Gamification and Oral Health in Children and Adolescents: Scoping Review.

BACKGROUND: Oral health is a determinant of overall well-being and quality of life. Individual behaviors, such as oral hygiene and dietary habits, play a central role in oral health. Motivation is a crucial factor in promoting behavior change, and gamification offers a means to boost health-related knowledge and encourage positive health behaviors. OBJECTIVE: This study aims to evaluate the impact of gamification and its mechanisms on oral health care of children and adolescents. METHODS: A systematic search covered multiple databases: PubMed/MEDLINE, PsycINFO, the Cochrane Library, ScienceDirect, and LILACS. Gray literature, conference proceedings, and WHOQOL internet resources were considered. Studies from January 2013 to December 2022 were included, except for PubMed/MEDLINE, which was searched until January 2023. A total of 15 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The eligibility criteria were peer-reviewed, full-text, and empirical research related to gamification in oral health care, reports of impact, and oral health care outcomes. The exclusion criteria encompassed duplicate articles; unavailable full texts; nonoriginal articles; and non-digital game-related, non-oral health-related, and protocol studies. Selected studies were scrutinized for gamification mechanisms and outcomes. Two main questions were raised: "Does gamification in oral health care impact oral health?" and "Does oral health care gamification enhance health promotion and literacy?" The PICO (Patient, Intervention, Comparison, Outcome) framework guided the scoping review. RESULTS: Initially, 617 records were obtained from 5 databases and gray literature sources. After applying exclusion criteria, 15 records were selected. Sample size in the selected studies ranged from 34 to 190 children and adolescents. A substantial portion (11/15, 73%) of the studies discussed oral self-care apps supported by evidence-based oral health. The most clearly defined data in the apps were "brushing time" (11/11, 100%) and "daily amount brushing" (10/11, 91%). Most studies (11/15, 73%) mentioned oral health care behavior change techniques and included "prompt intention formation" (11/26, 42%), "providing instructions" (11/26, 42%), "providing information on the behavior-health link" (10/26, 38%), "providing information on consequences" (9/26, 35%), "modeling or demonstrating behavior" (9/26, 35%), "providing feedback on performance" (8/26, 31%), and "providing contingent rewards" (8/26, 31%). Furthermore, 80% (12/15) of the studies identified game design elements incorporating gamification features in oral hygiene applications. The most prevalent gamification features were "ideological incentives" (10/12, 83%) and "goals" (9/16, 56%), which were found in user-specific and challenge categories, respectively. CONCLUSIONS: Gamification in oral health care shows potential as an innovative approach to promote positive health behaviors. Most studies reported evidence-based oral health and incorporated oral health care behavior change techniques.

Patient reported outcomes in oncology: changing perspectives-a systematic review.

In public health context, oncology is associated with severe negative impact on patients and on their relatives' quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver's adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver-patient-physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.

Head and Neck Cancer: Improving Patient-Reported Outcome Measures for Clinical Practice.

OPINION STATEMENT: Head and neck cancer includes a wide range of tumors that occur in several areas of the upper aerodigestive tract. Most head and neck cancer patients report treatment-related late effects (both physical and psycho-social). High-quality and patient-centered care in head and neck cancer depend on the understanding of the continuum patient's experience-the disease pathway. Healthcare has been improved by involving patients more actively in the disease process, and a few reports support that patient-reported outcomes-built around the patient's experience-given in a timely manner to oncologists are extremely valuable in oncology clinical care. Implementation and clinical use of patient-reported outcomes requires some procedures involving head and neck cancer patients, clinicians, researchers, and institutional leaders The unified and integrated vision is still absent and some current concerns are being discussed to optimize benefits of patient-reported outcomes use in clinical practice. The inclusion of all first-line caregivers, team formation and training, continuous monitoring improvement, and analysis are critical success factors to consider. Our team developed a broader and inclusive understanding of patient-reported outcomes. Patient-reported outcome (Health-Related Quality of Life) assessment is implemented as a systematic and routine process in Head and Neck Unit. Head and neck cancer patients consider the questionnaire administration as part of the clinical approach. We are currently working in a program (PROimp) using mathematical models to identify common head and neck cancer patterns and building prognostic predictive models, to predict future outcomes, to appraise risk/benefit of treatments (standard or new), and to estimate patient's risk of future disease development. It is our aim to better comprehend the singular and unexpected perceptions to really provide directed and personalized cancer care defining the patient pathway. The future holds promising for PROs that are ascending as a nuclear outcome in head and neck oncology.

Forensic Medicine and the Military Population: International Dental Records and Personal Identification Concerns.

INTRODUCTION: The first goal of this research was to perceive the global commitment towards the organization and archiving of dental records and to compare it with each country's security risk rating. The second one was to study dental records in a sample of the Portuguese military population, using the available national dental records. MATERIAL AND METHODS: An e-mail was sent to representative dentistry associations in several countries, requesting some information concerning the professionals' awareness of this issue. After obtaining permission from the Ethics Committee, the information was collected through the Forensic Dental Symbols® system into the Dental Encoder®, as an extension of a Spanish study, and a generic codification was used (unrestored, restored, missing and crowned teeth). RESULTS: The most common dental record retention period is ten years after treatment. Observing the samples' dental records (595 files), we found a total of 19 040 analyzed teeth, with the following frequencies: unrestored (89.6%), restored (7.0%), missing (2.2%) and crowned (1.1%). DISCUSSION: There is a wide range of guidelines on how long dentists should keep dental records. Especially for the military population, dental records must include detailed information concerning each tooth situation, in order to support the process of human identification. CONCLUSION: This article reinforces the need for mandatory quality dental records in all countries, which must be efficiently stored and easily accessible in case dental identification is necessary. For the military population, these requirements are especially important, due to the added risks to which this group is subject.

Introdução: Esta investigação teve o intuito de procurar conhecer o comprometimento global relativamente à organização e arquivo dos registos dentários e compará-lo com o risco de segurança de cada país. Por outro lado, procurou-se estudar os processos clínicos de uma amostra da população militar Portuguesa, utilizando-se para o efeito os registos dentários. Material e Métodos: Foi enviado um e-mail para associações dentárias e solicitada informação sobre o tempo de guarda dos registos dentários. Após autorização prévia da Comissão de Ética, a informação foi recolhida através do sistema Forensic Dental Symbols® para Dental Encoder®, como uma extensão de uma investigação realizada em Espanha e utilizada a codificação genérica (dentes sãos, com restaurações, ausentes e coroas). Resultados: Globalmente, dez anos após o último tratamento, foi o procedimento mais comum relativamente ao tempo de guarda dos documentos. Após observação dos registos dentários da amostra (595 militares) verificou-se um total de 19 040 dentes analisados, com as seguintes frequências: dentes sãos (89,6%), com restauração (7,0%), ausentes (2,2%) e coroas (1,1%). Discussão: Existe grande variedade de orientações sobre quanto tempo têm que ser guardados pelos profissionais de saúde os seus registos. Nos registos dentários da população militar deve-se incluir informação detalhada de cada dente, de maneira a suportar o processo de identificação humana. Conclusão: Este artigo reforça a necessidade de registos dentários de qualidade em todos os países, com manutenção eficiente para a identificação humana. Na população militar torna-se especialmente importante, devido ao facto de este ser um grupo sujeito a riscos acrescidos.

Health related quality of life of chronic patients with immune system diseases: a pilot study.

Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.

Health related quality of life of chronic patients with immune system diseases: a pilot study / Qualidade de vida relacionada com a saúde de doentes crónicos com patologias do sistema imune: estudo piloto / Calidad de vida relacionada con la salud de pacientes crónicos con enfermedades del sistema inmune: estudio piloto

Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.

A qualidade de vida relacionada com a saúde (QVRS) e sobrevivência são dois desfechos importantes nas doenças crónicas. Este estudo objetivou comparar a QVRS de pacientes com diferentes patologias crónicas do sistema imune e com os dados normativos da população Portuguesa. Foram seleccionados 103 pacientes para a amostra por conveniência, para completar o SF-32v2. As pontuações mais baixas foram encontradas entre as medidas para a saúde geral (41,0), vitalidade (47,5), dor (51,0) e saúde mental (56,4); as mulheres, exceto na função física, e os doentes com doenças autoimunes obtiveram piores escores em todas as dimensões, quando comparados com os dados normativos. Os escores mais altos foram obtidos nas dimensões: função física (69,1), funcionamento social (66,9) e função emocional (64,9). Viver com doenças crónicas imunológicas apresenta impacto sobre a QVRS e a versão Portuguesa do SF-36v2 fornece dados válidos e confiáveis na mensuração da QdV destes doentes.

Calidad de vida relacionada con la salud (CVRS) y la supervivencia son dos resultados importantes en las enfermedades crónicas. El objetivo de este estudio fue comparar la calidad de vida relacionada con la salud (CVRS) de los pacientes con diferentes patologías del sistema inmunológico y los datos normativos de la población portuguesa. 103 pacientes fueron seleccionados al acaso para completar el cuestionario SF-32v2. Las más bajas mensuras se encuentran entre las medidas de salud en general (41,0), vitalidad (47,5), dolor (51,0) y salud mental (56,4) que las mujeres en la función física y los pacientes con enfermedades autoinmunes también obtuvieron peores puntuaciones, en todas las dimensiones en comparación con los datos normativos. Las puntuaciones más altas se obtuvieron en las dimensiones: función física (69,1), funcionamiento social (66,9), función emocional (64,9). Vivir con enfermedades crónicas inmunológicas ten un impacto en la CVRS y la versión portuguesa del cuestionario SF 36v2 aporta datos válidos y confiables para medir la CdV de estos pacientes.

[Head and neck cancer: health related quality of life assessment considering clinical and epidemiological perspectives]. / Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde / Head and Neck Cancer: Health Related Quality of Life Assessment considering clinical and epidemiological perspectives

A importância das doenças oncológicas como causa de morbilidade e mortalidade está em crescimento, sendo reconhecido o seu impacto social e peso global pelos custos económicos e sociais envolvidos na sua prevenção, tratamento e reabilitação. As patologias oncológicas de cabeça e pescoço representam um dos seis tumores malignos mais prevalentes em todo o mundo, com um valor estimado de 900.000 novos casos diagnosticados anualmente em escala mundial. Estes doentes oncológicos apresentam deterioração de funções básicas que, quando percepcionadas, têm impacto negativo na sua Qualidade de Vida. Um registo oncológico adequado permite uma análise mais rigorosa dos resultados obtidos na avaliação da Qualidade de Vida Relacionada com a Saúde. Este estudo incluiu 380 doentes oncológicos de cabeça e pescoço e demonstra que as mulheres apresentam resultados de Qualidade de Vida globalmente inferiores. Salienta-se ainda a importância do diagnóstico precoce em oncologia, que se relaciona frequentemente com melhores scores e conclui-se que a localização do tumor tem impacto sobre a autopercepção de Qualidade de Vida. Os valores de Qualidade de Vida Relacionada com a Saúde devem ser interpretados à luz das variáveis sociodemográficas e clínicas, para melhor se avaliar a Patologia Oncológica de Cabeça e Pescoço numa perspectiva epidemiológica no sentido de melhor compreender o processo saúde - doença.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

A knowledge management system to study the quality of life in head and neck oncology patients.

The perception that an individual holds about his place in life, which depends upon his culture and values, defines this individual's Quality of Life (QoL). When applied in a health context this known as: Health-Related Quality of Life (HRQoL). The assessment of HRQoL is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. Obtaining a patient self-assessment with QoL measuring instruments on the platform developed in this project, through user-friendly software, aids the study, promotes the creation of databases, and accelerates its statistical treatment. The possibility of graphically representing results that physician needs to analyze, immediately after the answer collection, makes this assessment a diagnosis instrument ready to be used routinely in clinical practice. Knowledge Management Systems (KMS) applied to this context enable knowledge creation and storage, and guide therapeutic decisions.

Geriatric oncology: comparing health related quality of life in head and neck cancer patients.

BACKGROUND: Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care.This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients. METHODS: Two hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (≥ 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used. RESULTS: Head and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group.The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue.At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed.We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions. CONCLUSIONS: Geriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment.

[Computer-based quality-of-life monitoring in head and neck cancer patients: a validation model using the EORTC-QLQ C30 and EORTC- H&N35 Portuguese PC-software version]. / Avaliação da qualidade de vida em doentes com patologia oncológica da cabeça e pescoço: modelo de validação da versão electrónica Portuguesa do EORTC-QLQ C30 e EORTC- H&N35.

Quality of Life is a distinct and important emerging health focus, guiding practice and research. The routine Quality of Life evaluation in clinical, economic, and epidemiological studies and in medical practice promises a better Quality of Life and improved health resources optimization. The use of information technology and a Knowledge Management System related to Quality of Life assessment is essential to routine clinical evaluation and can define a clinical research methodology that is more efficient and better organized. In this paper, a Validation Model using the Quality of Life informatics platform is presented. Portuguese PC-software using European Organization for Research and Treatment of Cancer questionnaires (EORTC-QLQ C30 and EORTC-H&N35), is compared with the original paper-pen approach in the Quality of Life monitoring of head and neck cancer patients. The Quality of Life informatics platform was designed specifically for this study with a simple and intuitive interface that ensures confidentiality while providing Quality of Life evaluation for all cancer patients. For the Validation Model, the sample selection was random. Fifty-four head and neck cancer patients completed 216 questionnaires (108 using the informatics platform and 108 using the original paper-pen approach) with a one-hour interval in between. Patient preferences and computer experience were registered. Quality of Life informatics platform showed high usability as a user-friendly tool. This informatics platform allows data collection by auto-reply, database construction, and statistical data analysis and also facilitates the automatic listing of the questionnaires. When comparing the approaches (Wilcoxon test by item, percentile distribution and Cronbach's alpha), most of the responses were similar. Most of the patients (53.6%) reported a preference for the software version. The Quality of Life informatics platform has revealed to be a powerful and effective tool, allowing a real time analysis of Quality of Life data. Computer-based quality-of-life monitoring in head and neck cancer patients is essential to get clinically meaningful data that can support clinical decisions, identify potential needs, and support a stepped-care model. This represents a fundamental step for routine Quality of Life implementation in the Oncology Portuguese Institute (IPO-Porto), ORL and C&P department services clinical practice. Finally, we propose a diagram of diagnostic performance, considerating the generalized lack of mycological diagnosis in Portugal, which emphasizes the need for a careful history, focused on quantifying the latency period.

Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols.

BACKGROUND: Health Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed. METHODS: 102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation. RESULTS: A greater variability was always found in the EORTC QLC-C30 questionnaire's scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology. CONCLUSIONS: This study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization of results in real time and integration into clinical protocols are considered.

Development and use of touch - screen computer-assisted self interviewing in Portuguese patients with chronic immune diseases: evaluation of an electronic version of sf-36v2 .

AIM: The major purpose of this study was to evaluate alternative automated methods of collecting data on health related quality of life (HR-QoL). In order to achieve this, we developed a study with the following objectives: (1) to evaluated the feasibility of electronic version in patients with different chronic pathologies of the immune system using Short Form 36version2 (SF-36v2), (2) to evaluate the construct validity of SF-36v2 using the electronic data capture, and (3) to compare electronic version questionnaires with paper questionnaires in terms of patients' acceptance, data quality, and reliability. METHODS: Out-patients with chronic immune diseases (HIV infection, lupus, scleroderma, rheumatoid arthritis, Behçet and Sjögren), were randomly selected to completed electronic and paper SF-36v2 (n=50) before consultation in Clinical Immunology Unit, in Hospital Santo António-Centro Hospitalar do Porto (CI-HGSA). RESULTS: There were very high correlations in SF-36v2 responses (p< .001) between the paper and electronic forms. Internal reliability coefficients (Cronbach's alpha) showed good internal consistency for all reported responses in either, computer and paper. There were no missing data in electronic version or paper. About 84% of the patients prefer to use the computer version in future. CONCLUSION: The electronic HR-QoL assessment is technically possible and it can provide reliable and valid clinically significant information which can either be used in routine care appointments.