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.

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.

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.

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 Support as Smoking Prevention during Transition from Early to Late Adolescence: A Study in 42 Countries.

Family support has a beneficial impact on protecting health-risk behaviour in adolescents. This study aimed to explore whether family support is associated with risk of smoking during transition from early (11 years) to late (15 years) adolescence across 42 countries. The data from the cross-national Health Behaviour in School-aged Children (HBSC) study in 2017/2018 were employed (N = 195,966). Family support was measured using the four-item Family dimension of the Multidimensional Scale of Perceived Social Support (sum score 20 or more was categorised as high family support). Smoking was defined as a reported cigarette smoking at least 1-2 days in the last 30 days. The association between smoking and family support was assessed using a prevalence ratio (PR) obtained from the multivariate Poisson regression. Over two thirds of adolescents reported high levels of support from their family. Family support was found to significantly decrease with age in most of the countries, with the boys reported high level of family support more often than girls. The adolescents who reported having low family support also were more likely to smoke compared to their peers who reported having high family support (PR = 1.81; 95% CI: 1.71-1.91 in boys, and PR = 2.19; 95% CI: 2.08-2.31 in girls). The countries with a stronger effect of family support in reducing smoking risk indicated lower rates of adolescent smoking as well as lower increases in the cigarette smoking prevalence during the age period from 11 to 15 years. This study reinforces the need for family support, which is an important asset helping adolescents to overcome the risk of smoking during their transition from early to late adolescence.

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.

Dental Fear and Associated Factors among Children and Adolescents: A School-Based Study in Lithuania.

Dental fear is a challenging problem in dentistry and many contributing factors have been identified. Although this problem among children and adolescents has been studied in the literature for a long time, few such studies have been conducted in Lithuania. This study aimed to evaluate the prevalence of dental fear and examine its association with gender, age and several psychological and social factors among children and adolescents in Lithuania. The cross-sectional survey included a randomly selected sample (n = 1590) of children aged 11-14 and adolescents aged 15-18. The data were supplemented by interviewing the parents of these subjects (n = 1399). Dental fear was measured with a single five-score question. The data collection also included questions on oral health, socioeconomic status, oral health-related quality of life and self-esteem. Poisson regression analysis was used to assess the association between perception of dental fear and potential predictor variables. It was found that 32.2% (95% CI: 29.9-34.4%) of children and adolescents reported no fear of dental treatment, 12.5% (10.8-14.2%) of their peers were highly afraid of dental treatment, and other subjects assessed their dental fear gradually. Girls reported greater dental fear scores than boys, but the level of dental fear did not depend on the age. We identified the groups of subjects by gender and age, and a higher level of dental fear was significantly associated with untreated caries experience, a delay in the age of the subject's first visit to the dentist, low self-esteem, low oral health-related quality of life, low overall life satisfaction and low family affluence. The results also suggested that dental fear could originate from previous toothache, dentists' actions, high sensitivity in the child and poor psychological readiness for treatment. It was concluded that dental fear among Lithuanian children and adolescents is a common problem that is associated with gender and several dental, psychological and social factors. The findings indicate that school-based health policies, paediatric dentists and parents should be encouraged to focus on the psychosocial factors associated with dental fear because most of them can be prevented.

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND: High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe. OBJECTIVES: We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence. METHODS: We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups). RESULTS: In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05). CONCLUSIONS: Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

Burnout and Its Relationship with Demographic and Job-Related Variables among Dentists in Lithuania: A Cross-Sectional Study.

Although burnout has been described as a serious hazard for personal and professional lives and has been surveyed among dentists in many countries, no study has been published regarding burnout among dentists in Lithuania. This study aimed to evaluate the burnout level among Lithuanian dentists and its association with demographic variables, job satisfaction, and other job-related variables. The data were collected among dentists online or during professional conferences while using an anonymous questionnaire (n = 380). The Maslach Burnout Inventory (MBI) was used to evaluate the burnout level. A Poisson regression was applied for the analysis of relationships between variables. We observed that 42.3% of the respondents had a high emotional exhaustion (EE) (95% confidence interval (CI): 37.4-42.3%), while 18.7% (95% CI: 15.0-22.9%) and 28,2% (95% CI: 23.4-32.6%) had high depersonalization (DP) and low personal accomplishment (PA), respectively. Nonetheless, 15.3% (95% CI: 11.8-18.9%) of the study population experienced a high level of overall burnout. An original job satisfaction index was elaborated. It was significantly associated with sum scores of all burnout dimensions: with the EE sum score (Ratio of Sum Score Means (RSSM) 1.54; 95% CI: 1.46-1.62), DP sum score (RSSM 1.59; 95% CI: 1.45-1.74), and PA sum score (RSSM 0.88; 95% CI: 0.84-0.92). It was concluded that Lithuanian dentists can be characterised by high burnout intensity and high prevalence of burnout, being especially evident in emotional exhaustion. The dentist with low job satisfaction appeared to be the most vulnerable to all burnout dimensions.

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.

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.

Factorial Validity and Variance of the Maslach Burnout Inventory between Demographic and Workload Groups among Dentists of Lithuania.

There is a lack of evidence about burnout syndrome among Lithuanian dentists; as a reliable instrument to examine the syndrome in this professional group has not yet been tested. The study aimed to investigate the performance of the items and the subscales of the Maslach burnout inventory (MBI) by validating its factorial structure and analyzing its variance between demographic and workload groups of dental professionals in Lithuania. The survey was conducted among practicing dentists online or during the scientific conferences for dentists using an anonymous questionnaire. To evaluate the level of burnout the MBI was chosen. Reports of a total of 380 respondents were examined. Three-factor structure of the MBI with cross-loading of two items suggested a good fit to data (χ2/df = 1.67; CFI = 0.93; TLI = 0.93; IFI = 0.93; and RMSEA = 0.059) and was invariant across demographic and workload groups of dentists. Multigroup factorial analysis revealed that females as compared to males had higher average emotional exhaustion; and the respondents up to 30 years as compared to respondents over 30 years of age had higher averages of the emotional exhaustion and depersonalization components. Highly specialized dentists (oral surgeons, prosthodontists, orthodontists, endodontists and poedodontists) were particularly less prone to burnout syndrome than dentists of general practice. It was concluded that the MBI offers factorial validity and demonstrates its invariant structure and variance of burnout dimensions across demographic and workload groups. These findings are informative for burnout prevention and intervention programs among dentists in Lithuania. Such information may contribute to lessen professional burnout among dentists in Lithuania.

Relationships of Dental Caries and Malocclusion with Oral Health-Related Quality of Life in Lithuanian Adolescents Aged 15 to 18 Years: A Cross-Sectional Study.

There is a lack of evidence of the moderating effects of caries lesions and malocclusions on oral health-related quality of life (OHRQoL) among older adolescents. This study aimed to evaluate the relationship of dental caries and malocclusion with OHRQoL among Lithuanian adolescents aged 15 to 18 years. A survey in a representative sample of adolescents included a clinical examination to assess dental health status using the DMFT (Decayed, Missing, and Filled Permanent Teeth) index, and malocclusion using the Index of Complexity, Outcome, and Need (ICON). The Child Perceptions Questionnaire (CPQ) was used to evaluate respondents' OHRQoL. Negative binomial regression was fitted to associate the clinical variables with the CPQ scores. A total of 600 adolescents were examined. The overall mean DMFT score was 2.7. A need for orthodontic treatment was detected among 27.7% of adolescents. Subjects with caries lesions (DMFT > 3) had higher CPQ scores in the domains of functional limitations and social wellbeing (relative risks were 1.35 (95% confidence interval: 1.09-1.67) and 1.30 (1.03-1.64), respectively), while subjects with a need for orthodontic treatment (ICON > 43) had higher CPQ scores in the domains of emotional wellbeing and social wellbeing (relative risks were 1.81 (1.40-2.22), and 1.69 (1.34-2.14), respectively). It was concluded that both dental caries and malocclusion have negative relationships with OHRQoL in adolescents above 15 years, but their effects occur differently in each OHRQoL domain.

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.

Family Affluence Based Inequality in Oral Health-Related Quality of Life in a Population of Lithuanian Adolescents.

BACKGROUND: The social inequalities in oral health have had increasing attention in recent years. The present study aimed to explore the impact of family affluence on Oral Health-Related Quality of Life (OHRQoL) among Lithuanian adolescents aged 11-18 years. METHODS: The cross-sectional, population-based study included a representative sample of 881 adolescents aged 11-18 years (mean = 15.55; SD = 1.51) randomly selected from 20 schools in Lithuania. The schoolchildren completed questionnaires to evaluate their OHRQoL using a Lithuanian version of the Child Perceptions Questionnaire (CPQ). The adolescents' family affluence was indirectly assessed by inquiring whether they possessed various modern life items. In dental examination, the severity of malocclusion was predetermined by the Index of Complexity, Outcome, and Need (ICON). The relationship among variables was examined employing the negative binomial regression and the path analysis. RESULTS: The sum score of CPQ as a whole and the sum scores of all four domains were significantly associated with family affluence, indicating higher OHRQoL among adolescents from more affluent families. The severity of malocclusion had a significant association with emotional and social well-being domains of OHRQoL only. CONCLUSION: This study evidences the family affluence based inequality in OHRQoL among Lithuanian adolescents.

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.

The Association Between Cyberbullying, School Bullying, and Suicidality Among Adolescents.

BACKGROUND: Bullying and suicidality are serious worldwide problems with negative effects on the young population and therefore international comparisons in this field are of paramount importance. AIMS: To analyze the prevalence of bullying and cyberbullying and their association with suicidal behavior among school-aged children in Israel, Lithuania, and Luxembourg. METHOD: In total, 3,814 15-year-olds from schools in Israel, Lithuania, and Luxembourg were surveyed in the Health Behavior in School-Aged Children (HBSC) cross-national survey in 2013/2014 using standardized anonymous questionnaires. Data analysis employed logistic regression and structural equation modeling (SEM). RESULTS: In all, 6.5% of the adolescents reported being cyberbullied, 15.6% reported being bullied at school. In the previous 12 months, 38.6% reported experiencing emotions that stopped them from doing their usual activities, 17.8% considered attempting suicide, 12.0% made a suicide plan, and 9.5% attempted suicide. Victims of cyberbullying and school bullying had a significantly higher risk of suicidal ideations, plans, and attempts. The SEM analysis confirmed a significant overall effect of bullying on adolescent suicidality. The strongest effect was seen among Israeli students. LIMITATIONS: The prevalence estimates were obtained by self-report. CONCLUSION: The prevalence of adolescent cyberbullying, school bullying, and suicidal behavior is relatively high in Israel, Lithuania, and Luxembourg. Cyberbullying is a strong predictor of adolescent suicidality.