Toothbrushing practices as risk factors for dental fluorosis in an area with varying fluoride levels in drinking water.

BACKGROUND: Despite contributing to a reduction in dental caries, improper use of fluoridated toothpaste could add to the burden of dental fluorosis in children. AIM: To assess the association between tooth-brushing practices such as the type and amount of toothpaste used, frequency of tooth brushing, parental assistance in tooth brushing, timing of tooth brushing and dental fluorosis in school children in Kurunegala district, an endemic area for dental fluorosis in Sri Lanka. METHODS: For this case-control study, a sex-matched sample of 15-year-old school children attending government schools in Kurunegala district and who were lifetime residents of the district was selected. Dental fluorosis was measured using the Thylstrup and Ferjeskov (TF) Index. Those children with a TF⟩1 were considered as cases and those with a TF score of 0 or 1 served as controls. An interview of parents/caregivers of the participants was used to assess risk factors for dental fluorosis. The fluoride concentration in drinking water was measured using spectrophotometry. Data analysis used chi-square tests and conditional logistic regression. RESULTS: Tooth brushing ≥ twice/day, brushing after breakfast and parent/care giver brushing the child's teeth reduced the likelihood of developing fluorosis. CONCLUSION: Use of fluoridated toothpaste adhering to the recommended guidelines could prevent dental fluorosis in children in this endemic area.

First trimester feeding in a rural Sri Lankan population.

One hundred Sinhalese mothers with infants at three months age in a rural population in Central Sri Lanka were interviewed by questionnaire on the feeding of their infants from birth to 3 months of life. 96% of babies were being breast fed at 3 months age. However, 32% have already been started on formula. Of this 32, eight mothers were from poor families receiving state subsidies. 20 of the 32 were giving expensive formulas made by multinational companies, (including four of the eight mothers receiving state subsidies and feeding formula) in spite of the availability of cheap comparable state subsidized formulas. In rural Sri Lanka only about a quarter have access to drinking water but 96% were giving water or other weak nutritional solutions at 3 months of age. 72% were using bottles for feeding. 77% were being given sugar and, 13% salt through non-milk solutions while 11% were getting sugar through their formula. Maternal employment, increasing maternal age, less than sixteen hours of maternal contact time per day with child, delay in initiation of breast feeding after birth were all significantly associated with a higher risk of formula feeding. A lower birth order and early initiation of breast feeding after birth were associated with a higher risk of babies being fed on non-milk solutions. In the light of these findings it is suggested that the time is now opportune for the National Nutritional Programme to shift its present emphasis from the promotion of breast feeding in these (and similar) areas to the promotion of exclusive breast feeding in the early infant's diet, while discouraging formulas, non-milk solutions, weaning foods, salt, sugar and the use of the bottle as a feeding utensil.

Sociocultural factors and perinatal health in a Mexican-American community.

PIP: The complex relationship between sociocultural variables, such as ethnicity, language, and working status, and the utilization of facilities for perinatal health care were explored in a predominantly Mexican American community in Chicago. The project, which was initiated in 1977, was designed to provide objective data on utilization patterns of perinatal health facilities and to assess the importance of the migratory experience on the utilization of perinatal services among Mexican immigrants and Mexican Americans living in the community. Patterns of utilization of perinatal health facilities by pregnant women, preference for the ethnicity, language, and sex of the health care provider, and different patterns that influence the months of prenatal care were examined in the context of the migration factor. An interview instrument was developed to include both quantitative and qualitative data. Ages among the sample of women ranged from 16-41. 60 women were immigrants born in Mexico and 29 women were Mexican Americans born in the US. Women in the sample were using 2 major health care "tracks" for their perinatal care: public facilities for prenatal care, delivery, and pediatric care for the infant; and private physicians for prenatal care, pediatric care, and delivery in the small, Catholic hospitals where the physicians tended to have admitting privileges. 34 women were attending private facilities, and 55 women were using public facilties. 27 women (30.3%) cited economic considerations as the reason for choosing a physician or facility. Other reasons included personal referral or recommendation (27%), previously used (16.9%), and geographic proximity (6.7%). The use of public prenatal clinics correlated significantly with the citing of economic considerations as the basis for choosing this type of care. 32 women (36%) were working during their pregnancy. There was a significant relationship between choosing a private physician for prenatal care and being employed. Women who were recent immigrants, as well as Mexican Americans, tended to use public facilities. Mexicans who had been in Chicago for more than 2 years tended to use private facilities. The length of time since a woman left Mexico correlated negatively with the month of prenatal care. Traditional patterns of postpartum behavior were found to be persistent among the migrant women regardless of the time of migration and were found to be present among Mexican Americans.^ieng

A model of fertility control in a Puerto Rican community.

PIP: This article examines the fertility control decision making of Puerto Rican women in Hartford, Connecticut a city that has a high sterilization rate among Puerto Rican heads or co-heads of households. Decisions regarding fertility are conceptualized as a result of a complex interaction among individual needs of women, factors influencing the family, the impact of religious institutions, accessibility of medical services, and socioeconomic resources of the household and the local community. A survey of 153 female household heads in Hartford conducted in 1978-79 by the Hispanic Health Council found that 79 (51.6%) had been sterilized. Further analysis was aimed at identifying the factors linked to sterilization in a subsample of the original respondents that included 3 categories: those using no birth control, those using the IUD or oral contraception, and those sterilized. The results indicate that Puerto Rican women begin their sexual activity with limited use of birth control, accept reversible methods primarily after the 2nd and 3rd births, become sterilized in significant numbers after their 3rd child, and have generally attaned sterilization after 5 births. Sterilization is the fertility control method most frequently selected at the point where women feel they have reached their desired family size. Since optimal family size is achieved quickly, many Puerto Rican women seek sterilization in their 20s. This widespread acceptance of sterilization in part reflects the effects of recent sterilization campaigns in Puerto Rico. It further reflects health care providers' expectation that Puerto Rican women will not be successful in their use of reversible methods. The major difference between higher and lower socioeconomic groups centers around the point in family size at which sterilization takes place, with women of higher socioeconomic status terminating childbearing after fewer births. It is concluded that interventions should aim to increase use of reversible methods of birth control, both for birth spacing and family size limitation, among Puerto Rican women of higher socioeconomic status and that a comprehensive approach, involving both socioeconomic factors and fertility control, should be directed toward those of lower socioeconomic status.^ieng