Análise de redes aplicada a fatores relacionados à saúde bucal de populações indígenas / Network analysis applied to oral health-related factors of Indigenous populations

A análise de redes representa um conjunto de métodos e teorias com grande utilidade para descrever, explorar e compreender a estrutura de relações estatísticas em sistemas complexos de variáveis. Esta é uma importante ferramenta analítica com aplicações que variam desde análise exploratória até o desenvolvimento de intervenções. O objetivo desta tese foi mapear a arquitetura de interações entre fatores de saúde bucal de populações indígenas como sistemas de redes complexas. Este volume apresenta um compilado de quatro artigos científicos que investigaram: 1) o letramento em saúde bucal e fatores associados em uma população indígena australiana; 2) a validade estrutural do questionário Oral Health Impact Profile (OHIP-14) entre populações indígenas e não indígenas do Brasil e da Austrália; 3) as dinâmicas entre fatores relacionados à saúde bucal de crianças indígenas australianas ao longo do tempo; e 4) a habilidade de medidas de centralidade de uma rede transversal para predizer desfechos de saúde bucal longitudinalmente. Foram estimadas redes de correlação parcial, regularizadas, não direcionadas, baseadas em Modelos Gráficos Gaussianos. As propriedades de rede analisadas incluíram medidas de centralidade, coeficientes locais de agrupamento e coeficientes globais de agrupamento. A estabilidade das redes foi verificada através de um procedimento bootstrap de reamostragem. A Análise Exploratório de Gráficos foi utilizada para verificar a validade estrutural do instrumento de mensuração da qualidade de vida relacionada à saúde bucal. Foram analisadas as associações entre as medidas de centralidade de uma rede transversal com dados de mulheres grávidas e dois desfechos relacionados à saúde bucal de crianças indígenas mensurados aos 5 anos por meio de regressões lineares. Foi estimada uma rede que compreende as diferenças de pontuação dos desfechos relacionados à saúde bucal de crianças indígenas entre 2 e 5 anos ajustada pela rede de dados maternos. As correlações entre as medidas de centralidade dos modelos ajustado e não ajustado foram examinadas. Itens de letramento em saúde bucal pertencentes aos mesmos domínios conceituais da escala apresentaram fortes conexões positivas. Diferentes estruturas de rede emergiram para grupos de participantes que possuíam baixo e alto níveis de letramento em saúde bucal. A Análise Exploratória de Gráficos identificou quatro comunidades de nós referentes ao instrumento Oral Health Impact Profile em todas as amostras analisadas, embora populações indígenas apresentaram consistência estrutural reduzida em comparação com seus pares não indígenas. A intervenção de saúde bucal interagiu com a rede de fatores relacionados à saúde bucal por meio da percepção da saúde geral da criança e do conhecimento da saúde bucal infantil. Foram identificadas diferentes conexões entre experiência de cárie dentária e fatores relacionados à saúde bucal em cada fase do estudo. As redes tenderam a retornar a um estado inicial após a intervenção. Força foi a única medida de centralidade associada aos valores preditivos dos nós em relação aos desfechos de saúde bucal das crianças. Valores de Força explicaram 51% e 45% da variação nos valores preditivos dos nós em relação à experiência de cárie dentária e à utilização de serviços odontológicos aos 5 anos, respectivamente. Esta tese demonstrou diferentes aplicações da análise de redes no contexto da saúde bucal indígena. Fatores relacionados à saúde bucal de populações indígenas da Austrália e do Brasil emergiram como redes. Os achados empíricos apresentados contribuem para uma compreensão abrangente das múltiplas interações entre fatores relacionados à saúde bucal destas populações e apresentam implicações para a representação de construtos psicométricos, investigação de fenômenos em saúde bucal e desenvolvimento de intervenções.

Deadly places: The role of geography in Aboriginal and Torres Strait Islander COVID-19 vaccination.

OBJECTIVE: The objective of this study was to investigate the geospatial distribution of COVID-19 vaccination rates for Aboriginal and Torres Strait Islander Peoples across Local Government Areas in Australia. METHODS: We described the patterns of COVID-19 vaccination across jurisdictions, identified clusters with different levels of vaccination uptake, and assessed the relationship between contextual factors and vaccination (spatial error model, spatial lag model, and geographic weighted regression). RESULTS: The proportion of the Aboriginal and Torres Strait Islander population that received at least two doses of a COVID-19 vaccine by the last week of June 2022 ranged from 62.9% to 97.5% across Local Government Areas. The proportion of the overall population who is Aboriginal or Torres Strait Islander (ß = 0.280, standard deviation [SD] = 1.92), proportion of the total labour force employed (ß =0.286, SD = 0.98), and proportion of individuals who speak an Aboriginal or Torres Strait Islander language (ß =0.215, SD = 0.15) had, on average, the strongest effects on COVID-19 vaccination rates. CONCLUSION: Findings underscore the extent to which area-level demographic influence the COVID-19 vaccination for Aboriginal and Torres Strait Islander Australians. IMPLICATIONS FOR PUBLIC HEALTH: Findings can inform vaccination strategies that prioritise geographic areas with higher vulnerability to promote equity for Aboriginal and Torres Strait Islander Peoples.

Development and validation of an HPV infection knowledge assessment scale among Aboriginal and Torres Strait Islander Peoples.

Background: An increased incidence of Human Papillomavirus (HPV) infection and its related cancers has been observed in recent years. Correct knowledge about HPV infection can lead to a significant decrease in transmission and a subsequent increase in vaccine uptake. Awareness and behavioural perception towards HPV infections are critical for improving HPV vaccination rates among Aboriginal and/or Torres Strait Islander Peoples. However, to the best of our knowledge, there has been no instrument designed to measure knowledge about HPV infection that is culturally appropriate and validated among Aboriginal and/or Torres Strait Islander People. Aim: To address this research gap, this paper aims to examine the psychometric properties of the HPV Knowledge Tool (HPV-KT) in an Indigenous population sample from South Australia. Methodology: Data from 747 Indigenous Australian Adults who participated in the 12-month follow-up of the HPV and Oropharyngeal Carcinoma in Indigenous Australians Study was utilised for this study. The psychometric properties examined included1) dimensionality and item redundancy; (2) network loadings; (3) model fit; (4) criterion validity; and (5) reliability. The network model was estimated using the Graphical Least Absolute Shrinkage and Selector Operator (GLASSO). Evaluation of the HPV-KT (10 items) dimensionality and item redundancy was conducted within the framework of Exploratory Graph Analysis (EGA). Reliability was evaluated with the McDonald's Omega (ω) coefficient. Results: After the exclusion of two items, the HPV-KT exhibited good psychometric properties for Aboriginal and/or Torres Strait Islander Peoples. The two dimensions of "General HPV Knowledge" and "Commonness of HPV" were identified. The dimension of "Commonness of HPV" displayed poor reliability, so a sum score for this subscale is not recommended (i.e. the items can still be used individually) The network model of the 7-item HPV-KT was fitted in the validation sample and model fit was adequate (x2 (7) = 17.17, p < 0.016; CFI = 0.980; TLI = 0.94; RMSEA = 0.063, 90% CI = 0.025-0.010). Furthermore, the reliability of the "General HPV Knowledge" subscale (ω = 0.76, 95% CI: 0.72-0.79), while the reliability of the "Commonness of HPV" subscale (ω = 0.58, 95% CI0.58-0.88) was poor. Conclusion: The HPV-KT was adapted for an Aboriginal and/or Torres Strait Islander population and is readily available for future use in Australia. The addition of items assessing specifications of HPV infection, natural history and behaviour will improve the reliability and usability to assess the level of accurate knowledge about HPV infection. Future studies should investigate the possibility of developing new items for the dimension 'Commonness of HPV'.

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.

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.

Psychological Network of Stress, Coping and Social Support in an Aboriginal Population.

Over the past decades, increasing research interest has been directed towards the psychosocial factors that impact Aboriginal health, including stress, coping and social support. However, there has been no study that examined whether the behaviours, cognitions and emotions related to stress, coping and social support constitute a psychological network in an Aboriginal population and that examined its properties. To address this gap, the current study employed a new methodology, network psychometrics, to evaluate stress, coping and social support in an Aboriginal Australian population. This study conducted a secondary analysis of the South Australian Aboriginal Birth Cohort (SAABC) study, a randomised controlled trial in South Australia, which included 367 pregnant Aboriginal women at study baseline. The Gaussian Graphical Model was estimated with least absolute shrinkage and selection operator (LASSO). Node centrality was evaluated with eigencentrality, strength and bridge centrality. Network communities were investigated with the walktrap algorithm. The findings indicated that stress, coping and social support constituted a connected psychological network in an Aboriginal population. Furthermore, at the centre of the network were the troubles experienced by the Aboriginal pregnant women, bridging their perceptions of stress and coping and constituting a potential target for future interventions.

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.

Disparities in Human Papillomavirus vaccination coverage among adolescents in Australia: A geospatial analysis.

AIM: This ecological study aimed to examine the geographic patterns in Human Papillomavirus (HPV) vaccination rates among boys and girls aged 15 years across locations in Australia, in addition to assessing contextual area-level factors that may explain the variations in HPV vaccination coverage. METHODS: Aggregate HPV vaccination data for Australian girls and boys aged 15 years from 2015 to 16 was obtained from the Australian Institute of Health and Welfare for each Statistical Area level 4 (SA4). A Gradient Boosting Machine learning model was applied to assess the predictors' importance for the study outcomes. Geographically weighted regression (GWR) models were run to assess whether substantially different relationships between predictors and outcomes occur at different locations in space. RESULTS: Completed HPV vaccination across the 88 SA4 regions ranged from 57.6% to 90.6% among girls, and from 53.6% to 85.5% among boys. The 2016 SEIFA Index of Economic Resources was the variable with the highest contribution to the predictions of both girls' and boys' HPV vaccination rates. Selected predictors explained 45% and 72% of the geographic variance in vaccination rates among boys and girls, respectively. Normalised coefficients for both GWR models showed a high variation in the associations between predictors and HPV vaccination rates across regions. CONCLUSION: Socioeconomic and education factors were important predictors for HPV vaccination rates among Australian boys and girls aged 15 years, although no variable presented a uniform effect on HPV vaccination across SA4 regions. Important spatial heterogeneity in the effect of predictors was identified across the study area.

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).

Dynamics in oral health-related factors of Indigenous Australian children: A network analysis of a randomized controlled trial.

OBJECTIVES: Network analysis is an innovative, analytic approach that enables visual representation of variables as nodes and their corresponding statistical associations as edges. It also provides a new way of framing oral health-related questions as complex systems of variables. We aimed to generate networks of oral health variables using epidemiological data of Indigenous children, and to compare network structures of oral health variables among participants who received immediate or delayed delivery of an oral health intervention. METHODS: Epidemiological data from 448 mother-child dyads enrolled in a randomized controlled trial of dental caries prevention in South Australia, Australia, were obtained. Networks were estimated with nodes representing study variables and edges representing partial correlation coefficients between variables. Data included dental caries, impact on quality of life, self-rated general health, self-rated oral health, dental service utilization, knowledge of oral health, fatalism and self-efficacy in three time points. Communities of nodes, centrality, clustering coefficient and network stability were estimated. RESULTS: The oral health intervention interacted with the network through self-rated general health and knowledge of oral health. Networks depicting groups shortly after receiving the intervention presented higher clustering coefficients and a similar arrangement of nodes. Networks tended to return to a preintervention state. CONCLUSION: The intervention resulted in increased connectivity and changes in the structure of communities of variables in both intervention groups. Our findings contribute to elucidating dynamics between variables depicting oral health networks over time.

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic.

This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018-1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.

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.

Processo de mentoring: análise da percepção do estudante da disciplina de Gestão e Planejamento em Odontologia da FOUSP / Mentoring process: analysis of students' perception of the discipline of Management and Planning in Dentistry at FOUSP

O objetivo da presente pesquisa foi analisar a percepção dosestudantesde graduação do último ano do Curso de Odontologia da Faculdade de Odontologia da Universidade de São Paulo (FOUSP) em relação ao processo de mentoring. A amostra foi de 122 estudantes que estavam matriculados na disciplina de Gestão e Planejamento daFOUSP, os quais foram divididos em grupos de 8 integrantese, durante o semestre, as reuniões de tutoria eram realizadas pelos pós-graduandos, para debater questões pessoais e profissionais. Ao final do semestre os estudantes responderam a um questionário sobreoprocesso dementoringrealizado e a respeito de pontos positivos e negativos da disciplina. O treinamento dos tutores foi realizado no semestre anterior, juntamente com um estudo piloto com 20 graduandos. Foi realizada uma análise de correspondência para a avaliação da disciplina com o mentoringe uma análisequantitativa textual por meio do softwareIramuteq para avaliação das respostas da questão aberta. Dos estudantes incluídos, 96,7% participaram da pesquisa.Quanto àavaliação da disciplina, 55,1% dos respondentes aconsideraram boa e 33,9%como ótima. Em relação ao processo de mentoring, 62,7% consideraram ótimo e 32,2% bom. Quando questionados quais eram os pontos positivos da disciplina, 48,3% dos estudantes destacaram a tutoria. Ao verificar a coocorrência e conectividade das palavras, foi constatada uma forte relação entre os termos reunião, grupo, aluno e futuro. Diante disso, é possível concluir que a percepção do aluno de graduação é positiva em relação ao processo de mentoring, no qual além de ser um processo de instrução, serve também de apoio para o aluno do último ano (AU).

This study aimed to analyze the perception of graduate students in the last year of the Dentistry Course at the University of São Paulo School of Dentistry (FOUSP) ofthe mentoring process implemented in the discipline of Management and Planning. The sample comprised 122 students enrolled in the Management and Planning discipline at FOUSP. During mentoring, students were divided into groups of eight members, and tutoring meetings were held by post-graduate students to discuss personal and professional issues. At the end of the semester, students answered a questionnaire about the mentoring process and the positive and negative aspects of the discipline. Tutors were trained in the previous semesteralongsidea pilot study with 20 graduate students. A correspondence analysis was conducted to evaluate the discipline, and a quantitative textual analysis using the Iramuteq software was used to assess the responsesto the open questions. Approximately 97% of the students participated in the survey. The majority rated the discipline as good (55.1%) and excellent (33.9%). Regarding the mentoring process, 62.7% considered the activities excellent and 32.2% good. When asked about the strengths of the discipline, 48.3% of students highlighted tutoring. When verifying the co-occurrence and connectivity of the words, a strong relationship was found between the terms "meeting," "group," "student," and "future." Thus, graduate students' perception ofthe mentoring processis positive, which in addition to being aninstructional process,also serves as support for the final year at the university (AU).

Evaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults.

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.

A pilot study of an automated personal identification process: Applying machine learning to panoramic radiographs.

PURPOSE: This study aimed to assess the usefulness of machine learning and automation techniques to match pairs of panoramic radiographs for personal identification. MATERIALS AND METHODS: Two hundred panoramic radiographs from 100 patients (50 males and 50 females) were randomly selected from a private radiological service database. Initially, 14 linear and angular measurements of the radiographs were made by an expert. Eight ratio indices derived from the original measurements were applied to a statistical algorithm to match radiographs from the same patients, simulating a semi-automated personal identification process. Subsequently, measurements were automatically generated using a deep neural network for image recognition, simulating a fully automated personal identification process. RESULTS: Approximately 85% of the radiographs were correctly matched by the automated personal identification process. In a limited number of cases, the image recognition algorithm identified 2 potential matches for the same individual. No statistically significant differences were found between measurements performed by the expert on panoramic radiographs from the same patients. CONCLUSION: Personal identification might be performed with the aid of image recognition algorithms and machine learning techniques. This approach will likely facilitate the complex task of personal identification by performing an initial screening of radiographs and matching ante-mortem and post-mortem images from the same individuals.

Network analysis and psychometric properties of the Brazilian version of the eHealth Literacy Scale in a dental clinic setting.

BACKGROUND: The eHealth Literacy Scale (eHEALS) has become a standard tool for the evaluation of digital health literacy. OBJECTIVES: This study aims to examine the validity and reliability of the Brazilian version of the eHEALS in a sample of patients from a dental clinic setting. MATERIAL AND METHODS: A cross-sectional survey was conducted in a dental setting. The sample included patients from the Dental Clinic of the Dentistry School of the University of São Paulo between September 2019 and March 2020. The underlying structure of the data was exploratorily investigated using Exploratory Graph Analysis, a network analysis method. The internal reliability was assessed using the McDonald's Omega coefficient. Confirmatory Factor Analysis (CFA) was used to assess the fit of the structure identified by the network analysis. Convergent validity was assessed using the Average Variance Extracted, and measurement invariance was examined using nested models in multigroup CFA. Criterion-related validity was examined calculating the latent mean differences between subgroups (genders, age groups, and educational levels). RESULTS: The sample included 132 adults aged 18 to 82 years (mean 44.7 years). The eHEALS network indicated that items form a single-factor structure. The 1-factor model presented adequate fit (χ2 (18) = 29.873, p < 0.039; R-CFI = 0.997; R-TLI = 0.996; R-RMSEA = 0.032, 90% CI [0.000, 0.052]), good internal reliability, and convergent validity. Configural invariance was found for genders, educational levels, and age groups. Scalar invariance was observed for genders and age, whereas partial scalar invariance was confirmed for education. Participants aged 18 to 45 and those with higher education presented greater latent means for eHEALS subscales. There were no differences between genders. CONCLUSION: The BR-eHEALS presented good internal reliability, convergent validity, measurement invariance, and was able to discriminate the levels of eHealth literacy among groups with different ages and educational levels. These findings demonstrate that the tool is valid and reliable for use in a dental setting with the Brazilian population.

Análise de redes aplicada a fatores relacionados à saúde bucal de populações indígenas / Network analysis applied to oral health-related factors of Indigenous populations

A análise de redes representa um conjunto de métodos e teorias com grande utilidade para descrever, explorar e compreender a estrutura de relações estatísticas em sistemas complexos de variáveis. Esta é uma importante ferramenta analítica com aplicações que variam desde análise exploratória até o desenvolvimento de intervenções. O objetivo desta tese foi mapear a arquitetura de interações entre fatores de saúde bucal de populações indígenas como sistemas de redes complexas. Este volume apresenta um compilado de quatro artigos científicos que investigaram: 1) o letramento em saúde bucal e fatores associados em uma população indígena australiana; 2) a validade estrutural do questionário Oral Health Impact Profile (OHIP-14) entre populações indígenas e não indígenas do Brasil e da Austrália; 3) as dinâmicas entre fatores relacionados à saúde bucal de crianças indígenas australianas ao longo do tempo; e 4) a habilidade de medidas de centralidade de uma rede transversal para predizer desfechos de saúde bucal longitudinalmente. Foram estimadas redes de correlação parcial, regularizadas, não direcionadas, baseadas em Modelos Gráficos Gaussianos. As propriedades de rede analisadas incluíram medidas de centralidade, coeficientes locais de agrupamento e coeficientes globais de agrupamento. A estabilidade das redes foi verificada através de um procedimento bootstrap de reamostragem. A Análise Exploratório de Gráficos foi utilizada para verificar a validade estrutural do instrumento de mensuração da qualidade de vida relacionada à saúde bucal. Foram analisadas as associações entre as medidas de centralidade de uma rede transversal com dados de mulheres grávidas e dois desfechos relacionados à saúde bucal de crianças indígenas mensurados aos 5 anos por meio de regressões lineares. Foi estimada uma rede que compreende as diferenças de pontuação dos desfechos relacionados à saúde bucal de crianças indígenas entre 2 e 5 anos ajustada pela rede de dados maternos. As correlações entre as medidas de centralidade dos modelos ajustado e não ajustado foram examinadas. Itens de letramento em saúde bucal pertencentes aos mesmos domínios conceituais da escala apresentaram fortes conexões positivas. Diferentes estruturas de rede emergiram para grupos de participantes que possuíam baixo e alto níveis de letramento em saúde bucal. A Análise Exploratória de Gráficos identificou quatro comunidades de nós referentes ao instrumento Oral Health Impact Profile em todas as amostras analisadas, embora populações indígenas apresentaram consistência estrutural reduzida em comparação com seus pares não indígenas. A intervenção de saúde bucal interagiu com a rede de fatores relacionados à saúde bucal por meio da percepção da saúde geral da criança e do conhecimento da saúde bucal infantil. Foram identificadas diferentes conexões entre experiência de cárie dentária e fatores relacionados à saúde bucal em cada fase do estudo. As redes tenderam a retornar a um estado inicial após a intervenção. Força foi a única medida de centralidade associada aos valores preditivos dos nós em relação aos desfechos de saúde bucal das crianças. Valores de Força explicaram 51% e 45% da variação nos valores preditivos dos nós em relação à experiência de cárie dentária e à utilização de serviços odontológicos aos 5 anos, respectivamente. Esta tese demonstrou diferentes aplicações da análise de redes no contexto da saúde bucal indígena. Fatores relacionados à saúde bucal de populações indígenas da Austrália e do Brasil emergiram como redes. Os achados empíricos apresentados contribuem para uma compreensão abrangente das múltiplas interações entre fatores relacionados à saúde bucal destas populações e apresentam implicações para a representação de construtos psicométricos, investigação de fenômenos em saúde bucal e desenvolvimento de intervenções.