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PubMed2001

The impact of universal access to dental care on disparities in caries experience in children.

BACKGROUND: The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. METHODS: The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra- and interexaminer reliability was excellent (kappa > or = 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects. RESULTS: Only 8.4 percent of the children had visited a dental office before the age of 2 years, and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents' high education status, optimal fluoride concentration in schools' water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores. CONCLUSION: Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience. PRACTICE IMPLICATIONS: This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.

Age Factors↗

PubMed1999

Cognitive function in the Caerphilly study: associations with age social class, education and mood.

Baseline cognitive function was established for a study of pre-symptomatic cognitive decline in 1870 men from the general population aged 55-69 years as part of the third examination of the Caerphilly Study. Cognitive assessment included the AH4, a four choice serial reaction time task, a modified CAMCOG, MMSE, NART and various memory tests. Distributions and relationships with age, social class, education and mood at time of testing are presented for a younger population than has previously been available. Multiple linear regression showed cognitive function to be independently associated with all four factors. The age effect was equivalent to one half of a standard deviation (SD) in CRT and AH4 scores. Only the NART score was not associated with age, supporting the use of NART score as an estimate of pre-morbid IQ. The largest age adjusted differences between men with low and normal mood were for the AH4 (3 points, t = 5.6, p < 0.0001) and the CAMCOG (2 points, t = 5.8, p < 0.0001). The smallest age adjusted effect of mood was for the CRT (33 ms, t = 2.14, p = 0.32) and the MMSE (0.4 points, t = 2.97, p = 0.003). Age, mood and education adjusted social class effects were very large ranging between around 0.5 SD for the CRT, and 1.0 SD for the AH4 and NART, respectively. For educational status age, mood and social class adjusted differences were also substantial with tests for trend showing the largest differences for the NART (t = 12, p < 0.0001) and modified CAMCOG (t = 10.6, p < 0.0001) with the smallest differences for the CRT (t = 2.73, p = 0.006).

Affect↗

PubMed1992

Prevalence of non-cavitated and cavitated carious lesions in a random sample of 7-9-year-old schoolchildren in Montreal, Quebec.

This report describes the prevalence of non-cavitated and cavitated carious lesions in 911 randomly selected children in grades one through three on the Island of Montreal, Quebec, Canada. The criteria for diagnosis were developed for a longitudinal epidemiological study of restorative treatment decisions by dentists practising under a provincial dental insurance program for children. The intra- and inter-examiner reliability correlation coefficients of the two examiners were excellent (Kappa > or = 0.80). The most frequent carious lesion found in the examined children were non-cavitated carious lesions (incipient) within 1.5 of the gingival line on smooth tooth surfaces, and stained or non-cavitated carious lesions on pits and fissures. Out of 911 children in the study, 19.6% had sealants. Children whose parents completed a university education had a significantly lower prevalence of non-cavitated and cavitated carious lesions and fillings, and a significantly higher mean number of sealants than children whose parents had only primary school education. Education status of the parents was a significant risk marker of children with high caries experience and these children had a significantly higher mean number of non-cavitated carious lesions. This study has found that non-cavitated carious lesions are significantly more prevalent than cavitated carious lesions in children.

Chi-Square Distribution↗

PubMed1999

Infant-feeding practices in Al-Ain, United Arab Emirates.

A survey was conducted to study the practices of infant-feeding and the influencing factors in Al-Ain, United Arab Emirates. It involved 375 mothers of different nationalities and backgrounds and 300 healthy infants. The mothers were interviewed at four primary health care clinics in Al-Ain. Results showed that 46% of infants were breastfed for 4-6 months. The mother's nationality and her educational status were significant influences on the mother's decision to exclusively breast-feed the infant, for how long and when to introduce supplementary food. Fresh cow and goat milk were the most common supplements. Inclusion of baby formula as a supplement generally occurred early, perhaps because of advertising and the affluence in Al-Ain.

Adolescent↗

PubMed1984

Health library for patients in general practice.

We describe the establishment of a health lending library for patients in a suburban general practice. The library is housed in the surgery waiting room and comprises 413 books and 35 audio tapes on topics related to health. Analysis of the first year's use showed 703 borrowings (677 books and 26 audio cassettes). Borrowers ranged the spectrum of social class and educational status but women predominated, and borrowers included many who admitted that they seldom read books. Most borrowings were opportunistic, though some were planned by the patient and a few recommended by a health care professional. Most readers claimed to have learned from their reading and to have found their reading useful. We think that a health library is a useful tool of primary care, particularly for prevention.

Adolescent↗

PubMed1985

Reproductive factors, oral contraceptives and risk of malignant melanoma: Western Canada Melanoma Study.

A study of 361 female melanoma patients and age matched controls was conducted in the four western provinces of Canada. Analysis of reproductive factors showed a significant negative association between number of livebirths and risk of melanoma. The relationship persisted for superficial spreading melanomas after adjustment for host pigmentation factors, freckling, and educational status. An inverse association between bilateral oophorectomy and risk of superficial spreading melanoma was also seen. No association was found between risk of melanoma and age at first birth, age at menarche and age at natural menopause. No association was found between risk of superficial spreading or nodular melanoma and use of either oral contraceptives or menopausal oestrogens.

Adult↗

PubMed1992

Beliefs about prematurely erupted teeth in rural Yoruba communities, Nigeria.

A descriptive study was carried out in two villages: Badeku and Olodo, near the city of Ibadan, between May and November 1990. The objective of the study was to investigate the knowledge, beliefs and attitudes of respondents to premature eruption of deciduous teeth in babies. Of the 622 people interviewed, a large proportion (30.5%) believed that the first deciduous tooth should erupt between the age of 5-7 months; the next commonly mentioned time of tooth eruption was 7-9 months of age; and 50.3% of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth (P < 0.01). The majority of the people (53.7%) felt that the condition was an indication of an evil child. Only 22.1% of those interviewed thought it could be just an individual variation. On the recommended remedy or management of the condition, as many as 26 (4.1%) said they would get rid of the child. A high percentage felt that sacrifices should be offered to appease the gods. It is suggested that a transcultural approach be adopted in managing cases in which the parents feel particularly anxious and uncomfortable about prematurely erupted teeth in order to cater for the social well-being of the child and family. It is also recommended that appropriate health education be directed at the society as a whole concerning this condition.

Adult↗

PubMed1997

Sleep-disordered breathing and neuropsychological deficits. A population-based study.

The relationship of sleep-disordered breathing (SOB) to neuropsychological deficits was investigated with cross-sectional data from the Wisconsin Sleep Cohort Study, a population-based study of the natural history of SDB. A sample of 841 employed men and women ages 30 to 60 yr was studied by overnight polysomnography to assess the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). Prior to overnight polysomnography, the participants were given a battery of neuropsychological tests for functionally important capacities including motor skills, attention, concentration, information processing, and memory. Principal factor analysis of all the neuro-psychological test data revealed a psychomotor efficiency and a memory factor. Multiple regression analysis showed a significant negative association between logarithmically transformed AHI (LogAHI) and psychomotor efficiency score independent of age, gender, and educational status (p = 0.017). The relationship was not explained by self-reported sleepiness. No significant relationship was seen between LogAHI and memory score. In assessing the clinical significance of mild SDB, we estimate that an AHI of 15 is equivalent to the decrement in psychomotor efficiency associated with 5 additional yr of age, or to 50% of the decrement associated with hypnosedative use.

Adult↗

PubMed2005

Impediments to timely diagnosis of Alzheimer's disease in African Americans.

The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.

Activities of Daily Living↗

PubMed2003

Baseline fat-related dietary behaviors of white, Hispanic, and black participants in a cholesterol screening and education project in New England.

OBJECTIVE: To examine baseline fat-related dietary behaviors of white, Hispanic, and black participants in Minimal Contact Education for Cholesterol Change, a National Institutes for Health-funded cholesterol screening and education project conducted in New England. SUBJECTS: A sample of 9,803 participants who joined the study at baseline (n=7,817 white; n=1,425 Hispanic; and n=561 black). METHODS: Participants completed baseline questionnaires that included demographic and psychosocial items as well as the Food Habits Questionnaire, a dietary assessment tool measuring fat-related dietary behaviors. They also had their blood cholesterol level and height and weight measured. STATISTICAL ANALYSES: Analysis of variance (ANOVA) was used to compare racial/ethnic groups on continuous demographic variables, and the chi(2) test of association was used to compare groups on demographic categorical variables. Multivariate analysis of variance (MANOVA) was used to compare mean differences between racial/ethnic groups on six behavioral subscales (Fat Factors) differentiating domains of behavior related to fat intake and to compare 27 individual fat-related dietary behaviors. RESULTS: After adjusting for sex, age, marital status, education, employment status, and percent time lived in the United States, white participants had the lowest Food Habits Questionnaire summary score (2.44) (indicating a lower fat diet), followed by Hispanic (2.61) and black (2.68) participants. The three ethnic groups also differed on the prevalence of Fat Factors and specific fat-related dietary behaviors. White participants were more likely to use lower-fat alternatives, to avoid frying, to replace meat, and to modify meat to make it lower in fat. However, they were least likely to eat fruits and vegetables for snacks and desserts. Hispanic participants were more likely to engage in fat-avoidance behaviors and to eat fruits and vegetables for snacks and desserts. Black participants were less likely to eat meatless meals and modify meats to make them lower in fat. Black and Hispanic participants were more likely than white participants to fry foods. Hispanics were less likely to read food labels for nutrition information. The most and least prevalent fat-related behaviors also differed by each ethnic group, showing that different behaviors were more and less easily implemented by each ethnic group. CONCLUSIONS/APPLICATIONS: The results of this study suggest that there is a need for improvement in dietary behaviors related to fat intake, especially for blacks and Hispanics, and that the specific dietary behavior issues differ widely by ethnicity. These results can be used by nutrition educators and researchers to help them decide what messages to emphasize in dietary counseling, nutrition education programs, and materials. The results can also be used to help design better dietary assessment tools and more effective interventions for culturally diverse populations.

Black or African American↗

PubMed1998

Decreased stature in gestational diabetes mellitus.

Short stature has been associated with various degrees of abnormal glucose tolerance in middle-aged people, where the effects of age and metabolic control would be difficult to exclude. We chose to examine body stature in women with gestational diabetes mellitus (GDM), a prediabetic state affecting a young group of people. A sample of 2772 Greek pregnant women, referred for GDM screening was examined. After a 100-g oral glucose tolerance test, 1787 women were classified as normal (N), 300 women were found with one abnormal glucose value (OAV) and 685 women with GDM. Basal insulin resistance was calculated in 640 women by homeostasis model assessment. In addition, 51 pregnant women with pre-existing Type II (non-insulin-dependent) diabetes mellitus and 109 with pre-existing Type I (insulin-dependent) diabetes mellitus were included in the study. There was a gradual decrease in mean height (cm) as glucose intolerance became more severe: N: 161.0 +/- 6.2, OAV:160.2 +/- 6.1, GDM:158.7 +/- 6.3, Type II diabetes 158.2 +/- 7.0 (p < 0.001, analysis of variance]. Height in Type I diabetes (160.1 +/- 5.9) did not differ from the normal group. The difference in height between the normal and GDM groups remained (p < 0.001) when body weight, age, birth before or after 1960 and educational status were also taken into account. An independent correlation was also found between height and insulin resistance (n = 640) adjusted for the above mentioned variables. In conclusion, short stature appears to be associated with glucose intolerance as an independent variable, even when this intolerance is both mild and temporary. The previously unrecognised independent association of stature with basal insulin resistance merits further investigation.

Adult↗

PubMed2002

Cigarette smoking and khat chewing among university instructors in Ethiopia.

OBJECTIVE: To assess the prevalence and risk factors of cigarette smoking and khat chewing. DESIGN: College based cross sectional. SETTING: Four colleges found in north west Ethiopia namely Gondar College of Medical Sciences, Gondar College of Teachers Education, Bahr Dar University Engineering Faculty, and Bahr Dar University Education Faculty. SUBJECTS: All instructors in these colleges. MAIN OUTCOME MEASURES: Prevalence of cigarette smoking and khat chewing. RESULTS: Seventy six (42.0%) instructors were either lifetime smokers or lifetime khat chewers or both. The current prevalence rates of cigarette smoking and khat chewing were found to be 13.3% and 21.0%, respectively. The majority of the instructors started smoking (56.8%) and khat chewing (40.0%) while they were senior high school or first year college students. Most of the instructors (82.1%) knew that cigarette smoking is a risk factor for lung diseases including lung cancer. Statistically significant difference (p<0.05) was seen between the outcome variable and the independent variables faculty, religion, education status, income and family history of khat chewing. CONCLUSION: The prevalence of cigarette smoking seemed to decrease among university instructors but the prevalence of khat chewing is almost the same as it was some years ago. Instructors knew the common health risks associated with cigarette smoking. The high schools and colleges should inform their students about the health and socioeconomic problems associated with cigarette smoking and khat chewing. Additionally, college students need counseling service on ways of coping with their problems.

Adult↗

PubMed2002

[Frequency and determinants of breastfeeding in the State of São Paulo, Brazil].

OBJECTIVE: To meet the information need of Brazilian municipalities concerning breastfeeding practices as part of health care planning, a study was carried out to describe breastfeeding and to identify weaning-related factors. METHODS: Of all municipalities in the State of São Paulo, Brazil, openly called to participate in the study, 84 joined in. Personnel underwent training to collect data during the national mass immunization day in 1998. A sample strategy, proportional to the infant population, was developed for each participant. Standardized questionnaires were applied to assess infant feeding practices in the previous 24 hours. Descriptive statistic analysis on breastfeeding prevalence and logistic regression analysis of risk factors for discontinuing exclusive breastfeeding of infants aged less than 4 months and weaning of infants aged less than a year were performed. RESULTS: Exclusive breastfeeding rates in the first four months of life were under 30%. The risk factors were: lower maternal education status; lack of access to the so-called "Baby Friendly Hospital Initiative"; primiparity; and early age pregnancy. Around 50% of children under a year old were breastfed. CONCLUSIONS: Lacks of access to the "Baby Friendly Hospital Initiative", primiparity, and mother's unemployment or engagement in an informal occupation activity were risk factors for weaning. Local breastfeeding rates are extremely variable in the State of São Paulo, reinforcing the importance of local, swift, and easily feasible health care actions.

Brazil↗

PubMed1987

[West Indians in the Netherlands: prospects of return].

The return migration policy of the Netherlands and the probability of its success are assessed, with the focus on migrants from the Netherlands Antilles. Factors associated with return migration are studied using data from a sample survey and from other published sources. Age, educational status, and social welfare in the Netherlands show significant correlations with desire to return to the Netherlands Antilles. "Those who have actually returned belong to the higher social strata of the migrant group; having a job in the West Indies matters much more to them than housing conditions.... It is concluded that the Netherlands should increase their financial contribution to the system of social welfare in the West Indies and even more so to the economic development of these islands." (SUMMARY IN ENG)

Age Factors↗

PubMed1994

Incidence and mortality from breast cancer in the Mama Program for Breast Screening in Finland, 1973-1986.

BACKGROUND: A cohort of women enrolled in the Mama breast self-examination-(BSE) containing breast screening program in Finland from 1973 through 1975 (with BSE used for screening and mammography for diagnosis) was studied. METHODS: Twenty-eight thousand seven hundred eighty-five women who returned calendars recording their practice of BSE over a 2-year period have been followed by linkage with the records of the Finnish Cancer Registry through 1986. The incidence of and mortality from breast cancer was compared with that expected in the Finnish population based on a model incorporating Finnish national data for breast cancer incidence and case fatality. RESULTS: Breast cancer incidence was higher than expected (a rate ratio of 1.19 over all ages). The stage distribution of cases was not different from that expected from Finnish cancer registry data for 1980, but the breast cancer mortality was lower than expected (a rate ratio of 0.75). The latter difference occurred mainly in Years 3-6 of the follow-up period. The effect seemed similar in women under and over the age of 50 years. The cohort was of higher educational status than the Finnish population, and the mortality from all causes was lower than the general Finnish population, an effect seen in previous studies of compliers with breast screening. CONCLUSIONS: The reduction in mortality from breast cancer in the study cohort is consistent with an effect of the BSE-containing Mama program, though selection bias, inherent in any observational study of screening, provided an alternative explanation for the findings.

Adult↗

PubMed2006

The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort.

AIMS: To study the influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive) in the first year of life. METHODS: The Gateshead Millennium Baby Study is a population birth cohort in northeast England studied prospectively from birth, via parental questionnaires and a health check aged 13 months. Data were collected on maternal education, deprivation, eating attitudes, and depression, using the Edinburgh Post Natal Depression Scale (EPDS) at 3 months. Weight gain was assessed using change in weight SD score, conditional on birth weight (Thrive Index); weight faltering was defined as conditional weight gain below the 5th centile. RESULTS: Of 923 eligible infants born at term, 774 (84%) had both weight and questionnaire data. Replicating a previous finding, both the highest and the lowest levels of deprivation were associated with weight faltering; this was independent of the type of milk feeding. No relation was found with maternal educational status. Maternal eating restraint was unrelated to weight gain. Infants of mothers with high depression symptom scores (EPDS >12) had significantly slower weight gain and increased rates of weight faltering up to 4 months (relative risk 2.5), especially if they came from deprived families, but by 12 months they were no different from the remainder of the cohort. CONCLUSIONS: In this setting, social and maternal characteristics had little influence on infants' weight gain, apart from a strong, but transient effect of postnatal depression.

Child of Impaired Parents↗

PubMed2005

Type of kindergarten and other potential determinants of overweight in pre-school children.

OBJECTIVE: The study aimed to assess the relationship of various types of kindergarten differing in length of care and food availability with the development of overweight in pre-school children. DESIGN, SETTING AND SUBJECTS: A cross-sectional study was carried out in 2002 in Stuttgart, Germany, as part of the school entrance examination. Height and weight of 2140 children (participation 70.2%) were measured and information on type of kindergarten and other potential determinants of overweight was collected by a parental questionnaire. Change in relative body mass index (BMI) position between the ages of 4 and 6 years was assessed using medical records. RESULTS: The prevalence of overweight or change in relative BMI position did not differ according to the type of kindergarten. For the prevalence of overweight in German children, adjusted odds ratios (OR) comparing institutions that open only in the morning with those opening in the morning and afternoon or for the full day were 0.86 (95% confidence interval (CI) 0.40, 1.83) and 0.63 (95% CI 0.25, 1.58), respectively. Parental BMI and duration of television watching were positively associated, and maternal educational status and duration of breast-feeding were negatively associated, with overweight and/or change in relative BMI position. The prevalence of overweight was substantially higher among non-German than among German children (adjusted OR 2.17 (95% CI 1.53, 3.07)). CONCLUSIONS: These data show no association between different types of kindergarten and the development of overweight in early childhood. Duration of television watching and breast-feeding, as well as the relatively high prevalence of overweight in ethnic minorities, deserve further attention.

Body Mass Index↗

PubMed2005

Public perception of cross-infection control in dentistry in Nigeria.

OBJECTIVES: To assess the perception of patients on the use of gloves and facemasks in dental practice, methods of sterilisation and the risk of cross-infection. METHODS: Questionnaire survey of patients attending two teaching hospitals and a private dental clinic in Lagos, Nigeria. RESULTS: 228 respondents returned the questionnaires. Nearly all (98.6%) regarded the use of gloves as necessary and 189 (82.9%) did not mind the use of gloves, only 129 (56.6%) felt the facemask was necessary although 132 (57.9%) did not mind its use. More than half of the respondents (54%) felt they could contract an infection in the dental clinic and 43% of them identified HIV as a risk. This response was significantly affected by educational status (p<0.05). 140 patients (61.4%) would not attend a clinic if they knew that HIV patients were treated there. Females were significantly more unwilling to attend (p<0.05). CONCLUSION: While this survey shows a high level of acceptance of the use of gloves, there is a glaring lack of knowledge and acceptance of the use of the facemask indicating a need for more effective public enlightenment on the use of barrier methods. It also reveals a great deal of fear for HIV among Nigerians.

Adolescent↗