Vibeke Juul Poulsen

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

OBJECTIVE: To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care. BASIC RESEARCH DESIGN: The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied. PARTICIPANTS: Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site. RESULTS: 2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children. CONCLUSIONS: The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.

It is generally believed that a backrest facilitates lumbar lordosis. To test this, the spontaneously adopted postures of 12 healthy subjects were measured by a statometric method during 2-h sitting periods on three types of chairs in a stratified sequence. The only difference between the three workstations regarded backrest: 'A' had no backrest; 'B' had a vertical lumbar backrest; and 'C' had an anteriorly curved backrest. In general, the most lordotic postures were assumed with backrest C, whereas backrest B rather facilitated kyphosis as compared with sitting without a backrest. However, when specifically considering passive sitting, i.e. reading, both types of backrest facilitated kyphosis. Moreover, spinal shrinkage was evaluated by measuring exact height before and after each 2-h sitting period. This was done to assess spinal load. From this perspective, backrest C induced the greatest load on the spine. In conclusion, the traditional conception that a backrest facilitates lordosis is apparently not true. It seems rather that backrests actually facilitate the opportunity for the user to stabilize their lumbar spines by providing their lower backs with support, resulting in relative kyphotic increases. The practical ergonomic applications from this study are unclear. However, traditional concepts in backrest ergonomy should be re-considered.