BackgroundMany young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes.MethodsElectronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15‐30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies.ResultsEighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA1c was the most frequently measured outcome, but only 5 of 12 studies that measured it showed a significant improvement.ConclusionBased on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high‐quality, well‐designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.

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.

OBJECTIVE To evaluate the potential support of schools for oral health promotion and associated factors in Brazilian capitals.METHODS Data from 1,339 public and private schools of the 27 Brazilian capitals were obtained from the National Survey of School Health (PeNSE) 2015. Data from the capitals were obtained from the United Nations Development Program and the Department of Informatics of the Brazilian Unified Health System (Datasus). The indicator “ ambiente escolar promotor de saúde bucal ” (AEPSB – oral health promoting school environment) was designed from 21 variables of the school environment with possible influence on students’ oral health employing the categorical principal components analysis (CATPCA). Associations between the AEPSB and characteristics of schools, capitals and regions were tested (bivariate analysis).RESULTS Ten variables comprised CAPTCA, after excluding those with low correlation or high multicollinearity. The analysis resulted in a model with three dimensions: D1. Within-school aspects (sales of food with added sugar in the canteen and health promotion actions), D2. Aspects of the area around the school (sales of food with added sugar in alternative points) and D3. prohibitive policies at school (prohibition of alcohol and tobacco consumption). The sum of the scores of the dimensions generated the AEPSB indicator, dichotomized by the median. From the total of schools studied, 51.2% (95%CI 48.5–53.8) presented a more favorable environment for oral health (higher AEPSB). In the capitals, this percentage ranged from 36.6% (95%CI 23.4–52.2) in Rio Branco to 80.4% (95%CI 67.2–89.1) in Florianópolis. Among the Brazilian regions, it ranged from 45.5% (95%CI 40.0–51.2) in the North to 67.6% (95%CI 59.4–74.9) in the South. Higher percentages of schools with higher AEPSB were found in public schools [58.1% (95%CI 54.9–61.2)] and in capitals and regions with higher Human Development Index [61.0% (95%IC 55.8–66.0) and 57.4% (95%CI 53.2–61.4), respectively] and lower Gini index [55.7% (95%CI 51.2–60.0) and 52.8 (95%CI 49.8–55.8), respectively].CONCLUSIONS The potential to support oral health promotion in schools in Brazilian capitals, assessed by the AEPSB indicator, was associated with contextual factors of schools, capitals and Brazilian regions.

Objective: To investigate the association between the potential support of schools for oral health promotion and a set of oral health-related behaviours among adolescent students in Brazilian state capitals. Methods: A cross-sectional study using individual and school environment data from the 2015 Brazilian National Adolescent School-Based Health Survey (PeNSE) was conducted. The sample consisted of 51 192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11-19 years old. The outcomes were six oral health-related behaviours: dental visits; toothbrushing frequency; soft drink and sweets consumption; smoking and alcohol consumption. The explanatory variable was the Oral Health Promotion School Environment index (OHPSE). Covariates were the adolescents' sociodemographic characteristics and organizational aspects of the schools. A two-level multilevel mixed-effects Poisson regression analysis with fixed slopes and random intercepts was performed, considering the complex sample design. Results: The prevalence of risk behaviours was 28.0% for 'low frequency of annual dental visits', 6.9% for 'low daily toothbrushing frequency', 28.8% for 'high weekly soft drink consumption', 41.7% for 'high weekly sweet consumption', 18.9% for 'cigarette experimentation' and 52.6% for 'alcoholic beverage experimentation'. The schools were classified as low (36.3%), intermediate (30.4%) and high (33.3%) OHPSE. In the adjusted model, schools with 'high OHPSE' had lower prevalence of 'low frequency of annual dental visits' (PR = 0.94 [95% CI 0.90; 0.99]), 'high weekly frequency of soft drink consumption' (PR = 0.94 [95% CI 0.89; 0.99]) and 'sweet consumption' (PR = 0.96 [95% CI 0.93; 1.00]) than those with 'low OHPSE'. In addition, schools with 'intermediate OHPSE' had higher prevalence's of 'low daily toothbrushing frequency' (PR = 1.12 [95% CI 1.03; 1.23]) and 'cigarette experimentation' (PR = 1.08 [95% CI 1.01; 1.16]) than those with 'low OHPSE'. 'Alcoholic beverage experimentation' was not associated with OHPSE. Conclusions: The potential support of schools for oral health promotion was associated with most of the oral health-related behaviours among adolescent students. How to cite this article: Nery NG, Antunes JLF, Jordão LMR, Freire MDCM. Can the school environment influence oral health-related behaviours? A multilevel analysis of the

RESUMO O processo de envelhecimento populacional brasileiro é acelerado. Percebe-se na população idosa uma maior utilização dos serviços de saúde e grande carência de atenção odontológica. A Estratégia Saúde da Família (ESF)reorganizadora do Sistema Único de Saúde (SUS)-afirma a atenção integral à saúde, centrada na família, priorizando, entre outros, os idosos. Apresenta-se uma pesquisa, realizada em um município de aproximadamente 1.200.000 habitantes, que em 2004, iniciou a inclusão da odontologia na ESF, buscando ampliar o acesso às ações de saúde bucal. Objetivo: Conhecer a satisfação de idosos quanto à ESF, a partir da análise da atenção em saúde bucal. Material e Métodos: A metodologia foi qualitativa, utilizando grupos focais. Resultados: Foi percebida uma satisfação variável, sendo positiva com relação a experiências passadasdestacando relacionamento profissional-usuário e qualidade das ações clínicas e extra-clínicas-e negativa quanto a problemas rotineiros inerentes ao acesso, atenção ao idoso e sua família, resolutividade e questões organizacionais. Conclusão: A ESF precisa melhorar a atenção aos idosos nos aspectos relativos ao acesso, longitudinalidade e continuidade, ou seja, aspectos gerenciais e de gestão. Os profissionais foram avaliados positivamente pelos idosos no que se refere a relacionamento interpessoal e ações clínicas e promocionais.