Health and Quality of Life Outcomes
BioMed Central
Open Access
Research
Child-OIDP index in Brazil: Cross-cultural adaptation and
validation
Rodolfo AL Castro1, Maria IS Cortes2, Anna T Leão3, Margareth C Portela*1,
Ivete PR Souza3, Georgios Tsakos4, Wagner Marcenes5 and Aubrey Sheiham4
Address: 1National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480/724, Manguinhos, Rio de Janeiro, 21031210, Brazil, 2School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom Jose Gaspar, 500, Prédio 46, Coração Eucarístico,
Belo Horizonte, 35588-000, Brazil, 3School of Dentistry, Federal University of Rio de Janeiro, Avenida Brigadeiro Trompovsky s/n, Rio de Janeiro,
21941-590, Brazil, 4University College London, 1-19 Torrington Place, London, WC1E 6BT, UK and 5Barts and the London School of Medicine
and Dentistry, Institute of Dentistry, Turner Street, London, E1 2AD, UK
Email: Rodolfo AL Castro - rodolfoalcastro@globo.com; Maria IS Cortes - cortesmi@globo.com; Anna T Leão - atleao@globo.com;
Margareth C Portela* - mportela@ensp.fiocruz.br; Ivete PR Souza - pomarico@superig.com.br; Georgios Tsakos - g.tsakos@ucl.ac.uk;
Wagner Marcenes - w.marcenes@qmul.ac.uk; Aubrey Sheiham - a.sheiham@ucl.ac.uk
* Corresponding author
Published: 15 September 2008
Health and Quality of Life Outcomes 2008, 6:68
doi:10.1186/1477-7525-6-68
Received: 10 May 2008
Accepted: 15 September 2008
This article is available from: http://www.hqlo.com/content/6/1/68
© 2008 Castro et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Oral health-related quality of life (OHRQoL) measures are being increasingly used
to introduce dimensions excluded by normative measures. Consequently, there is a need for an
index which evaluates children's OHRQoL validated for Brazilian population, useful for oral health
needs assessments and for the evaluation of oral health programs, services and technologies. The
aim of this study was to do a cross-cultural adaptation of the Child Oral Impacts on Daily
Performances (Child-OIDP) index, and assess its reliability and validity for application among
Brazilian children between the ages of eleven and fourteen.
Methods: For cross-cultural adaptation, a translation/back-translation method integrated with
expert panel reviews was applied. A total of 342 students from four public schools took part of the
study.
Results: Overall, 80.7% of the sample reported at least one oral impact in the last three months.
Cronbach's alpha was 0.63, the weighted kappa 0.76, and the intraclass correlation coefficient (ICC)
0.79. The index had a significant association with self-reported health measurements (self-rated
oral health, satisfaction with oral health, perceived dental treatment needs, self-rated general
health; all p < 0.01).
Conclusion: It was concluded that the Child-OIDP index is a measure of oral health-related
quality of life that can be applied to Brazilian children.
Background
The World Health Organization (WHO) defines health as
a "state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity"
[1]. Based on this concept, measuring health should not
be confined to the use of exclusively clinical normative
indicators. Health-related quality of life (HRQoL) measures are being used nowadays to evaluate dimensions of
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health, such as psychological and social aspects, that are
not assessed by other measures. HRQoL measures can be
categorized as: generic or specific. The generic measures
are used to evaluate the impact of general health problems
on quality of life. The specific measures focus on the
repercussions of particular health conditions, health
problems or treatments on the quality of life [2].
Oral health-related quality of life (OHRQoL) indices have
a specific application in the evaluation of the impacts of
oral problems on daily activities. These indices are most
commonly used for adults or elderly populations. Some
authors have adapted and applied instruments developed
for adults to children and adolescents [3,4]. However,
there is a trend to generate specific indices which cater for
the needs of younger populations [5,6]. One of the measures developed specifically for children is the Child Oral
Impacts on Daily Performances (Child-OIDP) index.
Child-OIDP was developed in English, then validated in
Thailand, and more recently in other countries [7-10]. The
objective of this index is to measure the impacts of oral
health problems on daily activities commonly performed
by children. It comprises dimensions not tapped by clinical measures, such as functional, psychological and social
limitations. The index has applications in public health
for the assessment of oral health needs and can be a valuable indicator for the evaluation of oral health programs
[11].
The psychometric properties of the Child-OIDP have been
successfully assessed in several countries with different
cultures and languages, such as Thai, French, English,
Spanish and Kiswahili, but not in Portuguese. The availability of multi-lingual versions of instruments is important for epidemiological research. The aim of this study
was to carry out a cross-cultural adaptation of the ChildOIDP index and to assess its reliability and validity for
application among Brazilian children between the ages of
eleven and fourteen.
Methods
Study design and ethical considerations
The methodology emphasises the cross-cultural adaptation of the Child-OIDP and its psychometric testing for
test-retest reliability, internal consistency and construct
validity. Informed consent was sought and obtained from
the parents of the participants. The research protocol was
approved by the Ethics Committee of the National School
of Public Health of Brazil (approval number: 04/05).
Description of the index
For the application of the Child-OIDP the children were
initially asked to record all oral health related problems
they have experienced in the past three months (Table 1).
This was done in small groups, in order to reduce time.
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Then, data were collected on the impacts of oral problems, through face-to-face interviews, considering eight
common daily performances. These performances are:
eating, speaking, cleaning mouth, sleeping, emotional status, smiling, studying, and social contact (Table 1).
In the event that a child reported an impact on their performance of these eight daily performances, the child
responded to questions about the severity and frequency
of the specific impact; a score from 0 to 3 is given to rate
each of these characteristics. When no impact had been
reported, the child received a score of zero. The calculation of the index involves the multiplication of the severity and frequency of each performance. A sum is made of
the values obtained for the eight performances, resulting
in a number from 0 to 72, which is divided by 72 and then
multiplied by 100, so that the final Child-OIDP score varies from 0 to 100. A more detailed description of the index
can be obtained in the development paper of the ChildOIDP [5].
Cross-cultural adaptation
The methods used to translate the questions in the ChildOIDP index to Portuguese and to adapt the index to the
Brazilian culture followed published guidelines [12]. The
process of cross-cultural adaptation was conducted in Rio
de Janeiro and involved several steps: translation from
English to Portuguese; first meeting of the expert panel to
produce the first Portuguese version; pilot-testing in a
focus group of children; second meeting of the expert
panel to produce a new consensus version; back-translation to English; re-evaluation by the expert panel members and by the authors of the original Child-OIDP.
The Child-OIDP was translated from English to Portuguese by three native Portuguese-speaking professional
translators. Two of the three translators were unaware of
the concepts used and of the objectives of the study. These
three versions of the index were assessed by an expert
panel involving five specialists: two specialists in quality
of life measures, two experienced pediatric dentists, and
one specialist in Health Policy and Administration. Collectively, this team compiled a single version of ChildOIDP. This version was assessed for understanding and to
adjust the instrument's terminology in a focus group
study composed of ten 11–14 years-olds. Additionally,
the questionnaire was applied to a convenience sample of
thirteen 11–14 year-olds in a public school in Nova
Iguaçu, Rio de Janeiro to check the operational performance. The expert panel reviewed the results from the focus
groups and produced the first consensus version of the
Brazilian Child-OIDP.
To test the cross-cultural adaptation, the Brazilian Portuguese consensus version of the index was back-translated
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Table 1: Items and modifications from the original questionnaire (changes are in bold italics)
List of problems of the original Child-OIDP
First part of the instrument
List of problems of the Brazilian Child-OIDP (translated)
Toothache
Sensitive tooth
Erupting permanent tooth
Missing permanent tooth
Other (specify)
Toothache
Sensitive teeth (when you eat or drink: sweets, hot food such as
milk or coffee and cold food such as ice cream)
Tooth decay, hole in tooth
mobile milk teeth
Tooth space (due to an non-erupted permanent tooth)
broken permanent (new or definitive) tooth
Colour of tooth (darker or more yellow in color, or stained)
shape or size of tooth
(abnormally sized or shaped tooth, or larger or smaller than the
other teeth)
tooth position (crowded, crooked, separated, or protruding teeth)
bleeding of the gums (when brushing teeth)
swollen gums (inflamed or very red gums)
tartar
oral wounds
Bad breath (bafo: a popular term in Portuguese with no translation
to english)
Erupting permanent tooth
Missing, lost, or extracted permanent tooth
Others. Which?
Second part of the instrument
Performances of the original Child-OIDP
Performances of the Brazilian Child-OIDP (translated)
Tooth decay, hole in tooth
Exfoliating primary tooth
Tooth space (due to an non-erupted permanent tooth)
Fractured permanent tooth
Colour of tooth
Shape or size of tooth
Position of tooth (e.g. crooked or projecting, gap)
Bleeding gum
Swollen gum
Calculus
Oral ulcers
Bad breath
Eating food (e.g. meal, ice-cream)
Speaking clearly
Cleaning your mouth (e.g. rinsing your mouth, brushing your teeth)
Relaxing (including sleeping)
Maintaining your usual emotional state without being irritable
Smiling, laughing and showing your teeth without embarrassment
Carrying out your schoolwork
(e.g. going to school, learning in class, doing homework)
Contact with people
(e.g. going out with friend, going to a friend's house)
to English by two independent native English-speaking
professional translators. The index was then re-evaluated
for adequacy by the members of the expert panel and by
the authors of the original version of the Child-OIDP.
Reliability and validation studies
The Brazilian Child-OIDP [see Additional file 1] was
administered to 342 children between the ages of 11 and
14 in four different public schools located in the southeast
of Brazil. Two of the schools were located in the city of Rio
de Janeiro (n = 203) and two in Belo Horizonte (n = 139).
All were public schools. In Rio de Janeiro, one school was
in a deprived area and the other in a semi-deprived area;
in Belo Horizonte, both schools were in a semi-deprived
area. Children were randomly selected from official
school registries.
Eating food (e.g. meal, ice-cream)
Speaking clearly
Cleaning your mouth (e.g. rinsing your mouth, brushing your teeth)
Sleeping
Maintaining your emotional state (mood) without becoming irritated or
stressed
Smiling, laughing and showing your teeth without embarrassment
Carrying out your schoolwork
(e.g. going to school, learning in class, doing homework)
Contact with people
(e.g. going out with friend, going to a friend's house)
Two trained dentists conducted the interviews. Instructions for the interview were given by the authors of the
original questionnaire. The first part of the Child-OIDP
assessed common oral health problems, and was conducted in small groups of six children. Each child
answered the questionnaire without communicating with
each other. The second part assessed impacts of oral
health problems in a face-to-face interview performed
with each child individually. Also, it included questions
on self-rated oral and general health.
For test/retest reliability measurements, 20 children
received an additional interview with the index within
one-week interval of the first administration. Reliability
was tested using the weighted-kappa and the intraclass
correlation coefficient (ICC).
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In addition to the Child-OIDP, the interview also contained the following questions (all with 3-point ordinal
scales) that were used for the assessment of construct
validity: self-rated oral health (answers ranging from
"good" to "poor"), satisfaction with oral health (answers
ranging from "not at all" to "very satisfied"), perceived
oral treatment needs ("yes", "do not know", "no"), and
self-rated general health (answers ranging from "good" to
"poor").
Data analysis
Data were entered into Epi Info (version 3.4.3), and analyses were performed using SAS statistical package (version
9.1). Reliability testing referred to internal consistency
and test-retest reliability. Internal consistency was evaluated using the Cronbach's alpha, alpha if item deleted,
and inter-item and item-total correlation coefficients with
Pearson correlation coefficients (PCC). Test-retest reliability was determined by using: a) weighted Kappa, with the
Child-OIDP score categorised into five groups, and b) ICC
for the Child-OIDP score.
To establish construct validity, the Brazilian Child-OIDP
score was compared between the different groups of other
subjective oral and general health status variables (selfrated oral health, satisfaction with oral health, perceived
oral treatment needs, and self-rated general health),
through the use of the Kruskal-Wallis test.
Results
To accomplish an accurate cross-cultural adaptation of the
index, some words had to be modified from the original
version. The decision to modify the index was made collectively by the expert panel, using notes and data
obtained in the pilot testing. The experience of professionals of pediatric dentistry in the expert panel that knew the
terms used by children when referring to oral health and
problems was important for the modification process. The
modifications did not affect the content of the index but
aimed to facilitate comprehension and ease of administration in the culturally specific context. They varied from
broader issues, such as the use of pictures and examples in
answering options (pictures of a facial scale were used for
all children to help them decide on the severity of an
impact), to very detailed modifications, such as the choice
of the appropriate marking symbol. The choice of alternatives in the self-administered first part of the index was
supposed to be marked with a symbol (v), in Brazil it is
more common to use an "X" between two parenthesis
than using the suggested mark, so the "X" was adopted in
the Brazilian version. In addition, some terms used in the
questionnaire were replaced for words more common in
Brazil. Also, examples were included after "teeth/mouth
problems", in order to make the content more specific
and facilitate understanding (Table 1). To help children's
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comprehension of the severity of the impact, a facial scale
with three different expressions was added to the arrows
presented in the original version of the Child-OIDP.
When asking about the frequency of a problem a navigation question was inserted: "Did it happen one or more
times a month, or less than once a month?" to decide if
the problem has happened on a regular basis or not. If the
problem was on a regular basis, the child was asked about
the number of times it occurred. If it did not happen on a
regular basis, the next question was about on how many
days in total it happened. One of the performances was
modified from "relaxing (including sleeping)" to "sleeping", since it was observed in the pilot testing that the children did not use the term relaxing.
A total of 540 children were invited to participate in the
validation study and 342 parents signed the informed
consent, resulting in a response rate of 63.3%. The mean
age of the subjects was 12.8 (sd: ± 1.1), and the median
was 12.7. There were 172 (50.3%) girls and 170 (49.7%)
boys in the sample.
The sample reported high levels of perceived oral problems. The most prevalent perceived oral problem reported
in the first step of the Child-OIDP was sensitive teeth
(63.2%) followed by tooth color (42.4%) (Table 2). Overall, 80.7% of the sample reported at least one oral impact
in the last three months. The performances with the highest frequencies impacts were "eating" (59.4%), "emotional status" (33.6%), "cleaning mouth" (33.3%) and
"smiling" (21.3%), while the performance with the lowest
impact was "studying" (6.7%) (Table 3). The mean ChildOIDP score was 9.2 (sd: ± 10.1), quartile 75%: 13.9,
median: 5.5, and, quartile 25%: 1.4. When the index was
analyzed by performances, eating had the highest mean
impact score (Table 3).
The test-retest reliability of the index using weightedkappa for Child-OIDP categories was 0.76 and the average
measure ICC for the Child-OIDP score was 0.79.
The internal consistency analysis of the Child-OIDP
resulted in a standardized Cronbach's alpha of 0.63. There
were no negative correlation coefficients when the interitem correlation was done using PCC (Table 4). Alpha
value decreased when any item was deleted. Considering
item-total correlations, all items were above 0.20 (Table
5).
The relationship between the Child-OIDP score and the
self-rated measures demonstrated that children with perceptions of poor oral health had a higher median score of
the index (16.7) than children that evaluated their oral
health as good (1.4). Similarly, children who were more
satisfied with their oral health had a lower median Child-
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Table 2: Prevalence of perceived oral problems in 11–14 year old Brazilian children (n = 342)
List of common oral problems
Children with the problem % (n)
Sensitive tooth
Tooth color
Bleeding gums
Toothache
Dental caries
Position of teeth
Tooth shape or size
Erupting permanent tooth
Wounds
Bad breath
Space between teeth
Exfoliating primary teeth
Swollen gums
Broken permanent tooth
Tartar (calculus)
Missing permanent tooth
Deformed mouth or face
Other problems
63.2 (216)
42.4 (145)
36.8 (126)
35.4 (121)
32.7 (112)
32.2 (110)
30.4 (104)
25.4 (87)
22.8 (78)
17.3 (59)
16.1 (55)
14.6 (50)
12.0 (41)
9.6 (33)
7.0 (24)
6.7 (23)
0.9 (3)
2.3 (8)
OIDP score. The perception of the presence of oral treatment needs and the poor self-rated general health was
related with higher Child-OIDP index (Table 6). The
results suggest that children perceived the "do not know"
answering option as "I am not sure" when asked about the
perceived oral treatment needs. So it is considered as an
intermediate answer between "yes" and "no". There was a
clear trend in all the responses, revealing a gradual
increase in oral impacts with worsening subjective perceptions.
Discussion
The main contribution of this study was to rigourously
adapt the Child-OIDP index for Brazilian children aged
11–14 years and successfully assess its psychometric properties in a sample drawn from two culturally different
areas in Brazil. On the other hand, the following limitations should be pointed out: only public schools were
included, a convenience rather than a random sampling
approach was adopted, and the response rate was moderate.
The methods applied in the cross-cultural adaptation followed guidelines previously used in other validation studies [12] and assured the equivalence of the original and
adapted versions. Although word modifications were
made to take into account social and cultural differences,
during this process, much care was taken to ensure that
linguistic equivalence was achieved. Brazil has a continental dimension, with regional cultural differences. However, due to the fact that this study included two separate
cities in different states, the predicted applicability of the
Brazilian Child-OIDP may be considered nation-wide.
Test-retest reliability, evaluated using the Kappa and ICC,
was very good and shows that the index is a stable measure. This result is comparable to other validation studies
of the Child-OIDP [7-10]. As this index can be applied by
Table 3: Prevalence of oral impacts on daily performances (Child-OIDP) in 11–14 year old Brazilian children
Performances
Percentage of children with impact on performance
(n = 342)
Mean Child-OIDP
(± SD) on each performance (0 to 100)
Eating
Speaking
Cleaning mouth
Sleeping
Smiling
Emotional status
Studying
Social contact
At least one of above
59.4
14.0
33.3
10.5
21.3
33.6
6.7
12.3
80.7
21.4 (25.9)
5.6 (17.3)
12.5 (23.1)
3.0 (11.3)
7.7 (18.2)
15.7 (28.9)
2.6 (11.7)
4.9 (16.1)
-
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Table 4: Pearson correlation coefficients of performances of Child-OIDP index (n = 342)
Eating
Speaking
Cleaning mouth
Sleeping
Smiling
Emotional status
Studying
Social contact
Eating
Speaking
Cleaning Mouth
Sleeping
Smiling
Emotional status
Studying
Social Contact
1
0.12b
0.30a
0.17a
0.23a
0.04c
0.18a
0.08c
1
0.10c
0.18a
0.17a
0.17a
0.14b
0.23a
1
0.10c
0.32a
0.20a
0.15a
0.20a
1
0.01c
0.05c
0.29a
0.07c
1
0.25a
0.21a
0.21a
1
0.00c
0.24a
1
0.25a
1
ap
< 0.01
< 0.05
c Not significant
bp
any trained person, and not only a dentist, it can be used
in public health programs as a sociodental indicator of
oral health [11].
The internal consistency of the index, measured by the
Cronbach's alpha coefficient, despite not being satisfactory based on the criteria that defines a cut-off of 0.7 for
adequate consistency, was considered comparable to
other results obtained when validating the Child-OIDP in
other countries [7-9]. Quality of life is a multidimensional
concept. Therefore, any measure of health-related impacts
on daily life, including the Child-OIDP, needs to contain
various dimensions. This may explain why the ChildOIDP index, considering all the items, did not reach an
alpha of 0.7 or above, and yet was judged satisfactory.
Moreover, when any of the items were deleted the alpha
value decreased, hence providing evidence that all the
items are important to the establishment of the index. A
comprehensive evaluation of the validity of the ChildOIDP conducted in Peru reported that the small number
of items present in the index results in a lower alpha [9].
Clearly, the value of alpha is based on the correlation
between items and the number of items in a scale, with
scales with fewer items tending to have lower alpha values
Table 5: Standardised Cronbach's alpha, item-total correlation
and alpha with deleted items
Standardised Cronbach's alpha
Eating
Speaking
Cleaning mouth
Sleeping
Smiling
Emotional status
Studying
Social contact
0.63
Correlation with total
Alpha if deleted
0.30
0.29
0.37
0.23
0.38
0.25
0.33
0.35
0.59
0.59
0.57
0.61
0.56
0.60
0.58
0.57
[13-15]. As the Child-OIDP index is aimed to be a brief
and cost-effective measure with high applicability in public health and needs assessment, it assesses oral impacts in
relation to eight independent daily performances. Therefore, there is no merit in increasing the number of items,
with the aim of achieving higher alpha values, as this will
negatively affect the applicability of the measure. A relatively lower alpha value may be, to a certain extent, an
inherent attribute of a brief and practical OHRQoL measure that can be used for needs assessment in a population
[7].
Previous studies have adapted and applied sociodental
indices developed for adults in adolescents in Uganda and
in Brazil [3,4]. The present work validates an instrument
specifically constructed for children. Anguita et al [16]
concluded that the adaptation of an instrument is preferable to the development of a new one. Developing a new
instrument can be complex; the adapted version can be as
valid and reliable as the original; and, the presence of an
instrument of reference helps investigations where various countries take part, by allowing for direct comparability of findings.
The prevalence of impacts observed in Brazil (80.7%) was
comparable to those found in other countries where the
Child-OIDP was adapted and applied: Thailand (89.8%),
France (73.2%), Peru (82.0%) [17,7,18]. However, it was
higher than in England (40.4%) and Tanzania (28.6%)
[8,10]. In relation to the most prevalent oral impacts, eating and emotional status were the two performances
mostly affected in Brazil, while in France and England
cleaning mouth was the second most affected performance [8,9]. Eating was the most affected performance in all
studies using Child-OIDP in a general population. Concerning the perceived oral problems, sensitive tooth and
tooth color were the most commonly reported by the Brazilian children while in France the problems mentioned
were position of teeth and wounds [7].
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Table 6: Construct Validity: Child-OIDP score and self-rated measures of oral health (n = 342)
Self-rated oral health measures
Child-OIDP Score
Kruskal-Wallis test for association between Child-OIDP and oral health
measure
Median Mean (SD)
Perceived oral health
1. Poor (n = 40)
2. Regular (n = 223)
3. Good (n = 79)
16.7
6.9
1.4
17.8 (12.0)
8.9 (9.7)
5.5 (8.1)
p < 0.0001
Satisfaction with oral health
1. Not at all (n = 69)
2. Regular (n = 170)
3. Very satisfied (n = 103)
13.9
5.5
2.8
15.5 (11.3)
8.0 (8.8)
6.8 (9.7)
p < 0.0001
Perceived oral treatment needs
1. Yes (n = 221)
2. Do not know (n = 41)
3. No (n = 80)
8.3
4.2
1.4
11.1 (10.7)
7.9 (9.0)
3.5 (6.2)
p < 0.0001
Self-rated general health
1. Poor (n = 16)
2. Regular (n = 86)
3. Good (n = 240)
11.8
8.3
4.9
17.4 (13.7)
10.7 (11.0)
8.1 (9.4)
p < 0.01
In the evaluation of the construct validity of the ChildOIDP index, the score increased progressively, indicating
worse oral health-related quality of life, as the children's
self-rated oral health status, satisfaction and treatment
needs, as well as self-rated general health, changed from
healthy to unhealthy. This consistent pattern throughout
the construct validity testing is an interesting and strong
finding, because rather than merely observing a difference
in Child-OIDP scores between the worse off and the rest
of the population, there were gradual trends in all aforementioned associations, therefore highlighting the close
relationship between oral health-related quality of life
and other subjective measures of oral and general health.
These differences were statistically significant for all variables measured.
Conclusion and recommendations for future
research
It was concluded that the Child-OIDP index is a measure
of oral health-related quality of life that can be applied to
Brazilian children.
Future studies should be conducted on the Child-OIDP
index to fully evaluate its psychometric properties in a
population based epidemiological study. Its sensitivity to
change should also be established, so that it can be considered for clinical trials to assess the effect of treatment
on quality of life. Finally, the index can be used to assess
the relationship of oral impacts and quality of life with
clinical dental status and also contribute to assessing the
dental treatment needs of children.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
RALC contributed with conception, design, acquisition of
data, analysis, interpretation of data, draft and revision of
the manuscript. MISC contributed with conception,
design, acquisition of data, interpretation of data and revision of the manuscript. ATL and MCP contributed with
conception, design, acquisition of data, analysis, interpretation of data and revision of the manuscript. IPRS, GT,
WM and AS contributed with conception, design, interpretation of data and revision of the manuscript. All
authors read and approved the final manuscript.
Additional material
Additional File 1
Brazilian Child-OIDP. Instructions, questionnaire and record form of the
Brazilian Child-OIDP index.
Click here for file
[http://www.biomedcentral.com/content/supplementary/14777525-6-68-S1.pdf]
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Acknowledgements
Research (collection, analysis, and interpretation of data) was supported by
the Fundação Carlos Chaga Filho de Amparo à Pesquisa no Estado do Rio
de Janeiro (FAPERJ), Grant number: E-26/171.495/2004.
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