Objectives To describe the ‘Caries Assessment Spectrum and Treatment’ (CAST) instrument, its origin and content, and to provide an example of how results can be reported. Methods The CAST instrument covers the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and lesion care (restoration) to lesions in enamel and dentine, the advanced stages of carious lesion progression in pulpal and its consequences on tooth‐surrounding tissue and tooth loss due to caries. Using the RAND modified e‐Delphi consensus method two independent panels, comprising a total of 56 epidemiologists from 27 countries, determined the face and content validity of CAST. Panellists assessed 17 statements related to the content, description, suitability and international use of CAST. Agreement of 75% or higher was required for reaching consensus on a statement. Construct validity and reliability testing of CAST have been carried out, but results are not yet available. Results All 17 statements were approved by the panellists, who found the RAND modified e‐Delphi consensus method suitable for achieving consensus. The CAST codes were ordered hierarchically. External validity was obtained. Reporting using CAST can be performed for orally healthy dentitions and those having morbidity and mortality. A DMF score can easily be calculated from the CAST codes, thereby enabling retention of the use of existing DMF scores. Conclusion The CAST instrument for use in epidemiological surveys is very promising. Face and content validation is obtained. Construct validity and reliability testing will be completed soon. A structure for reporting results in a comprehensive, pragmatic and easily understood way is being developed.

After a total of four rounds with the panel members and one round with the feedback group, the CAST index was approved for face and content validity. External validity was obtained. The participating epidemiologists found the RAND modified e-Delphi consensus method to be a suitable instrument for reaching consensus.

BackgroundThe Caries Assessment Spectrum and Treatment (CAST) is a new epidemiological instrument for detection and treatment of dental caries. Worldwide, the WHO criterion constitutes the epidemiological tool most commonly used for caries detection. The objective of the present study is to determine the levels of similarity and difference between the CAST instrument and WHO criterion on the basis of caries prevalence, dmf/DMF counts, examination time and reporting of results.MethodsAn epidemiological survey was carried out in Brazil among 6-11-year-old schoolchildren. Time of examinations was recorded. dmft, dmfs, DMFT and DMFS counts and dental caries prevalence were obtained according to the WHO criterion and the CAST instrument, as well the correlation coefficient between the two instruments.ResultsFour hundred nineteen children were examined. dmft and dmfs counts were 1.92 and 5.31 (CAST), 1.99 and 5.34 (WHO) with correlation coefficients (r) of 0.95 and 0.93, respectively. DMFT and DMFS counts were 0.20 and 0.33 (CAST), 0.19 and 0.30 (WHO), with r = 0.78 and r =0.72, respectively. Kappa coefficient values for intra-examiner consistency were CAST = 0.91-0.92; WHO = 0.95-0.96 and those for inter-examiner consistency were CAST = 0.90-0.96; WHO = 0.94-1.00. Mean time spent on applying CAST and WHO were 66.3 and 64.7 sec, respectively p = 0.26. The prevalence of dental caries using CAST (codes 2, 5-8) and the WHO criterion for the primary dentition were 63.0% and 65.9%, respectively, and for the permanent dentition they were 12.7% and 12.8%, respectively.ConclusionsThe CAST instrument provided similar prevalence of dental caries values and dmf/DMF counts as the WHO criterion in this age group. Time spent on examining children was identical for both caries assessment methods. Presentation of results from use of the CAST instrument, in comparison to WHO criterion, allowed a more detailed reporting of stages of dental caries, which will be useful for oral health planners.

The Caries Assessment Spectrum and Treatment (CAST) is a newly developed epidemiological instrument. The aim of this study was to investigate its construct validity. Four calibrated examiners, using CAST codes 0-6, visually examined 109 surfaces of extracted and exfoliated teeth. These teeth were then hemisectioned, photographed, and assessed histologically by two calibrated examiners using the Downer criteria. Twenty-eight of the 109 teeth were scanned using micro-computed tomography (micro-CT) and assessed by the same examiners using the same criteria. Validation was determined through calculation of the sensitivity, specificity, and Youden index for two categories of carious lesions examined visually, with histology and micro-CT as gold standards. Interexaminer consistency was κ = 0.76: SE ± 0.05 between visual and histological assessments of teeth and was κ = 0.89: SE ± 0.08 between visual and micro-CT assessments. For the category 'healthy' vs. 'diseased' (CAST codes 0-2 vs. CAST codes 3-6), sensitivity, specificity, and Youden index values of 100%, 92.9%, and 93%, respectively, for micro-CT, and 96.6%, 86%, and 83%, respectively, for histology, were obtained. For the category 'dentine' vs. 'non-dentine lesions' (CAST codes 0-3 vs. CAST codes 4-6) sensitivity, specificity, and Youden index values of 90%, 100%, and 90%, respectively, for micro-CT, and 81.4%, 100%, and 81%, respectively, for histology, were obtained. Construct validity of the CAST instrument was obtained.

Este estudo, de abordagem qualitativa, investigou, por meio de entrevistas individuais e em grupo, a integração ensino-serviço entre uma universidade pública do sul do Brasil e os serviços públicos de saúde. Os dados foram analisados sob a Análise Temática de Conteúdo, e, na análise, emergiram dois eixos temáticos e quatro categorias. O eixo temático Ativador agrupou aspectos desenvolvidos no programa e o eixo em Construção revelou as dificuldades observadas. As categorias identificadas foram: Parceria Ensino-Serviço; Estrutura Curricular; Mudança de Paradigma e Práticas Pedagógicas. Conclui-se que os participantes compreendem a integração ensino-serviço como potencial estratégia colaboradora do processo de mudança de práticas na formação em saúde, apesar de haver grupos resistentes. O processo de mudança de práticas se desenvolveu ativamente a partir da reestruturação curricular. A integração ensino-serviço é um dos eixos que busca solidificar a proposta curricular, por meio de ações diversas na interface do ensino com o serviço.

A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to dental caries, in nine codes. The objective of this study was to determine the reproducibility of the CAST instrument in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2-6-year-old and 6-9-year-old children and 19-30-year-old adults. Four trained and calibrated examiners performed the examinations. Reproducibility was calculated for intra- and inter-examiner at surface and tooth levels and expressed as unweighted kappa-coefficient value (κ) and percentage of agreement (Po) for CAST codes (0-7) and for the categories healthy (0-2) versus diseased (3-7), and non-cavitated (0-3) versus cavitated (4-7) teeth. Using CAST codes (0-7) for the 2-6-year-old age group in primary dentitions, inter-examiner consistency was κ = 0.74 and Po was 98.3%. In the 6-9-year-old age group in primary dentitions, inter-examiner consistency ranged from κ = 0.68 to κ = 0.86 and Po was ≥ 93.7%. In the 19-30-year-old age group inter-examiner consistency was κ = 0.87 and Po was 94.1%. The reproducibility of the CAST instrument for use in the primary dentition of 2-6-year olds and of 6-9-year olds was 'substantial' to 'almost perfect'. The reproducibility for its use in the permanent dentition of 19-30-year olds was 'almost perfect'. The CAST instrument can reliably be applied in epidemiological studies covering these ages.

RESUMODesde o século XVIII, o sentimento de culpa esteve tão atrelado à maternidade quanto os ideais de dedicação e amor. Recentemente, discussões sobre ela têm aumentado, sobretudo nos sites de redes sociais. São debates que buscam, entre outros objetivos, repensar valores tradicionalmente associados à atividade materna. O artigo explora as modificações históricas e subjetivas que permitiram que mulheres falassem sobre uma questão íntima (a maternidade) em um ambiente compartilhado. Para isso, analisa alguns comentários feitos por mães no site de rede social Facebook sobre suas vivências maternas, tomando por base os conceitos de ruminação de Nietzsche (século XIX) e de culpa de Freud (século XX). Ao acionar dois dos mais influentes pensadores modernos para refletir sobre manifestações contemporâneas, percebese que os discursos produzidos pelas mães procuram se afastar do sentimento de culpa materna, em um processo que se aproxima do que Nietzsche classifica como ruminação das experiências. Palavras ABSTRACTSince the eighteenth century, the feeling of guilt has been as tied to motherhood as the ideals of dedication and love. Recently, discussions concerning motherhood have increased, including on social network sites. These debates seek, among other goals, to rethink values traditionally associated with maternal activity. The article explores the historical and subjective changes that allowed women to talk about an intimate issue (motherhood) in a shared environment. To reach such goal, the paper analyzes some comments made by mothers on the social network site Facebook reporting their maternal experiences, based on the concepts of Nietzsche's rumination (19th century) and Freud's guilt (20th century). By triggering two of the most influential modern thinkers to reflect on contemporary manifestations, it is perceived that the speeches produced by the mothers stray from the feeling of maternal guilt in a process that approaches what Nietzsche classifies as a rumination of experiences.

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