Associations of religiosity and spiritual well-being with appearance concerns after head and neck cancer surgery.

OBJECTIVE: To investigate whether religiosity and spiritual well-being are associated with appearance concerns among people with visible sequelae due to cancer surgery in the head and neck region. METHODS: A cross-sectional study was carried in 202 adult patients in a referral hospital for cancer treatment in Midwest Brazil. Data on sociodemographic, psychosocial and clinical aspects and cancer-related behaviours were collected through interviews, clinical examination and medical records. The outcome was the patients' appearance concerns (Derriford Appearance Scale-DAS24). The independent explanatory variables were religiosity (Duke University Religiousness Index-DUREL) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-FACIT-Sp12). Data were analysed using Pearson's chi-square and Poisson regression. RESULTS: Most of the participants were male (76.2%), and mean age was 58.6 years (SD = 11.6). The scores of appearance concerns (DAS24) ranged from 21 to 75 (median = 33.0). In the bivariate analysis, appearance concerns were associated with spiritual well-being (FACIT-Sp12), degree of disfigurement and treatment with radiotherapy/chemotherapy. Religiosity (DUREL) was not associated with the outcome. In the adjusted regression model, a lower prevalence of appearance concerns was found among patients with higher levels of spiritual well-being (PR = 0.86; CI = 0.79-0.94), males (PR = 0.87; CI = 0.79-0.95), those with lower degrees of disfigurement (PR = 0.89; CI = 0.82-0.98) and those who had no treatment with radiotherapy/chemotherapy (PR = 0.83; CI = 0.72-0.94). CONCLUSION: High spiritual well-being was independently associated with lower levels of appearance concerns in people with visible sequelae due to cancer surgery in the head and neck region. Understanding the role of this psychosocial determinant may help in the coping process.

Six-year trends in dental pain and maternal education inequalities among Brazilian adolescents.

OBJECTIVE: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. METHODS: Data from the National Adolescent School-Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11-17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9-11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao-Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). RESULTS: The prevalence of dental pain increased from 17.5% (95% CI = 16.9-18.2) in 2009 to 20.4% (95% CI = 19.7-21.1) in 2012, then to 21.8% (95% CI = 21.1-22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. CONCLUSIONS: The prevalence of dental pain increased in the 2009-2012 and 2012-2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies.

Individual and contextual determinants of dental pain in adolescents: Evidence from a national survey.

OBJECTIVE: To investigate the prevalence of dental pain among adolescent students and its association with individual, school and city variables, using a multilevel approach. SUBJECTS AND METHODS: Individual and school data were obtained from the National Adolescent School-Based Health Survey (PeNSE) conducted in Brazil in 2015 in a sample of 34,776 students from 1,339 schools in the 27 Brazilian capital cities. Secondary data on socioeconomic, structural and health indicators of the cities were obtained from public databases. The outcome was the prevalence of dental pain in the last six months (yes/no). Independent variables, consisting of potential social and behavioural determinants of dental pain, were structured in three levels: individual, school and city. Multilevel logistic regression was performed. RESULTS: Prevalence of dental pain was 21.8% (95% CI = 21.0-22.7). Unadjusted analysis showed significant associations between the outcome and most of the factors in the individual and in the contextual levels. In the final adjusted model, adolescents who reported unfavourable health-related behaviours, adverse socioeconomic or psychosocial characteristics, as well as those attending public schools and living in cities with high caries prevalence (DMFT) at age 12, were more likely to report dental pain. CONCLUSIONS: Prevalence of dental pain was high and associated with adverse individual and contextual factors in the school and city levels.

Relationship between rates of attending religious services and oral health in Brazilian adolescents.

OBJECTIVES: To determine whether there is a relationship between rates of attending religious services and oral health and oral health-related behaviors in Brazilian adolescents. METHODS: A cross-sectional study was carried out using clinical examinations and self-applied questionnaires. Sample was 664 15-year-old schoolchildren from public and private schools in the city of Goiânia-GO, Middle-West Brazil. Dependent variables were dental caries (DMFT and DMFS), periodontal condition (Plaque Index and bleeding on probing), perceived importance given to the care of the teeth and oral health-related behaviors (sugar consumption, oral hygiene and pattern of dental attendance). Independent explanatory variable was frequency of attending religious services. Poisson log-linear regressions were used for statistical analysis of the data. RESULTS: Oral health status was not associated with attending religious services. Attending religious services was positively associated with oral health behaviors such as pattern of dental attendance for dental checkups and to the importance given to the care of the teeth. These associations remained statistically significant after controlling for sex and social class (P < 0.05). CONCLUSIONS: Adolescents' frequency of attending religious services is not associated with their oral health status but is positively related to pattern of dental attendance and perceived importance of care of their teeth.

Cárie dentária em escolares de Goiânia no período de 1988 a 2010: tendência e desigualdades / Dental caries in schoolchildren from Goiânia in the period 1988-2010: trends and inequalities

A vigilância epidemiológica da saúde bucal no nível municipal pode fornecer informações úteis para as políticas locais e elucidar questões mais específicas sobre as desigualdades em saúde no país que, por razões operacionais, não podem ser incluídas em levantamentos nacionais. Objetivo: Descrever a tendência da prevalência e gravidade da cárie em escolares de 12 anos da rede pública de Goiânia no período de 1988 a 2010 e conhecer a distribuição da doença nos Distritos Sanitários (DS) do município. Material e método: Foram utilizados dados de estudos transversais realizados no período analisado. Para análise de tendência da prevalência de cárie, utilizou-se o coeficiente de correlação de Spearman. Comparações entre os DS foram feitas entre os anos de 1994 e 2010. Resultados: o CPOD médio diminuiu 78,5% no período analisado, de 8,26 em 1988 para 1,78 em 2010 (r = -1,0; p ? 0,01) e houve queda de 86,8% na média do componente cariado, 73,3% do perdido e 41,7% do obturado. Houve também aumento de 86,8% no número de escolares livres de cárie de 1994 a 2010 (r = 1,0; p ? 0,01). Escolares das instituições localizadas nos DS com piores indicadores socioeconômicos apresentaram maior prevalência de cárie e menor percentual de redução em comparação com aqueles com melhores indicadores. Conclusão: Houve declínio da prevalência de cárie em Goiânia de 1988 a 2010 e desigualdades na distribuição da doença entre os DS do município, que refletem a condição socioeconômica dos mesmos.

Epidemiological surveillance of oral health at the municipal level may provide useful information for local public policies and elucidate more specific questions about health inequalities in the country that, for operational reasons, cannot be included in national surveys. Objective: To describe trends in the prevalence and severity of dental caries in 12 year-old children attending public schools in Goiânia from 1988 to 2010 and to assess the distribution of the disease according to the county Health Districts (HD). Material and Method: Data from cross-sectional studies carried out in the investigated period were analysed. Spearman correlation coefficient was used for the analysis of caries prevalence tendency. Comparisons among the HD were carried out in 1994 and 2010. Results: The DMFT decreased 78.5% in the analyzed period, from 8.26 in 1988 to 1.78 in 2010 (r= -1.0; p ? 0.01) and there was a 86.8% reduction in the average number of decayed teeth, 73.3% of missing and 41.7% of filled teeth. There was also an increase of 86.8% in the number of caries-free schoolchildren from 1994 to 2010 (r = 1.0; p ? 0.01). Schoolchildren from institutions located in the HD with the worst socioeconomic indicators had higher caries prevalence and lower reductions compared with those attending schools located in HD with better indicators. Conclusion: There was a decline in dental caries prevalence in Goiânia from 1988 to 2010 and inequalities in the distribution of the disease among the county districts, as a reflex of their socioeconomic conditions.