Translation and validation of modified dental anxiety scale based on adult Taiwan population.

BACKGROUND: Dental anxiety is associated with negative experiences of dental treatment and dental-visiting behavior. The Modified Dental Anxiety Scale (MDAS) is widely used for assessing dental anxiety. The study aims to establish the psychometric properties of a Chinese version of the MDAS based on the Taiwan sample (i.e., T-MDAS). METHODS: The T-MDAS and dental-visiting behavior and experience were assessed for 402 adult subjects recruited from community and clinical sites. The following psychometric properties were assessed: (a) internal consistency, (b) temporal stability, (c) criterion-related validity (i.e., the association with the score of Index of Dental Anxiety and Fear, IDAF-4C), (d) discrimination validity (i.e., the difference in scores between the subjects with and without a habit of a regular dental visit, and (e) the construct validity from a confirmatory factor analysis (CFA). RESULTS: The T-MDAS showed good internal consistency (Cronbach's α = 0.88) and temporal stability (ρ = 0.69, p < 0.001). The score was significantly correlated with the score of the IDAF-4C (ρ = 0.76, p < 0.001) and differed between subjects who regularly visited a dentist or not, supporting good criterion-related validity and discrimination validity. Results from CFA supports good construct validity. Furthermore, higher dental anxiety was related to the lack of a regular dental visit, feeling pain during treatment, and feeling insufficient skills and empathy of dentists. A higher proportion of high-dental anxiety subjects in female subjects (8.5%), compared to male subjects (5.0%), was noted. CONCLUSIONS: The T-MDAS is a valid tool for assessing adult dental anxiety. The score is highly associated with dental-visiting behavior and experience of dental patients.

Effectiveness of a Sexuality Workshop for Nurse Aides in Long-Term Care Facilities.

BACKGROUND: In long-term care facilities, there are frequent conflicts related to elderly residents' sexual expression. Nurse aides usually handle such conflicts with negative or negligent attitudes; therefore, elderly sexuality is considered "problem behavior" and is stigmatized. OBJECTIVES: This study aimed to improve elderly residents' quality of sexual life by enhancing nurse aides' knowledge and attitudes toward elderly sexuality through sexuality workshops. METHODS: A quasi-experimental study was conducted with 64 nurse aides and 58 residents, who were divided into two groups, i.e., an experimental group and a control group, according to the floor where the residents resided. The nurse aides in the experimental group participated in sexuality workshops and were compared with those in the control group with respect to their knowledge of and attitudes toward sexuality; the residents' quality of sexual life was also compared between groups. RESULTS: Compared with the control group, in the experimental group, the nurse aides' knowledge of and attitudes toward elderly sexuality as well as the residents' quality of sexual life significantly and continually improved after the sexuality workshops. CONCLUSION: The four-week sexuality workshop is effective and may be used as an example in developing occupational education programs regarding elderly sexuality in long-term care facilities.

Magnification of fear and intention of avoidance in non-experienced versus experienced dental treatment in adults.

BACKGROUND: Dental fear is associated with the experience of prior dental treatment and avoidance of dental visits. It remains unclear if individuals show an intention of avoidance (IA) towards treatments that they have not received (i.e., non-experienced dental treatment). The study aims to investigated (a) if individuals showed an increased fear and IA to non-experienced, compared to experienced dental treatment, and (b) if fear and IA to non-experienced treatment is associated with dental anxiety. METHODS: Fear/IA of 12 common conditions of dental treatment of 402 adults were investigated. If subjects have experienced the condition, fear and IA were assessed based on subjects' prior experience (i.e., ExpFear/ExpIA). If they have not experienced the condition, fear and IA were assessed based on their anticipation (i.e., NExpFear/NExpIA). Trait dental anxiety was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+). RESULTS: (A) NExpFear and NExpIA were significantly higher than ExpFear and ExpIA, respectively. (B) The IDAF-4C+ scores are positively correlated with NExpFear/NExpIA and negatively correlated with the magnification of fear (i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions). (C) The condition 'extraction of a wisdom tooth' and 'root canal treatment' showed the highest ratings on NExpFear. CONCLUSIONS: Individuals may develop a high degree of fear and IA of the treatment they have not received. Trait dental anxiety plays a key role in the fear of non-experienced treatment.

Effects of an Adaptive Education Program on the Learning, Mental Health and Work Intentions of New Graduate Nurses.

Health care workers are at a higher risk of psychological distress than ordinary people. Stress affects physical and mental health, and can even produce an intention to leave. The current training for new graduate nurses (NGNs) during this transitional period mostly focuses on the cultivation of professional ability, with less attention to mental health or emotional feelings, and thus there are insufficient structured support strategies. As such, this study explores the effects of intervention through an appropriate education program on the learning, mental health and work intentions of new recruits during the transition period. A pre-test and post-test for a single group was designed for new nursing staff in a large teaching hospital in northern Taiwan. The test period was from May 2017 to December 2018, and a total of 293 cases were accepted. A three-month adaptive education program was provided and evaluated in terms of: care for learning, care for health, improving professional ability, and individualized guidance on satisfaction, mental health disturbance and work intention. The new graduate nurses who received gentle care and counseling showed a downward trend in their BSRS-5 scores and statistical differences over time (p < 0.001). The higher the BSRS-5 score, the easier it is for new graduate nurses in acute and intensive care units. There is a tendency for turnover leave (p = 0.03). After the intervention of the overall plan, the turnover rate of new graduate nurses within three months was 12.6%, and the one-year retention rate was 87.9%. The adaptive education program uses multiple support strategies to improve learning and professional abilities, to reduce psychological emotions, and thereby to increase retention. Today will face new medical challenges; the education programs will become more important across clinical care settings, and it will be important to rigorously validate their performance in helping NGNs.

Evaluation of Nurse Practitioners' Professional Competence and Comparison of Assessments Using Multiple Methods: Self-Assessment, Peer Assessment, and Supervisor Assessment.

PURPOSE: Nurse practitioners (NPs) are increasingly important in healthcare as they play a key role in leading advanced nursing practices. Assessing their professional competence is essential. The aim of this study was to evaluate NPs' professional competencies based on at a collaborative model around NP self and compare different methods of assessment. METHODS: This is a cross-sectional study, and a purposive sample of 211 participants in the teaching hospital was used. Methods used were self-assessment (nurse practitioners), peer assessment (physicians and nurses) and supervisor assessment (head nurses). RESULTS: The competence of nurse practitioners was rated as moderate (mean score = 3.45 of a possible 5; SD = 0.59). However, each method resulted in differences in competence for total scores and dimensions. The highest competence was in direct patient care (mean = 3.55, SD = 0.53), and the lowest score was in monitoring the quality of patient care (mean = 3.30, SD = 0.82). post hoc analysis shown that supervisor assessment rated professional competence significantly lower than the method of self-assessment and peer assessment (F = 10.07, p < .001). CONCLUSION: NPs require an increased effort to continuous learning for enhancing professional competencies. Moreover, using multiple methods for assessment to obtain a more comprehensive and accurate evaluation of NPs' professional competence.

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

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

The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach.

BACKGROUND: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. OBJECTIVE: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. METHODS: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. RESULTS: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. CONCLUSIONS: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer.

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

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

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users.

BACKGROUND: Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan. OBJECTIVE: This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users. METHODS: A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment. RESULTS: A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care. CONCLUSIONS: Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

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

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

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

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

Epidemiology of Sarcopenia and Factors Associated With It Among Community-Dwelling Older Adults in Taiwan.

BACKGROUND: Sarcopenia is a well-recognized geriatric syndrome. We sought to determine the prevalence of sarcopenia and factors associated with it among community-dwelling older adults in Taiwan. METHODS: A cross-sectional study was conducted in Yuanshan Township, Yilan County, Taiwan. Data of 731 community-dwelling adults aged 65 and older were evaluated. Demographic characteristics, anthropometry, medical history, biochemistry results, and dual-energy X-ray absorptiometry results were collected for analysis. RESULTS: Males had a higher rate of sarcopenia than did females and had lower values for body weight, body mass index, waist circumference, percentage of body fat, and lean body mass. Poor nutritional status as determined by the Mini Nutritional Assessment correlated positively with markers for sarcopenia. Levels of vitamin D and folic acid correlated positively with some sarcopenia markers. CONCLUSIONS: Gender differences and nutritional factors may influence the development of sarcopenia. Vitamin D is positively correlated with relative appendicular skeletal muscle mass in males with sarcopenia, and folic acid was positively correlated with gait speed in females with sarcopenia.

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

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

Development and validation of a Quality of Life Scale for elementary school students / Desarrollo y validadción de la Quality Life Scale para escolares de Educación Primaria

Emotional well-being affects the school performance of elementary school children. Quality of life (QoL) measurements are indicative of emotional well-being; however, the development of assessment tools suitable for measuring the QoL of elementary school children has received little attention and, therefore, the creation of reliable assessment tools for measuring QoL among this population is required. Method: We employed qualitative and quantitative research methods to develop and validate a QoL scale for elementary school children in Taiwan. We used cluster random sampling to recruit 711 fifth and sixth grade students, aged 10-12 years, from 14 elementary schools. Results: The scale comprised six factors (School function, Family function, Environmental life, Vitality for life, Learning ability, and Peer relationships) that explained 44% of the variance. The developed 21-item elementary school QoL (ESQoL) instrument had high internal consistency and satisfactory reliability and validity. Conclusions: The ESQoL instrument can facilitate the evaluation of factors associated with students’ emotional well-being. Additional studies using the ESQoL instrument are required to assess its applicability for evaluating relationships between QoL and school performance and other areas of student life (AU)

El bienestar emocional afecta el rendimiento escolar de los niños de Educación Primaria. Las mediciones de la calidad de vida (QoL) son indicativas del bienestar emocional. Sin embargo, el desarrollo de herramientas de evaluación adecuadas para medir la calidad de vida de niños de Educación Primaria ha recibido escasa atención y, por lo tanto, se requiere la creación de herramientas de evaluación confiables para medir la calidad de vida en esta población. Método: Se empleraron métodos de investigación cualitativa y cuantitativa para desarrollar y validar una escala de QoL para niños de Primaria en Taiwán. Se utilizó un muestreo aleatorio por grupos para reclutar a 711 estudiantes de Quinto y Sexto Grado, de 10 a 12 años, de 14 escuelas primarias. Resultados: La escala agrupa seis factores (Función escolar, Función familiar, Vida ambiental, Vitalidad para la vida, Capacidad de aprendizaje y Relaciones entre compañeros) que explican el 44% de la varianza. El instrumento de QoL (ESQoL) de 21 ítems tiene alta fiabilidad de consistencia interna y validez satisfactoria. Conclusiones: El instrumento ESQoL puede facilitar la evaluación de factores asociados con el bienestar emocional de los escolares. Se requieren estudios adicionales utilizando el instrumento ESQoL para evaluar su aplicabilidad en el análisis de las relaciones entre QoL y rendimiento escolar, y otras áreas del ámbito escolar (AU)

Development and validation of a Quality of Life Scale for elementary school students.

Emotional well-being affects the school performance of elementary school children. Quality of life (QoL) measurements are indicative of emotional well-being; however, the development of assessment tools suitable for measuring the QoL of elementary school children has received little attention and, therefore, the creation of reliable assessment tools for measuring QoL among this population is required. Method: We employed qualitative and quantitative research methods to develop and validate a QoL scale for elementary school children in Taiwan. We used cluster random sampling to recruit 711 fifth and sixth grade students, aged 10-12 years, from 14 elementary schools. Results: The scale comprised six factors (School function, Family function, Environmental life, Vitality for life, Learning ability, and Peer relationships) that explained 44% of the variance. The developed 21-item elementary school QoL (ESQoL) instrument had high internal consistency and satisfactory reliability and validity. Conclusions: The ESQoL instrument can facilitate the evaluation of factors associated with students' emotional well-being. Additional studies using the ESQoL instrument are required to assess its applicability for evaluating relationships between QoL and school performance and other areas of student life.

ANTECEDENTES/OBJETIVO: El bienestar emocional afecta el rendimiento escolar de los niños de Educación Primaria. Las mediciones de la calidad de vida (QoL) son indicativas del bienestar emocional. Sin embargo, el desarrollo de herramientas de evaluación adecuadas para medir la calidad de vida de niños de Educación Primaria ha recibido escasa atención y, por lo tanto, se requiere la creación de herramientas de evaluación confiables para medir la calidad de vida en esta población. Método: Se empleraron métodos de investigación cualitativa y cuantitativa para desarrollar y validar una escala de QoL para niños de Primaria en Taiwán. Se utilizó un muestreo aleatorio por grupos para reclutar a 711 estudiantes de Quinto y Sexto Grado, de 10 a 12 años, de 14 escuelas primarias. Resultados: La escala agrupa seis factores (Función escolar, Función familiar, Vida ambiental, Vitalidad para la vida, Capacidad de aprendizaje y Relaciones entre compañeros) que explican el 44% de la varianza. El instrumento de QoL (ESQoL) de 21 ítems tiene alta fiabilidad de consistencia interna y validez satisfactoria. Conclusiones: El instrumento ESQoL puede facilitar la evaluación de factores asociados con el bienestar emocional de los escolares. Se requieren estudios adicionales utilizando el instrumento ESQoL para evaluar su aplicabilidad en el análisis de las relaciones entre QoL y rendimiento escolar, y otras áreas del ámbito escolar.

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

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

Nurse characteristics, leadership, safety climate, emotional labour and intention to stay for nurses: a structural equation modelling approach.

AIM: The aim of this study was to propose a theoretical model and apply it to examine the structural relationships among nurse characteristics, leadership characteristics, safety climate, emotional labour and intention to stay for hospital nurses. BACKGROUND: Global nursing shortages negatively affect the quality of care. The shortages can be reduced by retaining nurses. Few studies have independently examined the relationships among leadership, safety climate, emotional labour and nurses' intention to stay; more comprehensive theoretical foundations for examining nurses' intention to stay and its related factors are lacking. DESIGN: Cross-sectional. METHODS: A purposive sample of 414 full-time nurses was recruited from two regional hospitals in Taiwan. A structured questionnaire was used to collect data from November 2013-June 2014. Structural equation modelling was employed to test the theoretical models of the relationships among the constructs. RESULTS: Our data supported the theoretical model. Intention to stay was positively correlated with age and the safety climate, whereas working hours per week and emotional labour were negatively correlated. The nursing position and transformational leadership indirectly affected intention to stay; this effect was mediated separately by emotional labour and the safety climate. CONCLUSION: Our data supported the model fit. Our findings provide practical implications for healthcare organizations and administrators to increase nurses' intent to stay. Strategies including a safer climate, appropriate working hours and lower emotional labour can directly increase nurses' intent to stay. Transformational leadership did not directly influence nurses' intention to stay; however, it reduced emotional labour, thereby increasing intention to stay.

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

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

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

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