Effectiveness of a smartphone application on dental anxiety in adolescents: A randomized controlled trial.

BACKGROUND: Dental anxiety is a common issue among adolescents. Despite the use of smartphones being an important part of their daily lives, only a few digital-based interventions for dental anxiety have been tested in randomized controlled trials (RCT). AIM: The aim of this study was to evaluate a new smartphone application (App) named FALE, which was designed to demonstrate interest from the dentist to adolescent and to reduce dental anxiety. DESIGN: This is a RCT in which 184 adolescents aged 10-19 years were randomly allocated into the intervention group (IG) or the control group (CG). The intervention was applied in the waiting room before the consultation at a dental clinic. The IG answered the FALE, which contained 14 questions-of which the first and last questions addressed anxiety, whereas the CG answered the question about anxiety twice with an interval between them. RESULTS: There was a significant difference in the distribution of anxiety rating frequencies before and after the intervention period in both groups. For the IG, there was a reduction in anxiety after the intervention of 16.29%, and, in the CG, a reduction of 2.2% (p < .001). CONCLUSION: The FALE App effectively reduced dental anxiety before the appointment.

Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials.

AIMS: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry. BACKGROUND: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols. REVIEW RESULTS: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials. CONCLUSION: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice. CLINICAL SIGNIFICANCE: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al. Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Is Binge Drinking Associated with Suicidal Behaviors among Brazilian Adolescents?

OBJECTIVE: To evaluate the association between suicidal behaviors and binge drinking among Brazilian adolescents. METHODS: A cross-sectional study was conducted with 2,476 students 14 to 19 years of age from 26 public high schools in the city of Olinda, Brazil. Data collection occurred between March and June 2018 through the self-administered Youth Risk Behavior Survey. Descriptive analysis and Poisson regression (p < 0.05, 95%CI) were performed. RESULTS: The prevalence of suicidal ideation, planning and attempt in the previous 12 months was 23.7%, 17.4% and 13.5%, respectively. Suicidal ideation was associated with binge drinking one to two days (PR:1.053, 95%CI:1.011-1.096) and ≥ three days in the previous 30 days (PR:1.069, 95%CI:1.016-1.125), sadness/hopelessness in the previous 12 months (PR:1.313, 95%CI:1.267-1.360), a report of family physical aggression in the previous 12 months (PR:1.111, 95%CI:1.068-1.155), the female sex (PR:1.082, 95%CI:1.049-1.115) and a non-nuclear family (PR:1.037, 95%CI:1.004-1.071). Suicidal planning was associated with sadness/hopelessness in the previous 12 months (PR:1.257, 95%CI:1.214-1.302), report of family physical aggression in the previous 12 months (PR:1.110, 95%CI:1.065-1.156) and the female sex (PR:1.072, 95%CI:1.041-1.104). Suicide attempt was associated with binge drinking ≥ three days in the previous 30 days (PR:1.062, 95%CI:1.008-1.119), sadness/hopelessness in the previous 12 months (PR:1.202, 95%CI:1.161-1.244), report of family physical aggression in the previous 12 months (PR:1.105, 95%CI:1.060-1.153) and the female sex (PR:1.064, 95%CI:1.034-1.095). The Catholic (PR:0.938, 95%CI:0.899-0.979; PR:0.925, 95%CI:0.888-0.9865; PR:0.937, 95%CI:0.899-0.977) and Evangelical (PR:0.956, 95%CI:0.922-0.992; PR:0.954, 95%CI:0.919-0.991) religions acted as a possible protective factor against suicidal behaviors. CONCLUSIONS: Suicidal ideation and attempt were associated with binge drinking.

LGB prevalence in schools is associated with unhealthy weight-control behaviors in lesbian, gay, and bisexual youth: a multilevel analysis.

BACKGROUND: Previous studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between lower LGB prevalence in schools and unhealthy weight-control behaviors among LGB youth. METHODS: A cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools), while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, sex, receiving a family allowance), obesity, and self-reported happiness. RESULTS: Lower LGB prevalence in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. No cross-level interactions between school context and individual characteristics were statistically significant. CONCLUSION: Lower LGB prevalence in schools was associated with a higher risk of unhealthy weight-control behaviors in youth regardless of sexual orientation, which may reflect either the contextual influence of school climate, or may be due to residual confounding.

Self-reported symptoms of temporomandibular pain and jaw dysfunction in adolescents are associated with exposure to violence.

BACKGROUND: Temporomandibular disorders (TMDs) are multifactorial, and high levels of stress seem to increase symptoms. The association with exposure to violence has not been explored in adolescent populations. OBJECTIVE: To examine the association of self-reported symptoms of temporomandibular pain and jaw dysfunction with child physical abuse, intimate partner violence, forced sexual intercourse, and bullying victimisation. METHODS: An epidemiological, cross-sectional, school-based study was conducted in Olinda, northeast Brazil. The sample comprised 2,431 adolescents aged 14-19 years. TMD-related symptoms and exposure to violence were assessed with questions from the 3Q/TMD screener and queries on exposure to different forms of violence. Multilevel logistic regressions were conducted to evaluate how 3Q screen-positive responses are associated with self-reported exposure to violence. RESULTS: Self-reported TMD-related symptoms had a prevalence of 40.5%. Significantly more females than males screened positive to all 3Q/TMD questions (p < .001). Adolescents experiencing intimate partner violence (p = .012) and bullying (p < .001) had significantly higher odds of 3Q positive responses than those who reported no exposure to violence. Significant associations of TMD-related symptoms with forced sexual intercourse (p = .014) and with bullying (p = .007) were observed. CONCLUSION: Adolescents with self-reported symptoms of temporomandibular pain and jaw dysfunction were significantly more often exposed to some type of violence. The number of adolescents reporting TMD-related symptoms increased in a dose-response manner with the number of violence forms the individual had experienced.

Determinants of self-perceived oral health in adolescents: A cross-sectional study.

BACKGROUND: Self-perceived oral health (SPOH) is a summary of multiple determinants related to oral health and has been suggested for use in clinical practice as a health assessment tool. AIM: To analyse determinants of SPOH among adolescents. DESIGN: In 2018, we selected 1742 participants from eight high schools in Olinda/PE, Brazil, using a multistage stratified cluster sample. The main survey item of SPOH was 'How would you rate your oral health'. Determinants of were queried with a questionnaire and a clinical examination: socio-demographic variables, exposure to family violence, somatic symptoms, and orofacial and general health factors. Pearson's chi-square test and logistic regressions evaluated associations between determinants and SPOH. RESULTS: Very poor SPOH had a prevalence of 8.7%. Nearly half (43.5%) rated their oral health as 'fair'. Very poor SPOH was associated with poor self-perceived general health (OR = 2.60), anterior open bite (OR = 2.24), not cohabiting with one or both parents (OR = 2.40), caries experience (OR = 1.93), dental pain (OR = 1.91), and temporomandibular disorders (OR = 1.77). CONCLUSION: Very poor self-perceived oral health indicates life stress and associates with poor oral conditions. Assessments should be used to explore individual treatment needs and abilities to comply with recommendations.

Reciprocal longitudinal relationship between dental fear and oral health in schoolchildren.

BACKGROUND: No longitudinal study has evaluated the mutual relationship between dental fear and oral health in the same investigation. AIM: To evaluate the reciprocal longitudinal relationship between dental fear and oral health in schoolchildren. DESIGN: This longitudinal study monitored 416 Brazilian children aged 5-7 years of age at baseline for 2 years. The decayed, filled and missing teeth were clinically assessed for each child. Dental fear was evaluated by Dental Anxiety Question. Multilevel mixed-effects linear and logistic regressions analysed the reciprocal relationship between dental fear and oral health. RESULTS: Children with caries experience had 1.8 times higher odds of dental fear compared to children who were caries free. The presence of a carious tooth increased the odds of dental fear by 1.2 times. Children with dental fear had 0.46 additional carious tooth; an additional 0.22 tooth indicated for extraction; and a 0.67 higher caries experience score compared to children without dental fear. CONCLUSIONS: We observed a reciprocal relationship between dental fear and poor oral health. Both parents and dentists should provide realistic information for the children, discouraging biased negative expectations regarding dental treatment. Ultimately, the child would acquire positive perceptions of the dental environment, reducing their phobia and consequently improving oral health.

Predictors of dental anxiety in Brazilian 5-7years old children.

OBJECTIVES: The aim of this study was to analyze the predictors of dental anxiety in 5 to 7-year-old children in a two years follow-up. MATERIALS AND METHODS: This is a longitudinal study conducted with 784 children with 5 to 7years old. A face-to-face interview was conducted with the parents. The Dental Anxiety Question (DAQ) answers were categorized as presence or absence of dental anxiety. The possible predictor factors analyzed were: related to the children (age, sex, parentage, childbirth, physical activity, body satisfaction, psychological well-being, physical well-being, dentist visit); and related to the parents or guardians (excessive alcohol consumption, smoke, family income, number of children). Forward stepwise logistic binary regression was performed for the multivariate analysis. The analysis was controlled by gender. RESULTS: The prevalence of dental anxiety was 17.4%. Children in lower family income had 2.3 (95% CI: 1.3-4.0) greater chance to report high dental anxiety in comparison to children in higher family income. Similarly, children's parents who reported lower psychological well-being had 1.5 (95% CI: 1.0-3.0) greater chance to report high dental anxiety in comparison to children's parents with higher psychological well-being. CONCLUSIONS: The prevalence of dental anxiety was high, and the family income and psychological well-being were inversely associated to dental anxiety in children. CLINICAL RELEVANCE: Knowing the dental anxiety predictors could help the pediatric dentist to analyze and understand who is more susceptible to develop dental anxiety. An adequate approach, a trust relationship could be built, improving the oral health conditions and reducing the need of treatment in children.

Association between adolescents who are victims of bullying and weapon possession.

OBJECTIVE: To verify the association between victims of bullying and weapon possession among school adolescents. METHODS: This cross-sectional study was carried out with 2,296 high school students aged 14-19 years. An instrument containing questions from the validated Youth Risk Behavior Survey questionnaire and the National School Health Survey was used. To describe the profile of interviewees, absolute and relative frequencies were calculated, and the chi-square test was applied to verify the existence of associations. To test the association of bullying with weapon possession, Poisson logistic regression (univariate and multivariate) was used. The significance level used for all analyses was 5%. RESULTS: Among adolescents interviewed, 23.1% reported being victims of bullying. Among victims of bullying, 37.6% (PR = 1.68; 95% CI = 1.30 - 2.17) reported having already carried some type of weapon (knife, revolver, or truncheon) in the last 30 days, while the reported firearm possession was 38% (PR = 1.67; 95% CI = 1.16 - 2.40) and 47.5% of these adolescents carried some type of weapon (knife, revolver or truncheon) in the school environment (PR = 2.10; 95% CI = 1.50 - 2.93). CONCLUSIONS: It could be observed that adolescents who are victims of bullying are twice as likely of carrying some type of weapon (knife, revolver, or truncheon) to the school environment, and are also more likely of carrying a firearm.

Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations.

BACKGROUND: Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach. AIM: The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years. DESIGN: The sample consisted of 190 restorations and placed in 155 children 6-7 years old of both genders. The treatment was performed by two final-year dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months. RESULTS: The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect. CONCLUSIONS: The rate of success of restorations using the ART approach was significantly lower for class II.

Demand for health services or professionals among adolescents: a multilevel study. / Procura por serviços ou profissionais de saúde entre adolescentes: um estudo multinível.

This study aimed to analyze the demand for health services or professionals by adolescents with individual determinants and contextual variables (school teaching modality and Social Vulnerability Index). Data were collected from March to June 2018, in state public schools in Olinda, Pernambuco, Brazil, through a structured questionnaire with questions from the Youth Risk Behavior Survey (YRBS) and the National School Health Survey (PeNSE). Among the 2,454 adolescents, the proportion of those looking for a health service was higher among women; in adolescents whose mothers had a minimum of nine schooling years; in the physically active; and whose parents did not receive a family aid (Bolsa Família). We observed that the contextual variables did not influence the demand for health services among adolescents. In the third model of the multilevel analysis, which analyzed the individual variables, we observed that only females (OR=1,80), having a mother with schooling greater than or equal to 9 years of study (OR=1,30), not receiving Bolsa Família (OR=1,23), and physically active (OR=1,32) were associated with an increased demand for health services or professionals.

O objetivo deste estudo foi analisar a procura por serviços ou profissionais de saúde pelos adolescentes com determinantes individuais e com variáveis contextuais, modalidade de ensino da escola e Índice de Vulnerabilidade Social. Os dados foram coletados no período de março a junho de 2018, em escolas públicas estaduais de Olinda, Pernambuco, através de um questionário estruturado com questões do Youth Risk Behavior Survey (YRBS) e da Pesquisa Nacional de Saúde do Escolar (PeNSE). Dentre os 2.454 adolescentes, a proporção daqueles que procuram por um serviço de saúde foi maior: no sexo feminino; em adolescentes cujas as mães tivessem escolaridade mínima de nove anos; naqueles fisicamente ativos; e cujos responsáveis não recebiam Bolsa Família. Observou-se que as variáveis contextuais não influenciaram a procura por serviços de saúde entre os adolescentes. No terceiro modelo da análise multinível, que analisou as variáveis individuais, observou-se que apenas o sexo feminino (OR=1,80), ter mãe com escolaridade maior ou igual a nove anos de estudo (OR=1,30), não receber Bolsa Família (OR=1,23) e ser ativo fisicamente (OR=1,32) foram associados a uma maior procura por serviços ou profissionais de saúde.

The social status associated with dental experience among Brazilian children.

Dentists should be alert not only to clinical variables, but also to socioeconomic, psychological and cultural factors, which have all been associated with the experience of dental caries. The aim of this study of was to assess social status and dental experience among Brazilian children. A cross-sectional study was conducted involving 1367 male and female children aged six and seven years enrolled at public and private schools in the city of Recife (Brazil) in 2013. The children at tending public schools were socioeconomically less privileged than those attending private schools. Data were collected through interviews and intraoral examinations. Caries experience was high (53.3%) in the overall sample, but less privileged children had larger percentages of decayed teeth and teeth that required extraction (p < 0.001). Children from less privileged social class had a greater chance of having a low (OR = 1.77 [95%CI 1.33 - 2.35]), moderate (OR = 4.41 [95%CI: 3.18 - 6,14]) and high (OR = 9.55 [95%CI 6.01 - 15.16]) caries experience. They also had a greater chance of never visiting a dentist (OR= 2.90 [95% CI 2.25 - 3.74]) and had dental anxiety (OR = 1.70 [95%CI 1.34-2, 16]). Socioeconomic status influences the dental caries experience, the visits to the dentist and the dental anxiety of the children analyzed.

Oral Health Status and Treatment Needs Among Disabled Children in Recife, Brazil.

PURPOSE: The objective of the present study was to investigate oral health status and treatment needs of children with disabilities in Recife, Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out in the six administrative districts of Recife. The sample consisted of 366 children with disabilities and age between 3 and 12 years. The oral health conditions investigated were dental caries (CPOD index and dmft index), gingival state (IPV and IGC index) and dental trauma. Data analysis involved descriptive statistics, Pearson's chi-square test, Fisher's exact test, and Poisson regression models. RESULTS: The prevalence of caries was 65% and was associated with age (p = 0.0027) and area of residence (p = 0.020). The prevalence of need for treatment was also 65%. The mean decayed, missing and filled teeth (DMFT)/DMFT index of the study population was 3.17/1.73. Their mean number of DMFT was 2.37, 0.55 and 0.25 for the deciduous dentition, as well as 1.56, 0.05 and 0.12 for the permanent dentition. Almost the entire sample (96.7%) had visible plaque, 77.3% had gingival bleeding and 27.6% had dental traumatism. CONCLUSION: Children with disabilities were found to have high rates of caries and gingivitis, as well as cumulative needs for preventive and curative treatment.

Prevalence of Dental Trauma in 1485 Brazilian Adolescents Aged Between 15 and 19 Years Old and Associated Factors.

PURPOSE: Investigate dental trauma among adolescents aged 15-19 years and associated factors. METHODS: The study was conducted in Recife, Brazil and the sample comprised 1485 adolescents of both sexes. The data was collected by clinical examination and interviews were conducted in-between classes by a single trained assessor. Two questionnaires (AUDIT and ASSIT 2.0) were used to investigate the involvement of adolescents with alcohol, tobacco and illicit drugs. The classification proposed by Andreasen was used to identify dental injuries. The sample size was calculated using 95% interval level. Pearson's chi-square test and Fisher's exact test were used to confirm the association between the variables. RESULTS: The prevalence of dental injuries was 17.8%. The main causes of trauma were playing with others (20.8%) and falls (25.4%). A statistically significant percentage of adolescents reported using illicit drugs (13.9%), 15.9% used tobacco and 56.8% used alcoholic beverages. However, no statistically significant difference between the consumption of this drugs and dental injuries (p >0.005) was found. CONCLUSION: The prevalence of dental trauma in adolescents was high, with no association with drugs use.

School academic climate and oral health (tooth loss) in adolescents.

BACKGROUND: Preventing tooth loss depends on oral health maintenance behaviors. This study hypothesized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status. AIM: To analyze the association between a school academic climate of educational aspirations and tooth loss (first permanent molars) among adolescents. METHODS: A cross-sectional study was designed to include 2,500 adolescents (aged 14-19 years) enrolled in public high schools of Olinda located in Northeast Brazil. Multilevel Poisson regression random intercept models were conducted with tooth loss (first permanent molars) as the outcome. The primary cohort of interest was school academic climate, as measured by the proportion of students taking the national high school exams. RESULTS: Tooth loss of the first permanent molars (assessed by clinical exam) was more prevalent in adolescents from more disadvantaged backgrounds (receiving family allowance, low maternal education). However, after controlling for a wide range of individual characteristics, adolescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85). CONCLUSION: The school academic climate is associated with tooth loss, suggesting that educational aspirations are linked to adolescent oral health maintenance behaviors.

Association between cigarette use and adolescents' behavior.

OBJECTIVE: To determine the prevalence of cigarette use among adolescents and to identify associated health risk behaviors. METHODS: This is a cross-sectional study with a representative sample, composed of 1059 adolescents between 13 and 19 years old, enrolled in primary and secondary public schools of Olinda, Pernambuco, in 2014. Information was obtained through self-administered questionnaires (validated version of YRBS 2007). Cigarette experimentation was defined as smoking at least once in life. Adolescents who smoked at least one day within 30 days prior to the survey were considered current smokers. Most students were female and 16 years old or older. RESULTS: Almost 30% used it in life and about 10% smoked within the 30 days before the survey. Suicidal ideation (PR = 1.51, 95%CI 1.25-1.82), alcohol use (PR = 1.41, 95%CI 1.03-1.92), marijuana (PR = 1.64, 95%CI 1.37-1.96), excessive alcohol consumption (PR = 1.57, 95%CI 1.15-2.16) and sexual experience (PR = 1.78, 95%CI 1.43-2.21) have increased the risk of using cigarettes. Feelings of sadness (PR = 1.70, 95%CI 1.22-2.36), alcohol use (PR=2.40, 95%CI 1.12-5.12), excessive alcohol consumption (PR = 2.5, 95% CI 1.24-5.38), marijuana (PR = 2.31, 95%CI.57-3.39) and cocaine (PR = 1.99, 95%CI.32-3.01) increased the risk of cigarette use within the 30 days before the survey. CONCLUSIONS: Cigarette use among adolescents from Olinda was high, being considered higher than the national prevalence. Possible factors associated with cigarette use were drug use (alcohol, marijuana, and cocaine) and behaviors related to sexual experience, feelings of sadness and suicidal ideation.

The atraumatic restorative treatment approach: an "atraumatic" alternative.

INTRODUCTION: Fear and anxiety are part of all human experiences and they may contribute directly to a patient's behavior. The Atraumatic Restorative Treatment (ART) is a technique that may be an alternative approach in treating special care patients or those who suffer fear or anxiety. OBJECTIVE: the aim of this paper is to review the ART technique as an alternative to reduce pain and fear during dental treatment. MATERIAL AND METHODS: A search for the term "atraumatic restorative treatment" was carried out in the MEDLINE search engine. References, from the last 10 years, containing at least one of the terms: "psychological aspects", "discomfort", "fear", "anxiety" or "pain", were selected. RESULTS: A total of 120 references were found, from which only 17 fit the criteria. DISCUSSION: All authors agreed that the ART promotes less discomfort for patients, contributing to a reduction of anxiety and fear during the dental treatment. Results also indicated that ART minimizes pain reported by patients. CONCLUSIONS: The ART approach can be considered as having favorable characteristics for the patient, promoting an "atraumatic" treatment. This technique may be indicated for patients who suffer from fear or anxiety towards dental treatments and whose behavior may cause the treatment to become unfeasible or even impossible altogether.

[Comparative study of health behavior among college students at the start and end of their courses]. / Estudo comparativo de condutas de saúde entre universitários no início e no final do curso.

OBJECTIVE: To analyze differences in health behavior among students studying health related subjects in public universities, between the beginning and end of their courses. METHODS: The study sample comprised 735 students in health sciences at the public universities in Pernambuco state (Northeastern Brazil) in 2006. The data were collected by means of the National College Health Risk Behavior Survey that had been validated previously for use among university students. Descriptive and inferential statistical techniques were used. The chi-square test or Fisher's exact test was used to analyze associations. Results were considered to be significant for p<0.05. RESULTS: The majority (69.5%) of students were female. Fewer students were found to be living with their parents or a guardian by the end of the course. However there were no significant differences for violent behavior, related to weight and physical activity, nor for most behavior relating to traffic safety and food intake. The consumption of alcohol (68.8% vs. 83.3%), tobacco (40.7% vs. 52.5%) and inhalants (10.2% vs. 21.9%) and sexual practices (62.5% vs. 85.0%) were more frequent by the end of the course, with statistically significant differences. CONCLUSIONS: In general, health behaviors did not differ significantly between students at the beginning and end of graduate courses in health sciences.

Bulimia nervosa as a risk factor for voice disorders--literature review.

UNLABELLED: Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. AIM: These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders. RESULTS: of the ninety three papers we found, twenty-three were used as a basis for this review, among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. CONCLUSION: It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change.

Association between adolescents who are victims of bullying and weapon possession

Abstract Objective To verify the association between victims of bullying and weapon possession among school adolescents. Methods This cross-sectional study was carried out with 2,296 high school students aged 14-19 years. An instrument containing questions from the validated Youth Risk Behavior Survey questionnaire and the National School Health Survey was used. To describe the profile of interviewees, absolute and relative frequencies were calculated, and the chi-square test was applied to verify the existence of associations. To test the association of bullying with weapon possession, Poisson logistic regression (univariate and multivariate) was used. The significance level used for all analyses was 5%. Results Among adolescents interviewed, 23.1% reported being victims of bullying. Among victims of bullying, 37.6% (PR = 1.68; 95% CI = 1.30 - 2.17) reported having already carried some type of weapon (knife, revolver, or truncheon) in the last 30 days, while the reported firearm possession was 38% (PR = 1.67; 95% CI = 1.16 - 2.40) and 47.5% of these adolescents carried some type of weapon (knife, revolver or truncheon) in the school environment (PR = 2.10; 95% CI = 1.50 - 2.93). Conclusions It could be observed that adolescents who are victims of bullying are twice as likely of carrying some type of weapon (knife, revolver, or truncheon) to the school environment, and are also more likely of carrying a firearm.