Showing papers by "Israel Ministry of Health published in 2009"

A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders.

Abstract: Sensory modulation symptoms are common in persons with autism spectrum disorders (ASD); however have a heterogeneous presentation. Results from 14 studies indicated a significant high difference between ASD and typical groups in the presence/frequency of sensory symptoms, with the greatest difference in under-responsivity, followed by over-responsivity and sensation seeking. Three moderators that reduced the variability in findings among studies were: chronological age, severity of autism, and type of control group. Sensory differences were highest for studies of children ages 6-9 years, samples with more than 80% with an autism diagnosis, and compared to a CA matched versus a MA or DD matched group. It is important to consider these moderators in the design of studies and interventions addressing sensory symptoms.

Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study.

Abstract: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Human pregnancy experience with propylthiouracil has not shown an increased risk of major anomalies, but its use in pregnancy has been associated with fetal or neonatal thyroid dysfunction with or without goitre. • The rate of these complications has not been prospectively evaluated. WHAT THIS PAPER ADDS • Based on prospective data from the Israeli Teratology Information Service, propylthiouracil was not associated with an increased teratogenic risk. • Hypothyroidism was found in 9.5% (56.8% of whom with goitre) of fetuses or neonates, whereas hyperthyroidism was detected in 10.3%. • In most cases neonatal thyroid functions normalized without treatment. AIMS Propylthiouracil (PTU) is presently considered to be the treatment of choice for hyperthyroidism in pregnancy. It is known to cross the human placenta, and therefore may affect the fetus. The major aims of this study were to evaluate the rate of major anomalies and to report the rate of fetal goitre, accompanied by hypothyroidism, in fetuses/ newborns of mothers after in utero exposure to PTU. METHODS Prospective observational controlled cohort study of PTU-exposed pregnancies of women counselled by the Israeli Teratology Information Service between the years 1994 and 2004 compared with women exposed to nonteratogens. RESULTS We followed up 115 PTU-exposed pregnancies and 1141 controls. The rate of major anomalies was comparable between the groups [PTU 1/80 (1.3%), control 34/1066 (3.2%), P= 0.507]. Hypothyroidism was found in 9.5% of fetuses/neonates (56.8% of whom with goitre). Hyperthyroidism, possibly resulting from maternal disease, was found in 10.3%. Goitres prenatally diagnosed by ultrasound were successfully treated in utero by maternal dose adjustment. In most cases neonatal thyroid functions normalized during the first month of life without any treatment. Median neonatal birth weight was lower [PTU 3145 g (2655–3537) vs. control 3300 g (2968–3600), P= 0.018]. CONCLUSIONS PTU does not seem to be a major human teratogen. However, it could cause fetal/neonatal hypothyroidism with or without goitre. Fetal thyroid size monitoring and neonatal thyroid function tests are important for appropriate prevention and treatment.

Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men

Abstract: Objective: To assess arterial stiffness in a cohort of hypogonadal males and to investigate the effect of testosterone replacement therapy on arterial properties in this specific group. Design: Eighteen male patients with untreated acquired hypogonadism due to either adult-onset idiopathic hypogonadotropic hypogonadism (nZ9) or pituitary tumor (nZ9) and 12 age-, sex, and weight-matched eugonadal healthy controls were recruited for the study. Arterial properties, plasma glucose, lipid profile, total, and bioavailable testosterone (BT) levels were measured in fasting state. In the hypogonadal subjects, the effect of transdermal testosterone replacement therapy on arterial properties was studied by repeat noninvasive measurements at baseline, as well as 48 h and 90 days following the initiation of treatment. Methods: Arterial stiffness was evaluated using applanation tonometry and pulse wave analysis by three different standard devices that assess various measures of arterial stiffness: pulse wave velocity (PWV), augmentation index (AIx), and large/small artery compliance (C1 and C2). Results: Age- and blood pressure-adjusted PWV was significantly higher in hypogonadal men (8.90G 2.29 vs 6.78G1.16 m/s in the control group; PZ0.025). Testosterone therapy increased BT level from 2.01G1.04 to 4.68G2.43 and 7.83G6.2 nmol/l after 48 h and 3 months respectively (PZ0.001). PWV decreased from 8.9G2.29 to 8.24G1.39 and 8.25G1.82 m/s after 48 h and 3 months of treatment respectively (PZ0.03). Conclusions: Male hypogonadism is associated with increased PWV, which is rapidly but incompletely ameliorated by normalization of circulating testosterone levels.

Toward a 21st-century health care system: Recommendations for health care reform

Abstract: The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges.

Genetic testing in Israel: an overview.

Abstract: In Israel, genetic screening and testing are widespread and are on the rise. The socialized medical system, the governmental National Program for the Detection and Prevention of Birth Defects, the central registry of genetic disorders, and the availability of medical genetic units influence the extensive utilization of genetic services. Israeli society is a complex one-ethnically, religiously, and culturally diverse, comprised of Jews of many ethnic backgrounds, as well as Christian and Moslem Arabs, Druze, and Bedouins. Multiple founder mutations have been documented in these various ethnic populations, often down to the level of specific villages or tribes. Although carrier screening and prenatal diagnostic testing are well established in the general population, the rejection of pregnancy termination by many religious communities often prevents participation in testing. Culturally appropriate genetic programs have been initiated in religious Jewish and non-Jewish communities in an attempt to overcome cultural barriers and reduce the frequency of severe genetic diseases nationwide.

A targeted population carrier screening program for severe and frequent genetic diseases in Israel

Abstract: A national carrier screening program targeted at communities in which severe genetic diseases are present with a frequency higher than 1/1000 live births, has been in existence in Israel since 2002. Within the communities at risk, carrier screening is voluntary whereas genetic counseling and testing is provided free of charge. During the first 5 years of the program more than 13 000 tests were performed, and at the end of 2007 it was offered in 35 different localities/communities for a total of 36 diseases. Many of the couples identified to be at risk opted for prenatal diagnosis and in two cases an affected pregnancy was terminated. In some cases the couples declined prenatal diagnosis and two of those families gave birth to an affected child. Based on the experience learnt from this targeted screening program it appears that a knowledge-based, voluntary screening program operated within the community is an effective way to provide genetic services and test referrals. The community program directed toward couples in their reproductive period does not seem to have led to stigmatization at either the individual or the community level.

Advances in Microbial Biofilm Prevention on Indwelling Medical Devices with Emphasis on Usage of Acoustic Energy

Abstract: Microbial biofilms are a major impediment to the use of indwelling medical devices, generating device-related infections with high morbidity and mortality. Major efforts directed towards preventing and eradicating the biofilm problem face difficulties because biofilms protect themselves very effectively by producing a polysaccharide coating, reducing biofilm sensitivity to antimicrobial agents. Techniques applied to combating biofilms have been primarily chemical. These have met with partial and limited success rates, leading to current trends of eradicating biofilms through physico-mechanical strategies. Here we review the different approaches that have been developed to control biofilm formation and removal, focusing on the utilization of acoustic energy to achieve these objectives.

Prevalence and determinants of physical activity and lifestyle in relation to obesity among schoolchildren in Israel

Abstract: Food and Nutrition Administration, Ministry of Health, Jerusalem, IsraelSubmitted 15 March 2007: Accepted 19 March 2008: First published online 4 August 2008AbstractObjective: To describe the relationships between physical activity, lifestyledeterminants and obesity in adolescent Israeli schoolchildren.Design and setting: Cross-sectional survey.Subjects: The MABAT Youth Survey was a nationally representative, school-basedstudy of youth in grades 7 to 12 (ages 11–19 years).Methods: Self-administered questionnaires assessed health behaviours andanthropometric indices were measured. Logistic regression analysis was used toexamine the associations between obesity, physical activity, socio-economicstatus and other lifestyle habits. One-way ANOVA was used to determine meanphysical activity levels (MET values) by BMI categories.Results: The prevalence of overweight was 13–15% and of obesity 4–9%depending on gender and ethnicity, and was higher among the non-Jewishsectors. Thirty-six per cent and 57% of Jewish girls and boys, and 40% and 58%of non-Jewish girls and boys, respectively, were optimally active. Boys fromlow socio-economic schools and those who slept for less than 6h at night wereless active. Girls from middle school were found to be 53% more optimallyphysically active among Jews, and 89% more among non-Jews, compared withgirls from high school (P50?001); girls with less educated parents were also lessphysically active. No clear relationship was found between the level of obesityand physical activity.Conclusions: Physical inactivity was strongly related to gender, age, social status,sleeping habits, hookah smoking, and parental educational status. Education andintervention programmes should focus on these risk factors.KeywordsOptimal physical activityBody mass indexObesitySchoolchildrenSleepParental educationWhile the wide range of health benefits of physicalactivity is undisputed in both adults and children, there isa declining trend in physical activity, particularly indeveloped countries. This has obvious effects on effortsto counteract the obesity pandemic. According to theWHO 2004 report, at least 60% of the world’s populationfails to achieve the minimum recommendation of 30minof moderate-intensity physical activity daily

Incidence of Schizophrenia Among Second-Generation Immigrants in the Jerusalem Perinatal Cohort

Abstract: Objective: Increased incidence of schizophrenia is observed among some immigrant groups in Europe, with the offspring of immigrants, ie ‘‘second-generation’’ immigrants particularlyvulnerable.Fewcontemporarystudieshaveevaluated the risk of schizophrenia among second-generation immigrants in other parts of the world. Methods :W e studied the incidence of schizophrenia in relation to parental immigrant status in a population-based cohort of 88829 offspring born in Jerusalem in 1964–1976. Parental countries of birth were obtained from birth certificates and grouped together as (1) Israel, (2) Other West Asia, (3) North Africa, and (4) Europe and industrialized countries. Cox proportional hazards methods were used in adjusting for sex, parents’ ages, maternal education, social class, and birth order. Results: Linkage with Israel’s Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. Incidence of schizophrenia was not increased among second-generation immigrants in this birth cohort, neither overall nor by specific group. Conclusions: The difference in risk of schizophrenia among second-generation immigrants in Europe and in this Israeli birth cohort suggests that the nature of the immigration experience may be relevant to risk, including reasons for migration, the nature of entry, and subsequent position in the host country for immigrants and their offspring. Minority status may be of importance as, in later studies, immigrants to Israel from Ethiopia had increased risk of schizophrenia.

Effect of socioeconomic status and parents’ education at birth on risk of schizophrenia in offspring

Abstract: Although it is known that schizophrenia is associated with social class, controversy exists as to the nature of this association. The authors studied the incidence of schizophrenia in relation to social class at birth in a population-based cohort of 88,829 offspring born in Jerusalem in 1964–1976. They constructed a six-point scale to index social class, based on paternal occupation at the time of birth, with each of 108 occupations being ranked by mean education. Cox proportional hazards methods were used in adjusting for sex, parents’ ages, duration of marriage and birth order. Linkage with Israel’s Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. There was no gradient of risk for schizophrenia associated with social class at birth; however, offspring of fathers in the lowest social class showed a modest increase in risk (adjusted Relative Risk = 1.4; 95% Confidence interval = 1.1–1.8, P = 0.002). These data suggest that in contrast to many other health outcomes, there is not a continuous gradient for increasing schizophrenia with decreasing social class of origin. Instead, a modest increase in risk for schizophrenia was observed only for those born at the bottom of the social ladder.

Studying the association between air pollution and lung cancer incidence in a large metropolitan area using a kernel density function

Abstract: In the absence of patient-specific data, composite level data are often used in epidemiological studies. However, since individual exposure levels cannot accurately be inferred from aggregate data, such an approach may lead to erroneous estimates of health effects of potential environmental risk factors. In the present study, we attempt to address this information-loss problem by using the “kernel density function”, which estimates the intensity of events across a surface, by calculating the overall number of cases situated within a given search radius from a target point. The present paper illustrates the use of this analytical technique for a study of association between the geographical distributions of lung cancer cases and SO2 air pollution estimates in the Greater Haifa Metropolitan Area (GHMA). In the analysis, the results obtained by kernel smoothing are contrasted with those obtained by areal aggregation techniques more commonly used in empirical studies.

Mumps outbreak in Jerusalem affecting mainly male adolescents.

Abstract: From mid-September 2009 to 7 December 2009, 173 cases of mumps have been reported in the Jerusalem District. Most cases (82.1%) were male adolescents (median age 14.5 years) who are students in religious boarding schools. The majority of them (74%) are appropriately vaccinated for their age; 67% had received two doses of mumps-containing vaccine. An epidemiologic connection has been reported with visitors from New York, some of whom had recently had mumps.

Virulence characteristics of male genital tract Escherichia coli isolated from semen of suspected infertile men.

Abstract: The role of Escherichia coli isolates from the semen in the etiology of male infertility, was investigated in this study. Several possible virulence factors of E. coli, such as possession of O antigens or certain K antigens (K1, K5), the type of fimbriae, resistance to antimicrobial drugs and adherence studies to various mammalian sperm cells were examined. It was found that out of 181 E. coli isolates 76.4% belonged to four different urinary serotypes: O1, O2, O4 and O6 (5.7%, 7.5%, 17.0% and 46.2%, respectively). The predominant fimbrial phenotype (81.2%) was T1F+/P-, while 15.8% showed also the possession of P fimbriae (T1F+/P+). No isolate was found with the T1F-/P+ phenotype. The possession of antigens K1, K5 was found to be low (12% only). A relatively high level of adherence to different mammalian sperm cells was found among E. coli isolates. 43% of the E. coli isolates were resistant to doxycycline (the drug of choice) and additionally, most of these were resistant also to ampicillin. We suggest that there is a close subpopulation of E. coli which possess certain virulence properties and have the potential to adhere to sperm cells and to colonize on other target tissues in the male genital tract. Such virulent may cause asymptomatic male infertility and may be termed male genital tract (MGT)-E. coli.

Estimation of the ROC curve under verification bias

Abstract: The ROC (receiver operating characteristic) curve is the most commonly used statistical tool for describing the discriminatory accuracy of a diagnostic test. Classical estimation of the ROC curve relies on data from a simple random sample from the target population. In practice, estimation is often complicated due to not all subjects undergoing a definitive assessment of disease status (verification). Estimation of the ROC curve based on data only from subjects with verified disease status may be badly biased. In this work we investigate the properties of the doubly robust (DR) method for estimating the ROC curve under verification bias originally developed by Rotnitzky, Faraggi and Schisterman (2006) for estimating the area under the ROC curve. The DR method can be applied for continuous scaled tests and allows for a non-ignorable process of selection to verification. We develop the estimator's asymptotic distribution and examine its finite sample properties via a simulation study. We exemplify the DR procedure for estimation of ROC curves with data collected on patients undergoing electron beam computer tomography, a diagnostic test for calcification of the arteries.

DISAST-CIR: Disastrous incidents systematic analysis through components, interactions and results: application to a large-scale train accident.

Abstract: Disasters or hazardous incidents, either natural or man-made, continue to increase in frequency and affect more and more citizens of the world community. Many of these are published in the medical literature, each being a "case report" of a single event. In clinical medicine, a common nomenclature and uniform reporting of data enables the collection of similar cases to series studies, with clinical conclusions being drawn. Such a platform is lacking in the field of disaster medicine, impairing the ability to learn from past experiences. In the Medical Department of the Israeli Home Front Command, we coordinate the operation of various medical units and forces in a wide array of events. By doing so, we collect and analyze the relevant data related to disaster management, various components of the medical response, interactions between different components, and the ensuing results. We developed a systematic method of analyzing and describing disaster management issues in various events-DISAST-CIR-Disastrous Incidents Systematic AnalysiS Through Components, Interactions, Results. In this article, we describe this method by presenting the components, interactions, and results of a large-scale train accident that resulted in 270 casualties, 35 of whom were evacuated by helicopters from the accident site. Casualties were distributed among 10 different hospitals. The death toll was 7 people, 5 of whom died at the scene and 2 who died in hospitals. We recommend this method as a standard for scientific reporting of hazardous incidents. Accumulation of data, reported in a similar standardized fashion, would enable comparison and reporting of series, improving our understanding regarding the optimal medical response to various events.

An association between stress-induced disruption of the hypothalamic-pituitary-adrenal axis and disordered glucose metabolism in an animal model of post-traumatic stress disorder.

Abstract: Retrospective clinical reports suggesting that traumatic stress populations display an increased propensity for glucose metabolism disorders were examined in a controlled prospective animal model. Stress-induced behavioural and hypothalamic-pituitary-adrenal (HPA) axis response patterns were correlated to central and peripheral parameters of glucose metabolism and signalling, and to body measurements in Sprague-Dawley rats exposed to predator scent stress. Forty days post-exposure, fasting blood glucose and insulin levels, oral glucose tolerance test, body weight and white adipose tissue mass, systemic corticosterone levels and brain expression of insulin receptor (IR) and insulin-sensitive glucose transporter 4 (GLUT4) protein levels were evaluated. In a second experiment inbred strains with hyper- (Fischer) and hypo- (Lewis) reactive HPA axes were employed to assess the association of metabolic data with behavioural phenomenology versus HPA axis response profile. For data analysis, animals were classified according to their individual behavioural response patterns (assessed at day 7) into extreme, partial and minimal response groups. The exposed Sprague-Dawley rats fulfilling criteria for extreme behavioural response (EBR) (20.55%) also exhibited significant increases in body weight, abdominal circumference and abdominal white adipose tissue mass; a hyperglycaemic oral glucose tolerance test; and fasting hyperglycaemia, hyperinsulinaemia and hypercorticosteronemia, whereas minimal responders (MBR) and control animals displayed no such disturbances. Hippocampal and hypothalamic expression of IR and GLUT4 protein were significantly lower in EBR than in MBR and control rats. The inbred strains showed no metabolic differences at baseline. Exposed Fischer rats displayed hyperglycaemia and hyperinsulinaemia, whereas Lewis rats did not. A significant protracted disorder of glucose metabolism was induced by exposure to a stress paradigm. This metabolic response was associated with the characteristic pattern of HPA axis (corticosterone) response, which underlies the behavioural response to stress.

The QuantiFERON-TB-GOLD assay for tuberculosis screening in healthcare workers: a cost-comparison analysis.

Abstract: The aim of this study was to assess the costs of screening healthcare workers (HCWs) for tuberculosis (TB) using the novel interferon-γ release assay QuantiFERON®-TB Gold In-tube (QFT) versus the tuberculin skin test (TST). We used a prospective observational study with a cost-comparison analysis. The study was conducted at a regional center for ambulatory TB treatment. The study included 100 Israeli HCWs who were referred for routine TB screening. The participants were tested with both TST and QFT. For the TST, induration of 10 mm or more was considered a positive test. For the QFT, a threshold of 0.35 IU/ml interferon-γ above background levels was a positive test. We developed a computerized model of the present TST-only screening method versus the QFT either alone (instead of the TST) or as a confirmatory test for a positive TST. Of the 100 subjects, 34 had a positive TST result and 17 had a positive QFT result. There was poor agreement between the TST and the QFT (κ = 0.19). Assuming adherence to treatment of 50%, costs were minimized by using the QFT to confirm a positive TST (€4155). The QFT-only model was cheaper than the TST-only model (€7280 vs. €8217, respectively). The QFT-only method required the fewest clinic visits (121) compared to the TST (344). Adherence to treatment in the QFT-positive group was 47% compared with 12% for the TST-positive group. Screening HCWs with the QFT test compared to the TST resulted in fewer possible cases being identified, lower costs, and increased adherence to treatment. Costs were minimized by using the QFT to confirm a positive TST. A QFT-based screening program for HCWs is feasible and should be evaluated systematically.

Carbon monoxide poisoning in Jerusalem: epidemiology and risk factors

Abstract: Objectives. To describe the epidemiology of carbon monoxide (CO) poisoning in Jerusalem and identify risk factors for such poisoning. Design. A retrospective descriptive analysis of patients with CO poisoning who presented to the Hadassah hospitals in Jerusalem from 1994 to 2006. Patients. All patients with suspected CO poisoning were examined and those with confirmed cases [carboxyhemoglobin (COHb) level >5%] were included. Sources of exposure, seasonal variation, and demographic characteristics were analyzed. Results. There were 292 patients (49% males) with 40 family clusters that accounted for 149 patients (51%); 230 patients (79%) presented during the winter months. All but one had unintentional CO intoxication. The main sources of exposure were faulty gas heaters (n = 135), fire (n = 102), and other residential heating systems (n = 40). The estimated annual incidence of CO poisoning decreased from 6.45 per 100,000 in 1994–2000 to 3.53 per 100,000 in 2001–2006. High-risk intoxication (COHb level >25%...

The effect of antimicrobial resistance on patient outcomes: importance of proper evaluation of appropriate therapy

Abstract: The impact of antimicrobial resistance on patient outcomes can be effectively measured only if the appropriateness of the antimicrobial therapy received is properly measured. Definition of appropriate therapy should include not only in vitro susceptibility but also the clinical adequacy of the antibiotic used, taking into account the pathogen isolated, the site of infection, known pharmacokinetic and pharmacodynamic properties of the drug, and dosing. In the absence of these data, the effect of delay or absence of appropriate therapy in patients infected with resistant bacterial pathogens is subject to confounding, and the true effect of resistance on outcomes may be obscured.

Most common genotypes and risk factors for HCV in Gaza strip: a cross sectional study.

Abstract: The present work aims at determining HCV genotypes in patients with chronic HCV infection, in Gaza strip, Palestine. The most common risk factors for HCV transmission were also evaluated in conjunction with the genotyping data. The study shows that there are only two major genotypes of HCV in Gaza Strip: Genotype 1 (subtypes 1a and 1b) collectively contribute to 28.3% of the cases, and genotype 4 (subtypes 4a and 4c/d) collectively contribute to 64.1% of the cases. Mixed infection with the two genotypes was also present among 7.6% of the cases. In this study a statistically significant relationship was established between the distribution of these genotypes and the patients' living place, traveling history, history of blood transfusion and history of surgical operations. The present study is the first to link HCV genotyping in Gaza strip with its possible roots of transmission. Traveling to endemic countries, especially Egypt; blood transfusion and surgical operations are major roots of HCV infection in Gaza strip. The results indicate that iatrogenic and nosocomial procedures may be responsible for the majority of HCV infections in Gaza strip.

Dental attendance and self-assessment of dental status by Israeli military personnel according to gender, education, and smoking status, 1998-2006.

Abstract: Objective: The goal of the study was to analyze dental attendance and self-assessment of dental status among Israeli military personnel, according to gender, education, and smoking status. Methods: Data were analyzed from a computerized questionnaire on dental attendance and dental status, completed by military personnel who attended one medical clinic for the required periodic medical examination between 1998 and 2006. Results: For 60% of the respondents, the last dental visit was within the previous 12 months. The last dental visit was for scheduled treatment for 49.8%, a dental examination for 21.5%, and emergency dental treatment for 12.2%. College graduates rated their dental self-care higher than non-college graduates, and nonsmokers rated their self-care higher than smokers. Of the participants, 50.9% considered their own dental status good or excellent and 7.2% considered their oral health status poor. No significant differences were found according to gender. Conclusions: The findings ind...