Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country.

This study aimed to assess changes in oral cancer patients' health-related quality of life (HRQOL) and the impact of disease stage on HRQOL scores. HRQOL data were collected from seven hospital-based centres using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4.0 instrument. The independent samples t-test, χ2 test, and paired samples t-test were used to analyse the data. A total of 300 patients were recruited. The most common oral cancer sub-site was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment modality. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Pre-treatment HRQOL scores were significantly lower for late than early stage patients. At 1 month post-treatment, the functional and head and neck domains and the FACT-H&N (TOI) summary scores showed significant deterioration in both early and late stage patients. In contrast, the emotional domain showed a significant improvement for early and late stage patients at 1, 3, and 6 months post-treatment. Although HRQOL deterioration was still observed among early and late stage patients at 6 months post-treatment, this was not statistically significant. In conclusion, advanced disease is associated with poorer HRQOL. Although ethnic differences were observed across different disease stages, the influence of ethnicity on patient HRQOL was not evident in this study.

Educating medical students in oral health care: current curriculum and future needs of institutions in Malaysia and Australia.

Poor oral health has been associated with compromised general health and quality of life. To promote comprehensive patient management, the role of medical professionals in oral health maintenance is compelling, thus indicating the need for educational preparation in this area of practice. This study aimed to determine the extent of training in oral health in Malaysian and Australian medical schools. An audio-recorded semi-structured phone interview involving Academic Programme Directors in Malaysian (n = 9, response rate=81.8%) and Australian (n = 7, response rate = 35.0%) medical schools was conducted during the 2014/2015 and 2014 academic years, respectively. Qualitative data was analysed via thematic analysis, involving coding and grouping into emerging themes. Quantitative data were measured for frequencies. It was found that medical schools in Malaysia and Australia offered limited teaching of various oral health-related components that were mostly integrated throughout the curriculum, in the absence of structured learning objectives, teaching methodologies and assessment approaches. Barriers to providing oral health education included having insufficient expertise and overloaded curriculum. As medical educators demonstrated support for oral health education, collaboration amongst various stakeholders is integral to developing a well-structured curriculum and practice guidelines on oral health management involving medical professionals.

Special needs dentistry: perception, attitudes and educational experience of Malaysian dental students.

A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self-administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient-centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.

Dental fear among medical and dental undergraduates.

OBJECTIVE: To assess the prevalence and level of dental fear among health related undergraduates and to identify factors causing such fear using Kleinknecht's Dental Fear Survey (DFS) questionnaire. METHODS: Kleinknecht's DFS questionnaire was used to assess dental fear and anxiety among the entire enrollment of the medical and dental undergraduates' of the University of Malaya. RESULTS: Overall response rate was 82.2%. Dental students reported higher prevalence of dental fear (96.0% versus 90.4%). However, most of the fear encountered among dental students was in the low fear category as compared to their medical counterpart (69.2 versus 51.2%). Significantly more medical students cancelled dental appointment due to fear compared to dental students (P = 0.004). "Heart beats faster" and "muscle being tensed" were the top two physiological responses experienced by the respondents. "Drill" and "anesthetic needle" were the most fear provoking objects among respondents of both faculties. CONCLUSION: Dental fear and anxiety are a common problem encountered among medical and dental undergraduates who represent future health care professionals. Also, high level of dental fear and anxiety leads to the avoidance of the dental services.

The prevalence of enamel opacities in permanent teeth of 11-12 year-old school children in Kuala Lumpur, Malaysia.

OBJECTIVE: To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community. DESIGN: A cross-sectional descriptive survey of enamel opacities in 11-12 year-old schoolchildren. CLINICAL SETTING: A questionnaire survey and a clinical examination of erupted teeth using the Modified DDE Index was conducted on schoolchildren in randomly selected schools. PARTICIPANTS: 957 schoolchildren from government schools in Kuala Lumpur comprising the three major ethnic groups of Malay, Chinese and Indian children. MAIN OUTCOME MEASURES: The severity of enamel opacities was assessed by the extent of buccal surface involvement. Normative treatment need was based on severity of opacities. RESULTS: Enamel opacities were found in 90.7% of subjects and 47.2% of teeth. Malays have the highest prevalence with Chinese the least. Although ethnic differences is statistically significant (p < 0.01), the differences in prevalence between ethnicity is small. The most common type of defect was "diffuse opacities" (88.6% of subjects). Most subjects (70%) showed bilateral distribution of diffuse opacities indicating a systemic disturbance. Posterior teeth were twice more commonly affected (p < 0.05). The majority of opacities in anterior teeth (66.7%) were minor, involving less than 1/3 of the labial surface. Only 0.6% of the whole sample required some form of aesthetic intervention. CONCLUSION: Despite the high prevalence of enamel opacities, the degree of severity is very mild with only minimal aesthetic and public health concern.

Clinical pathways in primary dental care in Malaysia: clinicians' knowledge, perceptions and barriers faced.

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.

Fluorosis prevalence among schoolchildren in a fluoridated community in Malaysia.

OBJECTIVES: This study aims to assess the magnitude of the problem of fluorosis among 10-11 year old schoolchildren in a fluoridated area in Malaysia. METHODS: An analytical cross-sectional design was adopted. Sampling of subjects was by a 2-stage systematic random sampling technique in Selangor, a fully fluoridated area. 1,343 10-11 year olds were assessed for fluorosis using the Dean's index. RESULTS: The prevalence of fluorosis was 58.7% (788 subjects); 478 (35.6%) subjects exhibited very mild fluorosis, 196 (14.6%) mild, 102 (7.6%) moderate, 12 (0.9%) severe and 555 (41.3%) no fluorosis. Tooth prevalence was 30.1%. Overall, the Community Fluorosis Index (CFI) was 0.96 and ranged from 0.23 to 1.72. Fifteen out of 30 schools had CFI > 1.0 (medium public health significance). CONCLUSIONS: The prevalence of dental fluorosis in Malaysia (mostly very mild to mild) at 58.7% is indicative of slightly above optimal levels of exposure. There were pockets of areas where fluorosis were of medium public health significance (CFI > 1.0). It must be cautioned that, fluorosis if not monitored closely, can become an increasing public health concern.

1-acetyl-3-[benzoyl(4-methoxyphenyl)methylene]-2,3-dihydro-1H-indol-2-one.

In the title compound, C25H19NO4, the indole moiety is not completely planar, the heterocyclic ring being distorted very slightly towards a half-chair conformation. The benzoyl and 4-methoxyphenyl substituents are individually almost planar and are in a bisecting and nearly perpendicular configuration, respectively, with respect to the plane of the indole moiety. The molecular and packing structures in the crystal are stabilized by intramolecular and intermolecular C-H...O interactions.

Diethyl 1-(p-fluorophenyl)-5-oxo-3-(2-thienyl)pyrrolidine-2,2-dicarboxylate.

In the title compound, C20H20FNO5S, the pyrrolidine ring adopts an envelope conformation. The fluorophenyl and thiophene rings are individually planar. The molecular and crystal structures are stabilized by intra- and intermolecular C-H...O interactions.

On the short carbonyl bond in bis[mu-1,2-benzisothiazol-3(2H)-one 1,1-dioxido-kappa2N:O]bis[[1,2-benzisothiazol-3(2H)-one 1,1-dioxido-kappaN]bis(imidazole)copper(II)].

The short carbonyl bond in the title compound, [Cu(2)(C(7)H(4)NO(3)S)(4)(C(3)H(4)N(2))(4)] [Liu, Huang, Li & Lin (1991). Acta Cryst. C47, 41-43], is an artifact of disorder in the isothiazol-3(2H)-one 1,1-dioxide part of the 1,2-benzisothiazol-3(2H)-one entity. In the present redetermination, all bond dimensions in the centrosymmetric dinuclear molecule are normal. The five-coordinate Cu atom shows trigonal-bipyramidal coordination. Hydrogen bonds from the imidazole donor ligand link adjacent molecules into a two-dimensional layer structure.

Methyl (SR)-10-chloro-1,2,3,4,5,6-hexahydro-6-hydroxy-8-methoxy-1-methyl-1,9-phenanthroline-6-carboxylate.

In the title compound, C(16)H(19)ClN(2)O(4), the pyridine ring is nearly planar, the piperidine ring is non-planar and the cyclohexane ring adopts a screw-boat conformation. The carboxylate group makes a dihedral angle of 80.9 (2) degrees with the least-squares plane through the cyclohexane ring.

1,4-Methano-11a-methyl-4,4a,11,11a-tetrahydro-1H-benzo[b]fluoren-11-one.

The title compound, C(19)H(16)O, crystallizes with two molecules of opposite chirality in the asymmetric unit. In both molecules, the naphthalene and cyclopentanone moieties are individually planar. The two cyclopentane rings adopt envelope conformations, while the cyclohexane ring adopts a boat conformation.

A mixed-valence manganese(III)-manganese(IV) di-mu-oxo complex, [(cyclam)MnO]2(ClO4)2(NO3).

The title dinuclear di-mu-oxo-bis[(1,4,8,11-tetraazacyclotetradecane-kappa(4)N)manganese(III,IV)] diperchlorate nitrate complex, [Mn(2)O(2)(C(10)H(24)N(4))(2)](ClO(4))(2)(NO(3)) or [(cyclam)MnO](2)(ClO(4))(2)(NO(3)), was self-assembled by the reaction of Mn(2+) with 1,4,8,11-tetraazacyclotetradecane in aqueous media. The structure of this compound consists of a centrosymmetric binuclear [(cyclam)MnO](3+) unit, two perchlorate anions and one nitrate anion. While the low-temperature electron paramagnetic resonance spectra show a typical 16-line signal for a di-mu-oxo Mn(III)/Mn(IV) dimer, the magnetic susceptibility studies also confirm a characteristic antiferromagnetic coupling between the electronic spins of the Mn(IV) and Mn(III) ions.

Water quality before and after deep tunnel operation in Milwaukee, Wisconsin.

The mitigative effects of the deep tunnel for temporary storage of storm water and sewage, on the water quality of the Milwaukee, Menomonee, and Kinnickinnic Rivers are investigated. The analysis is based on data from the Milwaukee Metropolitan Sewerage District's overflow and surface-water quality monitoring program. Statistical analysis of water quality parameters (BOD, phosphorus, suspended solid, fecal coliform counts, zinc, and chloride) in the three rivers indicates that Menomonee River benefits the most from the deep tunnel. Fecal coliform counts inside the CSO area, and to a certain extent BOD and zinc levels, exhibit the most significant decline after 1994 when the tunnel came on line. These conclusions are based on t-test comparisons of regional averages incorporating spatial and temporal correlations from 1991 to 1993 and 1994 to 1997. The results from t-tests are complemented and confirmed with results from Mann-Kendall tests for trend. Suspended solids and chloride do not decrease after 1994.

Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian schoolchildren.

OBJECTIVE: Data on malocclusion and orthodontic treatment need in Malaysia are limited. The purpose of this study was to evaluate malocclusion and orthodontic treatment need in a sample of 12-13-year-old schoolchildren using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and socio-demographic variables, perceptions of need for orthodontic treatment, aesthetic perception and social functioning. METHOD: The sampling procedure involved a multistage, clustered and stratified random sampling. The sample comprised of 1,519 schoolchildren attending 20 secondary government and government-aided schools in urban and rural areas of Klang District in Peninsular Malaysia. There were 772 males and 747 females. Each subject was administered a questionnaire eliciting standard demographic information such as gender, parents' income and ethnic origin and questions on perception of need for orthodontic treatment and satisfaction with dental appearance and function. Intra-oral examination for occlusal status using the DAI was performed for each subject. RESULTS: Most subjects (62.6%) require no orthodontic treatment. Only about 7% had handicapping malocclusion that needed mandatory treatment. Malocclusion, as defined in this study, was found to be significantly associated with gender and subjects' area of residence. There were no significant differences in mean DAI scores for Malays, Chinese and Indian children. Significant associations were found between DAI scores and perception of need for orthodontic treatment, satisfaction with dental appearance and social functioning (P<0.01). CONCLUSION: The findings will be useful for the public dental service to determine priority for orthodontic treatment as part of the comprehensive care provided by the School Dental Service (SDS).

(2-Methylquinolin-8-olato)iron(III) and -copper(II) complexes.

The crystal structures of tris(2-methylquinolin-8-olato-N,O)iron(III), [Fe(C10H8NO)3], (I), and aquabis(2-methylquinolin-8-olato-N,O)copper(II), [Cu(C10H8NO)2(H2O)], (II), have been determined. Compound (I) has a distorted octahedral configuration, in which the central Fe atom is coordinated by three N atoms and three O atoms from three 2-methylquinolin-8-olate ligands. The three Fe-O bond distances are in the range 1.934 (2)-1.947 (2) A, while the three Fe-N bond distances range from 2.204 (2) to 2.405 (2) A. In compound (II), the central Cu(II) atom and H2O group lie on the crystallographic twofold axis and the coordination geometry of the Cu(II) atom is close to trigonal bipyramidal, with the three O atoms in the basal plane and the two N atoms in apical positions. The Cu-N bond length is 2.018 (5) A. The Cu-O bond length in the basal positions is 1.991 (4) A, while the Cu-O bond length in the apical position is 2.273 (6) A. There is an intermolecular OW-H...O hydrogen bond which links the molecules into a linear chain along the b axis.

Bis(O,O'-di-p-tolyldithiophosphato-S,S')(1,10-phenanthroline-N,N')nickel(II).

The title coordination complex, [Ni(C14H14O2PS2)2(C12H8N2)] or [Ni(pMePh-dtp)2(phen)] (phen is 1,10-phenanthroline; dtp is diaryldithiophosphate), has a non-crystallographic twofold axis of symmetry through the Ni atom and the phen moiety. Two O,O-di-p-tolyldithiophosphate (dtp) ions act as bidentate ligands. The central metal atom is coordinated by four S atoms from two dtp groups and two N atoms from the phen ligand. The title compound displays distorted octahedral geometry around the central Ni atom.

catena-Poly[[bis(thiocyanato-N)-lead(II)]-mu-1,2-bis(4-pyridyl)-ethane-N:N'].

In the title coordination polymer, [Pb(NCS)(2)(C(12)H(12)N(2))], the coordination geometry about the Pb(II) atom is a distorted octahedron, composed of two N atoms from bpe ligands [bpe is 1,2-bis(4-pyridyl)ethane], two other N atoms from NCS(-) groups and two neighbouring S atoms through short contacts. The trans-bpe ligands act as bridges between two Pb(II) centres resulting in the formation of a linear chain. The terminal S atoms of the NCS(-) ligands make short contacts with the Pb(II) atom of neighbouring chains to form an infinite two-dimensional polymeric structure.

O-ethyl and o-methyl n-(2,3,4,6-tetra-o-acetyl-beta-d-glucopyranosyl)thiocarbamate.

In both the title structures, O-ethyl N-(2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)thiocarbamate, C(17)H(25)NO(10)S, and O-methyl N-(2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)thiocarbamate, C(16)H(23)NO(10)S, the hexopyranosyl ring adopts the (4)C(1) conformation. All the ring substituents are in equatorial positions. The acetoxymethyl group is in a gauche-gauche conformation. The S atom is in a synperiplanar conformation, while the C-N-C-O linkage is antiperiplanar. N-H.O intermolecular hydrogen bonds link the molecules into infinite chains and these are connected by C-H.O interactions.

Bis[2,2'-ethylenedioxydibenzaldehyde bis(thiocarbohydrazide)] tris(pyridine) solvate.

The title compound, a novel 30-membered 2:2 macrocyclic thiocarbohydrazone, C(34)H(32)N(8)O(4)S(2) x 3C(5)H(5)N, has been prepared and crystallographically characterized. The molecule of the compound is twisted. One dioxabutane group is boat-like in shape, whereas the other is highly disordered. The crystal structure is stabilized by inter- and intramolecular hydrogen bonds.