Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications

Purpose@#To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures. @*Materials and Methods@#Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics ® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually. @*Results@#The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa inFNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups. @*Conclusion@#Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.

Fragility Fractures of the Pelvis and Sacrum

The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications isneeded to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.

Importance of Balanced Attention Toward Coronavirus Disease 2019 and Neglected Tropical Diseases

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has been spreading since 2019, causing a worldwide pandemic. Amid the COVID-19 pandemic, tuberculosis, AIDS, and malaria have adversely affected the quality of life of patients and killed millions of people. In addition, COVID-19 continues to impede the delivery of health services, including those for the control of neglected tropical diseases (NTDs). Furthermore, NTDs have been reported as possible co-pathogens among patients infected with COVID-19. However, studies regarding parasitic co-infection among these patients have been limited. This review aimed to explore and describe the cases and reports of parasitic infections in the backdrop of COVID-19 to provide comprehensive knowledge regarding this aspect. We reviewed seven cases of patients who had parasitic co-infection and tested positive for COVID-19, and summarized the literature on the importance of controlling parasitic diseases. In addition, we identified recommendations for the control of parasitic diseases under possible difficulties, such as declining funding for parasitic diseases in 2020. This review highlights the growing burden of NTDs under COVID-19 that may be caused by the deficiency of healthcare infrastructure and human resources as the main reasons. Clinicians should remain vigilant for possible co-infections with parasites in COVID-19 patients, while policymakers are urged to reinforce a balanced and long-term health strategy that addresses both NTDs and COVID-19.

Microbiome of Haemaphysalis longicornis Tick in Korea

Ticks can transmit pathogenic bacteria, protozoa, and viruses to humans and animals. In this study, we investigated the microbiomes of Haemaphysalis longicornis according to sex and life stages. The Shannon index was significantly higher for nymphs than adult ticks. Principal coordinates analysis showed that the microbiome composition of female adult and male adult ticks were different. Notably, Coxiella-like bacterium (AB001519), known as a tick symbiont, was found in all nymphs and female adult ticks, but only one out of 4 male adult ticks had Coxiella-like bacterium (AB001519). In addition, Rickettsia rickettsii, Coxiella burnetii, and Anaplasma bovis were detected in this study.

Association between Sociodemographic Factors and Diarrhea in Children Under 5 Years in Rwanda

Diarrheal disease is the second leading cause of mortality and morbidity in children under 5 years old worldwide, and is the most common cause of malnutrition in sub-Saharan Africa. In Rwanda, diarrhea is the third leading cause of death in children under 5 years old. This study examined the association between sociodemographic factors and diarrhea in children under 5 years using the data of 7,474 households in the 2014-2015 Rwanda Demographic and Health Survey. Overall prevalence of diarrhea in this study was 12.7% in children. An increased risk for diarrhea was found for children aged 12-23 months (odds ratio (OR)=4.514), those with a low economic status (OR=1.64), those from the Western province (OR=1.439), those with poorly-educated mothers (OR=5.163), and those with families engaged in agricultural activities (OR=1.624). In conclusion, sociodemographic factors significantly affect the risk of developing diarrhea in children under 5 years in Rwanda. Designing and implementing health education promoting awareness of early interventions and rotavirus vaccination are essential to reduce diarrheal diseases for the Rwandan community.

Comparative Microbiome Analysis of Three Species of Laboratory-Reared Periplaneta Cockroaches

Cockroaches inhabit various habitats, which will influence their microbiome. Although the microbiome can be influenced by the diet and environmental factors, it can also differ between species. Therefore, we conducted 16S rDNAtargeted high-throughput sequencing to evaluate the overall bacterial composition of the microbiomes of 3 cockroach species, Periplaneta americana, P. japonica, and P. fuliginosa, raised in laboratory for several generations under the same conditions. The experiments were conducted using male adult cockroaches. The number of operational taxonomic units (OTUs) was not significantly different among the 3 species. With regard to the Shannon and Pielou indexes, higher microbiome values were noted in P. americana than in P. japonica and P. fuliginosa. Microbiome composition was also evaluated, with endosymbionts accounting for over half of all OTUs in P. japonica and P. fuliginosa. Beta diversity analysis further showed that P. japonica and P. fuliginosa had similar microbiome composition, which differed from that of P. americana. However, we also identified that P. japonica and P. fuliginosa host distinct OTUs. Thus, although microbiome compositions may vary based on multiple conditions, it is possible to identify distinct microbiome compositions among different Periplaneta cockroach species, even when the individuals are reared under the same conditions.

Molecular Detection of Toxoplasma Gondii in Haemaphysalis Ticks in Korea

Toxoplasma gondii are intracellular protozoa that can cause neurological disease or death in fetuses and even in immunocompromised human adults. Ticks are recognized as vectors of many microorganisms including viruses, bacteria, and protozoa. Recent studies detected T. gondii in various tick species in many countries. In this study, we performed PCR detection of the T. gondii B1 gene from Haemaphysalis ticks collected from vegetation in 4 localities, Wonju, Gunsan, Miryang, and Yangsan, in Korea. We analyzed DNA from 314 ticks (268 Haemaphysalis longicornis and 46 Haemaphysalis flava) and the B1 gene of T. gondii was detected in 13 of these. The detection of T. gondii in ticks differed significantly by region (P=0.021). T. gondii was detected in the following percentages of collected ticks: 3.7% (7 of 189) in Gunsan, 10% (5 of 50) in Wonju, 16.7% (1 of 6) in Yangsan, and 0% (0 of 69) in Miryang. The detection of T. gondii in ticks was not associated with tick species or development stage. This is the first report of T. gondii detection in ticks in Korea. Our results provide important information necessary to understand toxoplasmosis transmission.

Effectiveness of Mass Drug Administration on Neglected Tropical Diseases in Schoolchildren in Zanzibar, Tanzania

Soil-transmitted helminths and Schistosoma haematobium affect more than 3 billion people globally and mainly occur in sub-Saharan Africa. The present study assessed the overall infection status of a 1716-student cohort of school-children in Zanzibar and applied mass drug administration (MDA) to the cohort from 2007 to 2009. Schools in Pemba, Zanzibar, had a much higher prevalence of soil-transmitted helminth infections than those in Unguja, and the Chaani, Ghana, and Machui schools of Unguja exhibited high S. haematobium infection rates. The MDA program only partially controlled parasite infections, owing to high rates of re-infection. The infection rate of S. haematobium across all 10 schools, for example, was only reduced by 1.8%, and even this change not significant, even though the S. haematobiuminfection rates of the Chaani and Mzambarauni schools were significantly reduced from 64.4 and 23.4%, respectively, at the first screening, to 7.3 and 2.3% at the last screening. The overall infection rate of Ascaris lumbricoides was reduced from 36.0% at the first screening to 22.6% at the last screening. However, the infection rates for both Trichuris trichiuraand hookworm were generally unaffected by MDA. In the future, parasite control programs should involve strategically designed MDA schedules and holistic intervention (e.g., sanitation improvement, hygiene behavior changes, and control of intermediated hosts).

Survey of IgE Reactivity to Nonbiting Midges in Korea and Identification of IgE-Binding Protein

PURPOSE: Chironomids (nonbiting midges) are widely and abundantly distributed near ponds, rivers, and artificially dammed pools used for irrigation. Chironomids contain allergens and cause airway allergy in humans. In this study, we aimed to examine the allergic potential of chironomids in inhabitants living near artificially dammed pools. METHODS: We examined immunoglobulin E (IgE) reactivity to chironomid extracts in the sera of residents living around installed dams and assessed the correlations of IgE responses between chironomids (Chironomus flaviplumus, Chironomus kiiensis, Cricotopus bicinctus) and house dust mites (Dermatophagoides farinae). In addition, we identified potential IgE binding proteins specific for adult C. bicinctus, a popular species in Korea. Specific IgE antibodies in sera collected from the participants against the extracts were tested using enzyme-linked immunosorbent assay (ELISA). RESULTS: The average IgE-positive rates were 10.4%, 8.1%, and 8.2% in C. bicinctus, C. flaviplumus, and C. kiiensis, respectively. The IgE-positive rate and IgE titer of C. bicinctus antigen were higher in residents living around installed dams than in those who lived other places (P = 0.013). Western blotting using sera having high IgE titers to C. bicinctus in ELISA showed the presence of a protein of approximately 42 kDa that was homologous to the actin protein isoform in C. bicinctus extracts as demonstrated using mass spectrometry. CONCLUSIONS: Our results showed that people living near installed dams were more sensitized to C. bicinctus and that the 42 kDa IgE-binding protein could be useful for further studies on chironomid allergic disease and clinical applications.

Prevalence of Tick-Borne Pathogens from Ticks Collected from Cattle and Wild Animals in Tanzania in 2012

This study was aimed to disclose the prevalence rate of tick-borne pathogens from ticks collected from cattle and wild animals in Tanzania in 2012. Ticks were collected from slaughtered cattle and dead wild animals from November 5 to December 23, 2012 and identified. PCR for detecting Anaplasmataceae, Piroplamidae, Rickettsiaceae, Borrelia spp., and Coxiella spp. were done. Among those tested, Rickettsiaceae, Piroplasmidae, and Anaplasmataceae, were detected in ticks from the 2 regions. Rickettsiaceae represented the major tick-borne pathogens of the 2 regions. Ticks from animals in Maswa were associated with a higher pathogen detection rate compared to that in ticks from Iringa. In addition, a higher pathogen detection rate was observed in ticks infesting cattle than in ticks infesting wild animals. All examined ticks of the genus Amblyomma were infected with diverse pathogens. Ticks of the genera Rhipicephalus and Hyalomma were infected with 1 or 2 pathogens. Collectively, this study provides important information regarding differences in pathogen status among various regions, hosts, and tick species in Tanzania. Results in this study will affect the programs to prevent tick-borne diseases (TBD) of humans and livestock in Tanzania.

Implementation of a Direct Medical Direction System for 119 EMS Providers and Expansion of Scope of Practices Under the Indirect Protocols-Experience in Gyunggi Province

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.

Left Atrium Compressed by a Traumatic Focal Aneurysm of the Thoracic Aorta / 대한내과학회지

A 78-year-old woman presented to our hospital with progressive dyspnea (NYHA class I-II) and epigastric discomfort that had developed after a traffic accident. She had a history of hypertension and cerebral infarction, but no history of cardiovascular disease. Her blood pressure was 130/70 mmHg and her heart rate was 66 beats/min and regular. The electrocardiogram showed normal sinus rhythm. The chest X-ray revealed bilateral pleural effusions. Transthoracic echocardiography (TTE) demonstrated an aneurysm of the descending thoracic aorta compressing the left atrium (LA). Left and right ventricular systolic function was preserved. Whole-body computed tomography (CT) angiography revealed that a focal 40-mm-diameter saccular aneurysm in the descending aorta at the level of T7-8, with an intramural hematoma, was compressing the LA and left pulmonary vein. After surgical management, follow-up TTE and CT showed decompression of the LA and left pulmonary vein.

Vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women

OBJECTIVE: To evaluate the vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women and their relation with body mass index (BMI) and woman's age. METHODS: This retrospective study included 257 women who visited emergency center at university-based hospital from January to December 2011. All women underwent abdomino-pelvic computerized tomography (CT) due to various symptoms in a supine position. By using the electronic coronal CT images, the vertical distance between umbilicus and aortic bifurcation was measured. If aortic bifurcation was located below umbilicus, the distance was expressed as minus value (i.e., caudal to umbilicus). Age of woman, body weight, height and calculated BMI (kg/m2) were also recorded. RESULTS: Aortic bifurcation was located caudal to umbilicus in 52.9% and cephalad to umbilicus in 37.4%. The vertical distance had a negative relationship with BMI (r=.0.180, P=0.004), as well as woman's age (r=-0.382, P<0.001). However, a multivariate analysis revealed that the vertical distance had a significant negative relationship with woman's age (P<0.001) but not with BMI (P=0.510). An equation could be drawn to estimate the vertical distance by using woman's age and BMI: vertical distance (mm)=12.6-0.3x(age)-0.2x(BMI). CONCLUSION: The vertical distance from umbilicus to aortic bifurcation on coronal view showed a significant inverse correlation with woman's age, however, the distances varied widely. Most older or obese Korean women had aortic bifurcation caudal to umbilicus.

Corrected QT Interval Prolongation during Severe Hypoglycemia without Hypokalemia in Patients with Type 2 Diabetes

BACKGROUND: To evaluate the effects of severe hypoglycemia without hypokalemia on the electrocardiogram in patients with type 2 diabetes in real-life conditions. METHODS: Electrocardiograms of adult type 2 diabetic patients during the episodes of severe hypoglycemia and the recovered stage were obtained and analysed between October 1, 2011 and May 31, 2012. Patients who maintained the normal serum sodium and potassium levels during the episodes of severe hypoglycemia were only selected as the subjects of this study. Severe hypoglycemia was defined, in this study, as the condition requiring active medical assistance such as administering carbohydrate when serum glucose level was less than 60 mg/dL. RESULTS: Nine type 2 diabetes patients (seven men, two women) were included in the study. The mean subject age was 73.2+/-7.7 years. The mean hemoglobin A1c level was 6.07%+/-1.19%. The median duration of diabetes was 10 years (range, 3.5 to 30 years). Corrected QT (QTc) intervals were significantly increased during the episodes of severe hypoglycemia compared to the recovered stage (447.6+/-18.2 ms vs. 417.2+/-30.6 ms; P<0.05). However, the morphology and the amplitude of the T waves were not changed and ST-segment elevation and/or depression were not found during the episodes of severe hypoglycemia. CONCLUSION: In this study, QTc interval prolongation during the episodes of severe hypoglycemia was observed without hypokalemia. Therefore, the distinct alterations in cardiac repolarization during the episodes of severe hypoglycemia may not be associated with hypokalemia.

Association between serum anti-Mullerian hormone level and ovarian response to mild stimulation in normoovulatory women and anovulatory women with polycystic ovary syndrome / 대한생식의학회지

OBJECTIVE: To evaluate the correlation between serum levels of anti-Mullerian hormone (AMH) and ovarian response to mild stimulation in normoovulatory women and anovulatory women with polycystic ovary syndrome (PCOS). METHODS: Seventy-four cycles of mild stimulation (clomiphene citrate+gonadotropin followed by timed intercourse or intrauterine insemination) performed in normoovulatory women (57 cycles) and anovulatory women with PCOS (17 cycles). Ovarian sensitivity was defined by the number of mature follicles (> or =14 mm) on triggering day per 100 IU of gonadotropin. A correlation between ovarian sensitivity and the baseline serum AMH level (absolute or multiples of the median [MoM] value for each corresponding age) was calculated. Correlation between ovarian response and serum AMH level was evaluated. RESULTS: Ovarian sensitivity to mild stimulation was positively correlated with absolute serum AMH (r=0.535, p0.05, r=-0.265, p>0.05, respectively). CONCLUSION: Ovarian response to mild stimulation is possibly predicted by the serum AMH level in normoovulatory women, but not in anovulatory women with PCOS.

Effect of myoma size on failure of thermal balloon ablation or levonorgestrel releasing intrauterine system treatment in women with menorrhagia

OBJECTIVE: The aim of the present study was to identify variables associated with treatment failure in women with menorrhagia who were treated with thermal balloon ablation (TBA) or levonorgestrel releasing intrauterine system (LNG-IUS), and to determine if there are subgroups where one treatment type is more effective than the other. METHODS: The study included 106 women with menorrhagia who were treated with TBA or LNG-IUS at the study institute between January 2003 and December 2007, with a follow-up period greater than 12 months. Data were collected by retrospective review of medical records. Treatment failure was defined as persistent or recurrent menorrhagia within one year after treatment or hysterectomy at any time during follow-up. The relationships between variables and treatment outcome were analyzed using the chi-square or Fisher's exact test. The treatment outcome of TBA was compared with LNG-IUS. RESULTS: Sixty-seven women were treated with TBA and 39 women were managed with LNG-IUS. Fifty-two women had a myoma > or =2.5 cm. Treatment failure was observed in 24 women (2 recurrent or persistent menorrhagia and 22 hysterectomies) and myoma size (> or =2.5 cm vs. <2.5 cm) was associated with treatment outcome. TBA and LNG-IUS showed similar treatment outcomes. CONCLUSION: A large myoma is a risk factor for treatment failure in women with menorrhagia treated with TBA or LNG-IUS.

Intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis: Two case reports

Embolization of the uterine arteries is a valuable method for controlling postpartum hemorrhage. There have been recent attempts to apply this tool as a means of controlling bleeding during Cesarean section, especially in patients with placenta previa. However, the benefits are controversial due to lack of randomized controlled studies, no evidence of significant improved outcomes, and potential harm including radiation exposure. This paper includes two case reports of intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis.

Preoperative Serum Anti-Mullerian Hormone Level in Women with Ovarian Endometrioma and Mature Cystic Teratoma

PURPOSE: To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. MATERIALS AND METHODS: In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. RESULTS: Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean+/-SEM, 2.9+/-0.3 ng/mL vs. 3.3+/-0.3 ng/mL, p=0.28 and 1.3+/-0.1 vs. 1.6+/-0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1+/-0.3 vs. 3.1+/-0.4 ng/mL, p=0.02 and 1.1+/-0.1 vs. 1.7+/-0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7+/-0.5 vs. 3.4+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.5+/-0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0+/-0.5 ng/mL vs. 4.0+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.6+/-0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r2=0.13, p<0.01). CONCLUSION: In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma.

Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach

OBJECTIVE: To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. METHODS: A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. RESULTS: Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. CONCLUSION: Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.

Related factors of the approval for the community water fluoridation program in Incheon Metropolitan City / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to heighten the community residents' support and approval on the community water fluoridation program, which presents the basic data in devising strategies that will expand the program. METHODS: The research subjects of this study were 700 adults, over the age of 20, who resided in the Incheon Metropolitan City. In order to analyze the factors that were related to the approval on administering the community water fluoridation program, the data were analyzed using a chi-squared test and a multiple logistic regression analysis. RESULTS: Respondents approving the implementation of the community water fluoridation program, in Incheon Metropolitan City, were 58.7%. Major reasons for opposing the program were 'harmful', 'influence the taste and color of water', and 'objections without a particular reason'. The approval rate for implementation of the program was higher in the group who perceived that oral health was good and practiced oral health behaviors, like visiting the dental clinics on a regular basis. Also, it was higher in the group who had the experience of hearing of this program at least once and a higher knowledge of the community water fluoridation program. Especially, the strongest correlations were found between the knowledge of community water fluoridation program and the approval rate for implementation the program. CONCLUSIONS: In order to enhance the rate of approval on administrating the community water fluoridation program, it is necessary to publicize the purpose, effect, and stability of this program, through a diverse mass media and reinforce the health education program to oral health management.