Normatização dos escores da escala eHealth Literacy Scale para avaliação do letramento digital em saúde / Standardization of eHealth Literacy Scale scores for assessing digital health literacy / Estandarización de las puntuaciones de la escala eHealth Literacy Scale para evaluar la alfabetización digital en salud

Objetivo: analisar os dados de normatização dos escores da versão brasileira do instrumento eHealth Literacy Scale (eHeals) para avaliação do letramento digital em saúde. Método: estudo transversal com 502 adultos brasileiros, realizado em 2019. Dados coletados pelo instrumento eHeals e questionário sociodemográfico. Foram aplicadas árvores de decisão e análise discriminante. Estudo aprovado pelo Comite de Ética em Pesquisa. Resultados: a análise discriminante determinou as faixas de classificação do eHeals a partir da distribuição dos escores. A árvore de decisão indicou que a escolaridade afetou de forma relevante os resultados da escala. Os indivíduos com escolaridade até o ensino fundamental II incompleto: baixo (até 10), médio (11 a 25), alto (27 a 40), e escolaridade acima: baixo (até 25), médio (25 a 32) e alto LDS (33 a 40). Conclusão: a classificação dos níveis de letramento digital em saúde de adultos pelo eHeals deve ser controlada pelos níveis de escolaridade dos participantes.

Objective: to analyze the normative data of the scores of the Brazilian version of the eHealth Literacy Scale (eHeals) instrument for assessing digital health literacy. Method: cross-sectional study with 502 Brazilian adults in 2019. Data collected using the eHeals instrument and sociodemographic questionnaire. Decision trees and discriminant analysis were applied. Study approved by the Research Ethics Committee. Results: Discriminant analysis determined the eHeals classification ranges based on the distribution of scores. The decision tree indicated that education significantly affected the scale results. Thus, individuals with incomplete elementary school education up to II: low (up to 10), medium (11 to 25), high (27 to 40), and higher education: low (up to 25), medium (25 to 32) and high LDS (33 to 40). Conclusion: the classification of digital health literacy levels using eHeals in adults should be controlled by the participants' education levels.

Objetivo: analizar los datos de estandarización de las puntuaciones de la versión brasileña del instrumento eHealth Literacy Scale (eHeals) para evaluar la alfabetización digital en salud. Método: estudio transversal con 502 adultos brasileños que tuvo lugar en 2019. La recolección de datos se hizo mediante el instrumento eHeals y un cuestionario sociodemográfico. Se aplicaron árboles de decisión y análisis discriminante. El Comité de Ética en Investigación aprobó el estudio. Resultados: El análisis discriminante determinó los rangos de clasificación de eHeals con base en la distribución de puntuaciones. El árbol de decisión indicó que la educación afectó significativamente los resultados de la escala. Individuos con educación primaria incompleta: baja (hasta 10), media (11 a 25), alta (27 a 40), y educación superior a esa mencionada: baja (hasta 25), media (25 a 32) y alto LDS (33 a 40). Conclusión: la clasificación de los niveles de alfabetización en salud digital en adultos con eHeals debe ser controlada por los niveles de educación de los participantes.

Health literacy and self-efficacy associations with non-adherence to dental treatment among young adults.

The aim of this study was to investigate associations of health literacy (HL), general self-efficacy (GSE), and sociodemographic variables with non-adherence to dental treatment among Brazilian young adults. This is a cross-sectional study based on a cohort study of 248 young adults aged 19 to 25 years followed up in an earlier study. The participants completed the perceived general self-efficacy scale (GSE), a questionnaire on socioeconomic and demographic variables and were examined for oral conditions. HL was measured using the Brazilian version of the health literacy questionnaire (HLQ-Br), which provides nine individual scores based on an average of the items within each of the nine scales. Dental treatment adherence was evaluated as the decision of young adults to seek a dentist to finish the recommended restorative treatment for dental caries. The effects of HL domains on the adherence to dental treatment were analyzed by logistic regression and the effect was adjusted for sex, age, family income, paternal and maternal education, type of housing, and self-efficacy. The results of the adjusted analysis showed associations among young adults who did not adhere to dental treatment with lower self-efficacy levels, living in non-owner-occupied homes, and lower HL levels in almost all of the HL domains (p < 0.05). Only the HLQ6 domain "Ability to actively engage with healthcare providers" was not associated with the outcome (p>0.05). Adherence to dental treatment in primary care among young adults was associated with their general self-efficacy levels, socioeconomic characteristics, and individual's lower HL aspects.

Structure and replicability of oral health-related quality of life networks across patients with schizophrenia and the general community.

OBJECTIVES: Schizophrenia is a disabling mental disorder associated with severe social dysfunction. Individuals with long-term mental conditions have poorer Oral Health-Related Quality of Life (OHRQoL) compared to the general population, but little is known about the measurement properties of OHRQoL instruments in this group of patients. This study aimed to examine the replicability of OHRQoL networks across samples of the general community (GC) and patients with schizophrenia (PWS). METHODS: Data were obtained from 603 community-dwelling participants and 627 patients with schizophrenia. OHRQoL was measured using the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. A regularized partial correlation network was estimated for each sample. The number of dimensions and structural stability were assessed using Exploratory Graph Analysis. Global strength, edge weights and centrality estimates were compared. Network replicability was examined fitting the PWS data to the GC network structure. RESULTS: A single OHIP-14 dimension was identified in the GC sample, whereas three dimensions were detected in the PWS sample. Structural consistency was perfect in the network of GC participants (1), and considerably low in at least two dimensions of the PWS network (0.28; 0.65; 0.16). A moderate correlation for node strength estimates was observed (τ: 0.43; 95% CI: 0.13, 0.72), although edge weights were not correlated (τ: 0.025; 95% CI: -0.11, 0.16). The fit of the PWS data to the GC network structure was deemed unacceptable. CONCLUSION: Network models of OHRQoL did not replicate across samples of the general community and outpatients with schizophrenia. Prudent use of OHIP-14 to compare measures of OHRQoL between groups with significant cognitive impartment and the general population is recommended.

Fatores associados à autopercepção de desempenho acadêmico por estudantes de Odontologia durante a pandemia da COVID-19 / Factores asociados a la autopercepción del desempeño académico de los estudiantes de odontología durante la pandemia de COVID-19 / Factors associated with self-perceived academic performance by dentistry undergraduates during the COVID-19 pandemic

O estudo objetivou investigar associações entre a autopercepção do desempenho acadêmico e crenças de autoeficácia, variáveis sociodemográficas e vida acadêmica em graduandos em Odontologia no período de ensino remoto durante a pandemia de COVID-19. Trata-se de um estudo transversal que empregou os seguintes instrumentos no formato virtual: questões sociodemográficas, autopercepção do rendimento escolar, aprendizagem durante o período de ensino remoto, e Escala de Autoeficácia Geral Percebida (EAGP). Os questionários foram disponibilizados entre setembro de 2020 e abril de 2021 para os alunos matriculados entre o segundo e o quinto ano do curso. Utilizaram-se modelos de regressão para analisar as associações entre variáveis preditores com o desfecho autopercepção do desempenho acadêmico. Estimou-se odds-ratiosbrutos e ajustados com os respectivos intervalos de 95% de confiança. Uma amostra de 150 graduandos respondeu ao questionário, sendo 70,0% mulheres (n=105) com idade média de 21,7 anos. Verificou-se que a autopercepção do desempenho acadêmico classificada como 'insuficiente ou pouco suficiente' esteve associada aos estudantes que não se adaptaram bem à nova experiência de ensino e aprendizagem (OR=8,08; IC95%: 2,02-32,35), que acharam que não dominavam os conhecimentos e competências ensinados nas aulas remotas (OR=10,74; IC95%: 2,81-41,02) e que achavam que o seu desempenho como estudante havia piorado desde que as aulas presenciais foram suspensas (OR=8,19; IC95%: 1,59-42,12). Conclui-se que durante o período pandêmico, a baixa autopercepção do rendimento acadêmico esteve associada à dificuldade de adaptação ao novo modelo de ensino remoto, ao senso de não assimilação dos conteúdos e de piora do desempenho escolar (AU).

El estudio tuvo como objetivo investigar asociaciones entre la autopercepción del desempeño académico y las creencias de autoeficacia, variables sociodemográficas y vida académica en estudiantes de Odontología durante el período de enseñanza remota durantela pandemia de COVID-19. Se trata de un estudio transversal que utilizó los siguientes instrumentos en formato virtual: preguntas sociodemográficas, rendimiento académico autopercibido, aprendizaje durante el periodo de docencia remota y Escala de Autoeficacia General Percibida (EAGP). Los cuestionarios estuvieron disponibles entre septiembre de 2020 y abril de 2021 para estudiantes matriculados entre el segundo y quinto año del curso. Se utilizaron modelos de regresión para analizar las asociaciones entrelas variables predictivas y la autopercepción de resultados del rendimiento académico. Los odds ratios crudos y ajustados se estimaron con sus respectivos intervalos de confianza del 95%. Respondieron al cuestionario una muestra de 150 estudiantes universitarios, de los cuales el 70,0% eran mujeres (n=105) con una edad promedio de 21,7 años. Se encontró que la autopercepción del rendimiento académico clasificado como 'insuficiente o insuficiente' se asoció con estudiantes que no se adaptaron bien a la nueva experiencia de enseñanza y aprendizaje (OR=8,08; IC 95%: 2,02-32,35), quienes sintieron que no dominaban los conocimientos y habilidades impartidos en las clases remotas (OR=10,74; IC 95%: 2,81-41,02) y que sentían que su desempeño como estudiante había empeorado desde que se suspendieron las clases presenciales (OR=8,19; IC 95%: 1,59-42,12). Se concluye que durante el período de pandemia la baja autopercepción del rendimiento académico se asoció con la dificultad de adaptación al nuevo modelo de enseñanza a distancia, la sensación de no asimilación de contenidos y el empeoramiento del rendimiento académico (AU).

This cross-sectional study investigates associations between self-perceived academic performance by dentistry undergraduates and self-efficacy beliefs, sociodemographic variables and academic life during the remote teaching implemented due to the COVID-19 pandemic. Data collected by means of questionnaires (sociodemographic questions, self-perceived academic performance, learning during the remote teaching period) and the General Self-Efficacy Scale (GSE), answered online. The questionnaires were emailed between September 2020 and April 2021 to students enrolled between the second and fifth year. Associations between predictor variables and the outcome (self-perceived academic performance) were analyzed by regression models. Crude and adjusted odds-ratios were estimated with their respective 95% confidence intervals. A total of 150 undergraduates answered the questionnaires of which, 70.0% were women (n=105) with mean age of 21.7 years. Self-perceived academic performance classified as 'insufficient or insufficient' was associated with students who did not adapt well to the new teaching-learning experience (OR=8.08; 95%CI: 2.02­32.35), who felt that they lacked mastery of the knowledge and skills taught in remote classes (OR=10.74; 95%CI: 2.81­41.02) and who felt that their academic performance had worsened since in-class lessons were suspended (OR=8.19; 95%CI: 1.59­42.12). During the pandemic, low self-perceived academic performance was associated with difficulties in adapting to the new remote teaching model, a sense of non-assimilation of content and worsened academic performance (AU).

Factors associated with oral health literacy among users of primary health care: a cross-sectional study

Aim To analyze associations between sociodemographic factors, self-perception, self-care practices in health with Oral Health Literacy (OHL) levels among users of Primary Health Care (PHC). Methods A cross-sectional and analytical study was performed in Piracicaba (São Paulo), Brazil, in 2018, with a convenience sample of users of PHC that were aged over 18 years. Data were collected with a questionnaire by a trained dentist in two Family Health Units. The outcome variable was OHL, measured by the OHLA-B instrument, which was dichotomized by median into low (≤8 point) and high (>8 point). The independent variables were sociodemographic conditions (age, sex, self-declared skin color, and education), self-perceived oral health and self-care practices in health (tooth brushing frequency, smoking habits, reason for the last visit to the dentist, and source of health information search). Unadjusted and adjusted analyses were performed between OHL and independent variables for multiple logistic regression model (p≤0.05). Results The sample consisted of 450 adults. A total of 54.7% had a low OHL. After adjusting for sex and age, OHL was associated with skin color (OR=0.57; 95%CI=0.37-085), educational level (OR=4.92; 95%CI=3.16-7.79), health information from health professionals (OR=2.40; 95%CI=1.42-4.16) and internet (OR=2.88; 95%CI=1.59-5.32), toothbrushing >1 time a day (OR=3.23; 95%CI=1.27-9.92) and smokers (OR=0.42; 95%CI=0.23-0.73). After adjusting for sex, age and income, OHL was associated with (OR=0.63; 95%CI=0.41-096), educational level (OR=4.06; 95%CI=2.57-6.51) and smokers (OR=0.48; 95%CI=0.26-0.84). Conclusions Low OHL was associated with socioeconomic factors, source of information and smoking. This fact highlights the importance of health professionals to promote OHL.

Health literacy and self-efficacy associations with non-adherence to dental treatment among young adults

Abstract: The aim of this study was to investigate associations of health literacy (HL), general self-efficacy (GSE), and sociodemographic variables with non-adherence to dental treatment among Brazilian young adults. This is a cross-sectional study based on a cohort study of 248 young adults aged 19 to 25 years followed up in an earlier study. The participants completed the perceived general self-efficacy scale (GSE), a questionnaire on socioeconomic and demographic variables and were examined for oral conditions. HL was measured using the Brazilian version of the health literacy questionnaire (HLQ-Br), which provides nine individual scores based on an average of the items within each of the nine scales. Dental treatment adherence was evaluated as the decision of young adults to seek a dentist to finish the recommended restorative treatment for dental caries. The effects of HL domains on the adherence to dental treatment were analyzed by logistic regression and the effect was adjusted for sex, age, family income, paternal and maternal education, type of housing, and self-efficacy. The results of the adjusted analysis showed associations among young adults who did not adhere to dental treatment with lower self-efficacy levels, living in non-owner-occupied homes, and lower HL levels in almost all of the HL domains (p < 0.05). Only the HLQ6 domain "Ability to actively engage with healthcare providers" was not associated with the outcome (p>0.05). Adherence to dental treatment in primary care among young adults was associated with their general self-efficacy levels, socioeconomic characteristics, and individual's lower HL aspects.

Psychometric properties of the Brazilian version of the European Health Literacy Survey Questionnaire short form.

The aim of this study was to analyze the psychometric properties of the Portuguese Brazilian version of the instrument for measuring health literacy European Health Literacy Survey Questionnaire short form (HLS-EU-Q16). The study sample consisted of 783 Brazilian adults with a mean age of 38.6 years. The data were analyzed through an extensive and robust process of testing the properties with the combination of exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and item response theory (IRT) techniques, aiming to search for strong validation evidence in the internal structure and stability step for other sub-samples. The instrument's reliability was tested using Cronbach's alpha and McDonald's Omega. The analyses indicated the existence of only one dimension and good reliability values. The model tested with cross-validation indicated satisfactory, adequate, consistent and stable levels for EFA, IRT via item discrimination and CFA, both for primary indicators as factor loadings, communalities, item discrimination as well as for the model adequacy indicators. It is concluded that the Brazilian Portuguese version of the HLS-EU-Q16 proved to be a one-dimensional, consistent, accurate and stable model for measuring health literacy in Brazilian adults.

Health literacy (HL) is a field of scientific knowledge that has been related to the knowledge and skills of people to access, understand, evaluate and apply information in health. Among the currently existing instruments for measuring the HL construct in its broader aspects, involving multidimensional characteristics, there is the short version of European Health Literacy Survey Questionnaire (HLS-EU-Q16). The aim of this study was to investigate the psychometric properties of the Brazilian Portuguese version of the HL instrument European Health Literacy Survey Questionnaire in its short form, also known as HLS-EU-Q16. The instrument was applied to a sample of 783 Brazilian adults. Our results demonstrated that the Brazilian version of HLS-EU-Q16 presented good psychometric properties to measure HL in Brazilian adults.

Factors associated with the absence of Brazilians in specialized dental centers.

AIM: To identify the individual and contextual factors associated with the absence of Brazilians at a scheduled appointment in Dental Specialties Centers (DSC). METHODS: This cross-sectional design uses the National Program for Improving Access and Quality of Dental Specialties Centers database, 2018. The outcome was the users' lack of at least one of the scheduled appointments. Contextual and individual independent variables were used, considering Andersen's behavioural model. The analyses were performed with the R Core Team and SAS (Studio 3.8, Institute Inc, North Carolina, U.S, 2019) programs. RESULTS: Of the 10,391 patients interviewed, 27.7% missed at least one of the consultations. In the adjusted multivariate model, the interpretation based on the effect size and 95% CI showed that the behaviour individual predisposing factors such as age ≤ 42 years (OR = 1.10; 95%CI:1.01-1.21), individual need factors such as participation in the "Bolsa Família" program (OR = 1,14; 95%CI:1.02-1.27), not being covered by the Family Health Strategy (OR = 1.15; 95% CI:1.02-1.30), and users of periodontics services (OR = 1.22;95%CI:1.05-1.40) were associated with absences. The behavioural factor associated with the outcome was that the DSC facilities were not in good condition (OR = 1.18; 95%CI:1.03-1.34). DSC located in the capital (OR = 1.12; 95% CI: 0.92-1.48) were 12% more likely to have dental absences than those in the interior region. CONCLUSION: There are individual and contextual barriers associated with patients not attending specialised public dental consultations. DSC should offer adequate hours to patients, especially young adults and vulnerable people.

A psychometric network perspective to oral health literacy: Examining the replicability of network properties across the general community and older adults from Brazil.

OBJECTIVES: To evaluate the replicability of oral health literacy (OHL) network models across the general community and a sample of older adults from Brazil. METHODS: Data were obtained from two oral health surveys conducted with a total of 1138 participants. OHL was measured using the short form Health Literacy in Dentistry scale (HeLD-14). A regularized partial correlation network was estimated for each sample. Dimensionality and structural stability were examined via exploratory graph analysis. Network properties compared included global strength, edge weights, and centrality estimates. Model replicability was examined fitting the general community model to the older participants' data. RESULTS: Six dimensions with the exact same item composition were detected in both network models. Only the Receptivity domain in the older adults sample yielded low structural stability. Strong correlations were observed between edge weights (τ: 0.68; 95% CI: 0.62-0.74) and between node strength estimates (τ: 0.63; 95% CI: 0.36-0.89). No statistically significant differences were found for global strength. The fit of the older adults sample to the HeLD-14 network structure of the general community sample was satisfactory. CONCLUSION: Network models OHL replicated across the general community and a sample of older adults. The psychometric network approach is a useful tool to evaluate the measurement equivalence of OHL instruments across populations.

Letramento em saúde bucal e variáveis associadas a autopercepção de saúde bucal em adultos e idosos usuários da atenção básica: um estudo exploratório / Oral health literacy and variables associated with self-rated oral health in adults and elderly users of primary health care: an exploratory study

Resumo Introdução A Autopercepção da Saúde Bucal (ASB) é uma importante variável subjetiva associada à procura por serviços odontológicos e determinada por diversos fatores. Objetivo O objetivo deste trabalho foi investigar associações entre a ASB, o Letramento em Saúde Bucal (LSB) e covariáveis, em usuários da Atenção Básica. Método A amostra foi composta por 366 adultos e idosos, moradores em territórios adscritos a uma unidade de equipe de Saúde da Família (eSF) do município de Piracicaba, que procuraram por tratamento odontológico no ano de 2019 e que aceitaram participar da pesquisa. Aplicou-se o instrumento Health Literacy in Dentistry (HeLD-14) para avaliação do LSB, bem como um questionário para investigar características sociodemográficas e da ASB. Ademais, exames intrabucais foram realizados. Realizaram-se análises de regressões logísticas simples e múltipla, para se avaliar o nível de associação entre a variável ASB e as variáveis preditoras. Resultados Pacientes com menor escore de LSB, pior Autopercepção da Saúde Geral e com mais de um dente perdido tiveram, respectivamente, 2,73 (IC95%: 1,62-4,61), 14,24 (IC95%: 7,41-27,38) e 2,93 (IC95%: 1,76-4,89) vezes mais chance de apresentar pior ASB (p<0,05). Conclusão A ASB é um constructo associado a diversas variáveis não clínicas, incluindo o LSB.

Abstract Background The Self-Rated Oral Health (SROH) is an important subjective variable associated with the demand for dental services and determined by several factors. Objective The objective of this work was to investigate associations between SROH, Oral Health Literacy (OHL) and covariates in Primary Care users. Method The sample consisted of 366 adults and elderly living in territories assigned to a Family Health team unit in the municipality of Piracicaba who sought dental treatment in 2019 and who agreed to participate in the research. The Health Literacy in Dentistry instrument (HeLD-14) was applied to assess OHL, as well as a questionnaire to investigate sociodemographic and SROH characteristics. In addition, clinical dental examinations were performed. Simple and multiple logistic regression analyzes were performed to assess the level of association between the SROH variable and the predictor variables. Results Patients with lower OHL score, worse Self-Rated Health and with more than one missing tooth had, respectively, 2.73 (95% CI: 1.62-4.61), 14.24 (95% CI: 7.41-27.38) and 2.93 (95% CI: 1.76-4.89) times more likely to have worse SROH (p <0.05). Conclusion The SROH is a construct associated with several non-clinical variables, including OHL.

Coping strategies of caregivers in performing oral hygiene care in adults with special needs: A qualitative study.

INTRODUCTION: Basic and daily oral hygiene care is essential for maintaining oral health in adults with special needs. The caregivers act in this process and need to be understood about the difficulties and the resources they use to deal with this demand. The aim of this qualitative study was to understand the difficulties and strategies of caregivers regarding oral hygiene for adults with special health care needs (SHCN) METHODS: Twenty-one caregivers of adults with SHCN participated in an interview in which the following questions were asked: What are the greatest difficulties in performing oral hygiene for the adult with SHCN you take care? and "How do you overcome these difficulties?" The interviews were recorded and the qualitative data were analyzed using the Discourse of the Collective Subject technique RESULTS: All respondents were female with a mean age of 58.5 years (± 10.8) and the adults with SHCN presented mean age of 30 years (± 18). The greatest difficulty pointed out by caregivers regarding oral hygiene for adults with SHCN was their non-cooperation to do such activity. Regarding coping strategies, caregivers pointed out several strategies to perform oral hygiene in adults with SHCN, such as supervising their brushing, seek for a qualified dentist to assist with this task, performing oral hygiene during the bath, performing physical restraint, among others CONCLUSION: The caregivers' perspectives indicate feelings of failure, discomfort, but also the use of creative resources to deal with the task. The results bring up themes that refer to anxieties and are related to technical and dental issues, that could be explored and need to be recognized by the reference oral healthcare team, whose responsibility it is also to work for the empowerment of caregivers.

Association between oral health literacy and dental outcomes among users of primary healthcare services.

This study aimed to investigate the association between Oral Health Literacy (OHL) and dental outcomes. A sample of 920 adults above 18 years of age living in areas covered by 10 Family Health Units (FHUs) in a large city in São Paulo state, Brazil, was included. OHL was assessed using the short-form Health Literacy in Dentistry Scale (HeLD-14). Data on sociodemographic factors, oral health, and general health were obtained through a structured questionnaire. The investigated outcomes "tooth loss" and "reason for the last dental appointment" were evaluated using self-reported data. Simple logistic regression models were used to analyze the associations between each independent factor and outcomes. Factors that presented a significance level of ≤0.20 in the bivariate analysis were included in the hierarchical multiple logistic regression models. Participants with an education level up to high school, low OHL, and poor/fair self-rated oral health had 1.35 (95%CI, 1.01-1.80), 1.48 (95%CI, 1.12-1.95), and 1.46 (95%CI, 1.11-1.92) times more probability to report missing teeth, respectively. Adults from families with lower monthly income, low OHL, and poor/fair self-rated oral health had 1.70 (95%CI, 1.29-2.26), 1.89 (95%CI, 1.42-2.51), and 1.73 (95%CI, 1.30-2.30) times more chance, respectively, to have gone to the last dental appointment due to pain or caries. Adults with low OHL levels are more likely to have missing teeth and have gone to the last dental visit for pain, reinforcing the importance of OHL as an important determinant for promoting oral health.

Oral Health Literacy and Periodontal Disease in Primary Health Care Users.

BACKGROUND: Oral health literacy (OHL) is a key factor for reducing inequalities in oral health and promoting better health outcomes, including those related to periodontal health. This study aimed to evaluate associations between OHL and periodontal disease amongst users of primary health care services. METHODS: This cross-sectional study was carried out with a sample of 250 adult users of primary health care services in Brazil. OHL was measured using the Oral Health Literacy Instrument-Brazilian (OHLA-B). Participants also answered a structured questionnaire addressing sociodemographic and behavioural data. Clinical oral examination was performed using the Community Periodontal Index. Analyses of the crude associations were performed by simple logistic regression models, and estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Variables associated with a significance level <0.20 in bivariate analyses were included in hierarchical multiple logistic regression models. RESULTS: Amongst participants, 62% were female with an average age of 37.2 years. Adults aged 37 years or older (OR, 5.48; 95% CI, 2.68-11.21), with fewer years of study (OR, 3.34; 95% CI, 1.66-6.71), with low OHL levels (OR, 5.91; 95% CI, 1.71-20.49), and who smoked (OR, 3.29; 95% CI, 1.34-8.09) were more likely to have periodontal pockets compared to their counterparts. CONCLUSIONS: Primary health care users with low OHL levels presented with more severe periodontal diseases.

Patient ́s oral health literacy and associations with sociodemographic, source of information, and oral health variables

O objetivo desse estudo foi avaliar os níveis de Letramento em Saúde Bucal (LSB) de pacientes adultos atendidos em uma clínica odontológica universitária (COU) e associações com diversas variáveis. Foi realizado um estudo transversal com amostra de 312 usuários adultos de uma COU, no período de fevereiro a julho de 2018. A coleta de dados foi feita por meio de um questionário autoaplicável incluindo dados demográficos, HeLD-14 para avaliação do LSB, fontes de acesso a informações sobre saúde bucal, autoavaliação de saúde bucal (ASB) e motivos para procurar o dentista. Análises de regressão logística simples e múltipla foram realizadas para avaliar o nível de associação entre as variáveis independentes e dependente (LSB). O valor mediano para HeLD-14 foi de 44,2 (dp=7,8). No modelo final, os seguintes usuários tiveram uma probabilidade significativamente maior de apresentar níveis de OHL mais baixos em relação aos seus pares: aqueles com até o ensino fundamental (OR: 3,82, IC 95%: 1,85-7,88), aqueles com renda menor ou igual a 2 Salários Mínimos (OR: 3,65, IC 95%: 1,37-9,76), aqueles que utilizam televisão/rádio/jornal/revistas/outros como principal fonte de informação sobre saúde bucal (OR: 1,97, IC 95%:1,17 -3,30), os que classificaram sua ASB como regular/ruim (OR: 1,88, IC 95%:1,08-3,26), e os que foram ao dentista pela última vez por dor/extração (OR: 2,28, 95% IC: 1,35-3,85). Os níveis de LSB dos usuários estiveram associados a variáveis sociodemográficas, fontes de informação e saúde bucal, fato que deve ser considerado pelos estudantes de odontologia e seus docentes, nos processos de comunicação e educação em saúde com os usuários da COU, para uma melhor assistência à saúde bucal a eles (AU).

The objective of this study was toevaluate the levels of Oral Health Literacy (OHL) among adult patients attending in a university dental clinic (UDC) and associations with diverse variables. A cross-sectional study was conducted with a sample of 312 adultusers of aUDC, from February to July 2018. Data collection was done by using a self-administered questionnaire including demographics, HeLD-14 for evaluating OHL, sources for accessing information about oral health, self-rated oral health (SROH), and reasons to look for the dentist.Simple and multiple logistic regression analyses were performed to assess the level of association between independent and dependent variables (OHL). The median value for HeLD-14 was 44.2 (sd=7.8). In the final model, the following users had a significantly higher likelihood of presenting lower OHL levels compared to their counterparts: those with up to elementary school (OR: 3.82, 95%CI: 1.85-7.88), those whose income was less than or equal to 2 Brazilian Minimum Wages (OR: 3.65, 95%CI: 1.37-9.76), those who use television/radio/newspaper/magazines/others as their main source of oral health information (OR: 1.97, 95%CI:1.17-3.30), those who classified their SROH as fair/poor (OR: 1.88, 95%CI: 1.08-3.26), and those who had gone to the dentist the last time due to pain/extraction (OR: 2.28, 95%CI: 1.35-3.85). The users' OHL levels were associated with sociodemographic variables, sources of information, and oral health, a fact that must be considered by dental students and their professors, in the processes of communication and health education with UDC users, to provide better oral health care for them (AU).

Avaliação da cobertura populacional e caracterização do perfil de assistência odontológica como ferramenta para planejamento de atividades de integração ensino-serviço-comunidade / Assessment of population coverage and characterization of oral health profile as a tool to develop teaching-service-community integration activities

Objetivo: Para orientar esse planejamento objetivou-se avaliar a cobertura e caracterizar o perfil de assistência odontológica na Atenção Primária (AP) da XIV Diretoria Regional de Saúde do Estado de São Paulo (XIV DRS). Métodos: Utilizou-se dados secundários de acesso público do Sistema de Informação em Saúde para a Atenção Básica (SISAB), do sistema e-Gestor do Ministério da Saúde e do Instituto Brasileiro de Geografia e Estatística. Foram analisados dados entre 2015-19 dos 20 municípios da XIV DRS quanto à população, cobertura populacional de saúde bucal na AP, indicador de primeira consulta, tipo e quantidade de procedimentos odontológicos realizados e indicador de razão de exodontias em relação aos procedimentos odontológicos individuais. Os mapas evolutivos foram produzidos pela ferramenta Qlik Sense®. As análises descritivas e exploratórias foram realizadas por médias, desvios padrão e quartis, e comparações entre os anos foram realizadas pelos testes não paramétricos de Friedman e Nemenyi. As análises foram realizadas no programa R, com nível de significância de 5%. Resultados:Não houve variação significativa da cobertura. Houve aumento no número de procedimentos odontológicos e preventivos realizados e diminuição da proporção de exodontias com relação aos procedimentos individuais. Observou-se aumento no indicador de primeira consulta, estabilizando a partir de 2017. Existe grande variabilidade entre os municípios quanto à cobertura e indicadores de acesso. Conclusão: A XIV DRS apresentou resultados ainda distantes dos preconizados pela Política Nacional de Saúde Bucal, não sendo suficientes para uma mudança no perfil de assistência odontológica da região, pautado na prevenção e promoção da saúde.

Aim: To guide this planning, the aim was to assess the coverage and characterize the profile of dental care in Primary Care of the XIV Regional Board of Health of the State of São Paulo (XIV DRS). Methods: Accessible data were collected publicly from the Health Information System for Primary Care, from the e-Gestor Ministry of Health's System and from the Brazilian Institute of Geography and Statistics (IBGE). From the period of 2015 to 2019, data from the 20 municipalities of the XIV DRS were analyzed regarding: population, population coverage of oral health in primary care, indicator of first dental appointment, type and number of dental procedures performed, and indicator of tooth extraction in relation to total number of individual dental procedures. The Qlik Sense® tool produced the evolutionary maps. Descriptive and exploratory analyses were performed by means, standard deviations, and quartiles, and the comparisons between years were performed by applying the nonparametric tests of Friedman and Nemenyi. Analyses were performed using the R program, considering a 5% significance level. Results: No significant variation in population coverage was observed. This study showed an increase in the number of dental and preventive procedures performed and a decrease in the proportion of tooth extractions in relation to individual procedures. An increase in the indicator of first dental appointment was identified, stabilizing from 2017 onwards. A large variability was found among municipalities in the region. Conclusion: The XIV DRS presented results that are quite different from those recommended by the National Oral Health Policy, but they were not sufficient enough to change the region's dental care profile, based on prevention and health promotion.

Produção científica em saúde da população LGBTQIA+: uma análise crítica do conteúdo da literatura / Scientific production on LGBTQIA+ health: a critical analysis of the literature

Resumo Esta pesquisa traz em seu escopo a análise do potencial estigmatizador do conteúdo de estudos direcionados à população LGBTQIA+ indexados na plataforma PubMed. Por meio de uma ampla e sistemática pesquisa bibliográfica foram identificados e incluídos, respectivamente, 821 e 334 (40,68%) artigos, dos quais foram extraídos 1838 descritores. Da análise dos dados coletados foram identificados as maiores prevalências dos descritores "men having sex with man" (192 repetições) e "HIV" (98 repetições). Sendo assim, o percurso analítico das informações levantadas refletiu que a população LGBTQIA+ é essencialmente designada como "homens que fazem sexo com outros homens e soropositivos". Este estudo traz, portanto, a presença de características estigmatizantes nos estudos direcionados à população LGBTQIA+. Contudo, cabe destacar que o resultado encontrado é subsídio para o fortalecimento de uma perspectiva crítica de um fazer científico mais humanizado e direcionado às especificidades e necessidades da população LGBTQIA+.

Abstract This study analyzes the stigmatizing potential of studies on the LGBTQIA+ population indexed on the PubMED database. By a broad and systematic bibliographic search, 821 publications were found and 334 (40.68%) were included in this study. From these, 1838 keywords were extracted. Data analysis showed that the keywords "men who have sex with man" (192 repetitions) and "HIV" (98 repetitions) had the highest prevalence. Thus, according to the analysis, the LGBTQIA+ population is essentially described as "men who have sex with other men" and "HIV positive." This study unveils the presence of stigmatizing characteristics in studies on the LGBTQIA+ population. However, such findings can help strengthen the critical perspective of a more humanized scientific practice, actually concerned with the specificities and needs of the LGBTQIA+ population.

Fatores sociodemográficos, comportamentais e bucais associados a reprovação em escolares adolescentes: estudo transversal / Sociodemographic, behavioral, and oral factors associated with failure in adolescent schoolchildren: a cross-sectional study

Objetivo: avaliar associações entre fatores sociodemográficos, sociais e bucais e reprovação escolar entre adolescentes. Métodos: Trata-se de um estudo transversal e analítico realizado com 251 adolescentes, entre 14 e 18 anos, provenientes de cinco escolas estaduais do município de Piracicaba, São Paulo, Brasil. A variável desfecho avaliada foi a reprovação escolar e as variáveis independentes incluíram fatores sociodemográficos e bucais. Para se avaliar a associação entre as variáveis, realizou-se regressão logística simples e múltipla, permanecendo no modelo final as variáveis com p≤0,05, após o ajuste para as demais variáveis. Resultados: A maioria dos participantes era do sexo feminino (61,8%), com idade até 16 anos (58,6%), tinham mais que um irmão (60,2%) e o grau de instrução dos chefes das famílias era acima de oito anos (71,3%). A reprovação escolar foi relatada por 12,7% dos adolescentes. No modelo ajustado final, verificou-se que a reprovação escolar permaneceu associada aos adolescentes que apresentavam mais de um irmão (OR = 3,79: IC 95%: 1,34-10,73), que foram ao dentista na última vez por motivo de dor (OR = 3,00: IC 95%: 1,26-7,15) e com autoavaliação negativa da saúde bucal (OR = 5,50: IC9 5%: 2,10-14,36). Conclusão: Fatores sociodemográficos e bucais estiveram associados com a reprovação escolar em adolescentes. Nesse contexto, recomenda-se a continuidade das ações e políticas públicas intersetoriais entre os setores de educação e saúde para a melhoria da saúde bucal dos escolares, a qual apresenta associações com o rendimento acadêmico.

Aim: to evaluate the association between sociodemographic, social and oral factors, and school failure among adolescents. Methods: This is a cross-sectional and analytical study carried out with 251 adolescents, between 14 and 18 years of age, from five state schools in the city of Piracicaba, São Paulo, Brazil. This work evaluated the outcome variable of school failure, and the independent variables included sociodemographic, social, and oral factors. To assess the association between the variables, simple and multiple logistic regressions were performed, with the variables presenting p≤0.05 remaining in the final model after adjustments for the other variables. Results: Most participants were female (61.8%), up to 16 years of age (58.6%), who had more than one sibling (60.2%), and whose level of education of the heads of the household was over eight years (71.3%). School failure was reported by 12.7% of the adolescents. In the final adjusted model, school failure remained associated with adolescents who had more than one sibling (OR = 3.79: 95% CI: 1.34-10.73), who went to the dentist the last time due to pain (OR = 3.00: 95% CI: 1.26-7.15) and a negative oral health self-assessment (OR = 5.50: 95% CI: 2.10-14.36). Conclusion: Sociodemographic and oral factors were associated with school failure in adolescents. In this context, it is recommended to continue intersectoral actions and public policies between education and health to improve the oral health of schoolchildren and, consequently, their academic performance.

Association between oral health literacy and dental outcomes among users of primary healthcare services

Abstract This study aimed to investigate the association between Oral Health Literacy (OHL) and dental outcomes. A sample of 920 adults above 18 years of age living in areas covered by 10 Family Health Units (FHUs) in a large city in São Paulo state, Brazil, was included. OHL was assessed using the short-form Health Literacy in Dentistry Scale (HeLD-14). Data on sociodemographic factors, oral health, and general health were obtained through a structured questionnaire. The investigated outcomes "tooth loss" and "reason for the last dental appointment" were evaluated using self-reported data. Simple logistic regression models were used to analyze the associations between each independent factor and outcomes. Factors that presented a significance level of ≤0.20 in the bivariate analysis were included in the hierarchical multiple logistic regression models. Participants with an education level up to high school, low OHL, and poor/fair self-rated oral health had 1.35 (95%CI, 1.01-1.80), 1.48 (95%CI, 1.12-1.95), and 1.46 (95%CI, 1.11-1.92) times more probability to report missing teeth, respectively. Adults from families with lower monthly income, low OHL, and poor/fair self-rated oral health had 1.70 (95%CI, 1.29-2.26), 1.89 (95%CI, 1.42-2.51), and 1.73 (95%CI, 1.30-2.30) times more chance, respectively, to have gone to the last dental appointment due to pain or caries. Adults with low OHL levels are more likely to have missing teeth and have gone to the last dental visit for pain, reinforcing the importance of OHL as an important determinant for promoting oral health.

Evaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults / Evaluación de las propiedades psicométricas del instrumento eHealth Literacy Scale en adultos brasileños / Avaliação das propriedades psicométricas do instrumento eHealth Literacy Scale em adultos brasileiros

ABSTRACT Objective: To translate and adapt the eHealth Literacy Scale for the cultural reality of Brazil and to evaluate the psychometric properties of its Brazilian Portuguese version. Methods: The instrument was translated and adapted to Brazilian Portuguese and applied to a sample of 502 individuals from 18 to 80 years old who lived in the surrounding areas of six Family Health Units of a city in the countryside of the state of São Paulo, Brazil. The data was evaluated using exploratory and confirmatory factor analysis, item response theory, and instrument reliability measures (Cronbach's alpha and McDonald's omega). Results: The eHealth Literacy Scale - Brazilian version (eHEALS-Br) presented an excellent internal consistency (α = 0.95 e ω = 0.95), with only one dimension and an explained variation of 81.79%. Conclusions: The Brazilian version of the instrument showed excellent psychometric properties to measure the levels of digital health literacy in adults from the country.

RESUMEN Objetivo: Traducir y adaptar la eHealth Literacy Scale a realidad cultural Brasileña y evaluar sus propiedades psicométricas de la versión en portugués brasileño. Métodos: El instrumento fue traducido y adaptado al portugués brasileño y, en seguida, aplicado en una muestra de 502 individuos entre 18 y 80 años residentes en áreas cercas a seis Unidades de Salud de la Familia de un municipio del interior del estado de São Paulo, Brasil. Los datos fueron evaluados mediante análisis factorial exploratoria y confirmatoria, Teoría de Respuesta al Ítem y confiabilidad del instrumento (alfa de Cronbach y omega de McDonald). Resultados: El instrumento eHealth Literacy Scale - versión brasileña (eHEALS-Br) presentó excelente consistencia interna (α = 0,95 y ω = 0,95), apenas una dimensión y variancia explicada de 81,79%. Conclusiones: La versión brasileña del instrumento mostró excelentes propiedades psicométricas para contraste de los niveles de alfabetización digital en salud en adultos del nuestro país.

RESUMO Objetivo: Traduzir e adaptar a eHealth Literacy Scale para a realidade cultural do Brasil e avaliar suas propriedades psicométricas da versão em português brasileiro. Métodos: O instrumento foi traduzido e adaptado ao português brasileiro e, em seguida, aplicado em uma amostra de 502 indivíduos entre 18 e 80 anos residentes em áreas circunvizinhas a seis Unidades de Saúde da Família de um município do interior do estado de São Paulo, Brasil. Os dados foram avaliados mediante análises fatorial exploratória e confirmatória, Teoria de Resposta ao Item e confiabilidade do instrumento (alfa de Cronbach e ômega de McDonald). Resultados: O instrumento eHealth Literacy Scale - versão brasileira (eHEALS-Br) apresentou excelente consistência interna (α = 0,95 e ω = 0,95), apenas uma dimensão e variância explicada de 81,79%. Conclusões: A versão brasileira do instrumento mostrou excelentes propriedades psicométricas para aferição dos níveis de letramento digital em saúde em adultos do nosso país.