Structural equation modelling of the complex relationship between toothache and its associated factors among Indonesian children

Maternal Characteristics, Intention, Self-Efficacy, Perceived Social Support, and Exclusive Breastfeeding Practice: Structural Equation Modeling Approaches

Breast milk is a perfect food for infants; however, the rate of exclusive breastfeeding is low. The relationship between exclusive breastfeeding practices and influencing factors is complex and remains unclear. This cross-sectional study was conducted in Changsha County, China, and 414 mothers were enrolled. An online questionnaire was used to collect data on general information, obstetrics and gynecology characteristics, the initial breastfeeding intention, breastfeeding practice, frequency of attending conventional breastfeeding programs before delivery, the status of breastfeeding self-efficacy, and the status of perceived social support. Structural equation modeling (SEM) was used to estimate the association between exclusive breastfeeding and potential risk factors of failing to practice exclusive breastfeeding for 6 months. The rate of exclusive breastfeeding for 6 months was 46.1%. The median and interquartile range of the scores for breastfeeding self-efficacy and perceived social support were 51.0 (18.0) and 68.0 (20.0), respectively. Factors that were statistically significant in the univariate analysis were included in the SEM and model fitness was acceptable based on the results. Exclusive breastfeeding for 6 months was directly associated with intention and self-efficacy, while it was indirectly associated with perceived social support and frequency of attending a breastfeeding program. The findings support the recommendation that comprehensive breastfeeding promotion strategies should be implemented to call on the intention and self-efficacy of breastfeeding mothers through various measures, such as education or providing medical and health services.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Prevalence of toothache in Chinese adults aged 65 years and above

OBJECTIVES

To investigate the prevalence of toothache and its risk indicators in the older Chinese population.

METHODS

National cross-sectional survey data on 25 048 Chinese people ≥65 years in 2011, 2014 and 2018 survey year were analysed and then pooled. Chi-square test was used to examine the differences in prevalence among specific subgroups. Multivariate modified Poisson regression analyses with robust error variances were used to detect related factors and prevalence ratios (PR) were calculated.

RESULTS

The prevalence of toothache was 16.3% (95% CI: 15.5%-17.1%), 12.8% (95% CI: 12.0%-13.7%) and 16.0% (95% CI: 15.3%-16.7%) in years 2011, 2014 and 2018. In the pooled multivariate Poisson regression model, factors associated with toothache were female (PR: 1.27, 95% CI: 1.18-1.37), younger age (PR: 1.84, 95% CI: 1.63-2.09), currently married and living with spouse (PR: 1.08, 95% CI: 1.01-1.15), current living in urban area (PR:1.12, 95% CI: 1.06-1.20), enough financial support (PR: 0.69, 95% CI: 0.65-0.74), having chronic disease (PR: 1.46, 95% CI: 1.35, 1.57), higher sugar intake (PR: 1.10, 95% CI: 1.03-1.17), salty flavour (PR:1.15, 95% CI: 1.07-1.23), smoking (PR: 1.14, 95% CI:1.06-1.23) or drinking (PR: 1.17, 95% CI: 1.09-1.25), with denture (PR: 1.15, 95% CI: 1.08-1.22) and higher toothbrushing frequency (PR: 1.25-1.50).

CONCLUSIONS

More than one in ten older Chinese population had toothache, and it was related to age, gender, socioeconomic status, behaviour and oral health status. Lifestyle interventions should be taken to avoid the occurrence of the toothache.