博士
國立臺灣師範大學
健康促進與衛生教育學系
106
The purpose of this study was to create and evaluate the effect of oral health education intervention program, based on Social Cognitive Theory, among the elderly. ...Objectives: To investigate the influence of oral health education intervention on eating, oral health, chewing, and oral function of elderly in the Taipei city. Methods: A quasi-experimental study involving a non-equivalent control group design was conducted in the community and long-term care institutions in Taipei City. Two hundred thirty two elderly > 65 years of age were recruited; 126 were community residents (experimental group n=68 and control group n=58) and 106 were from long-term care institutions (experimental group n=53 and control group n=53). The intervention for the experimental group included 12 weeks of oral training and 4 oral hygiene courses; no intervention was provided to the control group. Dentists and oral hygienists collected a survey before and after the intervention, and a questionnaire
碩士
國立臺灣大學
流行病學研究所
89
Background: The impacts of the duration and the quantity of betel nuts, cigarettes, and alcohol on the disease natural history of oral pre-malignancy and economic aspect of oral ...cancer screening in betel nuts user have not been fully addressed.
Objectives: The purposes of this study are therefore (1) to quantify the impact of the duration and the quantity of betel nut, cigarette and alcohol on different oral pre-malignancy and transition parameters between states with respect to the disease natural history; and (2) to perform cost-effectiveness analysis for oral cancer screening.
Methods: An oral screening project for subjects with the habit of chewing betel nuts was conducted between 1998 and 1999. Oral pre-malignant lesions and oral cancer were screened by well-trained dentists. Information on socio-demographic characteristics, the duration and the quantity of betel nuts, cigarettes, and alcohol was collected by questionnaire. The disease natural history from normal, through leukoplakia and erythroplakia, and finally to oral cancer was constructed. Generalized logit model, proportional odds model and the stochastic model were adopted to elucidate factors affecting the disease natural history. Cost-effectiveness was also performed to assess different oral screening regimes.
Findings: (1) The duration and the quantity of betel nuts, to a larger extent, and smoking, to a lesser extent, play respective important roles in the development of oral pre-malignancy even after adjustment for demographic characteristics and three risk factors in each other. However, the impact of alcohol on the risk for oral pre-malignancy disappears after controlling for significant confounders such as betel nuts and smoking. The risk for leukoplakia, erythroplakia, and OSF is proportional to the quantity and the duration. The adjusted odds ratios for subjects chewing more than 20 pieces per day against occasional use were estimated as 5.5 (95%CI: 3.9-7.8), 38.4 (95% CI: 16.7-88.1), and 7.1 (95% CI: 5.1-9.9) for leukoplakia, erythroplakia, and OSF, respectively. (2) The average times from leukoplakia to erythroplakia and from erythroplakia to invasive carcinoma take around 20 years and 5.7 years, respectively. Taking the quantity into account, the average times from leukoplakia to erythroplakia were 27.3 yrs, 24.0 yrs, 15.3yrs, and 13.1 yrs. The similar results were also found while the duration is considered. (3) The incremental cost-effectiveness ratios for annual screening regime, five-yearly screening regime, 10-yearly screening regime, against the control group were calculated as $21.59, $36.34, $5.32 per life-year gained.
Conclusion: The impact of the quantity and the duration betel nuts, cigarette, and alcohol on disease natural history are quantified. Cost-effectiveness analysis for four screening regimes suggests that 10-year screening regime may be appropriate for this high-risk group.
