A review of satisfaction with dental service at a Jerusalem community clinic serving elderly patients.

AIM: The audit of dental satisfaction and its association with the reported outcome of a dental health care programme for elderly patients. DESIGN: A telephone survey of 162 patients in a Jerusalem municipal dental clinic for geriatric patients, who had completed a treatment course in oral rehabilitation. RESULTS: The average age of the respondents was 73.2 +/- 8.45 years, over 80% of who were very satisfied or satisfied with the treatment given by the dental clinic staff. Only 1.8% were not satisfied (the remaining 17.9% were unable to answer the question). Among those who responded, 91.6% were currently using their full dentures, 80.4% reported an improvement in chewing ability, and 82.3% an improvement in appearance. Respondents who reported daily use of dentures and improved chewing and appearance, also reported higher levels of satisfaction with the clinic. CONCLUSIONS: These results indicate a potentially important role of satisfaction with dental staff in optimal compliance and success of a geriatric oral health care programme.

Community-oriented oral health promotion for infants in Jerusalem: evaluation of a program trial.

OBJECTIVES: This study sought to measure the effect of a community health education program on reported infants' bottle-feeding practices and infants' toothbrushing behavior, with or without distribution of toothpaste and toothbrushes. METHODS: In this quasi-experimental comparison group design study conducted in mother and child health centers in Jerusalem, parents of 727 children were surveyed by telephone at baseline and six months later. The cohort of infants was aged 6-12 months at baseline. The program group received structured health education. The control group received no organized educational intervention. Within the program and control groups, half of the centers were randomly given toothpaste and toothbrushes. RESULTS: Parents' reports revealed a secular 32.5 percent increase in toothbrushing for infants with no intervention, 45.1 percent for infants only receiving toothpaste and toothbrushes, 43.7 percent for infants only receiving the health education program, and a 60.4 percent increase for infants receiving health education together with toothpaste and toothbrushes (chi-square, P = .0002). Modification of bottle-drinking practices, in this program, was unsuccessful. CONCLUSION: The free distribution of toothpaste and toothbrushes, together with an oral health education program, is recommended as a potentially practical and effective method of promoting early oral hygiene practices.

Onset and duration of breast feeding among Israeli mothers: relationships with smoking and type of delivery.

A study of 190 mothers of firstborn, 6 month-old infants showed that different mechanisms affect onset and duration of breast feeding. Maternal education is related both to onset and duration of breast feeding; more highly educated women begin breast feeding and they breast feed for a longer period. Type of delivery is significantly associated with onset of breast feeding, even when controlling for educational level: cesarean delivered women are less likely to begin breast feeding than mothers delivered vaginally, although once breast feeding has begun, type of delivery no longer plays any role. Smoking is associated only with duration of breast feeding and not with onset. Among those women who breast feed for a long period, all are non-smokers. Women usually do not resume smoking immediately after giving birth which may explain why smoking is associated only with duration and not with onset of breast feeding. The results suggest the importance of influencing mothers so they do not resume or, at least, delay resumption of smoking as long as possible after parturition, in order to increase the likelihood of breast feeding. Caesarean delivered women should be encouraged to begin breast feeding while still in hospital.

Episodes of illness in breast-fed and bottle-fed infants in Jerusalem.

In a prospective study on breast-feeding in Jerusalem, 274 middle-class Jewish women were interviewed about their breast-feeding practices, and symptoms and signs of disease, episodes of illness and hospitalization of the infant. Women of a higher education level breast-fed more often and for a longer period than did women with less education. Infants exclusively breast-fed had significantly fewer symptoms of disease than did those not breast-fed or partially breast-fed. The odds ratios for cough, respiratory difficulty, and diarrhea by breast-feeding practice were 3.66, 2.14 and 2.72 (P = 0.04). Significant differences in the number of illness episodes were found between breast-fed and bottle-fed infants at 20 weeks; infants exclusively breast-fed had the least number of illness episodes. A positive association was found between number of illness episodes and duration of breast-feeding. Infants who were breast-fed for 20 weeks had the least number of illness episodes; 52% of them had no episode compared with only 15% who were not breast-fed. Comparison of the numbers of illness episodes among non-breast-fed infants of mothers with low and high education levels indicated that the infants of better educated mothers had a significantly lower percentage of illness episodes (P less than 0.05). Even infants of a middle-class and well-educated population benefit from the breast-feeding practice and its protective effect, more so if they are exclusively breast-fed and for a longer period.

PIP: The frequency of illness episodes in bottlefed, partially breastfed, and exclusively breastfed infants was compared through the 19th postpartum week for 274 infants born at the Hadassah University Hospital between January and July 1979. 402 infants were selected for inclusion in the study from the 1000 consecutive births, which occurred at the hospital during that time period, on the basis of residential proximity to the hospital and single birth status. Mothers of the infants were interviewed after delivery, just prior to discharge, at 6-7 weeks postpartum, and at 20 weeks postpartum. 69% of the mothers were interviewed at all 4 stages, and 274 were interviewed at the 4th stage. At each stage the women were questioned about infant feeding practices and at the 3rd and 4th stage about illness episodes among their infants. 50% of the mothers were Israeli born, 31% were of European or American origin, and the remaining 19% were either from Ais or North Africa. 52% had more than 12 years of schooling, and 48% had less. 89% of the women started breastfeeding in the hospital, 41% still breastfed at 13 weeks, and 27% still breastfed at the 20th week. Prolonged breastfeeding was more common among the more educated mothers than among the less educated mothers. At 20 weeks postpartum the mothers were asked whether their infants experienced any of 10 symptoms during the previous week. Infants exclusively breastfed at 20 weeks had significantly fewer symptoms than partially breastfed and bottlefed infants. For example the proportion of infants who had more than 1 symptom was 8% for the exclusively breastfed, 43% for the partially breastfed, and 43% for the bottlefed infants. Odds ratios for the bottlefed infants compared to the breastfed infants for respiratory difficulties, cough, diarrhea, and vomiting were respectively 3.66, 2.14, 2.72, and 2.14. When educational level was controlled, the corresponding values were 3.33, 1.96, 2.27, and 1.49. An analysis of the number of illness episodes which occurred between the 6th and 20th postpartum weeks revealed that excusivley breastfed infants had significantly fewer episodes than the other 2 groups of infants. For example, the proportion of infants who had 3 or more illness episodes was 16% for bottlfed infants, 4% for partially breastfed infants, and 0% for exclusively breastfed infants; and the proportion reporting no episodes of illness was 62% for the exclusively breastfed, 47% for the partially breastfed, and 29% for the bottlefed. The pattern held for all educational groups and was strongest for infants whose mothers had the least education. Furthermore, 11% of the bottlefed, 8.1% of the partially breastfed, and 2.7% of the exclusively breastfed infants required hospitalization at some point between the 1st and 20th postpartum week. These findings demonstrate that even in predominantly middle class populations, breastfeeding provides health advantages for infants.

Advice from the obstetrician and other sources: do they affect women's breast feeding practices? A study among different Jewish groups in Jerusalem.

Breast feeding practices and the sources of advice that influenced them were studied in a sample of 276 women from North East Jerusalem. They were followed-up for 4 1/2 months and interviewed on 4 occasions during that period. It was found that 89.7% started breast feeding after parturition, 62.4% were breast feeding by 6 weeks, 40.3% were breast feeding after 3 months and 27.3% were still breast feeding by 4 1/2 months postpartum. Obstetrician's advice given at the 6 weeks postpartum examination was significantly associated with duration of breast feeding (P = 0.001). Other sources of guidance were not significantly related to duration of breast feeding when controlling for social class. Analysis of variance indicated that women of higher social classes breast fed more and for a longer period of time. There was no difference in the pattern of attendance at the obstetrician's examination by social class, although a very small proportion of women belonging to the lower social classes reported getting advice on breast feeding during that visit. There was a strong relation between advice of the obstetrician and percentage of women breast feeding 4 1/2 months postpartum. Country of origin of the women also affected breast feeding practices. Women of Western origin breast fed more and longer than women of Asian or North African origin. This might be explained by social movements that attempt a return to more natural life styles which are prominent in Western societies. The differential relationship between advice of obstetrician and women belonging to different social classes is discussed and key elements in the relation between obstetrician's advice and women's breast feeding practices are considered.