Patients' experience of patient safety information and participation in care during a hospital stay.

AIM: Having a culture of safety is crucial when providing high-quality health care, yet preventable adverse events are common in the Swedish healthcare system, especially in the field of surgical care. Research shows that patient participation can improve patient safety. This study aimed to explore patients' experience of the safety leaflet, "Your safety in hospital," including participation in care and feelings of safe care. DESIGN: This study uses a descriptive qualitative study design. METHODS: Twenty patients from surgical wards received patient safety leaflets and participated in semi-structured interviews during their hospital stay. Data were analysed using qualitative content analysis. RESULTS: Three categories emerged from the analysis: Positive and negative experiences of provided information, Experiences of participation in own care, and Feelings of being safe arising from a perception of good quality care. Most participants were satisfied with their participation in their care and felt safe during their hospital stay. Oral information about the safety leaflet from healthcare personnel was lacking.

Comparing oral health-related quality of life, oral function and orofacial aesthetics among a group of adolescents with and without malocclusions.

OBJECTIVE: The aim was to analyze how malocclusion relates to perception of oral health-related quality of life (OHRQOL), oral function and orofacial aesthetics among a group of adolescents in Sweden. MATERIAL AND METHODS: Thirty patients with a need for orthodontic treatment (IOTN-DHC grade 4 and 5) and 30 patients with normal occlusion (IOTN-DHC grade 1), aged 13-17 years, were included in the study. A questionnaire containing three parts was used; The Oral Health Impact Profile (OHIP-S14), Jaw Functional Limitational scale (JFLS-20) and Orofacial Aesthetic scale (OES). Malocclusions, orthodontic treatment need and confounders, such as earlier dental treatment and temporomandibular disorders, were registered. RESULTS: Adolescents with malocclusions were more often embarrassed by their mouth and teeth compared to controls (p < .05). Aesthetically, adolescents with malocclusions were more negatively affected by the appearance of the mouth and teeth as well as the over-all facial appearance (p < .05). CONCLUSIONS: Malocclusions clearly affects the adolescents with need for orthodontic treatment in this study. It influences their OHRQOL in the psychosocial impact dimension. Aesthetically they perceive their oral and facial appearance as worse compared to controls. Although embarrassed and unpleased with their oral appearance they still rate themselves as having a good oral health with low jaw function limitations.

Do preterm-born adolescents have a poorer oral health-related quality of life?

BACKGROUND: To evaluate oral health-related quality of life (OHRQoL) over a period of five years using the Oral Health Impact Profile (OHIP-14) questionnaire in a population of Swedish adolescents born preterm and full term. METHODS: In a longitudinal study of adolescents aged 12-14 and 17-19, changes over time in OHRQoL were measured by using OHIP-14. The OHIP-14 score, self-reported chronic illness, temporomandibular disorder (TMD pain) and subjective orthodontic treatment need were compared between 98 extremely and very preterm born (< 32 gestational week) and 93 full-term controls (≥ 37 gestational week) at two ages. The chi-square test was used for comparisons within the extremely-, very-, and full-term control groups, and to contrast the differences of mean scores of OHIP-14, the ANOVA test was used for comparisons within the study groups of extremely preterm, very preterm and full term-born adolescents. RESULTS: All adolescents reported a good self-perceived OHRQoL. No significant differences in the comparisons of the total mean scores were revealed between the groups, between gender or in domain-specific scores over the 5-year period. Very preterm adolescents with reported chronic illness at 12-14 years of age showed significantly higher mean scores of OHIP-14 compared with those without chronic illness (p = 0.015). At age 17-19, significantly higher mean scores of OHIP-14 were reported by very preterm adolescents with TMD pain compared to those without TMD pain (p = 0.024). Significantly higher mean scores of OHIP-14 were found among the extremely preterm (p = 0.011) and very preterm born adolescents (p = 0.031) with a subjective need of orthodontic treatment compared with those without orthodontic treatment need. CONCLUSIONS: Poor OHRQoL measured with OHIP-14 in very preterm adolescents aged 12-14 was related to chronic illness and aged 17-19 to TMD pain. In addition, extremely and very preterm-born adolescents with subjective orthodontic treatment need at 17-19 years of age also reported poor OHRQoL. To improve the dentist-patient relationship and achieve more successful treatment results, it is important for dental clinicians to understand the impact that chronic illness, TMD pain and orthodontic treatment need has on OHRQoL in preterm-born adolescents.

Translation and validation of the English-language instrument Orthognathic Quality of Life Questionair into Swedish.

INTRODUCTION: In orthognathic surgery, understanding the patient's motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument 'Orthognathic Quality of Life Questionnaire' (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test-retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

The impact of oro-facial appearance on oral health-related quality of life: A systematic review.

Esthetics in the oro-facial region are important for perceived oral health and a common reason for treatment of discoloured, missing or crowded teeth. As one of the fundamental bricks of a patient's oral health, changes in the domain of oro-facial esthetics resides within the oral health-related quality of life (OHRQoL) of an individual. Four main dimensions, oral function, oro-facial pain, oro-facial appearance and psychosocial impact, are suggested to cover the concept of OHRQoL. The aim of this systematic review was to map the impact from oral conditions with principal impact on the oro-facial appearance dimension of OHRQoL (PROSPERO: CRD42017064033). Publications were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with esthetic treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss or tooth whitening. A search in PubMed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO 8 June 2017 and updated 14 January 2019, identified 2,104 abstracts. After screening of abstracts, 1607 articles were reviewed in full text and 33 articles included. These 33 articles reported OHIP-data for 9409 patients grouped in 63 patient populations. Median oro-facial appearance impact scores on a standardised 0-8 scale, for populations with treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss and tooth whitening, ranged from 0.13 for tooth wear to 3.04 for tooth whitening populations. In conclusion, a moderate impact for the oro-facial appearance dimension of OHRQoL was found in patients with different conditions with esthetically related treatment need.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

Costs and health-related quality of life in relation to caries.

BACKGROUND: Dental caries remains a common and expensive disease for both society and affected individuals. Furthermore, caries often affect individuals' health-related quality of life (HRQoL). Health economic evaluations are needed to understand how to efficiently distribute dental care resources. This study aims to evaluate treatment costs and QALY weights for caries active and inactive adult individuals, and to test whether the generic instrument EQ-5D-5 L can distinguish differences in this population. METHODS: A total of 1200 randomly selected individuals from dental clinics in Västerbotten County, Sweden, were invited to participate. Of these, 79 caries active and 179 caries inactive patients agreed to participate (response rate of 21.7%). Inclusion criteria were participants between 20 and 65 years old and same caries risk group categorization in two consecutive check-ups between 2014 and 2017. RESULTS: Treatment costs showed to be twice as high in the caries active group compared to the caries inactive group and were three times higher in the caries active age group 20-29 compared to the caries inactive age group 20-29. Differences between the groups was found for number of intact teeth according to age groups. In the EQ-5D-5 L instrument, more problems relating to the dimension anxiety/depression was seen in the caries active group. QALY weights showed tendencies (non-significant) to be lower in the caries active group. CONCLUSIONS: These findings highlight the need for efficient treatments and prevention strategies as well as adequate money allocation within dentistry. However, further research is needed to assess appropriate instruments for health economic evaluations.

Prevalence and normative values for jaw functional limitations in the general population in Sweden.

OBJECTIVES: For jaw functional limitations measured by the Jaw Functional Limitation Scale (JFLS), (a) determining prevalence in the Swedish general adult population, (b) investigating the influence of demographic factors and self-reported dental status and (c) deriving normative values. METHODS: A random sample of the general adult population in Sweden was approached (response rate: 46%, N = 1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender and dental status was investigated with regression analyses and normative values presented. RESULTS: The JFLS median score was 0, and all items had prevalences ≤30%. Age and gender did not influence jaw functional limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7th, 8th and 9th deciles, respectively. In dental status-stratified norms, 9th deciles were 20, 43 and 100, for subjects with natural teeth only, removable and complete dentures, respectively. CONCLUSIONS: The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9th decile as threshold for functional limitation.

Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2- or 3-dimensional planning: A randomized double-blind active-controlled clinical trial.

INTRODUCTION: Thorough treatment planning is essential for a good clinical outcome in orthognathic treatment. The planning is often digital. Both 2-dimensional (2D) and 3-dimensional (3D) software options are available. The aim of this randomized 2-arm parallel double-blinded active-controlled clinical trial was to compare the outcomes of computer-based 2D and 3D planning techniques according to patient-reported health related quality of life. The hypothesis was that a 3D technique would give a better treatment outcome compared with a 2D technique. METHODS: Orthognathic treatment for 62 subjects, aged 18 to 28 years, with severe Class III malocclusion was planned with both 2D and 3D techniques. After treatment planning but before surgery, the patients were randomly allocated via blind collection of 1 enveloped card for each subject in a 1:1 ratio to the test (3D) or the control (2D) group. Thus, the intervention was according to which planning technique was used. The primary outcome was patient-reported outcome measures. The secondary outcome was relationship between patient-reported outcome measures and cephalometric accuracy. Questionnaires on the patient's health-related quality of life (HRQoL) were distributed preoperatively and 12 months after surgical treatment. The questionnaires were coded, meaning blinding throughout the analysis. Differences between groups were tested with the Fisher permutation test. The HRQoL was also compared with measurements of cephalometric accuracy for the 2 groups. RESULTS: Three subjects were lost to clinical follow-up, leaving 57 included. Of these, 55 subjects completed the questionnaires, 28 in the 2D and 27 in the 3D groups. No statistically significant difference regarding HRQoL was found between the studied planning techniques: the Oral Health Impact Profile total showed -3.69 (95% confidence interval, -19.68 to 12.30). Consistent results on HRQoL and cephalometric accuracy showed a difference between pretreatment and posttreatment that increased in both groups but to a higher level in the 3D group. A difference between pretreatment and posttreatment HRQoL was shown for both groups, indicating increased quality of life after treatment. This supports recent findings comparing 3D and 2D planning techniques. No serious harm was observed during the study. CONCLUSIONS: Improvements of HRQoL were shown after treatment independent of which planning technique, 2D or 3D, was used. No statistically significant difference was found between the planning techniques. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: This project was supported by personal grants to Martin Bengtsson from the Scandinavian Association of Oral and Maxillofacial Surgeons (25000 SEK), the Southern Region of the Swedish Dental Association (50000 SEK), and the Swedish Association of Oral and Maxillofacial Surgeons (25000 SEK). The sponsors had no influence on the study design, analysis of the data, or the writing of the article.

Integration of oral health-related quality of life instruments.

OBJECTIVES: To integrate items from two widely used oral health-related quality of life (OHRQoL) questionnaires, the General Oral Health Assessment Index (GOHAI) and the Oral Impacts on Daily Performances (OIDP), as well as culturally-specific items of the Oral Health Impact Profile (OHIP) into a four-dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. METHODS: Subjects came from an ancillary study of the Dimensions of Oral Health-Related Quality of Life Project (N=267 patients, mean age±SD: 54.0±17.2years, 58% women.) Patients filled in the original 49 items of OHIP and 22 additional OHRQoL items in a cross-sectional study. These additional items consisted of 7 culturally specific OHIP items and 15 GOHAI or OIDP items with unique content not covered in OHIP-49. Before data collection, three experts hypothesized to which of the four OHRQoL dimensions these items belong. Hypotheses were tested in correlation analyses between the 22 items and the four dimension scores that were derived from OHIP-49. RESULTS: Five of the 22 items did not provide sufficient information to which dimension they belong. In 16 of the remaining 17 items, the pattern of correlation coefficients fitted experts' a priori hypotheses. Acceptance of 16 of the 17 hypotheses was interpreted as evidence that additional (not in OHIP-49 contained) OHRQoL items can be assigned to Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. CONCLUSION: Items of three OHRQoL instruments can be integrated into a dimensional OHRQoL model consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. CLINICAL SIGNIFICANCE: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact can serve as a simple and clinically appealing set of oral health-related quality of life (OHRQoL) dimensions and therefore provide an opportunity for simpler, but psychometrically improved OHRQoL measurement in the future.

A 7-day recall period for a clinical application of the oral health impact profile questionnaire.

OBJECTIVES: Aims were to investigate and compare the validity and reliability of Oral Health Impact Profile (OHIP) scores referencing 7-day and 1-month recall periods in international prosthodontic patients. MATERIAL AND METHODS: A sample of 267 patients (mean age = 54.0 years, SD = 17.2 years, 58 % women) with stable oral health-related quality of life was recruited from prosthodontic treatment centers in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. These patients completed the OHIP on two occasions using a new 7-day recall period and the traditional 1-month recall period. OHIP score validity and reliability were investigated with structural equation models (SEMs) that included OHIP(past 7 days) and OHIP(1 month) latent factors and single indicator measures of global oral health status. The SEMs assessed measurement invariance and the relative validities of the two OHIP latent factors (representing the two recall periods). RESULTS: The SEMs provided cogent evidence for recall period measurement invariance for the two OHIP forms and equal validities (r = .48) with external measures of global oral health status. CONCLUSION: When assessed in international prosthodontic patients, OHIP scores using the new 7-day recall period were as reliable and valid as the scores using the 1-month recall period. CLINICAL RELEVANCE: Conceptual advantages make a 7-day recall period a preferred frame of reference in clinical applications of the OHIP questionnaire.

Factor analyses of the Oral Health Impact Profile - overview and studied population.

PURPOSE: A desideratum of oral health-related quality of life (OHRQoL) instruments - such as the Oral Health Impact Profile (OHIP) - is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders. MATERIALS AND METHODS: The DOQ Project's aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. RESULTS: The combined data set includes 10778 OHIPs from 9348 individuals (N=6349 general population subjects, N=2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N=5173) for exploratory analyses and a Validation Sample (N=5022) for confirmatory analyses. Additional data (N=583) were assigned to a third data set. CONCLUSION: The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire.

Validation of the Orofacial Esthetic Scale in the general population.

BACKGROUND: The Orofacial Esthetic Scale (OES) is an eight-item instrument to assess how patients perceive their dental and facial esthetics. In this cross-sectional study we investigated dimensionality, reliability, and validity of OES scores in the adult general population in Sweden. METHODS: In a random sample of the adult Swedish population (response rate: 39%, N=1159 subjects, 58% female, mean age (standard deviation): 49.2 (17.4) years), dimensionality of OES was investigated using factor analytic methods to determine how many scores are needed to characterize the construct. Reliability of scores was calculated using Cronbach's alpha. Score validity was determined by correlating the OES summary score with a global indicator of orofacial esthetics (OE). RESULTS: Factor analyses provided support that a single score can sufficiently characterize OE. A Cronbach's alpha of 0.93 indicated excellent reliability. A validity coefficient of r=0.89 (95% confidence interval: 0.87-0.90) indicated that OES summary scores correlated highly with a global OE assessment. CONCLUSIONS: The OES is a promising instrument to measure the construct OE. Factor analyses supported that this construct can be assessed with one score, offering a feasible and acceptable standardized assessment of OE. The present study extends the OES use to the general population, an important target population for assessment of orofacial esthetics.

Methodological studies of orofacial aesthetics, orofacial function and oral health-related quality of life.

Among researchers and in the general population, awareness of the impact of health and health care on the quality of human life is increasing. An important medical and dental research area that addresses this issue is health measurement scales and psychometrics. Such instruments have numerous uses, such as to screen psychosocial aspects in individual patient care, assess perceived health or disease in population surveys, measure outcome in clinical trials, and gather data for cost-utility analyses. Assessing and improving oral health-related quality of life (OHRQoL), orofacial function, and orofacial aesthetics are three major goals in dental care. The overall aim of this thesis was to describe how three assessment tools were developed-using current scientific methodology-to measure these concepts in the Swedish culture. This thesis comprises five studies. In article I, recommended guidelines were used to translate the Oral Health Impact Profile (OHIP), an OHRQoL instrument, into Swedish. A group of 145 consecutive patients comprising five diagnostic groups participated in reliability and validity evaluations of OHIP-S, the Swedish OHIP version. Data supported excellent reliability and acceptable validity. In article II, the Jaw Functional Limitation Scale (JFLS) was developed, and reliability and validity were assessed in 132 consecutive patients from five diagnostic groups. An expert panel identified 52 functional limitation items. Rasch methodology reduced the number of items to 20 and assessed model fit. Three constructs were identified-mastication, vertical jaw mobility, and emotional and verbal expression-and good reliability and validity were found. The JFLS-20 is an organ-specific instrument for assessing functional status of the masticatory system while the shorter JFLS-8 assesses global functional limitation. Article III describes development of the Orofacial Aesthetic Scale (OAS), in particular its conceptual framework, measurement model, and method of questionnaire item generation. Interview and questionnaire data from 17 prosthodontic patients created an initial 28-item pool. After focus group reduction and pilot testing, a final 8-item instrument was generated. Exploratory factor analysis investigated OAS dimensionality, and item analysis was performed in 119 subjects. Forward and backward translations and reconciliation produced an English version of the instrument. Exploratory factor analysis supported OAS unidimensionality. In article IV, psychometric properties of the OAS were evaluated in 119 patients from four groups: aesthetically compromised, functional disability, and two age- and gender-matched control groups. Various methods of testing reliability and validity supported good score reliability and validity. In article V, the OAS was part of a mail survey to a national sample of 3000 persons and normative values were derived. Survey respondents totaled 1406, and missing data were analyzed. There was a significant difference in OAS for age, gender, self-reported oral health, and self-reported general health status groups. Subjects who reported extreme satisfaction (item score of 10) varied between 17% for "color of the teeth" and 30% for "appearance of face" and "profile". The OHIP, JFLS, and OAS are considered well suited for use in research and as clinical outcome measures in patients with functional and aesthetic concerns, such as prosthodontic patients.

Reliability and validity of the Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: This study evaluated the reliability and validity of the Orofacial Esthetic Scale (OES)-an instrument assessing self-reported orofacial esthetics in prosthodontic patients. MATERIALS AND METHODS: The OES has seven items addressing direct esthetic impacts in the orofacial region, as well as an eighth global assessment item. The response format was a 0 to 10 numeric rating scale (very dissatisfied to very satisfied with appearance, respectively). OES summary scores ranged from 0 (worst score) to 70 (best score). Test-retest reliability (n = 27) and internal consistency (n = 119) were assessed. Content validation (asking patients about their satisfaction with the questionnaire content, n = 119) and discriminative validation (comparing OES scores between patients and healthy controls, n = 119) were performed. Convergent validity was assessed by correlating patients' own OES scores (n = 29) with ratings from a consensus expert group (n = 4) and with the Oral Health Impact Profile (OHIP) esthetic-item summary score (n = 119). RESULTS: Test-retest reliability was excellent for the OES scores (intraclass correlation coefficient = .96). Internal consistency was satisfactory for esthetically impaired patients (n = 27, Cronbach alpha = .86). Patients rated their satisfaction with the questionnaire content as 7.8 +/- 1.3 units on a 0 to 10 numeric rating scale (0 = very dissatisfied, 10 = very satisfied). OES scores discriminated esthetically impaired patients (31.4 units) from healthy controls (45.9 units, P < .001). OES scores correlated well with other measures of the same construct (r = .43 for patients' own assessment with an assessment by experts using the OES, r = -.72 for a correlation with the OHIP's three esthetic-related items). CONCLUSIONS: The OES, developed especially for prosthodontic patients, exhibited good score reliability and validity.

Development of an Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model. MATERIALS AND METHODS: After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. RESULTS: Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES. CONCLUSIONS: The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions.

AIMS: To develop the Jaw Functional Limitation Scale (JFLS), comprising 3 constructs and a global scale, based on a preliminary instrument, and to investigate content validity of the overall functional limitation construct, reliability, and generalizability. A temporomandibular disorders (TMD) patient group, compared to other diagnostic groups, was hypothesized to report further limitation in each of the 3 new proposed constructs. METHODS: One hundred thirty-two consecutive patients from 5 diagnostic groups (TMD, primary Sjogren syndrome, burning mouth syndrome, skeletal malocclusion, and healthy controls) participated in a known-groups validity design. Fifty-two jaw functional limitation items were identified by an expert panel for content validity. Rasch methodology was used for item reduction and assessment of model fit. The instrument was retested 1 to 2 weeks later. RESULTS: Three constructs (mastication, vertical jaw mobility, and emotional and verbal expression) comprising a total of 20 items were identified along with a global scale (the JFLS-20), and each exhibited excellent psychometric properties with respect to modeled variance, item fit, reliability, and internal consistency. The psychometric properties of each construct remained satisfactory when analyzed separately among the 5 diagnostic groups. Temporal stability was satisfactory. A shorter 8-item form (JFLS-8) also proved useful for assessing global functional jaw limitation. CONCLUSION: The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw. The JFLS-8 emerged as a short form for measuring global functional limitation of the jaw.

Psychiatric nursing care of suicidal patients described by the Sympathy-Acceptance-Understanding-Competence model for confirming nursing.

Our aim was to describe psychiatric nursing care of suicidal patients from an action-theoretical and confirmatory perspective using the Sympathy-Acceptance-Understanding-Competence (SAUC) model for confirming nursing. Twenty-nine nurses were interviewed and asked to answer a questionnaire. The interview results showed that the nurses' care consisted of 83% of person support, 16% of self-support, and less than 1% of self-perspective support. However, the questionnaire responses showed that the nurses regarded all levels of support as equally important. Theoretical frameworks, such as the SAUC model, facilitate descriptions of nursing and may be used to improve the care of suicidal patients by making it deliberate and possible to evaluate.

Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP-S).

The aim of this study was to translate the Oral Health Impact Profile (OHIP) into Swedish and evaluate the reliability and validity of the Swedish version (OHIP-S). The OHIP is a 49-item, self-administered questionnaire divided into 7 different subscales. The original version in English was translated into Swedish, accompanied by back-translation into English, after which the Swedish version was revised. A total of 145 consecutive patients participated and answered a questionnaire. The patients comprised five clinically separate groups: temporomandibular dysfunction (TMD) (n = 30), Primary Sjögren's Syndrome (SS) (n = 30), burning sensation and pain in the oral mucosa (oral mucosal pain, OMP) (n = 28), skeletal malocclusion (malocclusion) (n = 27), and healthy dental recall patients (controls) (n = 30). The TMD group and the control group participated in a test-retest procedure. The internal reliability of each subscale was calculated with Cronbach's alpha and found to be high and to range from 0.83-0.91. The stability (test-retest) of the instrument, calculated using the intraclass correlation coefficient, ranged from 0.87 to 0.98. The construct validity of OHIP-S was compared with subscales of the Symptom Check List (SCL-90) (rho 0.65) and the Jaw Function Limitation Scale (FLS) (rho 0.76) and analyzed with Spearman's correlation coefficient. Convergent validity was evaluated by comparing OHIP with self-reported health using Spearman's correlation coefficient and was found to be acceptable (rho 0.61). In the evaluation of the discriminative ability of the instrument, significant differences were found in the total OHIP-S score between the controls and the other four groups (P < 0.001). We conclude that the reliability and validity of OHIP-S is excellent. The instrument can be recommended for assessing the impact of oral health on masticatory ability and psychosocial function.