Dental caries in schoolchildren: influence of inattention, hyperactivity and executive functions

Abstract Attention-deficit/hyperactivity disorder (ADHD) is characterized by inappropriate levels of hyperactivity, impulsivity, and/or inattention. Individuals with ADHD may present limitations with regard to executive functions and performing activities that involve planning and/or attention/concentration. The aim of the study was to investigate the association between dental caries and signs of ADHD in a representative sample of schoolchildren. A representative sample of 851 schoolchildren aged seven to 12 years was randomly selected from public and private schools. Data acquisition involved a clinical dental examination for cavitated permanent and deciduous teeth using the DMFT/dmft indices. Neuropsychological evaluations, including the assessment of intelligence (Raven's Colored Progressive Matrix Test) and executive functions (Corsi Tapping Blocks tests and Digit Span test) were also performed. Parents/caregivers and teachers answered the SNAP-IV Questionnaire for the investigation of signs of inattention and hyperactivity in the family and school environment. Parents/caregivers also answered questionnaires addressing socioeconomic and socio-demographic characteristics. Descriptive analysis of the variables and Poisson regression with robust variance were performed. Parental reports of signs of inattention (PR: 1.28; p < 0.05) and hyperactivity (PR: 1.15; p < 0.05) were associated with a greater occurrence of caries. A better performance on the backward order of the Corsi Tapping Blocks tests (PR: 0.94; p < 0.05) and higher level of mother's schooling were associated with a lower frequency of caries. A better performance on executive function tasks was a protective factor against dental caries, whereas children considered inattentive and/or hyperactive by their parents had a higher prevalence rate of dental caries.

Reconhecimento e avaliação da ansiedade em indivíduos com paralisia cerebral durante consultas odontológicas / Recognition and evaluation of anxiety in individuals with cerebral palsy during dental appointments

Objetivo: o objetivo deste estudo foi verificar a correlação entre a avaliação da ansiedade realizada por meio de medidas fisiológicas e pela observação do comportamento de pacientes com paralisia cerebral realizado pelo dentista durante a primeira consulta odontológica. Métodos: quarenta pacientes com idade variando de 7 a 26 anos, com paralisia cerebral foram submetidos a exames odontológicos. A pressão arterial e a frequência cardíaca foram aferidas no início e no final da primeira consulta odontológica. O dentista avaliou o comportamento antes e após o exame clínico dentário através da observação do comportamento do paciente (inquietação / agitação / tiques nervosos, palidez, transpiração excessiva, resistência e mudança aparente na frequência respiratória). Foi utilizado o teste de correlação de Spearman para determinar a correlação entre as medidas fisiológicas e a classificação comportamental da ansiedade feita pelo cirurgião dentista a um nível de significância de 95%. Resultados: os sinais comportamentais mais frequentes foram inquietação / agitação / tiques nervosos (50,0%) e resistência (27,5%). Foi encontrada uma correlação positiva significativa entre os dois métodos de avaliação de ansiedade utilizados (p <0,05). Os pacientes considerados ansiosos pelo dentista apresentaram medidas fisiológicas mais elevadas do que aqueles considerados calmos (p <0,05). Conclusão: a observação contínua do comportamento de pacientes com paralisia cerebral durante o exame odontológico é uma ferramenta valiosa para o reconhecimento e avaliação da ansiedade por parte da equipe odontológica. Estudos adicionais são necessários para validar um código de expressões faciais e corporais ou reações de ansiedade em pacientes com paralisia cerebral.(AU)

Aim: The present study aimed to verify the correlation between the evaluation of anxiety performed through physiological measures and the observation of the behavior of patients with cerebral palsy performed by the dentist during the first dental visit. Methods: Forty patients with cerebral palsy, varying from seven to 26 years of age, were submitted to dental examinations. The blood pressure and heart rate were measured at the beginning and end of the first dental appointment. The dentist evaluated the behavior before and after the dental exam by observing the patient's behavior (restlessness / agitation / nervous tics, pallor, excessive perspiration, resistance, and apparent change in breathing rate). The Spearman correlation test was used to determine the correlation between the physiological measures and the behavioral classification of anxiety made by the dentist at a significance level of 95%. Results: The most frequent behavioral signs were restlessness / agitation / nervous tics (50.0%), and resistance (27.5%). Through the Kruskal-Wallis test and Spearman's correlation, a significant positive correlation was found between the two anxiety assessment methods used in this study (p<0.05). The patients considered anxious by the dentist presented higher physiological measurements than did those considered calm (p<0.05). Conclusion: It can therefore be concluded that the continuous observation of the behavior of patients with cerebral palsy during the dental examination is a valuable tool for the recognition and evaluation of anxiety on the part of the dental team. Further studies are warranted to validate a code of facial and body expressions or anxiety reactions in patients with cerebral palsy.(AU)

School Achievement Test: normative data for a representative sample of elementary school children

The present study established norms for the spelling and arithmetic subtests of the School Achievement Test (Teste do Desempenho Escolar [TDE]) in two Brazilian cities located in the state of Minas Gerais and compared the results with those obtained from the original normative sample. A stratified proportional sample of 1,034 students from Belo Horizonte and Mariana, from the 1st to 6th grades, was selected. The participants were assessed by the spelling and arithmetic subtests of the TDE. Significant differences were found between the results from Minas Gerais and Rio Grande do Sul, with moderate to high effect sizes. Significant differences were found in percentiles and classification parameters. The educational performance of the children from Minas Gerais was generally classified as less than expected (i.e., inferior) when the original norms were used as a classification parameter. Considering the high variability of educational data in different Brazilian regions, using norms for educational assessment based on only one Brazilian region is inappropriate.

Risk behavior for the Human Immunodeficiency Virus among motel clients / Comportamentos de risco frente ao vírus da imunodeficiência humana entre frequentadores de motéis / Las conductas de riesgo al virus de inmunodeficiencia humana entre usuarios de moteles

This study aimed to verify risk behavior for infection with the Human Immunodeficiency Virus in people who attended motels. This is a cross-sectional study conducted in two motels in two municipalities in the state of Minas Gerais, Brazil, with a sample of 308 randomly selected individuals, aged between 18 and 60 years. Bivariate (chi-square and t test for independent samples) and multivariate (logistic regression) statistical tests were performed. A total of 45.8% of the participants reported not having used a condom during the last vaginal sexual intercourse, 48.4% did not use a condom during the last oral sex, while 26.3% reported not having used a condom in the last anal intercourse. Having a steady partner was the strongest predictor of not using condoms. Probable beliefs regarding loyalty involved in a stable relationship may be contributing to the failure to use condoms during intercourse, increasing the risk of HIV infection.

Este estudo teve por objetivo verificar comportamentos de risco referentes à infecção pelo vírus da imunodeficiência humana (HIV) em pessoas que frequentaram motéis. Trata-se de estudo transversal, realizado em dois motéis de dois municípios do interior de Minas Gerais, com amostra de 308 indivíduos, seguindo cálculo amostral, selecionados aleatoriamente, com idade entre 18 e 60 anos. Foram realizados testes estatísticos bivariados (qui-quadrado e teste t para amostras independentes) e multivariados (regressão logística). Dentre os participantes, 45,8% relataram não ter usado preservativo na última relação sexual vaginal, 48,4% não utilizaram preservativo na última relação sexual oral, enquanto 26,3% afirmaram não ter usado na última relação anal. Ter um parceiro fixo foi o maior preditor do não uso do preservativo. Prováveis crenças de fidelidade, envolvidas em um relacionamento estável, podem estar contribuindo para o não uso do preservativo nas relações, aumentando o risco de infecção pelo HIV.

Este estudio tuvo como objetivo determinar las conductas de riesgo al virus de inmunodeficiencia humana en personas que asistieron moteles. Estudio transversal realizado en dos moteles en dos municipios de Minas Gerais con una muestra de 308 personas. Bivariado se realizaron pruebas estadísticas (Jue-cuadrado y t para muestras independientes) y multivariado (regresión logística). La mayoría (42,5%) tenían entre 18 y 25 años y el 45,8% no había utilizado preservativo en sus últimas relaciones sexuales vaginales, 48,4% no usó condón para sexo oral, mientras que 26,3 % reportó no haber utilizado el su última relación anal. Tener una pareja estable fue el mejor predictor para no usarse condones. Llegamos a la conclusión de que la lealtad tiende a estar involucrada en una relación estable puede estar contribuyendo a la no utilización de preservativos en las relaciones, aumentando la vulnerabilidad.

Perfil cognitivo, déficits motores e influência dos facilitadores para reabilitação de crianças com disfunções neurológicas / Cognitive profile, motor deficits and influence of facilitators for rehabilitation of children with neurological dysfunction

OBJETIVO: Investigar se crianças e adolescentes saudáveis e com doenças neurológicas podem ser reunidas em grupos distintos e homogêneos, usando como critérios o desempenho cognitivo, o funcionamento motor e as percepções dos pais quanto aos facilitadores para a reabilitação. MÉTODOS: Participaram deste estudo 15 crianças saudáveis (C) e 43 pacientes (28 com paralisia cerebral e 15 com acidente vascular cerebral), entre cinco e 18 anos. Foi aplicado aos pais o instrumento denominado Avaliação dos Fatores Ambientais relacionados à Reabilitação Neurológica Infantil (AFARNI). O comprometimento cognitivo foi avaliado por meio do Mini-Exame do Estado Mental, adaptado para essa faixa etária, e o comprometimento motor foi investigado por avaliação clínica. Para comparar os resultados, foi realizada uma análise de conglomerados e ANOVA. RESULTADOS: A análise de conglomerados identificou quatro grupos de pacientes com características clínicas e sociodemográficas distintas, confirmados pela ANOVA (p<0,001). Houve dissociação entre os grupos com relação ao comprometimento cognitivo e motor. Os pais de crianças com maior comprometimento avaliaram de forma mais positiva os facilitadores para a reabilitação. CONCLUSÕES: A qualificação dos facilitadores para a reabilitação por meio da AFARNI e a avaliação cognitiva com auxílio do Mini-Exame do Estado Mental podem contribuir para identificar as necessidades de suporte para crianças com deficiências neurológicas que apresentam comprometimento cognitivo e motor.

OBJECTIVE: To investigate whether healthy children and adolescents suffering from neurological diseases can be grouped into distinct and homogeneous groups using criteria such as cognitive performance, motor functioning and parents' perceptions about the rehabilitation facilitators. METHODS: Sample was comprised by 15 healthy children and 43 patients (28 with cerebral palsy and 15 with stroke (n=15), aged from five to 18 years old. The Environment Factors Assessment related to the Children Neurologic Rehabilitation (EFACN) was used to assess parents' perception about the rehabilitation facilitators. Cognitive impairment was assessed using the Mini Mental Status Examination (MMSE), adapted for this age, and the motor impairment was clinically evaluated. Cluster analysis and one way ANOVA were conducted to compare the results. RESULTS: Cluster analysis identified four groups with distinct clinical and socio-demographic patterns, confirmed by ANOVA (p<0.001). Dissociation between cognitive and motor functions was found. Parents of children with severe impairment evaluated more positively rehabilitation facilitators. CONCLUSIONS: The qualification of rehabilitation facilitators by EFACN and cognitive assessment by MMSE can help to identify the needs of children with neurological disabilities who present cognitive and motor impairment.