Validity of a questionnaire survey: response patterns in different subgroups and the effect of social desirability

Does Self-Reported BMI Modify the Association Between Stroke and Depressive Symptoms?

BACKGROUND

Depressive symptoms are common in stroke survivors. While obesity has been associated with stroke and depression, its influence on the association between stroke and depressive symptoms is unknown.

METHODS

Cross-sectional data from 2015 to 2016 Canadian Community Health Survey was used. History of stroke was self-reported and our outcome of interest was depressive symptoms in the prior 2 weeks, measured using the 9-item Patient Health Questionnaire. Self-reported body mass index (BMI) was modeled as cubic spline terms to allow for nonlinear associations. We used multivariable logistic regression to evaluate the association between stroke and depressive symptoms and added an interaction term to evaluate the modifying effect of BMI.

RESULTS

Of the 47,521 participants, 694 (1.0%) had a stroke and 3314 (6.5%) had depressive symptoms. Those with stroke had a higher odds of depressive symptoms than those without (aOR = 3.13, 95% CI 2.48, 3.93). BMI did not modify the stroke-depressive symptoms association (P interaction = 0.242) despite the observed variation in stroke-depressive symptoms association across BMI categories,: normal BMI [18.5-25 kg/m2] (aOR† = 3.91, 95% CI 2.45, 6.11), overweight [25-30 kg/m2] (aOR† = 2.63, 95% CI 1.58, 4.20), and obese [>30 kg/m2] (aOR† = 2.76, 95% CI 1.92, 3.94). Similar results were found when depressive symptoms were modeled as a continuous measure.

CONCLUSION

The association between stroke and depressive symptoms is not modified by BMI, needing additional work to understand the role of obesity on depression after stroke.

Validity of self-reported educational level in the Tromsø Study

BACKGROUND

Self-reported data on educational level have been collected for decades in the Tromsø Study, but their validity has yet to be established.

AIM

To investigate the completeness and correctness of self-reported educational level in the Tromsø Study, using data from Statistics Norway. In addition, we explored the consequence of using these two data sources on educational trends in cardiometabolic diseases.

METHODS

We compared self-reported and Statistics Norway-recorded educational level (primary, upper secondary, college/university <4 years, and college/university ⩾4 years) among 20,615 participants in the seventh survey of the Tromsø Study (Tromsø7, 2015-2016). Sensitivity, positive predictive value and weighted kappa were used to measure the validity of self-reported educational level in three age groups (40-52, 53-62, 63-99 years). Multivariable logistic regression was used to compare educational trends in cardiometabolic diseases between self-reported and Statistics Norway-recorded educational level.

RESULTS

Sensitivity of self-reported educational level was highest among those with a college/university education of 4 years or more (⩾97% in all age groups and both sexes). Sensitivity for primary educational level ranged from 67% to 92% (all age groups and both sexes). The lowest positive predictive value was observed among women with a college/university education of 4 years or more (29-46%). Weighted kappa was substantial (0.52-0.59) among men and moderate to substantial (0.41-0.51) among women. Educational trends in the risk of cardiometabolic diseases were less pronounced when self-reported educational level was used.

CONCLUSIONS

Self-reported educational level in Tromsø7 is adequately complete and correct. Self-reported data may produce weaker associations between educational level and cardiometabolic diseases than registry-based data.

Association between sexual function in women and sleep quality

Objective

To determine the relationship between sexual dysfunction and sleep disorders.

Methods

Observational study was conducted in 2021 and 2022 including 975 Spanish women over 18 years of age. The Women's Sexual Function Questionnaire (FSM-12) was used as a source of information, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. A bivariate and multivariate analysis was performed using binary logistic regression, adjusting for confounding variables. Crude (OR) and adjusted (aOR) odds ratios were estimated with their respective 95% confidence intervals (CI).

Results

Around 29.2% (285) of the women presented some type of sexual dysfunction, and 73.4% (716) showed sleep disturbance with scores ≥5 on the PSQI scale. The mean score on the PSQI was 8.23 points (SD = 3.93). All the dimensions of the sexual function scale were statistically related to sleep disturbance (p  ≤ 0.05), except for sexual activity and the reasons for sexual activity not having penetration. In the multivariable analysis, women with sexual dysfunction presented an aOR of sleep disturbance of 1.88 (95% CI: 1.29-2.76) compared to women without dysfunction.

Conclusion

Global sexual dysfunction and almost all the dimensions that make up sexual function are related to changes in sleep quality.

Green illusions in self-reporting? Reassessing the intention-behavior gap in waste recycling behaviors

Improving residents' waste recycling behavior is crucial for enhancing resource efficiency and reducing carbon emissions. Previous questionnaire-based studies have reported that individuals exhibit a high willingness to recycle, yet often fail to convert this intention into action. Analyzing 180,417 Internet of Things (IoT) behavior data points, we discovered that the intention-behavior gap might be larger than anticipated. Our findings indicate that: 1) Intentions to recycle alone can predict self-reported recycling behavior (p < 0.01, t = 2.841), but not actual recycling behavior in the absence of other possible moderators (p > 0.1, t = 0.777); 2) Self-reported behavior predicts real behavior, but with limited explanatory power; and 3) The intention-behavior gap primarily results from forgetting or habituation (p < 0.01, t = 2.653), while social desirability plays an insignificant role (p > 0.1, t = 0.246). This study contributes to our understanding of the intention-behavior gap and provides direction for future pro-environmental behavior research.

Evidence-based dentistry: Knowledge, Practice, Confidence and Attitude amongst Malaysian dental undergraduate students: A Multi-institutional study

INTRODUCTION

Evidence-based dental practice provides patient-centred, compatible and efficient interventions and forms the basis for health profession education. So far, there is a paucity of data about Malaysian undergraduate dental education and the role of evidence-based dentistry in it. The current research aimed to study the level of knowledge, attitude, practice and confidence of dental undergraduate students in Malaysia towards evidence-based dental practice.

METHODS

This cross-sectional study included final-year undergraduate dental students (N = 645) who completed a pre-tested self-administered questionnaire that analysed the domains of perceived knowledge, practice, critical appraisal and attitude towards evidence-based dentistry. We further explored the association between these domains with the type of curriculum, sex, prior research experience and EBD training.

RESULTS

A total of (n = 526) students participated (response rate of 81.55%). About 92% knew about evidence-based dentistry. Whilst 58% had undergone formal training in evidence-based dentistry, 90% of the respondents showed an overall positive attitude towards evidence-based dentistry. However, only 45% of them practised it most of the time. Schools with an integrated curriculum showed more willingness and practised evidence-based dentistry more frequently (p < 0.001). More than 50% of the participants rated their confidence in appraisal as moderate.

CONCLUSION

Our findings revealed that Malaysian dental undergraduate students who are well aware of evidence-based dentistry displayed a positive attitude towards it. The type of dental curriculum had a significant association with practice and attitude towards evidence-based dental knowledge and practice.

Evaluation of national dental curriculum in Iran using senior dental students' feedback

BACKGROUND

Dental curriculums require regular revision to stay up to date in scientifical and societal fields. Senior dental students are among the main stakeholders of such curriculums. The present study investigated the opinions of Iranian senior dental students regarding the adequacy of their dentistry program and the national dental curriculum in training a competent dentist, the program's content, and its structure.

METHODS

A previously designed and validated questionnaire on the opinion of senior dental students regarding curriculum adequacy was sent to a representative in each of the country's dental schools. Before the COVID pandemic terminated data collection, a total of 16 schools (438 students) managed to respond (37%). The questionnaire asked the students to assess the adequacy of the training received in curriculum's theoretical and practical competencies with the help of a five-point Likert scale that ranged from "Completely inadequate" to "Completely adequate". It also questioned them on its teaching methods and intensity. SPSS software version 24 and Chi-square test served for statistical analysis.

RESULTS

In total, the study has 438 participants, 245 female and 193 male. Significant sex differences were spotted in the responses concerning both theoretical and practical training. Regarding general training adequacy, 50 (22.6%) female students and 50 male ones (30.7%), P = 0.08 agreed that the program was acceptable. The numbers for students of old (more than 15 years of activity) and new schools were 47 (21.7%) and 53 (31.7%), respectively (P = 0.03). Nearly one-third deemed the teaching methods appropriate. Regarding the duration of curriculum phases, 33 students (8.3%) believed that basic science required extension, while 108 (28.6%) and 266 (69.1%) reported such need for pre-clinical and clinical phases. The school's years of activity emerged as significant, as 38.1% of students from new schools versus 21.7% of those from old ones deemed the extension of pre-clinical phase necessary (P < 0.001).

CONCLUSION

A significant number of Iranian senior dental students found the undergraduate dental curriculum inadequate regarding competencies, content, and teaching. Further investigations will determine whether it's the curriculum or its implementation that warrants revision.

Does the built environment of settlements affect our sentiments? A multi-level and non-linear analysis of Xiamen, China, using social media data

Introduction

Humans spend most of their time in settlements, and the built environment of settlements may affect the residents' sentiments. Research in this field is interdisciplinary, integrating urban planning and public health. However, it has been limited by the difficulty of quantifying subjective sentiments and the small sample size.

Methods

This study uses 147,613 Weibo text check-ins in Xiamen from 2017 to quantify residents' sentiments in 1,096 neighborhoods in the city. A multilevel regression model and gradient boosting decision tree (GBDT) model are used to investigate the multilevel and nonlinear effects of the built environment of neighborhoods and subdistricts on residents' sentiments.

Results

The results show the following: (1) The multilevel regression model indicates that at the neighborhood level, a high land value, low plot ratio, low population density, and neighborhoods close to water are more likely to improve the residents' sentiments. At the subdistrict level, more green space and commercial land, less industry, higher building density and road density, and a smaller migrant population are more likely to promote positive sentiments. Approximately 19% of the total variance in the sentiments occurred among subdistricts. (2) The proportion of green space and commercial land, and the density of buildings and roads are linearly correlated with residents' sentiments. The land value is a basic need and exhibits a nonlinear correlation with sentiments. The plot ratio, population density, and the proportions of industrial land and the migrant population are advanced needs and are nonlinearly correlated with sentiments.

Discussion

The quantitative analysis of sentiments enables setting a threshold of the influence of the built environment on residents' sentiments in neighborhoods and surrounding areas. Our results provide data support for urban planning and implementing targeted measures to improve the living environment of residents.

Early childhood caries, obesity and anthropometric measurements: Is there a relationship?

This brief research report explored the relationship among obesity, anthropometric measurements, and early childhood caries (ECC), in 3–5 years-old children. Three hundred and ninety-one Brazilian preschoolers were given anthropometric examinations for the assessment of general, peripheral, and central adiposity, by the following measures: body mass index (BMI), hip circumference, and waist circumference. Obesity status was determined by BMI according to WHO standards. Parent's age and BMI were assessed by questionnaire, and sucrose exposure was tracked by means of a food diary. For the assessment of ECC, dental examinations were performed according to modified WHO criteria. Also, the presence of dental biofilm in maxillary incisors was detected. A direct association between BMI and ECC was found in the bivariate analysis and the best possibility of logistic regression model showed that hip circumference (HC) values ≥62 centimeters (OR = 1.63; p = 0.033) jointly with the presence of dental biofilm (OR = 2.38; p = 0.000), children's ages ≥37 months (OR = 5.09; p = 0.012), and mothers younger than 35 years (OR = 1.96; p = 0.004) were significantly connected with ECC. In conclusion, peripheral adiposity (represented by HC) in young children was in fact associated with ECC. Thus, hip circumference might be a valuable tool for exploring the relationship between caries and obesity in the early years of life.

Ideology and COVID-19 Vaccination Intention: Perceptual Mediators and Communication Moderators

Widespread COVID-19 vaccination is critical to slow the spread of the illness. This study investigates how political ideology is associated with COVID-19 vaccine intention via perceived effectiveness of the vaccine, perceived side effects, and perceived severity of the illness, three key aspects of the Health Belief Model (HBM). This study also examines how partisan information flow moderates the effects of ideology on these three HBM components. Using survey data collected from two battleground states in the 2020 election (N = 1849), regression, mediation and moderation analyses revealed that conservatives were less likely to intend to get vaccinated against COVID-19, and this association was significantly mediated by perceived effectiveness and perceived side effects of vaccination, as well as perceived severity of COVID-19. In addition, partisanship of news sources and discussion partners were significant moderators of ideology's association with perceived vaccine effectiveness, with conservatives viewing COVID-19 vaccination as less effective if they were frequently exposed to liberal news, and if they had frequent conversations with fellow conservatives. This suggests boomerang effects for cross-cutting mass media exposure, and reinforcement effect for interpersonal communication. Implications for efforts to promote COVID-19 vaccine uptake are discussed, including tailored and targeted campaign strategies.

Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database

Pregnant women have a high risk of severe influenza, associated with obstetrical complications. The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012. The vaccination coverage remains low worldwide, and in Europe, due to a lack of proposition from the health care providers, and a high refusal rate from the women. The primary aim of this study was to estimate the influenza vaccination coverage (IVC) in a population of pregnant women in France, and to analyse its evolution from 2009 to 2018. The secondary objective was to describe the vaccinated population and to find determinants associated with the vaccination. This retrospective cohort study is based on the EGB French health care database, a representative sample of the French population containing data from the health insurance system. All pregnant women who delivered medically or spontaneously over the 2009–2018 period were included. In the 2009–2018 period, only 1.2% pregnant women were vaccinated against influenza (n = 875/72,207; 95% CI 1.14–1.30). The IVC slightly increased after the 2012 WHO recommendation, from 0.33 to 1.79% (p < 0.001) but remained extremely low (4.1% in 2018). Women younger than 25 years old had a low coverage (0.6%) whereas women over 35 years old were more likely to get the influenza vaccine (1.7%; OR: 2.82, 95% CI 2.14–3.71). The vaccination behavior was not influenced by multifetal pregnancy or parity, but socio-economically deprived women were less likely to be vaccinated (OR: 0.81, 95% CI: 0.67–0.98). Women with pre-existing medical conditions had an overall higher vaccination rate (2.5%; OR: 2.32, 95% CI: 1.94–2.77). The vaccine was mainly prescribed by family physicians (58%). Influenza vaccination in pregnant women in France remains very low, particularly in younger, healthy women, and measures such as information campaigns towards pregnant women and studies of the knowledge, attitudes, and practices of the health care professionals need to be undertaken to improve the coverage.

Oral health behaviours in 12-year-olds. Association with caries and characteristics of the children?

OBJECTIVE

To explore frequency of tooth brushing, dental flossing, fluoride supplements and sugar snacking in 12-year-olds, and to study how these oral health behaviours were associated with background characteristics and caries prevalence.

MATERIAL AND METHODS

The study included 4779 children. Data were collected by clinical examination and questionnaires regarding oral health behaviours and child characteristics. Informed consent was obtained from all participants. Data were tested using Chi-square statistics and analyzed by logistic regression. The study was ethically approved.

RESULTS

Of the children, 81% brushed twice daily, 36% flossed once a week or more often, 39% used fluoride supplements daily and 48% consumed sugar between meals once a week or less often. Children who brushed twice daily more often flossed regularly, used fluoride daily and consumed sugar between meals less often than other children (p < .05). Girls and children whose parents had long education more often had favourable oral health behaviours than other children; brushed more frequently, more often used floss and fluoride supplements and consumed sugary snacks less often than other children (p < .05). In total, 40% of the children were caries-free. Children who brushed less than twice daily had more often caries than other children (OR 1.50, CI 1.29-1.74) when controlling for background characteristics and other oral health behaviours.

CONCLUSIONS

The majority of children brushed twice daily and these children had caries less often than other children. The use of dental floss, fluoride supplements or sugar snacking in addition to brushing twice daily, did not reduce the probability of having caries.

Determining the Influence of Oral Health Infotainment Module on Behavior and Oral Hygiene of 6-year-old School-children and their Mothers in Davangere City

Aim and background

Dental plaque and calculus are common in school-aged children worldwide causing unsatisfactory oral health. This stage is a critical time to establish attitudes, beliefs, and shape an individual's health-related behavior. Moreover, parental oral health knowledge and attitudes are known to influence their child's oral health and hygiene.

Materials and methods

A cross-sectional study with a two-stage intervention trial involving a sample of 6-year-olds from two schools in Davangere city was done. Children were randomly allocated into three intervention groups by lottery method. Data included plaque index (PI) modified for 6-year-old children at baseline, 30th day, and at 60th day. Children and their mothers were requested to fill a self-administered questionnaire. The statistical analysis used ANOVA followed by Tukey's post hoc test and measures ANOVA. p ≤ 0.05 was considered statistically significant.

Results

There was a significant reduction in the PI modified in 6-year-olds within and among the three groups at the end of 60 days (p = 0.001). Maximum reduction was seen in group II followed by group III and thereafter group I in both the age-groups.

Conclusion

The study shows that at 60 days, the oral health infotainment module involving parental support was able to achieve appreciable improvement in the child's oral health and hygiene and inculcate a better attitude toward oral self-care.

How to cite this article

Potlia I, Naveen Kumar PG, Ramesh MV, et al. Determining the Influence of Oral Health Infotainment Module on Behavior and Oral Hygiene of 6-year-old Schoolchildren and their Mothers in Davangere City. Int J Clin Pediatr Dent 2021;14(5):633–639.

The impact of novel and traditional food bank approaches on food insecurity: a longitudinal study in Ottawa, Canada

Background

Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients’ cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres.

Methods

This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants – people who accessed these food banks – were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time.

Results

The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres.

Conclusions

Food banks offer some relief of food insecurity but they don’t eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

The impact of oral health education taken by personal support workers caring for a geriatric population in a long-term care facility: A mixed-methods study

OBJECTIVE

To evaluate the impact of an online oral health education module on personal support workers' (PSW) knowledge and beliefs in their care for long-term care (LTC) residents in one Canadian LTC residence.

BACKGROUND

LTC residents are dependent on PSWs for their oral health needs. However, PSWs receive minimal to no oral health education placing residents at risk for poor oral health.

METHODS

A mixed-methods convergent design comprising a before-and-after questionnaire (N = 88), focus groups (N = 23) and interviews (N = 4) exploring module learning. Analysis of each data set was followed by their amalgamation and comparison.

RESULTS

The online module had limited impact on the PSWs' knowledge and beliefs regarding resident oral health care. The quantitative results demonstrated knowledge improvements in two domains and changes in two belief domains. However, the qualitative results demonstrated new knowledge was not developed or sustained in practice. Themes that emerged include the following: lack of module recall, unmet learning needs and methods for oral care delivery, and timing of oral care in a busy clinical environment.

CONCLUSION

Online oral health education alone has limited impact on PSWs' knowledge and beliefs. Research evaluating multifaceted education interventions including hands-on training with a dental expert is warranted.

Career Choice and Attractiveness of Child and Adolescent Psychiatry as a Medical Specialty: A National French Questionnaire Survey

Context: The shortage of child and adolescent psychiatrists in France affects access to early interventions and mental health services and impacts therapeutic practices and prescribing trends. This study aimed to describe factors associated with choosing child and adolescent psychiatry (CAP) as a career specialty and with assessing the level of attractiveness of this discipline and its predictors. Methods: We generated a self-report questionnaire using a modified two-step Delphi approach. The survey was conducted from January 13 to February 16, 2020, and targeted French child and adolescent psychiatrists or psychiatrists, mainly working with children and/or adolescents. We used a logistic regression model to assess the factors associated with the perception of CAP as attractive. A thematic qualitative analysis of the free comments section of the questionnaire was performed. Results: Of 863 doctors contacted by email, the response rate was 77.4% (668 respondents). Two-thirds of respondents were female and had an official specialization in CAP. One-third were aged between 31 and 40 years. The main reasons for choosing to specialize in CAP were interest in working with children (64.2%), interest in psychotherapy (52.8%), and influence of an internship in CAP during medical studies (46.0%), although only one-third of respondents actually did an internship. Over half of respondents (57.3%) identified personal factors as implicated in their choice of CAP, mainly personal psychotherapy (22.2%) and personal trauma (14.4%). Although only 58.4% of respondents perceived CAP as attractive, 97.8% had no regret about their choice, and 83.5% would make the same career choice today. A positive perception by respondents' surroundings for choosing CAP at the time of the choice was associated with a perception of CAP as currently attractive by respondents (odds ratio: 1.82; 95% confidence interval: 1.27-2.60; p = 0.001). Conclusion: CAP is in crisis and faces many challenges in France, with an urgent need to redress its demographics. Many child and adolescent psychiatrists do not regret their choice and would choose the same specialty today. To increase its attractiveness, better visibility during medical school, enhanced academic recognition, and increased remuneration seem promising.

Willingness of parents to vaccinate their 6-60-month-old children with EV71 vaccines: a cross-sectional study in rural areas of northern Jiangsu Province

Enterovirus 71 (EV71) is the dominant pathogen in severe and fatal hand-foot-mouth disease (HFMD) cases. Since 2015, three inactivated EV71 vaccines have been approved in China. The vaccination coverage of the EV71 vaccine has been relatively low, especially in rural areas. A cross-sectional survey from July 19 to August 22, 2018, was conducted in three rural counties of northern Jiangsu Province among parents of children aged 6-60 months. We adopted a pretested validated questionnaire to assess knowledge, awareness, and attitude of HFMD and EV71 vaccines among respondents and used univariate and multivariate binary logistic analyses to explore potential factors associated with the acceptance of EV71 vaccines. Of the 1,112 parents who participated, 87.8% were willing to vaccinate their children with EV71 vaccines. Parents over 40 y old were less likely to have their children vaccinated [adjusted odds ratio (aOR) = 2.12, 95% confidence interval (CI): 1.13-3.97]. Parents who lived in Ganyu (aOR = 0.50, 95% CI: 0.31-0.79) or Xinyi county (aOR = 0.33, 95% CI: 0.20-0.53), had a university or higher degree (aOR = 0.26, 95% CI: 0.11-0.64), had good knowledge of EV71 vaccines (aOR = 0.81, 95% CI: 0.67-0.98), perceived their children's disease susceptibility, and worried about the severity of HFMD had a higher willingness to vaccinate their children. Most parents were willing to vaccinate their children against EV71-related HFMD. Parental age, location, education level, knowledge of EV71 vaccines, concern about susceptibility, and severity of HFMD were all factors that influenced willingness to vaccinate.

Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2-5 Years Receiving Dental Treatment Under General Anesthesia

Aim: This study was conducted to evaluate the impact of health promotion interventions on early childhood caries prevention in 2–5 year-olds receiving dental treatment under general anesthesia.

Materials and Methods: Thirty-seven mother-child couples presenting to the clinic of the Dental School of Tehran University of Medical Sciences for treatment under general anesthesia were randomly divided to two groups: 19 couples in the pamphlet and fluoride varnish four times a year, and 18 couples in the pamphlet plus six phone call reminders and fluoride varnish four times a year. A standard questionnaire on demographics and children oral health-related practice of parents was completed by respondents. On children's oral examination, the Simplified Oral Hygiene Index (OHI-S), dmft, and the presence of new white spot lesions (WS) were recorded in both phases. At the final stage, Early Childhood Oral Health Impact Scale (ECOHIS) was completed by parents. The length of follow-up was 24 months.

Results: In both groups, there was an increase in the number of mothers who knew how to brush their children's teeth as well as the number of mothers who brushed their children's teeth (P < 0.05). In the reminder group, an improvement occurred in the mothers' perception of their perceived ability to make their children brush their teeth twice a day (P = 0.03). Clinical examination revealed a significant decrease in the OHI-S (from 1.9 ± 0.8 to 1.15 ± 0.5) and the number of WS (from 8.5 ± 5.5 to 0.08 ± 0.5) in both groups on the follow-up visit. The mean dmft was 11.0 ± 4.0 with a mean d component of 10.56 ± 4 at the baseline, which decreased significantly to 1.44 ± 1.96 after dental treatment. No significant increase was seen in new caries in the intervention groups. There was no significant difference in the ECOHIS score between the two groups.

Conclusion: The similar impact of both interventions suggests the possibility of applying the simpler one, i.e., the educational pamphlet, fluoride varnish and frequent follow-ups. However, in the reminder group, the mothers' perception of their perceived ability to make children brush their teeth twice a day was improved.

Plaque Fluoride Levels as a Predictor of Caries Development in Early Childhood with High Sugar Exposure - A Preliminary Study

Objective

This longitudinal study aimed to investigate if the plaque fluoride (PF) concentration can predict the early childhood caries onset. Design: As part of a larger study, 188 preschoolers were clinically evaluated for early childhood caries diagnosis, at baseline and after 1-year follow-up. After that, the final sample comprised: 1. children who had already caries at baseline (decayed, missing or filled surfaces, as well as white chalky white spot lesions adjacent to gingival margins) and developed at least one more cavitation after one year (n=16), and 2. children who never had or developed any caries lesions, including active white spots lesions (n=15). Before the clinical examinations, dental plaque was collected. PF concentration was determined with an ion-specific electrode. A chart was used to estimate the mean daily sugar exposure. The results were statistically analyzed by Spearman correlation and logistic regression analyses (α=0.05).

Results

After one year, a positive significant correlation between caries development and liquid sucrose, total sugar and total sucrose consumption increments was found (p<0.05). Moreover, the solid sugar, solid sucrose and total sugar exposure at baseline were positively correlated with the presence of dental plaque at follow-up (p<0.05). To top it all, children with PF concentrations ≤0.1 μg/mg at baseline were 10 times more likely to develop caries.

Conclusion

In conclusion, this study demonstrated for the first time in vivo that low PF concentration is a predictor of caries development in primary teeth.

The mental health and depression of rural-to-urban migrant workers compared to non-migrant workers in Shanghai: a cross-sectional study

BACKGROUND

Migrant workers worldwide commonly are susceptible to mental disorders. Since the 1980s, there has been a large-scale increase in the number of migrant workers in China; this development parallels the acceleration of socio-economic transformation. Studies addressing this population rarely focus on workers' mental health or psychological well-being, yet it is imperative to understand the mental health status of rural-to-urban migrant workers and study the relationship between migration and mental health.

METHODS

A cross-sectional survey of 3286 participants (response rate 85.4%) was conducted among different work units in Shanghai. All of the variables of this survey were assessed by a self-administered questionnaire, with depression measured by the Patient Health Questionnaire-9 (PHQ-9) scale and poor mental health (PMH) measured by the World Health Organization 5-Item Well-Being Index (WHO-5) scale. Pearson's χ2 test and logistic regression were used to compare migrants with urbanites, and to identify factors related to mental health outcomes.

RESULTS

Migrant workers (15.3%) had a slightly higher prevalence of depression than non-migrant (12.0%) workers, with notable PMH (26.9%) among participants >45 y of age. In the logistic regression models, those who reported low job satisfaction, unhealthy organizations, poor physical health (self-rated) and long working hours were 2.86 (95% CI 2.14 to 3.84), 1.42 (95% CI 1.06 to 1.91), 1.89 (95% CI 1.41 to 2.55) and 1.48 (95% CI 1.08 to 2.03) times more likely to have depression, respectively. Similarly, workers >45 y of age were 2.92 (95% CI 1.65 to 5.16) and 1.80 (95% CI 1.01 to 3.21) times more likely to have PMH for low job satisfaction and unhealthy organizations, respectively.

CONCLUSIONS

There are numerous potential causes affecting the mental health of Chinese internal migrant workers. Strengthening the construction of healthy organizations and enhancing workers' job satisfaction may improve the mental health status or psychological well-being of this group.

Effect of Long Working Hours on Depression and Mental Well-Being among Employees in Shanghai: The Role of Having Leisure Hobbies

Our aim is to examine the associations between long working hours and depression and mental well-being among the working population in Shanghai, as well as to identify the impact of having hobbies on these relationships. A cross-sectional study was conducted in Shanghai, with depression assessed by the Patient Health Questionnaire-9 (PHQ-9) scale and mental well-being assessed by the World Health Organization five-item Well-Being Index (WHO-5) scale. The phenomenon of long working hours (69.3%) was quite common among employees in Shanghai, and the rate of working over 60 h was 19.3%. Those who worked over 60 h had the highest prevalence of poorer mental health compared with individuals working ≤40 h per week. After adjustment in the logistic regression model, those who reported weekly working time over 60 h were 1.40 (95%CI: 1.03–1.90) and 1.66 (95%CI: 1.26–2.18) times more likely to have depression and poor mental well-being (PMWB), respectively. Adjusted ORs for having hobbies were 0.78 (95%CI: 0.62–0.97) and 0.62 (95%CI: 0.51–0.75), respectively. Meanwhile, having hobbies could significantly lower the mean score on the PHQ-9 and elevate the mean score on the WHO-5 in each working time group, with no interaction effect. Long working hours could have a significantly negative impact on workers’ psychological health. Importantly, having hobbies in their daily lives might help to mitigate the adverse effects of long working hours on workers’ depression and mental well-being.

Association of oral health behavior and the use of dental services with oral health literacy among adults in Tehran, Iran

Objective:

To assess the association of oral health behavior (OHB) and the use of dental services with oral health literacy (OHL) among Iranian adults.

Methods:

This was a cross-sectional population study of a random sample of 1031 adults aged 18–65 in Tehran, Iran. We collected data on tooth brushing frequency, the consumption of sugary snacks and beverages, and time since last dental visit. To measure OHL, we used a validated OHL adults’ questionnaire (OHL-AQ). In addition to descriptive analysis, we used multiple logistic regression models to assess the association of OHB and the most recent dental visit with OHL while controlling for socioeconomic and demographic factors.

Results:

The participants’ mean age was 36.3 (standard deviation 12.9), and 51% were women. Of the participants, 81.3% reported brushing their teeth daily (≥1/day), 37.6% consumed sugary snacks or beverages between meals less than once daily (<1/day), and 36.8% used dental services within the past 6 months. In the adjusted models, high OHL scores significantly correlated with daily (≥1/day) tooth brushing (odds ratio [OR] = 1.97, 95% confidence interval [CI]: 1.30–2.98), the consumption of sugary snacks or beverages (<1/day between meals) (OR = 1.56, 95% CI: 1.13–2.15) and the recent use of dental services (≤6 months) (OR = 1.59, 95% CI: 1.15–2.21), respectively.

Conclusions:

OHL relates significantly to improved OHB and the use of dental services. Oral health promotion programs should, therefore, take into account improvements in adults’ OHL, particularly in countries with developing health-care services.

Effectiveness of two interactive educational methods to teach tobacco cessation counseling for senior dental students

Objective:

Nowadays, one of the major health problems in many countries is tobacco use. Dental professionals are in a unique position to promote smoking cessation since they have the opportunity for regular interaction with their patients. The purpose of the present study was to compare the effectiveness of two educational methods to teach tobacco cessation counseling (TCC) in dental practice for senior dental students.

Materials and Methods:

In this interventional study, 93 eligible senior dental students from two dental schools in Tehran, Iran were randomly divided into two groups. Two educational programs, role play (RP) and problem-based learning (PBL), with the same aim about TCC in dental practice, were developed and implemented for the two groups. The score of knowledge, attitude, and skill were determined in both groups before and after participation in the course using a questionnaire. The changes in the scores from pre- to post-test were statistically analyzed using repeated measure ANOVA test.

Results:

Total scores of knowledge, attitude, and skill of the participants showed improvements when compared to scores before training (P < 0.001, P = 0.003, and P < 0.001, respectively). However, the differences between the two study methods were statistically insignificant (P > 0.05).

Conclusion:

The results suggested that TCC training through RP and PBL methods leads to improvement in knowledge, attitude, and skills of dental students in the short-term evaluation.

A Tripartite Model of Community Attitudes to Palliative Care

Background:

Despite a growth in palliative care services, access and referral patterns are inconsistent and only a minority of people who would benefit from such care receive it. Use of palliative care is also affected by community attitudes toward palliative care. As such, determining community attitudes toward palliative care is crucial. We also need to determine what predicts attitudes in order to provide appropriate information and education.

Objectives:

The 2 research questions were: (1) What are community attitudes toward palliative care? and (2) what are the determinants of community attitudes toward palliative care?

Design:

A tripartite model of attitudes was used, which articulates attitudes as comprising knowledge and experience, emotions, and beliefs. A cross-sectional descriptive survey was used.

Participants:

A community sample of 180 participants completed the survey.

Results:

The average attitude and belief responses were very positive, the average emotions responses were somewhat positive. The sample had good knowledge of palliative care. Lowest knowledge scores were reported for the items: “Euthanasia is not part of palliative care,” “Palliative care does not prolong or shorten life,” and “Specialist palliative care is only available in hospitals.” After controlling place of birth and age, it was found that beliefs, emotions, and knowledge each accounted for a significant proportion of unique variance in attitude toward palliative care. Each variable had a positive relationship with attitude.

Conclusion:

Beliefs, emotions, and knowledge all need to be incorporated into palliative care community education programs.

Investigating inequities in hospital care among lesbian, gay, bisexual, and transgender (LGBT) individuals using social media

RATIONALE

Persons who identify as lesbian, gay, bisexual, and transgender (LGBT) face health inequities due to unwarranted discrimination against their sexual orientation or identity. An important contributor to LGBT health disparities is the inequitable or substandard care that LGBT individuals receive from hospitals.

OBJECTIVE

To investigate inequities in hospital care among LGBT patients using the popular social media platform Twitter.

METHOD

This study examined a dataset of Twitter communications (tweets) collected from February 2015 to May 2017. The tweets mentioned Twitter handles for hospitals (i.e., usernames for hospitals) and LGBT related terms. The topics discussed were explored to develop an LGBT position index referring to whether the hospital appears supportive or not supportive of LGBT rights. Results for each hospital were then compared to the Healthcare Equality Index (HEI), an established index to evaluate equity of hospital care towards LGBT patients.

RESULTS

In total, 1856 tweets mentioned LGBT terms representing 653 unique hospitals. Of these hospitals, 189 (28.9%) were identified as HEI leaders. Hospitals in the Northeast showed significantly greater support towards LGBT issues compared to hospitals in the Midwest. Hospitals deemed as HEI leaders had higher LGBT position scores compared to non-HEI leaders (p = 0.042), when controlling for hospital size and location.

CONCLUSIONS

This exploratory study describes a novel approach to monitoring LGBT hospital care. While these initial findings should be interpreted cautiously, they can potentially inform practices to improve equity of care and efforts to address health disparities among gender minority groups.

Not enough time for research? Use of supported funding to promote allied health research activity

Purpose

The current project evaluated the impact of a short-term, supported funding initiative that allowed staff from allied health (AH) professions to undertake research activity within rostered employment time. Specifically, the project will report on outcomes pertaining to individual research capacity, research output, and overall satisfaction with the initiative.

Participants and methods

Sixteen AH clinicians (n=16) from six AH professions participated in the evaluation of the initiative, with data being collected within a service improvement framework. Clinicians received up to 4 weeks of protected time relieved from their clinical duties to undertake research activities, including writing for publication, undertaking a systematic review, data analysis, and preparation of ethics applications. An AH Research Fellow provided additional support and mentorship, including the development of an implementation plan. Evaluation included pre–post measures of individual research capacity using a 15-item self-report Research Capacity and Culture (RCC) survey, a post-implementation satisfaction survey, and monitoring of research output achieved.

Results

Statistically significant improvements (p<0.05) were found on 14 out of 15 items on the RCC tool, with meaningful improvements in securing funding, analyzing qualitative data, writing for publication, literature searching skills, and providing advice to less experienced researchers. Overall satisfaction with the initiative was high, with positive comments from AH professionals (AHPs) regarding the initiative. Research output arising from the initiative included eleven manuscripts being submitted, with six currently in publication and others under review.

Conclusion

The preliminary findings support the feasibility of implementing a local, clinical funding model to promote individual research capacity and research output for AHPs. The short-term funding should be supported by local mentorship and guidance. Local barriers and suggestions to optimize implementation, including integrating within existing research infrastructure and using flexible “backfill” options, will also be described.

Neural mechanisms underlying the link between effortful control and aggression: An ERP study

Aggression and violence are social behaviors that exact a significant toll on human societies. Individuals with aggressive tendencies display deficits in effortful control, particularly in affectively charged situations. However, not all individuals with poor effortful control are aggressive. This study uses event-related potentials (ERPs) recorded from a large sample (n = 75 undergraduates) to decompose the chronology of neural mechanisms underlying the ability to effortfully-control behavior, and then explores whether deficits in these cognitive functions might then lead to aggressive behavior. This study investigated which ERPs moderate the effortful control - aggression association. We examined three successive ERP components, the P2, N2, and P3, which have been associated with attentional orienting, response conflict, and working memory updating, for stimuli that required effortful control. N2 amplitudes were larger for trials requiring a switch from a preplanned action strategy than trials where a preplanned action strategy was followed. Furthermore, results indicated that N2 activation, but not P2 or P3 activation, moderated the relationship between effortful control and aggression. Our results suggest that small (less negative) N2s moderate the association between effortful control and aggression. These effects were present only in negative contexts, and only for high-conflict trials. Results suggest that individual differences in neural processing efficiency contributes to the execution of effortfully controlled behavior and avoidance of aggression.

Frequent consumption of sugar-sweetened beverages and sweets starts at early age

OBJECTIVES

We aimed to investigate the habitual consumption of sugar-sweetened beverages (SSBs) and sweets in relation to mothers' behaviours and practices with their infants.

METHODS

We targeted mothers with children 1-24 months (N = 200) visiting Public Child Health clinics in Finland. During routine visits mothers (N = 179) volunteered to complete a self-administered anonymous questionnaire about their child's health-related behaviours (consumption of sweets and SSBs, tooth brushing frequency). The questionnaires also included questions about the mothers' background (age, education) and health-related behaviours (consumption of sweets, tooth brushing frequency and smoking habits). The children were categorised by age, and Chi-squared tests, Fischer's exact test, ANOVA and correlation coefficient served for the statistical analyses.

RESULTS

Of those under 6 months, almost half (44%) received SSBs, and 45% of them more than once a week. Their use gradually increased by age such that by 19-24 months, all received SSBs at least sometimes, and 56%, frequently. Fewer than half of the mothers (33-43%) gave sweets to their children between the ages of 10-15 months, but 92% by the age of 2 years. Children's twice-a-day tooth brushing increased from 14% to 33%. The child's age and tooth brushing frequency correlated with the consumption of sugar-sweetened products (r = 0.458).

CONCLUSIONS

Infants frequent consumption of sugar-sweetened products begins early in childhood. Thus, tackling these common risk factors in the first years of life is essential and calls for health-promoting actions in multiple areas that target primarily the parents of infants.

Knowledge, Attitude and Practices (KAP) Regarding Chronic Complications of Diabetes among Patients with Type 2 Diabetes in Dhaka

BACKGROUND

To reduce morbidity and mortality, awareness regarding diabetes and its complications is necessary. This study aimed at assessing the level of knowledge, attitude, and practices (KAP) regarding complications of diabetes mellitus among patients with type 2 diabetes in Dhaka, Bangladesh.

METHODS

A cross-sectional study was carried out recruiting patients with diabetes from the outpatient department of BIRDEM hospital in Dhaka. Overall, 425 patients with diabetes were enrolled in this study. A pretested questionnaire was filled by the interviewer with face to face interview. Levels of KAP were determined by calculating the scores. Multivarable linear regression was used to determine significant predictors for knowledge, attitude, and practices.

RESULTS

On average, the level of knowledge, attitude, and practices were 9.2 (out of 14), 7.9 (out of 13), and 16.9 (out of 27), respectively. Age and gender were significant predictors of knowledge and attitude. Females had better level of knowledge and attitude compared to males (βs = 0.55 and 1.24, respectively). Patients with graduate degrees and above compared to illiterates reported significantly greater knowledge and practice (βs = 1.27 and 1.44, respectively), after adjustments for covariates. Educational program was the most important significant predictor of KAP. Higher duration of diabetes (β = 0.07) and positive marital status (β = 1.21) had influenced better practice.

CONCLUSIONS

Lack of knowledge, poor attitude, and inadequate practice were found in this surveyed communinty. Level of education and educational program on diabetes were the most significant contributing factors. The current study suggests the need of structured educational programs on diabetes and its complications on a regular basis to assist patients in living a productive life.

Too Many Blood Donors - Response Bias in the Swiss Health Survey 2012

BACKGROUND

Data on blood donor status obtained from general surveys and health interview surveys have been widely used. However, the integrity of data on self-reported blood donor status from surveys may be threatened by sampling and non-sampling error. Our study aimed to compare self-reported blood donors (including one-time as well as regular donors) from the Swiss Health Survey 2012 (SHS) with register-based blood donors recorded by blood establishments and evaluate the direction and magnitude of bias in the SHS.

METHODS

We compared population-weighted SHS point estimates of the number of blood donors with their corresponding 95% confidence intervals to the respective figures from blood donor registries (birth cohorts 1978-1993) and estimates of donors based on period donor tables derived from blood donor registries (birth cohorts 1920-1993).

RESULTS

In the birth cohorts 1978-1993, the SHS-predicted number of donors was 1.8 times higher than the respective number of donors based on registry data. Adjusting for foreign and naturalized Swiss nationals that immigrated after their 18th birthday, the SHS overall predicted number of donors was 1.6 times higher. Similarly, SHS estimates for the 1920-1993 birth cohorts were 2.4 and 2.1 times higher as compared to register-based estimates. Generally, the differences between SHS and register-based donors were more pronounced in men than in women.

CONCLUSION

Self-reported blood donor status in the SHS is biased. Estimates of blood donors are substantially higher than respective estimates based on blood donor registries.

Measurement of Function Post Hip Fracture: Testing a Comprehensive Measurement Model of Physical Function

BACKGROUND

Measurement of physical function post hip fracture has been conceptualized using multiple different measures.

PURPOSE

This study tested a comprehensive measurement model of physical function.

DESIGN

This was a descriptive secondary data analysis including 168 men and 171 women post hip fracture.

METHODS

Using structural equation modeling, a measurement model of physical function which included grip strength, activities of daily living, instrumental activities of daily living, and performance was tested for fit at 2 and 12 months post hip fracture, and among male and female participants. Validity of the measurement model of physical function was evaluated based on how well the model explained physical activity, exercise, and social activities post hip fracture.

FINDINGS

The measurement model of physical function fit the data. The amount of variance the model or individual factors of the model explained varied depending on the activity.

CONCLUSION

Decisions about the ideal way in which to measure physical function should be based on outcomes considered and participants.

CLINICAL RELEVANCE

The measurement model of physical function is a reliable and valid method to comprehensively measure physical function across the hip fracture recovery trajectory.

Physicians' Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators

This study assessed pediatric physicians' use of shared decision making (SDM) in 2 chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians' preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM.

Understanding motivations to participate in an observational research study: Why do patients enroll?

By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects.

The initial evaluation of an Internet-based support system for audiologists and first-time hearing aid clients

OBJECTIVES

Audiologists provide professional contact and support between appointments to clients with hearing impairment using telephone and e-mail, but more advanced and flexible technological platforms are also possible. The present study aimed to evaluate the clinical application of an Internet-based support system for audiologists and their first-time hearing aid clients.

DESIGN

An Internet-based support system developed by Månsson et al. (2013) for psychologists and their clients was adapted for audiologic purposes. Three audiologic clinics in Sweden tested the support system with their clients.

STUDY SAMPLE

Twenty-three clients managed by four audiologists used and evaluated the support system. In addition, five of the clients and all four audiologists were interviewed and their responses were analyzed using content analysis.

RESULTS

The clients and the audiologists reported positive experiences and overall satisfaction but audiologists reported that the support system did not address the needs of all clients. More positive experiences and greater satisfaction with the support system were associated with reductions on self-reported consequences of hearing loss and positive hearing aids outcomes.

CONCLUSIONS

An Internet-based support system can be used in audiologic rehabilitation. Both audiologists and clients recognized the system's potential value to offer an online support to the provision of audiologic services.

Oral health behaviors and bacterial transmission from mother to child: an explorative study

Background

Health behaviors play a major role in the prevention of the most common oral diseases. To investigate health behaviors related to the potential transmission of oral bacteria from mother to child using novel multiple correspondence analysis (MCA).

Methods

Mothers (n = 313) with children under three years attending two municipal child health clinics in Finland completed a self-administered questionnaire on health knowledge and behaviors such as sharing a spoon with their child, kissing on the lips, and the mothers’ tooth brushing, smoking, age, and level of education. We used MCA to reveal the relationships between the mothers’ behaviors and background factors, along with unconditional, binary, multivariable logistic regression models, odds ratios (OR) and their 95 % confidence intervals (95 %CI).

Results

Of the mothers, 38 % kissed their child on the lips and 14 % shared a spoon with their child; 11 % believed that oral bacteria cannot be transmitted from mother to child. Two-thirds (68 %) of them reported tooth brushing twice daily, and 80 % were non-smokers. MCA revealed two diverging dimensions of the mothers’ behaviors: a ‘horizontal’ one showing clear evidence of relationships between tooth brushing, smoking, age and education, whereas the ‘vertical’ one revealed the mothers’ habits of kissing the child on the lips and sharing a spoon related to each other. Spoon sharing was related to the kissing on lips (OR 10.3), a higher level of education (OR 3.1), and, inversely, older age (OR 0.1), whereas kissing on lips behavior was inversely related to a higher level of education (OR 0.5).

Conclusion

The study revealed two diverging dimensions of the mothers’ health behaviors. More emphasis in health education ought to be put to how to avoid bacterial transmission from caregiver to child during feeding.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland

BACKGROUND

Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers.

METHODS

A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound.

RESULTS

732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively.

CONCLUSIONS

Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Effect of a telephone-delivered coronary heart disease secondary prevention program (proactive heart) on quality of life and health behaviours: primary outcomes of a randomised controlled trial

BACKGROUND

Participation in coronary heart disease secondary prevention programs is low. Innovative programs to meet this treatment gap are required.

PURPOSE

To aim of this study is to describe the effectiveness of a telephone-delivered secondary prevention program for myocardial infarction patients.

METHODS

Four hundred and thirty adult myocardial infarction patients in Brisbane, Australia were randomised to a 6-month secondary prevention program or usual care. Primary outcomes were health-related quality of life (Short Form-36) and physical activity (Active Australia Survey).

RESULTS

Significant intervention effects were observed for health-related quality of life on the mental component summary score (p = 0.02), and the social functioning (p = 0.04) and role-emotional (p = 0.03) subscales, compared with usual care. Intervention participants were also more likely to meet recommended levels of physical activity (p = 0.02), body mass index (p = 0.05), vegetable intake (p = 0.04) and alcohol consumption (p = 0.05).

CONCLUSIONS

Telephone-delivered secondary prevention programs can significantly improve health outcomes and could meet the treatment gap for myocardial infarction patients.

Developing a Persian inpatient satisfaction questionnaire

Purpose

– Valid and reliable measures are required for assessing patient satisfaction meaningfully. The purpose of this paper was to develop and validate a Persian-language in-patient satisfaction questionnaire for patients discharged from Iranian medical and surgical services.

Design/methodology/approach

– The cross-sectional survey included 400 patients randomly selected from six Tehran hospitals. A total of 405 patients responded to the questionnaire (76.3 percent response). To assess inter-item reliability and construct validity, factor analysis was carried out. Items belonging to each factor and their Cronbach's alpha coefficient were calculated.

Findings

– A total of seven dimensions were identified: doctor-patient communication; nursing care; convenience; visitors; cleanliness; costs; and general satisfaction. Together, these dimensions explained 60 percent of the variance. All items, except three, revealed loadings above 0.4, while Cronbach's alpha exceeded 0.8 for all dimensions, except visitors (0.66). Patient satisfaction levels were relatively high.

Practical implications

– Results must be interpreted cautiously owing to high satisfaction, which should not be considered as comprehensive evidence of high performance without important additional service-performance information. Qualitative studies are recommended to complement the authors' quantitative satisfaction study.

Originality/value

– The patient satisfaction questionnaire strives to be a valid and reliable instrument for assessing in-patient satisfaction with hospital services in Iran.

Healthcare providers' knowledge, attitudes and counselling on injury prevention for preschool children in Croatia

Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.

Determinants of preventive oral health behaviour among senior dental students in Nigeria

BACKGROUND

To study the association between oral health behaviour of senior dental students in Nigeria and their gender, age, knowledge of preventive care, and attitudes towards preventive dentistry.

METHODS

Questionnaires were administered to 179 senior dental students in the six dental schools in Nigeria. The questionnaire obtained information on age, gender, oral self-care, knowledge of preventive dental care and attitudes towards preventive dentistry. Attending a dental clinic for check-up by a dentist or a classmate within the last year was defined as preventive care use. Students who performed oral self-care and attended dental clinic for check-ups were noted to have complied with recommended oral self-care. Chi-square test and binary logistic regression models were used for statistical analyses.

RESULTS

More male respondents agreed that the use of fluoride toothpaste was more important than the tooth brushing technique for caries prevention (P < 0.001). While the use of dental floss was very low (7.3%), more females were more likely to report using dental floss (p=0.03). Older students were also more likely to comply with recommended oral self-care (p<0.001). In binary regression models, respondents who were younger (p=0.04) and those with higher knowledge of preventive dental care (p=0.008) were more likely to consume sugary snacks less than once a day.

CONCLUSION

Gender differences in the awareness of the superiority of using fluoridated toothpaste over brushing in caries prevention; and in the use of dental floss were observed. While older students were more likely to comply with recommended oral self-care measures, younger students with good knowledge of preventive dental care were more likely to consume sugary snacks less than once a day.

A cross sectional study examining social desirability bias in caregiver reporting of children's oral health behaviors

Background

Our previous research (Pediatrics 2010:126) found a strong association between caregiver oral health literacy (OHL) and children’s oral health status; however, we found a weak association with oral health behaviors (OHBs). We hypothesize that this may be due to social desirability bias (SDB). Our objectives were to compare caregivers’ responses to traditional OHB items and newer SDB-modulating items, and to examine the association of caregiver literacy with OHBs.

Methods

We performed a cross-sectional study of 102 caregiver-child dyads, collecting data for OHBs using both traditional and new SDB-modulating items. We measured OHL using REALD-30, a validated word recognition test. We relied upon percent agreement and Cohen’s kappa (k) to quantify the concordance in caregivers’ responses and multivariate log-binomial regression to estimate the impact of OHL on OHBs.

Results

Caregivers’ mean REALD-30 score was 20.7 (SD = 6.0), range 1-30. We found an association between OHL and 4 of 8 OHBs examined. A subset of behavior questions compared traditional versus SDB-modulating items: history of bottle-feeding: agreement = 95%, k = 0.83 (95% CL:0.68,0.99); daily tooth brushing: agreement = 78%, k = 0.25 (95% CL:0.04,0.46); fluoridated toothpaste use: agreement = 88%, k = 0.67 (95% CL:0.49,0.85). After controlling for caregivers’ race, marital status and study site, higher literacy scores remained associated with a decreased prevalence of parental report of “decided not brush the child’s teeth because it would be frustrating”.

Conclusions

Agreement between responses was high for 2 of 3 behavior items. Item 3 (tooth brushing frequency) revealed discordance, likely due to SDB. Use of the SDB-modulating items appears to yield a better estimate of OHB.

Longitudinal relationships between stress of conscience and concepts of importance

The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one's conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one's conscience in one's work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.

Determinants of oral health: does oral health literacy matter?

Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 participants (mean age 36.3 (SD 12.9); 51% female), women reported brushing their teeth more frequently (P < 0.001) and scored higher for oral health literacy (mean 10.9 versus 10.2, P < 0.001). In the adjusted model, high age (OR = 1.01, 95% CI 1.003–1.034), low education (OR = 1.88, 95% CI 1.23–2.87), small living area in square meters per person (OR = 1.85, 95% CI 1.003–3.423), poor tooth brushing behavior (OR = 3.35, 95% CI 2.02–5.57), and low oral health literacy scores (OR = 1.58, 95% CI 1.02–2.45) were significant risk indicators for poor self-reported oral health. Conclusions. Low oral health literacy level, independent of education and other socioeconomic determinants, was a predictor for poor self-reported oral health and should be considered a vital determinant of oral health in countries with developing health care systems.

Changing Gender Preference in China Today: Implications for the Sex Ratio

There is growing evidence in China that son preference is on the decline. But sex ratios at birth, despite a recent small reduction, are still the highest in the world at around 120 male births to every 100 females. We carried out this research to explore current attitudes towards gender preference amongst people of reproductive age in China today, with a view to understanding better the persistently high sex ratio. We conducted in-depth interviews with 212 individuals, aged 18 to 39, in rural and urban areas of three provinces—Yunnan, Guizhou and Zhejiang—and have shown that while son preference has weakened considerably in this reproductive generation, it has by no means disappeared. The sex ratio remains high because of this small minority of individuals who still expresses a clear son preference and who choose sex-selective abortion to ensure male offspring. But its numbers are falling, and this may help to explain the recent downturn in sex ratio and perhaps signals the beginning of a trend towards its normalisation. Intensive local policy interventions have been successful in reducing the sex ratio in some areas and these should be disseminated widely.

Validation of the Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries"

OBJECTIVES

To translate and validate a Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" as a method of collecting information about treatment decisions on caries management in Chilean primary health care services.

MATERIALS AND METHODS

The original questionnaire proposed by Espelid et al. was translated into Spanish using the forward-backward translation technique. Subsequently, validation of the Spanish version was undertaken. Data were collected from two separate samples; first, from 132 Spanish-speaking dentists recruited from primary health care services and second, from 21 individuals characterised as cariologists. Internal consistency was evaluated by the generation of Cronbach's alpha, test-retest reliability was evaluated by Cohen's kappa, convergent validity was evaluated by comparing the total scale scores to a global evaluation of treatment trends and discriminant validity was evaluated by investigating the differences in total scale scores between the Spanish-speaking dentist and cariologist samples.

RESULTS

Cronbach's alpha indicated an internal consistency of 0.63 for the entire scale. Cohen's kappa correlation coefficient expressed a test-retest reliability of 0.83. Convergent validity determined a Pearson's correlation coefficient of 0.24 (p < 0.01). The comparison of proportions (chi-squared) indicated that discriminant validity was statistically significant (p < 0.01), using a one-tailed test.

CONCLUSIONS

The Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" is a valid and reliable instrument for collecting information regarding treatment decisions in cariology.

CLINICAL RELEVANCE

The clinical relevance of this study is to acquire a reliable instrument that allows for the determination of treatment decisions in Spanish-speaking dentists.