Initial and Continuous Effects of Essential Oil Therapy in Relieving Knee Pain Among Older Adults With Osteoarthritis.

Background: For older adults, osteoarthritis (OA) is a common chronic disease that may cause pain, stiffness, and even disability of the affected knee joints. Aromatherapy might presumed to be an alternative and supplemental therapy. Primary Study Objective: To investigate the effects of aromatherapy on relieving knee pain and improving physical functions among older adults with OA. Methods/Design: A true experimental design with randomized assignment of both treatment (aromatherapy) and control (placebo) groups was used for this study. Participants: Volunteers from 3 local communities aged ≥50 y with self-reported OA-related knee pain were recruited. Interventions: A synergistic blend of essential oils diluted to a concentration of 3% was administered to participants in treatment (essential oil) group, whereas mineral oil without essential oil was applied to participants in control (placebo) group. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), including subscales of pain, stiffness, and physical function, was employed to record scores before intervention, 4 wk postintervention, and 8 wk postintervention. Pain scores were also measured and collected by using the visual analog scale at the above counterparts. The Stata v.13 software was used to perform referent statistics with a significance level (α) of 0.05 adopted. Results: The progressive linear model showed that continuous use of essential oils for 8 wk not only relieves pain immediately, but also further reduces the pain scores of participants, thus proving the long-term effect of aromatherapy on alleviating knee arthritis. Repeated measures analysis of variance further showed that time (intervention duration) is an important factor affecting all outcome scores. Except for stiffness subscales measured by WOMAC, all interactions between groups were significant. Conclusions: Aromatherapy is validated to be an effective alternative therapy in improving clinical outcomes for patients with OA-induced knee conditions. In addition, longer intervention duration (8 wk instead of 4 wk) yielded better treatment results for participants.

Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to critically evaluate and summarise all available evidence derived from randomised clinical trials (RCTs) regarding aromatherapy's effects on labour pain and anxiety relief. Literature search was performed in MEDLINE/PubMed, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus since their respective inception to January 2019. Additionally, Google Scholar was also searched to explore citations of eligible final studies which were subsequently included in the systematic review. The search strategy used was: (pregnancy or pregnant or prenatal or antenatal or perinatal or maternal) AND (aromatherapy or essential oils or aroma therapy). Per inclusion and exclusion criteria established by the current study, nine RCTs were included in the systematic review. Results from the current study suggested that aromatherapy significantly decreased pain and anxiety in the first stage of labour.IMPACT STATEMENTWhat is already known on this subject? Several studies have shown aromatherapy's effectiveness in relieving pain and anxiety for hospitalised patients and on relieving nausea and vomiting for women during pregnancy. Some results have further indicated that aromatherapy was effective in facilitating episiotomy healing and in reducing pain, fatigue and distress. Aromatherapy was also found to play a role in improving maternal moods; reducing post-caesarean pain; and preventing or mitigating stress, anxiety and depression after childbirth. Though most non-pharmaceutical pain management options were considered non-invasive and presumably safe for mothers and their foetuses, their exact efficacies remained unclear due to a lack of high quality evidence.What the results of this study add? This systematic review and meta-analysis summarises all evidence derived from RCTs wherein aromatherapy was performed as a supportive analgesic method during labour. Results of this meta-analysis identified more credible evidence validating that aromatherapy could significantly decrease labour pain both in early active and late active phases.What the implications are of these findings for clinical practice and/or further research? Availability of credible evidence supporting aromatherapy's effectiveness on reducing physiological and psychological stress during pregnancy and childbirth would be useful, both theoretically and practically, for all stakeholders concerned, such as pregnant women, medicine and midwifery students, midwives, nurses, gynaecologists and health policymakers.

Association of oral health-related quality of life and Alzheimer disease: A systematic review.

STATEMENT OF PROBLEM: Oral health-related quality of life (OHRQoL) is a subjective measure that assesses a person's perception of oral health. Patients with Alzheimer disease (AD) suffer from impaired cognitive function and a compromised ability to perform activities of daily living. Further exploration is needed to clarify whether OHRQoL is negatively impacted by cognitive degeneration and oral health conditions among patients with AD. PURPOSE: The purpose of this systematic review was to increase understanding of OHRQoL among patients with AD and explore factors that may affect OHRQoL. MATERIAL AND METHODS: Searches were conducted in PubMed, the Cochrane Library database, Medline, EBSCO, ProQuest, and EMBASE until August 30, 2018, with no date restrictions. The initial search targeted quantitative observational studies published in English that included the keywords AD, oral, prosthesis, and OHRQoL. Data extraction was independently conducted by 2 reviewers. OHRQoL was investigated as the outcome. Cognitive status and oral health conditions were treated as exposures. Tools used to measure OHRQoL included the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile. The research adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Six studies were included. The sample sizes ranged from 30 to 226 participants, 5 studies used cross-sectional designs, and 1 was a nonrandomized controlled trial. Three studies reported higher OHRQoL scores among participants with AD than those among controls, but only 1 study showed a statistically significant difference. A statistical analysis was conducted with 4 studies that reported GOHAI scores, and no significant differences were found in GOHAI scores between participants with AD and controls (standard mean difference: 0.09; 95% confidence interval: -0.66 to 0.85). All studies that explored factors affecting OHRQoL showed different associations between cognitive impairment, oral health conditions, and OHRQoL. One study showed that cognitive impairment was negatively associated with OHRQoL. Three studies found oral health conditions (including periodontitis, gingival bleeding, probing depth >4 mm, and number of natural teeth) impaired the OHRQoL of participants with AD. Three studies reported that prosthetic type and quality positively affected OHRQoL among participants with AD. CONCLUSIONS: OHRQoL may not fully represent actual oral health problems of patients with AD. Clinical dentists should evaluate oral problems in this population, preferably by using both subjective and objective examinations, including oral and dental conditions. This will ensure oral problems among patients with AD can be detected early and timely treatment provided.

Correlation Between Blood Loss and Patient-Related Factors in the Bilateral Parasymphyseal Osteotomy.

The aim of this study was to determine the correlation between pre- and postsurgical loss of blood and blood components among patients undergoing treatment of facial deformities by bilateral parasymphyseal osteotomy (BPsO).The pre- and postoperative values of blood components were determined in 30 facial deformity patients who underwent orthognathic surgery by hypotensive anesthesia. Correlations among the blood loss, sex, age, operation time, and reduced values of blood components were assessed by a correlation matrix. The mean blood loss and operation time were 437.5 (± 52.5) mL and 355.8 (± 209.42) minutes, respectively. Two patients included in this study had required blood transfusion. The mean reduced red blood cell (× 10/µL), hemoglobin (g/dL), and hematocrit (%) were -1.02, -2.98, and -9.18, respectively. There was no significant correlation between blood loss and other related factors (eg, age, operation time, and reduced blood components). All patients, however, showed significantly lower values of blood components after surgery. In conclusion, no significant factor was associated with blood loss and reduced blood components among patients undergoing BPsO. Furthermore, hypotensive anesthesia is a well-accepted method to reduce blood loss during orthognathic surgery.

Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan.

BACKGROUND: Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan. METHODS: The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants' socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable. RESULTS: All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores. CONCLUSIONS: Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

Masticatory factors as predictors of oral health-related quality of life among elderly people in Kaohsiung City, Taiwan.

OBJECTIVE: This study aimed to evaluate which masticatory factor is the best predictor of oral health-related quality of life (OHRQoL) in elderly Taiwanese individuals aged 65 years and older. METHODS: Subjects were 332 community-dwelling, independently living elderly adults (mean age, 76.0 ± 0.4 years) in Kaohsiung City, Taiwan. Information concerning age, gender, and socioeconomic status was collected via face-to-face interview questionnaires; the number of food groups rated 'easy to chew' was determined by using food intake questionnaires; and OHRQoL data were obtained by using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The number of natural teeth, functional tooth units, and posterior occlusal contacts according to Eichner Index was assessed by dental examination. Multiple regression analysis was conducted to determine the best masticatory factor that could serve as a predictor of GOHAI scores. RESULTS: The number of food groups rated 'easy to chew' was found to be the only masticatory factor affecting GOHAI-T scores, after adjustment for age, gender, socioeconomic status, and other masticatory variables. As compared to subjects who listed less food groups as 'easy to chew,' subjects who rated more food groups as 'easy to chew' were less likely to have low GOHAI-T scores. CONCLUSIONS: Of the masticatory predictors analyzed in this study, perceived masticatory ability, as measured using a food intake questionnaire, could be the best masticatory predictor of OHRQoL in the elderly.

Impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults.

PURPOSE: To evaluate the impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults. SUBJECTS AND METHODS: Subjects comprised dentate patients (mean age, 60.0 ± 9.9 years) in Taiwan. Information on demographic data, oral health behaviours, oral habits and self-perceived health status was collected via self-administered questionnaires and dentition status was assessed by oral examination. Multiple logistic regression analyses were used to determine variables correlated with the low dentition group (subjects with less than 20 natural teeth or 8 functional tooth units). RESULTS: The analysis showed that the low dentition group was more likely to be older and to exhibit low educational levels, less frequent use of dental floss, more common smoking habits, poor self-perceived dental health and to be exbetel- nut chewers. In addition, the low dentition group was less likely to be current betel-nut chewers. CONCLUSIONS: These results underscore the importance of the use of dental floss and confirm the adverse effects of smoking on dental health. Hence, the dental profession should continue to encourage proper oral health behaviours and oral habits.

Household secondhand smoke exposure of elementary schoolchildren in Southern Taiwan and factors associated with their confidence in avoiding exposure: a cross-sectional study.

BACKGROUND: Exposure to household Secondhand Smoke (SHS) poses a major health threat to children after an indoor smoking ban was imposed in Taiwan. This study aimed to assess the household SHS exposure in elementary school children in southern Taiwan and the factors associated with their avoidance of SHS exposure before and after the implementation of Taiwan's new Tobacco Hazards Prevention Act in 2009. METHODS: In this cross-sectional school-based study, data on household SHS exposure, avoidance of SHS and related variables was obtained from the 2008 and 2009 Control of School-aged Children Smoking Study Survey. A random sample of 52 elementary schools was included. A total of 4450 3-6 graders (aged 8-13) completed the questionnaire. Regression models analyzed factors of children's self-confidence to avoid household SHS exposure. RESULTS: Over 50% of children were found to have lived with a family member who smoked in front of them after the new law enacted, and 35% of them were exposed to household SHS more than 4 days a week. Having a positive attitude toward smoking (ß = -0.05 to -0.06) and high household SHS exposure (ß = -0.34 to -0.47) were significantly associated with a lower avoidance of SHS exposure. Comparing to girls, boys had lower scores in their knowledge of tobacco hazards; and this factor was significantly related to their SHS avoidance (ß = 0.13-0.14). CONCLUSIONS: The intervention program should enhance school children do actively avoid exposure to SHS in home settings, and more importantly, provide tobacco hazard knowledge to male students to avoid exposure to household SHS for themselves. The results also provide further evidence that Tobacco Hazards Prevention Act should perhaps be extended to the family environment in order to protect children from the hazards of household SHS exposure.

Evaluation of a self-assessed screening test for masticatory ability of Taiwanese older adults.

OBJECTIVES: The aim of this study was to evaluate a screening test based on a food intake questionnaire to discriminate the masticatory ability of Taiwanese older adults with 20 and more natural teeth and at least 8 functional tooth units (FTUs) from the masticatory ability of those with fewer than 20 natural teeth and 8 FTUs. MATERIALS AND METHODS: The subjects were 2244 patients (mean age, 60.4±10.0 years) recruited from 23 counties and cities in Taiwan. Information about their demographic data, dentition, and masticatory ability was collected. Masticatory ability was measured for 23 food groups comprising 35 common Taiwanese foods, and receiver operation characteristic curve analysis was performed. RESULTS: The results showed that the final questionnaire included 14 food groups and a subject choosing 'difficult to eat' responses for 4 and more of these food groups had the same masticatory ability as individuals with fewer than 20 natural teeth and 8 FTUs. CONCLUSION: In conclusion, foods that are the most difficult to eat are not necessarily good discriminatory indicators. Hence, the 14-food group questionnaire can be considered the best screening test for masticatory ability of Taiwanese older adults in terms of the presence of 20 and more natural teeth and at least 8 FTUs.

Anti-Oxidative Effect of Pu-erh Tea in Animals Trails: A Systematic Review and Meta-Analysis.

This study adopted systematic literature review and meta-analysis methodology to explored anti-oxidative effect of pu-erh tea. Study authors have systemically searched seven databases up until 21 February 2020. In performing the literature search on the above-mentioned databases, the authors used keywords of pu-erh AND (superoxide dismutase OR glutathione peroxidase OR malondialdehyde). Results derived from meta-analyses showed statistically significant effects of pu-erh tea on reducing serum MDA levels (SMD, −4.19; 95% CI, −5.22 to −3.15; p < 0.001; I2 = 93.67%); increasing serum SOD levels (SMD, 2.41; 95% CI, 1.61 to 3.20; p < 0.001; I2 = 91.36%); and increasing serum GSH-Px levels (SMD, 4.23; 95% CI, 3.10 to 5.36; p < 0.001; I2 = 93.69%). Results from systematic review and meta-analyses validated that various ingredients found in pu-erh tea extracts had anti-oxidation effects, a long-held conventional wisdom with limited supporting evidence.

Kinesio Taping Relieves Pain and Improves Isokinetic Not Isometric Muscle Strength in Patients with Knee Osteoarthritis-A Systematic Review and Meta-Analysis.

This study investigated the effects of kinesio taping (KT) or KT plus conventional therapy on pain, muscle strength, funrefction, and range of motion in patients with knee osteoarthritis (OA). Data sources: Databases included PubMed, Ovid Medline, CINAHL, Airiti Library, EMBASE, and WOS search engines. Search terms related to KT and knee OA were combined and searched. Articles that met the inclusion criteria and were graded with a Jadad score ≥3 were included in a meta-analysis to calculate the total effect. The exclusion criteria were non-English-language articles, non-original articles, non-full-text articles, no description of the intervention, or articles with a Jadad score ≤2. Eleven articles were included in the meta-analysis. KT treatment had a significant small total effect on pain reduction (p < 0.001; n = 1509; standardized mean difference (SMD) = -0.42; 95% CI = -0.65 to -0.18) and a significant moderate total effect on isokinetic muscle strength improvement (p = 0.001; n = 447; SMD = 0.72; 95% CI = 0.28 to 1.16). No significant total effects of KT on isometric muscle strength, time to complete functional tasks, or ROM improvement were found. KT or KT plus conventional therapy has a significant effect on pain relief and isokinetic but not isometric muscle strength improvement in patients with knee OA. KT can be an effective tool for treating knee OA pain and is especially valuable for aiding in isokinetic muscle strength. (PROSPERO register ID: CRD42021252313).

A multilevel-based study of school policy for tobacco control in relation to cigarette smoking among children in elementary schools: gender differences.

The aim was to comprehensively examine school-based tobacco policy status, implementation and students' perceived smoking at school in regard to gender-specific differences in smoking behavior. We conducted a multilevel-based study to assess two-level effects for smoking among 2350 grades three to six students in 26 randomly selected elementary schools in southern Taiwan. A series of multilevel models were analyzed separately for male and female students. The school-level variables appear to be related to smoking behavior in male students. Among males, the risk of ever-smoking was significantly associated with those schools without antitobacco health education activities or curricula [adjusted odds ratio (aOR) = 6.23, 95% confidence interval (CI): 2.55-15.24], with a high perceived smoking rate (aOR = 3.08, 95% CI: 1.41-6.72) and located in a mountainous region (aOR = 2.53, 95% CI: 1.15-5.58). The risk of ever-smoking among females was significantly associated with those schools without antitobacco activities or curricula (aOR = 3.10, 95% CI: 1.27-7.55). As compared with female counterparts, the specific school that the male students attended had a positive significant effect on the risk of being ever-smokers. The findings suggest that effective tobacco policy implementation should be considered in elementary schools that are currently putting children at the greatest risk for cigarette smoking, especially in regard to male students.

The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors.

This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients' behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001-1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414-8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers' use of care resources (p < 0.01). Health professionals have to evaluate the patients' BPSD and identify the caregivers' essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.

Effects of Exercise on Sleep Quality in Pregnant Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: Sleep quality was considered a priority concern facing pregnant women. Conventional wisdom argues that good sleep quality benefits pregnant women and their fetuses. The aim of this study is to assess the effects of a specific exercise program on the　sleep quality in pregnant women. METHODS: Searches were executed in seven databases since their inceptions until February 28, 2019, for randomized controlled trials evaluating the effects of an exercise program on the sleep quality and insomnia in pregnant women. A random-effects model was applied for meta-analysis, and odds ratio, mean differences (MDs), and 95% confidence intervals (CIs) are shown as parts of outcomes. RESULTS: Seven studies were included for meta-analysis. Compared with their not-exercising counterparts, analyses showed that regularly exercising women had significantly enhanced sleep quality, with an odds ratio of 6.21 (95% CI, 2.02-19.11;p = .001; I2 = 80.2%), with a standardized MD of -0.93 (95% CI, -1.19 to -0.67; p < .001; I2 = 30.0%). However, exercising women showed no significant insomnia improvement, with an standardized MD of -2.85 (95% CI, -7.67 to 1.98; p = .250; I2 = 97.0%), relative to their not-exercising counterparts. CONCLUSION: This research indicated that exercise has a positive impact on the sleep quality of pregnant women. Despite the aforementioned positive impact on sleep quality, the present study did not find evidence to support that exercise may also improve insomnia for pregnant women.

Horticultural Therapy in Patients With Dementia: A Systematic Review and Meta-Analysis.

BACKGROUND: World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason results in hospitalization of dementia patients. Horticulture is one of the favorite activity for many peoples to relax their minds. OBJECTIVES: To investigate psychological health benefits of horticulture intervention in dementia patients. METHODS: The databases including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, and Ovid Medline were searched up to August 2017. RESULTS: Twenty-three articles for systematic review, whereas 8 articles were included in meta-analysis. Meta-analysis verified the beneficial effect of horticultural therapy (HT) on agitation level (standard mean difference: -0.59; P < .00001); increase time spent on activity engagement (mean differences [MD]: 45.10%, P < .00001); decrease time for doing nothing (MD: -29.36%, P = .02). CONCLUSIONS: Patients with dementia benefit from horticultural by alleviating their degrees of agitate behaviors, increasing time of engaging in activities and decrease time of doing nothing.

Effectiveness of a theory of planned behavior-based intervention for promoting periodontal preventive behaviors among medical students in Taiwan.

OBJECTIVE: To evaluate the effectiveness of an oral self-care education intervention based on the Theory of Planned Behavior in Taiwanese undergraduates. PARTICIPANTS: We recruited 63 and 90 students in the experimental group (EG) and comparison group (CG), respectively, from a medical university. METHODS: A quasi-experimental design was employed. The EG received health education and a brief action and coping planning intervention. RESULTS: The EG was significantly more likely to brush for more than 3 minutes (adjusted odds ratio [aOR] = 2.52), use the modified Bass brushing technique (aOR = 7.81), and floss (aOR = 21.21) at the 2-week follow-up than was the CG. At the 6-week follow-up, the combined effect of high action and coping planning with high perceived power for predicting floss use was observed in the EG (p < 0.05). CONCLUSIONS: Intervention may promote periodontal-disease-preventing behaviors in undergraduates, particularly for achieving adherence to daily flossing.

Inhibitory effects of pu-erh tea on alpha glucosidase and alpha amylase: a systemic review.

OBJECTIVE: Pu-erh tea was presumed to have anti-hyperglycemic effects via inhibition on alpha-amylase and alpha-glucosidase. However, no integerated literatures were published to substantiate such presumption. METHODS: Current study adopted systemic review method to validate inhibitory effects on alpha amylase and alpha-glucosidase. Five English databases (PubMed, EBSCO, SCOPUS, Cochrane Library, Web of Science) and three Chinese ones (Airti Library, CNKI Library, and Google Scholar) were searched up to 22 March 2018 for eligible literatures, using keywords of Pu-erh, Pu'er, alpha-amylase or alpha-glucosidase. RESULTS: Six studies exploring inhibitory effects on alpha-glucosidase and seven on alpha-amylase were included for systemic review. Though results showed pu-erh tea has significant inhibitory effects on alpha-amylase and alpha-glucosidase, high heterogeneity was detected among studies included. CONCLUSIONS: High heterogeneity may be due to complex alterations of chemicals under different degrees of fermentation. More future studies are required to further identify principal bioactive component(s) at work.

Perceived smoking prevalence at school-level and children's smoking initiation: a multi-level analysis of a cross-sectional data in Taiwan.

OBJECTIVES: Literature on the influence of smoking prevalence at school-level on the smoking initiation among elementary school children is scarce. The aim of the current study was to explore this in school clusters stratified according to student's perceived smoking prevalence in the school while adjusting for social impact of individual students. METHOD: The data was obtained from a survey administered to 13 elementary schools in Taoyuan County, a final sample of 1585 3rd and 4th grade students. Multi-level logistic regression analysis (MLRA) was used to examine the influence variable at school-level as well as individual socio-environment level had on smoking status of elementary schools students. RESULTS: Attending a school where the students reported a perception of high smoking prevalence had a greater effect on smoking behavior in boys than girls when compared with students attending a lower smoking prevalence school, after adjustment for student-level characteristics. CONCLUSIONS: Our study confirmed that a broader school environment with a high student perception of smoking prevalence is associated with children's smoking behavior in boys. The findings further indicate the need for enforcement of anti-smoking policies within schools with higher smoking rates to reduce visibility of smoking among school children.

Lifestyle and psychosocial factors associated with chronic periodontitis in Taiwanese adults.

BACKGROUND: The development of chronic periodontitis (CP) is a multifactorial process and variation in severity cannot be explained by just a few risk factors. The aims of this study were: 1) to explore the lifestyle and psychosocial factors of CP patients and 2) to estimate the proportion of total CP cases attributable to one or more risk factors considered. METHODS: A case-control study of 250 cases of CP patients and 250 controls were matched by age (within 3 years) and gender. Complete dental examinations were performed based on the clinical criteria for CP for both groups. Structured questionnaires were conducted to collect lifestyle and psychosocial factors. Multivariate logistic regression was applied to assess the association between risk factors and chronic periodontitis. RESULTS: Conditional multivariable logistic regression analysis showed that toothbrushing frequency (odds ratio [OR]: 5.77, if rarely; OR: 3.50, if once a day), mental illness (OR: 5.32, if Chinese Health Questionnaire scores were > or = 6), and smoking (OR: 3.93, if pack years smoked was > 21) are significantly and independently associated with chronic periodontitis. In addition, all these variables reflected a dose-response effect (P trend = <0.001, 0.004, and 0.005, respectively). CONCLUSIONS: For Taiwanese adults, 36.10% of CP cases were presumably attributable to toothbrushing frequency, mental illness, and smoking. These three factors should be the first priorities in establishing a preventive program to improve the periodontal health status.

Area disparity in children's perceptions of access to tobacco and cigarette purchasing experiences in Taiwan.

BACKGROUND: Adolescents who perceive easy access to tobacco are more likely to acquire cigarettes and experience smoking. This study assesses area disparities in perceptions of access to tobacco and cigarette purchasing experiences among schoolchildren. METHODS: Data on children's tobacco-related variables were obtained from the Control of School-Aged Children Smoking Study Survey in Taiwan. A stratified random sample of 65 primary schools was included. Polytomous logistic regression analyzed factors associated with tobacco accessibility and purchasing experiences. RESULTS: More than half of the children reported that tobacco retailers often or always sold cigarettes to them. Rural and mountainous children were more likely to have access to cigarettes (adjusted odds ratio [AOR] = 2.01 and 3.01, respectively) and have cigarette purchasing experiences (AOR = 3.06 and 13.76, respectively). Cigarette purchasing from retailers (AOR = 1.84) was significantly associated with children's perceptions of access to tobacco. The factors associated with cigarette purchasing experiences were families smoking (AOR = 8.90), peers smoking (AOR = 2.22), frequent exposure to entertainer smoking on TV and in films (AOR = 2.15), and perceived access to tobacco (AOR = 1.51). CONCLUSIONS: The health department should strictly enforce laws regarding retailers selling tobacco to underage, particularly in remote areas. Schools can reinforce tobacco-use prevention messages.