Family and contextual factors associated with licit drug use in adolescence.

OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01-1.59), family cohesion (PR = 9.81; 95%CI: 1.23-72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57-0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46-214.87) and separated type (PR = 13.54; 95%CI: 1.40-130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

Contributions of school context to caries on anterior teeth: a multilevel analysis.

OBJECTIVE: To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS: A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS: The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24-2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13-1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05-3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07-1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78-3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05-0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98-0.99) were associated with the outcome. CONCLUSIONS: Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

Association of Oral Health Literacy and School Factors with Untreated Dental Caries among 12-Year-Olds: A Multilevel Approach.

Dental caries are a global health problem that affects all age groups and must be considered a public health priority due to its significant financial costs and impact on the quality of life. This study evaluated the association between oral health literacy (OHL), school factors, and untreated dental caries in 12-year-old Brazilian adolescents using a multilevel approach. A population-based cross-sectional study was carried out with 740 adolescents randomly selected from private and public schools in Campina Grande, Brazil. Two dentists were trained and calibrated to diagnose dental caries using the Nyvad index and OHL using the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30). The caregivers of the adolescents reported demographic data (sex, skin color, and socioeconomic status). Data of school factors such as the type of school and the school grade retention rate were classified through a 2-step hierarchical cluster analysis to obtain the school environment. A robust multilevel log-linear negative binomial regression for complex samples was performed (p < 0.05). In the analysis, adjusted by individual determinants, nonwhite skin color (RR = 2.20; 95% CI 1.56-3.12), a low socioeconomic status (RR = 1.60; 95% CI 1.09-2.34), a low OHL score (RR = 0.94; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.25; 95% CI 1.67-3.04) were associated with untreated dental caries. The following factors remained associated with untreated dental caries in the final model: students from an unfavorable learning environment (RR = 2.20; 95% CI 1.27-3.80), nonwhite skin color (RR = 1.92; 95% CI 1.27-2.91), a low socioeconomic status (RR = 1.82; 95% CI 1.12-2.94), a low OHL score (RR = 0.95; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.07; 95% CI 1.47-2.91). Untreated dental caries in early adolescence were impacted by the school environment, the socioeconomic status, OHL, and the adolescent's satisfaction with the last dental appointment.

Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents.

BACKGROUND: The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments. AIM: To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents. DESIGN: A cross-sectional study was conducted with 740 12-year-old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD-30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed. RESULTS: A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01-1.03), high social class (PR = 1.28; 95% CI: 1.09-1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37-1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19-2.02) and connected (PR = 1.22; 95% CI: 1.02-1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01-1.38) remained associated with having visited a dentist. CONCLUSIONS: Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.

Family and contextual factors associated with licit drug use in adolescence

ABSTRACT OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01-1.59), family cohesion (PR = 9.81; 95%CI: 1.23-72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57-0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46-214.87) and separated type (PR = 13.54; 95%CI: 1.40-130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

Contributions of school context to caries on anterior teeth: a multilevel analysis

ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24-2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13-1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05-3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07-1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78-3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05-0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98-0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

Degree of family cohesion and social class are associated with the number of cavitated dental caries in adolescents.

The aim of this study was to evaluate the association between number of cavitated dental caries in adolescents and family cohesion, drug use, sociodemographic factors and visits to the dentist. A cross-sectional study was conducted with 746 adolescents aged 15 to 19 years from Campina Grande, Brazil. The parents answered a questionnaire addressing sociodemographic data, and the adolescents answered questionnaires on drug use, type of family cohesion and visits to the dentist. Two examiners underwent training and calibration exercises (K > 0.80) to diagnose dental caries using the Nyvad criteria. A directed acyclic graph was created to select the variables to be controlled in the statistical model. Associations between the independent variables and the outcome were determined using robust Poisson Regression analysis for complex samples (α = 5%). Rate ratios (RR) and 95% confidence intervals (CI) were calculated. The prevalence of dental caries and cavitated lesions among the adolescents was 92.8% and 41.6%, respectively. The following variables remained associated with the number of cavitated lesions in the multivariate analysis: disengaged (RR: 6.30; 95%CI: 1.24-31.88; p = 0.028 ), separated (RR: 4.80; 95%CI: 1.03-22.35; p = 0.046) and connected (RR: 5.23; 95%CI: 1.27-21.59; p = 0.024) levels of family cohesion, and high social class (RR: 0.55; 95%CI: 0.39-0.76; p = 0.001). In conclusion, this paper posits that adolescents with a lower socioeconomic status, and those whose family cohesion was classified as disengaged, separated or connected, had a larger number of cavitated lesions.

Socioeconomic status and family functioning influence oral health literacy among adolescents.

OBJECTIVE: Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS: Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87-0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS: The following variables remained associated with better OHL: high mother's schooling level (RR = 1.07; 95%CI: 1.03-1.12), high income (RR = 1.04; 95%CI: 1.01-1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01-1.10), married parents (RR = 1.04; 95%CI: 1.01-1.09), "enmeshed" family cohesion (RR = 1.21; 95%CI: 1.12-1.30), "structured" (RR = 1.06; 95%CI: 1.01-1.12) or "rigid" (RR = 1.11; 95%CI: 1.04-1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01-1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03-1.13). CONCLUSION: Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

The impact of oral health literacy and family cohesion on dental caries in early adolescence.

OBJECTIVES: The aim of this study was to evaluate the association between the prevalence of cavitated dental caries and oral health literacy (OHL), family characteristics and sociodemographic factors in early adolescence. METHODS: A cross-sectional study was conducted with 740 twelve-year-old students. The students' guardians provided information on sociodemographic data, and the students provided information on family characteristics and OHL. Two trained dentists examined the participants for dental caries and administered the Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry (BREALD-30). Control variables were selected using a directed acyclic graph. Descriptive analysis was performed; this was followed by robust Poisson regression analysis for complex samples to evaluate the association between dental caries and socioeconomic and family predictors (α = 5%). RESULTS: The following variables were associated with a greater number of cavitated caries lesions: low level of education completed by the mother (RR = 1.58; 95% CI: 1.12-2.24), less privileged social class (RR = 1.89; 95% CI: 1.28-2.80), non-White ethnicity (RR = 1.64; 95% CI: 1.0-2.48), larger number of residents in the home (RR = 1.87; 95% CI: 1.25-2.81), low level of OHL (RR = 2.02; 95% CI: 1.28-3.18), and the 'connected' (RR = 4.72; 95% CI: 1.17-18.90), 'separated' (RR = 4.09; 95% CI: 1.05-15.86) and 'disengaged' (RR = 4.20; 95% CI: 1.09-16.18) types of family cohesion. CONCLUSIONS: A low level of oral health literacy, sociodemographic factors, and a low level of family cohesion are predictors of cavitated caries lesions in early adolescence.

Degree of family cohesion and social class are associated with the number of cavitated dental caries in adolescents

Abstract The aim of this study was to evaluate the association between number of cavitated dental caries in adolescents and family cohesion, drug use, sociodemographic factors and visits to the dentist. A cross-sectional study was conducted with 746 adolescents aged 15 to 19 years from Campina Grande, Brazil. The parents answered a questionnaire addressing sociodemographic data, and the adolescents answered questionnaires on drug use, type of family cohesion and visits to the dentist. Two examiners underwent training and calibration exercises (K > 0.80) to diagnose dental caries using the Nyvad criteria. A directed acyclic graph was created to select the variables to be controlled in the statistical model. Associations between the independent variables and the outcome were determined using robust Poisson Regression analysis for complex samples (α = 5%). Rate ratios (RR) and 95% confidence intervals (CI) were calculated. The prevalence of dental caries and cavitated lesions among the adolescents was 92.8% and 41.6%, respectively. The following variables remained associated with the number of cavitated lesions in the multivariate analysis: disengaged (RR: 6.30; 95%CI: 1.24-31.88; p = 0.028 ), separated (RR: 4.80; 95%CI: 1.03-22.35; p = 0.046) and connected (RR: 5.23; 95%CI: 1.27-21.59; p = 0.024) levels of family cohesion, and high social class (RR: 0.55; 95%CI: 0.39-0.76; p = 0.001). In conclusion, this paper posits that adolescents with a lower socioeconomic status, and those whose family cohesion was classified as disengaged, separated or connected, had a larger number of cavitated lesions.

Socioeconomic status and family functioning influence oral health literacy among adolescents

ABSTRACT OBJECTIVE Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87-0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS The following variables remained associated with better OHL: high mother's schooling level (RR = 1.07; 95%CI: 1.03-1.12), high income (RR = 1.04; 95%CI: 1.01-1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01-1.10), married parents (RR = 1.04; 95%CI: 1.01-1.09), "enmeshed" family cohesion (RR = 1.21; 95%CI: 1.12-1.30), "structured" (RR = 1.06; 95%CI: 1.01-1.12) or "rigid" (RR = 1.11; 95%CI: 1.04-1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01-1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03-1.13). CONCLUSION Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

Adolescents with worse levels of oral health literacy have more cavitated carious lesions.

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18-2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01-1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39-2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

Psychometric properties of BREALD-30 for assessing adolescents' oral health literacy.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS: The study included 750 adolescents: 375 aged 12 years and 375 aged 15-19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS: BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach's alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48-3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24-3.11]. CONCLUSIONS: BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.

Condição dentária de pacientes com disfunção temporomandibular / Dental condiction of patients with temporomandibular dysfunction / Condición dental de pacientes con disfunción temporomandibular

RESUMO Objetivo Avaliar a condição dentária e a dimensão vertical em pacientes portadores de DTM, bem como a idade e origem da DTM. Metodologia Realizou-se um estudo descritivo, observacional de corte transversal, com uma amostra de trinta pacientes com DTM, diagnosticado pelo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Esta amostra foi determinada através de estimativas de atendimento, desta forma, uma amostra de conveniência. A associação entre o gênero, idade, dimensão vertical e condição dentária com DTM foram verificadas através do teste estatístico qui-quadrado, com intervalos de confiança de 95%. Resultados Constatou-se que 26 pacientes eram do sexo feminino e 4 do sexo masculino. Quinze sujeitos apresentaram idade inferior a 36,5 anos. Quanto a origem da DTM, 19 sujeitos tinham desordem articular, e 11 muscular. Determinou-se que não houve associação estatisticamente significante entre as variáveis independentes com a DTM. Conclusão Os fatores etiológicos analisados isoladamente parecem não influenciam de forma única no desenvolvimento da DTM, mas poderão atuar em conjunto com outros fatores, já que a sua causa é multifatorial.(AU)

ABSTRACT Objective To evaluate the dental condition and the vertical dimension in patients with TMD, and the age and origin of the DTM. Methods Was performed a descriptive study, observational, cross-sectional, with a sample of thirty patients with TMD, diagnosed by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). This sample was determined based on estimates the service thus a sample of convenience. The association between gender, age, vertical dimension and dental condition with TMD were verified using the chi-square statistical test with 95% confidence intervals. Results It found that 26 patients were female and 4 males. Fifteen subjects presented aged below 36.5 years. How much the origin of the DTM, 19 subjects had articular disorder, and 11 muscle disorder. Has been determined that there was no statistically significant association between the independent variables with the DTM. Conclusion The etiological factors analyzed in isolation do not seem to influence in a unique way in the development of TMD, but may act together with other factors, because the cause is multifactorial.(AU)

RESUMEN Objetivo Evaluar la condición dental y la dimensión vertical en pacientes portadores de DTM, así como la edad y origen de la DTM. Metodología Se realizó un estudio descriptivo, observacional de corte transversal, con una muestra de treinta pacientes con DTM, diagnosticado por el Research Diagnostic Criteria para desórdenes temporomandibulares (RDC / TMD). Esta muestra se determinó a través de estimaciones de atención, a través de una muestra de conveniencia. La asociación entre el género, la edad, la dimensión vertical y la condición dental con DTM se verificó mediante la prueba estadística chi-cuadrado, con intervalos de confianza del 95%. Resultados Se constató que 26 pacientes eran del sexo femenino y 4 del sexo masculino. 15 sujetos presentaron una edad inferior a 36,5 años. En cuanto al origen de la DTM, 19 sujetos tenían desorden articular, y 11, muscular. Se determinó que no hubo asociación estadísticamente significativa entre las variables independientes con la DTM. Conclusión Los factores etiológicos analizados aisladamente parecen no influenciar de forma única en el desarrollo de la DTM, pero podrán actuar en conjunto con otros factores, ya que su causa es multifactorial.(AU)

Psychometric properties of BREALD-30 for assessing adolescents' oral health literacy

ABSTRACT OBJECTIVE To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS The study included 750 adolescents: 375 aged 12 years and 375 aged 15-19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach's alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48-3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24-3.11]. CONCLUSIONS BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.

Prenatal care and hypertensive gestational syndromes: A systematic review / Atenção pré-natal e síndromes gestacionais hipertensivas: uma revisão sistemática

Abstract Objective Evaluate the influence of prenatal care on the occurrence of gestational hypertension. Methods The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103). Results The seven studies hada lowriskof bias,withmethodological quality scores ranging fromsix to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size. Conclusion Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.

Resumo Objetivo Avaliar a influência da assistência pré-natal no acometimento de síndromes hipertensivas gestacionais. Métodos A revisão buscou artigos publicados nas plataformas eletrônicas de pesquisa Web of Science, Scopus, Pubmed, Cochrane e Clinical Trials, sem restrições de linguagem e com os artigos publicados entre 01/01/2012 e 31/12/2016. Os descritores utilizados foram: assistência pré-natal, assistência médica, educação pré-natal, hipertensão induzida pela gravidez, gestação. Foi utilizado o checklist preferred reporting items for systematic reviews and meta-analyses PRISMA. A busca na literatura, de acordo com a estratégia adotada, identificou 240 artigos. Contudo, somente 7 artigos foram selecionados de acordo com os critérios de inclusão. A revisão sistemática foi incluída no registro prospectivo internacional de revisões sistemáticas (PROSPERO, na sigla em inglês; #CRD42017064103). Resultados Cinco estudos encontraram relação positiva entre a assistência pré-Natal e síndromes hipertensivas gestacionais. Dois estudos não encontraram uma associação estatística significativa entre estas duas variáveis. Os sete estudos apresentam um baixo risco de viés, com as pontuações na análise de qualidade variando entre seis e oito. As possíveis diferenças entre os achados podem ser devidas ao momento do diagnóstico das síndromes hipertensiva gestacionais, tipo de serviço onde foi realizada a pesquisa e o tamanho amostral. Conclusão Embora os estudos apresentem diferentes aspectos metodológicos, observou-se a importância da implementação da Assistência Pré-Natal durante o período gestacional, o que atuará como medida de promoção e prevenção em saúde.

Prenatal Care and Hypertensive Gestational Syndromes: A Systematic Review.

OBJECTIVE: Evaluate the influence of prenatal care on the occurrence of gestational hypertension. METHODS: The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103). RESULTS: The seven studies had a low risk of bias, with methodological quality scores ranging from six to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size. CONCLUSION: Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.

OBJETIVO: Avaliar a influência da assistência pré-natal no acometimento de síndromes hipertensivas gestacionais. MéTODOS: A revisão buscou artigos publicados nas plataformas eletrônicas de pesquisa Web of Science, Scopus, Pubmed, Cochrane e Clinical Trials, sem restrições de linguagem e com os artigos publicados entre 01/01/2012 e 31/12/2016. Os descritores utilizados foram: assistência pré-natal, assistência médica, educação pré-natal, hipertensão induzida pela gravidez, gestação. Foi utilizado o checklist preferred reporting items for systematic reviews and meta-analyses PRISMA. A busca na literatura, de acordo com a estratégia adotada, identificou 240 artigos. Contudo, somente 7 artigos foram selecionados de acordo com os critérios de inclusão. A revisão sistemática foi incluída no registro prospectivo internacional de revisões sistemáticas (PROSPERO, na sigla em inglês; #CRD42017064103). RESULTADOS: Cinco estudos encontraram relação positiva entre a assistência pré-Natal e síndromes hipertensivas gestacionais. Dois estudos não encontraram uma associação estatística significativa entre estas duas variáveis. Os sete estudos apresentam um baixo risco de viés, com as pontuações na análise de qualidade variando entre seis e oito. As possíveis diferenças entre os achados podem ser devidas ao momento do diagnóstico das síndromes hipertensiva gestacionais, tipo de serviço onde foi realizada a pesquisa e o tamanho amostral. CONCLUSãO: Embora os estudos apresentem diferentes aspectos metodológicos, observou-se a importância da implementação da Assistência Pré-Natal durante o período gestacional, o que atuará como medida de promoção e prevenção em saúde.

Influência da técnica de inserção da resina composta odontológica na lisura superficial da restauração / Influence of the technique of integration of dental composite resin restoration in surface smoothness

Introdução: A lisura final é uma característica desejada nas restaurações odontológicas, pois a torna menos propensa a retenção do biofilme dental, um dos responsáveis por insucessos de trabalhos dentários. Objetivo: mensurar "in vitro" a lisura superficial de uma resina composta micro-híbrida quanto à influência da técnica de inserção do material restaurador na qualidade da lisura final da restauração. Material e Método: Uma análise de 12 corpos de prova, padronizados e confeccionados em resina composta Z-100 (3M), divididos em grupos com tipos diferentes de inserção do material restaurador. Os corpos de prova foram submetidos à avaliação da lisura superficial através de um Rugosímetro (ITRPSD 200 Rugosímetro de Superfície Digital Portátil). Em seguida os mesmos receberam acabamento e polimento e nova avaliação rugosimétrica. Os valores obtidos foram submetidos aos testes de Kruskal-wallis, para comparação entre os grupos da pesquisa, e Wilcoxon para comparação entre as duas fases (antes e após o polimento). Resultados: Os valores médios da rugosidade superficial dos grupos antes do polimento ficaram entre 0,43mm e 0,70mm e após o polimento, entre 0,11mm e 0,26mm. Não houve significância estatística entre as técnicas de inserção avaliadas, mas sim, entre as duas fases da pesquisa (pré e pós-polimento). Conclusões: Não existe superioridade de uma das técnicas, porém o uso do pincel odontológico se mostrou eficaz para melhorar as características superficiais. Reafirma-se a necessidade da aplicação das técnicas de polimento nas terapias restauradoras visando um resultado final de excelência.

Introduction: The final smoothness is a desired feature in dental fillings as they make it less prone to retention of biofilm, the one responsible for failures of dental work. Objective: To measure "in vitro" the surface smoothness of a composite micro-hybrid as the influence of the restorative material insertion technique as the final smoothness of the restoration. Methods: An analysis of 12 specimens, standardized and made of composite resin Z-100 (3M), divided into groups with different types of insertion of the restorative material. The samples were evaluated for surface smoothness through a Surface Roughness Tester (ITRPSD 200 Surface Roughness Tester Digital Surface Portable). Then they received finishing and polishing and reassessment rugosimetric. The values obtained were submitted to the Kruskal-Wallis test for comparison between the research groups and Wilcoxon for comparison between the two phases (before and after polishing). Results: The mean values of surface roughness of the groups prior to polishing were among 0,43mm e 0,70mm e after polishing, between 0,11mm e 0,26mm. There was no statistical significance between the insertion techniques evaluated, but between the two phases of the study (before and after polishing). Conclusions: There is no superiority of one technique, but the use of dental brush is effective to improve the surface characteristics. Reaffirms the need of the application of polishing techniques in restorative therapies targeting a final result of excellence.

Lisura superficial da resina composta frente a técnicas de polimento / Surface smoothness of composite resin compared to different polishing techniques

A lisura superficial é um dos objetivos finais dos tratamentos restauradores. O presente estudo compara quatro técnicas diferentes de polimento em resina composta. Na fase experimental, realizou-se polimentos em 60 corpos de prova de resina composta divididos em quatro grupos por técnica de polimento: discos de lixa, pontas de silicone, discos de feltro com pasta abrasiva e discos de lixa juntamente com discos de feltro. Mensurou-se a rugosidade superficial em micrômetros, computou-se ou dados em Microsoft Excel e submeteram-se os mesmos ao teste de Kruskal-Wallis. Após a avaliação dos resultados constatou-se que não houve diferença estatística entre as técnicas quanto à superioridade de uma sobre as outras, sendo todas eficazes de acordo com a rugosidade admitida pela literatura como aceitável.

Surface smoothness is one of the last steps of restorative treatment. This study compares four polishing techniques in composite resin. in Sixty specimens of composite resin were divided in four groups defined by polishing techniques: sanding discs, silicon tips, felt discs with abrasive pasts and sanding discs together with felt discs. The surface roughness in micrometers were measured and the data were statistically processed. No statistical difference between the techniques regarding the superiority of one over the others were found, being all effective according to roughness admitted in the literature as acceptable.

Cobertura da atenção secundária em saúde bucal no Rio Grande do Norte (RN) à perspectiva do Decreto 7508/2011 e do GraduaCEO / Coverage of oral secondary health care in the State of Rio Grande do Norte (RN) in the light of the Decree 7508/2011 and the GraduaCEO

No Brasil, a Política de Saúde Bucal ao longo da história passou por mudanças significativas em sua forma de prestar assistência, chegando aos dias atuais regida pelo Decreto 7.508/2011, que traz em sua essência a regionalização como forma de aprimorar os serviços de saúde pública. Para se obter assistência resolutiva é necessário prestar serviços nos diferentes níveis hierárquicos do sistema. No que se refere à saúde bucal, o Centro de Especialidades Odontológicas (CEO) se mostra como uma importante ferramenta em atenção secundária para propiciar a integralidade da assistência. O objetivo deste estudo é avaliar a distribuição geográfica dos CEOs do Estado do Rio Grande do Norte, assim como sua série histórica de produção, a fim de aferir a possibilidade de se ter resolutividade com o processo de regionalização da assistência, relacionando os achados com o mais novo componente da Política Nacional de Saúde Bucal, o GraduaCEO. Houve evolução no número de CEOs e de procedimentos em atenção secundária no estado. Apesar de todas as regiões do RN terem a presença de CEOs, o percentual médio de cobertura municipal é de 12,6%, variando de 8% a 80% por região, indicando a necessidade de se rever o planejamento das ações e serviços da rede de saúde bucal, levando em conta a possibilidade de implantação do GraduaCEO (AU).

The Brazilian oral health assistance model has undergone significant changes throughout history. Nowadays, the model is governed by Decree 7,508/2011, which brings in its essence regionalization as a way to improve public health services. To obtain resolutive care is necessary to provide services in different hierarchical levels of the system. With regard to oral health, the Center for Dental Specialties (Centro de Especialidades Odontológicas - CEO) is an important tool in the secondary health care level to provide comprehensive care. This study evaluate the geographical distribution of CEOs in the Rio Grande do Norte (RN) state, as well as its historical productivity data in order to assess the possibility of having resoluteness in the regionalization process of assistance and to relate the findings with the newest component of the National Oral Health Policy, the GraduaCEO. There was an increase in the number of CEOs and dental procedures in secondary care in the RN state. The data collected show CEOs in all RN regions, with an average of municipal coverage of 12.6%, ranging from 8% to 80% by region. These data indicate the need to review the planning of actions and oral health services network, taking into account the possibility of implementation of GraduaCEO (AU).