Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study.

BACKGROUND: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. OBJECTIVE: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. METHODS: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app. RESULTS: The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (-7.24 vs -4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). CONCLUSIONS: Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968.

Knowledge, attitudes, practice and related factors of oral cancer prevention among public health nurses in Taiwan.

OBJECTIVES: Public health nurses (PHNs) in Taiwan act as individual/family-based primary care providers and as population-based community care providers. A little information is currently available on the ability of PHNs to prevent oral cancer. We surveyed knowledge, attitudes and behaviour of oral cancer prevention among PHNs. METHODS: This study recruited 400 PHNs through the Taiwan Public Health Center. A structured electronic questionnaire was used to collect PHNs' demographics and scale scores for oral cancer knowledge, attitudes and preventive behaviour. RESULTS: Providing PHNs with oral cancer prevention education, having the supervisor's support for preventive work and receiving in-service education would improve PHNs' knowledge, attitude and behaviour for oral cancer prevention. Attitude, oral cancer-related courses arranged by current employer (major factor), supervisor's support for work and having responsibility for oral cancer prevention were associated with the oral cancer preventive behaviour of PHNs, and explain 41.1% of total variance. CONCLUSIONS: We established a linear regression model for understanding the role of PHNs in the practice of preventing oral cancer. It may be useful for the government in improving school-based and in-service oral cancer prevention education programmes for PHNs as well as developing programmes for increasing public awareness and education of oral cancer prevention.

Impact of periodontal disease and chewing ability on the quality of life of the elderly in an affluent community.

BACKGROUND/PURPOSE: Improvement of the medical and social environment is an important aspect of government policies in assuring the quality of life (QoL) of older adults. However, few studies have appraised the impact and relationship of QoL with clinical factors among elderly individuals in affluent residential areas. METHODS: A total of 166 older adults from Chang Gung Health and Culture Village were enrolled. Oral health-related QoL was measured using the Geriatric Oral Health Assessment Index. Self-assessed chewing abilities and demographic characteristics were collected by questionnaire. Physical health was scored by activities of daily living (ADL) and instrumental ADL. Mini nutrition assessment questionnaire was used to evaluate the nutritional intake. Multiple linear regression was used to predict risk factors affecting QoL and to examine whether chewing ability was a mediator of oral health-related QoL. RESULTS: Poor chewing ability was associated with older age (OR = 1.82 for 76-85 years and 3.58 for 86-95 years), sufficient economic status (OR = 5.55) and removable denture-wearing (OR = 7.52). On the other hand, poor chewing ability (OR = 0.11), removable denture-wearing (OR = 0.48), periodontal disease (OR = 0.38) had lower likelihood of good oral health-related QoL. Mediator analyses showed that chewing ability was a mediator for the association between oral health-related QoL and economic status or removable denture-wearing or having more than 20 teeth. Periodontal disease was an independent factor for oral health-related QoL. CONCLUSION: Among older adults in an affluent community, periodontal disease is an independent risk factor directly related to oral health-related QoL, whereas chewing ability is a mediator between QoL and removable denture-wearing.

Correlation Between Postoperative Health-Related Quality of Life and Care Needs of Oral Cancer Patients.

BACKGROUND: Oral cancer is the fifth most common form of cancer in Taiwan in terms of incidence and death rate and results in at least 2700 deaths each year. OBJECTIVE: The aims of this study were to assess the postoperative health-related quality of life (QOL) and care needs of oral cancer patients comprehensively and to evaluate the correlation between health-related QOL and care needs. INTERVENTIONS/METHODS: This cross-sectional study enrolled 126 oral cancer patients who had received surgical treatment within the previous 2 years and were without cognitive impairment. Each patient completed a demographic questionnaire, the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Scale, and the Short-Form Cancer Needs Questionnaire. RESULTS: Female patients and patients receiving 3 or more chemotherapy treatments were significantly associated with increased Short-Form Cancer Needs Questionnaire scores (higher level of care needs) (ß = 0.177 and 28.49, both P < .05) and patients receiving 3 or more chemotherapy treatments were significantly associated with increased Head and Neck Cancer Quality of Life Scale scores (higher level of symptoms and problems) (ß = 27.77, P = .007). Results of stepwise multiple linear regression analysis indicated that 4 oral cancer-related symptoms and problems, "trouble with social contacts," "swallowing problems," "teeth problems," and "feeling ill," were significantly associated with higher care needs in oral cancer patients (all P ≤ .05). CONCLUSION: A significant correlation exists between health-related QOL and care needs. IMPLICATIONS FOR PRACTICE: Using a valid health-related QOL scale may help nurses determine their perceived physical and psychological care needs.

Effect of a comprehensive plan for periodontal disease care on oral health-related quality of life in patients with periodontal disease in Taiwan.

A comprehensive plan for periodontal disease (PD) care in Taiwan provides non-surgical and supportive periodontal treatment. The aim of this study was to determine whether the care plan could improve the oral health-related quality of life of patients with PD.This study was conducted by purposive sampling and a quasi-experimental design. Patients with PD were assigned to either comprehensive periodontal treatment (n = 32) or a simple cleaning regimen (n = 32). Their oral health-related quality of life (OHRQoL) was measured using the Taiwanese version of the Brief World Health Organization Quality of Life (WHOQOL-BREF) scale (general QoL) and the Oral Health Impact Profile (OHIP-14) (OHRQoL). Both scales were completed 14, 28, and 90 days after the initial assessment. The extent of PD in the experimental group was determined again at the end of the study.On the 28-item WHOQOL-BREF scale, the scores of the experimental group were higher than those of the control group on 5 items and the environmental domain at 14 days. There was a significant improvement in the experimental group on 2 items at 28 days and at 90 days after periodontal treatment (both P < .05). No difference was found between the 2 groups in score on the OHIP-14; however, there was a significant improvement in the experimental group in total score at 28 and 90 days after periodontal treatment (both P < .05). The number of teeth with probing depth ≥5 mm and the percentage of dental plaque were both significantly reduced after the intervention (both P < .001).Patients with a comprehensive plan for PD care showed some improvement in QoL, including in the environmental domain, and on the total score for OHRQoL. Comprehensive periodontal treatment also alleviated periodontal symptoms.

Associations between dental anxiety and postoperative pain following extraction of horizontally impacted wisdom teeth: A prospective observational study.

The aim of the study is to identify associations between dental anxiety and postoperative pain in patients undergoing extraction of horizontally impacted wisdom teeth.A total of 119 volunteers provided demographic data, and completed questionnaires, the State-Trait Anxiety Inventory (STAI), Chinese Index of Dental Anxiety and Fear (C-IDAF)-4C, and the Numeric Rating Scale (NRS) for pain.Mean SAI, TAI, and C-IDAF-4C scores were 42.5 ±â€Š8.7, 46.4 ±â€Š10.9, and 16.9 ±â€Š7.2, respectively. Mean postoperative pain level score was 3.0 ±â€Š1.8 (range: 0.3-8.4). SAI scores increased as preoperative pain levels increased (ß = 1.30, 95% confidence interval [CI]: 0.62-1.98, P < .001); females had higher SAI scores than males (5.34; 95% CI: 1.74-8.95, P = .004). Multivariable analysis revealed that females, bad exodontic experience, and higher predicted pain levels were associated with higher IDAF-4C scores. SAI scores (γ = 0.611, P < .001) and TAI scores (γ = 0.305, P < .001) increased as C-IDAF-4C scores increased. Higher C-IDAF-4C scores and longer operative time were significantly associated with higher levels of postoperative pain.Specific factors are associated with anxiety and stress, and postoperative pain in patients undergoing wisdom teeth extraction. Addressing these factors preoperatively may reduce stress and anxiety, and lead to more favorable treatment outcomes.

Effect of oral health education programs for caregivers on oral hygiene of the elderly: A systemic review and meta-analysis.

OBJECTIVES: To evaluate the effects of oral health education for caregivers on the oral health status of the elderly. DESIGN: A systematic review and meta-analysis. DATA SOURCES: The Medline, EMBASE, Cochrane Library (CENTRAL), PsycINFO, CINAHL were searched up to September, 2014. REVIEW METHODS: Randomized controlled trials or comparative before-and-after studies involving an oral health education program for caregivers of the elderly (≥65 years old) were identified by two independent reviewers. Primary outcome was the percentage of patients with normal mucosa in the oral cavity. The secondary outcomes were the percentage of patients with no visible plaque and the percentage of patients without denture stomatitis. RESULTS: A total of five studies, involving 602 elders, met the eligible criteria for inclusion in the meta-analysis. It was found that the percentage of residents with normal oral mucosa (odds ratio (OR)=1.81, P=0.027), no visible plaque (OR=1.54, P=0.001), and no detectable denture stomatitis (OR=2.89, P<0.001) significantly increased after the group was treated by caregivers who had received a recent oral health education program. CONCLUSIONS: The systemic review and meta-analysis found limited evidence that oral health education for caregivers may be effective for improving the oral health of the elderly.

Effects of periodontal therapy on metabolic control in patients with type 2 diabetes mellitus and periodontal disease: a meta-analysis.

Epidemiologic studies have reported increased incidence, prevalence and acuity of periodontitis in adults with diabetes and some have also suggested that treating periodontal disease may improve glycemic control in diabetic patients. This meta-analysis was conducted to evaluate the effects of different periodontal therapies on metabolic control in patients with type 2 diabetes mellitus (T2DM) and periodontal disease. We searched the Medline, EMBASE and Cochrane Library (Central) databases up to January 2014 for relevant studies pertaining to periodontal treatments and glycemic control in adults with T2DM. The search terms were periodontal treatment/periodontal therapy, diabetes/diabetes mellitus, periodontitis/periodontal and glycemic control. The primary outcome measure taken from the included studies was glycated hemoglobin (HbA1c). We compared differences in patients' pre- and post-intervention HbA1c results between a treatment group receiving scaling and root planing (SRP) combined with administration of oral doxycycline (n=71) and controls receiving SRP alone or SRP plus placebo (n=72). Meta-analysis was performed using Comprehensive Meta Analysis software. Nineteen randomized controlled trials (RCTs) were identified. Four trials involving a total of 143 patients with T2DM and periodontal disease were determined to be eligible for analysis. Data of 1 study were not retained for meta-analysis because HbA1c results were recorded as median with IQR. Meta-analysis of the included 3 studies revealed no significant differences in HbA1c results between the periodontal treatment group (n=71) and control group (n=72) (HbA1c SMD=-0.238, 95% CI=-0.616 to 0.140; P=0.217). Systemic doxycycline added to SRP does not significantly improve metabolic control in patients with T2DM and chronic periodontitis. Current evidence is insufficient to support a significant association between periodontal therapy and metabolic control in this patient population. However, evidence suggests that periodontal therapy itself improves metabolic control and reinforces that T2DM is a risk factor for periodontitis.

Investigating tooth loss and associated factors among older Taiwanese adults.

The aim of this study was to evaluate factors associated with tooth loss in older Taiwanese adults with different numbers of remaining teeth. This study evaluated oral health status and tooth loss among 2286 adults aged over 65. Subjects were classified according to number of teeth (Group 1 <20 teeth vs. Group 2 ≥20 teeth). Tooth loss and oral health data were collected from the National Health Interview Survey (NHIS), compared between groups and analyzed by multivariate modeling. Group 1 subjects were older and had more partial dentures. Tooth loss was associated with self-limited food choices due to oral health status, and malnutrition. Tooth loss in Group 2 subjects was significantly associated with lower mental status. Tooth loss may predict cognitive status (odds ratio (OR) 1.30) and physical-disability (OR 1.79). Our results suggested that tooth loss was associated with age, more partial dentures, self-limited food choices, malnutrition, and lower mental and cognitive status and physical disability.

Assessing the effects of oral health-related variables on quality of life in Taiwanese adults.

PURPOSE: The impact of oral health status on Taiwanese adults' quality of life has not been measured definitively. This study evaluated the effects of oral health-related variables on quality of life among adults in Taiwan. METHODS: A cross-sectional study design with secondary database analysis was adopted. Information about oral health-related variables in adults aged 18-64 years was collected from the National Health Interview Survey and quality-of-life data from the Short-Form Health Survey (SF-36). Univariate and multivariate regression analysis was used to determine risk factors for oral health and associations between oral health and eight domains of quality of life defined by the SF-36. RESULTS: Gender (P < 0.001), marital status (P < 0.001), monthly income (P < 0.001), disease history (P < 0.001), betel nut chewing (P < 0.001), oral hygiene (P < 0.001), oral health status (P < 0.001), and dental care utilization (P = 0.001) had significant effects on general health as an aspect of quality of life; gender (P < 0.001), marital status (divorced, P < 0.001), income level (20,000-80,000 NTD, P < 0.001), disease history (P < 0.001), oral hygiene, oral health-related food choice limitations (P < 0.001), and dental care utilization (P < 0.001) had significant effects on general mental health. Subjects who practiced dental self-care with tooth brushing had significantly higher social functioning scores than those who did not (P < 0.001). Significant differences were also found in scale items for physical functioning, role limitations due to physical health, bodily pain, vitality, and role limitations due to emotional problems (all P < 0.001). CONCLUSIONS: Demographic (i.e., age, gender, and marital status and income levels) and oral health-related factors (i.e., oral hygiene, dental visits, disease history, and lifestyle factors such as cigarette smoking, alcohol use, and betel nut chewing) are all significantly associated with oral health-related quality of life in Taiwanese adults.