Multimedia information intervention and its benefits in partners of the head and neck cancer patients.

We aimed to investigate the levels of anxiety, depression, satisfaction with information provision and cancer-related knowledge in partners of head and neck cancer (HNC) patients receiving a Multimode Comprehensive Tailored Information Package (MCTIP). A non-randomised, controlled trial was conducted with partners of HNC patients recruited at two academic hospitals in Montreal. The Test participants received the MCTIP, while the Control participants received information in an ad hoc manner. All participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), Satisfaction with Cancer Information Profile and a cancer knowledge questionnaire at baseline, and 3 and 6 months later. Data were analysed using descriptive statistics, t-test and chi-square test, and mixed model analysis to test the impact of the intervention. A total of 31 partners of HNC patients participated in this study and completed all the evaluations. The partners in the Test group experienced significantly lower levels of anxiety (P = 0.001) and depression (P = 0.003) symptoms and were more satisfied (P = 0.002) with cancer information provided than partners in the Control group. Providing tailored information seems to have positive outcomes regarding anxiety, depression, and satisfaction in partners of HNC patients. Larger randomised studies are warranted to validate these effects.

Reproducibility and diagnostic outcomes of two visual-tactile criteria used by dentists to assess caries lesion activity: a cross-over study.

UNLABELLED: The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment. TRIAL REGISTRATION: ISRCTN65592532.

Salivary Cortisol and Anxiety in Canadian Dentists over 1 Year of COVID-19.

The dental profession has endured unprecedented disruption amid COVID-19. Novel stressors have included a high risk of occupational exposure to COVID-19, financial losses, and stricter infection prevention and control requirements. The present study investigated the longitudinal impact of COVID-19 on the stress and anxiety levels of a cohort of Canadian dentists (N = 222) between September 2020 and October 2021. Salivary cortisol was selected as a biomarker of mental stress, and 10 sets of monthly saliva samples (2,131 in total) were self-collected, sent to our laboratory in prepaid courier envelopes, and analyzed by enzyme-linked immunosorbent assay. To assess COVID-19 anxiety, 9 monthly online questionnaires were administered, comprising a general COVID-19 anxiety instrument and 3 items regarding the impact of dentistry-related factors. Bayesian log-normal mixed effect models were fitted to estimate the longitudinal trajectory of salivary cortisol levels and their association with the disease burden of COVID-19 in Canada. After accounting for age, sex, vaccination status, and the diurnal rhythm of cortisol secretion, a modest positive association was found between dentists' salivary cortisol levels and the count of COVID-19 cases in Canada (96% posterior probability). Similarly, the self-reported impact of dentistry-related factors, such as fear of getting COVID-19 from a patient or coworker, was greatest during peaks of COVID-19 waves in Canada; however, general COVID-19 anxiety decreased consistently throughout the study period. Interestingly, at all collection points, the majority of participants were not concerned about personal protective equipment. Overall, participants reported relatively low rates of psychological distress symptoms in relation to COVID-19, a result that should be reassuring for the dental community. Our findings strongly suggest a link between self-reported and biochemical measurements of stress and anxiety in Canadian dentists during the COVID-19 pandemic.

Tooth erosion with low severity does not impact child oral health-related quality of life.

BACKGROUND: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, no study has addressed the impact of this condition on child oral health-related quality of life (COHRQoL). This study assessed the impact of tooth erosion on COHRQoL. METHODS: This study followed a cross-sectional design, with a multistage random sample of 944 11- to 14-year-old children representative of Santa Maria, a southern city in Brazil. They were examined for recording the prevalence and severity of tooth erosion by 2 examiners. Children completed the Brazilian version of Child Perceptions Questionnaire (CPQ(11-14)) and data about socioeconomic variables of the target population were collected by means of a structured questionnaire. The Poisson regression model using robust variance was performed to assess the association between the predictor variables and the outcomes. RESULTS: Prevalence of tooth erosion (7.2%) and severity were low. Poisson regression models showed a distinct gradient in mean CPQ(11-14) scores by socioeconomic indicators. Children with tooth erosion with low levels of severity did not report higher means in the total scores or domains of CPQ(11-14). CONCLUSION: The presence of tooth erosion of low severity did not have a significant negative impact on the children's perception of oral health or on their daily performance.

Relationship between mothers' sense of coherence and oral health status of preschool children.

OBJECTIVE: The aim of the present study was to investigate the relationship between mothers' sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. METHODS: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky's SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. RESULTS: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01-2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06-3.77) or filled teeth (OR = 1.85, 95% CI = 1.12-3.06) regardless of the child's social class and gender. CONCLUSION: The data indicate that mothers' SOC is an important psychosocial determinant of the oral health status among preschool children.

Family Impact Scale (FIS): psychometric properties of the Brazilian Portuguese language version.

AIM: Evaluate the psychometric properties of the Brazilian version of the Family Impact Scale (FIS). METHODS: Following translation and cross-cultural adaptation, the FIS was tested on 123 parents-caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents were recruited from the Paediatric Dental and Orthodontic clinics where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. RESULTS: The mean FIS score was 6.97 (SD 7.81) for the dental caries group and 7.25 (SD 7.70) for the malocclusion group. The FIS score was unable to discriminate different family impact caused by children's oral health conditions. Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.79. Test-retest reliability revealed good reproducibility (ICC 0.83). Construct validity was good, demonstrating highly significant correlations between parent's perceptions regarding the overall wellbeing indicator for their children and the total FIS and subscales. Financial burden demonstrated no significant correlation with global indicators. CONCLUSIONS: Overall psychometric results for the Brazilian version of the FIS confirm it as a reliable, valid questionnaire for assessing the family impact caused by children's oral conditions.

Preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10.

AIM: The aim of the study was to perform a preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10 (CPQ 8-10). METHODS: The sample used to test the measurement equivalence was made up of 59 children from 8 to 10 years of age at the Federal University of Minas Gerais, Brazil. The CPQ 8-10 was administered, and clinical exams were performed by a single examiner, calibrated for the diagnosis of dental caries (Kappa= 0.98) and malocclusion (weighted Kappa and intraclass correlation coefficient = 0.66-1.00). The children were divided into three groups according to their clinical condition (22 with cavitated carious lesions; 20 with malocclusion; 17 with both oral conditions). STATISTICS: The internal consistency of the instrument was assessed by Cronbach's alpha Coefficient. The Intraclass correlation coefficient (ICC) was used for the test-retest reliability (40 children). Discriminant validity was determined using the Kruskal-Wallis test. RESULTS: An assessment of the psychometric properties revealed the instrument to be reliable (Cronbach's alpha=0.92 for the total scale and 0.63-0.85 for the subscales), exhibiting excellent stability (ICC=0.96 for the total scale and 0.79-0.95 for the subscales). Construct validity was demonstrated through the significant correlations between the global indicators and subscales. There were statistically significant differences between the clinical groups regarding the total scale, thereby demonstrating discriminant validity (p=0.03). CONCLUSIONS: The preliminary validation of the Brazilian version of the CPQ 8-10 showed valid and reliable for use on Brazilian children.

Life-course epidemiology: concepts and theoretical models and its relevance to chronic oral conditions.

Etiological models that predominantly emphasize current adult life styles, such as smoking, diet and lack of exercise have recently been seriously challenged by a growing body of evidence that disturbed early growth and development, childhood infection, poor nutrition, and social and psychosocial disadvantage across the life-course affect chronic disease risk, including chronic oral disease. This relatively new area of research is called life-course epidemiology. The life-course framework for investigating the aetiology and natural history of chronic disease proposes that advantages and disadvantages are accumulated throughout life generating differentials in health along the life-course, but most importantly later in life. Furthermore, its dynamic framework brings together the effects of intrinsic factors (individual resources) with extrinsic factors (environmental factors). The aim of this paper is to give an overview of this new epidemiological approach and to discuss how the life-course framework has been applied to chronic oral conditions.

Chewing indicators between adults with Down syndrome and controls.

Down syndrome induces a neuromotor deficiency that affects the orofacial musculature, and thus could be implicated in the feeding difficulties affecting people with this disease. This study aimed to investigate the differences in chewing indicators between a group of 11 adults with Down syndrome and a group of 12 healthy subjects without Down syndrome. Chewing ability was evaluated by means of video recordings taken during a standardized meal that included 10 natural foods. The variables collected were masticatory time, number of masticatory cycles, chewing frequency, number of open masticatory cycles, and number of food refusals. There were several differences in both directions for masticatory time and number of masticatory cycles between the two groups. In addition, with the exception of purée, the group with Down syndrome had significantly lower mean chewing frequency than the reference group, and was unable to eat all the foods presented.

Clinical evaluation of mastication: validation of video versus electromyography.

BACKGROUNDS AND AIMS: The ability to evaluate masticatory function in people with neurological disabilities is important as this function is often compromised in these groups. However, current standard techniques are often impossible in such groups due to cognitive difficulties. This study is a validation of several variables read from standardised video recordings of mastication as indicators of masticatory function. METHODS: Fifteen healthy, fully dentate male subjects were recorded using EMG and by video simultaneously. An evaluation was undertaken of the video parameters (i) to compare their validity against the electromyographic parameters, (ii) to test intra-rater and inter-rater reliability and (iii) to test the ability to discriminate between four model foods differing in hardness. RESULTS: Masticatory time and the number of masticatory cycles counted on video were found to be valid and reliable indicators. In addition, the number of active chewing cycles performed with an open mouth and identification of the chewing side, were found to have reasonable validity and reliability. The former may allow discrimination between food types. CONCLUSION: As an alternative to the complex evaluation of masticatory function, observation of certain parameters from video recording could be an alternative for use in uncooperative patients.

Cloning and sequencing of a gene encoding pyruvate kinase from Schizosaccharomyces pombe; implications for quaternary structure and regulation of the enzyme.

A cDNA encoding pyruvate kinase from Schizosaccharomyces pombe has been isolated from a lambda ZAPII library. This cDNA was sequenced and found to contain an open reading frame of 1524 nucleotides, giving a predicted protein subunit M, of 55470. The sequence shows a high degree of identity with other pyruvate kinase sequences, with residues implicated in the binding of substrate and metal ion co-factors conserved. However, there are significant differences in the putative subunit interface and effector binding regions which may account for the unusual quaternary structure and regulatory properties of the S. pombe enzyme.

Alcohol consumption is associated with improved health-related quality of life in head and neck cancer patients.

The study aim was to investigate the relationship between alcohol consumption and health-related quality of life (HRQL) in post-therapeutic head and neck cancer patients. A cross-sectional study design was used with a sample of 191 subjects. Data were collected through interview and chart review. Alcohol consumption was evaluated through the dichotomous response to the question "During the past month have you drunk alcohol on one or more occasions?" HRQL was evaluated through the EORTC QLQ-C30 and H&N35 instruments. Data were also collected concerning sociodemographic and clinical variables. Multivariate regression was used to evaluate the hypothesized association. Of 28 domains comprising the EORTC QLQ-C30 and H&N35 instruments, eight were significantly associated with alcohol consumption, while 19 of the 20 remaining domains showed a tendency towards an association. Alcohol drinking was associated with significantly better physical and role functioning, and better global HRQL, plus less fatigue, pain, problems swallowing, dry mouth and feelings of illness. This suggests that, while the study findings are limited by its design and the sample bias, despite alcohol's role as an aetiological factor, it may be reasonable to drink a little as one recovers from head and neck cancer.

Factors associated with smoking and alcohol consumption following treatment for head and neck cancer.

The study aim was to investigate the correlates of smoking and alcohol drinking in post-therapeutic head and neck (H&N) cancer patients. A cross-sectional design was used with a sample of 191 patients. Data were collected by interview and chart review. Multiple logistic regression analysis was used to evaluate the correlates of dependent variables. Higher education, living with one's partner, later stage, laryngeal site and having surgery or combined therapy were associated with decreased odds for smoking. There was a significant trend for decreasing odds for smoking with increasing stage. Male gender, stage I disease and longer time since treatment were associated with increased odds for drinking alcohol. There was a significant trend for increased odds for drinking with increased time since treatment. These findings suggest that smoking and alcohol drinking have different patterns of associated variables in post-therapeutic H&N cancer patients, which has important implications for intervention design.

The relationship between dental status and health-related quality of life in upper aerodigestive tract cancer patients.

Although the oral sequelae of treatments for upper aerodigestive tract (UADT) cancers have been well described, very little is known about the relationship between dental status and health-related quality of life (HRQL) in patients with UADT cancer. The aim of this study was to investigate the hypothesis that dental status is a predictor of HRQL in a sample of post-therapeutic UADT cancer patients. A cross-sectional study design was used with a sample of 188 subjects. HRQL was evaluated through the global domain of the EORTC QLQ-C30 instrument and data were collected on sociodemographic, disease, treatment and dental status variables. Linear multiple regression analysis was used to determine those variables with a significant independent association with the HRQL. Two multivariate models were developed each containing age, gender, employment status, cancer site and disease stage, plus either the dental status category "partially dentate with no prosthesis" (P/NP) (F-value for model = 7.31; P < 0.0001; r2 = 0.20) which predicted a significantly worse HRQL, or the dental status category "edentulous with prostheses" (E/WP) (F-value for model = 7.56; P < 0.0001; r2 = 0.20) which predicted a significantly better HRQL. Furthermore, the P/NP group reported significantly more "problems with their teeth" (ANOVA, P = 0.0004), significantly more "trouble eating" (ANOVA, P = 0.024) and significantly more "trouble enjoying their meals" (ANOVA, P = 0.01). Although the cross-sectional nature of the data collection and the somewhat crude nature of the dental status variable limit inferences, the results of this study suggest that dental status has an important effect on HRQL in post-therapeutic UADT cancer patients.

Teaching head and neck cancer patients coping strategies: results of a feasibility study.

To test the feasibility of providing a psycho-educational intervention for people with head and neck (H&N) cancer. A prospective non-randomized design was used. Subjects were patients with H&N cancer. They were offered the Nucare coping strategies program in one of three formats: small group and one-to-one formats with therapists; and a home format, with material for home use, without a therapist. Outcomes measures (quality of life (QOL) and anxiety and depression) were collected at baseline and following the intervention. Analyses were performed using non-parametric statistics. Of 128 people invited to participate, 66 agreed, 59 completed the intervention and 50 had outcomes data. Following the intervention, there were significant improvements in physical and social functioning and global QOL, and reduced fatigue, sleep disturbance and depressive symptoms. These data suggest that the intervention may have some beneficial effects, although an appropriately designed study is required to confirm this.

Quality of life: a dynamic construct.

The principle of Einstein's theory of special relativity is that an observer of an apparently moving body cannot be sure if the body really has moved, if he/she has moved or if both events have occurred. Although Einstein was discussing physical events, a similar hypothesis may apply to quality of life. When using quality of life instruments, one presumes that the point of reference (the observer in Einstein's terms) does not move, i.e. that an individual's attitude towards a particular construct will remain stable. Otherwise, changes in response to particular variables cannot be interpreted. However, attitudes are not constant: they vary with time and experience and are modified by such psychological phenomena as adaptation, coping, expectancy, optimism, self-control and self-concept. For example, eating problems may be extremely important at one point in a person's life. However, when oral discomfort has been diagnosed as cancer and treated with surgery or radiation, the same individual may "objectively" demonstrate more problems when eating, but report them as less because they have now become relatively unimportant. Furthermore, paradoxical reports that some groups of ill individuals rate their quality of life higher than do "healthy" persons raise similar questions concerning between-group point of reference differences. Investigators in the fields of organisational management, education and psychology have developed techniques such as "then ratings", saliency indicators and individualised questionnaires in attempts to quantify within-subject variability and between-group differences pertaining to point of reference. We suggest that similar methods may help us to measure change in the impact of the different items of quality of life instruments. In this paper, we will describe the theories of change associated with quality of life measurement. In addition, we will present evidence suggesting that the point of reference does change, the reasons for this and possible solutions to the problem.

Health-related quality of life comparisons in French and English-speaking populations.

OBJECTIVE: A comparison of health-related quality of life (HRQL) outcomes across three culturally different groups of head and neck (H&N) cancer patients. BASIC RESEARCH DESIGN: A cross-sectional study design with convenience samples. PARTICIPANTS: Study subjects were English- and French-speaking H&N cancer patients recruited in Quebec and France. INTERVENTION: Subjects completed EORTC QLQ-C30 and H&N35 HRQL instruments 3-6 months following the completion of cancer therapy. The former (the core instrument) is a HRQL instrument designed to be used as an outcome measure in patients with any form of cancer, while the latter instrument (the H&N module) is an outcome measure specific to people with H&N cancer. Both instruments are designed to generate domain scores rather than an overall evaluation. The core instrument has 15 domains and the H&N module 18. RESULTS: In the second study, of 33 HRQL domains tested, only 'head and neck pain' and 'constipation' were associated significantly with cultural background, with French-speaking Canadians reporting higher levels of both. CONCLUSION: This study suggests that cultural background is not related to the large majority of HRQL domains assessed by the EORTC QLQ-C30 and H&N35 instruments, thereby enabling international comparisons of (oral) HRQL.

The oral assessment in Down syndrome questionnaire (OADS): development of an instrument to evaluate oral health problems in individuals with Down syndrome.

OBJECTIVE: To develop a French language instrument whose primary aim is the description of oral health status in Down syndrome (DS) individuals. METHOD: Due to the reduced intellectual capacity in DS individuals, the instrument was designed to be completed by their parents. Items were generated through a literature review plus interviews with relevant professionals and DS parents. Following pilot testing, the 31-item questionnaire was divided into seven domains (access, function, development, signs, pain, disability and a global evaluation of oral health status), and subjected to a psychometric evaluation of internal reliability, test-retest reliability and discriminant validity. Internal reliability was assessed through evaluation of Cronbach's alpha or the Kuder-Richardson-20 value where appropriate. Test-retest reliability was assessed through the evaluation of the intra-class correlation coefficient (ICC) for each domain. Discriminant validity was assessed through evaluations of hypothesised differences in domain scores between different groups of DS individuals by age and between DS and non-DS individuals. The theoretical domain categorisation was empirically evaluated through the generation of inter-item correlation coefficients. RESULTS: Internal reliability coefficients ranged from 0.43 for the disability domain to 0.83 for the function domain, while the domain ICCs ranged from 0.56 to 0.77 for the signs and function domains respectively. For discriminant validity, the domains largely performed as hypothesised. Finally, inter-item correlation coefficients largely supported the proposed domain structure of the questionnaire. CONCLUSION: This investigation of the psychometric properties of a proxy. French language, assessment of oral health problems in the DS population has demonstrated an instrument with good preliminary indicators of reliability and validity.

A study of the dietary fluoride supplementation prescribing pattern of south Glamorgan dentists.

Following the inclusion of dietary fluoride supplements in the Dental Practitioners Formulary on 1st January 1993, the aims of this study were to observe the fluoride supplementation prescribing pattern of South Glamorgan general dental practitioners and relate it to the latest caries prevalence data. The analysis was carried out on the prescribers and recipients of the prescriptions using post codes to locate all members of both groups into one of 26 dental planning areas (DPA) within the district. As the age of a minority of recipients could not be substantiated, an assumption that they were all 14 years or under was used to calculate a prescription to population ratio for each DPA. These ratios were correlated against the latest available caries prevalence data for each DPA to ascertain any relationship between the level of fluoride supplement prescription and the caries prevalence within South Glamorgan. Data were collected via the Prescription Pricing Division of Welsh Health Common Services Authority for the six month period, 1st January to 30th June 1993. Of 623 prescriptions dispensed within South Glamorgan, 581 were issued by dentists working in the District for patients living in the District. Of the 163 dentists registered within South Glamorgan FHSA, (boundary coterminous with the DHA) 49 made one or more prescription. Of these, 10 dentists wrote 20 prescriptions or more, totalling 401, during the study period, i.e. 6 per cent of the dentists made 69 per cent of the prescriptions. The correlation of the number of prescriptions issued per DPA (according to the dentists' location) with whole time equivalents in that DPA was 0.58 (P < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)