Orientador: Marcelo de Castro Meneghim / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T05:51:22Z (GMT). No. of bitstreams: 1 Tonello_AlineSampieri_D.pdf: 1951799 bytes, checksum: 27b4d5ce5f510d6096bf44b78d9cfbd9 (MD5) Previous issue date: 2010 / Resumo: O presente trabalho, composto por dois estudos teve como objetivos: a) descrever as prevalências de cárie e fluorose dentária em escolares de 12 anos de idade de Piracicaba/SP e Iracemápolis/SP, Brasil, 2007 e comparar estes dados com outros levantamentos epidemiológicos realizados anteriormente, em Piracicaba para a cárie dentária (1971-2005) e para a fluorose dentária (1991-2001) e em Iracemápolis para a cárie e fluorose dentária (1991-2004); b) avaliar a experiência de cárie e a prevalência de fluorose dentária em escolares de 12 anos de idade de Piracicaba/SP, Brasil, 2007 e verificar a relação entre essas alterações e os fatores socioeconômicos e variáveis comportamentais relacionadas com a saúde bucal. A amostra constituiu de 724 escolares provenientes de escolas públicas e privadas de Piracicaba/SP e 197 escolares provenientes de escolas públicas de Iracemápolis/SP. Os exames foram realizados por um examinador previamente calibrado, no pátio das escolas, sob luz natural, com auxílio de espelho bucal plano, sonda IPC e escovação prévia, seguindo as recomendações da OMS. A cárie dentária foi avaliada utilizando os índices CPOD e SiC (Significant Caries Index), e a fluorose pelo índice T-F. As variáveis socioeconômicas (renda familiar, número de residentes na mesma casa, escolaridade do pai e da mãe e habitação) e as informações comportamentais foram obtidas por meio de um questionário semi estruturado enviado aos pais. A associação entre as variáveis dependentes (CPOD e fluorose) e as variáveis independentes (variáveis socioeconômicas e comportamentais) foi determinada por meio de análise de regressão logística múltilpa. O CPOD médio foi de 0,85 (dp=1,54) e 1,02 (dp=1,61) e o índice SiC de 2,52 (dp=1,72) e 2,83 (dp=1,60) em Piracicaba e Iracemápolis, respectivamente. A prevalência de fluorose foi de 29,4% e 25,4% em Piracicaba e Iracemápolis, respectivamente. Comparando o presente estudo com outros levantamentos realizados anteriormente, foi observada uma significativa redução da experiência de cárie em ambas as cidades, (90,12%) em Piracicaba e 85,07% em Iracemápolis (p<0,01). Com relação à prevalência da fluorose dentária, verificou-se um aumento de 44,1% em Piracicaba, observando uma menor prevalência entre alguns anos. Já em Iracemápolis, o aumento foi de 1170%. Com base no modelo de regressão logística múltipla, as crianças pertencentes a uma família com renda mensal inferior ou igual a quatro salários mínimos apresentaram 2,58 vezes mais chances de terem cárie (CPOD>0) do que aquelas pertencentes a uma família com renda mensal superior a quatro salários mínimos. Além disso, aquelas crianças que consultaram ao dentista apresentaram 4,27 vezes mais chances de serem diagnosticadas ou tratadas em relação à cárie do que aquelas que nunca foram ao dentista. Porém, em relação à fluorose, o modelo de regressão logística não foi significativo. Em conclusão, os resultados desta tese demonstraram uma contínua redução da experiência de cárie em ambas as cidades no decorrer dos anos. Em relação à fluorose dentária, verificou-se uma tendência de estabilização em Piracicaba, porém em Iracemápolis, observou-se um aumento constante. Adicionalmente, observou-se uma associação entre a presença de cárie e renda familiar mensal, como também entre cárie e consultas ao dentista. Entretanto, em relação à fluorose dentária, nenhuma das variáveis testadas foi associada com esta alteração / Abstract: The present study was composed by two papers which aims were: a) to describe the prevalence of dental caries and dental fluorosis in 12-years-old schoolchildren from Piracicaba/SP and Iracemápolis/SP, Brazil, 2007 and to compare current prevalence rates with those from previous epidemiological surveys developed in Piracicaba, for dental caries (1971-2005), and for dental fluorosis (1991-2001) and in Iracemápolis for dental caries and dental fluorosis (1991-2004); b) to evaluate the caries experience and dental fluorosis prevalence in 12-years-old schoolchildren from Piracicaba/SP, Brazil, 2007 and to verify the relationship between these trends, socioeconomic factors, and behavioral variables related to oral health. The sample consisted of 724 schoolchildren from public and private schools from Piracicaba/SP and 197 schoolchildren from public schools from Iracemápolis/SP. Examinations were executed by a previously calibrated examiner, in outdoor settings, under natural light, using dental mirror, CPI probe, and previous tooth brushing, followed the WHO recommendations. Dental caries was measured by DMFT and SiC (Significant Caries Index) indexes and dental fluorosis by T-F index. Socioeconomic variables (monthly income, number of residents in home, mother's and father's education and home ownership) and behavioral information were collected by means of a parental semi structured questionnaire. Then multiple logistic regression analyses using the stepwise procedure were performed in order to verify the relationship among the dependent variables (DMFT and fluorosis) and the independent variables (socioeconomic and behavioral variables). The mean of DMFT was 0.85 (SD=1.54) and 1.02 (SD=1.61) and the SiC Index was 2.52 (SD=1.72) and 2.83 (SD=1.60) in Piracicaba and Iracemápolis, respectively. The fluorosis prevalence was 29.4% and 25.4% in Piracicaba and Iracemápolis, respectively. Comparing the present study to another previous epidemiological surveys, in both towns, a significant caries reduction of 90.12% (Piracicaba) and of 85.07% (Iracemápolis) (p<0.01), have been observed. Concerning dental fluorosis prevalence, an increase of 44.1% was noted in Piracicaba, where a small prevalence was observed throughout the years. Although, the increase was 1170% in Iracemápolis. By means of multiple logistic regression model, children, whose family earned up to four minimum wages, were 2.58 more prone to have caries (DMFT>0) than those whose family earned over four minimum wages. Besides, those children who visited the dentist were 4.27 more prone of being diagnosed with dental caries and receive treatment in comparison to those who never had visited the dentist. However, for fluorosis prevalence the multiple logistic regression model was not significant. In conclusion, the results of this thesis demonstrated continuous decrease in dental caries experience in both Brazilian towns. Concerning dental fluorosis, stabilization trends were observed in Piracicaba. In Iracemápolis, however, a constant increase was noted. Moreover, significant associations between the presence of dental caries and monthly family income, as well as between dental caries and visiting to the dentist, were observed. However, in relation to dental fluorosis, no tested variable was associated with the disturb / Doutorado / Saude Coletiva / Doutor em Odontologia

Este estudo mostrou uma forte influência dos fatores socioeconômicos e ambientais na prevalência da cárie dentária. Vinte e duas variáveis socioeconômicas e ambientais foram relacionadas a um indicador de saúde bucal. Este indicador consiste na soma dos índices CPO-D e ceo-d nos grupos de alunos de 5 a 12 anos para os 131 municípios que fizeram parte do Levantamento de Saúde Bucal do Estado de São Paulo em 1998. Destes 131 municípios estudados, 9% apresentaram Indicador baixo (&#61603; 2,6); 55% dos municípios, Indicador moderado (2,7 - 4,4); 34% dos municípios, Indicador considerado alto (4,5 - 6,5) e 2% apresentaram indicador muito alto (> 6,6). A prevalência de cárie dentária no Estado de São Paulo para esta faixa etária de 5 a 12 anos, medida por meio do Indicador, mostrou correlação significativa (p<0,05) com 17 das variáveis utilizadas. O modelo de regressão multifatorial mostrou correlação direta de 63% com três fatores principais: presença de flúor na água de abastecimento público, porte populacional do município e Índice de Desenvolvimento Humano Municipal para Educação. Este modelo final pode explicar 38% da variação da prevalência da cárie dentária no Estado de São Paulo em 1998. Em relação aos aspectos geográficos, a epidemiologia espacial evidenciou que os maiores índices de cárie dentária encontraram-se nas regiões Sudoeste, Central e Nordeste do Estado de São Paulo. Os resultados mostraram que condições socioeconômicas e ambientais satisfatórias podem contribuir de maneira importante para a saúde bucal. Mostraram, também, que o emprego da epidemiologia espacial pode contribuir para a identificação de áreas com maior necessidade de cuidados odontológicos e preventivos. / The result of this study showed a strong influence of socioeconomic and environmental background in the dental caries. Twenty-two socioeconomic and environmental variables were correlated to an oral health indicator. This indicator consisted of the sum of the DMFT and dmft indices in students from 5 to 12 years old in 131 cities, which were participants in the Epidemiological Survey of Oral Health in São Paulo State in 1998. Out of the 131 cities studied, 9% had a low indicator (&#61603; 2,6); 55% had a medium indicator (2,7 - 4,4); 34% had a considerable high indicator (4.5 - 6.5) and 2% had a very high indicator (> 6.6). The indicators showed that the prevalence of dental caries in the Sao Paulo State for this age range is significantly related (p<0.05) to 17 of the variables used. The regression multifactor model showed direct correlation of 63% with three main factors: the presence of fluoride in public water, population size of each city and Municipal Human Development index in education. This final model could explain 38% of the variation of the presence of dental decay in the São Paulo State in 1998. With regard to the geographical aspects, spatial epidemiology pointed out that the higher dental caries indices are located in the southwest, central and northwest areas of the studied State. The results showed that the socioeconomic and environmental conditions might greatly contribute to the dental health. In addition to this, the use of spatial epidemiology can contribute to identify the areas in need of oral health promotion and dental care.

Philosophiae Doctor - PhD / The research problem for this study is the limited and unsuccessful implementation of the IWRM concept. This thesis has argued that comprehensive assessment of physical and socioeconomic conditions is essential to provide explanation on factors that limit the successful execution of the IWRM approach. It has further argued that the local IWRM works as proxy for full and successful implementation of the IWRM approach.To contextualise this thesis, the prevailing physical and socioeconomic factors in Malawi in relation to current management and usage of water resources were explained.With 1,321m3 per capita per year against index thresholds of 1,700-1,000m3 per capita per year, this study showed that Malawi is a physically water stressed country but not physically water scarce country although economically it is a water scarce country. This novelty is against some literature that present Malawi as a water abundant country.Again, this study showed that executing a full and successful IWRM in Malawi remains a challenge because of the prevailing socioeconomic situation in terms of water policies,water laws, institutions and management instruments. These aspects have not been reformed and harmonised to facilitate a successful operation of the IWRM approach.The main water-related problem in Malawi is the mismanagement of the available water resources. This is largely due to the lack of implementing management approaches which can generate systematic data for practical assessment of water resources to guide the coordinated procedure among water stakeholders working in catchments. This lack of implementing a coordinated management approach commonly known as integrated water resources management (IWRM) can be attributed to various reasons that includei) lack of comprehensive assessment of factors that can explain lack of successful IWRM implementation at catchment level and ii) lack of methods to demonstrate data generation and analysis on quantity, quality and governance of water that show practical operation of IWRM at community level using groundwater as a showcase among others.This study revealed that introducing local IWRM requires a prior knowledge of the evolution and role of the full IWRM concept in the international water policy which aimed at addressing broader developmental objectives. Globally, the current status of the IWRM concept has potential to address such broader developmental objectives, but sustaining IWRM projects where they have been piloted showed slow progress. Basing on the factors that slow such a progress, local IWRM approach has emerged as a proxy to execute the full IWRM as demonstrated in chapter 8 in this thesis. However, the observed lack of sustainable resources to fund continual functioning of local IWRM activities will defeat its potential solution to water management challenges. The main threat for sustainable local IWRM activities is the tendency of national governments to decentralise roles and responsibilities to local governments and communities without the accompanying financial resources to enable the implementation of the local participation, investments and initiatives at local level. If this tendency could be reversed, the contribution by local IWRM towards solving management problems in the water sector will be enormous. Chapter four has provided the general case-study approach used in this study in terms of research design, data collection methods, data analysis methods, ethical consideration and limitation of the current study within the context of water resource management with a focus on groundwater management.Using geologic map, satellite images, photographs and hydrogeologic conceptual model, the following results emerged: 1) that the Upper Limphasa River catchment has fractured rock aquifer with limited permeability and storage capacity; 2) The topographic nature and north-south strikes of the lineaments explained the north-south flow direction of groundwater in the catchment; 3) The drainage system observed in the Kandoli and Kaning’ina Mountains to the east and west of the Upper Limphasa River catchment respectively (Fig. 5.1; Fig.5.2) formed a groundwater recharge boundary; 4)The regional faults in the same mountains (Fig. 5.1; Fig.5.2) formed structural boundar as well as hydrogeologic boundary which controlled flow direction of the groundwater;5) the hydrogeologic conceptual model showed the existence of the forested weathered bedrock in the upland areas of the entire catchment which formed no-flow boundary and groundwater divide thereby controlling the water flow direction downwards (Fig. 5.9);6) The major agricultural commercial activities existed in Lower Limphasa catchment while only subsistence farming existed in Upper Limphasa catchment. This knowledge and visualization from the map (Fig. 5.3) and conceptual model (Fig.5.9) showed interactions between upland and lowland areas and the role of physical factors in controlling groundwater flow direction in the catchment. It also provided the enlightenment on implications of socioeconomic farming activities on water management. These insights enabled this study to recommend the need for expedited implementation of holistic effective management for sustainable water utilization.Using different physical factors, water scarcity indices and methodologies, this study showed that Malawi is a physically water stressed as well as an economic water scarce country. This novelty is against some literature that present Malawi as a water abundant country. Again, despite the high proportion (85%) of Malawians relying on groundwater resource, groundwater availability (storage in km3) is relatively low (269 km3 in Table 6.10) compared to other countries within SADC and Africa. Given the complexity of groundwater abstraction, the available groundwater for use is further reduced for Malawians who depend on such a resource for their domestic and productive livelihoods. Such insights provided the basis for discussing the need for IWRM.Although daily statistics on groundwater demand (i: 21.20 litres; 116.91 litres;80,550.99 litres), use (ii: 16.8 litres; 92.55 litres; 63,766.95 litres) and abstracted but not used (iii: 4.4; 24.36; 16,784.04 litres) were relatively low per person, per household and per sub-catchment respectively, such statistics when calculated on monthly basis (i.Demand: 636 litres; 3,507.30 litres; 2,416,529.70 litres; ii.Use:504 litres; 2,776.5 litres;1, 913, 008.5 litres iii. Abstracted but not used: 132 litres; 730 litres; 503, 521.2); and on yearly basis (i. Demand: 7,632 litres; 42,087.6 litres; 28,998,356.4 litres; ii. Use: 6,048 litres; 33,318 litres; 22, 956, 102 litres; iii: Abstracted but not used: 1,584 litres; 8,769.6 litres; 6,042,254.4 litres) per person, per household and per sub-catchment provided huge amount of groundwater (Table 6.5). Given the limited storage capacity of fractured rock aquifer in the basement complex geology, the monthly and yearly groundwater demand and use on one hand and abstracted but not used on the other was considered enormous. With the population growth rate of 2.8 for Nkhata Bay (NSO, 2009) and the observed desire to intensify productive livelihoods activities coupled with expected negative effects of climate change, the need to implement IWRM approach for such groundwater resource in the study catchment remains imperative and is urgently needed.In addition to identifying and describing factors that explain the limited groundwater availability in the study catchment, the study developed a methodology for calculating groundwater demand, use and unused at both households and sub-catchment levels.This methodology provided step-by-step procedure for collecting data on groundwater demand and use as a tool that would improve availability of data on groundwater.Implications of such results for IWRM in similar environments were discussed. Despite the time-consuming procedure involved in using the developed methodology, the calculations are simple and interpretation of results is easily understood among various stakeholders. Hence, such an approach is recommended for the IWRM approach which requires stakeholders from various disciplines to interact and collaborate. Nonetheless, this recommends the use of this method as its further refinement is being sought. The analysis on groundwater quality has shown that the dominant water type in the aquifers of Upper Limphasa catchment was Ca-HCO3, suggesting that the study area had shallow, fresh groundwater with recent recharged aquifer. Analyses on physicochemical parameters revealed that none of the sampled boreholes (BHs) and protected shallow dug wells (PSWs) had physical or chemical concentration levels of health concern when such levels were compared with 2008-World Health Organisation(WHO) guidelines and 2005-Malawi Bureau of Standards (MBS). Conversely, although the compliance with 2008-WHO and 2005-MBS of pathogenic bacteria (E.coli) in BHs water was 100% suggesting that water from BHs had low risk and free from bacteriological contamination, water from PSWs showed 0% compliance with 2008-WHO and 2005-MBS values implying high risk to human health. The overall assessment on risk to health classification showed that PSWs were risky sources to supply potable water, hence the need to implement strategies that protect groundwater.On the basis of such findings, the analysis in this study demonstrated the feasibility of using IWRM approach as a platform for implementing environmental and engineering interventions through education programmes to create and raise public awareness on groundwater protection and on the need for collaborative efforts to implement protective measures for their drinking water sources. The use of different analytical methods which were applied to identify the exact sources of the observed contaminants in the PSWs proved futile. Therefore, this study concluded that rolling-out PSWs either as improved or safe sources of drinking water requires further detailed investigations.However, this research recommended using rapid assessment of drinking water-quality (RADWQ) methods for assessing the quality of groundwater sources for drinking. Despite the study area being in the humid climatic region with annual rainfall above 1,000 mm, many of the physical factors were not favourable for availability of more groundwater in the aquifers. Such observation provided compelling evidence in this study to commend the local IWRM as a proxy for the full IWRM implementation for sustainable utilization of such waters. Although institutional arrangements, water laws and water policy were found problematic to facilitate a successful implementation of full IWRM at national level in Malawi, this thesis demonstrated that local institutional arrangements, coordination among institutions, data collection efforts by local community members (active participation), self-regulation among local community committees were favourable conditions for a successful local IWRM in the Upper Limphasa River catchment. This research recommends continuation of such local participation, investment and initiatives as proxy for the full and successful IWRM beyond the study catchment. However, the observed lack of financial resource from central government to facilitates local IWRM activities were seen as counterproductive.In addition, this thesis recommended further studies which should aim at improving some observed negative implications of self-regulations on community members and the limited decentralisation elements from the Department of Water Development.Finally, one of the contributions from this study is the scientific value in using different methods to assess the quality of groundwater as presented in chapter 7. The second value is the demonstration of applying practical techniques to evaluate factors that explain the amount of groundwater storage in the aquifers that can be understood by water scientists, water users, water developers and water managers to implement IWRM collaboratively using groundwater as a showcase. The third contribution is the provision of the procedure to systematically generate data on demand (abstraction) and use of groundwater in unmetered rural areas which has the potential to guide water allocation process in the catchment. Fourthly, the thesis has provided a hydrogeologic conceptual model for the first time for Limphasa River catchment to be used as a visual tool for planning and developing management practices and addressing current water problems.Fifthly, the study has shown how local IWRM works at community level as a proxy for the full implementation of IWRM despite the absence of Catchment Management Agencies. The last contribution is the dissemination of results from this study made through publications and conference presentations as outlined in the appendix.

This study is a part of a three stage pursuit to examine and to comprehend the relationship between the resources available, the apparent utilization patterns of those resources by the population being served, and the selected characteristics of the populations utilizing and not utilizing the prevailing medical care system. The first stage of the research involves the examination of the existing patterns of medical care utilization by socioeconomic status groups. Cross-national Comparison of Physician Utilization by the Socioeconomic Status Groups is the pilot research for the first stage and both modifies and develops the methodology for this type of research and also examines the physician utilization patterns of a population in well defined basic measurements — in this case the socioeconomic status index, the diagnosed disease, and the number of physician contacts. The comparison of the physician utilization patterns of socioeconomic status groups in respect to the prevailing medical care delivery system necessarily involves cross-area studies at least at regional level, but most likely cross-national comparisons as well. This study used already collected data, nevertheless, primary data, which had been collected and partly analysed in the World Health Organization/International Collaborative Study of Medical Care Utilization. The data came from twelve geographical areas, altogether from seven countries, and provided documented research material on the surveyed respondents' social characteristics, standard diagnostic procedures, and standard definitions of the interactions between the users and the prevailing medical care delivery systems. The social characteristics were used separately, but in a standardized way, in order to derive socioeconomic status groups in each area; the diseases distributions were examined in relationship to the socioeconomic status groups, and the physician utilization patterns were related to the socioeconomic status groups while controlling for the distributions of selected diseases, after which the study areas were compared to each other in terms of the exhibited relationships between the physician utilization and the socioeconomic status groups. The physician utilization patterns were found to vary only little from one area to another, however, consistently, to warrant the use of derived information for the second stage of the research. Physician utilizations were very weakly correlated to the socioeconomic status and these correlations were not substantially effected by the selection of the controlling disease, i.e., they were consistent. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

There is lack of evidence on which of the two highly recommended malaria prevention methods, insecticide treated bednets and indoor residual spraying, is more effective than the other. There is also limited peer reviewed literature that compares the characteristics of people who use the two malaria prevention methods. Based on the Health Belief Model, the research questions tested whether there is any relationship between the use of mosquito bednet or the use of indoor residual spraying and contracting malaria, and whether there is any relationship between sociodemographic and socioeconomic factors and the use of malaria prevention methods. Using a quantitative research design, secondary data from the 2011 Angola malaria indicator survey were analyzed. Chi-square for association, logistic regression, and multinomial logistic regression tests were used. There was no statistically significant association between the use of mosquito bednet and having malaria. However, the use of indoor residual spraying significantly reduced the likelihood of getting malaria. There was also a statistically significant association between place of residence, wealth index, level of education, and number of household members and using mosquito bednet and between wealth index and using indoor residual spraying. In conclusion, the malaria prevention programs should focus on indoor residual spraying. It is recommended that all households in southern Africa malaria prone areas should be regularly sprayed. The findings of this study contribute to positive social change in the sense that by using more effective malaria prevention method, individuals will be able to function normally on daily basis, save on expenses related to employment loses or treatment and care of the sick, as well as loss of life and improve own economic status.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Purpose: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. Methods: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Results: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. Conclusion: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Objetive: To describe the prevention and control practices for the infection to SARS-COV2 in the Peruvian population. Material and Methods: Observational descriptive study. We evaluated a non-probabilistic sample of adult residents in some departments of Peru. Preventive practices were evaluated in people without a history of COVID-19 and control practices in people who had suffered it. Results: We evaluated 3630 Peruvians (mean age 25.4 ± 9.5), of that 3231 don't have a history of COVID-19 and 399 who had suffered it. The prevention and control practices that were realized often or always, with more frequencies, was the use of a mask when they go out home (97.9% vs 87.7), cover their nose or mouth when they sneeze (95.4% vs 89.9%), save the distance to other people in the street (91.4% vs 74.7%), wash their hands when they came home (92.5% vs 88.7%), and disinfect the objects and personal places (82.6% vs 77.4%). The 22.1% and 83.7%, the 59.7% and 80.2, and the 8.0% and 16.8% consumed some type of medicine, medicinal plant, and chlorine dioxide to prevent and control the infection, respectively. Conclusion: In general, less than 50% of the participants performed prevention and control practices against COVID-19 often or always. / Revisión por pares

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to evaluate the status of a sample of children ages 6 to 36 months with regard to prevalence of tooth decay in a community with an optimum fluoridated water supply. It was determined whether a relation existed between these data and the socioeconomic level of the family. One hundred and fifty children ages 6 to 36 months born and reared in Marion County, Indiana were examined with a dental mirror, explorer and a portable light. Parents/legal guardians of these children were given a questionnaire to obtain family history. Caries prevalence for children ages 6 to 12, 13 to 18, 19 to 24, 25 to 30, and 31 to 36 months were 4%, 0%, 22%, 23%, and 26%, respectively. Age, mother's educational attainment, and Medicaid experience remained significant predictors of caries experience: the odds of caries were 1.1 times for each monthly increase in age. Gender, father's educational attainment, family household income, and single parent status remained marginally significant predictors of caries experience. Results for similar correlation studies between caries prevalence and socioeconomic status for children ages 6 to 36 months are inconsistent. Further research is needed for children ages 6 to 36 months. Caries experience begins before age one. Patients, parents, and health care professionals need to be aware that the caries process begins at an early age, and prevention should begin as early as 6 months of age.

No description available.

This study tested the Adolescent Family Assessment Model, using a descriptive correlational design. The model describes the relationships between caregiving behaviors, caregiving knowledge, peer and family approval, and the outcome variable of family functioning. Social exchange theory and social learning theory guided the study. Model building procedures involved replicated testing with data from two samples: Anglo and Mexican American adolescent mothers. The subjects were 50 Anglo and 64 Mexican American adolescent mothers living in the southwest, nineteen years of age or less, who had not yet completed their high school education, and were living in the same household as their child. Family was operationalized for both the family of origin and the current family unit of the adolescent mother. Eighty-three percent (N = 94) of the sample were enrolled in teen parent programs. Four instruments were tested and used to measure the concepts: the Infant Caregiving Inventory (alpha =.93); Smilkstein's Family Apgar (alpha =.90); the Peer Approval Instrument (alpha =.73); and the Family Approval Instrument (alpha =.83). Results for Anglo mothers indicated that caregiving behavior was explained by single marital status (R² =.22). Family functioning was explained by the age of the adolescent's first child (R² =.11). The empirical Mexican American model differed from the Anglo model. Caregiving knowledge was explained by past experience caring for toddlers (R² =.14), while family functioning was explained by caregiving behavior (R² =.10). The variables function differently in Mexican American and Anglo families, reflecting the cultural value of family within the groups. Results offer direction to health care providers working with adolescent parents and for future research endeavors.