Determinants of cervical spine disorders in military pilots: a systematic review.

BACKGROUND: Neck pain and cervical spine disorders are widespread among military cockpit aircrew pilots and are often recognized as occupational stressors. AIMS: This systematic review aimed to identify significant determinants for military pilot neck pain and cervical spine disorders determined through multivariable logistic regression studies. METHODS: This systematic review was conducted according to the recommendations of the Statement of Systematic Review and Meta-analysis Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]-P). The following databases were searched for literature: Medline and Embase. We included studies that studied neck pain, cervical spine disorders, and/or radiological abnormalities and associated exposures (adjusted odds ratios, ORadj) in military cockpit aircrew. The trustworthiness, relevance and results of the published papers were evaluated using the Joanna Briggs Institute critical checklist. RESULTS: A total of three studies quantified the strength of the correlations between exposures and outcomes. Significant determinants/risk factors of neck pain, cervical spine disorders and radiological abnormalities were identified as age (ORadj: 1.092 [95% CI 1.054, 1.132]), fighter type (ORadj: 3.9 [95% CI 1.1, 13.9]) and absolute rotation angle of C2-7 (ARA) (ORadj: 0.91 [CI 0.85, 0.98]). The following variables were unable to demonstrate statistical significance: flying hours, body height and body mass index. CONCLUSIONS: Military cockpit aircrew's frequent neck pain after a flight raises concerns about cervical spine disorders. Age, fighter type and ARA C2-7 are strong predictors of neck pain and cervical spine disorders. More research is needed on occupational determinants and risk factors for neck pain and cervical spine disorders in military cockpit aircrew.

Dental caries and dental fluorosis among 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait.

The purpose of the present study was 1) to describe the occurrence of dental caries and fluorosis among children in kindergartens and public schools in Kuwait, and determine their need for dental health care, 2) to describe changes in caries prevalence and experience from 1982 to 1993 and 3) to provide a baseline for the evaluation of the preventive oral health programmes starting in Kuwait in 1994. The study population comprised 3,500 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait, selected by stratified cluster sampling. Dental caries was scored by surface in accordance with WHO criteria, and dental fluorosis was registered by Dean's index (modified). The mean deft was 4.6 at age 4 years, and 6.2 at age 6; 8 and 11 percent of the decay had been treated by extractions or fillings in the two respective age groups. Among the 6-, 12- and 15-year-old children DMFT was 0.2, 2.6 and 3.6 respectively; 12 and 14 percent of the decayed teeth of 12- and 15-year-old children had been treated. As to the 4- and 6-year-old children, 19 and 9 percent were caries-free in the deciduous teeth, while 86, 21 and 14 percent of the 6-, 12- and 15-year-old children were caries-free in the permanent teeth. Among the 4-year-old children 47 percent had caries in the front teeth. None of the children had severe dental fluorosis, but 6 percent at 12 and 15 years showed mild to moderate, but manifest, dental fluorosis. The survey revealed that caries experience as well as caries prevalence had increased since 1982, although there was a marked increase in the number of filled tooth surfaces in all age cohorts. However, in 1993 the DMFT of 12-year-old children was still well within WHO's global goal for the year 2000, whereas the prevalence of dental caries among 6-year-old was considerably higher than the WHO goal.

Dental knowledge, attitudes and behavior among Kuwaiti mothers and school teachers.

In one region in the state of Kuwait children in first grade have been offered a systematic dental health care program. The purpose of this study was to assess (1) dental knowledge, attitudes, and health behavior among the mothers of children in first grade, and (2) dental knowledge and attitudes of schoolteachers, and their involvement in health education. Before the children were enrolled in the program 187 mothers (response 76%) were interviewed. Self-administered questionnaires were used to collect data on schoolteachers (n = 135, response 695). Most of the mothers (74%) answered that dental caries is caused by sweets/candy; the role of bacteria was mentioned by 9%. Half of the mothers were aware of the harmful effect of sugary drinks, and 50% knew about the preventive effect of fluoride. Knowledge about causes and prevention of periodontal disease was diffuse. According to the mothers, 68% of the children were in need for dental treatment; 37% were seen by a dentist once a year for symptomatic reasons, and 49% brushed their teeth at least twice a day. Sixteen-percent of the mothers helped their child in brushing every day. Sugar consumption among mothers and children was high, e.g. 66% of the children had chocolate bars and 44% had soft drinks several times a day. The level of dental knowledge was higher among teachers than mothers; the mothers were mostly informed through television/radio, while teachers had received information from various sources, including the dentists. The teachers responded positively to prevention of dental diseases among children and should be considered key persons in dental health education. For the Kuwaiti children and the mothers the active involvement principle, group presentations, and one-to-one communications are recommended for the school based dental health program.