Digital surveillance: The interest in mouthwash-related information.

BACKGROUND: The comprehension of the interests of Internet users regarding their health-related searches may reveal the community's demands about oral health. The study aimed to characterize the interests of Google users related to mouthwash in Australia, Brazil, Chile, Japan, Mexico, Russia, the United Kingdom, the United States, Saudi Arabia and South Africa applying the Google Trends. METHODS: This longitudinal retrospective study analysed the mouthwash-related interest of Google users from January 2004 to December 2020. The monthly variation of relative search volume (RSV) and the main queries related were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for mouthwash for additional 12 months. Auto-correlation plots and a general additive model (GAM) were used to diagnose trends and seasonality in RSV curves. In addition, the influence of social isolation related to the outbreak of COVID-19 were analysed. RESULTS: The RSVs curves showed a considerable increase in searches related to mouthwash to AUS, BRA, JAP, MEX, GBR and USA (RSV > 25), while the growth was slight to CHI, KSA, RSA and RUS (RSV < 25) over the years, without influence of monthly seasonality. All countries showed a significant increase in mouthwash interest after the outbreak of COVID-19, except for KSA and RUS. The mouthwash-related searches were associated to specific brands or chemical compositions, treatments, whitening agents, homemade mouthwash and indications for the 'best mouthwash'. CONCLUSIONS: In general, there was an increasing interest of Google users in mouthwash-related topics between 2004 and 2020. In addition, in most countries, there was an expansion in searches during the social isolation of the COVID-19 pandemics.

Toothpaste-related interests of Google users from different countries.

The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users' interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

eHEALS as a predictive factor of digital health information seeking behavior among Brazilian undergraduate students.

This study aimed to perform the cross-cultural adaptation and validation of the eHealth Literacy Scale (eHEALS) for Brazilian Portuguese. The cross-cultural adaptation was conducted through conceptual equivalence, verbatim translation, semantic, item and operational equivalence, and back-translation. Subsequently, 521 undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14) and sociodemographic and health-related questions. Statistical analysis was performed to determine the dimensionality, internal consistency, stability and concurrent/convergent/discriminant/predictive validities of the eHEALS (p < 0.05). The adequacy of sample size was confirmed by a non-identity correlation matrix (Bartlett's test of sphericity, p < 0.001), without influence of multicollinearity (determinant = 0.026). The confirmatory factor analysis identified four factors in agreement to the constructs namely as online searching self-efficacy, awareness of available sources, information usage ability, and critical analysis of useful information. The eHEALS displayed an excellent internal consistency (Cronbach's alpha = 0.88), a good stability (ICC = 0.71, 95% CI: 0.49-0.84), and it was significantly correlated with GSES (concurrent validity). Higher eHEALS scores were identified among (i) white and (ii) younger students, (iii) from health sciences courses, (iv) with more years of graduation, (v) who their fathers were working in specialized functions (discriminant validity), and (vi) among those who were frequently interested in digital health information (convergent validity). The students with higher eHealth literacy levels were more likely to seek health information in the last 24 h (predictive validity). In conclusion, the eHEALS demonstrated adequate psychometric properties to be applied for the Brazilian population.

The eHealth Literacy Scale (eHEALS) is a self-fulfilling tool designed to determine individuals' levels of electronic health literacy. It helps to determine how people deal with electronic health-related information, being useful to identify potential difficulties of accessing, evaluating and using online health information, with potential to support the planning of educational interventions. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for being applied to Brazilian Portuguese native speakers. Five hundred twenty-one undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14), and sociodemographic and health-related questions. The tool showed sufficient consistency and stability, with the detection of higher eHEALS scores among white and younger people who reported a frequent interest for seeking digital health information, students from health sciences courses, those with more years of graduation, and who their fathers were working in specialized functions. Also, the students with higher eHealth literacy scores were more likely to seek health information in the last 24 h. In conclusion, the eHEALS demonstrated being adequate to be applied for the Brazilian population.

Toothpaste-related interests of Google users from different countries

Abstract The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users' interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

[Talking about COVID-19: contributions to the construction of a collective memory of the syndemic through the lens of food]. / Hablar de COVID-19: aportes a la construcción de una memoria colectiva de la sindemia desde la alimentación.

This article explores the question of why the nine pandemics prior to COVID-19 - which have affected millions of people since the second half of the 20th century - were not recorded in collective memory despite their magnitude and extent. Thus, it proposes a reading of the pandemic as one component of a wider syndemic made up of contagious diseases, climate change, and malnutrition. This piece offers a narrative of the origins, development, and prospects of the pandemic within the dynamics of the global food system and national economic and political systems, highlighting components and connections. It includes a warning that - along with climate change and malnutrition (undernourishment-obesity) - pandemics are known and expected outcomes of the workings of a socio-political system that, as in the case of other components of the syndemic, by naturalizing causes and individualizing consequences, conspire against the creation of narratives that go beyond cosmetic changes.

Este trabajo se pregunta por qué las nueve pandemias que afectaron a millones de personas desde la última mitad del siglo XX no se inscribieron en la memoria colectiva pese a su gravedad y difusión. Propone leer la pandemia de COVID-19 como componente de la sindemia enfermedades infecciosas-cambio climático-malnutrición, y genera un relato de los orígenes, desarrollo y perspectivas del COVID-19 dentro de la dinámica del sistema alimentario global y los sistemas económico-políticos nacionales, señalando componentes y relaciones. Advierte que, como en el caso del cambio climático o la malnutrición (desnutrición-obesidad), las pandemias son subproductos conocidos y esperables del funcionamiento del sistema sociopolítico que, al igual que en los otros componentes de la sindemia, la naturalización de las causas y la individualización de las consecuencias conspiran contra la creación de una narrativa que vaya más allá de admitir cambios cosméticos.

High mortality among hospitalized adult patients with COVID-19 pneumonia in Peru: A single centre retrospective cohort study.

BACKGROUND: Peru is the country with the world's highest COVID-19 death rate per capita. Characteristics associated with increased mortality among adult patients with COVID-19 pneumonia in this setting are not well described. METHODS: Retrospective, single-center cohort study including 1537 adult patients hospitalized with a diagnosis of SARS-CoV-2 pneumonia between May 2020 and August 2020 at a national hospital in Lima, Peru. The primary outcome measure was in-hospital mortality. RESULTS: In-hospital mortality was 49.71%. The mean age was 60 ± 14.25 years, and 68.38% were males. We found an association between mortality and inflammatory markers, mainly leukocytes, D-dimer, lactate dehydrogenase, C-reactive protein and ferritin. A multivariate model adjusted for age, hypertension, diabetes mellitus, and corticosteroid use demonstrated that in-hospital mortality was associated with greater age (RR: 2.01, 95%CI: 1.59-2.52) and a higher level of oxygen requirement (RR: 2.77, 95%CI: 2.13-3.62). Conclusions: In-hospital mortality among COVID-19 patients in Peru is high and is associated with greater age and higher oxygen requirements.

Digital surveillance: Monitoring the activity of Internet users searching for information related to early childhood caries.

This study evaluated the behavior of Internet users from seven countries through the analysis of the monthly variation of the Relative Search Volume (RSV) for queries related to early childhood caries (ECC), retrieved by Google Trends application programming interface between January 2004 to December 2020. The association of RSV with years lived with disability (YLDs) for untreated dental caries in deciduous teeth and Internet penetration were tested by regression models. Forecasting models were developed to predict the interests until December 2021. Relevant topics linked to searches were assessed qualitatively. Increasing levels of interests were observed in most countries, regarding the comparison of periods 2004-2012 and 2013-2021, without influence of seasonality. These results were associated with YLDs only in France and with the Internet penetration in Mexico and France. Searches were mostly related to the definition, risk factors, and preventive care of ECC. The interests of Internet users in ECC-related information increased in the last years in all seven countries, although it was maintained low over time. It might indicate a lack of awareness about the negative consequences of the disease in the early stages of life. Specific policies should be developed toward the dissemination of oral health information and the prevention of the disease.

Hablar de COVID-19: aportes a la construcción de una memoria colectiva de la sindemia desde la alimentación / Talking about COVID-19: contributions to the construction of a collective memory of the syndemic through the lens of food

RESUMEN Este trabajo se pregunta por qué las nueve pandemias que afectaron a millones de personas desde la última mitad del siglo XX no se inscribieron en la memoria colectiva pese a su gravedad y difusión. Propone leer la pandemia de COVID-19 como componente de la sindemia enfermedades infecciosas-cambio climático-malnutrición, y genera un relato de los orígenes, desarrollo y perspectivas del COVID-19 dentro de la dinámica del sistema alimentario global y los sistemas económico-políticos nacionales, señalando componentes y relaciones. Advierte que, como en el caso del cambio climático o la malnutrición (desnutrición-obesidad), las pandemias son subproductos conocidos y esperables del funcionamiento del sistema sociopolítico que, al igual que en los otros componentes de la sindemia, la naturalización de las causas y la individualización de las consecuencias conspiran contra la creación de una narrativa que vaya más allá de admitir cambios cosméticos.

ABSTRACT This article explores the question of why the nine pandemics prior to COVID-19 - which have affected millions of people since the second half of the 20th century - were not recorded in collective memory despite their magnitude and extent. Thus, it proposes a reading of the pandemic as one component of a wider syndemic made up of contagious diseases, climate change, and malnutrition. This piece offers a narrative of the origins, development, and prospects of the pandemic within the dynamics of the global food system and national economic and political systems, highlighting components and connections. It includes a warning that - along with climate change and malnutrition (undernourishment-obesity) - pandemics are known and expected outcomes of the workings of a socio-political system that, as in the case of other components of the syndemic, by naturalizing causes and individualizing consequences, conspire against the creation of narratives that go beyond cosmetic changes.

Análisis para el diseño de campañas de comunicación para promover la alimentación saludable en adolescentes / Analysis for the design of communication campaigns to promote healthy eating in adolescents

Las campañas de comunicación son instrumentos útiles para aumentar la concientización e involucrar a la ciudadanía en distintas problemáticas. Objetivos detectar y analizar las actitudes y percepciones de los y las adolescentes frente a las campañas de comunicación que buscan promover una alimentación saludable en Argentina. Métodos 6 grupos focales (n=6) de adolescentes entre 13 y 1 5 años de distintos niveles socioeconómicos. Resultados Según los relatos de los participantes, una campaña eficaz debería incluir los siguientes conceptos principales a) temáticas de interés de la población objetivo, que les resulte cercana y cotidiana; b) mensajes informativos con énfasis en la libertad de elección (y no con tono imperativo o directivo), y/o mensajes informativos de pérdida para comunicar consecuencias o riesgos de determinadas acciones; c) Imágenes relacionadas directamente con la temática d) textos cortos, claros y concisos; frases cortas que generen impacto con información novedosa y con lenguaje comprensible; e) contenido claro, simples, impactantes visualmente y de corta duración f) material con imágenes estáticas por sobre el uso de videos, publicaciones con bajo contenido de texto, uso de colores, tipografías. Conclusión Este estudio brinda elementos, tanto desde la matriz de comunicación-persuasión como desde el marketing social representando un insumo para el diseño de campañas más efectivas para la promoción de la alimentación saludable en población que interpelen a los adolescentes.

Sensitivity and specificity of increased pulse pressure as a diagnostic test for K/DOQI stage III-b CKD.

BACKGROUND: Increased pulse pressure (IPP) is associated with an estimated glomerular filtration ≤ 60/mL/min/1.73 m2; thus, it can be useful as a diagnostic test to identify people with K/DOQI stage III-b chronic kidney disease (CKD). OBJECTIVE: To determine the usefulness of IPP as a diagnostic test for K/DOQI stage III-b CKD. METHOD: Diagnostic test study that included adult patients without comorbidities, registered in the Health Workers Cohort. The CKD-EPI formula was used to calculate glomerular filtration. Pulse pressure was determined by subtracting diastolic from systolic blood pressure. Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were calculated using standard formulas. A ROC curve was generated to determine the area under the curve. RESULTS: A total of 6,215 patients were included. An IPP ≥ 50 mmHg was observed to have a sensitivity of 74 %, specificity of 70 %, positive predictive value of 1 %, negative predictive value of 100 % and a prevalence of 1 %. The inflection point in the ROC curve to identify K/DOQI III-b CKD was 0.71. CONCLUSION: An IPP ≥ 50 mmHg is useful as a diagnostic test to identify people with K/DOQI stage III-b CKD.

INTRODUCCIÓN: La presión de pulso ampliada (PPA) se asocia a un filtrado glomerular calculado ≤ 60/mL/minuto/1.73 m2, por lo que puede ser útil como prueba diagnóstica para identificar a personas con insuficiencia renal crónica (IRC) estadio K/DOQI III-b. OBJETIVO: Determinar la utilidad de la PPA como prueba diagnóstica de IRC estadio K/DOQI III-b. MÉTODO: Estudio de prueba diagnóstica que incluyó a pacientes adultos sin comorbilidades, registrados en la Cohorte de Trabajadores de la Salud. Se utilizó la fórmula CKD-EPI para calcular la filtración glomerular. Se determinó la presión de pulso restando la presión arterial diastólica a la presión arterial sistólica. Se calculó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y prevalencia. Se elaboró una curva ROC para determinar el área bajo la curva. RESULTADOS: Se incluyeron 6215 pacientes. Se observó que una PPA ≥ 50 mm Hg tuvo sensibilidad de 74 %, especificidad de 70 %, valor predictivo positivo de 1 %, valor predictivo negativo de 100 % y prevalencia de 1 %. El punto de inflexión en la curva ROC para identificar IRC K/DOQI III-b fue de 0.71. CONCLUSIÓN: La PPA ≥ 50 mm Hg es útil como prueba diagnóstica para identificar a personas con IRC estadio K/DOQI III-b.

Sensibilidad y especificidad de la presión de pulso ampliada como prueba diagnóstica de IRC estadio K/DOQI III-b / Sensitivity and specificity of increased pulse pressure as a diagnostic test for K/DOQI III-b

Resumen Introducción: La presión de pulso ampliada (PPA) se asocia a un filtrado glomerular calculado ≤ 60/mL/minuto/1.73 m2, por lo que puede ser útil como prueba diagnóstica para identificar a personas con insuficiencia renal crónica (IRC) estadio K/DOQI III-b. Objetivo: Determinar la utilidad de la PPA como prueba diagnóstica de IRC estadio K/DOQI III-b. Método: Estudio de prueba diagnóstica que incluyó a pacientes adultos sin comorbilidades, registrados en la Cohorte de Trabajadores de la Salud. Se utilizó la fórmula CKD-EPI para calcular la filtración glomerular. Se determinó la presión de pulso restando la presión arterial diastólica a la presión arterial sistólica. Se calculó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y prevalencia. Se elaboró una curva ROC para determinar el área bajo la curva. Resultados: Se incluyeron 6215 pacientes. Se observó que una PPA ≥ 50 mm Hg tuvo sensibilidad de 74 %, especificidad de 70 %, valor predictivo positivo de 1 %, valor predictivo negativo de 100 % y prevalencia de 1 %. El punto de inflexión en la curva ROC para identificar IRC K/DOQI III-b fue de 0.71. Conclusión: La PPA ≥ 50 mm Hg es útil como prueba diagnóstica para identificar a personas con IRC estadio K/DOQI III-b.

Abstract Introduction: Increased pulse pressure (IPP) is associated an estimated glomerular filtration ≤ 60/mL/min/1.73 m2; thus, it can be useful as a diagnostic test to identify people with K/DOQI stage III-b chronic kidney disease (CKD). Objective: To determine the usefulness of IPP as a diagnostic test for K/DOQI stage III-b CKD. Method: Diagnostic test study that included adult patients without comorbidities, registered in the Health Workers Cohort. The CKD-EPI formula was used to calculate glomerular filtration. Pulse pressure was determined by subtracting diastolic from systolic blood pressure. Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were calculated using standard formulas. A ROC curve was generated to determine the area under the curve. Results: A total of 6,215 patients were included. An IPP ≥ 50 mmHg was observed to have a sensitivity of 74 %, specificity of 70 %, positive predictive value of 1 %, negative predictive value of 100 % and a prevalence of 1 %. The inflection point in the ROC curve to identify K/DOQI III-b CKD was 0.71. Conclusion: An IPP ≥ 50 mmHg is useful as a diagnostic test to identify people with K/DOQI stage III-b CKD.

Feelings, Stress, and Adaptation Strategies of Nurses against COVID-19 in Guayaquil

Objective. To explore the feelings, stress factors, and adaptation strategies of nurses during the COVID-19 pandemic in Guayaquil, Ecuador. Methods. A cross-sectional, descriptive quantitative study, conducted through the application of a 52-item questionnaire with four sections (feelings, perceived stress, stress-reducing factors, and adaptation strategies). The study population was 227 nursing professionals from "Hospital General del Guasmo Sur" of the Ministry of Public Health, who worked during the peak of the pandemic from March to May 2020. The sample comprised 155 nurses who voluntarily accepted to participate. The study received 127 complete questionnaires for analysis. Results. The data showed the priority of humanist feelings and professional duty for these nurses, mostly young (59% under 35 years of age and with the professional exercise of three and fewer years), against the fear of contagion and the stress of strenuous work. They also revealed the great importance for them of the institutional support, recognition to the staff, and strict organization of safe care, like strategies for coping with this difficult experience. Conclusion. The COVID-19 pandemic represented for nurses from Guayaquil a great professional and emotional challenge. Health services and society could consider these findings to avoid burning out nurses and their professional desertion.

Objetivo. Explorar los sentimientos, factores de estrés y estrategias de adaptación de los enfermeros durante la pandemia del COVID-19 en Guayaquil, Ecuador. Métodos. Estudio cuantitativo, descriptivo, de corte transversal, realizado mediante la aplicación de un cuestionario de 52 ítems con cuatro secciones (sentimientos, estrés percibido, factores reductores de estrés y estrategias de adaptación). La población del estudio fueron 227 profesionales de enfermería del "Hospital General del Guasmo Sur" del Ministerio de Salud Pública, que laboraron durante el pico de la pandemia en los meses de marzo a mayo de 2020. La muestra fueron 155 enfermeros que aceptaron voluntariamente participar. Se recibieron 127 cuestionarios completos para el análisis Resultados. Los datos mostraron la prioridad de los sentimientos humanistas y del deber profesional para estos enfermeros, en su mayoría jóvenes (59% menores de 35 años y con ejercicio profesional de tres y menos años), frente al temor al contagio y al estrés de un trabajo extenuante. Revelaron también la gran importancia que tiene para ellos el soporte institucional, el reconocimiento al personal y la estricta organización de una prestación segura, como estrategias para el afrontamiento de esta difícil experiencia. Conclusión. La pandemia del COVID-19 representó para los enfermeros de Guayaquil un gran desafío tanto profesional como emocional. Los servicios de salud y la sociedad podrían considerar estos hallazgos para evitar el desgaste de los enfermeros y su deserción profesional.

Objetivo. Explore os sentimentos, fatores de estresse e estratégias de adaptação de enfermeiras durante a pandemia COVID-19 em Guayaquil, Equador. Métodos. Estudo quantitativo, descritivo, transversal, realizado por meio da aplicação de um questionário de 52 itens com quatro seções (sentimentos, estresse percebido, fatores redutores do estresse e estratégias de adaptação). A população do estudo foi de 227 profissionais de enfermagem do "Hospital Geral de Guasmo Sur" do Ministério da Saúde Pública, que trabalharam durante o pico da pandemia nos meses de março a maio de 2020. A amostra foi de 155 enfermeiros que aceitaram participar voluntariamente. Foram recebidos para análise 127 questionários completos. Resultados. Os dados evidenciaram a prioridade do sentimento humanístico e do dever profissional para esses enfermeiros, em sua maioria jovens (59% menores de 35 anos e com prática profissional de até três anos), frente ao medo do contágio e ao estresse do trabalho extenuante. Também revelaram a grande importância do apoio institucional, do reconhecimento da equipe e da estrita organização de uma prestação segura, como estratégias para o enfrentamento dessa difícil experiência. Conclusão. A pandemia COVID-19 representou um grande desafio profissional e emocional para as enfermeiras de Guayaquil. Os serviços de saúde e a sociedade poderiam considerar essas descobertas para evitar a exaustão do enfermeiro e sua deserção profissional.

Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial.

OBJECTIVES: To evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children. METHODS: A single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer's exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05). RESULTS: Despite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children's consumption of sugar-free sweets and controlling the severity of ECC. CONCLUSION: Therefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children's dietary patterns. CLINICAL SIGNIFICANCE: These findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

Is the Quality of Toothache-Related Information Published in Brazilian Websites Adequate to Assist People in Seeking Dental Treatment?

PURPOSE: The aim of this study was to evaluate the readability and the quality of toothache-related information found in Brazilian websites. MATERIALS AND METHODS: Fifty-five websites retrieved from Google Search, Baidu, Yahoo! and Bing were evaluated by two independent examiners using the DISCERN questionnaire, the Journal of American Medical Association (JAMA) benchmark criteria and the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). Additionally, the websites were categorised according to their information, adopting four criteria related to: (i) endodontic pain, (ii) toothache relief or treatment, (iii) the self-resolution of pain, and (iv) the promotion of home remedies usage. The statistical analysis was performed using Spearman's rank correlation coefficient, Mann-Whitney U test, hierarchical clustering analysis by Ward's minimum variance method, Kruskal-Wallis test, post-hoc Dunn's test and Chisquare test. P < 0.05 was considered statistically significant. RESULTS: The overall means (± SD) of DISCERN and FRE-BP were, respectively, 31.02 (± 5.56) and 61.20 (± 11.79), without quality-based differences between the websites with health- and non-health-related authors, and distinct clusters. CONCLUSION: Therefore, the quality of toothache-related information found in this sample of Brazilian websites was classified as simple, accessible and of poor quality, which can hamper the personal decision-making process of seeking dental treatment, leading to damages caused by the non-effective self-management of toothache.

Parental perspectives on early childhood caries: A qualitative study.

BACKGROUND: Early childhood caries (ECC) affects about 621 million children worldwide, causing chronic pain, infections, sleeping disorders, and tooth extraction. AIM: To determine perspectives of parents and caregivers of preschoolers regarding ECC. DESIGN: Three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were video- and audio-recorded, and the contents were transcribed verbatim. Then, textual passages were examined and coded using the software NVivo 12 Plus. RESULTS: The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience. CONCLUSIONS: Based on these results, parents and caregivers understand the unfavourable effects of ECC on children's quality of life; however, their attitudes against the disease seemed to be inaccurate, influenced by their daily routines, doubts, and beliefs.

Síndrome de insensibilidad androgénica. A propósito de un caso clínico / Androgenic insensitivity syndrome. About a clinical case

RESUMEN El síndrome de insensibilidad androgénica (SIA) es una de las anormalidades de la diferenciación sexual (desarrollo sexual diferente). Es un trastorno genético dependiente del cromosoma X, produce una alteración en el receptor de andrógenos, se asocia con testículos en las mujeres cuyo cariotipo es XY y con agenesia vaginal y uterina. Acuden a la consulta médica los padres con su hija recién nacida de 12 días de edad. Motivo de consulta: masa en la región inguinal derecha. Examen físico: signos vitales normales, activa al manejo, reactiva. Se observa una masa en la región inguinal derecha de aproximadamente 2 cm de diámetro, reductible, no dolorosa. Genitales externos femeninos: normales. La paciente es referida al Servicio de Cirugía para proceder a la corrección del defecto herniario. Se indica realizar un estudio citogenético y medir los niveles hormonales en sangre. Resultado del estudio anatomopatológico posquirúrgico, luego de 7 días de haber sido intervenida quirúrgicamente: "Tejido gonadal de tipo testicular con zonas de congestión vascular y hemorragia focal". Los niveles hormonales sanguíneos son normales; el cariotipo es normal masculino XY. Diagnóstico: debido a que el resultado del cariotipo es concluyente, se diagnostica síndrome de insensibilidad androgénica (SIA)" completo.Palabras claves: síndrome de insensibilidad androgénica, hernia inguinal, cariotipo

ABSTRACT Androgen insensitivity síndrome (AIS) is one of the causes of abnormalities in sexual differentiation (different sexual development). SIA is an X-linked genetic condition caused by an androgen receptor disorder, associated with vaginal and uterine agenesis, and the presence of testicles in women with an XY karyotype. Parents with 12-day-old neonates go to medical consultation. The reason for consultation is a mass in the right inguinal region. On physical examination: normal vital signs, active on management, reactive. A mass is observed at the level of the right inguinal region of approximately 2 cm in diameter, reducible and not painful. Female external genital with normal characteristics. The patient is referred for surgery to correct hernia defect. A cytogenetic study and blood hormone leves are indicated. Seven days after the intervention, parents came with the results of the postoperative pathological study: testicular gonadal tissue with áreas of vascular congestion and focal hemorrhage. Blood hormonal lever are normal and anormal XY male karyotype is seen. Diagnosis: the result of the karyotype is conclusive and a complete AIS is diagnosed.Keywords:androgen insensitivity syndrome, inguinal hernia, karyotype.

Are the Internet users concerned about molar incisor hypomineralization? An infoveillance study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental enamel defect characterized by well-demarcated discolorations frequently detected in molars, causing pain and esthetic alterations. AIM: To assess the interests of Google users on MIH-related information. DESIGN: Digital data were collected in Google Trends through two search strategies, 'molar incisor hypomineralization' (topic) and 'MIH' (search term), between January 2004 and November 2018. ARIMA models were applied to analyze trends of curves and to predict the activity of Google users during 12 months. Autocorrelation and partial autocorrelation (ACF/PACF) plots were used to detect trends in the variation of relative search volume (RSV) related to search strategies over time. The most popular queries were analyzed qualitatively, whereas geographical heat maps were retrieved to determine search volumes according to countries (P < .05). RESULTS: Gradual increasing trends were detected, with forecasts indicating similar levels of RSVs to the period between December 2017 and November 2018. Most popular queries and topics were associated with MIH diagnosis, being retrieved predominantly in European countries. CONCLUSIONS: The activity of Google users related to this condition is maintained low, with a reduced intensification over time, suggesting that the awareness on MIH is probably confined to dentists and affected people worldwide.

Levels of toothache-related interests of Google and YouTube users from developed and developing countries over time.

BACKGROUND: The preferences of Web users can be influenced by distinct factors of populations. Hence, hypothetically, source-based patterns of health-related Web searches might differ between individuals from developed and developing countries, due to their distinct educational, social, economic, political, cultural, and psychosocial backgrounds. In this context, this study aimed to determine the trends of toothache-related searches performed on Google Search and YouTube, regarding differences between developed and developing countries. METHODS: This retrospective longitudinal study analyzed computational metadata on toothache-related interests of Internet users. Google Trends was accessed to obtain the monthly variation of relative search volume (RSV) of the topic "Toothache-Disease" on Google (G) and YouTube (YT) through 2008-2017. Autocorrelation and partial autocorrelation plots, ARIMA models, Kruskal-Wallis, Dunn's and T tests were performed for evaluating trends, 12-month forecasts and the differences of annual ratios of YT/G searches between developed and developing countries, respectively (P < 0.05). RESULTS: Uptrends of RSVs were observed in both country groups over time, although 12-month forecasts tended to plateau.The volumes of searches were higher in developed countries in comparison to developing ones; however, this difference was not observed regarding Google searches performed between 2016 and 2017. Independently of country groups, the ratios YT/G remained relatively constant throughout the period, indicating a greater interest in toothache-related information available on Google. CONCLUSION: In conclusion, toothache-related searches from Google and YouTube increased during the last decade. The preferences of Web users seemed to be influenced by the differences between developed and developing countries, such as the availability and penetration of the Internet, and education levels.

The Effectiveness of Educational Mobile Messages for Assisting in the Prevention of Early Childhood Caries: Protocol for a Randomized Controlled Trial.

BACKGROUND: In 2017, approximately 3.7 billion downloads of health apps were made on mobile phones and tablets. In this sense, a massive number of people could benefit by electronic mobile-based health interventions, making information available even with the lack of material and human resources. Hence, the use of electronic apps for dental education might be extremely useful for the prevention of early childhood caries (ECC). OBJECTIVE: This study aims to evaluate the effectiveness of messages sent via mobile phones as an adjuvant method for the prevention of ECC. METHODS: A single-blinded, randomized, and parallel-group clinical trial will be conducted with dyads of parents or caregivers and children aged between 36 and 60 months, recruited from kindergartens and schools of Bauru, São Paulo. The determination of sample size resulted in a total of 104 dyads of parents and children, considering a power of 80%, a significance level of 5%, and an attrition of 30%. This sample will be randomly assigned to test and control groups, being divided in 52 dyads per group according to the health literacy levels of parents and the age, gender, and oral health status of children. Every 2 weeks, only participants in the test group will receive messages via WhatsApp containing preventive and education-related ECC information. The dyads will visit the dentist every 3 months during a year for the assessment of primary outcomes (sugar consumption and the International Caries Detection and Assessment System, visible plaque, and community periodontal indices) and to receive dental care measures. Secondary outcomes (electronic health literacy and general perceived self-efficacy) will be determined only at baseline and after 12-month follow-up. The quality of randomization will be evaluated throughout the study, comparing the test and control groups systematically by Student t tests for continuous variables and chi-square tests for categorical variables. Listwise deletion method will be applied in cases of dropouts, if the missing values satisfy the criteria of missing completely at random; otherwise, multiple imputation data strategy will be conducted. The Kolmogorov-Smirnov and Levene tests will be used to determine the normality and homogeneity of data, respectively, which will indicate further statistical analyses for elucidating significant differences between groups (P<.05). A Student t test or Mann-Whitney U test will be employed for parametric or nonparametric analyses, respectively. RESULTS: The project was funded in 2018, and enrollment was completed in August 2019. Allocation is currently under way and the first results are expected to be submitted for publication in 2020. CONCLUSIONS: The results will contribute to understanding the importance of educational mobile messages toward the adoption of healthy behaviors for the prevention of ECC in a given population. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials Universal Trial Number U1111-1216-1393; http://www.ensaiosclinicos.gov.br/rg/RBR-2b6r7q/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13656.

Digital behavior surveillance for monitoring the interests of Google users in amber necklace in different countries.

AIM: To determine the interests of Google users in information about amber necklace in distinct countries over time. DESIGN: This longitudinal retrospective study analyzed the amber necklace-related computational data generated from the activity of Google users from17 countries, by the application of Google Trends. Four search strategies were defined in English, Spanish, Portuguese, and Italian, for retrieving the monthly variation of relative search volume (RSV) between January 2004 and September 2018, including all categories and sources of search. Trends and 12-month predictive interests of users were analyzed by forecasting autoregressive integrated moving average models, while the influences of seasonality were evaluated by generalized additive models. The most popular queries employed for Google users were determined to qualitative analysis. P values < 0.05 were considered significant. RESULTS: In general, RSV curves were characterized by uptrends in most studied countries over the years, without the influence of monthly or quarterly seasonality. The queries were frequently associated with a desire for additional information, with respect to the definition, usability, and teething symptoms relief promoted by amber jewelries. CONCLUSIONS: These findings indicate an increasing interest of Google users in amber necklace-related topics in different countries.