Exploring the Threefold Viewpoint on Children's Oral Health in a Cross-Sectional Study.

Oral health is situated within the framework of the global health agenda, addressing facets pertaining to well-being and quality of life. The research is based on the need to address variables at the community level to improve schoolchildren's oral health and promote healthy behaviors and aims to carry out an in-depth analysis from the perspective of the factors that influence children's oral health. Step 1, designed by the World Health Organization, was utilized. An easy-to-use web interface was created for data collection. The statistical analysis consisted of using multinomial and binominal logistic regression models. The level of education of the adult has a high probability of influencing the consumption of unhealthy or healthy foods, it has a significant probability of exerting influence on social or medical problems and a correlation was found between the level of academic education and the pattern of dental visits. The development of health-promoting behaviors begins in childhood and involves parents, who have an essential role in the education of their children. Oral health promotion programs in schools need to target the child-adult-teacher-dentist relationships. Taking into consideration the aforementioned, a threefold viewpoint is necessary for the development of a national program aimed at promoting the oral health of schoolchildren in Romania.

Evolution of Primary Research Studies in Digital Interventions for Mental Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on the Web of Science.

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around "Mindfulness", "Anxiety", "COVID-19", "Acceptance and Commitment Therapy", "Depression", "Web-based", and "Positive Psychology". Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field's dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed.

Contribution of environmental determinants to the risk of developing type 2 diabetes mellitus in a life-course perspective: a systematic review protocol.

BACKGROUND: Prevention policies against type 2 diabetes mellitus (T2DM) focus solely on individual healthy lifestyle behaviours, while an increasing body of research recognises the involvement of environmental determinants (ED) (cultural norms of land management and planning, local foodscape, built environment, pollution, and neighbourhood deprivation). Precise knowledge of this relationship is essential to proposing a prevention strategy integrating public health and spatial planning. Unfortunately, issues related to the consistency and synthesis of methods, and results in this field of research limit the development of preventive strategies. This systematic review aims to improve knowledge about the relationship between the risk of developing T2DM in adulthood and long-term exposure to its ED during childhood or teenage years. METHODS: This protocol is presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) tools. PubMed, Embase, CINAHL, Web of Science, EBSCO, and grey literature from the Laval University Libraries databases will be used for data collection on main concepts such as 'type 2 diabetes mellitus', 'zoning' or 'regional, urban, or rural areas land uses', 'local food landscape', 'built environment', 'pollution', and 'deprivation'. The Covidence application will store the collected data for selection and extraction based on the Population Exposure Comparator Outcome and Study design approach (PECOS). Studies published until December 31, 2023, in English or French, used quantitative data about individuals aged 18 and over that report on T2DM, ED (cultural norms of land management and planning, local foodscape, built environment, and neighbourhood deprivation), and their association (involving only risk estimators) will be included. Then, study quality and risk of bias will be conducted according to the combined criteria and ratings from the ROBINS-E (Risk of Bias in Non-randomised Studies-of Exposures) tools and the 'Effective Public Health Practice Project' (EPHPP). Finally, the analytical synthesis will be produced using the 'Synthesis Without Meta-analysis' (SWiM) guidelines. DISCUSSION: This systematic review will summarise available evidence on ED associated with T2DM. The results will contribute to improving current knowledge and developing more efficient cross-sectoral interventions in land management and public health in this field of research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023392073.

An exploration of the influencing factors for effective public health messaging during disasters: a scoping review.

OBJECTIVES: Public health messaging during disasters help to provide knowledge and guidance for preventative behaviours and risk reduction. The aim of this review is to explore how public health messages are currently being provided during disasters and identify what influencing factors contribute to the effectiveness of these messages. STUDY DESIGN: Scoping review. METHODS: A scoping review was conducted using guidance from Joanna Briggs Methodology for Scoping Reviews. A narrative synthesis was utilised due to the heterogeneity of findings. The review included seventeen sources, addressing a variety of disasters around the globe over the past two decades. RESULTS: Three key influencing factors were identified and are illustrated in a concept model called the Audience, Information, Messenger and Mode (AIMM) Public Health Messaging Scale. This conceptual model depicts considerations such as the quantity, quality, and framing of information, the human and technological sources used for delivery and the audience needs and capabilities required for optimal message impact and effectiveness. CONCLUSIONS: Public health messages do influence prevention behaviours during disasters, but they must be carefully tailored and delivered to ensure adequate reach, comprehension, and compliance.

An mHealth Application in German Health Care System: Importance of User Participation in the Development Process.

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications.

Beyond Diagnosis: Preliminary Study of Impact on Children and Parents in Neurodevelopmental Disorders and Juvenile Idiopathic Arthritis-Associated Uveitis.

Chronic diseases are a growing problem for global health due to the large number of people they involve, the repercussions they have on the mental and physical well-being of those affected, and the costs to society. Particularly, chronic illnesses of childhood have important psychological implications, not only for affected children but also for their parents. Among these pathologies, neurodevelopmental disorders (NDDs) and uveitis associated with juvenile idiopathic arthritis (JIA-U) may affect mental and physical health, emotions, memory, learning, and socializing. This study evaluates the psychological and behavioral/emotional impact of NDDs and JIA-U on children and parents. Specifically, 30 children with active JIA-U and 30 children with NDDs and their parents completed the Child Behavior Checklist (CBCL) and Parent Stress Index-Short Form (PSI) questionnaires. Children with NDDs have statistically significant differences in all the emotional and behavioral variables compared to JIA-U children, and parents of children with NDDs experience an increased stress load compared to parents of children with JIA-U. This study emphasizes the wide range of emotional and behavioral challenges that parents face with NDDs. This study emphasizes that parents of children with NDDs not only experience higher levels of stress compared to parents of normally developing children but also experience higher levels of stress compared to parents of children with potentially debilitating chronic diseases such as JIA-U.

Whole-family programmes for families living with parental mental illness: a systematic review and meta-analysis.

Several interventions have been developed to support families living with parental mental illness (PMI). Recent evidence suggests that programmes with whole-family components may have greater positive effects for families, thereby also reducing costs to health and social care systems. This review aimed to identify whole-family interventions, their common characteristics, effectiveness and acceptability. A systematic review was conducted according to PRISMA 2020 guidelines. A literature search was conducted in ASSIA, CINAHL, Embase, Medline, and PsycINFO in January 2021 and updated in August 2022. We double screened 3914 abstracts and 212 papers according to pre-set inclusion and exclusion criteria. The Mixed Methods Appraisal Tool was used for quality assessment. Quantitative and qualitative data were extracted and synthesised. Randomised-control trial data on child and parent mental health outcomes were analysed separately in random-effects meta-analyses. The protocol, extracted data, and meta-data are accessible via the Open Science Framework ( https://osf.io/9uxgp/ ). Data from 66 reports-based on 41 independent studies and referring to 30 different interventions-were included. Findings indicated small intervention effects for all outcomes including children's and parents' mental health (dc = -0.017, -027; dp = -0.14, -0.16) and family outcomes. Qualitative evidence suggested that most families experienced whole-family interventions as positive, highlighting specific components as helpful, including whole-family components, speaking about mental illness, and the benefits of group settings. Our findings highlight the lack of high-quality studies. The present review fills an important gap in the literature by summarising the evidence for whole-family interventions. There is a lack of robust evidence coupled with a great need in families affected by PMI which could be addressed by whole-family interventions. We recommend the involvement of families in the further development of these interventions and their evaluation.

Aktualisierung zu: Leitfaden zur Vorbeugung, Erfassung und Sanierung von Schimmelbefall in Gebäuden (2017) ­ Kapitel 6.1 "Nutzungsklassen".

The guidelines published by the German Environment Agency in 2017 on the "Prevention, detection and remediation of mould in buildings" were clarified in two points. First, Chapter 6.1 "Utilisation classes" now includes the definition of an "indoor space" in relation to human use. Second, the previous utilisation class IV - which concerned cavities and building components - was removed. These changes avoid misinterpretations and emphasise the hygiene-preventive approach of the guideline. An English full-text version of this article is available at SpringerLink as Supplementary Information.

Effectiveness of video-based health promotion: A systematic review and meta-analysis.

BACKGROUND: Although health promotion scholars and practitioners frequently employ video-based promotion, its effectiveness remains uncertain due to mixed findings. Nuanced details regarding content and design also remain under-explored. METHODS: We conducted a comprehensive search across nine databases to identify relevant empirical research articles. RESULTS: Our systematic review included a total of 54 studies, with 38 studies eligible for meta-analysis. Findings highlight the promising potential of video messaging strategies in promoting health behaviors. CONCLUSIONS: Future research should focus on designing video content that targets detection behaviors within an appropriate length, guided by robust theoretical frameworks to maximize the efficacy of video promotion. More substantial evidence is needed to assess whether video promotion can achieve similar persuasive effectiveness across diverse cultural, political, and economic circumstances. Factors related to the audience (e.g., distinct psychological and personality influences) and message characteristics (e.g., length, credibility) should be further explored to better elucidate the relationship between video-based health promotion and health outcomes. PRACTICE IMPLICATIONS: Health practitioners and organizations should incorporate video-based messages in interventions as supplement or alternative means to educate audiences of positive prevention methods, establish accurate attitude and intentions toward prevention behaviors, and increase their vigilance toward risky behaviors.

Health Prevention Interventions for Adults in the Community: A Scoping Review of Intervention Characteristics.

This scoping review was designed to determine which adults receive preventative health interventions, the types of interventions for modifiable risk factors, the health professionals, including occupational therapy practitioners providing these interventions, and where they are delivered to adults in the community. The databases searched were PubMed, Ageline, and CINAHL and included research meeting the inclusion criteria and published between 2016-2021. All included studies addressed health prevention. 5,399 articles were screened with 83 of these included in the final review. Older adults, White and Black individuals, and females were the most prevalent individuals and groups to receive health prevention interventions and occupational therapy professionals were involved in 5% of the reviewed studies. As there is a need for preventative health interventions to help reduce negative health outcomes and occupational therapy professionals have important skills in health prevention this study illustrates the types of health prevention provided to adults receiving intervention in the community and points to areas of opportunity for occupational therapy professionals.

A professional and institutional organization based on the "Aller vers" dynamic / Un acteur professionnel et institutionnel fondé sur la dynamique du « Aller Vers ¼

The French Union for Oral Health (UFSBD) embodies a professional initiative in institutional form, based on the philosophy of "Aller vers" (going toward). Based on plural representation, it brings together a variety of dentists, who are representative of the diversity of practices, whether in urban or rural areas, as employees or independent practitioners, or in local practice or hospital contexts. Proximity to the public is the very essence of its action and gives it a good understanding of realities on the ground. Since its creation, the UFSBD has been engaged in an ever-evolving collective mission, adapting its efforts to the changing needs of society and citizens. Its bold approach goes beyond the traditional boundaries of dental practice, by reaching out to the most vulnerable people and those furthest from the health system. This translates into an inclusive, proactive, and local approach. This dynamic has played a decisive role in advocating, since the 1990s, the recognition of oral health as an essential component of general health. Despite the obstacles and the time required to change mentalities, the UFSBD persevered, particularly regarding the challenge that periodontal diseases represent for oral health. Challenges persist, particularly with regard to access to prevention for populations at risk, population aging, and the integration of oral health into overall care pathways. However, the main objective remains that oral health regains its place as an undeniable national priority. Indeed, the mouth is at the heart of general health and can play an essential transversal role in public health.

L'Union Française pour la Santé Bucco-dentaire (UFSBD) incarne une initiative professionnelle sous forme institutionnelle qui repose sur la philosophie du « Aller Vers ¼. Fondée sur une représentation plurielle, elle réunit une diversité de Chirurgiens-dentistes, qui sont représentatifs de la diversité des pratiques, que ce soit en milieu urbain ou rural, en tant que salariés ou praticiens libéraux, dans des contextes citadins ou hospitaliers. Cette proximité avec les populations est l'essence même de son action et lui donne une bonne vision des réalités de terrain. Depuis ses débuts, l'UFSBD s'est engagée dans une mission collective en constante évolution, adaptant ses efforts aux besoins changeants de la société et des citoyens. Son approche audacieuse dépasse les frontières traditionnelles des cabinets dentaires, en se lançant à la rencontre des populations les plus vulnérables et éloignées du système de santé. Cela se traduit par une approche inclusive, proactive et de proximité. Cette dynamique a joué un rôle déterminant en plaidant, depuis les années 90, pour la reconnaissance de la santé bucco-dentaire en tant que composante essentielle de la santé générale. Malgré les freins et le temps nécessaire des plaidoyers pour faire évoluer les mentalités, l'UFSBD a persévéré, en particulier dans le défi que représentent les maladies parodontales pour la santé bucco-dentaire. Des défis perdurent, notamment en ce qui concerne l'accès à la prévention pour les populations à risques, le vieillissement de la population et l'intégration de la santé bucco-dentaire dans les parcours de soins globaux. Cependant, l'objectif principal demeure que la santé bucco-dentaire retrouve sa place de priorité nationale incontestable. En effet, la bouche est au cœur de la santé générale et peut jouer un rôle transversal essentiel en santé publique.

Why we should focus more attention on uncertainty distress and intolerance of uncertainty in adolescents and emerging adults.

Sivertsen et al. (2023) showed that adolescents endorsing high levels of internalizing and externalizing symptoms are at risk of increased mental health problems during emerging adulthood and suggested the existence of both homotypic and heterotypic continuities of mental disorders over time. Since adolescence and emerging adulthood are transition periods highly intertwined with uncertainty, the present perspective contextualizes the findings by Sivertsen et al. (2023) in relation to the extant literature on intolerance of uncertainty and the recently developed Uncertainty Distress Model. Moreover, it claims for further research addressing the way adolescents and emerging adults process and deal with uncertainty. Indeed, focusing more attention on the implications of trans-situational and trans-diagnostic constructs such as uncertainty distress and intolerance of uncertainty in these life stages may hold great promise to design and implement effective mental health prevention programs.

Participatory Action Research as a Driver for Health Promotion and Prevention: A Co-creation Process Between Professionals and Citizens in a Deprived Neighbourhood in the Hague.

Introduction: Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk. Methods: The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups. Results: Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness. Discussion and conclusion: This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities.

Modelling the transmission and control of COVID-19 in Yangzhou city with the implementation of Zero-COVID policy.

In the fight against the COVID-19 pandemic, China has long adhered to the "Dynamic Zero COVID-19" strategy till the end of 2022. To understand the mechanism of this strategy, we used the case of the Yangzhou summer outbreak in 2021 and a multi-stage dynamical model incorporating city-wide and key area testing-trace-isolation (TTI) strategies. We defined two time-varying indexes for measuring the disease transmission risk and the public health prevention and control force, respectively, which allowed us to explore the mechanisms of TTI policies. Integrating with the historical data and literature parameter values, we first estimated the parameters and then quantified the relevant indexes over time. The findings showed that multiple rounds of rapid testing were one of the critical measures to overcome the outbreak in Yangzhou within one month. In addition, we compared the impact of the duration of the free transmission stage, tracking rate, testing interval and precise division of key areas on the epidemiological indicators, including the final sizes of infections and isolations, peak value, peak arrival time and epidemic duration and the minimum round of testing. Our results suggest that the early detection of the epidemic, an improved efficiency of tracking, and a reduced duration of each test play a positive role in restraining COVID-19; however, a considerable investment of resources was essential to achieve a significant effect quickly.

Pre-Clinical Mobility Limitation (PCML) Outcomes in Rehabilitation Interventions for Middle-Aged and Older Adults: A Scoping Review.

Individuals with pre-clinical mobility limitation (PCML) are at a high risk of future functional loss and progression to disability. The purpose of this scoping review was to provide a comprehensive understanding of PCML intervention studies in middle-aged and older adults. We present the interventions that have been tested or planned, describe how they have been conducted and reported, identify the knowledge gaps in current literature, and make recommendations about future research directions. An initial search of 2,291 articles resulted in 14 articles that met criteria for inclusion. Findings reveal that: (1) there is limited published work on PCML interventions, especially in middle-aged populations; and (2) the complexity and variety of PCML measures make it difficult to compare findings across PCML studies. Despite the diversity of measures, this review provides preliminary evidence that rehabilitation interventions on PCML help to delay or prevent disability progression.

Interprofessional Survey on Knowledge and Attitudes on Oral Health among Nurses in France.

PURPOSE: Healthcare professionals (HCPs) play a key role in improving the health literacy of patients. Since oral health is an essential part of overall health, the objective of this study was to assess the knowledge and attitudes about oral health among registered nurses. MATERIALS AND METHODS: A four-component questionnaire was used to assess the oral health training, oral health knowledge and attitudes of registered nurses. Participants were recruited from the city of Montpellier, France, and the surrounding area between May and June 2022 via e-mail and social media. RESULTS: In total, 416 responses were included in our study. Only 35.8% of nurses reported that they had received specific training on oral health and 24.3% had never advised patients to consult a dentist. Participants demonstrated good overall knowledge, but stated there were weaknesses in a variety of areas, such as oral health in children. The nurses proposed methods to improve understanding of the importance of oral health, namely by setting up training courses and better interdisciplinary collaboration. CONCLUSION: Our study showed that some aspects of oral health are not well understood by nurses. Initial training should be improved and supplemental training should be offered to improve the knowledge, attitude and practices of nurses in order to improve patient care.

Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality.

PURPOSE: Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS: A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS: A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS: AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.

The Effect of Anticipated Regret on Flu Vaccination Campaigns.

The anticipation of regret is known to be a primary motivator of receiving a vaccination. Aim of this study is to evaluate whether the use of messages that leverage the anticipated emotion of regret can increase the intention to get the flu vaccination. The participants (N = 110) randomly received a leaflet containing a standard prevention message (control condition) or message modified to induce the anticipation of regret over not being vaccinated (experimental condition), along with a questionnaire. The experimental condition's participants reported significantly higher levels of regret and higher intention to vaccinate than the participants in the control condition. Anticipated regret resulted to be a significant mediator of the intention to get vaccinated. Manipulating the salience of regret appears to be a simple and inexpensive way of effectively promoting preventive behaviour. The implications of this result for reducing COVID-19 vaccine hesitation are discussed.

Participation and physical activity in organized recess tied to physical education in elementary schools: An interventional study.

Maintaining physical activity habits is important for long-term health benefits. Many children do not achieve the World Health Organization (WHO) benchmark of 60 min Moderate-to-Vigorous Physical Activity (MVPA) daily. Comprehensive school physical activity programs (CSPAP) target all opportunities at school for children to be physically active. The purpose of this intervention study was to investigate boys' and girls' voluntary participation and MVPA in physical activity recess sessions during and after these were connected with the content of physical education. 147 (55 girls, 92 boys; mean age = 8 years) second grade children from seven different schools received a 10-lesson parkour unit in physical education and were concurrently offered five parkour recess sessions. After the parkour unit in physical education (i.e., maintenance) another five parkour sessions in which children could voluntarily participate were organized. Systematic observation tools were used to assess children's MVPA. Overall participation in parkour recess was 64% for both boys and girls. Participation decreased from intervention to maintenance phase for both boys (75% vs 54%; p < .001) and girls (80% vs 49%; p < .001). MVPA was higher for boys compared to girls in parkour recess (64% vs 58%; p = .002) and traditional recess (49% vs 39%; p = .006), but not in physical education (40% vs 37%). One aspect of physical activity promotion is to connect recess activities with the content taught in physical education, which could contribute up to 20% of the daily recommended MVPA. Positive effects maintained when the connection between physical education and recess stopped.

Plasma homocysteine levels and associated factors in community-dwelling adolescents: the EVA-TYROL study.

Background: Homocysteine (Hcy) has been associated with an adverse cardiovascular risk profile in adolescents. Assessment of the association between plasma Hcy levels and clinical/laboratory factors might improve our understanding of the pathogenesis of cardiovascular disease. Methods: Hcy was measured in 1,900 14- to 19-year-old participants of prospective population-based EVA-TYROL Study (44.3% males, mean age 16.4 years) between 2015 and 2018. Factors associated with Hcy were assessed by physical examination, standardized interviews, and fasting blood analysis. Results: Mean plasma Hcy was 11.3 ± 4.5 µmol/L. Distribution of Hcy was characterized by extreme right skew. Males exhibited higher Hcy and sex differences increased with increasing age. Univariate associations with Hcy emerged for age, sex, body mass index, high-density lipoprotein cholesterol, and for factors pertaining to blood pressure, glucose metabolism, renal function, and diet quality, whereas the most important multivariate predictors of Hcy were sex and creatinine. Discussion: Clinical and laboratory factors associated with Hcy in adolescents were manifold, with sex and high creatinine identified as strongest independent determinants. These results may aid when interpreting future studies investigating the vascular risk of homocysteine.