Development and validation of the dental vulnerability scale in the primary health care setting Danielle Palacio D Palacio 2,1 , ACCN Mafra 2 , D Bonfim 2 , F Rebustini 3 , DB de Oliveira 2 , ACF Martins 2 , JMT de Mendonc ¸a 2 , JL Miraglia 2 , AC Pereira 4 1 Albert Einstein Hospital, Sa ˜ o Paulo, Brazil 2 Hospital Israelita Albert Einstein, Sao Paulo, Brazil 3 Escola de Artes, Cie ˆ ncias e Humanidades - Universidade de Sa ˜ o Paulo, Sao Paulo, Brazil 4 Faculdade de Odontologia de Piracicaba - UNICAMP, Piracicaba, Brazil Contact: daniellepalacio@yahoo.com.br Background: Offering equitable access to dental care remains a challenge and methods to risk-stratify individuals to prioritize care could help to attain that goal. The interaction of multiple risk factors associated with oral disease vulnerability can outweigh protective factors conferring resilience and resistance to individuals and their communities; however, there is no validated instrument for measuring oral disease vulnerability. Hence, the objective of this study was to develop a Dental Vulnerability Scale (EVO) for primary health care (PHC) and evaluate its content validity and internal structure. Methods: This was a psychometric study conducted in Sa ˜o Paulo, Brazil, in 2019. During content validation, 172 items were evaluated by a panel of 40 judges with diverse background and with the application of the Content Validity Ratio (CVR), considering a critical CVR value> 0.26. During the internal structure evaluation, the EVO was applied to a sample of 1227 individuals in the PHC setting and the results were analyzed using Exploratory and Confirmatory Factor Analysis, in addition to the application of 3 reliability indicators (Cronbach’s alpha, McDonald’s Omega and Greatest Lower Bound). Results: The CVR was 0.33 for relevance and 0.39 for clarity, resulting in 41 items. The final EVO was composed of 4 dimensions (general health, oral health, infrastructure and health services) with a total of 15 items. Factor loadings ranged from 0.37 to 0.96, with R-squared values ranging from 0.14 to 0.91. The reliability indicators values were a = 0.64, ! = 0.99 and GLB=0.82. The Goodness of fit were NNFI = 0,95, CFI = 0,98, GFI = 0,96 and AGFI = 0,97. The EVO instrument was considered valid to be used among oral health professionals in the PHC setting. Conclusions: The EVO showed satisfactory psychometric properties and could be employed by health professionals and managers to plan actions and  inform  policies related to oral health. Key messages:  The EVO could be used to risk-stratify individuals in the PHC setting.  The EVO could help to inform oral health policies. Urban rural paradox -when easy access to mammography services does not mean active participation Cindy Padilla C Padilla 1 , N Prajapati 1 , P Soler Michel 2 , VM Vieira 3 1 REPERES, EHESP, Rennes, France 2 De ´ pistage des cancers, Centre re ´ gional de coordination des de ´ pistages des cancers Auvergne Rho ˆ ne Alpes, Lyon, France 3 Program in Public Health, University of California, Irvine, USA Contact: cindy.padilla@ehesp.fr Introduction: The detection of breast cancer in its latent stages through mammography screening can improve patient’s chances of recovery. However, geographic variation in mammography participation remains. Our objectives were first to assess whether the geographic accessibility of mammography-screen- ing services influences mammography-screening participation and second to estimate the extent to which geographic variation in the use of cancer screening can be explained by spillover effects between adjacent areas, while controlling for covariates. Methods: Mammography-screening services participation rates were calculated, for women aged 50-74 years who live in Lyon metropolitan area and did a mammography between 2015- 2016 after being invited with a letter by the mammography screening program. We used spatial autoregressive models to estimate the extent of spatial spillover effects by applying spatial lag models. The geographic accessibility (availability, distance and affordability) on participation was evaluated adjusting on socioeconomic characteristics of census blocks. Results: We found evidence of urban rural paradox. The mammo- graphy screening participation was 53.2% in residential and rural areas and 46.6% in urban and active areas, p < 0.001. Conversely to rural areas, women living in urban census blocks had high availability, lower distance to the closest mammo- graphy services, and lower mammography screening participa- tion. Moreover, the coefficients for the spatial lag are significant and positive. The positive spatial lags indicate that screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas. Conclusions: This study makes an important methodological contribution to measure access to services and better understand the variety of community contextual factors that drive mammography use decisions; which is a critical component of health care planning and equity almost everywhere. Key messages:  Evidence of urban rural paradox in mammography screen- ing participation.  Screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas. The wider consequences of obesity: estimated social and economic costs from Mendelian Randomization Amanda Hughes A Hughes 1 , S Harrison 1 , P Dixon 1 , M Dickson 2 , A Davies 3 , F Rice 4 , N Davies 1 , L Howe 1 1 MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK 2 Institute for Policy Research, University of Bath, Bath, UK 3 Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, UK 4 School of Medicine, University of Cardiff, Cardiff, UK Contact: amanda.hughes@bristol.ac.uk Background: Obesity is a key public health issue worldwide. Accurate estimates of its full impacts on health, social, and economic outcomes are required, but are difficult to obtain due to bias from confounding and reverse causality (the impact of social and economic factors on obesity). Methods: Using data from the UK Biobank and ALSPAC, we applied a genetic causal inference approach (Mendelian Randomization, MR) to estimate the impact of body mass index (BMI) on key social and economic outcomes. Because genetic variants are assigned before birth and cannot change, estimates from MR studies are less liable to confounding and reverse causation. Results: Effects of higher BMI were often larger in MR than conventional (non-genetic) models, suggesting previous stu- dies may have underestimated the impact of BMI. For example, in adolescents, MR models implied a standard deviation increase in BMI led to exam scores around 1/3 of a grade lower in all subjects at age 16, and 8.7% (CI: 1.8% to 16.1%) more school absence. In adults a 5kg/m2 increase in BMI corresponded, among other negative outcomes, to £2,778 less annual household income (CI: £1,864 to £3,693), less chance of owning one’s home (-1.6%, CI: -2.4% to -0.8%), and higher chance of being lonely (2.4%, CI: 1.4% to 3.5%). At v378 European Journal of Public Health, Volume 30 Supplement 5, 2020 Downloaded from https://academic.oup.com/eurpub/article/30/Supplement_5/ckaa165.1026/5915082 by guest on 22 October 2022