Do Subjects from Different Occupational Groups Experience Dental Fear and Anxiety Equally?

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients.

Knowledge, attitudes, and interest in orthodontic treatment: a cross-sectional study in adults with stage III-IV periodontitis and secondary malocclusions.

BACKGROUND: An increasing number of patients with advanced stages of periodontitis are seeking for treatment options. The study aimed to determine interest in orthodontic treatment (OT) and its association with oral health status and knowledge about the disease in adult subjects with stage III-IV periodontitis. METHODS: 96 subjects ≥ 30 years, with stage III-IV periodontitis agreed to fill in a questionnaire and undergo a comprehensive periodontal-orthodontic examination. The questionnaire included 44 questions: demographic, dental, health related habits, self-perceived overall and oral health, knowledge of periodontitis, and attitude toward OT. The statistical analysis was performed using a paired-sample T-test, Receiver Operating Characteristic (ROC) and binary logistic regression analysis (LRA). RESULTS: Stage IV periodontitis was observed in 32.3% of subjects and Class II malocclusion was most prevalent (53.1%). More than half of subjects were interested in OT. Oral health, knowledge about periodontitis and age were significant predictors for interest in OT. CONCLUSIONS: Knowledge spread about OT possibilities in advanced stages of periodontitis is very important both for the dental community and older subjects to save natural dentition.

Pathways of Adolescent Life Satisfaction Association with Family Support, Structure and Affluence: A Cross-National Comparative Analysis.

Background and Objectives: Despite the importance of life satisfaction for health and well-being, there is a paucity of cross-national comparative studies in life satisfaction related to the family environment. The present research examined the pathways of life satisfaction association with perceived family support and other family environment variables among adolescents aged from 11 to 15 years in 45 countries. Materials and Methods: Samples from the Health Behaviour in School-aged Children (HBSC) survey in 2017/2018 were analysed (n = 188,619). Path analysis was applied to evaluate the associations among the study variables. Results: A positive association between the life satisfaction score and high family support was identified in all 45 countries (standardized regression weight ranged from 0.067 to 0.420, p < 0.05). In majority of countries, living with both parents and higher levels of family affluence had a positive effect on adolescent life satisfaction both directly and indirectly through family support. In the described path model, the proportion of life satisfaction score variance that was accounted for by family support, family structure, family affluence, gender and age was up to 25.3%. The path models made it possible to group the participating countries into two clusters. In the first cluster (10 countries) the Eastern and Southern European countries dominated, while the second cluster (35 countries) united the countries of Western and Central Europe. Conclusions: There is evidence that countries with high level of adolescent life satisfaction differ in the high rate of intact family structure and the strong relation between family support and perceived life satisfaction.

Reliability and Validity of a Lithuanian Version of the Oral Health Impact Profile-A Study in Patients with Stage III-IV Periodontitis.

Background and Objectives: The study aimed to translate the original English version of Oral Health Impact Profile (OHIP) into Lithuanian and to assess reliability and validity of the translated instrument (OHIP-Lt) in patients with advanced stages of periodontitis. Materials and Methods: Subjects (N = 67) with stage III-IV periodontitis aged 30-63 years were surveyed by questionnaire and examined clinically. Psychometric analysis included explanatory (EFA) and confirmatory (CFA) factor analyses and psychometric tests. Results: Cronbach's alpha of the translated OHIP was 0.96. EFA revealed four dimensions which Cronbach's alpha ranged from 0.75 to 0.96. Construct validity of the four-factor model derived from the OHIP-Lt was supported by findings of CFA (RMSEA = 0.077). The total OHIP-Lt and its subscale scores increased as the patients' self-rated oral health status changed from healthy to unhealthy. Discriminative validity of the OHIP-Lt was confirmed by its higher scores among patients who had an increased spacing between the maxillary anterior teeth and increased clinical attachment level (CAL ≥ 5 mm) compared to those who did not. Conclusions: The translated Lithuanian version of OHIP-Lt was identified as four-dimension inventory. Good reliability and validity of the OHIP-Lt provide the evidence for its further use in study on advanced periodontal disease burden among Lithuanian patients.

Family structure and affluence in adolescent eating behaviour: a cross-national study in forty-one countries.

OBJECTIVE: To investigate the family structure and affluence-related inequality in adolescent eating behaviour. DESIGN: Multivariate binary logistic regression and path analyses were employed to evaluate the impact of family structure and affluence on the consumption of fruits, vegetables, sweets and soft drinks among adolescents. SETTING: The cross-national Health Behaviour in School-aged Children study in 2013/2014 across forty-one countries. PARTICIPANTS: Adolescents aged 11-15 years old (n 192 755). RESULTS: Adolescents from a non-intact family were less likely to eat daily fruits (OR 0·82; 95 % CI 0·80, 0·84), vegetables (OR 0·91; 95 % CI 0·89, 0·93) and sweets (OR 0·96; 95 % CI 0·94, 0·99), but were more likely to consume soft drinks (OR 1·14; 95 % CI 1·11, 1·17), compared with their counterparts from an intact family. Adolescents who had the lowest family affluence scores (FAS) were less likely to eat daily fruits (OR 0·51; 95 % CI 0·49, 0·53), vegetables (OR 0·58; 95 % CI 0·56, 0·60) and sweets (OR 0·94; 95 % CI 0·90, 0·97), but were more likely to consume soft drinks (OR 1·25; 95 % CI 1·20, 1·30), compared with their counterparts who had the highest FAS. Across countries, a wide range of social inequality in daily consumption of foods was observed. CONCLUSIONS: Among adolescents in Europe, Canada and Israel, there was a high level of family structure and family affluence inequalities in daily food consumption. Different aspects of family socio-economic circumstances should be considered at the national level designing effective interventions to promote healthy eating among adolescents.

Burnout, lifestyle and relaxation among dentists in Lithuania: a cross-sectional study.

BACKGROUND: The aim of this study was to estimate the association of burnout level with lifestyle and relaxation among dentists in Lithuania. A better understanding of this association could help in the development of targeted interventions to prevent burnout among these professionals. METHODS: The survey was conducted among practising dentists (N = 380) using the Maslach Burnout Inventory (MBI) and an authors' proposed scale to measure lifestyle and relaxation. Poisson regression was applied to examine the association between variables. RESULTS: Regular cigarette smoking among dentists in Lithuania was 16.8 % and alcohol consumption was 31.3 %. Some forms of active relaxation were also common: regular playing sports (57.9 %), and spending time in nature (61.4 %). Emotional exhaustion (EE) and depersonalization (DP) burnout dimensions were negatively related to the regular use of illegal substances, alcohol, medication and smoking, while personal achievement (PA) was negatively related to smoking only. Dentists who regularly exercised had significantly lower EE and DP sum scores, and better assessments of PA. There were also positive relationships of EE, DP and PA sum scores with the variables of relaxation (e.g., spending time with family or friends, visiting a theatre, engaging in art, listening to music). CONCLUSIONS: It was concluded that the burnout dimensions are negatively associated with unhealthy lifestyle factors and positively associated with active relaxation among dentists in Lithuania. Therefore, burnout prevention should target specific lifestyle and relaxation improvement strategies.

The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study.

BACKGROUND: We recently showed headache to be common in children (aged 7-11 years) and adolescents (aged 12-17) in Lithuania. Here we provide evidence from the same study of the headache-attributable burden. METHODS: Following the generic protocol for Lifting The Burden's global schools-based study, this cross-sectional survey administered self-completed structured questionnaires to pupils within classes in 24 nationally representative schools selected from seven regions of the country. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH; defined as mild headache with usual duration < 1 h). Burden enquiry was conducted in multiple domains. RESULTS: Questionnaires were completed by 2505 pupils (1382 children, 1123 adolescents; participating proportion 67.4%), of whom 1858 reported headache in the preceding year, with mean frequency (±SD) of 3.7 ± 4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Mean intensity on a scale of 1-3 was 1.6 ± 0.6 (mild-to-moderate). Symptomatic medication was consumed on 1.5 ± 2.8 days/4 weeks. Lost school time was 0.5 ± 1.5 days/4 weeks (migraine 0.7 ± 1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day. More days were reported with limited activity (overall 1.2 ± 2.4, migraine 1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school. One in 30 parents (3.3%) missed work at least once in 4 weeks because of their son's or daughter's headache. Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension-type headache, and UdH least. Burdens were greater in adolescents than children as UdH differentiated into adult headache types. CONCLUSIONS: Headache in children and adolescents in Lithuania is mostly associated with modest symptom burden. However, the consequential burdens, in particular lost school days, are far from negligible for migraine (which is prevalent) and very heavy for pMOH (which, while uncommon in children, becomes four-fold more prevalent in adolescents). These findings are of importance to both health and educational policies in Lithuania.

The prevalence of headache disorders in children and adolescents in Lithuania: a schools-based study.

BACKGROUND: While the Global Burden of Disease (GBD) study reports headache disorders as the second-highest cause of disability worldwide, the headache data in GBD come very largely from adults. This national study in Lithuania was part of a global schools-based programme within the Global Campaign against Headache contributing data from children (7-11 years) and adolescents (12-17 years). METHODS: The methods followed the generic protocol for the global study. The basic study design was a cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in 24 schools selected from seven regions of Lithuania to be nationally representative. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH). RESULTS: Of 3714 potential participants, 2505 (children 1382 [55.2%], adolescents 1123 [44.8%]; males 1169 [46.7%], females 1336 [53.3%]) completed the questionnaire. Adolescents and males were therefore relatively under-represented, with non-participation (32.6%) due in most cases to lack of parental consent. Observed lifetime prevalence of headache was 92.2%. Gender- and age-adjusted 1-year prevalence was 76.6% (migraine: 21.4%; tension-type headache [TTH]: 25.6%; UdH: 24.0%; all headache on ≥15 days/month: 3.9%; probable medication-overuse headache: 0.8%). All headache types except UdH were more prevalent among females than males, and among adolescents than children. UdH showed a complex relationship with age, but represented 38.0% of all reported headache in children, 27.4% in adolescents. Headache yesterday (HY) was reported by 17.5%, almost double the 9.8% predicted from prevalence and headache frequency to have headache on any day. The reason was unclear. CONCLUSIONS: Findings were not very different from those reported in Turkey and Austria, but with more TTH. Headache has, therefore, again been shown to be common in children and adolescents, and UdH confirmed as a headache type that must be recognised and included in accounts of headache in these age groups.

Development of a scale for measuring collaboration between physicians and nurses in primary health-care teams.

During past decades the science of collaboration in health care has progressed significantly worldwide, although in some regions (e.g.: Central and Eastern Europe) these processes are slower. The aim of this study was to develop a new, multidimensional measurement tool of the developing collaboration in primary health care (PHC). This study included both qualitative (thematic analysis of the data from focus group discussions) and quantitative (a 36-item cross-sectional questionnaire) methods in order to develop and test a new measurement scale. The collaboration scale between community nurses (CNs) and general practitioners (GPs) in primary health-care teams (COPAN scale) was created. It initially revealed five determining factors: "Goal Oriented Team Synergy", "Team Structure and Leadership", "Organizational Background for Teamwork", "Competence" and "Diffusion of Functions." Two and three-factor scales (COPAN-2 and COPAN-3) were developed after confirmatory factor analysis with sufficient psychometric characteristics to be applied in practice. This study reports the reliability of a novel tool that can be used to measure collaboration of CNs and GPs in PHC. The newly developed scale has the potential to become an easy-to-use tool in the monitoring of teamwork situations within PHC settings of low integration or newly evolving teams.

Modification and psychometric evaluation of the child perceptions questionnaire (CPQ11-14) in assessing oral health related quality of life among Lithuanian children.

BACKGROUND: Oral health related quality of life (OHRQoL) research among children and adolescents in Lithuania is just starting and no measures have been validated to date. Therefore, this study aimed to validate a Lithuanian version of the full (37 items) Child Perceptions Questionnaire (CPQ11-14) within a random sample of children aged 11 to 14. METHODS: A cross-sectional survey among a randomly selected sample of schoolchildren (N = 307) aged 11 to14 was conducted. An anonymous questionnaire included the full CPQ11-14 and items on global life satisfaction, oral health and oral life quality self-rating. The questionnaire was translated into Lithuanian using translation guidelines. In addition, an item on the oral pain was modified identifying the pain location. Standard tests (Cronbach's α, construct validity and discriminant validity), supplemented with both exploratory and confirmatory factor analyses, were employed for psychometric evaluation of the instrument. The questionnaire was also tested by comparison students' and their parents' (N = 255) responses about oral symptoms and functional limitations. RESULTS: The modified Lithuanian version of CPQ11-14 revealed good internal consistency reliability (Cronbach's alpha for the total scale was 0.88). The measure showed significant associations with perceived oral health status and oral well-being, as well as with global life satisfaction (p < 0.01). Discriminant validity of the instrument was approved by comparison of children's groups defined by self-reported caries experience and malocclusion. Factor analysis revealed a complex structure with two or three factors in each of four domains of the CPQ11-14. Excellent or acceptable levels of indices of model fitting with the given data were obtained for oral symptoms, functional limitations and emotional well-being domains, but not for the social well-being domain. A significant association between child and parental responses was found (intraclass correlation coefficient was 0.56 and 0.43, correspondingly in domains of oral symptoms and functional limitations). CONCLUSION: The Lithuanian version of the CPQ11-14 (with a modified item that identifies location of oral pain) appears to be a valid instrument to be used in further studies for measuring OHRQoL among 11 to 14 year old children in Lithuania.

Smoking and attitudes towards its cessation among native and international dental students in Lithuania.

BACKGROUND: Dental professionals are uniquely positioned to discourage smoking among their patients. However, little is known about the role of cultural background and attitudes towards smoking in the education of these professionals. Our study aimed to compare native Lithuanian and international dental students' smoking habits, knowledge about the harmfulness of smoking and attitudes towards smoking cessation. METHODS: We conducted a cross-sectional survey of smoking and its cessation among dental students at the Lithuanian University of Health Sciences (Kaunas, Lithuania) in 2012. All Lithuanian and international dental students in each year of dental school were invited to participate in the survey during a compulsory practical class or seminar. Altogether 606 students participated in the survey with a response rate of 84.2%. Explanatory factorial analysis (EFA), multivariate Discriminant Analysis (DA) and Binary Logistic Regression (BLR) served for the statistical analyses. RESULTS: The percentages of occasional/current regular smokers were 41.1% and 55.7% (p = 0.068) among Lithuanian and international male students, and 22.7% and 22.9% (p = 0.776) among Lithuanian and international female students, respectively. The international dental students had a deeper knowledge of the harmfulness/addictiveness of smoking and held more positive attitudes towards smoking cessation among their patients than did the native Lithuanian dental students. CONCLUSIONS: The findings of the study underscored the need to properly incorporate tobacco cessation training into the curriculum of dental education. However, consideration of the cultural background of dental students in building up their capacity and competence for intervening against smoking is essential.

Prevalence and familial predictors of suicidal behaviour among adolescents in Lithuania: a cross-sectional survey 2014.

BACKGROUND: In the past decades Lithuania has been experiencing a very high suicide rate among young people and there are scarce data on the role of the family in shaping these people suicidal behaviour. This study investigated the prevalence of suicidal ideation and attempts, as well as their association with a range of familial factors in a representative sample of Lithuanian adolescents. METHODS: Study subjects (N = 3572) were adolescents aged 13- and 15-years from the schools in Lithuania who were surveyed in Spring 2014 according to the methodology of the cross-national Health Behaviour in School-aged Children (HBSC). A standard HBSC international questionnaire was translated into Lithuanian and used anonymously to obtain information about suicidal behaviour (stopped doing activities, considered suicide, planned suicide, and suicide attempts) and family life (family structure, quality of communication in family, parental monitoring and bonding, parenting style, family time, etc.). Logistic regression was used to assess association between suicidal behaviours and familial variables. RESULTS: Forty three percents of surveyed adolescents reported presence of emotions that stopped doing activities during the last 12 months, 23.8 % seriously considered attempting suicide, 13.7 % made a suicide plan, 13.2 % attempted suicide, and 4.1 % needed treatment because of suicide attempt in the previous year. Adolescents from non-intact families reported more suicidal ideation (OR ranged from 1.32 to 1.35, P < 0.05) and more suicide attempts (OR = 1.70, 95 % CI 1.38-2.09, P < 0.001). Among adolescents from intact families, some manisfestations of suicidal behaviour were significantly associated with low satisfaction in family relationships, low father's and mother's emotional support, low mother's monitoring, low school-related parental support, authoritarian-repressive father's parenting style and permissive-neglectful mother's parenting style, but rare family time together and rare electronic media communication with parents were inversely associated with suicidal behaviour. The boys, 15-year-olds and adolescents who indicated often activities together with their families were more likely than their counterparts to report suicide attempts treated by a doctor or nurse. CONCLUSION: The young people of Lithuania are at particular risk for suicides. A non-intact family structure and weak family functioning are significant predictors of suicidal ideation and attempts among adolescents of Lithuania. It is essential to consider family life practices in planning intervention programs for prevention of suicides among adolescents.

Familial determinants of current smoking among adolescents of Lithuania: a cross-sectional survey 2014.

BACKGROUND: Understanding the role of the family in shaping adolescent health risk behaviours has recently been given increased attention. This study investigated association between current smoking and a range of familial factors in a representative sample of Lithuanian adolescents. METHODS: Study subjects (N = 3696) were adolescents aged 13- and 15-years from the schools in Lithuania who were surveyed in Spring 2014 according to the methodology of the cross-national Health Behaviour in School-aged Children (HBSC). A standard HBSC international questionnaire was translated into Lithuanian and used anonymously to obtain information about current smoking patterns and family life (family structure, quality of communication in family, parental monitoring, bonding, parenting style, family time, etc.). Logistic regression was used to assess association between smoking and familial variables. RESULTS: The prevalence of current smoking was 16.5 % (20.8 % in boys and 11.9 % in girls; P < 0.001). Adjusting for gender, age and family affluence, adolescents from non-intact families were significantly more likely to be current smokers (OR = 2.10; 95 % CI: 1.74-2.54) compared with intact families. Five independent familial factors were significantly related to increased risk for adolescent smoking: low maternal monitoring (OR = 2.79; 95 % CI: 1.98-3.92), low satisfaction with family relationships (OR = 1.89; 95 % CI: 1.27-2.83), low school-related parental support (OR = 1.40; 95 % CI: 1.01-1.95), easy communication with the father (OR = 0.56; 95 % CI: 0.38-0.80) and often use of electronic media for communication with parents (OR = 0.66; 95 % CI: 0.50-0.88). The last two determinants showed an inverse effect than it was hypothesized. CONCLUSION: Higher prevalence of smoking among adolescents of Lithuania is associated with a non- intact family structure as well as weaker parental support and bonding. Family life practices are critical components to be incorporated in prevention and intervention programs for adolescent smoking in Lithuania.

Trends in adolescents' perceived parental communication across 32 countries in Europe and North America from 2002 to 2010.

BACKGROUND: The quality of communication with parents is a determinant of health and well-being during adolescence, being predictive of self-esteem, self-rated health and the ability to navigate health risk behaviours. METHODS: This article describes trends in adolescent's (aged 11, 13 and 15 years) perception of communication with mothers and fathers by gender across 32 European and North American countries from 2002 to 2010. Analyses were performed on 425 699 records employing a General Linear Model (MANOVA). RESULTS: In most countries, significant increases in the prevalence of ease of communication with both mothers and fathers were observed, with the greatest positive changes over time in Estonia, Denmark and Wales. In some countries, the opposite trend was found with the greatest negative changes occurring in France, Slovenia and Poland. Across the pooled dataset, a significant positive trend was observed for ease of communication with father, for both boys and girls and for ease of communication with mother for boys only. CONCLUSION: The temporal trends demonstrated an increase in a positive health asset for many young people, that of family communication. Positive trends may be a feature of the economic boom over the past decade coupled with cultural changes in attitudes to parenting, especially fathering.

Changes in public attitudes towards confidential adolescent sexual and reproductive health services in Lithuania after the introduction of new legislation: findings from the cross-sectional surveys conducted in 2005 and 2012.

BACKGROUND: In Lithuania, the right to confidentiality in healthcare for adolescents over the age of 16 was guaranteed in 2010 through the adoption of new legislation. This study sets out to explore changes in Lithuanian residents' attitudes towards confidentiality protection in adolescent sexual and reproductive healthcare (SRH) by comparing data from surveys administered in 2005 and 2012. METHODS: For both surveys, the participants were random samples of the Lithuanian residents aged 16 to 74. A 23-item questionnaire was used in 2005 and complemented with 2 items in 2012. Linear regression analysis was employed to estimate absolute differences in prevalence of belief in whether or not adolescents would find confidentiality important when consulting a physician on SRH issues. A log-binomial regression model was fitted to estimate the relative changes (prevalence ratio) of the independent variables. RESULTS: The total number of respondents was 1054 (response rate 83%) in 2005 and 1002 (response rate 80%) in 2012. The proportion of respondents who reported a belief that adolescents would find confidentiality important when seeing a physician for SRH issues increased significantly from 62% in 2005 to 73% in 2012. Regardless of their belief in the importance of confidentiality, in 2012 respondents more often indicated positive outcomes on the relations between the physician and the minor patient, such as increased trust of the adolescent in the physician and more frequent visits to physicians. However, study participants who believed that adolescents would find confidentiality important in 2012 were less optimistic about potential positive outcomes of further legal consolidation of adolescents' right to confidentiality than in 2005. Younger respondents were the most optimistic about potential outcomes if laws were enacted to further protect adolescent confidentiality. CONCLUSIONS: This study uncovers the dynamics of public attitudes towards the socially and ethically sensitive issue of adolescent SRH. Our study suggests that legislation could be a factor prompting changes in public opinion, but not sufficient in and of itself for its social acceptance.

Public expectations concerning confidentiality protection of adolescents' sexual and reproductive health care in Lithuania: findings of the surveys conducted in 2005 and 2012.

OBJECTIVE: An adolescent's right to confidential healthcare is protected by international law and professional consensus. However, parental and social support for confidential sexual and reproductive health (SRH) services, in particular, varies greatly. This study documents Lithuanian residents' expectations with regard to confidentiality protection for adolescents in this domain, and explores the factors related to the diversity of these expectations. METHODS: Two national surveys of Lithuanian residents completed in 2005 and 2012 using anonymous questionnaires. Participants rated their expectations for confidentiality using a five-point Likert scale for eight types of SRH consultations. RESULTS: Public anticipation for confidentiality depended on whether issues related to sexual behaviour or to its consequences were addressed during adolescent consultation. Only younger respondents had higher expectations for confidentiality in both contexts. Public expectations regarding confidentiality were less demanding in 2012 than in 2005. CONCLUSIONS: The expectation of confidentiality protection was greater for topics related to sexual behaviour than for the consequences of sexual behaviour, such as pregnancy, abortion or a sexually transmitted infection. This implies a need for targeted information strategies for the general population and explicit guidance for physicians on when and for whom care should remain confidential.

Parental Attitudes towards Child Oral Health and Their Structural Analysis.

The relationship between parental attitudes towards health and child development has been a topic of interest for many years; however, research results in this field are still inconsistent. This study aimed to develop a structural equation model of the Parental Attitudes toward Child Oral Health (PACOH) scale, using this model to analyse the relationship between parental attitudes with demographic variables and the oral health-related behaviour of parents and children. A total of 302 parents (87% mothers) answered questions regarding their own and their children's, aged 4-7 years, oral health-related actions and completed the 38-item PACOH scale. The structural equation model indicated that parental attitudes captured by the PACOH scale can be fitted to a second-order factorial model, even with the scale shortened to 21 items. The model demonstrated good fit characteristics (CFI = 0.925; IFI = 0.927; GFI = 0.915; RMSEA = 0.049), making it a reliable tool for examining the structure of parental attitudes. This model was employed in the multi-group analysis, revealing the close relationship between positive parents' attitudes towards their child's oral health and oral health-promoting behaviour both in parents and children, such as regular tooth brushing (p < 0.001), visiting the dentist (p = 0.027), and parents helping their child brush his/her teeth (p < 0.001). In light of these findings, it was concluded that Parental Attitudes towards Child Oral Health should be considered an essential factor influencing the development of oral health-promoting behaviour in children.

Factors associated with breastfeeding duration.

BACKGROUND AND OBJECTIVE: The assessment of the factors associated with breastfeeding duration helps in creation of a national policy according to the World Health Organization strategy and recommendations. The objective of the study was to identify the factors associated with breastfeeding duration. MATERIAL AND METHODS: These analyses are based on a sample of mothers with babies attending one family health center in Kaunas, Lithuania. Completed questionnaires were obtained from 195 mothers (response rate, 97.5%). One year later, the same respondents, who had 1-year-old children, answered questions of the second questionnaire. RESULTS: Half (53.8%) of the surveyed women breastfed for 3-5 months, 29.7% for 6 months and more, and 16.5% of the respondents breastfed for less than 3 months. The oldest (31-40 years) women breastfed their babies significantly longer than the youngest (<20 years) mothers. The mothers with a higher education breastfed their babies significantly longer than the less educated mothers. The married women breastfed longer than single or living with a partner. The mothers who did not give extra fluids and pacifiers breastfed significantly longer than the women who gave them. The majority of the mothers who had sore nipples, milk stasis, and mastitis breastfed for only up to 3 months. CONCLUSIONS: Mothers at risk of short breastfeeding duration should be targeted as a group for breastfeeding promotion early in the pregnancy. The education of healthcare professionals who provide prenatal and postnatal care allows them to choose women who need additional breastfeeding support.

Adolescent Toothbrushing and Its Association with Sociodemographic Factors-Time Trends from 1994 to 2018 in Twenty Countries.

Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.

Health-behaviour inequalities among Russian and ethnic majority school-aged children in the Baltic countries.

AIMS: The main aim of this paper was to investigate whether ethnic heath inequalities exist in self-rated health and risk-taking behaviours (smoking, drunkenness, use of cannabis) between ethnic majority (Estonian, Latvian, Lithuanian) and minority (Russian) population groups of school-aged children in three Baltic countries. METHODS: Investigation was carried out in the framework of Health Behaviour in School-aged Children (HBSC) study. Randomly selected students aged 11, 13, and 15 years answered questionnaires in the classroom in 2006. In total, 14,354 questionnaire forms were selected for analysis. RESULTS: Russian boys were more likely (p<0.05) to evaluate their self-rated health positively in schools with Russian teaching language. Odd ratios for current smoking and drunkenness were significantly lower among Russian boys in the schools with Russian language of instruction (p<0.05) in comparison with the reference group. Russian girls did not differ significantly (the exceptions were smoking in Estonia and cannabis use in Latvia) from the majority population girls by self-rated health as well as by the risk of smoking, drunkenness, and use of cannabis. CONCLUSIONS: The study found some differences in self-rated health and in risk-taking behaviours between Russian minority and ethnic majority students as well as between students of schools with different language of instruction (majority language vs. Russian) in Estonia, Latvia, and Lithuania. Being a member of minority group was not related with poor self-rated health or involvement in risk-taking behaviours in school-aged children in the Baltic countries.