To assess the cross-sectional construct validity of the Malay-translated and cross-culturally adapted FACT-H&N (v 4.0) for discriminative use in a sample of Malaysian oral cancer patients. A cross-sectional study of adults newly diagnosed with oral cancer. HRQOL data were collected using the FACT-H&N (v 4.0), a global question and a supplementary set of eight questions ('MAQ') obtained earlier in pilot work. Of the 76 participants (61.8% female; 23.7% younger than 50), most (96.1%) had oral squamous cell carcinoma; two-thirds were in Stages III or IV. At baseline, patients' mean FACT summary (FACT-G, FACT-H&N, FACT-H&N TOI, and FHNSI) and subscale (pwb, swb, ewb, fwb, and hnsc) scores were towards the higher end of the range. Equal proportions (36.8%) rated their overall HRQOL as 'good' or 'average'; fewer than one-quarter rated it as 'poor', and only two as 'very good'. All six FACT summary and most subscales had moderate-to-good internal consistency. For all summary scales, those with 'very poor/poor' self-rated HRQOL differed significantly from the 'good/very good' group. All FACT summary scales correlated strongly (r>0.75). Summary scales showed convergent validity (r>0.90) but little discriminant validity. The discriminant validity of the FHNSI improved with the addition of the MAQ. The FACT-H&N summary scales and most subscales demonstrated acceptable cross-sectional construct validity, reliability and discriminative ability, and thus appear appropriate for further use among Malaysian oral cancer patients.
The Oral Health Division, Ministry of Health in Malaysia piloted clinical pathways (cpath) in primary care in early 2003. This study investigated the knowledge, perception of cpaths and barriers faced by the clinicians involved in the pilot project. Self-administered questionnaires were sent to the clinicians (n=191). Dentists (67.9%) and dental nurses (70.6%) had good overall knowledge of cpaths. The majority of the clinicians (67.9% to 95.6%) perceived cpath positively in all areas. Only 9.2% of dentists encountered difficulties in using cpath forms compared to 28.4% of dental nurses. A higher proportion of dental nurses (73.5%) compared to dentists (64.8%) were willing to continue using cpath. The majority of dentists (76.7%) and dental nurses (73.1%) were willing to participate in future development of cpaths. Overall, there was evidence of managerial support for the pilot project. A follow-up of the pilot project was somewhat lacking as less than half (43.3%) of the clinicians reported that the state coordinator obtained feedback from them. The findings auger well for the future implementation of cpath should the Oral Health Division decide to adopt cpath routinely in the public oral health care service.
Recent studies suggested that exposure to household smoking (HHS) could be a modifiable risk factor for caries development among children. Majority of the studies were cross sectional in nature. Therefore, a case-control study was designed to test the hypothesis that HHS is a risk factor to caries experience in permanent teeth. Calculation of sample size was based on the ratio of 1 case to 4 controls. Case was defined as a child aged 13-14 years old with caries in at least one second permanent molar and control was defined as a child from the same age and school with no caries second permanent molars. Matching was done for gender and ethnicity. School dental records provided information on oral health status and oral hygiene status. Information on HHS, socio-economic status, child’s smoking status and child’s oral health practices were obtained from a self- administered questionnaire, completed by the children and their parents. The result showed that 55.9% of the case group was exposed to HHS, as compared to 44.1% among the control group. In the final multiple logistic regression model after controlling for important risk factors for caries, children with caries were almost twice as likely to have been exposed to HHS for more than 10 years as compared to children with no caries, (Adjusted OR=1.90 and 95% CI=1.35, 2.60). In addition, children who only received dental care from the school dental service had reduced risk of having dental caries by more than one third (36%) as compared with those who received dental care from school dental service (SDS) as well as had additional dental problem solving visit outside SDS (Adjusted OR=0.64 and 95% CI=0.50, 0.90). It is concluded that exposure to HHS for a long duration (> than 10 years) increase the risk to have caries experience in permanent teeth of children.
Study site: 12 secondary schools, Kelang District, Selangor, Malaysia
A house to house random survey on elderly subjects was undertaken in the District of Klang in Malaysia. The objective of this study was to investigate the prevalence of oral mucosal lesions (OML) among the elderly in this area. The primary units in the sampling frame were the Enumeration Blocks (EBs) as defined under the population census. All households of the selected EBs were considered as sampling units and members aged 60 and above were considered as respondents. There was a slight preponderance of females, with the Malays comprising the majority of the subjects. Of the 486 respondents, mean aged 69.1 +/- 7.3 yr, 111 had at least one oral mucosal lesion, a prevalence of 22.8%. A total of 145 lesions were detected. The prevalence of OML was highest among Indians and least among the Chinese. The most common finding was tongue lesions, recording a prevalence of 10.7%, followed by oral pigmentation (4.9%) and white lesions (4.3%). Denture related lesions were comparatively low at 2.5%. Two cases of oral cancer if representative would give a relatively high prevalence of 0.4%.
The objective of this study is to share cost analysis methodology and to obtain cost estimates for posterior restorations in public sector dental clinics. Two urban and 2 rural dental clinics in Selangor state were selected. Only cases of 1 posterior restoration per visit by dental officers were included over 6 months. One capsulated amalgam type, 1 capsulated tooth-colored, and 1 non-capsulated tooth-colored material were selected. A clinical pathway form was formulated to collect data per patient. Annual capital and recurrent expenditures were collected per clinic. The mean cost of an amalgam restoration was RM 30.96 (sdRM 7.86); and tooth-colored restorations ranged from RM 33.00 (sdRM 8.43) to RM 41.10 (sdRM 10.61). Wherein 1 USD = RM 2.8. Restoration costs were 35% to 55% higher in clinics in rural areas than in urban areas. The findings demonstrate economy of scale for clinic operation and restoration costs with higher patient load. Costs per restoration were higher in rural than in urban dental clinics. More studies are recommended to address the dearth of dental costs data in Malaysia.
Identification of diagnostic markers for early detection and development of novel and therapeutic agents for effective patient management are the main motivation for cancer research. Biological specimens from large cohort and case-control studies which are crucial in providing successful research outcomes are often the limiting factor that hinders research efforts, especially in developing countries. Therefore, the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS) were established to systematically collect large number of samples with comprehensive sociodemographic, clinicopathological, management strategies, quality of life and associated patient follow-up data to facilitate oral cancer research in Malaysia. The MOCDTBS also promotes sharing among researchers and the development of a multidisciplinary research team. The following article aims to describe the process of setting-up and managing the MOCDTBS.