***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Adherence to oral self-care behaviors is low among adolescents . Purpose This study aims to examine effects of two message framing interventions on oral self-care behaviors and health among Iranian adolescents . Methods Cluster-r and omized controlled trial , with four schools r and omly assigned to receive gain-framed , loss-framed , or no messages .  Brushing/flossing , attitudes , intentions , oral health related quality of life ( OHRQOL ) , and clinical examinations were measured at baseline , two and twenty-four weeks . Data were analyzed using multilevel modeling . Results At 2 weeks , loss-frame participants reported higher brushing and flossing rates , and more favorable attitudes and intentions to brush , compared to the other groups . At 24 weeks , loss-frame participants showed better OHRQOL , gingival health and less dental plaque compared to the other groups . Attitudes and intentions mediated intervention effects for the loss-framed group . Conclusions Loss-framed messages were more effective than gain-framed messages in encouraging oral self-care behaviors among Iranian adolescents . These effects were mediated through attitudes and intentions . ( clinical trials.gov number NCT01421108 . OBJECTIVES Determine the impact of an oral health education program on oral hygiene and the awareness level of elementary schoolchildren . METHODS A total sample of 247 schoolchildren between the ages of 7 and 15 years from the public school system of Parnamirim , Brazil , were selected and r and omly allocated to a control ( n=115 ) and experimental ( n=132 ) group .  Sociodemographic data were recorded and a clinical examination was given to establish the decayed , missing and filled surfaces index ( DMFS ) and the dmfs index . The visible plaque index ( VPI ) and gingival bleeding index ( GBI ) were collected before and after the intervention . A closed- question question naire was applied to the schoolchildren before and after intervention to determine their knowledge of oral health . The experimental group took part in oral health education activities over a 4-month period . RESULTS The VPI ( P = 0.014 ; CI 0.24 - 0.86 ) and GBI ( P = 0.013 ; CI 0.28 - 0.87 ) of the experimental group were significantly lower after educational activities . Similarly , the experimental group also obtained a higher number of correct answers on the question naire ( P < 0.0001 ; CI 3.73 - 26.81 ) . However , there was no association between oral hygiene indicators , VPI ( P = 0.311 ; CI 0.23 - 1.60 ) , and GBI ( P = 0.927 ; CI 0.43 - 2.16 ) , and the information level of the schoolchildren . CONCLUSIONS Context ualized educational activities in the school routine had positive effects on oral hygiene and the level of information about oral health , although the more informed individuals did not always practice better oral hygiene Objective : To evaluate the effects of exposure to the School Oral Health Program ( SOHP ) during primary school years on the current oral health ( OH ) knowledge and practice s and OH-related quality of life ( OHRQoL ) of Kuwait University students . Subjects and Methods : 300 university students , aged 17.6 - 24.3 years , completed a vali date d question naire that consisted of 5 sections about demographics , health self-evaluation , OH knowledge and practice s and OHRQoL. Of these students , 260 were female , 40 male , 262 single and 38 married . 189 participants had attended the SOHP , while 111 had not . Frequencies and means were used for data description . The Student t test was used to compare the means , while χ2 analysis was used for the associations between SOHP and non-SOHP attendance . The odds ratios ( ORs ) were calculated for significant factors . Results : The SOHP attendees were twice as aware of the relationship between gum problems and heart diseases than the non-SOHP ( OR = 2 , 95 % CI = 1.15 - 3.48 , p = 0.013 ) . The daily activities of the non-SOHP attendees were twice as likely to be affected by dental health issues compared to those of the SOHP attendees ( OR = 2.28 , 95 % CI = 1.41 - 3.68 , p < 0.001 ) . In addition , the SOHP attendees were 3 times as likely to describe their OH status as good/very good/excellent than the non-SOHP attendees ( OR = 2.85 , 95 % CI = 1.31 - 6.18 , p = 0.008 ) . Conclusions : The SOHP attendees had a better OHRQoL and overall self-satisfaction with their OH than the non-SOHP attendees with insignificant differences between the 2 groups in OH knowledge and practice The purpose of this study was to test the efficacy of an educational program aim ed at improving oral health knowledge and behaviors in junior high school students in indigenous communities in Taiwan . Two junior high schools were r and omly selected . Students in the intervention school received an oral health education program . Both groups received structured question naires to assess their  oral health practice s and risk behaviors at baseline and after the intervention . The intervention group had statistically significant positive changes in their oral health knowledge ( p<.001 ) , an increase in tooth-brushing frequency ( p<.001 ) , and a decrease in tobacco use ( p=.01 ) . Most ( 87 % ) students considered the educational program excellent or good . Carefully design ed health education programs delivered within schools in areas with limited access to health care can improve the students ’ knowledge and reduce their risk behaviors which may prove to be a mechanism that ultimately reduces health disparities Parents and school staff play important roles in promoting children 's oral health . Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren . Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group r and omized trial from September 2010 to March 2011 . Schools were r and omly allocated into three groups : comprehensive , student , and control . Intervention in the comprehensive group consisted of strategies to encourage children , their parents , and school staff to increase the frequency of toothbrushing and flossing . In the student group , the intervention targeted only children . The control group received no intervention . The primary outcome was change in oral-health behaviors ( brushing and flossing ) , while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components . Multilevel modeling was employed for data analyses . Students who were in the comprehensive intervention group  brushed and flossed significantly more frequently compared with those in the student intervention group . Although students ' gingival health improved significantly in the comprehensive intervention group , such significant improvement was not seen in the student group . In conclusion , promising results are seen when the oral-health education targets both school and home setting Considerable re sources are expended in dealing with dental disease easily prevented with better oral hygiene . The study hypothesis was that an evidence -based intervention , framed with psychological theory , would improve patients ’ oral hygiene behavior . The impact of trial methodology on trial outcomes was also explored by the conducting of two independent trials , one r and omized by patient and one by dentist . The study included 87 dental practice s and 778 patients ( Patient RCT = 37 dentists/300 patients ; Cluster RCT = 50 dentists/478 patients ) . Controlled for baseline differences , pooled results showed that patients who experienced the intervention had better behavioral ( timing , duration , method ) , cognitive ( confidence , planning ) , and clinical ( plaque , gingival bleeding ) outcomes . However , clinical outcomes were significantly better only in the Cluster RCT , suggesting that the impact of trial design on results needs to be further explored The objective of this study was to compare the impact on knowledge and counseling skills of face-to-face and Internet-based oral health training programs on medical students . Participants consisted of 148 ( 82 percent ) of the 180 invited students attending their fifth academic year at the Faculty of Medicine , University of São Paulo , Brasil , in 2007 . The interventions took place during a three-month training period in the clinical Center for Health Promotion , which comprised part of a clerkship in Internal Medicine . The students were divided into four groups : 1 ) Control Group ( Control ) , with basic intervention ; 2 ) Brochure Group ( Br ) , with basic intervention plus complete brochure with oral health themes ; 3 ) Cybertutor Group ( Cy ) , with basic intervention plus access to an Internet-based training program about oral health themes ; and 4 ) Cybertutor + Contact Group ( Cy+C ) , the same as Cy plus brief proactive contact with a tutor . The impact of these interventions on student knowledge was measured with pre- and post assessment s , and student skills in asking and counseling about oral health were assessed with an objective structured clinical examination ( OSCE ) . Multivariate logistic regression models were applied to identify the odds ratios of scoring above Control 's medians on the final assessment and the OSCE . In the results , Cy+C performed significantly better than Control on both the final assessment ( OR 9.4 ; 95 % CI 2.7 - 32.8 ) and the OSCE ( OR 5.6 ; 95 % CI 1.9 - 16.3 ) and outperformed all the other groups . The Cy+C group showed the most significant increase in knowledge and the best skills in asking and counseling about oral health 
    Output:
    
This study found that past OHEPIs are effective and positive impacts on dental visits , attitudes , as well as brushing and flossing behaviours during 3 months post-intervention among children