Implications of the health information pollution for society, health professionals, and science

Abstract In the era of ultra-connectivity, the proliferation of speculative notions driven by personal emotions eclipses the credibility of scientific evidence. This trend has led to an alarming surge in information pollution, particularly by the pervasive influence of social media platforms. Consequently, this overflow of falsehoods poses a significant threat to public health and overall societal well-being. In this sense, this critical review aims to present the harmful impacts of the health information pollution on society, health professionals, and health science, as well as strategies for their mitigation. The management of information pollution requires coordinated efforts to develop and implement multiple effective preventive and debunking strategies, such as the regulation of big tech companies' actions and algorithm data transparency, the education of health professionals on responsible social media use, and the establishment of a novel academic culture, shifting from the valorization of productivism to socially relevant scientific production. By acknowledging the complexities of this contemporary issue and drawing insights from distinct perspectives, it is possible to safeguard the integrity of information dissemination and foster a more informed and resilient community.

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.

Consenso Abem para o ensino de comunicação nas escolas médicas brasileiras / ABEM consensus for the brazilian medical schools' communication curriculum

Resumo: Introdução: A comunicação é uma competência essencial para o(a) médico(a) e outras categorias profissionais, e deve ser desenvolvida durante sua formação profissional. A elaboração de um projeto de comunicação, incluindo um consenso brasileiro, visou subsidiar as escolas médicas a preparar os estudantes de Medicina para se comunicarem efetivamente com os(as) cidadãos/cidadãs brasileiros(as), de características plurais intra e inter-regionais, pautando-se no profissionalismo e nos princípios do Sistema Único de Saúde (SUS). Objetivo: Este manuscrito apresenta o consenso para o ensino de comunicação nas escolas médicas brasileiras. Método: O consenso foi construído colaborativamente com 276 participantes, experts em comunicação, docentes, profissionais de saúde e discentes, de 126 escolas médicas e cinco instituições de saúde, ao longo de nove encontros presenciais em congressos e de encontros virtuais quinzenais ou mensais. Nos encontros, compartilharam-se as experiências dos participantes e o material bibliográfico, incluindo os consensos internacionais, e apresentou-se o consenso em construção, com discussão em grupos para elencar novos componentes para o consenso brasileiro, seguida por debate com todos para pactuá-los. A versão final foi aprovada em reunião virtual, com convite a todos(as) os(as) participantes em julho de 2021. Após submissão, diversas alterações foram requeridas, o que demandou novos encontros para revisão da versão final do consenso. Resultado: O consenso tem como pressupostos que a comunicação deve ser centrada nas relações, pautada nos princípios do SUS, na participação social e no profissionalismo, e embasada nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina, em referenciais teóricos e nas evidências científicas. São descritos objetivos específicos para desenvolver a competência em comunicação nos estudantes, abrangendo: fundamentos teóricos; busca e avaliação crítica da literatura; elaboração e redação de documentos; comunicação intrapessoal e interpessoal no ambiente acadêmico-científico, na atenção à saúde em diversos contextos clínicos e na gestão em saúde. Recomenda-se a inserção curricular da comunicação do início ao final do curso, integrada a outros conteúdos e áreas de saber. Conclusão: Espera-se que esse consenso contribua para a revisão ou implementação da comunicação nos currículos das escolas médicas brasileiras.

Abstract: Introduction: Communication is an essential competence for the physician and other professional categories, and must be developed their professional training. The creation of a communication project including a Brazilian consensus aimed to subsidize medical schools in preparing medical students to communicate effectively with Brazilian citizens, with plural intra and inter-regional characteristics, based on the professionalism and the Brazilian Unified System (SUS) principles. Objective: The objective of this manuscript is to present the consensus for the teaching of communication in Brazilian medical schools. Method: The consensus was built collaboratively with 276 participants, experts in communication, faculty, health professionals and students from 126 medical schools and five health institutions in face-to-face conference meetings and biweekly or monthly virtual meetings. In the meetings, the participants' experiences and bibliographic material were shared, including international consensuses, and the consensus under construction was presented, with group discussion to list new components for the Brazilian consensus, followed by debate with everyone, to agree on them. The final version was approved in a virtual meeting with invitation to all participants in July 2021. After the submission, several changes were required, which demanded new meetings to review the consensus final version. Result: The consensus is based on assumptions that communication should be relationship-centered, embedded on professionalism, grounded on the SUS principles and social participation, and based on the National Guidelines for the undergraduate medical course, theoretical references and scientific evidence. Specific objectives to develop communication competence in the students are described, covering: theoretical foundations; literature search and its critical evaluation; documents drafting and editing; intrapersonal and interpersonal communication in the academicscientific environment, in health care and in health management; and, communication in diverse clinical contexts. The inclusion of communication in the curriculum is recommended from the beginning to the end of the course, integrated with other contents and areas of knowledge. Conclusion: It is expected that this consensus contributes the review or implementation of communication in Brazilian medical schools' curricula.

Perfil dos frequentadores e padrão de utilização das academias ao ar livre: revisão de escopo / Profile of users and usage pattern of outdoor gyms: scoping review

Com objetivo de identificar e sumarizar os dados de pesquisas que investigaram o perfil dos usuários das Academias ao Ar Livre (AAL) no Brasil, assim como o padrão de utilização destes espaços, em dezembro de 2020 foi realizada uma revisão de escopo, procurando por artigos observacionais, conduzidos no território brasileiro, que identificaram o perfil dos frequentadores e o padrão de utilização das AAL. Dos 16 artigos encontrados, que representam 10 distintos projetos, identificou-se que mulheres, pessoas na faixa etária entre 40 e 59 anos de idade, com ensino médio completo, casados/as e com sobrepeso representam o perfil mais comum de frequentadores das AAL no país. Complementarmente, a síntese também aponta que frequentadores utilizam as AAL há, pelo menos, 12 meses, com periodicidade de utilização de, pelo menos, três dias da semana, geralmente, nos dias úteis. Em conclusão, as AAL contribuem para a equidade ao acesso à atividade física. Entretanto, novos projetos são necessários, com utilização de abordagens mistas, para uma melhor compreensão das características que ao momento ainda são inconclusivas

In order to identify and summarize data from research which investigated the Profile of Outdoor Gyms (OG) users in Brazil, as well as the usage patterns of these spaces, in December 2020 a scoping review was developed, looking for observational studies, conducted in the Brazilian territory, which identified the users' profile and the usage pattern of OG. Of the 16 papers found, which represent 10 different studies, it was identified that women, people between 40 and 59 years of age, with complete secondary education, married and overweight represent the profile of the public who frequent OG in the country. Complementarily, the synthesis also points out that frequenters have been using OG for at least 12 months, with periodicity of use of at least three days a week, usually on working days. In conclusion, the OG contribute to equity of access to physical activity. However, new studies are needed, using mixed approaches, to better understand the characteristics that are still inconclusive at the moment

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.

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.

Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups. MATERIALS AND METHODS: Observational studies were retrieved by Cochrane, Embase Search, Portal BVS, Clinical Trials, Ovid, Open Gray, PubMed, Scopus, and Web of Science, and they were manually checked for the inclusion of additional articles of interest. The assessment of quality of studies was performed by the application of three different versions of the Newcastle-Ottawa Scale, for cohort, case-control, and cross-sectional studies. Only studies with low or unclear/moderate risk of bias contributed to meta-analyses, regarding the analysis of random effects of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures. RESULTS: Of 276 articles initially retrieved, 10 were included in the systematic review, while only 6 studies with unclear/moderate risk of bias were considered in meta-analyses. The mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls (1.20; 95% CI 0.27-2.14; P = 0.01). Additionally, a moderate positive correlation was observed between dental beliefs and dental fear measures (r = 0.54, 95% CI 0.47-0.60;P< 0.001). CONCLUSIONS: Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias. CLINICAL RELEVANCE: Dental fear and anxiety is an important obstacle for the access of dental treatment and patient-dentist relationship, leading to inadequate oral health levels.

Digital behavior surveillance: Monitoring dental caries and toothache interests of Google users from developing countries.

OBJECTIVE: To determine the differences between the levels of interest of South American Google users on information related to dental caries and toothache over time. MATERIALS AND METHODS: The monthly variation of Relative Search Volume (RSV) for both queries was obtained in Google Trends between 2004 and 2017. The association between RSVs, Internet penetration, and disability-adjusted life-years (DALYs) for dental caries in permanent teeth were tested by distinct regression models. Forecasting ARIMA models were developed to analyze trends and predict the interests until December 2018. RESULTS: In general, toothache-related searches presented an uptrend associated positively with Internet penetration and negatively with DALYs, whereas dental caries-related searches presented a downtrend associated negatively with Internet penetration and positively with DALYs. The seasonality affected only dental caries curves, with the highest rates observed in the first trimester and the lowest rates in June, July, and December. CONCLUSION: The levels of interests of South American Google users in seeking dental caries and toothache information appear to have a direct connection with the burden of untreated dental caries lesions and Internet penetration. The no association between dental caries- and toothache-related interests reinforces the unfamiliarity of most people about the relationship of dental pain with the final stages of chronic oral diseases.

The Brazilian validation of a health literacy instrument: the newest vital sign.

OBJECTIVE: This study aimed to perform the cross-cultural adaptation and validation of the NVS for Brazilian Portuguese. MATERIAL AND METHODS: Two hundred and fifty adults responded to the adapted version of the NVS, the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), ten questions of the National Functional Literacy Index (NFLI), and a questionnaire about demographic and oral health-related aspects. Statistical analysis determined the internal consistency, stability, difficulty of items, and convergent/discriminant/predictive validities of the NVS. p < .05 was considered significant. RESULTS: The NVS displayed a good internal consistency (Cronbach's alpha = 0.79) and a fair stability (ICC = 0.57; 0.39-0.70 95% CI). Seventy-two percent of participants answered the easier question (#5) correctly, whereas only 28.4% were successful in responding the most difficult question (#1). The convergent validity of the NVS was demonstrated by its significant correlation with the BREALD-30 (Rs = 0.601, p < .001) and NFLI (Rs = 0.544, p < .001). The observation of higher NVS scores among health professionals, white and more educated people confirmed the discriminant validity of the instrument. Moreover, health literacy was a significant predictor of self-reported oral health and reason for dental utilization. CONCLUSION: The NVS demonstrated adequate psychometric properties to be applied in Brazilian oral health epidemiological surveys.

What Can Google Inform Us about People's Interests regarding Dental Caries in Different Populations?

The diagnosis or suspicion of dental caries can lead people to seek additional information on the Internet through the use of structured queries in search engine tools. This action generates a considerable volume of data, which can be analyzed to provide a better understanding of the public's behavior linked to the consumption of oral health information. This study aimed to assess the volume and profile of web searches on dental caries-related queries performed by Google users from different countries. The monthly variation of the Search Volume Index (SVI) for dental caries was obtained in Google Trends for the period between January 2004 and September 2016. The validity of SVI data was assessed by their levels of stability and correlation with the disability-adjusted life-years (DALYs) for permanent teeth. In all countries, a trend of an increasing interest of Google users in dental caries issues was revealed by the comparison of the means observed in the predictive models and those in the last 12 months. The interest levels varied throughout the year, with the observation of the highest SVI values in the spring and the lowest in the summer. The most popular queries were markedly associated with symptoms and treatments, with a little interest in prevention. In conclusion, the use of Internet data mining could be helpful in establishing the dental needs of specific population groups in a near real-time, since the web consumption of dental information is increasing in importance and appears to have a direct relation with untreated dental caries.

Evaluating the Dental Caries-Related Information on Brazilian Websites: Qualitative Study.

BACKGROUND: Dental caries is the most common chronic oral disease, affecting 2.4 billion people worldwide who on average have 2.11 decayed, missing, or filled teeth. It impacts the quality of life of patients, socially and economically. However, the comprehension of dental caries may be difficult for most people, as it involves a multifactorial etiology with the interplay between the tooth surface, the dental biofilm, dietary fermentable carbohydrates, and genetic and behavioral factors. Therefore, the production of effective materials addressed to the education and counseling of patients for the prevention of dental caries requires a high level of specialization. In this regard, the dental caries-related contents produced by laypersons and their availability on the Internet may be low-quality information. OBJECTIVE: The aim of this study was to assess the readability and the quality of dental caries-related information on Brazilian websites. METHODS: A total of 75 websites were selected through Google, Bing, Yahoo!, and Baidu. The websites were organized in rankings according to their order of appearance in each one of the 4 search engines. Furthermore, 2 independent examiners evaluated the quality of websites using the DISCERN questionnaire and the Journal of American Medical Association (JAMA) benchmark criteria. The readability of the websites was assessed by the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). In addition, the information presented on the websites was categorized as etiology, prevention, and treatment of dental caries. The statistical analysis was performed using Spearman rank correlation coefficient, Mann-Whitney U test, hierarchical clustering analysis by Ward minimum variance method, Kruskal-Wallis test, and post hoc Dunn test. P<.05 was considered significant. RESULTS: The Web contents were considered to be of poor quality by DISCERN (mean 33.48, standard deviation, SD 9.06) and JAMA (mean 1.12, SD 0.97) scores, presenting easy reading levels (FRE-BP: mean 62.93, SD 10.15). The rankings of the websites presented by Google (ρ=-.22, P=.08), Baidu (ρ=-.19, P=.53), Yahoo! (ρ=.22, P=.39), and Bing (ρ=-.36, P=.23) were not correlated with DISCERN scores. Moreover, the quality of websites with health- and nonhealth-related authors was similar (P=.27 for DISCERN and P=.47 for JAMA); however, the pages with a greater variety of dental caries information showed significantly higher quality scores than those with limited contents (P=.009). CONCLUSIONS: On the basis of this sample, dental caries-related contents available on Brazilian websites were considered simple, accessible, and of poor quality, independent of their authorship. These findings indicate the need for the development of specific policies focused on the stimulus for the production and publication of Web health information, encouraging dentists to guide their patients in searching for recommended oral health websites.

Analysis of the interests of Google users on toothache information.

BACKGROUND: The knowledge on health interests of a given population of Internet users might contribute to the increase of evidence on community's dental needs, and consequently, to the improvement of public health planning. The frequency of searches for specific issues on Google can be analyzed by the application of Google Trends. AIM: In this study, we aimed to characterize the interests on toothache information of Google users from the United States, United Kingdom, Australia and Brazil. METHODS: The monthly variation of relative search volume (RSV) and the lists of main toothache-related queries were determined from January 2004 through April 2016 using Google Trends. Autoregressive Integrated Moving Average (ARIMA) forecasting models were developed to determine predictive RSV values for toothache for additional 12 months. Autocorrelation plots and general additive model (GAM) were applied to determine trends and seasonality in RSV curves. Through linear regression models, we assessed the association between the variation of annual means of RSV values and national statistics for toothache in the U.S. and U.K. Subsequently, the distribution of main queries according to the identification of endodontic pain, type of searching information, and the interest in self-management of toothache was evaluated for the four countries. RESULTS: The autocorrelation plots showed patterns of non-stationary time series. The monthly variation influenced the data of the U.S. and U.K., with the higher RSV values found respectively in January/July and December. Also, the interest on toothache in the U.K. increases in the second semester and in the fourth quarter, especially in December. Additionally, an annual variation affected significantly all time series, with the increment of RSV means over the years, varying from 265% in the U.S. to 745% in Brazil. In parallel, the increments in RSV values were also observed in all predictive curves. The annual variation of observed and fitted RSV values was directly associated with the increase of toothache visits in the U.S. and urgent dental treatments in the U.K. Moreover, the queries typed on Google were markedly linked to searches on endodontic pain information, especially in Brazil, where the residents usually searched for relief and/or self-management of pain. CONCLUSIONS: Therefore, these findings indicate an increasing interest of Google users on toothache-related topics, regardless of country and season. The Internet activity can be used by policy makers as a complementary source of data for the development and implementation of strategies to control and prevent toothache complications.

The Brazilian version of the 20-item rapid estimate of adult literacy in medicine and dentistry.

BACKGROUND: The misunderstanding of specific vocabulary may hamper the patient-health provider communication. The 20-item Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD-20) was constructed to screen patients by their ability in reading medical/dental terminologies in a simple and rapid way. This study aimed to perform the cross-cultural adaptation and validation of this instrument for its application in Brazilian dental patients. METHODS: The cross-cultural adaptation was performed through conceptual equivalence, verbatim translation, semantic, item and operational equivalence, and back-translation. After that, 200 participants responded the adapted version of the REALMD-20, the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), ten questions of the Brazilian National Functional Literacy Index (BNFLI), and a questionnaire with socio-demographic and oral health-related questions. Statistical analysis was conducted to assess the reliability and validity of the REALMD-20 (P < 0.05). RESULTS: The sample was composed predominantly by women (55.5%) and white/brown (76%) individuals, with an average age of 39.02 years old (±15.28). The average REALMD-20 score was 17.48 (±2.59, range 8-20). It displayed a good internal consistency (Cronbach's alpha = 0.789) and test-retest reliability (ICC = 0.73; 95% CI [0.66 - 0.79]). In the exploratory factor analysis, six factors were extracted according to Kaiser's criterion. The factor I (eigenvalue = 4.53) comprised four terms- "Jaundice", "Amalgam", "Periodontitis" and "Abscess"-accounted for 25.18% of total variance, while the factor II (eigenvalue = 1.88) comprised other four terms-"Gingivitis", "Instruction", "Osteoporosis" and "Constipation"-accounted for 10.46% of total variance. The first four factors accounted for 52.1% of total variance. The REALMD-20 was positively correlated with the BREALD-30 (Rs = 0.73, P < 0.001) and BNFLI (Rs = 0.60, P < 0.001). The scores were significantly higher among health professionals, more educated people, and individuals who reported good/excellent oral health conditions, and who sought preventive dental services. Distinctly, REALMD-20 scores were similar between both participants who visited a dentist <1 year ago and ≥1 year. Also, REALMD-20 was a significant predictor of self-reported oral health status in a multivariate logistic regression model, considering socio-demographic and oral health-related confounding variables. CONCLUSION: The Brazilian version of the REALMD-20 demonstrated adequate psychometric properties for screening dental patients in relation to their recognition of health specific terms. This instrument can contribute to identify individuals with important dental/medical vocabulary limitations in order to improve the health education and outcomes in a person-centered care model.

Relação entre tempo de aleitamento materno, hábitos bucais deletérios e cárie dentária em bebês / The relationship between breastfeeding duration, deleterious oral habits, and dental caries in babies

A associação entre amamentação materna e cárie dentária é controversa. O presente estudo avaliou a experiência de cárie dentária entre bebês exclusivamente amamentados pelo seio materno ou pelo uso complementar de métodos artificiais auxiliares. Dados demográficos, valores do índice ceod, tempo de aleitamento materno e diagnóstico de hábitos bucais deletérios de sucção foram coletados dos prontuários clínicos-odontológicos de 299 bebês. Valores de P < 0,05 foram considerados para diferenças estatisticamente significantes. Os resultados demonstraram um significativo aumento da experiência de cárie dentária entre os bebês amamentados exclusivamente pelo seio materno. A média do tempo de aleitamento materno foi maior entre bebês com diagnóstico de cárie precoce da infância (CPI) (14,7±8,7 meses) quando comparado com bebês sem diagnóstico de CPI (8,3±6,8 meses) (P<0,001). Entretanto, bebês que desenvolveram hábitos bucais deletérios foram amamentados por menos tempo. O aleitamento materno deve ser estimulado, pois é capaz de prevenir infecções, mortalidade infantil, respiração bucal e hábitos bucais deletérios, além de favorecer o estabelecimento do vínculo emocional entre mãe e flho. Entretanto, o maior risco de lesões de cárie dentária deve determinar atenção especial da equipe de saúde da família em relação à manutenção das condições adequadas da saúde bucal dos bebês

The association between breastfeeding and dental caries is controversial. This study aimed to evaluate the experience of dental caries among exclusively breastfed infants and non-exclusively breastfed infants. Demographic data, dmft index scores, breastfeeding duration, and diagnosis of deleterious oral sucking habits were collected from 299 patient records of the Clinic of Babies of Cuiabá School of Dentistry. Statistical differences were considered to be signifcant with P values < 0.05. The results demonstrated a signifcant increase of experience of dental caries among exclusively breastfed infants. The mean of breastfeeding duration in infants with early childhood caries (ECC) diagnosis (14,7±8,7 months) was higher than those infants without ECC diagnosis (8,3±6,8 months) (P<0,001). The breastfeeding needs to be continuously estimulated because it prevents infections, infant mortality, oral breathing, deleterious oral sucking habits, besides favoring the maternal bonding. Higher risks of dental caries lesions among infants breastfed for longer, however, must lead family health teams to a special focus on the maintenance of good conditions of infants' oral health