Validación de contenido de un cuestionario para explorar actitudes y prácticas de odontólogos no especialistas en periodoncia

Objetivo: Validar el contenido de un cuestionario de auto-reporte en español para explorar actitudes, prácticas y barreras de odontólogos no especialistas en periodoncia frente al diagnóstico y tratamiento de problemas periodontales y criterios para derivar. Materiales y métodos: Seis especialistas en periodoncia de cinco países latinoamericanos construyeron versión#1 de un cuestionario. 21 expertos de tres áreas disciplinares de 6 países valoraron de 1 a 5 (1: totalmente en desacuerdo, 5: totalmente de acuerdo) cada ítem en su pertinencia, relevancia, claridad y coherencia. Según grado de acuerdo se reformuló cada ítem y se construyó versión#2 que fue piloteada en 60 odontólogos no especialistas en periodoncia, 3 de ellos fueron entrevistados para evaluar la comprensión y semántica. Luego del análisis se elaboró la versión final (versión#3). Resultados: Los ítems formulados de versión#1 tuvieron una valoración promedio de 4,6 (rango 3.7-5). Fueron reformulados evitando palabras confusas y que tuvieran aceptación transversal en países participantes, se eliminó ítem con menor puntuación de acuerdo de expertos. La aplicación de versión#2 tuvo un tiempo de respuesta de 12 minutos, se reformularon opciones y agregaron 4 ítems para obtener la versión final con 44 preguntas. Conclusiones: Se construyó un cuestionario de auto-reporte con validez de contenido para evaluar actitudes y prácticas en salud-enfermedad periodontal en odontólogos generales o no especialistas en periodoncia de habla hispana.

Aim: T o validate the content of a self-report questionnaire in Spanish to explore attitudes, practices and barriers of dentists non-specialized in periodontics when facing the diagnosis and treatment of periodontal problems and criteria for referral. Materials and methods: Six specialists in periodontics from five Latin American countries constructed version#1 of a questionnaire. Twenty-one experts from 3 disciplinary areas from 6 countries rated each item from 1 to 5 (1: totally disagree, 5: totally agree) regarding its appropriateness, relevance, clarity, and coherence. According to the degree of agreement, the item was reformulated, and version #2 was built, which was tested on 60 dentists non-specialized in periodontics. Then, 3 of them were interviewed to assess comprehension and semantics. After analysis, the final version was prepared (version#3). Results: The items formulated in version#1 had an average score of 4.6 (range 3.7-5). Questions and options were reformulated, avoiding confusing words and having transversal acceptance in the participating countries. The items with the lowest degree of expert agreement were eliminated. The application of version#2 had a response time of 12 minutes, options were reformulated, and 4 items were added to obtain the final version with 44 questions. Conclusions: A self-report questionnaire with content validity was constructed to assess attitudes and practices in periodontal health and disease in Spanish-speaking general dentists or non-specialists in periodontics.

Psychometric Properties of the Personality Inventory for DSM-5 faceted Brief Form in a Brazilian Community Sample / Propiedades Psicométricas del Inventario de Personalidad Para la Forma Breve Facetada del DSM-5 en una Muestra Comunitaria Brasileña

abstract Objective: The aim of the present study was to verify the psychometric qualities of the PID-5-FBF in a community sample of Brazilian adults. The internal consistency of the facets and the internal structure of the dimensions were checked. In addition, we verified the correlations between the PID-5-FBF facets and domains with a five-factor model measure. Methods: The sample of this study consists of the 774 Brazilian adults aged 18 to 73 years (mean 28.9 ± 11.58) who answered the PID-5-FBF and BFI-2S. Results: The alpha values were adequate. The internal structure was similar to the PID-5 original form. All the factors and dimensions of the PID-5-FBF have a negative association with agreeableness, while, on the other hand, all correlations with neuroticism were positive. Neuroticism was the factor with the highest correlation with the PID-5-FBF, and openness was the one with the lowest number of correlations. Conclusions: This research contributes to adding evidence of validity to the PID-5-FBF in the Brazilian community sample. Our results are important because it is the first study with the PID-FBF in a Brazilian sample.

resumen Objetivo: El objetivo del presente estudio es verificar las cualidades psicométricas del PID-5- FBF en una muestra comunitaria de adultos brasileños. Se comprobó la consistencia interna de las facetas y la estructura interna de las dimensiones. Además, se verificaron las correlaciones entre las facetas y los dominios de PID-5-FBF con una medida del modelo de 5 factores. Métodos: Formaron la muestra de este estudio los 774 adultos brasileños de 18 a 73 (media, 28,9±11,58) an˜ os que respondieron al PID-5-FBF y BFI-2S. Resultados: Los valores alfa fueron adecuados. La estructura interna era similar a la forma original del PID-5. Todos los factores y dimensiones del PID-5-FBF tienen una asociación negativa con la agradabilidad y, por otro lado, todas las correlaciones con el neuroticismo fueron positivas. El neuroticismo fue el factor con mayor correlación con el PID-5-FBF y la apertura, el de menor número de correlaciones. Conclusiones: La presente investigación contribuye a agregar evidencia de validez al PID-5- FBF en la muestra de la comunidad brasileña. Nuestros resultados son importantes porque es el primer estudio con PID-FBF en una muestra brasileña.

Validation of the Brazilian version of the Short Inventory of Grazing (SIG)

Abstract Objective Grazing is a disturbed eating pattern that has been associated with eating disorders and obesity. One of the new measures to investigate this eating behavior is the Short Inventory of Grazing (SIG), a two-item questionnaire that assesses grazing in general and grazing associated with the feeling of loss of control over eating (LOC grazing). However, the psychometric properties of the SIG have not been assessed in the Brazilian population. The present study aimed to cross-culturally adapt and validate a Brazilian version of the SIG. Methods The SIG was adapted to the Brazilian context following international guidelines. Then, 90 undergraduate students completed an online survey including questions from the SIG, the Binge Eating Scale (BES), the Patient Health Questionnaire-9 (PHQ9), the Generalized Anxiety Disorder-7 (GAD7), and a question related to self-reported health status. The internal consistency, test-retest reliability, and convergent validity of the questionnaire were assessed. Results The prevalence rates of at least one weekly episode of grazing in general and LOC grazing were 71.1 and 54.5%, respectively. The internal consistence of the SIG was acceptable (0.81). In addition, SIG scores on both items were positively and significantly associated with BES, GAD7, and PHQ9 scores, and with poorer self-rated health. However, SIG test and retest scores differed significantly. Conclusion Overall, the Brazilian version of the SIG demonstrated adequate psychometric properties. The instrument had adequate internal consistency, with both items exhibiting good convergent validity with related measures.

Reliability and validity of remote Life Space Assessment: LSA in persons with chronic stroke / Confiabilidade e validade da escala Life Space Assessment aplicada remotamente: LSA em pacientes com AVC crônico

Abstract Background StepWatch Activity Monitor (SAM) is used to measure the mobility of chronic hemiparetic patients and the Life Space Assessment (LSA) scale was developed to assess the displacement of hemiparetic patients in different contexts through self-reporting. Studies that apply the LSA remotely and correlate it with the number of steps measured by the SAM were not found. Objective To evaluate the measurement properties of the LSA applied remotely and to evaluate the correlation between the LSA scale score and the number of steps measured by the SAM in post-stroke chronic hemiparetic patients. Methods Nineteen patients participated in the study. The LSA scale was applied remotely and later, face to face. The SAM measured the steps taken by the participants over a period of three consecutive days. The correlation between the LSA and the SAM was performed using Pearson's correlation. The measurement properties calculated of remote LSA were the intraclass correlation coefficient (ICC), Cronbrach's alpha, standard error of measurement (SEM), and smallest real difference (SRD). Results The reproducibility of the LSA scale between remote and face-to-face applications was considered excellent with ICC = 0.85 (IC 95% 0.62-0.94); SEM = 8.4; SRD = 23.2, and Cronbach's alpha = 0.85. The correlation between SAM and LSA was positive, considered moderate (r = 0.51) and significant (p = 0.025). Conclusion The LSA is a reproducible measure for post-stroke chronic hemiparetic patients even if applied remotely and can be used as a remote measurement for mobility in a real-world environment for people with chronic hemiparesis after stroke.

Resumo Antecedentes O StepWatch Activity Monitor (SAM) é utilizado para medir a mobilidade de pacientes hemiparéticos crônicos e a escala Life Space Assessment (LSA) avalia o deslocamento de pacientes hemiparéticos em diferentes contextos por meio de autorrelato. Não foram encontrados estudos que tenham aplicado a LSA remotamente nem que a correlacionam com o número de passos mensurados pelo SAM. Objetivo Avaliar as propriedades de medida da LSA aplicada remotamente e avaliar a correlação entre o escore da escala LSA e o número de passos mensurados pelo SAM em pacientes com hemiparesia crônica pós-AVC. Métodos Dezenove participantes responderam a LSA remotamente e, posteriormente, presencialmente. O SAM mediu os passos dados pelos participantes durante um período de três dias consecutivos. A correlação entre a LSA e o SAM foi realizada por meio da correlação de Pearson. As propriedades de medida calculadas da LSA aplicada remotamente foram o coeficiente de correlação intraclasse (ICC), alfa de Cronbrach, erro do padrão de medida (SEM) e menor diferença real (SRD). Resultados A reprodutibilidade da escala LSA entre as aplicações remotas e presenciais foi considerada excelente com ICC = 0,85 (IC 95% 0,62-0,94); SEM = 8,4; SRD = 23,2 e alfa de Cronbrach = 0,85. A correlação entre SAM e a LSA foi positiva, considerada moderada (r = 0,51) e significativa (p= 0,025). Conclusão A LSA é uma medida reprodutível para pacientes hemiparéticos crônicos pós-AVC mesmo se aplicada remotamente e pode ser usada como uma medida remota de mobilidade em ambiente real para pessoas com hemiparesia crônica após AVC.

Autopercepção sobre habilidades auditivas e acadêmicas de adultos / Auditory and academic skills self-perception in adults

RESUMO Objetivo Descrever e analisar queixas auditivas e acadêmicas de universitários e funcionários de uma universidade pública federal. Métodos O estudo foi realizado por amostra não-probabilística. A Escala de Autopercepção de Habilidades do Processamento Auditivo Central com adaptações foi utilizada para cumprir os objetivos da pesquisa. Esta possui 14 questões sobre queixas relacionadas às habilidades auditivas e 12 relacionadas ao ambiente acadêmico. Foi realizada a análise descritiva dos dados por meio da distribuição de frequência das variáveis categóricas e, para as análises de associação, foi utilizado o teste Qui-quadrado de Pearson. Resultados Participaram da pesquisa 646 indivíduos com faixa etária entre 17 e 67 anos. As queixas mais prevalentes foram: dificuldade acadêmica relacionada à memória, concentração e planejamento, ouvir e compreender a fala no ruído, e memorização de tarefas que foram apenas ouvidas. Houve associação com significância estatística bidirecional entre as queixas acadêmicas e auditivas. Conclusão Foi possível observar que há associação entre queixas auditivas e acadêmicas em adultos, marcada pela relação de aspectos cognitivos com aspectos auditivos. É relevante que esses fatores sejam considerados ao realizar avaliações do Processamento Auditivo Central, ao se intervir em pacientes com queixas auditivas, e na vida estudantil.

ABSTRACT Objective To describe and analyze auditory and academic complaints of students and employees of a federal public university. Methods The study was carried out using a non-probabilistic. The EAPAC Scale with adaptations was used to fulfill the research objectives. It has 14 questions about complaints related to listening skills and 12 questions related to the academic environment. Descriptive data analysis was performed through the frequency distribution of categorical variables and Pearson's chi-square test was used for association analyses. Results 646 individuals aged between 17 and 67 years old participated in the research. The most prevalent complaints were academic difficulty related to memory, concentration, and planning, hearing and understanding speech in noise, and memorization of tasks that were only heard. There was an association with bidirectional statistical significance between academic and auditory complaints. Conclusion It was possible to observe that there is an association between auditory and academic complaints in adults, marked by the relationship between cognitive and auditory aspects. It is relevant that these factors are considered when performing assessments of Central Auditory Processing when intervening in patients with auditory complaints, and in student life.

Normative Values for the Spanish Version of the Voice Symptom Scale (VoiSS)

Objective: The aim of this study was to establish normative values for the Voice Symptom Scale (VoiSS) in the Spanish community population (without voice problems), using a sample from a large area of southeastern Spain. Method: The sample consisted of 115 adults from ages 16 to 87, 60 of whom were women and 55 were men. Participants included the family members of patients who attended the Otorhinolaryngology (ENT) and Speech Therapy Clinic at a referral hospital in the region of Murcia, Spain, and some of the clinic's staff. All the participants reported never having suffered from any voice disorder before. Results: The normative values obtained in this study for the VoiSS were 14.61 (SD=8.18) for the total score, 7.57 (SD = 5.42) for the Impairment subscale, 1.04 (SD = 1.65) for the Emotional subscale, and 5.99 (SD = 3.61) for the Physical subscale. The percentile values were also obtained for the VoiSS scale and for its three subscales. Conclusions: This study presents normative values for the VoiSS scale that have not previously been obtained in Spain. These values can be used as a reference to detect possible voice disorders.

Objetivo: El objetivo de este estudio fue establecer valores normativos para la escala Voice Symptom Scale (VoiSS) en población comunitaria española (sin problemas de voz), utilizando una muestra de un área extensa del sureste de España. Metodología: La muestra estuvo compuesta por 115 personas (60 mujeres y 55 hombres) con edades comprendidas entre los 16 y 87 años. Los participantes eran familiares que acompañaron a los pacientes a las sesiones clínicas de ORL y de Logopedia de un hospital de referencia de la Región de Murcia, así como personal del hospital. Todos declararon no padecer ningún trastorno de la voz. Resultados: Los valores normativos obtenidos en este estudio para el VoiSS fueron 14.61 (SD=8.18) para la puntuación total, 7.57 (SD = 5.42) para la subescala Limitación, 1.04 (SD = 1.65) para la subescala Emocional y 5.99 (SD = 3.61) para la subescala Física. Los valores percentílicos se obtuvieron también para la escala VoiSS y para sus tres subescalas. Conclusiones: Este estudio presenta valores normativos para la escala VoiSS que no han sido todavía obtenidos en España. Estos valores pueden utilizarse como referencia para detectar posibles trastornos de voz.

Diseño y validación de una escala de soporte social para adolescentes / Design and validation of a social support scale for adolescents

Introducción: el soporte social es de gran importancia en la adolescencia; aquellos adolescentes con mayor soporte tienen mejores estrategias de salud. Existen pocos instrumentos para evaluar el soporte social en todas sus dimensiones y las fuentes de éste, ninguno ha sido validado en español. El objetivo de este estudio es evaluar la validez y confiabilidad de un nuevo instrumento para identificar el soporte social y la fuente de este soporte en adolescentes. Material y métodos: la escala de soporte social para adolescentes (ESSA) consiste en un cuestionario de autoaplicación de 22 ítems, con cinco opciones de respuesta tipo Likert que van de nunca a siempre, con seis subescalas: familia, mejor amigo, compañeros de clase, profesores, otras relaciones, y salud general y oral. Los datos de la ESSA se recogieron de estudiantes de secundaria (N = 191; edad media 16.1 ± 1.2 años). Los análisis psicométricos incluyeron análisis factorial de ejes principales, consistencia interna (alfa de Cronbach) y correlaciones de la escala con la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Depresión 20 del Centro de Estudios Epidemiológicos (CESD20) (correlaciones de Spearman, p). Resultados: el análisis factorial de ejes principales mostró que la escala explica el 72.23% de la variabilidad. La escala completa mostró una consistencia interna adecuada, con un alfa de Cronbach = 0.92 [0.90-0.93]. En cuanto a la validez discriminativa, la correlación con las puntuaciones de la escala CES-D20 fue ρ = -0.32, la escala mostró una fuerte correlación con las puntuaciones MSPSS (p = 0.81). Los resultados fueron estables en la repetibilidad (ICC = 0.93). Conclusiones: la ESSA es válida y confiable. Este instrumento podría ser adecuado para una amplia gama de aplicaciones de investigación entre la población adolescente (AU)

Introduction: social support is of great importance in adolescence; those who have more support have better health strategies. There are few instruments to evaluate social support in all its dimensions and the sources of this support, and none has been validated in Spanish. The aim of this study is to evaluate the validity and reliability of a new instrument to identify social support and the source of this support for adolescents. Material and methods: the adolescent social support scale (ADSSS) consists of a 22-item self-report questionnaire with 5 Likert-type responses ranging from never to always and six different subscales: family, best friend, classmates, teachers, other relationships, and general and oral health. ADSSS data were collected from high school students (N = 191; mean age 16.1 years [standard deviation = 1.2]). Psychometric analyses included main axis factor analysis, internal consistency (Cronbach's alpha), and scale correlations with the multidimensional scale of perceived social support (MSPSS) and the Center for Epidemiologic Studies Depression Scale-20 (CES-D20) (Spearman correlations, p). Results: main axis factor analysis showed that the scale explained 72.23% of the variability. The entire scale showed adequate internal consistency, with Cronbach's alpha = 0.92 [0.90-0.93]. For discriminative validity, the correlation with CES-D20 scores was p = -0.32, and the scale showed a strong correlation with MSPSS scores (p = 0.81). The results were stable across repeated measurements (ICC = 0.93). Conclusions: the ADSSS has good reliability and validity. This instrument could be suitable for a broad range of research applications among adolescents (AU)

Concordancia entre dos encuestas para el diagnóstico de fatiga visual digital en estudiantes de una universidad en Perú / Concordance between tow questionaries for the diagnosis of digital eye strain in students of a university in Peru

RESUMEN Objetivo: Obtener la frecuencia de fatiga visual digital (FVD) mediante dos cuestionarios entre los estudiantes de una universidad privada en Lima, Perú; para estimar el grado de concordancia entre ambos métodos. Métodos: Se realizó un estudio transversal en una muestra de 345 participantes mayores de 18 años, estudiantes de una universidad en Lima, Perú y que completaron el instrumento de recogida de datos. Los dos métodos usados para la medición de FVD fueron el cuestionario de Hayes que define un caso positivo para FVD con un puntaje igual o mayor a 20; y el cuestionario CVS-Q de Seguí, que define como positivo para FVD con un puntaje mayor a 6. Se estimó el coeficiente kappa de Cohen con su intervalo de confianza al 95% para medir la concordancia global y por estratos. Resultados: El cuestionario de Hayes identificó a 167 (48,4%) participantes con un diagnostico presuntivo de FVD, el cuestionario de Seguí identificó a 247 (71,6%) estudiantes. En el análisis de concordancia, el coeficiente Kappa de Cohen fue 0,45 (IC95%; 0,37 - 0,53) (p < 0,01) en el análisis global, considerado como moderado. Conclusiones: El grado de concordancia entre ambos métodos fue moderado, el instrumento de Seguí identificó una mayor proporción de estudiantes universitarios con FVD.

ABSTRACT Objective: To obtain the frequency of digital visual fatigue (DVF) using two questionnaires among students of a private university in Lima, Peru; to estimate the degree of agreement between both methods. Methods: A cross-sectional study was conducted in a sample of 345 participants over 18 years old, students of a university in Lima, Peru and who completed the data collection instrument. The two methods used for the measurement of DVF were the Hayes questionnaire, which defines a positive case for DVF with a score equal to or greater than 20; and the Seguí CVS-Q questionnaire, which defines a positive case for DVF with a score greater than 6. The Cohen's kappa coefficient with its 95% confidence interval was estimated to measure the overall agreement and by strata. Results: The Hayes questionnaire identified 167 (48.4%) participants with a presumptive diagnosis of DVF, the Seguí questionnaire identified 247 (71.6%) students. In the concordance analysis, Cohen's Kappa coefficient was 0.45 (95%CI; 0.37 - 0.53) (p < 0.01) in the overall analysis, considered moderate. Conclusion: The degree of concordance between both methods was moderate, the Seguí instrument identified a higher proportion of university students with DVF.

Health-related quality of life of HIV-infected children in Uyo. Akwa Ibom State, Nigeria

Background: HIV-infected children are surviving into adolescence and adulthood due to the effectiveness of highly active antiretroviral therapy (HAART) but they now have to cope with living with a chronic disease. Health-related quality of life (HRQOL) has been shown to be an invaluable tool in assessing health outcome in chronic health conditions including HIV. Little is known about the HRQOL of HIV-infected children in both developing and developed countries. The study aimed at assessing the HRQOL of Nigerian children with HIV infection and compare it with that of healthy children in Uyo. Methods: A cross-sectional study of 211 HIV-infected children aged 2 to 15 years and 211 age, sex and social class-matched HIV-uninfected children with their caregivers was conducted at the University of Uyo Teaching Hospital, Uyo for a duration of nine months from October 2016 to July 2017. A generic version of the Pediatric Quality of Life Inventory (PedsQL 4.0) was used to measure their HRQOL. Results: From both self and proxy reports, there was no significant difference in the mean total HRQOL score of HIV-infected children and that of HIV-uninfected children. Conclusions: HRQOL of HIV-infected children in Uyo, Akwa Ibom state was good and comparable to that of HIV-uninfected children. Assessment of HRQOL should be incorporated into routine antiretroviral therapy ART programmes as a measure of the outcome of disease management. This will further help to identify needs and direct interventions for holistic care of these vulnerable children.

Inventory of Interpersonal Problems-Personality Disorders: adaptation to Brazil and test of a bifactor model

Objective: The Inventory of Interpersonal Problems-Personality Disorders (IIP-PD-47) has a controversial factor structure, as some studies have provided support for 5 correlated factors, and others have suggested the existence of a general second-order dimension. One approach of data modelling that reconciles multidimensionality and the existence of a general factor is the bifactor analysis. We used unrestricted exploratory-confirmatory bifactor modelling to validate the Brazilian version of the IIP-PD-47. Methods: The sample consisted of 1,091 subjects aged 18-64 years who answered the IIP-PD-47 and a collateral measure of pathological traits, the Dimensional Clinical Personality Inventory 2 (IDCP-2). Results: After testing many candidate models, our data were best represented by a bifactor model with one general factor and five specific uncorrelated factors. Nevertheless, a closer inspection of the discriminant validity of each IIP-PD-47 factor revealed strong support for the general factor and a factor capturing aggressive behaviours, but less support for the additional four specific factors. Conclusions: The theoretical and practical implications of these findings are discussed, and some recommendations are offered about the need for controlling response styles when assessing PD traits via self-report inventories. Our findings indicate that the Brazilian version of IIP-PD has promising psychometric properties.

Objetivo: El Inventario de Problemas Interpersonales-Trastornos de la Personalidad (IIP-PD-47) tiene una estructura factorial controvertida, ya que algunos estudios han apoyado 5 factores correlacionados y otros han sen˜ alado la existencia de una dimensión general de segundo orden. Un enfoque del modelado de datos que concilia la multidimensionalidad y la existencia de un factor general es el análisis de bifactores. Para validar la versión brasileña del IIP-PD-47, se utilizó un modelo bifactorial confirmatorio exploratorio sin restricciones. Métodos: La muestra incluyó a 1.091 sujetos de 18 a 64 anos que respondieron al IIP-PD-47 y una medida colateral de rasgos patológicos, el Inventario de Personalidad Clínica Dimensional 2 (IDCP-2). Resultados: Después de probar muchos modelos candidatos, nuestros datos se representaron mejor mediante un modelo bifactorial con 1 factor general y 5 factores específicos no correlacionados. Sin embargo, una inspección más cercana de la validez discriminante de cada factor IIP-PD-47 reveló un fuerte respaldo del factor general y un factor que capta comportamientos agresivos, pero menos respaldo a los 4 factores específicos adicionales. Conclusiones: Se discuten las implicaciones teóricas y prácticas de estos hallazgos y se ofrecen algunas recomendaciones sobre la necesidad de controlar los estilos de respuesta al evaluar los rasgos de la EP a través de inventarios de autoaplicados. Nuestros hallazgos indican que la versión brasileña de IIP-PD tiene propiedades psicométricas prometedoras.

La interseccionalidad como herramienta teórico-analítica para estudiar las desigualdades en salud en las Américas / Intersectionality as a theoretical-analytical tool to study health inequalities in the Americas / A interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas

RESUMEN Objetivo. Analizar las desigualdades en la salud autopercibida entre grupos de población situados en las intersecciones de identidad de género, grupo étnico y nivel de educación en países de las Américas, clasificados según su nivel de ingreso. Métodos. Se utilizaron datos en panel de la Encuesta Mundial de Valores en el período comprendido entre los años 1990 y 2022. La muestra de este estudio incluyó 58 790 personas entre 16 y 65 años, provenientes de 14 países del continente americano. La variable dependiente fue la mala salud autopercibida, las variables independientes fueron el género, el nivel de educación y el grupo étnico. Para el análisis interseccional intercategórico se creó una variable multicategórica de 12 estratos. Se realizó un análisis de heterogeneidad individual y precisión diagnóstica mediante cinco modelos de regresión logística ajustados por edad y ola de encuesta. Resultados. Se observó un claro y persistente gradiente interseccional para la mala salud autopercibida en todas las desagregaciones de países por su ingreso. Comparados con la categoría más aventajada (hombres de etnia mayoritaria y educación superior), los demás grupos incrementaron el riesgo de mala salud, con el mayor riesgo en las mujeres de etnia minoritaria o pueblos indígenas con nivel de educación inferior a secundaria (tres a cuatro veces mayor). Además, las mujeres tuvieron mayor riesgo de mala salud respecto a los hombres en cada uno de los pares de estratos interseccionales. Conclusiones. El análisis interseccional demostró la persistencia de un gradiente social de la mala salud autopercibida en el continente americano.

ABSTRACT Objective. Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Methods. Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. Results. A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. Conclusions. The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.

RESUMO Objetivo. Analisar desigualdades na autopercepção de saúde entre grupos populacionais localizados nas interseções de identidade de gênero, etnia e nível de escolaridade em países das Américas, classificados pelo nível de renda. Métodos. Foram usados dados em painel da Pesquisa Mundial de Valores referentes ao período de 1990 a 2022. A amostra deste estudo incluiu 58 790 pessoas com idades entre 16 e 65 anos de 14 países das Américas. A variável dependente foi a autopercepção de problemas de saúde, e as variáveis independentes foram gênero, nível de escolaridade e etnia. Para a análise interseccional intercategórica, foi criada uma variável multicategórica de 12 estratos. Foi realizada uma análise da heterogeneidade individual e da precisão do diagnóstico usando cinco modelos de regressão logística ajustados por idade e onda de pesquisa. Resultados. Observou-se um gradiente interseccional claro e persistente para a autopercepção de problemas de saúde em todas as desagregações de países por renda. Em comparação com a categoria mais favorecida (homens de etnia majoritária e com ensino superior), todos os outros grupos apresentaram maior risco de problemas de saúde, com o maior risco para mulheres de etnias minoritárias ou povos indígenas com nível de escolaridade inferior ao ensino médio (três a quatro vezes maior). Além disso, as mulheres tinham um risco maior de problemas de saúde do que os homens em cada um dos pares de estratos interseccionais. Conclusões. A análise interseccional demonstrou a persistência de um gradiente social na autopercepção de problemas de saúde nas Américas.

Validade do autorrelato de hipertensão arterial em trabalhadores / Validity of workers self-reports of hypertension

Resumo Introdução O monitoramento da hipertensão arterial sistêmica (HAS) é realizado no Brasil, fundamentado no autorrelato, por meio do sistema VIGITEL. Tendo em vista lacunas acerca desse agravo em populações de trabalhadores, estas devem ser alvo da ação ampliada para o seu diagnóstico epidemiológico. Objetivo Testar a validade de critério do autorrelato de HAS, comparando-o com medidas aferidas de pressão arterial (PA). Método Realizou-se estudo de corte transversal com amostra aleatória do universo de 1.561 trabalhadores de um serviço judiciário na Bahia. Calcularam-se sensibilidade, especificidade, valores preditivos e razões de probabilidade para o autorrelato de HAS, comparando-os com a aferição direta da PA, medida de referência. O diagnóstico de HAS foi a média de duas aferições com PA sistólica ≥ 140 mmHg, e/ou PA diastólica ≥ 90 mmHg, e/ou uso regular de anti-hipertensivos. Resultados Em amostra de 391 trabalhadores, verificou-se sensibilidade de 66,4% (57,1-74,6%), especificidade de 87,9% (83,2-91,4%), valor preditivo positivo de 70,5% (61,1-78,6%), valor preditivo negativo de 85,7% (80,9-89,4%), razões de probabilidade positiva e negativa de 5,5 (3,88-7,72) e de 0,4 (0,30-0,49), respectivamente. Conclusão Este estudo evidenciou o autorrelato como medida válida para o diagnóstico epidemiológico da HAS entre trabalhadores, recomendando seu uso. No entanto, esta validade depende do diagnóstico prévio do agravo.

Abstract Background Monitoring of hypertension, based on self-report, has been performed in Brazil through VIGITEL. In view of the gaps about this problem in worker populations, these should be the targets of the expanded action of epidemiological diagnosis of hypertension. Objective To test the validity of hypertension self-report in comparison to blood pressure (BP) measurements. Method A cross-sectional study was conducted on a random sample of 1561 workers from a Judicial Service in Bahia. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for the hypertension self-report in comparison with direct BP measurement (reference). Hypertensive cases presented the mean of two BP measurements, with systolic BP ≥ 140 mmHg, and/or diastolic BP ≥ 90 mmHg and/or regular use of antihypertensive drugs. Results In a sample of 391 workers, there was a sensitivity of 66.4% (57.1-74.6%), a specificity of 87.9% (83.2-91.4%), a positive predictive value of 70.5% (61.1- 78.6%), a negative predictive value of 85.7% (80.9-89.4%), a positive and negative likelihood ratio of 5.5 (3.88-7.72) and 0.4 (0.30-0.49) respectively. Conclusion This study showed self-report as a valid measure to implement the epidemiological diagnosis of hypertension among workers, recommending its use. However, its validity depends on the previous diagnosis.

Self-Awareness in research: From its functional constituents to investigation models / Autoconsciência em pesquisa: dos constituintes funcionais aos modelos de investigação

Objective The present theoretical study aimed to describe the functionalist origins of self-awareness construct and its importance in grounding an empirical investigation agenda within psychological scientific literature. Method We first conceptually analyzed William James definitions for self-related processes and then examined its repercussion for empirical self-awareness research in personality and cognitive neuroscience literature. Results Initial challenges of the field to put forward investigations that encompassed both dispositional and situational aspects of self-awareness were found. Moreover, progress observed in different trends of self-awareness investigation, in the last 20 years, were approached in its connection to technological advances evidenced in science. Conclusion The need for more integration between different levels of evidence and research fields are discussed as a mean to build an effective full understanding of self-awareness.

Objetivo O presente estudo teórico teve como objetivo descrever as origens funcionalistas do construto autoconsciência e sua importância na fundamentação de uma agenda de pesquisas empíricas na literatura de psicologia científica. Método Inicialmente analisamos conceitualmente as definições de William James para processos autorreferentes e depois examinamos suas repercussões para a pesquisa empírica de autoconsciência nas literaturas de personalidade e neurociências cognitivas. Resultados Desafios iniciais do campo para definir investigações que abrangessem tanto aspectos disposicionais como situacionais da autoconsciência foram encontrados. Além disso, progressos observados em diferentes tendências de investigação da autoconsciência, nos últimos 20 anos, foram abordados em sua conexão com os avanços tecnológicos evidenciados nas ciências. Conclusão A necessidade de maior integração entre diferentes níveis de evidência e campos de pesquisa é discutida como uma forma de construir uma efetiva compreensão global da autoconsciência.

Impact of oral health on frailty syndrome in frail older adults

ABSTRACT Objective This study aimed to correlate oral and general health in frail and non-frail older adults. Methods This observational study included 52 older adults, of whom 35 were frail (Frail Group), and 17 were non-frail (Non-Frail Group), according to Fried's self-reported test addressing oral health variables, number of systemic diseases, and medications in use. The geriatric oral health assessment index was used to assess the oral hygiene of the groups. Results The number of preserved teeth in dentulous older adults was significantly higher in the Non-Frail Group (p=0.048). No significant differences were observed between the two groups in the use of dental prostheses or in the detection of soft tissue lesions. Overall, 74.3% of the Frail Group had a "bad" geriatric oral health index score, which significantly differed from that of the Non-Frail Group (p=0.045). The numbers of systemic diseases and medicines used were higher in the Frail Group than in the Non-Frail Group (p<0.001), demonstrating the pathophysiological characteristics of multimorbidity and polypharmacy in frailty syndrome. Conclusion The results showed a clear correlation between oral and general health conditions and frailty syndrome.

Cognitive Reserve in Older Adults: A Cluster Analysis / Reserva Cognitiva em Adultos Idosos: Uma Análise de Cluster

Abstract Cognitive reserve (CR) is a construct generally associated with neurodegenerative diseases in aging. The aim of this paper was to examine the CR profiles of older adults at different stages of their lifespan and evaluate the importance of: (a) gender and CR; and (b) CR, cognition, and symptoms of depression. A sample of 195 older adults volunteered to participate in the study, and a cluster analysis was carried out on their responses in terms of the Cognitive Reserve Scale. The cluster analysis depicted two different profiles. Furthermore, women had a better CR than men. The results provide an important contribution to understanding the variables related to the CR construct.

Resumo A reserva cognitiva (RC) é um construto geralmente associado a doenças neurodegenerativas no envelhecimento. O objetivo deste estudo foi examinar os perfis de RC em adultos idosos em diferentes estágios da vida, e avaliar o efeito de: (a) gênero e RC; e (b) RC, cognição e sintomas depressivos. A amostra contou com 195 adultos, e uma análise de cluster foi realizada a partir dos escores obtidos na Escala de Reserva Cognitiva. A análise de cluster descreveu dois perfis diferentes. Além disso, as mulheres apresentaram maior RC em comparação aos homens. Os resultados fornecem contribuições importantes para as variáveis relacionadas ao construto da RC.

Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study

Abstract Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. Methodology Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. Results In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. Conclusions We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related "common risk factors".

Fatores associados à adesão a terapia imunossupressora em indivíduos transplantados renais / Factors associated with adherence to immunosuppressive therapy in renal transplant recipients / Factores asociados a la adherencia a la terapia inmunosupresora en receptores de trasplante renal

Objetivo: Analisar os fatores associados à adesão a terapia imunossupressora em indivíduos transplantados renais. Métodos: Trata-se de estudo de corte transversal, com indivíduos transplantados renais em acompanhamento ambulatorial, na cidade do Recife, Nordeste do Brasil. Utilizou-se a Assessment of Adherence with Immunosuppressive Medication Scale para avaliar a adesão aos imunossupressores. Resultados: Em 147 transplantados renais, foi observada uma prevalência de mulheres (51,70%) com baixa escolaridade e baixo nível socioeconômico (60,54%). A amostra foi composta, em sua maioria, por receptores de enxerto renal proveniente de doador cadáver (50,34%), com tempo de espera para o transplante de até 48 meses (62,59%). A taxa de adesão dos participantes foi de 56,42%, e esteve associada ao tempo médio pós-transplante (p=0,033), com maior índice naqueles com menos de 5 anos de transplante renal. Os fatores associados a não adesão foram atrasos e esquecimentos. Conclusão: Considerando a necessidade de ampliar a taxa de adesão, é fundamental considerar o tempo de transplante renal no planejamento das ações. Além disso, é preciso utilizar estratégias que auxiliem na manutenção da tomada dos imunossupressores conforme prescrição médica a fim de contribuir para a manutenção do enxerto renal. (AU)

Objective: To analyze the factors associated with adherence to immunosuppressive therapy in kidney transplant patients. Methods: This is a cross-sectional study, with kidney transplant patients undergoing outpatient follow-up, in the city of Recife, Northeast Brazil. The Assessment of Adherence with Immunosuppressive Medication Scale was used to assess adherence to immunosuppressants. Results: In 147 kidney transplant recipients, there was a prevalence of women (51,70%), with low education and low socioeconomic status (60,54%). The sample consisted, mostly, of kidney graft recipients from cadaver donors (50,34%), with a waiting time for transplantation of up to 48 months (62,59%). The adherence rate of the participants was 56.42%, and was associated with the average post-transplant time (p = 0.033), with a higher rate in those with less than 5 years of kidney transplantation. The factors associated with non-adherence were delays and forgetfulness. Conclusion: Considering the need to increase the adherence rate, it is essential to consider the time of kidney transplantation when planning actions. In addition, it is necessary to use strategies that assist in maintaining the intake of immunosuppressants according to medical prescription in order to contribute to the maintenance of the renal graft. (AU)

Objetivo: Analizar los factores asociados a la adherencia a la terapia inmunosupresora en receptores de trasplante renal. Métodos: Se trata de un estudio transversal con pacientes con trasplante renal en seguimiento ambulatorio, en la ciudad de Recife, noreste de Brasil. Se utilizó la Assessment of Adherence with Immunosuppressive Medication Scale para evaluar la adherencia a los inmunosupresores. Resultados: En 147 receptores de trasplante renal, hubo una prevalencia de mujeres (51,70%), con bajo nivel educativo y nivel socioeconómico bajo (60,54%). La muestra estuvo compuesta, mayoritariamente, por receptores de injerto renal de donante cadáver (50,34%), con un tiempo de espera para el trasplante de hasta 48 meses (62,59%). La tasa de adherencia de los participantes fue del 56,42% y se asoció con el tiempo medio pos trasplante (p = 0,033), con una tasa mayor en aquellos con menos de 5 años de trasplante renal. Los factores asociados a la no adherencia fueron los retrasos y el olvido. Conclusión: Considerando la necesidad de incrementar la tasa de adherencia, es fundamental considerar el momento del trasplante renal a la hora de planificar acciones. Además, es necesario utilizar estrategias que ayuden a mantener la ingesta de inmunosupresores según prescripción médica para contribuir al mantenimiento del injerto renal. (AU)

Construindo escalas de autorrelato: o que fazer? / Developing self-report scales: what to do? / Construcción de escalas de autoinforme: ¿qué hacer?

Escalas de autorrelato são comuns no cotidiano de pesquisadores, porém detalhes, que às vezes parecem de pouca importância, acabam sendo desconsiderados. Autorrelato são caracterizados pela pessoa de interesse ser a própria fonte de informação do pesquisador, assim a forma em que as possibilidades de resposta são apresentadas é de suma importância. Os formatos de resposta mais comuns são tipo Likert e as escolhas forçadas que vem ganhando popularidade nos últimos anos. Neste artigo são apresentados os elementos necessários que devem ser observados quando se constrói ou se escolhe escalas que possuam esses dois formatos de resposta. São discutidos também a quantidade de itens ou blocos necessários, as opções de resposta, polaridade dos itens, sistema de correção, bem como ao final são indicadas boas práticas na construção de itens para ambos os formatos. Dessa forma, pretende-se contribuir para a Psicologia, em especial a área de construção de instrumentos de autorrelato.(AU)

Self-report scales are common in the daily lives of researchers, however, details, which sometimes seem of little importance, can end up being disregarded. Self-reports are characterized by the person of interest being the researcher's own source of information, therefore the way in which the response possibilities are presented is of paramount importance. The most common response formats are Likert type and forced choice, which have been gaining popularity in recent years. This article presents the elements that must be observed when developing or choosing scales that have these two response formats. Also discussed are the number of items or blocks needed, the answer options, item polarity, the correction system, and good practices in the construction of items for both formats. The intention is to contribute to Psychology, especially the area of construction of self-report instruments.(AU)

Las escalas de autoinforme son habituales en el día a día de los investigadores, pero los detalles, que a veces parecen de poca importancia, acaban siendo desestimados. Los autoinformes se caracterizan porque la persona de interés es la propia fuente de información del investigador, por lo que la forma en que se presentan las posibilidades de respuesta es de suma importancia. Los formatos de respuesta más comunes son tipo Likert y las elecciones forzadas, que han ido ganando popularidad en los últimos años. Este artículo presenta los elementos necesarios que se deben observar al momento de construir o elegir escalas que tengan estos dos formatos de respuesta. También se discute la cantidad de ítems o bloques necesarios, las opciones de respuesta, la polaridad de los ítems, el sistema de corrección, así como las buenas prácticas en la construcción de ítems para ambos formatos. De esta forma, se pretende contribuir a la Psicología, especialmente al área de construcción de instrumentos de autoinforme.(AU)

Self-reported periodontal disease, dental loss and COVID-19 in older adults / Autorreporte de enfermedad periodontal, pérdida dentaria y COVID-19 en adultos mayores

ABSTRACT Introduction: Upon completion of this research, there was no evidence of studies addressing self-reported periodontal disease in Cuba, nor any antecedent of research relating it to COVID-19 in adults over 60. Objective: To determine the relationship between self-reported periodontal disease, dental loss, and COVID-19 activity. Methods: A descriptive cross-sectional investigation was carried out. The sample included 238 individuals aged over 60 who were infected with COVID-19, and survived. They gave their consent. The study was performed for over 1 year in Playa municipality of Havana, Cuba. Variables such as gender, age, COVID-19 evolutionary severity, comorbidities, and self-reported periodontal disease were used. A validated 4-question survey was applied to identify the periodontal disease and all data were processed in a database. Some variables were dichotomized to perform the odds ratio and Pearson's Chi-squared test, and determine the relationship between possible risk factors and the evolutionary severity of COVID-19. Results: As a result, the odds ratio values and confidence intervals for periodontal disease and advanced periodontal disease were 1.598 (0.261; 9.78) and 1.814 (0.296; 11.105) respectively, and the p-values were 0.609 and 0.514 respectively. Conclusion: A relationship between periodontal disease and the evolutionary severity of COVID-19 cannot be established. However, a relationship was observed targeting dental loss and respiratory diseases as determinant risk factors in the severity of COVID-19.

RESUMEN Introducción: Hasta el momento de culminada esta investigación no se encontró evidencia de estudios que aborden el autorreporte de enfermedad periodontal en Cuba, ni antecedentes de estudios que la relacionen con la COVID-19 en adultos mayores de 60 años. Objetivo: Determinar la relación entre el autorreporte de enfermedad periodontal, la pérdida dentaria y características de la COVID-19. Métodos: Se realizó una investigación descriptiva transversal. La muestra fue de 238 individuos mayores de 60 años, que contrajeron la COVID-19 y sobrevivieron. Todos dieron su consentimiento informado. El estudio fue realizado en el período de 1 año en el municipio Playa, La Habana, Cuba. Las variables estudiadas fueron, sexo, edad, gravedad evolutiva de la COVID-19, comorbilidades y autorreporte de enfermedad periodontal. Se les aplicó una encuesta validada de 4 preguntas, para identificar enfermedad periodontal y los datos fueron procesados en una base de datos. Algunas variables fueron dicotomizadas para realizar la prueba de odds ratio y ji cuadrado de Pearson, para determinar la relación entre posibles factores de riesgo y la gravedad evolutiva de la COVID-19. Resultados: Los valores de odds ratio e intervalos de confianza de la enfermedad periodontal y la enfermedad periodontal avanzada fueron de 1,598 (0,261; 9,78) y 1,814 (0,296; 11,105) y los valores de p de 0,609 y 0,514 respectivamente. Conclusiones: No se comprueba que exista relación entre la enfermedad periodontal y la gravedad evolutiva de la COVID-19. Sin embargo, existe una relación que señala a la pérdida dentaria y las enfermedades respiratorias como factores de riesgo determinante en la gravedad de la COVID-19.

Association between the level of indifference to dental treatment and habits of oral hygiene in adults / Asociación entre el nivel de indiferencia al tratamiento dental y los hábitos de higiene bucal

Introduction: Inadequate oral hygiene habits such as lack of tooth brushing, use of irrigators, fluoridated toothpastes, and dental floss, as well as the importance of worrying about going to the dentist in the event of any problem in the oral cavity and the continuity of treatment are factors that could increase the risk in patients. Objetive: To determine the association between the level of indifference to dental treatment and the oral hygiene habits of those surveyed adults. Material and Methods: An observational, analytical and cross-sectional study. The level of indifference to dental treatment was evaluated using a translated virtual questionnaire and subsequently internally validated (Cronbach's alpha: 0.91). There were a total of 249 participants, 150 males and 99 females, with a mean age of 30.69 years. For the association of the qualitative variables and the report of the crude and adjusted odds' ratio (OR), a logistic regression was used. We worked with a level of statistical significance of p<0.05 and a confidence interval of 95%. Results: A high level of indifference to dental treatment was obtained in 57.83% of the respondents. Likewise, a statistically significant association was found between indifference to dental treatment and education (p = 0.012). Regarding oral hygiene habits, a statistically significant association was found with flossing (OR = 2.22; 95% CI: 1.10-4.46) (p = 0.025) and brushing before sleeping (OR = 5.26; 95%: 2.26-12-22) (p<0.001). Conclusion: There is a statistically significant association between the level of indifference to dental treatment with oral hygiene habits, flossing and brushing before sleeping. It is advisable to carry out activities in the communities to promote oral health care to reduce levels of indifference to dental treatment.

Introducción: Los inadecuados hábitos de higiene bucal como la falta de cepillado dental, uso de irrigadores, pastas dentales fluoradas e hilo dental, así como la importancia de preocuparse por acudir al odontólogo ante cualquier problema en la cavidad oral y la continuidad del tratamiento son factores que podrían agravar el riesgo en los pacientes. Objetivo: Determinar la asociación entre el nivel de indiferencia al tratamiento dental y los hábitos de higiene bucal de los encuestados en adultos en edades comprendidas entre los 18 a 45 años de la urbanización Buenos Aires de Villa en Chorrillos, Perú. Material y Métodos: Se realizó un estudio observacional, analítico y transversal. El nivel de indiferencia al tratamiento dental fue evaluado mediante un cuestionario virtual traducido y posteriormente validado internamente (alpha de Cronbach: 0.91). Se tuvo un total de 249 participantes, entre ellos 150 hombres y 99 mujeres con una media edad de 30,69 años. Para la asociación de las variables cualitativas y el reporte de las Odds Ratio (OR) crudas y ajustadas, se empleó una regresión logística. Se trabajó con un nivel de significancia estadística de p<0.05 y un intervalo de confianza del 95%. Resultados: Se obtuvo un alto nivel de indiferencia al tratamiento dental en el 57.83% de los encuestados. Asimismo, se encontró una asociación estadísticamente significativa de la indiferencia al tratamiento dental con la educación (p= 0.012). Respecto a los hábitos de higiene bucal, se encontró asociación estadísticamente significativa con uso de hilo dental (OR=2.22; IC del 95%: 1.10-4.46) (p=0.025) y el cepillado antes de dormir (OR=5.26; IC del 95%: 2.26-12-22) (p<0.001). Conclusión: Se concluyó que existe una asociación estadísticamente significativa entre el nivel de indiferencia al tratamiento dental con los hábitos de higiene bucal uso de hilo dental y cepillado antes de dormir. Se aconseja realizar actividades en las comunidades para promover el cuidado de la salud bucal con la finalidad de reducir los niveles de indiferencia al tratamiento dental.