Validity and reliability of the COVID-19 Anxiety Syndrome Scale in Canadian dentists.

BACKGROUND: The COVID-19 pandemic has resulted in a high level of mental health problems for the population worldwide including healthcare workers. Several studies have assessed these using measurements for anxiety for general populations. The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a self-report measure developed to assess maladaptive forms of coping with COVID-19 (avoidance, threat monitoring and worry) among a general adult population in the United States. We used it in a prospective cohort study of COVID-19 incidence rates in practising Canadian dentists. We therefore need to ensure that it is valid for dentists in French and English languages. This study aimed to evaluate the validity of the C-19ASS in that population. METHODS: Cross-sectional data from the January 2021 monthly follow-up in our prospective cohort study were used. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. RESULTS: The results of EFA revealed a 2-factor structure solution that explained 47% of the total variance. The CFA showed a good model fit on the data in both English and French languages. The Cronbach's alpha indicated acceptable levels of reliability. Furthermore, the C-19ASS showed excellent divergent validity from the Generalized Anxiety Disorder-7 (GAD-7) scale. CONCLUSIONS: The C-19ASS is valid and reliable instrument to measure COVID-19-related anxiety in English and French among Canadian dentists. PRACTICAL IMPLICATIONS: This validated measure will contribute to understanding of the mental health impact of the pandemic on dentists in Canada and enable the dental regulatory authorities and organizations to intervene to help dentists.

Information service in head and neck cancer care-a qualitative study.

AIM: We aimed to understand how information was delivered to head and neck (H&N) cancer patients and describe the perceptions of the H&N patients concerning information delivery. METHODOLOGY: This qualitative investigation was a part of our larger quantitative study that was conducted with H&N cancer patients at two academic hospitals in Montreal. After obtaining the ethical approval, a purposeful sample of participants was recruited from the main study until the content of the information gathered reached saturation. Data were collected by observing the information delivery and interviewing the study participants and Nurse Pivots. All observations and interviews were audiotaped. Data were transcribed verbatim; transcripts were developed, audited, and subjected to a thematic analysis. RESULTS: Eleven H&N patients participated in the study. We found that the doctors were the main source of information at both hospitals; one hospital delivered information systematically to every patient using a multimedia-based information disseminating tool while the second hospital delivered information verbally in an ad hoc manner. Those who received information using the multimedia tool understood what was said to them and were better prepared for the next step, while those who received information verbally did not retain much, were confused, and expressed dissatisfaction. CONCLUSIONS: Although the doctors were the main source of information, patients experience difficulties in understanding what was said to them. Comprehensive information together with audiovisuals, when provided to H&N cancer patients based on their needs, seems to improve their understanding of their cancer and prepare them for their treatment.

Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges.

BACKGROUND: Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance. METHODS: We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists' experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation. RESULTS: Dentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government's duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them. CONCLUSIONS: The efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.

Caries lesions progression in adults: A prospective 2-year cohort study.

OBJECTIVE: Dental caries is one of the most prevalent chronic non-communicable diseases worldwide. There is a lack of evidence, especially in adult populations, documenting caries disease progression considering lesion severity, activity and tooth surface-level characteristics. The study aimed to investigate the extent to which primary active caries lesions in adults affect caries lesions progression compared with inactive caries lesions over a 2-year follow-up period, considering their severity, surface and tooth type. METHODS: A prospective study data set from a cohort of workers in a factory in Belarus were used. Participants aged 18-64 years with 20 or more natural teeth were included in the study. The participants were clinically examined twice within an interval of 2 years and completed a self-reported questionnaire. One calibrated examiner evaluated caries lesions using the International Caries Detection and Assessment System (ICDAS) and the Nyvad system. The primary outcome was caries lesions' progression. The lesion was classified as 'progressed' if it turned to a more advanced severity stage, was restored or missing/extracted due to caries. A multilevel Poisson regression was used to estimate the association between baseline caries lesions' characteristics and caries lesion progression. RESULTS: Out of 495 participants, 322 people completed clinical examinations at baseline and 2 years later, with an attrition rate of 35%. The prevalence of active DS1-6 and DS5-6 lesions at the baseline was 83.8% and 64.8%, respectively. In 2 years, 24% of active non-cavitated and 31% of active micro-cavitated/shadowed caries lesions progressed, while 15% of inactive caries lesions, non- or micro-cavitated/shadowed, progressed. The adjusted rate ratio (RR) for ICDAS3 + 4 caries lesions progression was 1.41 (CI 95% 1.16, 1.70) than ICDAS1 + 2 lesions. The RR for ICDAS1 + 2, active and ICDAS3 + 4, active lesions was 1.78 (CI 95%, 1.40, 2.27) and 1.97 (CI 95%, 1.53, 2.55), respectively than ICDAS1 + 2, inactive lesions. The RR for caries lesions progression on proximal surfaces and on pits and fissures was 1.57 (CI 95%, 1.30, 1.89) and 1.37 (CI 95%, 1.11, 1.67), respectively than smooth surface lesions. CONCLUSION: In caries active adults over 2 years, most non- and micro-cavitated/shadowed active and inactive caries lesions did not progress. Among caries lesions that showed progression, more severe lesions were more likely to progress than less severe lesions; active lesions were more likely to progress than inactive lesions. Pit and fissure caries lesions and proximal lesions were more likely to progress than smooth surface lesions.

Investigating the perceptions and experiences of Canadian dentists on dental regulatory bodies' communications and guidelines during the COVID-19 pandemic.

OBJECTIVE: Dental regulatory bodies aim to ensure the health and safety of dentists, dental staff patients and the public. An important responsibility during a pandemic is to communicate risk and guidelines for patient care. Limited data exist on the perceptions and experiences of dentists navigating new guidelines for mitigating risk in dental care during the pandemic. The objective of this study was to use a qualitative approach to explore how dentists in Canada experienced and perceived their regulatory bodies' communication about COVID-19 risks and guidelines during the pandemic. METHODS: Participants were Canadian dentists (N = 644) recruited through the email roster of nine provincial dental associations or regulatory bodies. This qualitative analysis was nested within a prospective longitudinal cohort study in which data were collected using online questionnaires at regular intervals from August 2020 to November 2021. To address the objective reported in this paper, a conventional qualitative content analysis method was applied to responses to three open-ended questions included in the final questionnaire. RESULTS: Participants encountered challenges and frustrations amid the COVID-19 pandemic, grappling with diverse regulations and communications from dental bodies. While some bodies offered helpful guidance, many participants felt the need for improved communication on guidelines. Dentists urged for expedited, clearer and more frequent updates, expressing difficulty in navigating overwhelming information. Negative views emerged on the vague and unclear communication of COVID-19 guidelines, contributing to confusion and frustration among participants. CONCLUSION: As COVID-19 persists and in planning for future pandemics, these experiential findings will help guide regulatory bodies in providing clear, timely and practical guidelines to protect the health and safety of dentists, dental staff, patients and the public.

Cross-cultural adaptation and validation of a Brazilian version of an instrument to assess impairments related to oral functioning of people with Down syndrome.

BACKGROUND: An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity. FINDINGS: After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers' educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05). CONCLUSIONS: Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil.

How health professionals perceive and experience treating people on social assistance: a qualitative study among dentists in Montreal, Canada.

BACKGROUND: In Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance. METHODS: This descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists' offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study. RESULTS: Dentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists' willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement. CONCLUSIONS: The current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions.

Oral pain and its covariates: findings of a Canadian population-based study.

OBJECTIVE: To describe the prevalence of oral pain in Canada and to identify its covariates. METHODS: Data were derived from the 2007-2009 Canadian Health Measures Survey. Data were analyzed for a total of 5284 respondents (2558 males, 2726 females) aged 6-79 years. The outcome variable was self-reported pain in the mouth in the past 12 months. Bivariate and multivariate analyses were used to investigate the relationship between oral pain and 4 sets of covariates: socio-demographic factors, dental service utilization, oral health behaviours and clinical oral health. RESULTS: Oral pain in the past 12 months was reported by 11.7% of respondents. Oral pain was slightly, but not significantly, more prevalent among females than males (13.6% vs. 10.0%). The lowest and highest prevalence of oral pain were reported by children and young adults, respectively. Multivariate analyses suggested that oral pain was significantly more prevalent among adolescents and adults, those in the lowest income groups, those who avoided a dental professional because of the cost and those with untreated decayed teeth. CONCLUSION: Canadians with financial barriers to accessing dental care and those with untreated dental decay were at risk of having dental pain. These findings have important implications for the provision of dental care in Canada.

Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic.

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

Coping and psychological distress among head and neck cancer patients.

INTRODUCTION: Few studies have described the relationship between the psychological distress associated with head and neck cancer and how patients cope with their disease. PURPOSE: The purpose of this study is to investigate how head and neck cancer patients 6-12 months after their diagnosis cope with their disease and how their coping skills are related to their anxiety and depression levels. METHODS: We conducted a cross-sectional study among 157 head and neck cancer patients. We evaluated coping strategies using the Ways of Coping Checklist and anxiety and depression using The Hospital Anxiety and Depression Scale. RESULTS: Bivariate analyses revealed that there was an association between patients' levels of anxiety and depression and the type of coping strategies used. Patients with higher levels of anxiety and depression used more "blamed self", "wishful thinking", and "avoidance" coping strategies. These associations were further confirmed by multivariate linear regression analyses that controlled for age, gender, time since end of treatment, tumor stage, and occupation. CONCLUSION: These findings suggest that coping strategies in head and neck cancer patients vary according to their level of psychological distress. However, the cross-sectional nature of the data does not permit directional inferences for this association.

Delivering dental care as we emerge from the initial phase of the COVID-19 pandemic: teledentistry and face-to-face consultations in a new clinical world.

At a time when access to health care and services for the global population is a concern due to the COVID-19 pandemic, health professionals and their teams are struggling to find a way to adapt their practices. Dental professional organizations and decision-makers are required to provide guidance in a rapidly evolving environment based on the current data, available research, and existing knowledge. Continuous progress in the information communication technology field and universal access to social communication platforms have allowed clinicians to creatively transcend some of the existing traditional barriers in clinical and technological workflows. The aim of this paper is to provide insight and propose future directions concerning the use of teledentistry for dental care in crisis situations such as the COVID-19 pandemic as well as the continuous implementation of teledentistry in noncrisis scenarios. This paper provides information to support the use of teledentistry as a promising avenue for dental professionals when possible, during and possibly beyond the outbreak.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - short forms.

BACKGROUND: The need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ(11-14)), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8--ISF:8) and 16 items (Impact Short Form: 16--ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ(11-14) short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children. METHODS: Following translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities. RESULTS: The mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbach's alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ(11-14) was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05). CONCLUSION: The Brazilian versions of CPQ(11-14) ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.

Validation of a French language version of the Early Childhood Oral Health Impact Scale (ECOHIS).

BACKGROUND: An English language oral health-related negative impact scale for 0-5 year old infants (the Early Childhood Oral Health Impact Scale [ECOHIS]) has recently been developed and validated. The overall aim of our study was to validate a French version of the ECOHIS. The objectives were to investigate the scale's: i) internal consistency; ii) test-retest reliability; iii) convergent validity; and iv) discriminant validity. METHODS: Data were collected from two separate samples. Firstly, from 398 parents of children aged 12 months, recruited to a community-based intervention study, and secondly from 94 parents of 0-5 year-old children attending a hospital dental clinic. In a sub-sample of 101 of the community-based group, the scale was distributed a second time two weeks after initial evaluation. Internal consistency was evaluated through generation of Cronbach's alpha, test-retest reliability through intra-class-correlation coefficients (ICC), convergent validity through comparing scale total scores with a global evaluation of oral health and discriminant validity through investigation of differences in total scale scores between the community- and clinic-based samples. RESULTS: Cronbach's alpha for both the child and family impact sections was 0.79, and for the whole scale was 0.82. The ICC was 0.95. Mean ECOHIS scores for parents rating their child's oral health as "relatively poor", "good" and "very good" were 10.8, 3.4 and 2.7 respectively. In the community- and clinic-based samples, the mean ECOHIS scores were 3.7 and 4.9 respectively. CONCLUSION: These results suggest this French language version of the ECOHIS is valid.

Measurement properties of the Brazilian version of the Pediatric Quality of Life Inventory (PedsQL) cancer module scale.

BACKGROUND: The use of health-related quality of life (HRQOL) measurements has been increased progressively in health surveys. These measurements document the functional and psychosocial outcomes of health conditions and complement clinical indicators to provide a comprehensive description of individuals and populations' health. The Pediatric Quality of Life Inventory (PedsQL) is a promising instrument with age-appropriate versions. The objective of the current paper was to evaluate the psychometric properties of the PedsQL 3.0 Cancer Module cross-culturally adapted for use in Brazil. METHODS: A cross-sectional study was developed with 190 Brazilian families of individuals from 2 to 18 years of age, of both genders, with cancer in various phases of treatment or control. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. 'In-treatment' status was defined as individuals who were receiving medical care to induce remission. 'Off-treatment' status was defined as individuals for whom all therapy was completed for a period of at least one month. Reliability was determined through test-retest reliability and internal consistency. The validity of the Cancer Module was determined through discriminant and convergent validity. Correlations between the scores obtained by the children/adolescents with cancer and their guardians were assessed. RESULTS: Test-retest reliability demonstrated good correlation (0.69-0.90 for children/adolescents; 0.71-0.93 for guardians) and adequate agreement of the items (0.26-0.85 for children/adolescents; 0.25-0.87 for guardians). Internal consistency demonstrated adequate indices in comparisons between groups (alpha = 0.78-0.80 for children and adolescents; 0.68-0.88 for guardians). The 'pain and hurt', 'nausea', 'procedural anxiety' and 'treatment anxiety' subscales proved capable of distinguishing the groups of children in treatment and off treatment (p < 0.05). Positive significant correlations were observed between the scores of the PedsQL 3.0 Cancer Module and the PedsQL 4.0 Generic Core scales. Weak correlations were found between the reports of the children and those of the guardians. CONCLUSION: The Brazilian version of the PedsQL 3.0 Cancer Module exhibited good measurement properties regarding reproducibility and construct validity.

The pediatric quality of life inventory (PedsQL) family impact module: reliability and validity of the Brazilian version.

BACKGROUND: Pediatric health-related quality of life (HRQOL) has emerged as an important health outcome in clinical trials and healthcare research, for which HRQOL assessment instruments have played an important role. However, these instruments are not available in all countries or all languages. The Pediatric Quality of Life Inventory (PedsQL) Family Impact Module is a multidimensional instrument developed to assess the impact of chronic medical conditions on the HRQOL of parents and family functioning. The objective of the present study was to evaluate the psychometric properties of the PedsQL Family Impact Module cross-culturally adapted for use in Brazil. METHODS: The PedsQL Family Impact Module was administered to 95 parents/guardians of children with cancer in active therapy from 2 to 18 years of age of both genders. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. The 'in-patient' sample was defined as individuals who were hospitalized for the administration of chemotherapy. The 'out-patient' sample was defined as individuals who were receiving chemotherapy and were not hospitalized. RESULTS: Test-retest reliability exhibited correlation values ranging from 0.81 to 0.96 for all subscales. Internal consistency reliability was demonstrated for the PedsQL Family Impact Module: Total Scale Score (alpha = 0.89), Parent Health-Related Quality of Life Summary Score (alpha = 0.83) and Family Summary Score (alpha = 0.73). The Total Impact Score for the in-patient and out-patient samples was 67.60 and 56.43, respectively (p < 0.01). The construct validity demonstrated that the PedsQL Family Impact Module proved capable of distinguishing between families whose children/adolescents were hospitalized and families of children/adolescents who are being taken care of at home. CONCLUSION: The Brazilian version of the PedsQL Family Impact Module was considered reliable and valid for assessing the impact of a chronic pediatric health condition on the HRQOL of parents and family functioning. The instrument should be field tested on other chronic pediatric illnesses.

Cross-cultural adaptation of the Child Perceptions Questionnaire 11-14 (CPQ11-14) for the Brazilian Portuguese language.

BACKGROUND: Oral-Health-Related Quality of Life (OHRQoL) instruments are being used with increasing frequency in oral health surveys. However, these instruments are not available in all countries or all languages. The availability of cross-culturally valid, multi-lingual versions of instruments is important for epidemiological research. The Child Perceptions Questionnaire 11-14 (CPQ11-14) is an OHRQoL instrument that assesses the impact of oral conditions on the quality of life of children and adolescents. The objective of the current study was to carry out the cross-cultural adaptation of CPQ11-14 for the Brazilian Portuguese language. METHODS: After translation and cross-cultural adaptation, the CPQ 11-14 was tested on 160 11-to-14-year-old children who were clinically and radiographically examined for the presence or absence of dental caries. The children were receiving dental care at the Pediatric Dental and Orthodontic clinics of the Federal University of Minas Gerais, Brazil. To test the quality of the translation, 17 children answered the questionnaire. The internal consistency of the instrument was assessed by Cronbach's Alpha Coefficient and the test-retest reliability by Intraclass Correlation Coefficient (ICC). RESULTS: The mean CPQ11-14 score were 24.5 [standard deviation (SD) 18.27] in the group with caries and 12.89 [SD 10.95] in the group without caries. Median scores were 20 and 10 in the groups with and without caries, respectively (p < 0.001). Significant associations were identified between caries status and all CPQ domains (p < 0.05). Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.86. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The questionnaire proved to be a valid instrument. Construct validity was satisfactory, demonstrating highly significant correlations with global indicators for the total scale and subscales. The CPQ11-14 score was able to discriminate between different oral conditions (groups without and with untreated caries). CONCLUSION: The present study demonstrated that the CPQ11-14 is applicable to children in Brazil. It has satisfactory psychometric properties, but further research is required to evaluate these properties in a population study.

Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients.

PURPOSE: The aim of this study was to investigate the hypothesis that, independent of other known prognostic factors, pessimistic head and neck (H&N) cancer patients have a greater risk of being dead 1 year after diagnosis than do optimistic patients. PATIENTS AND METHODS: A prospective observational study design was used with a cohort of H&N cancer patients diagnosed during the period from March 1, 1997, to August 31, 1998, at the Centre Hospitalier Universitaire, Clermont-Ferrand, France. Dispositional optimism (DO) was evaluated at baseline using a French version of the Life Orientation Test translated and validated for this study. One-year survival status was collected on all subjects. The analysis of the hypothesized association between DO and 1-year survival was performed using multiple logistic regression analysis, controlling for other sociodemographic and clinical variables. RESULTS: The sample size was 101 patients, representing all but one of those patients fitting the inclusion criteria who were diagnosed during the recruitment period. Of these, 51 were alive at 1 year after diagnosis, 45 were dead, and five were lost to follow-up. The multivariate analysis was performed on the data from the 96 subjects in whom 1-year survival status was known. Controlling for known predictors of H&N cancer survival, pessimistic subjects (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01 to 1.24) and those living alone (OR, 4.14; 95% CI, 1.21 to 14.17) were more likely than optimistic subjects and those living with others to be dead at 1 year. CONCLUSION: The results of this study of a cohort of French H&N cancer patients indicate that dispositional optimism predicts 1-year survival independent of other sociodemographic and clinical variables.

Validity of an instrument assessing oral health problems in people with Down syndrome.

AIM: The aim of this study was to validate a proxy measure of oral health designed to be completed by the English-speaking parents of people with Down syndrome (DS) aged four years or more. METHODOLOGY: Items were generated through literature review, interviews with parents of people with DS and professional experts and through frequency testing. Data were gathered from one population-based and two clinic-based samples for the separate aspects of validation. Validation consisted of evaluation of: i) internal reliability of the domain structure through Cronbach's alpha; ii) criterion validity against clinical indicators and a clinician's evaluation of some items; iii) construct validity involving an age-matched comparison of domain scores between people with DS and non-DS siblings, and within the DS group by health status indicators; and iv) test-retest reliability through the generation of intra-class correlation coefficients (ICC). RESULTS: A 20-item instrument with four domains (communication, eating, parafunction and symptoms) was developed. Cronbach's alpha by domain was 0.5-0.8. Indicators of criterion validity for domains against clinical indicators (Spearman's coefficient 0.1-0.4) and parent-rated items against clinician-rated items (weighted Kappa 0.1-0.8) were varied as anticipated. Indicators of construct validity (differences with non-DS siblings and correlations with medical status within the DS group) were excellent. Test-retest reliability was good (ICC range 0.64-0.84). CONCLUSION: These data suggest the test instrument is valid as a descriptive, discriminative, proxy English language measure of oral health problems in people with DS aged four years or more.