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Background: To assess associations between oral health behaviour and physical activity and related factors among adolescents., Methods: The study population (n = 76 529) consisted of a representative sample of 16- to 18-year-old Finnish adolescents (boys: 37 211, girls: 39 318). An anonymous, confidential and voluntary classroom-administered questionnaire included questions about tooth brushing frequency, physical activity, BMI and eating habits. Moderate-to-vigorous physical activity (MVPA) was used to assess the adolescents' physical activity. The chi-square test and multiple binary logistic regression were used for statistical analyses. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were calculated for MVPA, BMI, breakfast, smoking and socioeconomic factors as parents' education and school type., Results: The prevalence of twice daily tooth brushing was highest among adolescents reporting 4 hours or more of MVPA (51-77%). Obese and smoking adolescents exercised less often than normal weighted and non-smokers. Girls brushed their teeth twice daily significantly more often than boys (P < 0.001), and high-school students brushed their teeth significantly more often than vocational school students (P < 0.001). Logistic regression models showed that obesity (OR = 2.14, 95% CI 1.92-2.37) and irregular breakfast eating (OR = 2.35, 95% CI 2.19-2.52) among boys, and obesity (OR = 2.81, 95% CI 2.48-3.17), physical inactivity (OR = 1.89, 95% CI 1.78-2.00) and irregular breakfast eating (OR = 1.91, 95% CI 1.79-2.04) among girls were strong predictors for poor tooth brushing., Conclusions: Physically active adolescents had better oral health behaviour than less active adolescents. Obesity and smoking were associated with infrequent tooth brushing., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Health coaching (HC) is based on 'partnering with clients in a thought-provoking and creative process that inspires them to maximise their personal and professional potential' to adopt healthy lifestyles through 'building awareness and empowerment'. This study's objective is to assess, for the first time to our knowledge, the effectiveness of HC compared with health education (HE) using clinical and subjective measures among type 2 diabetes (DM2) patients in Turkey and Denmark., Methods: This stratified random prospective study selected type 2 diabetes patients in Turkey (n = 186) (TR) (2010-2012) and in Denmark (n = 116) (DK) (2012-2014). Participants were assigned to HC or HE groups. Selected outcomes were HbA1c, periodontal treatment need index (CPI), health behaviours and anthropometric measures. The study duration was 12 months (6 months initiation-maintenance, 6 months follow-up)., Results: At baseline, there were no statistically significant differences between the HC and HE groups. Post-intervention, a reduction of HbA1c in the HC groups was observed (TR: 0.8%; DK: 0.4%, P < 0.01) but not in the HE groups. The HC patients had a higher reduction in CPI than the HE group (P < 0.01). Principal component analysis showed that HbA1c, CPI and 'behaviour change' compose one cluster in the HCTR and HETR groups. Three clusters were formed for the HCDK; respectively HbA1c and CPI, lean mass and body fat percentage, 'behaviour change'., Conclusions: The results indicate that HC has a greater impact on DM management and health outcomes. There is a need for common health promotion strategies with behavioural interventions such as health coaching for the management of type 2 diabetes that focus on multidisciplinary approaches including oral health., (© 2017 FDI World Dental Federation.)

Background: This is a protocol for a systematic review of the impact of health coaching on changing the health behaviour of offenders. Prisoners are more likely to suffer from health-related issues when compared to the general population. Health coaching has been shown to influence health outcomes of patients with chronic conditions. This review, therefore, aims to assess the effectiveness of health coaching interventions on the health of adolescent and adult offenders in custodial institutions., Methods: We plan to conduct a systematic review of the current literature on health coaching interventions delivered in the prison setting. We will include randomised controlled trials and observational studies that compare health coaching to the usual care or other alternative interventions. The ideal interventions will be delivered either by health professionals or peer coaches, and the outcomes extracted in the data collection will be disease-specific, clients' life and self-management skills, behavioural and psychosocial outcomes. If appropriate, a meta-analysis of the data collected will be carried out on the last stage of the review., Discussion: This systematic review will identify and gather evidence on the impact of health coaching interventions delivered in the prison setting and can function as a supporting material for health professionals, prison staff, the healthcare system, and public health departments when considering delivering health coaching., Systematic Review Registration: PROSPERO CRD42016053237 .

There is a need for an alternative approach for health promotion prisons since previous work has indicated that health education, while improving health knowledge, does not result in behaviour change. Evidence has suggested that a health coaching assists in this regard. However, the question remained whether this approach would be appropriate and possible in prisons? This paper presents the public health strategies used to work in partnership with prison management to address challenges and accept opportunities as a health coaching intervention protocol was developed for oral health and wellbeing in the prison setting., (Copyright© 2017 Dennis Barber Ltd.)

Purpose: To assess the correlation between toothbrushing (TB) and the common biological (HDL) and quality-of-life-related risk factors for noncommunicable diseases (NCDs) and communicable diseases among patients with diabetes mellitus type 2 (DM2)., Materials and Methods: The present study is part of a prospective intervention study among DM2 patients (n=200), randomly selected from the outpatient clinics, Istanbul, Turkey. The assessed variables were: TB, self-reported gingival bleeding (SRGB), HDL, BMI, body-fat proportion, modified quality of life scale (WHOQOL-BrefPhPs). Descriptive statistics, frequency distributions, Spearman rank correlation, the chi-square test and factor analysis were applied., Results: A minority of the patients brushed their teeth twice a day or more (27%) and reported no gingival bleeding (37%). Favourable HDL and high WHOQOL-BrefPhPs were 77% and 57%, respectively. A majority of patients had unhealthy BMI (83%) and body-fat proportions (63%). SRGB was negatively correlated with WHOQOL-BrefPhPs (rs=-0.24, p<0.05) and TB (rs=-0.25, p<0.01). The patients who reported less than daily TB were more likely to have unfavourable HDL and low WHOQOL-BrefPhPs (32% vs 54%) than those brushing their teeth daily (17% vs 35%, p<0.05). Principal component analysis revealed two clusters: 'healthy weight' (WHOQOL-BrefPhPs, TB, BMI) and 'oral health' (SRGB, HDL)., Conclusion: The present results demonstrate a correlation between TB and biological and quality-of-life-related risk markers of NCDs and communicable diseases. There seems to be a need to increase the awareness of the significance TB's potential intermediatory role between NCDs and communicable diseases.

Objectives: This study is the first to our knowledge that aims to evaluate the impact of Health Coaching (HC) compared to Health Education (HE) on oral health and diabetes management among patients with diabetes type II (DM2)., Material and Methods: The study is part of a prospective intervention among randomly selected DM2 patients (n = 186), Istanbul, Turkey. The data analyzed were Community Periodontal Need Index (CPI) and HbA1c (glycated hemoglobin percentage). Data was collected initially and at the end of the intervention. The participants, both attending oral examinations and filing out questionnaires (n = 179), were allocated to HC (n = 77) and HE (n = 102) groups by means of a block table of random numbers., Results: At baseline, there was no statistical difference between HC and HE groups in terms of CPI and HbA1c (p > 0.05). At postintervention, the HC group had significantly lower CPI and HbA1C than the HE group (p < 0.01). There was a significant reduction at HbA1c (0.8 %) and CPI (74 %) in HC group (p < 0.05). The impact of HE on CPI was less significant (21 % reduction) (p = 0.001); however, it was not significant on HbA1c (p = 0.68). The improvement at CPI from baseline to postintervention had significant impact on reduced HbA1c in the HC group (p < 0.05)., Conclusions and Clinical Relevance: The present findings imply that HC has a significantly higher impact on better management of diabetes and oral health when compared to formal HE. This calls for the use of HC by dentists, physicians, and diabetes educators in order to improve quality of life of DM2 patients by facilitating better oral health and diabetes self-management.

Purpose: To assess the role of toothbrushing self-efficacy (TBSE) in diabetes management by comparing health education (HE) and health coaching (HC) in type 2 diabetes., Methods: The data [HbA1c , Clinical Attachment Loss (CAL), TBSE] were collected initially and after intervention. Participants were allocated randomly to HC (n = 77) and HE (n = 109) groups., Results: The low TBSE subgroup showed greater improvement in TBSE in the HC group (∆mean:23.4 ± 9.2) than the HE group (∆mean:12.4 ± 10.3), (P < 0.01). The moderate TBSE group showed significant improvements only in the HC group (P < 0.001).There was a significant reduction in HbA1c and CAL in all the TBSE subgroups in HC (P < 0.05), which was significantly higher than in the HE groups (P < 0.05). Improvements in TBSE and CAL were explanatory variables for the reduction in HbA1c among the HC patients in all the TBSE subgroups (P < 0.05). Among HE patients, improvement in CAL was an explanatory variable for change at HbA1c in the low TBSE subgroup., Conclusions: The present findings show that HC is more effective in terms of reduced HbA1c and CAL compared with HE. The data suggest that HC unlocks positive self-intrinsic motivation, anchoring the self-efficacy/competency beliefs for adjustment of healthy lifestyles. Thus, TBSE may be a practical starting point for empowerment and more effective outcomes., (© 2014 FDI World Dental Federation.)

Purpose: To assess the impact of empowerment (health coaching, HC) on toothbrushing self-efficacy (TBSE) and toothbrushing frequency (TB) and their effects on diabetes management (HbA1c, physical activity) and quality of life in comparison to health education (HE) among patients with diabetes type 2 (DM2)., Materials and Methods: The data (HbA1c [glycated haemoglobin], TB, physical activity, TBSE, quality of life) were collected at baseline and at post-intervention at outpatient clinics of two hospitals in Istanbul, Turkey. Participants were allocated randomly to HC (n = 77) and HE (n = 109) groups., Results: At baseline, there were no statistical differences between HC and HE groups in terms of all measures (P > 0.05). At post-intervention, there was improvement in oral health- and diabetes-related variables in the HC group, whereas only TBSE and TB slightly improved in the HE group (P < 0.05). At post-intervention among patients brushing their teeth at least once a day, HC group patients were more likely to be physically active and to have high self-efficacy than those in HE group (P < 0.01). TBSE was correlated with favourable HbA1c levels (< 6.5%) in the HC group and quality of life (P < 0.05) in both groups., Conclusion: The findings show that HC-based empowerment towards improving self-efficacy is more effective at improving toothbrushing behaviour than is HE and that interaction contributes significantly to diabetes management in terms of reduced HbA1c, increased physical activity and quality of life. TBSE can be a practical starting point for empowerment and toothbrushing can be used as an effective and practical behaviour to observe personal success in diabetes management.

The present study aims to assess how patient satisfaction with medical provider-patient communication can affect oral health, diabetes, and psychobehavioural measures among type 2 diabetes (T2DM) patients. It is part of a prospective intervention study among randomly selected T2DM patients, in Turkey. The data analyzed were Community Periodontal Need Index (CPI), HbA1c, patient satisfaction with communication, and psychobehavioural variables. Data was collected initially and at the end of the intervention. The participants were allocated to either health coaching (HC) or health education (HE). At baseline, there were no statistical differences between the HC and the HE groups on any of the measures (P > 0.05). Patients in both the HC and the HE groups had low satisfaction with communication. At postintervention, the increase in patient satisfaction with communication in the HC group was significantly higher than that in the HE group (P = 0.001). Principal component analysis revealed that patient satisfaction with communication shared the same cluster with clinical measures (CPI and HbA1c) and quality of life in the HC group. In conclusion, the present study showed, to our knowledge for the first time, that overall patient satisfaction with medical care provider-patient communication, empowered by HC approach, was interrelated with well-being of T2DM patients, in terms of psychobehavioural and clinical measures.

Objectives: The aim of this study was to assess the relationship between tooth loss, toothbrushing behaviour, diabetes type 2 (DM2), obesity and sleep apnea among diabetics., Material and Methods: DM2 patients (n = 165) in Istanbul, Turkey, were randomly selected from the outpatient clinics of two hospitals. Baseline clinical measurements (HbA1c, fasting blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), body mass index (BMI), body-fat proportion, tooth loss) and self-administered questionnaires (toothbrushing, gingival bleeding, sleep apnea) provided data for factor and principal component analysis with Varimax rotation. Univariate statistics and chi-square tests were derived., Results: Mean maxillary tooth loss (4.49 ± 3.69 teeth) was higher than in the mandible (3.43 ± 3.12 teeth, p< 0.001). Favourable HDL was measured among most patients (77%); other favourable clinical measures occurred only in a minority of participants (HbA1c, 28%; fasting blood glucose, 17%; LDL, 30%). Twice daily toothbrushing was reported by 33% (17%) for healthy BMI; 37% when healthy body-fat proportions. There was risk of sleep apnea in 37 %. The higher number of lost teeth in the maxilla was linked with obesity and sleep apnea. Non-daily toothbrushers were more likely to have high LDL and low HDL cholesterol and a higher risk of sleep apnea. When "at least occasionally" bleeding on toothbrushing occurred, higher HbA1c levels and sleep apnea were more likely., Conclusion: Oral care with early diagnosis and monitoring of glycaemic level can help prevent complications of DM2., Clinical Relevance: Dentists may play a key role in better managing and diagnosing sleep apnea early by referring the patients with severe tooth loss and periodontal disease for general medical examination.

Purpose: To assess the role of toothbrushing self-efficacy (TBSE) in toothbrushing (TB) behaviour and diabetes management, measured in terms of HbA1c knowledge, quality of life, BMI, self-reported health and physical activity among Turkish type-II-diabetes (DM2) patients., Materials and Methods: A pilot study using self-administered health questionnaires was conducted among a random sample of 60 patients (aged 40 to 70 years) in Istanbul, Turkey. The assessed variables were: TBSE, TB, glycated haemoglobin (HbA1c) knowledge, quality of life, BMI, self-reported health and physical activity. Descriptive statistics, frequency distributions, Pearson's correlation, the chi-square test and MANOVA were applied., Results: Almost half of the patients reported low TBSE (mean >= 53%). and TB once a day (54%). Most (77%) did not know their HA1C level and they were overweight (42%) and obese (32%). Almost half of the patients reported good quality of life (> mean, 55%), being physically active (51%) and in good health (mean < 46%). The patients reporting high levels of TBSE were more likely to know their HbA1c (OR= 10.5: 95%CI= 1.01-103.24) and to report better health (OR= 10.0: 95%CI = 1.80-55.63) and were less likely to be obese (OR= 0.16: 95%CI= 0.02-1.00) (P < 0.05). There was a strong correlation between TBSE and TB (rs = 0.61, P < 0.01)., Conclusion: The present study underlines the need for TBSE-integrated common health promotion for oral health and DM2, considering the relation of TBSE, HbA1c, BMI and toothbrushing.

Obesity, dental caries and periodontal diseases are among major public health concerns which may affect children's growth and development. This study seeks any clustering between obesity, oral health and life-style factors among school children in Istanbul, Turkey. A cross-sectional study of children, 10- to 12-year-olds, from a public and a private school was undertaken with questionnaires for children and their mothers and child oral health data, in Istanbul (n = 611). DMFS (number of decayed, missing and filled surfaces of permanent teeth), CPI (Community Periodontal Index), body mass index (BMI) and life-style factors (tooth-brushing frequency, milk consumption at breakfast and bedtimes on school nights) of children were examined. Data analysis included factor analysis, Student's t test and Chi-square tests by cross-tabulation. Public school children were more dentally diseased but less obese than were those in private school (P < 0.001). They more frequently had calculus (62%) and reported non-recommended tooth-brushing (68%) than did those in private school (37%, 56%; P < 0.05). Principal component analysis revealed that DMFS, CPI and BMI shared the same cluster among all children. A need exists for addressing obesity, oral health and nutrition jointly in health promotion strategies to improve children's well-being and empower good life-style factors.

Purpose: To assess any clustering between obesity, dental health, and lifestyle factors (dietary patterns, physical activity, smoking, and alcohol consumption) among adolescents., Material and Methods: A cluster sample of 15-year-old Danish adolescents (DA) from eight municipalities was selected. Self-reported questionnaires for adolescents and their mothers to assess body-mass index (BMI), socioeconomic and lifestyle factors, and clinical examinations to examine adolescents' dental status (DMFT) were used. Descriptive statistics, chi-square tests, and factor analysis were applied., Results: The mean DMFT was 2.03 and mean BMI was 21.30 among DA.Of the whole sample, 62% experienced caries (DMFT > 0) and 16% were classified as obese. No association appeared between obesity and DMFT (p > 0.05). Most adolescents were likely to have breakfast every day (76%), but their daily consumption of fruit was lower (38%). More than half of adolescents reported having physical exercise (66%) and no alcohol consumption (57%). Smokers were more likely to consume alcohol (80%) but less likely to exercise (44%) than nonsmokers (alcohol consumption, 55%; exercise, 68%), (P < 0.05). Principal component analysis revealed that DMFT and obesity were interrelated in DA., Conclusion: In line with earlier studies, obesity and dental caries share common lifestyle factors among adolescents, regardless of nationality and different health-care systems. Thus, it seems that dental health is a global health concern. There is a need for collaboration between dental and general health-care providers to manage both obesity and dental caries in adolescents by using a holistic approach.

Obesity and dental caries in childhood are among the major public health concerns described as a global pandemic because of their global distribution and severe consequences. A consensus has developed as to a recently emerging and alarming common risk factor that leads to the double burden of dental caries and obesity; energy-dense foods (sugar-coated cereals, high-sugar yogurt, soft drinks) are becoming very popular among children because of their dense marketing, cheaper price, increased supply and variety. Implementation of health-promoting and -supporting marketing strategies for healthy food can be one initial cornerstone for successful application of the common risk factor approach in prevention of obesity and dental caries, as also suggested by World Health Organization. Labelling healthy food with a 'health-friendly' logo, illustrating that the teeth and the heart are both parts of the whole body (standing side by side supporting each other as close friends), both happy and protected because of consumption of healthy food for the whole body, can promote the foods that are friendly to health of the whole body, implementing the common risk factor approach under a single theme. Labelling healthy food as 'health-friendly' based on an international consensus will provide a clear and uniform picture of what is healthy to eat and result in an international integrated programme for prevention of obesity and caries.

Purpose: The aim of this study was to investigate the association between cognitive and behavioural factors of preadolescents and those of their mothers, assessed in terms of self-efficacy beliefs and toothbrushing among Turkish and Finnish population in the framework of Social Cognitive Theory. The specific objective was to test if this possible association worked regardless of cultural differences., Materials and Methods: Self-administered questionnaires for Finnish (n = 338) and Turkish (n = 611) pre-adolescents and their mothers were used to collect the information on cognitive (pre-adolescent and maternal self-efficacy) and behavioural factors (toothbrushing frequencies)., Results: Turkish mothers and pre-adolescents reported lower levels of self-efficacy and toothbrushing than did their Finnish counterparts (P < 0.005). Finnish pre-adolescents reporting high self-efficacy were more likely to have mothers with high levels of self-efficacy (OR = 2.14, 95% CI = 1.16 to 3.93), (P = 0.014). Similar positive associations emerged between Turkish (OR = 2.45, 95% CI = 1.70 to 3.52), (P = 0.001) and Finnish (OR = 6.76, 95% CI = 2.21 to 20.65), (P = 0.001) pre-adolescent self-efficacy and maternal recommended (twice daily) level of toothbrushing behaviour. For pre-adolescents' toothbrushing, their own self-efficacy was the common explanatory variable. Binary logistic regression models revealed that the maternal toothbrushing accounted for the Turkish pre-adolescents' toothbrushing behaviour, whereas maternal self-efficacy did so for the Finnish pre-adolescents' (P < 0.001) toothbrushing behaviour., Conclusions: This study underlines the need for integration of pre-adolescent self-efficacy and maternal cognition and behaviour into oral health intervention programmes because of their relation to recommended toothbrushing behaviour among pre-adolescents, regardless of cultural differences. These findings seem to fit with the Social Cognitive Theory, which emphasises the significance of cultural factors and cognition as the determinants of behaviour.

Objectives: Interest is growing on conceptualizing dental disease aetiology under the life-course approach. The aim of this study was to assess the association of dental caries experience with the major components of life-course approach, health- and behavioral capital, among Turkish and Finnish pre-adolescents, with different family-related characteristics, as this association has not been explored yet., Methods: A cross-sectional study of Finnish (n=338) and Turkish (n=611) pre-adolescents was undertaken with questionnaires and oral health data., Results: Turkish pre-adolescents, more dentally diseased (84%) than the Finnish (33%) (P<.01), had lower means of health (body height-weight) and behavioural (self-esteem, tooth-brushing self-efficacy) capital, (P<.01). Finnish pre-adolescents were less likely to live in two-parent families (P=.001) and spent less time with their mothers (P<.05). Turkish pre-adolescents with high levels of self-esteem were more likely to spend time with their mothers and less likely to live in families with three or more children (28%) than were their counterparts with low levels of self-esteem (41%). Such associations were not evident among Finnish pre-adolescents (P>.05). Health capital, in terms of body height, and family-related characteristics in differing patterns, contributed to DMFT, in common, among Turkish and Finnish pre-adolescents. Self-esteem, behavioural capital was explanatory variable for DMFT only for the Turks., Conclusions: Dental health of pre-adolescents was associated with health- and behavioural capital in different pathways under the influence of family-related characteristics. The cooperation of paediatricians and dentists is vital in assessment of general and dental health in a holistic context throughout the life-course, to enhance the well-being of pre-adolescents.

Purpose: To assess psychological, individual and maternal factors related to dental anxiety among pre-adolescents in the different cultural settings of Turkey and Finland., Materials and Methods: A cross-sectional study of Finnish (n = 338) and Turkish (n = 611) pre-adolescents aged 10-12 years old by paired matching of questionnaires for the subjects and their mothers. These questionnaires, along with modified dental anxiety scales, were designed to collect data on the pre-adolescents' and their mothers' oral and dietary behaviours in relation to psychosocial factors. Multiple linear regression and factor analyses as well as descriptive and correlation statistics were applied., Results: The Turkish pre-adolescents (TP) reported poorer dental health (50%) and more frequent gingival bleeding (26%) than did the Finnish pre-adolescents (FP) (26%, 0%), (p < 0.05). A similar trend occurred for reported toothache (70% and 17% for TP and FP respectively [p = 0.00]). Mean dental anxiety (DA) for TP and their mothers, and Finnish counterparts respectively were 9.64 +/- 6.01, 8.70 +/- 4.53 and 7.39 +/- 4.51, 6.02 +/- 5.50 (p < 0.05). Among TP, those with low DA reported high levels of toothbrushing and dietary self-efficacy (DSES) and self-esteem (p < 0.05); FP showed similar trends for DSES and self-esteem. Principal component analysis revealed that maternal DA and regular dental visits largely accounted for primary associations with DA among TP., Conclusions: Appreciating the impact of various psychosocial factors may provide a better understanding of DA among preadolescents, and thus may reduce dental avoidance and behavioural management problems for the overall improvement of young patients' oral health.

Increase in blood viscosity, defined as resistance to flow, is one factor in hypertension and atherosclerosis that contributes to the morbidity and mortality associated with tissue ischemia. In this research we evaluated the effect of hematocrit on increasing viscosity, and possible related changes in blood pressure, flow rate, and the equivalent physiologic compensation ratios. Blood samples were taken from 32 healthy individuals and centrifuged for 5 min at 3000 rpm to obtain 2.5 mL of erythrocyte mass from each. Then, at each step 0.5 mL of plasma was consecutively added in a total of 17 steps. The resultant hematocrit and viscosity changes were measured. Viscosity measurement was performed by capillary viscometer. The results were evaluated by the Student t test. It was observed that in the range of 60.16% and 25.32%, a 10.99% increase of hematocrit produced an increase of 1 unit relative viscosity, which means approximately a 20% increase in blood viscosity for a healthy individual. According to Poiseuille's equation, with a constant vessel length, if viscosity is increased by 20%, the decrease in blood flow rate will be 16.67% (100/120 = 83.33%; 100 - 83.33 = 16.67%). For the physiologic compensation of 20% increased viscosity, blood pressure increase will be 20% or vasodilation will be 4.66% in radius. Atherosclerotic and some healthy vessels with little vasodilatory capacities might benefit from treatment modalities to decrease the viscosity by hemodilution.