particular da cidade de Juiz de Fora. RESULTADOS: a prevalência da necessidade normativa de tratamento ortodôntico em crianças de 12 anos de idade, utilizando o Índice de Estética Dentária (DAI), foi de 65,6% (n = 155). A percepção da necessidade pelos responsáveis foi de 85,6% e pelas crianças foi de 83,8%. No entanto, somente a percepção dos responsáveis teve uma correlação significativa com a necessidade normativa (p = 0,023). CONCLUSÕES: existe uma alta prevalência (65,6%) de má oclusão com necessidade de tratamento ortodôntico em escolares brasileiros de 12 anos de idade. As más oclusões mais prevalentes no estudo foram apinhamento, relação molar de Classe II e sobressaliência maxilar. Não houve uma correlação significativa entre a percepção da estética dentária por meio do IOTN-AC (Index of Orthodontic Treatment Need) e a necessidade de tratamento normativo avaliada por meio do DAI.

The use of occlusal indices in high-impact literature.

UNLABELLED: Malocclusion is difficult to define because individuals and cultures vary widely in their perceptions of what constitutes an occlusal problem. A number of occlusal indices have been devised but, probably because of this perceptual problem, none has ever emerged as a standard. OBJECTIVE: The main objective was to review the use of the principal occlusal indices. BASIC RESEARCH DESIGN: The PUBMED database was searched for the main occlusal indices employed, journals with an impact in dentistry and specialist orthodontics journals. RESULTS: The occlusal indices most frequently employed were IOTN (163 studies), PAR (132 studies), DAI (68 studies) and ICON (32 studies). The journals publishing the greatest number of studies using these occlusal indices are those specialising in orthodontics. CONCLUSIONS: In the high-impact scientific literature, the indices in greatest use are IOTN, followed by PAR, DAI and ICON. DAI and IOTN are mainly used in epidemiological or prevalence studies, while PAR is generally used for longitudinal studies. IOTN is used more in Europe. DAI is used worldwide; though least in Europe.