Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area.

Introduction: Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka. Design: A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered. Results: The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis. Conclusion: The severity of dental fluorosis was not associated with OHRQoL of the participants.

A bi-level intervention to improve oral hygiene of older and disabled adults in low-income housing: results of a pilot study.

OBJECTIVE: This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing. METHODS: The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth. MAIN OUTCOME MEASURES: Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months. RESULTS: Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46). CONCLUSIONS: This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.

Local responses to the Maharashtra gutka and pan masala ban: a report from Mumbai.

BACKGROUND: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. OBJECTIVE: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. MATERIALS AND METHODS: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. RESULTS: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. CONCLUSIONS: To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

Correlates of self-efficacy in diabetes self-care among Hispanic adults with diabetes.

PURPOSE: The purpose of this study was to examine factors associated with increased diabetes self-efficacy among insulin-requiring Hispanic adults with diabetes. METHODS: A cross-sectional survey design was used to obtain self-reported data on a nonrandom sample of 97 insulin-requiring Hispanic adults with diabetes. The Insulin Management Diabetes Self-Efficacy Scale (IMDSES) was translated into Spanish and administered with a demographic questionnaire by trained bilingual/bicultural interviewers in each respondent's own home. Factor analysis of the IMDSES revealed 4 subscales that corresponded with major diabetes self-care management behaviors. RESULTS: Respondents gave low to average self-efficacy ratings on their ability to manage all aspects of their disease. Behaviors that required problem solving in changing circumstances received the lowest scores. Attending diabetes classes and having home nursing visits were associated with an increased sense of self-efficacy, particularly as it related to diet and insulin. English-speaking ability was associated with a general sense of self-efficacy in managing diabetes care. CONCLUSIONS: The model tested was able to explain modest levels of self-efficacy, particularly in 2 of the most important diabetes management areas, insulin and diet management.

Organizing community research partnerships in the struggle against AIDS.

Despite pharmaceutical advances, AIDS remains a health problem difficult to treat, leaving preventive interventions as the primary means of promoting risk avoidance. Increasing the capacity of university-based researchers to develop culturally, developmentally, and contextually appropriate AIDS prevention strategies requires the collaboration of community service and advocacy partners. To date, neither university researchers nor community providers have a great deal of partnership experience. Thus, a common language and set of experiences are yet to be developed. This article reviews the history of university-community and researcher-community collaboration for AIDS research and intervention, placing the innovative work of the University of California, San Francisco (UCSF) Center for AIDS Prevention Studies and its community and foundation partnerships among those efforts at the forefront of the community-university dialogue. It concludes with suggestions derived from the collaborative work of UCSF researchers and community service partners to strengthen efforts to develop theory, research methods, and results that are immediately useful and productive of long-term prevention research efforts.

AIDS prevention for African-American and Latina women: building culturally and gender-appropriate intervention.

African-American and Latino women are at high risk of HIV infection through heterosexual transmission, reflected in the significant increases in reported AIDS cases of women thus infected. Few AIDS-prevention programs have addressed this risk for women by directly, separately and, in appropriate ways, focusing on specific women's issues of gender roles, sexuality, and differential power relationships with men, in the context of racial and class relations, as these affect HIV transmission. This article discusses the contributions of a community-based AIDS-prevention program to the development of culturally and gender-appropriate intervention for African-American and Latina women at high risk. Further such programs are needed which build on the use of ethnic cultural concepts, racial and other social relations, and acknowledge issues specific to minority women in order to prevent their infection with HIV.

Approaches to case management in Puerto Rican communities.

This article reviews some critical elements of case management as they apply to Puerto Ricans seeking quality and consistency in health care and social services in a system which is culturally foreign, difficult to negotiate, and frequently unresponsive, especially to those with limited economic resources and government rather than private insurance. Following a brief outline of some principles of case management, we discuss aspects of Puerto Rican history, family organization, and health-seeking behavior that relate to case management. Descriptions of three programs illustrate several case management approaches that combine methods to access care with those needed to organize coordinated inter-institutional care. Finally, we suggest ways for case managers to successfully work with Puerto Rican families.

Sociocultural factors associated with smoking behavior by Puerto Rican adolescents in Boston.

This study examined cigarette smoking among Puerto Rican adolescents in the Boston area in its sociocultural context by describing who uses cigarettes, and by identifying factors that encourage or discourage cigarette use. The study, conducted from 1986-87, used two approaches. The first was to survey 605 Puerto Rican households with adolescents 11-20 years old. Households were identified from a random sample of census blocks in five neighborhoods. In each household, interviews were completed with one adolescent and his or her female caretaker. The second approach was to conduct ethnographic interviews with 40 adolescents selected through a purposive sample of survey respondents from three of the study neighborhoods. Bivariate and multivariate statistical analyses were used to examine the relationships between smoking behavior and characteristics of the adolescents. The results of these analyses were examined in light of the ethnographic data. Overall, 13.7% reported smoking in the month preceding the interview. Smoking was most prevalent among males 17-20. Patterns of smoking were associated with teens' social networks. The Puerto Rican adolescents in this study were more likely to smoke when their friends and household members smoked, if they participated in recreational activities such as sports or unsupervised games, and if they were not in school. These effects varied according to the gender of the respondent.