Adequate Behaviors Research Articles

Personal Hygiene Practices related to Genito-urinary Tract and Menstrual Hygiene Management in Female Adolescents.

The study was to survey personal hygiene practice related to genito-urinary tract and menstrual hygiene management in female adolescents in order to obtain basic information for health education. With a descriptive survey design, 389 adolescents were recruited via convenience sampling in Korea. Survey instrument was the feminine and menstrual hygiene practice and perception of vaginal douching. Data were collected from a self-administered structured questionnaire. Mean age of adolescents was 16.09 and menarche was at 13.21. While washing hands after urination/defecation was highly performed, wipe front to back and wash with soap and water were reported as being not well done. Twenty-eight percent reported douching habit. More positive beliefs about douching were reported by adolescents who practiced douching. Menstrual hygiene management was very appropriate with changing sanitary pads regularly with hand washing; but less performed for limiting bathing activity during menstrual periods and washing hands after activity of genito-urinary area. Some adolescents practiced inadequate hygiene practices especially for body cleansing during menstrual period and vaginal douching. It is important to develop and implement school health education programs on feminine and personal hygiene for adolescents to help them perform adequate health behaviors.

Interfaces endowed with nonconstant surface energies revisited with the d’Alembert–Lagrange principle

The equation of motions and the conditions on surfaces and edges between fluids and solids in presence of non-constant surface energies, as in the case of surfactants attached to the fluid particles at the interfaces, are revisited under the principle of virtual work. We point out that adequate behaviors of surface concentrations may drastically modify the surface tension which naturally appears in the Laplace and the Young-Dupre equations. Thus, the principle of virtual work points out a strong difference between the two revisited concepts of surface energy and surface tension.

Le aggressioni nei confronti degli infermieri dei dipartimenti di emergenza: revisione della letteratura internazionale

Workplace violence is a widespread phenomenon in every kind of settings. Among these ones there are emergency departments (ED), that have distinctive features as like the large daily number of patients' presentations, and high emotional content or stressing situations related to the management of diagnostic-therapeutic priorities. We reviewed the medical and nursing literature to quantify the international widespread of aggressions towards nurses working in EDs, distinguish the typologies and the perpetrators, and identify the consequences on victims and healthcare organizations. Original papers were searched using Medline, CINHAL, and Medscape databases. 35 research articles met the inclusion criteria, but 6 were not retrieved. The rate of verbal abuses reported by ED nurses varies from 50% to 100% of those who were surveyed, while physical violence ranges between 16.7% and 72%. Patients and relatives are the main perpetrators, followed by doctors, and, only in lower percentages, by nurses colleagues. Alcohol, drugs abuse, and overcrowding in EDs are acknowledged as motivating factors for violent events. Under-reporting of aggressions is frequent up to the 80% of victims, and some papers report that nurses consider assaults as a normal part of their work. There is a direct relation between aggressions and symptoms of post-traumatic stress disturb syndrome. Moreover there is a sense of continuous fear in nurses, causing the likelihood of workplace leaving. Special educational courses seem to be effective in diminishing the number of aggressions and to adopt adequate adaptive behaviors.

MIXING SEQUENCE IN NATURAL RUBBER CONTAINING ORGANOCLAY AND NANO–CALCIUM CARBONATE TERNARY HYBRID NANOCOMPOSITES

ABSTRACT Rubber nanocomposites containing one type of nanofiller are common and are widely established in the research field. In this study, natural rubber (NR) based ternary nanocomposites containing both calcium carbonate and organoclay have been characterized on the basis of morphology, cure characteristics, and physico-mechanical behavior. Natural rubber nanocomposite samples containing modified silicate (Cloisite 15A) and also nano-carbonate calcium were prepared using a laboratory internal mixer. The effect of the mixing sequence on the morphology and mechanical properties of the samples was investigated. Based on results of morphology and mechanical properties, the dual fillers phase nanocomposites (hybrid nanocomposite) perform better in comparison with single filler phase nanocomposites. The reinforcing capability of nano-CaCO3 and organoclay in NR was characterized by means of cure rheometry, morphology, and mechanical properties. NR/single filler phase and two filler phase nanocomposites were prepared by simple melt mixing method. Concentration of nano-CaCO3 and organoclay in NR was 10 and 5 parts per one hundred parts of rubber by weight, respectively. The microstructure and homogeneity of the compounds was confirmed by studying the dispersion of nanoparticles in NR via X-ray diffraction and field emission scanning electron microscopy. A more pronounced effect was achieved by using dual filler based nanocomposites as compared with single filler phase nanocomposites. The obtained results reveal that hybrid nanocomposites have more adequate morphology, rheometery, and mechanical behaviors as well as swelling resistance. The effect of mixing sequence of fillers has been studied in detail. Simultaneous addition of the two nanofillers to the NR compound would lead to better nanocomposite properties compared with other mixing sequences. Also, the results show that the mixing sequence of these nanofillers in NR has little effect on the performance of the nanocomposite.

Objectifs et besoins éducatifs des patients atteints de rhumatismes inflammatoires chroniques

Therapeutic education for patients with inflammatory rheumatisms is worthwhile as the disease impacts daily life, with pain, handicap and psychosocial impairment. The educative process seeks for patients needs in order to determine shared objectives. Health professionals try to enhance the patients’ adherence to therapeutic strategies and promote adequate behaviors, especially to prevent complications and adverse effects of medications. For the patient, therapeutic education carries the hope of better quality of life and autonomy.

Occupational Exposure to Ultraviolet Radiation and Risk of Non-Melanoma Skin Cancer in a Multinational European Study

BackgroundStudies suggest that ambient sunlight plays an important role in the pathogenesis of non-melanoma skin cancers (NMSC). However, there is ongoing controversy regarding the relevance of occupational exposure to natural and artificial ultraviolet radiation (UV) radiation.ObjectivesWe investigated potential associations between natural and artificial UV radiation exposure at work with NMSC in a case-control study conducted in Hungary, Romania, and Slovakia.MethodsOccupational exposures were classified by expert assessment for 527 controls and 618 NMSC cases (515 basal cell carcinoma, BCC). Covariate information was collected via interview and multiple logistic regression models were used to assess associations between UV exposure and NMSC.ResultsLifetime prevalence of occupational exposure in the participants was 13% for natural UV radiation and 7% for artificial UV radiation. Significant negative associations between occupational exposure to natural UV radiation and NMSC were detected for all who had ever been exposed (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.27–0.80); similar results were detected using a semi-quantitative metric of cumulative exposure. The effects were modified by skin complexion, with significantly decreased risks of BCC among participants with light skin complexion. No associations were observed in relation to occupational artificial UV radiation exposure.ConclusionsThe protective effect of occupational exposure to natural UV radiation was unexpected, but limited to light-skinned people, suggesting adequate sun-protection behaviors. Further investigations focusing on variations in the individual genetic susceptibility and potential interactions with environmental and other relevant factors are planned.

운동지속수행능력과 기후적응성에 따른 의복행동과 건강에 대한 인지도에 관한 연구

The study aimed to investigate the effects of climate adaptability and physical activity adherence on clothing behavior and health perception. Total usable questionnaires were obtained from 352 university students(126 male & 226 female students). Results were gained from the statistical analysis such as factor analysis, cluster analysis, ANOVA, t-test using SPSS 19.0. The results were as follows. First, male students showed higher figures than female students in physical activity adherence, cold adaptability, and health perception but vice versa in clothing behaviors related to the seasons, weather forecasts and the situation. Second, the group which had good physical activity adherence showed adequate clothing behaviors and fine health perception, which meant proper relations between exercise, clothing behavior, and health. Finally, the group which had lower climate adaptability but adequate clothing behavior according to the season showed a fine health perception. The relation between clothing behavior and health perception was checked through this.

NATURAL RUBBER HYBRID NANOCOMPOSITES REINFORCED WITH SWELLED ORGANOCLAY AND NANO-CALCIUM CARBONATE

Abstract Two natural rubber (NR) nanocomposites have been prepared with organoclay(MMT) and swelled organoclay (SMMT) using melt intercalation method. The effect of these two MMTss on the morphology, rheometery, and mechanical behaviors of NR has been evaluated. Scorch times for the MMT-filled compounds were very short compared to unfilled compounds. A more pronounced effect was achieved by using SMMT as reinforcing agent. The obtained results reveal that nanocomposites reinforced by SMMT have more adequate morphology, rheometery, and mechanical behaviors as well as swelling resistance. The microstructure of the NR/MMT systems was studied by x-ray diffraction and field emission scanning electron microscopy. Following, the effect of different content of nano-calcium carbonate on dispersion of MMT layers in NR/SMMT nanocomposites was investigated. The results show that the optimized value of filler in dual fillers-based nanocomposite systems was equal to 10 phr nano-calcium carbonate. NR based hybrid nanocomposites containing SMMT and nano-calcium carbonate was showed 445% increase in tensile strength, 144% stress improvement at 100% strain, and only 3% increase in elongation at break compared to pure NR.

Psychosocial correlates of HIV-monoinfection and HIV/HCV-coinfection among men who have sex with men

Rates of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM) appear to be high and rising. In other demographic groups, HIV/HCV-coinfection is associated with poor physical and psychological outcomes. In this study, we examined health-related and psychosocial correlates of HIV/HCV-coinfection in a clinic sample of MSM. Cross-sectional data were collected from 171 MSM. One-third of the sample was coinfected. Higher rates of depressive and PTSD symptoms were observed in coinfected patients. Coinfected men were more likely to report perfect 30-day medication adherence, but exhibited lower CD4 cell counts and more past year emergency room visits. Despite consistent engagement with care and higher rates of medication adherence, HIV/HCV-coinfected MSM exhibited significantly more mental health problems. Medical and mental health providers should be especially attentive to the mental health status of HIV/HCV-coinfected MSM, despite adequate health behaviors and physical health status.

Predictors of caregiver supportive behaviors towards reproductive health care for women with intellectual disabilities

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of “2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan” were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively.

Microstructures and mechanical properties evaluation of TiAlN/CrSiN multilayered thin films with different bilayer periods

The Ti 0.45Al 0.55N/Cr 0.75Si 0.25N nanoscale multilayered coatings were deposited periodically by a bipolar asymmetric pulsed DC reactive magnetron sputtering technique. The structures and bilayer period of multilayer coatings were characterized by an X-ray diffractometer. The surface and cross-sectional morphologies of thin films were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), respectively. The surface roughness of thin films was explored by atomic force microscopy (AFM). A nanoindenter, a micro Vickers hardness tester and pin-on-disk wear tests were used to evaluate the hardness, fracture toughness and tribological properties of the thin films, respectively. Six coatings with bilayer period ranges from 6 nm to 40 nm were produced in this work. It was observed that the hardness increased with increasing bilayer period and reached the maximum at 12 nm and then leveled off at periods larger than 12 nm. An optimal hardness, and plastic deformation resistance, as well as adequate tribological behaviors were found on the coating with a critical bilayer period of 12 nm.

Support behavior and relationship satisfaction in couples dealing with diabetes: Main and moderating effects.

This study examined associations between support behavior, i.e. active engagement and protective buffering, and relationship satisfaction in both patients with diabetes and their partners. Active engagement refers to supportive behavior characterized by involving one's partner in discussions, asking how the other feels, and problem solving strategies. Protective buffering refers to less supportive behavior characterized by denying fears and worries, and by pretending everything is fine. Furthermore, we examined whether there were interactive effects of these two support behaviors on patients' and partners' relationship satisfaction. At baseline (T1), 205 couples rated to which degree they received active engagement and protective buffering from their partners, and completed a measure of relationship satisfaction. At three follow-up assessments, couples were asked to fill out the same measures. Using dyadic data analytic approaches, we found relationship satisfaction to be positively associated with active engagement, and negatively with protective buffering, in both patients and partners. Moreover, we found a moderating effect, in that the negative association between protective buffering and relationship satisfaction was only present when levels of active engagement were relatively low. Again, these results were found for patients as well as their partners. We were able to replicate the T1 results at the other three assessment points. Our findings illustrate the need to consider adequate and less adequate support behaviors simultaneously, and to study the effects on both patients and partners.

Nutrition intervention and adequate hygiene practices to improve iron status of vulnerable preschool Burkinabe children

Objective To determine the impact of an intervention that combined an increase in dietary and bioavailable iron intakes and an improvement in hygiene behaviors on the iron status of preschool children from Burkina Faso. Methods Thirty-three orphans and vulnerable children from 11 families who were 1–6 y old, were non-anemic, or had mild to moderate anemia were enrolled in an 18-wk trial. Using the probability approach for planning diets in an assisted-living facility, bioavailable iron intake was increased from 0.4 to 0.9 mg/d by increasing the amounts of meat and citrus fruits and by adding iron-rich condiments to the diet, for an estimated cost of U.S. $0.59/mo. Hygiene behaviors were modified by implementing hand-washing before meals and by the use of individual plates for meals. Iron status indicators were measured twice and means at enrollment and after intervention were compared. Results After intervention, hemoglobin concentration increased from 98.7 to 103.8 g/L ( P = 0.006). There was a decrease in total iron binding capacity (107 to 91 μmol/L, P = 0.05) and a marginal increase in transferrin saturation (13% to 17%, P = 0.06). Significant improvement was not observed for serum ferritin concentration or prevalence of depleted iron stores, likely due to the confounding effect of infection. Anemia and iron-deficiency anemia were decreased from 64% to 30% and from 61% to 30%, respectively. Conclusion Dietary modification associated with adequate hygiene behaviors could be a relevant strategy to control iron deficiency and anemia in areas where infection is a major health problem.

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility. This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine-touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury.

Efeitos de um Programa de Práticas Educativas para monitoras de um abrigo infantil

Este estudo é parte de uma pesquisa de doutoramento que teve por objetivo elaborar e avaliar um Programa de Treinamento em Práticas Educativas para monitores de abrigos para crianças vítimas de violência doméstica. O estudo original trabalhou com 14 monitoras, porém o objetivo específico aqui consiste em analisar o comportamento de interação de duas monitoras com duas crianças ao longo do Programa de Intervenção. Os resultados obtidos demonstraram que a freqüência dos comportamentos de interação positiva das monitoras e das crianças aumentou, e os de interação coercitiva diminuíram, após as sessões analisadas. Esses resultados possivelmente demonstram que procedimentos para diminuir a freqüência de comportamentos inadequados infantis mantidos por atenção, e os que visam aumentar a freqüência dos adequados, são concorrentes com os padrões de interação coercitiva entre o cuidador e a criança e, por isso, fazem com que eles diminuam de imediato.

Comportements alimentaires de l’enfant et attitudes parentales: le point de vue de la psychologie expérimentale

Children show a clear preference, throughout development, for high energy density foods, and particularly for sweet and/or fat products. Most parents disapprove of this behavior, in the present context of high obesity prevalence and widespread acceptance of thinness as a model. Children’s appetite for such foods has adaptive value, so far as the growing child has not lost his/her ability for energy adjustment. A few studies suggest that excessive control over children’s food choices contributes to a loss of the child’s capacity to energy adjustment. Education models that include both the teaching of rules and adjustments to the child’s requests seem to facilitate the acquisition of adequate eating behaviors, which favor a varied diet and body weight control.

Knowledge about symptoms of Alzheimer's disease: correlates and relationship to help-seeking behavior.

The aim of this study was to assess relationships between knowledge about symptoms of Alzheimer's disease (AD) and help seeking intention among the lay public. A convenience sample of 150 community-dwelling persons aged over 45, who did not have a close relative diagnosed with AD, participated in the study. Knowledge about 11 warning signs of AD as described in the information provided by the Alzheimer's Association, and four non-AD symptoms was assessed, together with intentions to seek help from professional and non-professional sources. Background characteristics included socio-demographic characteristics, personal experience with AD, and perceived threat. Although participants' knowledge about AD symptoms overall was fair, only a slight percentage reported memory problems to be symptoms of the disease. Participants differentiated between AD warning and non-warning signs. Older participants reported consistently more AD and non-AD symptoms, while higher concerns about developing the disease was associated with reporting more non-AD symptoms. Higher knowledge about AD symptoms was associated with increased intentions to seek help from professional sources. Efforts to increase knowledge about AD symptoms should be expanded, with special attention to risk groups. Improved recognition of AD symptoms will promote adequate help-seeking behaviors and will increase early identification and treatment of AD.

Parenting of mothers with a serious mental illness: Differential effects of diagnosis, clinical history, and other mental health variables

This study examined the effects of mental illness on parenting in a large urban-based sample of women with serious mental illness. Seventy percent of the sample were women from ethnic minority groups, average age mid-30s; all had care responsibility for at least one minor child. Diagnostic Interview Schedule modules were administered; the women were interviewed to obtain information on parenting, clinical history, and current functioning. Diagnosis had a small but significant negative effect on parenting attitudes and behaviors, and there were race-by-diagnosis interactions. However, current symptoms mediated the effects of diagnosis and chronicity on parenting stress, and current symptomatology and community functioning partially mediated the effects of diagnosis on parenting satisfaction. Researchers--practitioners need to assess the status of mothers with mental illness rather than assuming problems or intervention needs. Key words: diagnosis; mental illness; mothers; parenting; symptomotology ********** Maternal mental illness is clearly a risk factor for children. Children whose mothers have long-term, serious mental illness are at increased risk of being placed in alternative settings such as foster care (for example, Oyserman, Benbenishty, & Ben Rabi, 1992). Furthermore, in their lifetimes, from one-third to more than one-half of these children will themselves have a DSM diagnosable disorder (Amminger et al., 1999; Jacobsen, Miller, & Kirkwood, 1997; Waters & Marchenko-Bouer, 1980). Some of the association between mother and child diagnosis may reflect the heritability (that is, estimated proportion of the phenotypic variance that is genetically determined) of major mental illnesses--estimated at 80 percent for bipolar disorder, from 34 percent to 48 percent for depression, and 75 percent for schizophrenia (Rutter, Silberg, O'Connor, & Simonoff, 1999). Children's increased risks of mental health and behavioral problems have also been related to the parenting provided by their mothers with mental illness (Masten, Best, & Garmezy, 1990). A recent review of the empirical literature on the influence of serious mental illness on parenting concluded that these mothers have significantly less adequate parenting skills and behaviors than mothers who do not have a mental illness (Oyserman, Mowbray, Allen-Meares, & Firminger, 2000). Specifically, in parenting their children from preschool age through adolescence, mothers with a serious mental illness have been found to be less emotionally available, less reciprocal, less involved, and less positive (Cohler, Gallant, Grunebaum, Weiss, G Cohler & Musick, 1983; Klehr, Cohler, & Musick, 1983; Musick, Stott, Spencer, Goldman, & Cohler, 1984; Stott, Musick, Clark, & Cohler, 1983; Stott et al., 1984). They are also less encouraging (Scherer, Melloh, Buyck, Anderson, & Foster, 1996); less affectionate and responsive (Goodman & Brumley, 1990); and less able to differentiate their own needs from those of their children (Cohler et al., 1980) than are mothers who do not have an illness. Sandler (2001) has presented a conceptual model of the aspects of adversity that contribute to problem outcomes in childhood; they include threats to satisfying basic needs for safety and biological integrity, self-worth, sense of personal control, social relatedness, and attaining developmental competencies. Masten et al. (1990) described how living with parents with mental illness might affect the physical and emotional care provided to children and therefore increase the likelihood that these children experience the stated aspects of adversity. Furthermore, Oyserman et al. (2000) summarized empirical support for a mediational model wherein maternal diagnosis and symptoms affect positive parenting attitudes that then affect children's behavior (for example, aggressive behavior, Hops et al. …

Dehydration: biological considerations, age-related changes, and risk factors in older adults.

Maintenance of water balance is essential to normal physiologic function and vigorous aging. Older adults, however, frequently experience alterations in fluid homeostasis, which result in dehydration. This article describes the physiology of water balance, age-related changes that influence fluid regulation, and associated risk factors for dehydration in older adults. Fluid hygiene is an important health promotion activity for this age group, but when efforts to prevent imbalance are unsuccessful, early identification and intervention to correct problems should be done to minimize adverse consequences. Although much is known about fluid homeostasis, dehydration, and contributory factors in the aging process, water disorders remain prevalent in this group. A great deal of work is still needed to determine "best practices" and creative clinical interventions to support adequate fluid intake behaviors. Both quality management programs and research studies provide avenues for systematic evaluation.

Relationship of stress, distress and inadequate coping behaviors to periodontal disease.

The association of stress, distress, and coping behaviors with periodontal disease was assessed. A cross-sectional study of 1,426 subjects between the ages of 25 and 74 years in Erie County, New York, was carried out to assess these relationships. Subjects were asked to complete a set of 5 psychosocial questionnaires which measure psychological traits and attitudes including discrete life events and their impact; chronic stress or daily strains; distress; coping styles and strategies; and hassles and uplifts. Clinical assessment of supragingival plaque, gingival bleeding, subgingival calculus, probing depth, clinical attachment level (CAL) and radiographic alveolar crestal height (ACH) was performed, and 8 putative bacterial pathogens from the subgingival flora measured. Reliability of subjects' responses and internal consistencies of all the subscales on the instruments used were high, with Cronbach's alpha ranging from 0.88 for financial strain to 0.99 for job strain, uplifts, and hassles. Logistic regression analysis indicated that, of all the daily strains investigated, only financial strain was significantly associated with greater attachment and alveolar bone loss (odds ratio, OR = 1.70, 95% CI = 1.09 to 2.65 and OR = 1.68, 95% CI = 1.20 to 2.37, respectively) after adjusting for age, gender, and cigarette smoking. When coping behaviors were evaluated, it was found that those with more financial strain who were high emotion-focused copers (a form of inadequate coping) had a higher risk of having more severe attachment loss (OR = 2.24, 95% CI = 1.15 to 4.38) and alveolar bone loss (OR = 1.91, 95% CI = 1.15 to 3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. Similar results were found among the low problem-focused copers for AL (OR = 2.21, 95% CI = 1.11 to 4.38) and ACH (OR = 2.12, 95% CI = 1.28 to 3.51). However, subjects with high levels of financial strain who reported high levels of problem-based coping (considered adequate or good coping) had no more periodontal disease than those with low levels of financial strain, suggesting that the effects of stress on periodontal disease can be moderated by adequate coping behaviors. We find that psychosocial measures of stress associated with financial strain and distress manifest as depression, are significant risk indicators for more severe periodontal disease in adults in an age-adjusted model in which gender (male), smoking, diabetes mellitus, B. forsythus, and P. gingivalis are also significant risk indicators. Of considerable interest is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studies also are needed to help establish the time course of stress, distress, and inadequate coping with respect to the onset and progression of periodontal disease, and the mechanisms that explain this association.