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.

Unveiling deception: Characterizing false amber necklace messages on Facebook

BACKGROUND

Messages promoting the benefits of amber necklaces for children are common on social media, despite their health risks.

AIM

This study characterized Facebook posts with false content about the efficacy of amber necklaces in teething.

DESIGN

A sample of 500 English-language Facebook posts was analyzed by two investigators to determine the motivations, author's profile, and sentiments of posts. Latent Dirichlet Allocation topic modeling was used to identify salient terms and topics. An intertopic distance map was created to calculate the topic similarity. These data were analyzed using descriptive analysis, the Mann-Whitney U test, Cramer's V test, and multiple logistic regression models, regarding the time since initial posting and interaction metrics.

RESULTS

Most posts were made by business profiles and expressed positive sentiments, with social, psychological, and financial motivations. The posts were categorized into the topics "giveaway," "healing features," and "sales." Overperforming scores and total interaction increased with time since the initial posting. Posts with links had higher overperforming scores.

CONCLUSION

The findings suggest that Facebook posts about the efficacy of amber necklaces in teething are motivated by financial interests, using psychological and social mechanisms to achieve greater interaction with their target audience.

Uncovering a pseudoscience: an analysis of 'biological dentistry' Instagram posts

OBJECTIVE

This infodemiology study aimed to analyze characteristics of English-language Instagram posts on 'Biological Dentistry'.

MATERIALS AND METHODS

Using CrowdTangle, we analyzed 500 'Biological Dentistry' posts published on Instagram from May 2017 to May 2022. Two researchers assessed each post for facticity, motivation, author's profile, sentiment, and interaction metrics. Statistical analysis was employed to compare interaction metrics between dichotomized categories of posts' characteristics and determine predictors of misinformation and user engagement.

RESULTS

Over half of the posts (58.4%) were from health-related authors, and a considerable number contained misinformation (68.2%) or were financially motivated (52%). Sentiment was mostly negative or neutral (59.8%). Misinformation was associated with financial motivation (OR = 2.12) and health-related authors (OR = 5.56), while non-health-related authors' posts associated with higher engagement (OR = 1.98). Reliable content, non-health-related authorship, and positive sentiment were associated with increased user interaction.

CONCLUSION

Misinformation about 'Biological Dentistry' on Instagram is mainly spread by financially incentivized health-related authors. Yet, non-health-related authors' posts resonate more with audiences, highlighting a nuanced relationship between content facticity, authorship, and engagement.

Untangling the truth: User engagement with misinformation in toothache-related Facebook posts

OBJECTIVE

Social media is a platform for sharing views on aspects of life, including oral health. This study aimed to characterize Facebook posts related to toothache information.

METHODS

Two independent investigators retrieved 500 English-language posts with the highest level of interaction using CrowdTangleTM and analyzed their facticity, motivation, author's profile, content, sentiment, and type of post. Data were analysed descriptively and using Pearson's Chi-square and Mann-Whitney U tests and multiple logistic regression models.

RESULTS

Most posts were produced by regular users and were not financially motivated, although commercial posts had significantly higher total interaction among users. While link- or video-containing posts (OR = 1.66) and posts with positive sentiments (OR = 1.53) were associated with users' total interaction, older (OR = 1.81) and link- or video-containing posts (OR = 2.04) were associated with overperforming scores. Misinformation was positively associated with financial motivation (OR = 2.03) and positive sentiments (OR = 3.79).

CONCLUSION

This study highlights the importance of addressing the spread of misinformation related to oral health on social media and taking steps to ensure that accurate and reliable information is readily available. Toothache-related misinformation was associated with positive sentiments and financial motivation. Links, videos, and positive sentiments awakened greater user engagements with toothache-related posts.

What is the impact of artificial intelligence-based chatbots on infodemic management?

Artificial intelligence (AI) chatbots have the potential to revolutionize online health information-seeking behavior by delivering up-to-date information on a wide range of health topics. They generate personalized responses to user queries through their ability to process extensive amounts of text, analyze trends, and generate natural language responses. Chatbots can manage infodemic by debunking online health misinformation on a large scale. Nevertheless, system accuracy remains technically challenging. Chatbots require training on diverse and representative datasets, security to protect against malicious actors, and updates to keep up-to-date on scientific progress. Therefore, although AI chatbots hold significant potential in assisting infodemic management, it is essential to approach their outputs with caution due to their current limitations.

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.

Decoding early childhood caries: an in-depth analysis of YouTube videos for effective parental education

PURPOSE

To assess the coverage of information about early childhood caries (ECC) available on YouTube videos in three different languages, regarding technical characteristics of videos and interaction metrics.

METHODS

Search strategies were developed in English, Spanish, and Portuguese to make a comprehensive collection of videos from YouTube, encompassing 60 samples for each language, regarding all video types. The videos were assessed by a thematic checklist regarding 17 items on ECC. Videos were dichotomized according to the median of the thematic score and the nature of their authorship (health and non-health authors) to compare groups. The statistical analysis was performed using the Statistical Package for Social Science (version 25.0), applying Spearman's rank correlation coefficient and Mann-Whitney U test. P < 0.05 values were considered significant.

RESULTS

Among 120 videos meeting inclusion criteria, ECC aetiology and prevention information proved incomplete, with a median score of 5 (Q1-Q3 = 3-7). No correlation emerged between this score and other video characteristics. However, interaction metrics like views, likes, dislikes, and viewing rates displayed significant correlations. Health authors primarily created these videos, yet non-health author channels had more subscribers. Surprisingly, videos focused on the impact of regular sugary food and beverage consumption on ECC progression received the most attention.

CONCLUSIONS

Videos that presented information about the aetiology and prevention of ECC invariably focused on partial aspects of the disease. This highlights the need for better-quality educational videos and the importance of dental professionals in guiding patients toward reliable sources of information.

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.

Can heart rate variability data from the Apple Watch electrocardiogram quantify stress?

Chronic stress has become an epidemic with negative health risks including cardiovascular disease, hypertension, and diabetes. Traditional methods of stress measurement and monitoring typically relies on self-reporting. However, wearable smart technologies offer a novel strategy to continuously and non-invasively collect objective health data in the real-world. A novel electrocardiogram (ECG) feature has recently been introduced to the Apple Watch device. Interestingly, ECG data can be used to derive Heart Rate Variability (HRV) features commonly used in the identification of stress, suggesting that the Apple Watch ECG app could potentially be utilized as a simple, cost-effective, and minimally invasive tool to monitor individual stress levels. Here we collected ECG data using the Apple Watch from 36 health participants during their daily routines. Heart rate variability (HRV) features from the ECG were extracted and analyzed against self-reported stress questionnaires based on the DASS-21 questionnaire and a single-item LIKERT-type scale. Repeated measures ANOVA tests did not find any statistical significance. Spearman correlation found very weak correlations (p < 0.05) between several HRV features and each questionnaire. The results indicate that the Apple Watch ECG cannot be used for quantifying stress with traditional statistical methods, although future directions of research (e.g., use of additional parameters and Machine Learning) could potentially improve stress quantification with the device.

Analysis of Fluoride-Free Content on Twitter: Topic Modeling Study

BACKGROUND

Although social media has the potential to spread misinformation, it can also be a valuable tool for elucidating the social factors that contribute to the onset of negative beliefs. As a result, data mining has become a widely used technique in infodemiology and infoveillance research to combat misinformation effects. On the other hand, there is a lack of studies that specifically aim to investigate misinformation about fluoride on Twitter. Web-based individual concerns on the side effects of fluoridated oral care products and tap water stimulate the emergence and propagation of convictions that boost antifluoridation activism. In this sense, a previous content analysis-driven study demonstrated that the term fluoride-free was frequently associated with antifluoridation interests.

OBJECTIVE

This study aimed to analyze "fluoride-free" tweets regarding their topics and frequency of publication over time.

METHODS

A total of 21,169 tweets published in English between May 2016 and May 2022 that included the keyword "fluoride-free" were retrieved by the Twitter application programming interface. Latent Dirichlet allocation (LDA) topic modeling was applied to identify the salient terms and topics. The similarity between topics was calculated through an intertopic distance map. Moreover, an investigator manually assessed a sample of tweets depicting each of the most representative word groups that determined specific issues. Lastly, additional data visualization was performed regarding the total count of each topic of fluoride-free record and its relevance over time, using Elastic Stack software.

RESULTS

We identified 3 issues by applying the LDA topic modeling: "healthy lifestyle" (topic 1), "consumption of natural/organic oral care products" (topic 2), and "recommendations for using fluoride-free products/measures" (topic 3). Topic 1 was related to users' concerns about leading a healthier lifestyle and the potential impacts of fluoride consumption, including its hypothetical toxicity. Complementarily, topic 2 was associated with users' personal interests and perceptions of consuming natural and organic fluoride-free oral care products, whereas topic 3 was linked to users' recommendations for using fluoride-free products (eg, switching from fluoridated toothpaste to fluoride-free alternatives) and measures (eg, consuming unfluoridated bottled water instead of fluoridated tap water), comprising the propaganda of dental products. Additionally, the count of tweets on fluoride-free content decreased between 2016 and 2019 but increased again from 2020 onward.

CONCLUSIONS

Public concerns toward a healthy lifestyle, including the adoption of natural and organic cosmetics, seem to be the main motivation of the recent increase of "fluoride-free" tweets, which can be boosted by the propagation of fluoride falsehoods on the web. Therefore, public health authorities, health professionals, and legislators should be aware of the spread of fluoride-free content on social media to create and implement strategies against their potential health damage for the population.

Tweeting for Health Using Real-time Mining and Artificial Intelligence-Based Analytics: Design and Development of a Big Data Ecosystem for Detecting and Analyzing Misinformation on Twitter

BACKGROUND

Digital misinformation, primarily on social media, has led to harmful and costly beliefs in the general population. Notably, these beliefs have resulted in public health crises to the detriment of governments worldwide and their citizens. However, public health officials need access to a comprehensive system capable of mining and analyzing large volumes of social media data in real time.

OBJECTIVE

This study aimed to design and develop a big data pipeline and ecosystem (UbiLab Misinformation Analysis System [U-MAS]) to identify and analyze false or misleading information disseminated via social media on a certain topic or set of related topics.

METHODS

U-MAS is a platform-independent ecosystem developed in Python that leverages the Twitter V2 application programming interface and the Elastic Stack. The U-MAS expert system has 5 major components: data extraction framework, latent Dirichlet allocation (LDA) topic model, sentiment analyzer, misinformation classification model, and Elastic Cloud deployment (indexing of data and visualizations). The data extraction framework queries the data through the Twitter V2 application programming interface, with queries identified by public health experts. The LDA topic model, sentiment analyzer, and misinformation classification model are independently trained using a small, expert-validated subset of the extracted data. These models are then incorporated into U-MAS to analyze and classify the remaining data. Finally, the analyzed data are loaded into an index in the Elastic Cloud deployment and can then be presented on dashboards with advanced visualizations and analytics pertinent to infodemiology and infoveillance analysis.

RESULTS

U-MAS performed efficiently and accurately. Independent investigators have successfully used the system to extract significant insights into a fluoride-related health misinformation use case (2016 to 2021). The system is currently used for a vaccine hesitancy use case (2007 to 2022) and a heat wave-related illnesses use case (2011 to 2022). Each component in the system for the fluoride misinformation use case performed as expected. The data extraction framework handles large amounts of data within short periods. The LDA topic models achieved relatively high coherence values (0.54), and the predicted topics were accurate and befitting to the data. The sentiment analyzer performed at a correlation coefficient of 0.72 but could be improved in further iterations. The misinformation classifier attained a satisfactory correlation coefficient of 0.82 against expert-validated data. Moreover, the output dashboard and analytics hosted on the Elastic Cloud deployment are intuitive for researchers without a technical background and comprehensive in their visualization and analytics capabilities. In fact, the investigators of the fluoride misinformation use case have successfully used the system to extract interesting and important insights into public health, which have been published separately.

CONCLUSIONS

The novel U-MAS pipeline has the potential to detect and analyze misleading information related to a particular topic or set of related topics.

Exploring online oral health misinformation: a content analysis

Considering the unfavorable implications of health falsehoods and the lack of dental research into information disorder, this study aimed to identify and characterize online oral health misinformation. A total of 410 websites published in English were retrieved using Google Advanced Search and screened by two independent investigators to compile falsehoods through thematic content analysis. Afterward, 318 pieces of misinformation were consensually divided into four groups concerning their informational interest (G1), financial, psychological, and social interests produced/disseminated by non-dental professionals (G2) or by dental professionals (G3), and political interests (G4). Social media (Facebook and Instagram) and fact-checking tool (Snopes) were also screened to determine the spread of falsehoods by identifying corresponding posts and warnings. As a result, misinformation was mainly associated with gum diseases (12.0%), root canal treatment (11.6%), toothache (10.4%), fluoride (10.4%), and dental caries (9.8%), with a special highlight on recommendations for the usage of natural products, toxicity concerns, and anti-fluoridation propaganda. Additionally, most misinformation was allocated in G3 (41.9%), which presented a statistically higher frequency of financial interests than G4. Finally, falsehoods were considerably identified on Facebook (62.9%) and Instagram (49.4%), especially G3 and G4. Nevertheless, Snopes has debunked only 5.9% of these content items. Therefore, misinformation was predominantly produced or disseminated by dental professionals mainly motivated by financial interests and usually linked to alternative/natural treatments. Although these items were shared on social media, fact-checking agencies seemed to have limited knowledge about their dissemination.

Reacting, Sharing, and Commenting: How Many Facebook Users Are Engaging with Posts Related to Dental Caries That Contain Misinformation?

Recent studies have been concerned about the vast amount of misinformation detected on social media that directly hampers the prevention and control of chronic diseases. Based on these facts, the aim of this study was to identify and characterize misinformation about dental caries-related content found on Facebook, regarding the predictive factors of user interaction with posts. Then, CrowdTangle retrieved 2,436 posts published in English, ordered by the total interaction of the highest users. A total of 1,936 posts were selected for inclusion and exclusion criteria to select a sample of 500 posts. Subsequently, two independent investigators characterized the posts by their time of publication, author's profile, motivation, the aim of content, content facticity, and sentiment. The statistical analysis was performed using Mann-Whitney U and χ2 tests and multiple logistic regression models to determine differences and associations between dichotomized characteristics. p values <0.05 were considered significant. In general, posts were predominantly originated from the USA (74.8%), related to business profiles (89%), presented preventive content (58.6%), and noncommercial motivation (91.6%). Furthermore, misinformation was detected in 40.8% of the posts and was positively associated with positive sentiment (OR = 3.43), business profile (OR = 2.22), and treatment of dental caries (OR = 1.60). While the total interaction was only positively associated with misinformation (OR = 1.44), the overperforming score was associated with posts from the business profile (OR = 5.67), older publications (OR = 1.57), and positive sentiment (OR = 0.66). In conclusion, misinformation was the unique predictive factor of increased user interaction with dental caries-related posts on Facebook. However, it did not predict the performance of the diffusion of posts such as business profiles, older publications, and negative/neutral sentiment. Therefore, it is essential to promote the development of specific policies toward good quality information on social media, which includes the production of adequate materials, the increase of the critical sense of consuming health content, and information filtering mediated by digital solutions.

Ethical principles for infodemiology and infoveillance studies concerning infodemic management on social media

Big data originating from user interactions on social media play an essential role in infodemiology and infoveillance outcomes, supporting the planning and implementation of public health actions. Notably, the extrapolation of these data requires an awareness of different ethical elements. Previous studies have investigated and discussed the adoption of conventional ethical approaches in the contemporary public health digital surveillance space. However, there is a lack of specific ethical guidelines to orient infodemiology and infoveillance studies concerning infodemic on social media, making it challenging to design digital strategies to combat this phenomenon. Hence, it is necessary to explore if traditional ethical pillars can support digital purposes or whether new ones must be proposed since we are confronted with a complex online misinformation scenario. Therefore, this perspective provides an overview of the current scenario of ethics-related issues of infodemiology and infoveillance on social media for infodemic studies.

Psychophysiological reactions of Internet users exposed to fluoride information and disinformation: Protocol for a randomized controlled trial (Preprint)

Background

False messages on the internet continually propagate possible adverse effects of fluoridated oral care products and water, despite their essential role in preventing and controlling dental caries.

Objective

This study aims to evaluate the patterns of psychophysiological reactions of adults after the consumption of internet-based fluoride-related information and disinformation.

Methods

A 2-armed, single-blinded, parallel, and randomized controlled trial will be conducted with 58 parents or caregivers of children who attend the Clinics of Pediatric Dentistry at the Bauru School of Dentistry, considering an attrition of 10% and a significance level of 5%. The participants will be randomized into test and intervention groups, being respectively exposed to fluoride-related information and disinformation presented on a computer with simultaneous monitoring of their psychophysiological reactions, including analysis of their heart rates (HRs) and 7 facial features (mouth outer, mouth corner, eye area, eyebrow activity, face area, face motion, and facial center of mass). Then, participants will respond to questions about the utility and truthfulness of content, their emotional state after the experiment, eHealth literacy, oral health knowledge, and socioeconomic characteristics. The Shapiro-Wilk and Levene tests will be used to determine the normality and homogeneity of the data, which could lead to further statistical analyses for elucidating significant differences between groups, using parametric (Student t test) or nonparametric (Mann-Whitney U test) analyses. Moreover, multiple logistic regression models will be developed to evaluate the association of distinct variables with the psychophysiological aspects. Only factors with significant Wald statistics in the simple analysis will be included in the multiple models (P<.2). Furthermore, receiver operating characteristic curve analysis will be performed to determine the accuracy of the remote HR with respect to the measured HR. For all analyses, P<.05 will be considered significant.

Results

From June 2022, parents and caregivers who frequent the Clinics of Pediatric Dentistry at the Bauru School of Dentistry will be invited to participate in the study and will be randomized into 1 of the 2 groups (control or intervention). Data collection is expected to be completed in December 2023. Subsequently, the authors will analyze the data and publish the findings of the clinical trial by June 2024.

Conclusions

This randomized controlled trial aims to elucidate differences between psychophysiological patterns of adults exposed to true or false oral health content. This evidence may support the development of further studies and digital strategies, such as neural network models to automatically detect disinformation available on the internet.

Trial Registration

Brazilian Clinical Trials Registry (RBR-7q4ymr2) U1111-1263-8227; https://tinyurl.com/2kf73t3d

International Registered Report Identifier (IRRID)

PRR1-10.2196/39133

Online quality and readability assessment of Early childhood caries information available on websites from distinct countries: A cross-sectional study

AIM

To assess the quality and readability of ECC-related Web information available in English, Spanish, and Brazilian Portuguese language.

METHODS

This study assessed the quality and readability of information related to ECC in three different languages found on the most popular Internet search engines worldwide. Websites were retrieved from different search engines using specific strategies. DISCERN questionnaire, JAMA benchmark criteria, and language-based readability formulas were used by two independent investigators to evaluate the quality and readability of websites. Also, contents were categorised according to aetiology, prevention, and treatment of ECC. The statistical analysis was performed using Spearman's rank correlation coefficient, hierarchical clustering analysis by Ward's minimum variance method, and Mann-Whitney U test. P values < 0.05 were considered significant.

CONCLUSION

ECC-related digital contents were considered simple, accessible and of poor quality, independently of their language and authorship. These findings indicate the importance of professional counseling to empower parents in selecting and consuming adequate information towards the improvement of children's oral health.

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.

Characterization of misleading fluoride information on Instagram: An infodemiology study (Preprint)

Background

Online false or misleading oral health–related content has been propagated on social media to deceive people against fluoride’s economic and health benefits to prevent dental caries.

Objective

The aim of this study was to characterize the false or misleading fluoride-related content on Instagram.

Methods

A total of 3863 posts ranked by users’ total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors’ interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models.

Results

Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author’s profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda.

Conclusions

False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.

Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19

Objectives

The aim of this ecological study was to analyze the relationship of social restriction measures and people's interest in searching toothache‐related information on the Internet.

Materials and Methods

The following indicators Stringency Index (SI), Years Lived with Disability (YLDs) for untreated caries in permanent teeth, Google market share, Internet penetration, and relative search volume (RSV) for the Topic "Toothache" in Google Trends were determined for 21 countries with available data, from April 2018 to May 2020. Statistical analysis was performed using Mann–Whitney U test, t‐Student test, Pearson's Chi‐square test, and Spearman and Pearson's cross‐correlation tests (α = 0.05).

Results

Relative search volume values increased significantly after restriction measures in all countries, except for Japan. Higher RSV values were found among 11 countries that presented a cross‐correlation between RSV and SI with r≥│0.6│. The most common queries were linked to the treatment and self‐resolution of toothache, with a sudden increase of searches that combined the symptom with COVID‐19.

Conclusions

The interests in toothache‐related digital information were associated with social restriction measures. These results allow the identification of dental demands of distinct populations, contributing to the planning of specific public health policies during and after the pandemic period.

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

•

Educational mobile text messages were effective to control the severity of ECC.

•

They influenced changes in parental reports about children’s sugar consumption.

•

Also, they seemed beneficial to improve parental electronic health literacy levels.

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.

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.

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.

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 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.

Blackawton bees

BACKGROUND

Real science has the potential to not only amaze, but also transform the way one thinks of the world and oneself. This is because the process of science is little different from the deeply resonant, natural processes of play. Play enables humans (and other mammals) to discover (and create) relationships and patterns. When one adds rules to play, a game is created.

THIS IS SCIENCE

the process of playing with rules that enables one to reveal previously unseen patterns of relationships that extend our collective understanding of nature and human nature. When thought of in this way, science education becomes a more enlightened and intuitive process of asking questions and devising games to address those questions. But, because the outcome of all game-playing is unpredictable, supporting this 'messyness', which is the engine of science, is critical to good science education (and indeed creative education generally). Indeed, we have learned that doing 'real' science in public spaces can stimulate tremendous interest in children and adults in understanding the processes by which we make sense of the world. The present study (on the vision of bumble-bees) goes even further, since it was not only performed outside my laboratory (in a Norman church in the southwest of England), but the 'games' were themselves devised in collaboration with 25 8- to 10-year-old children. They asked the questions, hypothesized the answers, designed the games (in other words, the experiments) to test these hypotheses and analysed the data. They also drew the figures (in coloured pencil) and wrote the paper. Their headteacher (Dave Strudwick) and I devised the educational programme (we call 'i,scientist'), and I trained the bees and transcribed the childrens' words into text (which was done with smaller groups of children at the school's local village pub). So what follows is a novel study (scientifically and conceptually) in 'kids speak' without references to past literature, which is a challenge. Although the historical context of any study is of course important, including references in this instance would be disingenuous for two reasons. First, given the way scientific data are naturally reported, the relevant information is simply inaccessible to the literate ability of 8- to 10-year-old children, and second, the true motivation for any scientific study (at least one of integrity) is one's own curiousity, which for the children was not inspired by the scientific literature, but their own observations of the world. This lack of historical, scientific context does not diminish the resulting data, scientific methodology or merit of the discovery for the scientific and 'non-scientific' audience. On the contrary, it reveals science in its truest (most naive) form, and in this way makes explicit the commonality between science, art and indeed all creative activities.

PRINCIPAL FINDING

'We discovered that bumble-bees can use a combination of colour and spatial relationships in deciding which colour of flower to forage from. We also discovered that science is cool and fun because you get to do stuff that no one has ever done before. (Children from Blackawton)'.