Methodological issues in epidemiological studies of periodontitis - how can it be improved?

Background: This position paper was commissioned by the European Association of Dental Public Health, which has established six working groups to investigate the current status of six topics related to oral public health. One of these areas is epidemiology of periodontal diseases. Methods: Two theses "A systematic review of definitions of periodontitis and the methods that have been used to identify periodontitis" [1] and "Factors affecting community oral health care needs and provision" [2] formed the starting point for this position paper. Additional relevant and more recent publications were retrieved through a MEDLINE search. Results: The literature reveals a distinct lack of consensus and uniformity in the definition of periodontitis within epidemiological studies. There are also numerous differences in the methods used. The consequence is that data from studies using differing case definitions and differing survey methods are not easily interpretable or comparable. The limitations of the widely used Community Periodontal Index of Treatment Need (CPITN) and its more recent derivatives are widely recognized. Against this background, this position paper reviews the current evidence base, outlines existing problems and suggests how epidemiology of periodontal diseases may be improved. Conclusions: The remit of this working group was to review and discuss the existing evidence base of epidemiology of periodontal diseases and to identify future areas of work to further enhance it

Voluntary Environmental Management Initiatives in Southern China: Regulatory Styles, Environmental Knowledge Governance, and Policy Outcomes

The literature on corporate environmental management suggests that, in developed countries at least, the 1990s witnessed a gradual but decisive “Environmental Policy Evolution” in environmental policy approaches, characterized by a global shift away from the command-and-control model toward the voluntary initiatives typology. This thesis has recently been extended to the discussion on how the “greening of industry” in developing countries and transitional economies such as China develop in this context of a policy re-orientation toward a more “voluntary” approach. This proposition emphasizes the importance of building effective government-industry-society partnership to overcome institutional barriers such as “implementation deficit” that is arguably inherent in the state-dominated environmental policy approach. A review on the Cleaner Production (CP) policy scheme at the national scale since the early 1990s shows two interestingly distinctive features of the voluntary environmental policy landscape in China. First, there was a policy-driven geographical unevenness in the implementation of CP scheme at the national scale... Secondly, a systematic analysis of CP case studies revealed a very strong dose of state intervention in the development of this particular policy initiative, especially in terms of how the generation, use and transfer of CP-related environmental knowledge were initiated and governed among regulators, businesses, and other stakeholder groups. This latter phenomenon on “Environmental Knowledge Governance” is particularly interesting as it seems to contradict the conventional wisdom on voluntary environmental policy development: the strategic significance and value of voluntary initiatives lie exactly in its potential of initializing environmental innovations by providing businesses with the flexibility in environmental decision-making and remedying “state failure” through diminishing the dominant role of government regulators. The empirical findings in Southern China raise a series of interesting and unanswered questions on the nature of the voluntary policy approach to corporate greening in transitional economies