Students' resilience and mental health in the dental curriculum.

OBJECTIVES: Dental education is perceived as a source of students' psychological and occupational stress. Resilience has been proposed as a protective factor that may support students' in managing that stress. The objectives of this study were twofold: to map the mental health and well-being content in the curriculum of the Faculty of Dentistry (FoD) at the University of British Columbia (UBC) and to investigate factors influencing resilience levels amongst dental students at UBC. METHODS: The curricular database and website of UBC's FoD were used to gather information on mental health content. A survey with the Connor-Davidson 10-Item Resilience Scale was distributed to dental students at UBC (N = 289). Students' de-identified demographic data were also collected. RESULTS: Two main mental health and well-being curricular components were identified: one didactic session on stress management and one interactive workshop on resilience. The response rate for the survey was 68.2%. Students who did not receive any mental health content (2020/21 year 1 students) had higher resilience scores (p = .043) when compared to students who received both components (2019/20 year 1 students and 2018/19 year 2 students). The multiple regression analysis highlighted North American/European ethnic origins as a predictor for higher resilience levels (p = .008). CONCLUSIONS: The results of this study showed that ethnic origins and major life events, such as the pandemic, influenced resilience. Curricular activities promoting resilience seemed to not necessarily impact students' resilience. Further longitudinal studies are needed to assess the curricular and non-curricular activities influence over dental students' well-being.

Early childhood caries and oral health-related quality of life of Brazilian children: Does parents' resilience act as moderator?

BACKGROUND: Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. AIM: To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. DESIGN: Population-based, cross-sectional study with 497 children (4-6 years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self-completed the Brazilian version of the early childhood oral health impact scale (B-ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P < .05). RESULTS: Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60-3.49) and fistula/abscess had 3.57 (95% CI: 2.23-5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP = 2.33;95% CI: 1.58-3.43; OHRQoL vs fistula/abscess RP = 3.65;95% CI: 2.22-5.99). CONCLUSION: Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience.

Study of dental phobia, psychological resilience, and related factors in children aged 8-9 years in Weifang city.

OBJECTIVES: To investigate the influencing factors of children's dental fear (CDF) and the relationship of CDF with resilience in children aged 8-9 years in Weifang city to provide evidence for the early prevention and intervention of CDF. METHODS: Random cluster sampling method was applied. A total of 1 995 children aged 8-9 years from 10 primary schools in four districts of Weifang city were selected from June to October 2021 as the survey objects. General information questionnaire, the children's fear survey schedule-dental sub-scale, and adolescent resilience scale were used in the investigation. RESULTS: The CDF detection rate was 31.78% (634 cases) in children aged 8-9 years in Weifang city, including 28.41% (296 cases) in boys and 35.47% (338 cases) in girls. Multivariate logistic analysis showed that female gender [odds ratio (OR)=1.329, 95% confidence interval (CI)=1.062-1.665], dental caries (OR=1.961, 95%CI=1.330-2.891), dental pain (OR=2.133, 95%CI=1.700-2.676), and dental treatment experience (OR=3.621, 95%CI=2.888-4.540) are risk factors for CDF. Parents with tertiary education or higher (OR=2.123, 95%CI=1.546-2.916; OR=3.304, 95%CI=2.368-4.612), high scores in the positive cognition factor of the psychological resilience-personal strength dimension (OR=1.520, 95%CI=1.141-2.025), high scores in the interpersonal assistance factor of the psychological resilience-support strength dimension (OR=3.819, 95%CI=2.743-5.318), and high scores in the family support factor (OR=5.634, 95%CI=4.047-7.844) were protective factors for CDF occurrence (P<0.05). CONCLUSIONS: Children with high psychological resilience scores have low CDF incidence, and good parenting practices are beneficial in reducing CDF incidence.

Psychosocial associated factors of early childhood caries and oral health-related quality of life: Structural equation model approach.

OBJECTIVE: To identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families. METHODS: A population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from Ribeirão das Neves, MG. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS­epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6. RESULTS: Lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b = 0.122; p = 0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable 'frequency of free sugar consumption' (b=-0.089; p = 0.048). ECC was associated with lower child's OHRQoL (b = 0.587; p<0.001) and lower family's OHRQoL (b = 0.506; p<0.001). CONCLUSION: Structural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience. CLINICAL SIGNIFICANCE: T The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.

Psychological resilience and diurnal salivary cortisol in young adulthood.

BACKGROUND: Adversity exposure and the negative psychological responses that often result have been linked with poor physical health outcomes and deteriorative physiological processes, like dysregulated circulating cortisol. Individuals exposed to early adversity who also demonstrate positive psychological functioning may be characterized as psychologically resilient, but few studies have evaluated whether psychological resilience may disrupt the health-damaging effects of adversity. We tested the hypothesis that among young adults exposed to early adversity, those who are psychologically resilient may manifest more normative diurnal cortisol patterns relative to those who experience more psychological distress. METHODS: Data are from Growing Up Today Study I participants who provided information on psychological resilience and diurnal salivary cortisol (n = 916). Psychological resilience was derived from self-report questionnaires administered between 2007 and 2010, and salivary cortisol was obtained from saliva samples collected between 2011 and 2014. The predictor of interest, psychological resilience, was defined using two domains: (1) adversity exposure measured via a count of 7 potential psychosocial adversities experienced before age 18, and (2) psychological health in young adulthood measured via a composite score reflecting low psychological distress and high positive affect. The outcome was mean log-transformed diurnal salivary cortisol across 4 samples from one day. Linear regressions evaluated associations of adversity, psychological health, and their potential multiplicative interaction with mean diurnal log-transformed cortisol, adjusting for baseline socio-demographic variables and biological and behavioral factors from the day of saliva sampling. RESULTS: Relatively few individuals with high adversity demonstrated positive psychological health. Both adversity exposure and psychological health were independently associated with mean log cortisol levels. Models stratified by lower versus higher adversity suggested complex relationships with cortisol, however the interaction between adversity and psychological health was not statistically significant. High adversity was associated with blunted cortisol levels, regardless of psychological health. Conversely, among those with lower adversity, overall levels of cortisol were higher and psychological health associated with more normative, lower cortisol levels. CONCLUSIONS: Psychological resilience domains were independently associated with diurnal salivary cortisol in young adulthood. High burden of early adversity may disrupt the physiological stress system, while psychological health may be associated with more normative cortisol levels when adversity is low.

The effects of the COVID-19 outbreak on physicians' psychological resilience levels.

BACKGROUND: Health-care workers exposed to coronavirus19 disease could be psychologically stressed. The objective of this study is to assess the anxiety, depression levels, and psychological resilience of physicians working during the Covid-19 outbreak and to evaluate the related factors that are associated with their psychological resilience. METHODS: The sample of this descriptive study was composed of medical doctors and dentists. The data were obtained online between April 13-23, 2020 through a survey prepared by the researchers. In addition, a questionnaire about the participants' sociodemographic characteristics, the Psychological Resilience Scale and Hospital Anxiety Depression Scale (HAD-A/HAD-D) was given. RESULTS: The average age of the 671 participants was 44.0 ± 9.0 years. Psychological resilience scores were significantly higher in those who had children, who had worked for 15 years or more, and who had received training about COVID-19 (p < 0.05). Depression scores were higher among women and in those who reported having a chronic disease, whose workload increased after the outbreak, and who had physical contact with COVID-positive patients. The anxiety scores were also higher among women and in those whose workload had increased and who had contact with COVID-positive patients (p < 0.05). The physicians with scores below the cutoff point on the HAD-D/HAD-A had significantly higher scores on the Psychological Resilience Scale (p < 0.05). DISCUSSION: Depression and anxiety levels were found to be significantly lower in physicians with greater psychological resilience. Psychological and social support of all health-care workers, especially physicians, is important in the struggle with the pandemic. It is thought that determining the variables related to psychological resilience in health-care workers will be a guide for psychosocial services.

Family Functioning as a Possible Factor that Modulates Empathy Levels in Dental Students

Aim: The objective of this paper is to explore whether there are differences in the levels of empathy and its dimensions between family typologies in dental students. Methodology: A quantitative and not experimental study, with a cross-sectional descriptive design, a population of dental students from the Evangelical University of El Salvador, and a convenience sample were applied. The levels of empathy and family functioning were evaluated using the Jefferson Scale of Empathy for Health Professions students and the Brief Scale of Family Functioning. The construct validity of both instruments was estimated using Confirmatory Factor Analysis. The reliability was estimated using McDonald's omega and Cronbach's alpha. Comparisons of empathy and its dimensions between family typologies were made using a two-factor analysis of variance. Results: No statistical differences were observed in empathy and its dimensions based on family typologies. It was found that women are more empathic than men. This result is not in accordance with other studies carried out in Latin America on dental and medical students evaluating empathy and family functioning with the same instruments. Conclusions: The distribution of empathy levels and their dimensions are similar among the family typologies studied. Therefore, it was not found that family functioning can influence empathy in the population studied. It is necessary to continue these studies to obtain more empirical evidence regarding the influence of family functioning on empathy.

Objetivo: El objetivo del presente trabajo es determinar la existencia de diferencias de los niveles de empatía y de sus dimensiones entre las tipologías familiares en estudiantes de odontología. Metodología: Estudio cuantitativo y no experimental, con un diseño descriptivo transversal, una población de estudiantes de odontología de la Universidad Evangélica de El Salvador y una muestra por conveniencia. Fueron evaluados los niveles de empatía y el funcionamiento familiar mediante la Escala de Empatía de Jefferson para estudiantes de profesiones de la salud y la Escala Breve de Funcionamiento Familiar. Se estimó la validez de constructo de ambos instrumentos mediante Análisis Factorial Confirmatorio y la confiabilidad mediante omega de McDonald y alfa de Cronbach. Las comparaciones de la empatía y sus dimensiones entre las tipologías familiares fueron realizadas mediante análisis de varianza bifactorial. Resultados: No se observaron diferencias estadísticas en la empatía y en sus dimensiones en función de las tipologías familiares. Se encontró que las mujeres son más empáticas que los hombres. Este resultado no está en concordancia con otros estudios realizados en América Latina en estudiantes de odontología y medicina, evaluando la empatía y el funcionamiento familiar con los mismos instrumentos. Conclusiones: La distribución de los niveles de empatía y de sus dimensiones son semejantes entre las tipologías familiares estudiadas. Por lo tanto, no se constató que el funcionamiento familiar tenga un efecto sobre la empatía en la población estudiada. Es necesario continuar estos estudios para obtener mayor evidencia empírica respecto de la influencia del funcionamiento familiar en la empatía.

[Development and Application of an Overcoming Compassion Fatigue Program for Emergency Nurses].

PURPOSE: This study was conducted to develop a program to help emergency nurses overcome compassion fatigue, and to analyze the effects of the program. METHODS: A nonequivalent control group pretest-posttest design was used. There were 14 participants in the experimental group and 18 subjects in the control group. The program was comprised of five, weekly 80-minute sessions including understanding and assessment of compassion fatigue, enhancing positive affect, balancing work-life, planning self care, training in relaxation techniques and cognitive restructuring, and getting social support. Research variables were ego-resiliency, compassion satisfaction and compassion fatigue of the ProQOL 5, and salivary cortisol. Data were analyzed using Chi-square test, independent t-test, and paired t-test. RESULTS: The first hypothesis, "There will be a difference in scores for ego resiliency between the experimental group and the control group". was not supported. The second hypothesis, "There will be a difference in scores for compassion satisfaction between the experimental group and the control group" was supported (t=2.15, p=.046). The third hypothesis, "There will be a difference in scores for compassion fatigue between the experimental group and the control group" was not supported. CONCLUSION: The first program for emergency nurses to overcome compassion fatigue in Korea was effective in increasing emergency nurses' compassion satisfaction and decreasing salivary cortisol level in the experimental group. Therefore, this program for overcoming compassion fatigue is useful to increase emergency nurses' compassion satisfaction. However replication studies of short-term intensive program reflecting emergency nurses' opinion are needed.

Teaching Medical Students How to Ask Patients Questions About Identity, Intersectionality, and Resilience.

INTRODUCTION: Medical education addressing people with sexual and gender minority (SGM) identities often focuses on sexual risk, is delivered in silos, and overlooks intersecting identities. SGM individuals-particularly those with coexisting stigmatized identities-experience a disproportionate burden of discrimination, which increases vulnerability to adverse health outcomes, especially when maladaptive coping behaviors are used to manage stress. Adaptive coping and resilience can develop in the context of identity affirmation and social support, for which sensitive clinician-patient interactions provide a crucial foundation. Guided by the AAMC publication Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD: A Resource for Medical Educators, this session introduced first-year medical and dental students to the concepts of identity and intersectionality, providing an opportunity to practice apropos interviewing techniques. METHODS: This 2-hour session includes prework, a didactic presentation, role-play scenarios, and a small-group session. Prior to the session, faculty facilitators had small-group leadership experience, and students had already mastered social history taking. Electronic student and faculty surveys provided qualitative assessment. RESULTS: Faculty and students reported that the session increased awareness of the health impact of identity and intersectionality and the clinician's role in establishing rapport. Suggestions included adding a prework video defining diversity terminology and a patient panel describing diverse identities and experiences. DISCUSSION: Addressing health issues related to SGM and other sociocultural identities is challenging yet crucial. This innovative session gave students an opportunity to explore their unconscious biases and practice novel interviewing techniques in a supportive environment.

Aspectos psicossociais e percepção de impacto da saúde bucal na qualidade de vida em adultos do Sul do Brasil / Psychosocial aspects and the impact of oral health on quality of life of Brazilian adults

RESUMO: Introdução: A pesquisa objetivou investigar a associação entre os aspectos psicossociais e o impacto das condições bucais sobre a qualidade de vida de adultos, escopo ainda pouco explorado em pesquisas nacionais. Método: Um estudo transversal de base populacional foi realizado com 1.100 adultos de 20 anos de idade ou mais, em uma cidade de médio porte do Rio Grande do Sul. O desfecho foi avaliado por meio do Oral Health Impact Profile (OHIP-14) enquanto as exposições incluíram medidas de apoio social, resiliência, senso de coerência, espiritualidade, qualidade de vida e estresse. Foram calculadas as razões de chances brutas e ajustadas, bem como seus intervalos de confiança de 95% utilizando-se regressão logística ordinal. Resultados: Após o ajuste para variáveis demográficas, socioeconômicas e comportamentais, indivíduos com baixo apoio social, baixo senso de coerência, baixa qualidade de vida e alto nível de estresse possuíam respectivamente 2,16; 2,90; 2,94; 1,50 vezes mais chance de relatar um pior impacto da condição na qualidade de vida quando comparados aos indivíduos com estas características favoráveis. Conclusões: Os achados sugerem que os aspectos psicossociais podem influenciar a avaliação que as pessoas fazem do impacto da condição bucal sobre a qualidade de vida. É importante que políticas, programas e serviços de saúde reconheçam a relação mútua entre os indicadores de saúde bucal e os aspectos psicossociais de adultos.

ABSTRACT: Introduction: This research aimed to investigate the association between psychosocial aspects and the impact of oral health on quality of life among adults. Method: This population-based cross-sectional study was conducted with 1,100 adults aged 20 years or older from a medium-sized city in Rio Grande do Sul, Southern Brazil. The outcome was Oral Health Impact Profile (OHIP-14) in three categories: better (OHIP=0: 50% of lower scores), moderate (OHIP 1-12.6: 25% of intermediate scores), and worse (OHIP≥12.7: 25% of higher scores). The exposures included measurements of social support, resilience, sense of coherence, spirituality, quality of life, and stress. We calculated crude and adjusted odds ratios and their respective 95% confidence intervals using ordinal logistic regression. Results: After adjustment for demographic, socioeconomic, and behavioral variables, individuals with low social support, low sense of coherence, low quality of life, and high level of stress were, respectively, 2.16, 2.90, 2.94, and 1.50 times more likely to report a worse impact of oral health on quality of life than those with favorable characteristics. Conclusions: The findings suggest that psychosocial aspects can influence the perceived impact of oral health on quality of life. Health policies, programs, and services must recognize the mutual relationship between oral health indicators and psychosocial aspects among adults.

Cárie na primeira infância, má oclusão, fatores psicossociais e qualidade de vida relacionada à saúde bucal de crianças e suas famílias / Early childhood caries, malocclusion, psychosocial factors and oral health-related quality of life in children and their families

Cárie na primeira infância (CPI) e má oclusão podem afetar a qualidade de vida relacionada à saúde bucal (QVRSB) de crianças e suas famílias. Fatores psicossociais relacionados às crianças, suas famílias e comunidade na qual estão inseridas devem ser estudados. Diante disso, os objetivos desta tese foram: 1) verificar a associação entre fatores psicossociais associados à CPI e à QVRSB em pré-escolares e suas famílias (Artigo 1); 2) avaliar o impacto da mordida aberta anterior (MAA) e da mordida profunda (MP) na QVRSB de préescolares, e verificar o papel da resiliência parental como um fator moderador nessa associação (Artigo 2). Foi realizado um estudo transversal representativo com pré-escolares de 4-6 anos de idade e seus pais/responsáveis em Ribeirão das Neves, MG, Brasil. Os pais/responsáveis responderam às versões brasileiras do Early Childhood Oral Health Impact Scale (ECOHIS) e Escala de Resiliência, e um questionário com dados socioeconômicos e de comportamento de saúde bucal da criança. Os pré-escolares foram examinados por duas dentistas treinadas e calibradas para o diagnóstico de CPI e consequências pulpares de lesões cariosas não tratadas (Kappa>0,95), utilizando-se a versão epidemiológica do International Caries Detection and Assessment System (ICDASepi) combinado com o índice pufa e, assim categorizados: sem cárie, estágio inicial (opacidade notável/pigmentação retida em fundo de fóssulas e fissuras), estágio moderado (cavitação em esmalte/sombreamento em dentina subjacente), estágio extenso sem consequências pulpares (cavitação com exposição dentinária) e estágio extenso com consequências pulpares (cavitação com exposição dentinária, com envolvimento pulpar e/ou presença de fístulas/abscessos). A presença de MAA e MP foi avaliada através do índice de Foster e Hamilton. Os dados foram analisados por meio da modelagem por equações estruturais, utilizando-se o software Mplus, versão 8.6 (Artigo 1) e por meio da análise de moderação, utilizando-se o PROCESS (PROCESS for SPSS, version 3.4) (Artigo 2). Os resultados do artigo 1 demonstraram que menor status socioeconômico (ß =-0,250; p<0,001) e maior frequência de consumo de açúcares livres (ß=0,122; p=0,033) foram associados diretamente com estágio extenso de cárie com consequência pulpar, enquanto menor resiliência dos pais impactou indiretamente estágios mais avançados da CPI, por meio da variável frequência de consumo de açúcares livres (ß =-0,089; p=0,048). Além disso, CPI foi associada com piores escores tanto da QVRSB da criança (b=0,587; p<0,001) quanto da família (ß =0,506; p<0,001). Os resultados do artigo 2 demonstraram que préescolares filhos de pais com baixa resiliência, e que possuíam MAA apresentaram impacto negativo na QVRSB (ß:3,95;p=0,025) em comparação àqueles que apresentaram oclusão normal. A resiliência parental não atuou como fator moderador na associação entre MP e QVRSB (p>0,05). Conclui-se que quanto maior a gravidade da CPI, maior o impacto negativo na QVRSB de pré-escolares e suas famílias. Os principais fatores associados à CPI mais grave foram menor nível socioeconômico, maior frequência de consumo de açúcar livre e menor resiliência parental (Artigo 1). MAA interferiu negativamente na QVRSB dos pré-escolares, sendo essa associação mais forte quando a resiliência parental era baixa. Portanto, a resiliência dos pais atuou como fator moderador na relação entre MAA e QVRSB (Artigo 2).

Early childhood caries (ECC) and malocclusion can affect the oral health-related quality of life (OHRQoL) of children and families. Psychosocial factors related to children, their families and the community in which they are inserted must be studied. Therefore, the objectives of this thesis were: 1) to verify the association between psychosocial factors with ECC and OHRQoL in preschoolers and their families (Manuscript #1); 2) to evaluate the impact of anterior open bite (AOB) and deep bite (DB) on the OHRQoL of preschool children and the role of parental resilience as a moderating factor in such association (Manuscript #2). A representative crosssectional study was carried out with 4-to-6-year-old preschoolers and their parents/caregivers from Ribeirão das Neves, MG, Brazil. Parents/caregivers selfadministered the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire about socioeconomic and child's oral health behavior data. Preschoolers were examined by two trained and calibrated dentists for the diagnosis of ECC and pulpal consequences of untreated carious lesions (Kappa>0.95), using the epidemiological version of the International Caries Detection and Assessment System (ICDASepi) index combined with the pufa index: no caries, early stage (notable opacity/retained pigmentation in the background of pits and fissures), moderate stage (cavitation in enamel/shading in underlying dentin), extensive stage without pulpal consequences (cavitation with dentin exposure) and extensive stage with pulpal consequences (cavitation with dentin exposure, and pulp involvement and/or fistulas/abscesses). The presence of AOB and DB were evaluated using the Foster and Hamilton index. Data were analysed through Structural Equation Model (SEM), using the Mplus software, version 8.6 (Manuscript #1) and through moderation analysis, using PROCESS (PROCESS for SPSS, version 3.4) (Manuscript #2). The results of the Manuscript #1 demonstrated that lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of consumption of free sugars (ß=0.122; p=0.033) were directly associated with an extensive stage of caries with pulpal consequences, while lower parental resilience indirectly impacted more advanced stages of ECC, through the variable frequency of consumption of free sugars (b=-0.089; p=0.048). In addition, ECC was associated with worse scores in both the child's (ß=0.587; p<0.001) and the family's (ß=0.506; p<0.001) OHRQoL. The results of the Manuscript #2 demonstrated that preschoolers whose parents presented low resilience, and preschoolers who presented OAB, had a negative impact on OHRQoL (ß:3.95; p=0.025) compared to those who had normal occlusion. Parental resilience did not act as a moderating factor in the association between DB and OHRQoL (p>0.005). It is concluded that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families, and the main factors associated with the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience (Manuscript #1). OAB negatively interfered with the OHRQoL of preschoolers, with this association being stronger when parental resilience was low. Therefore, parental resilience acted as a moderating factor in the relationship between OAB and OHRQoL (Manuscript # 2).

Can more resilient elderly people be more satisfied with dental services? / Idosos com maior potencial de resiliência podem estar mais satisfeitos com os serviços odontológicos?

Introduction: With respect to dental health services, few studies have been developed to understand the satisfaction of this age group with these services. Objective: To investigate the association between resilience and satisfaction with dental services among elderly people, using a model adjusted for confounding factors. Material and method: The locus of the research was the Lomba-Parthenon district management, in Porto Alegre, Rio Grande do Sul, Brazil. 771 elderly people living in their homes were identified through cluster sampling. The subjects responded to a socio-demographic and health behaviors questionnaire, the Resilience Scale and to questions regarding their satisfaction with dental care accessed. Furthermore, a brief oral examination was conducted to count the number of teeth and to identify the use of dental prostheses. Result: Based on a hierarchical approach conducted using Multivariate Logistic Regression and after fully adjusted analysis, the estimated odds ratios of the variables that were significantly associated with the outcome of this study, satisfaction with dental care, were: 1) obtaining a dental appointment, classified as regular: OR= 1.85, 95% CI (1.10 to 3.12); 2) obtaining a dental appointment, classified as bad: OR= 2.17, 95% CI (1.05 to 4.50); and, 3) high potential for resilience: OR= 0.60, 95% CI (0.37 to 0.97). Conclusion: The results confirm the hypothesis of an association between high potential for resilience and satisfaction with the Dental Services accessed by elderly people.

Introdução: No que diz respeito aos Serviços de Saúde Bucal, poucos estudos têm sido desenvolvidos na ambição de conhecer a satisfação deste grupo etário com tais serviços. Objetivo: Investigar a associação entre a resiliência e satisfação com serviços odontológicos entre os idosos, por meio de um modelo ajustado para fatores de confusão. Material e método: O lócus da pesquisa foi Lomba-Partenon, em Porto Alegre - RS, onde 771 idosos foram identificados em seus domicílios por meio de amostragem por conglomerado. Os indivíduos responderam a um questionário sócio-demográfico e de comportamentos em saúde, à Escala de Resiliência e a questões relativas ao Serviço Odontológico acessado e à satisfação com o mesmo; além disso, foi realizado um breve exame bucal para contagem do número de dentes e identificação do uso de prótese dentária. Resultado: Baseado em uma abordagem hierárquica realizada através de Regressão Logística Multivariada, as odds ratios estimadas das variáveis que ficaram significativamente associadas com o desfecho em estudo, satisfação com o Serviço Odontológico, após a análise totalmente ajustada, foram: 1) obtenção de consulta odontológica classificada como regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtenção de consulta odontológica classificada como ruim: OR= 2,17, 95% IC (1,05 a 4,50) e 3) alto potencial de resiliência: OR= 0,60, 95% IC (0,37 a 0,97). Conclusão: Os resultados confirmam a hipótese de associação entre elevado potencial de resiliência e satisfação com os Serviços Odontológicos acessados por idosos.

A resiliência dos pais afeta o impacto da cárie dentária e suas consequências pulpares na qualidade de vida de pré-escolares? / Does parental resilience affect the impact of dental caries and their pulprelated consequences for the quality of life of preschool children?

A cárie dentária é a condição bucal que mais afeta a qualidade de vida de crianças préescolares e sua presença pode trazer consequências pulpares, como envolvimento pulpar, fístulas e abscessos. Estes, por sua vez, podem ser mais prejudiciais para a saúde e bemestar da criança do que as próprias lesões cariosas. Dessa forma, é importante explorar resultados de saúde bucal utilizando um quadro mais amplo com a inclusão de fatores contextuais e, dentre estes fatores, está a resiliência. Esta, por sua vez, pode alterar a atitude dos pais/responsáveis, sendo que isto pode influenciar a saúde bucal e a percepção do seu impacto na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) de seus filhos. Observa-se que não há, na literatura, estudos que testam se a resiliência dos pais e/ou responsáveis afeta a QVRSB das crianças. Diante disso, o objetivo desse estudo foi avaliar o impacto da cárie dentária e suas consequências pulpares na QVRSB de pré-escolares, bem como se a resiliência dos pais/responsáveis atua como fator moderador alterando a forma de percepção e relato desse impacto. Foi realizado um estudo transversal representativo de pré-escolares de 4-6 anos de idade de Ribeirão das Neves, MG. Os pais/responsáveis responderam as versões brasileiras do Early Childhood Oral Health Impact Scale (ECOHIS) e da Escala de Resiliência, assim como um questionário com dados socioeconômicos e de comportamento de saúde bucal da criança. Um total de 497 préescolares foi examinado por duas dentistas calibradas para o diagnóstico de cárie dentária, utilizando-se o índice ICDAS simplificado: estágio inicial (opacidade notável/pigmentação retida em fundo de fóssulas e fissuras), estágio moderado (cavitação em esmalte/sombreamento em dentina subjacente), estágio extenso (cavitação com exposição pulpar); e suas consequências pulpares, por meio do índice pufa: envolvimento pulpar, ulceração causada por fragmentos de dentes, fístula e abscesso. Análises descritivas, regressão de Poisson bivariada e multivariada, com abordagem hierárquica, e teste de sensibilidade foram utilizadas para análise dos dados (p<0,05). O modelo multivariado final, ajustado para resiliência, condições socioeconômicas e comportamentais, mostrou que a presença de lesões cariosas não impacta a QVRSB de pré-escolares, independente do estágio do ICDAS (p>0,05). Entretanto, quando consideramos as consequências pulpares das lesões cariosas, observamos que envolvimento pulpar (RP=2,01; 95%IC:1,47-2,74) e fístula/abscesso (RP=3,18; 95%IC:2,05-4,92) apresentam associação com maiores escores do ECOHIS, comparado com aquelas lesões cariosas que não apresentam consequências pulpares. As seções do ECOHIS, Impacto na Criança e Impacto na Família, também estavam associados à presença de envolvimento pulpar (RP=2,11 ;95%IC:1,48-3,00; RP=1,99; 95%IC:1,36-2,91) e fístula/abscesso (RP=3,38; 95%IC:2,14-5,33; RP=2,85; 95%IC:1,73-4,67), respectivamente. Além disso, o teste de sensibilidade mostrou que praticamente não houve diferença na força da associação, quando a resiliência foi removida do modelo, entre presença de envolvimento pulpar e fístula/abscesso com as Seções de Impacto na criança (RP=2,10; 95%IC:1,48-2,98; p<0,001; RP=1,99; 95%IC:1,37-2,87; p<0,001) e Impacto na Família (RP=3,43; 95%IC:2,16-5,45; p<0,001; RP=2,88; 95%IC:1,75-4,75; p<0,001), respectivamente. Portanto, conclui-se que a presença de consequências clínicas pulpares da cárie repercutiu negativamente na QVRSB de préescolares e suas famílias e a resiliência dos pais não atuou como fator moderador alterando esta associação. (AU)

Dental caries is the oral condition that most affects the quality of life of preschool children, and their presence can have pulp-related consequences, such as pulp involvement, fistulas and abscesses. These may be more harmful to the health and well-being of the child than the carious lesions themselves. It is therefore important to explore oral health outcomes using a broader framework, including contextual factors such as resilience. This can change the attitude of parents/caregivers, and can influence oral health and the perception of its impact on the oral health-related quality of life (OHRQoL) of their children. There are no studies in literature that test whether the resilience of parents and/or caregivers affects the OHRQoL of their children. The aim of the present study was therefore to evaluate the impact of dental caries and their pulp-related consequences on the OHRQOL of preschoolers, as well as whether caregiver resilience acts as a moderator, affecting how they perceive and report this impact. A representative cross-sectional study with 4-6-year-old preschool children from Ribeirão das Neves, Minas Gerais, Brazil was carried out. Parents/caregivers responded to the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire with socioeconomic data and child's oral health behavior. A total of 497 preschool children were examined by two calibrated dentists to diagnose dental caries, using the simplified ICDAS index: initial stage caries (first or distinct visual changes in enamel), moderate stage caries (localized enamel breakdown or an underlying dentin shadow), extensive stage caries (distinct cavity with visible dentin); and their pulp-related consequences, through the pufa index: pulp involvement, ulceration caused by root fragments, fistulas or abscesses. Descriptive analyses, bivariate and multivariate Poisson regression with a hierarchical approach, and sensitivity testing were used for data analyses (p<0.05). The final multivariate model was adjusted for resilience and socioeconomic and behavioral conditions and showed that the presence of carious lesions does not impact the OHRQoL of preschool children, independent of ICDAS stage (p>0.05). However, when the pulp-related consequences of carious lesions were considered, it was observed that pulp involvement (PR=2.01; 95%CI:1.47-2.74) and fistulas/abscesses (PR=3.18; 95%CI:2.05-4.92) are associated with higher ECOHIS scores, compared with carious lesions that do not exhibit pulp-related consequences. The ECOHIS Sections Impact on the Child and Impact on the Family were also associated with the presence of pulp involvement (PR=2.11;95%CI:1.48-3.00; PR=1.99; 95%CI:1.36-2.91) and fistulas/abscesses (PR=3.38; 95%CI:2.14-5.33; PR=2.85; 95%CI:1.73-4.67), respectively. In addition, the sensitivity test showed that there was almost no difference in strength of association, without resilience in the model, between the presence of pulp involvement and fistulas/abscesses and the sections Child Impact (PR=2.10; 95%CI:1.48-2.98; p<0.001; PR=1.99; 95%CI:1.37-2.87; p <0.001) and Family Impact (PR=3.43; 95% CI:2.16-5.45; p<0.001; PR=2.88; 95%CI:1.75-4.75; p<0.001), respectively. In conclusion, the presence of the clinical pulp-related consequences of caries, and not the presence of carious lesions per se, had a negative repercussion on the OHRQoL of preschool children and their families, and parental resilience did not act as a moderating factor for this association. (AU)