Effectiveness of a short web-based film targeting parental oral health knowledge in a well-child care setting.

Young children rely on their parents with respect to oral health routines. However, parental knowledge on this topic is often insufficient. Well-child care may be an excellent route to reach parents because almost all of them attend. To evaluate the effectiveness of an 8.5 min web-based film about oral health, provided by well-child care, a non-blinded quasi-experimental study was performed. Parents attending well-child care clinics in the Netherlands were assigned to an intervention (n = 88) or control group (n = 41). The control group received care as usual. We measured parental knowledge of oral health with a questionnaire (range of scores 1-12) before and directly after the intervention, and 6 months later, and assessed differences between the intervention and the control group. Parental oral health knowledge improved after watching the film: the intervention group's mean score of 11.1 (SD 1.3) was greater than the mean score of 7.1 (SD 2.0) of the control group (Cohen's d = 2.64). Scores remained higher in the intervention group 6 months after watching the film (mean 9.1, SD 1.3) than before (Cohen's d = 1.25). A web-based educational film delivered in a well-child care setting can be an effective way to address oral health and to improve parental knowledge.

The effect of using a mobile application ("WhiteTeeth") on improving oral hygiene: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of the WhiteTeeth mobile app, a theory-based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients. METHODS: In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check-ups: at baseline (T0), at 6-week follow-up (T1) and at 12-week follow-up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al-Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed-model analyses to determine the intervention effects. RESULTS: At 6-week follow-up, the intervention led to a significant decrease in gingival bleeding (B = -3.74; 95% CI -6.84 to -0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At 12-week follow-up, dental plaque accumulation (B = -11.32; 95% CI -20.57 to -2.07) and the number of sites covered with plaque (B = -6.77; 95% CI -11.67 to -1.87) had been reduced significantly more in the intervention group than in the control group. CONCLUSIONS: The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017.

Psychosocial developmental trajectory of a cohort of young adults born very preterm and/or with a very low birth weight in the Netherlands.

BACKGROUND: The achievement of age-specific developmental milestones in youth is of great importance to the adjustment in adult life. Young adults who were born preterm, might go through a different developmental trajectory and transition into adulthood than their peers. This study aimed to compare the psychosocial developmental trajectory of young adults who were born preterm with peers from the general population. Young adults from the POPS (Project On Preterm and Small for gestational age infants) cohort study, born in 1983 in the Netherlands, completed online the Course of Life Questionnaire (CoLQ - achievement of psychosocial developmental milestones) at 28 years of age. Analysis of variance by group, age and gender was performed to test differences on the CoLQ scale scores between the POPS-group and 211 peers (25-30 years) from the general population (Ref-group). Differences on item level, representing the achievement of individual milestones, were analyzed with logistic regression analyses by group, age and gender. RESULTS: The POPS-group (n = 300, 32,3% biased response) scored significantly lower than the Ref-group on the scales Psychosexual Development (effect size - 0.26, p < 0.01), Antisocial Behavior (ES - 0.44, p < 0.001) and Substance Use & Gambling (ES - 0.35, p < .001). A further exploration on item-level revealed, among others, that the POPS-group had their first boyfriend/girlfriend at later age, were more often single, misbehaved less at school and smoked, drank and gambled less than the Ref-group. On the scales Autonomy Development and Social Development no differences were found between the POPS-group and the Ref-group. CONCLUSIONS: A relatively less vulnerable respondent group of young adults born preterm showed some psychosocial developmental trajectory delays and might benefit from support at teenage age. Because of the non-response bias, we hypothesize that the total group of young adults born preterm will show more severe psychosocial developmental problems.

Study protocol of a randomized controlled trial to test the effect of a smartphone application on oral-health behavior and oral hygiene in adolescents with fixed orthodontic appliances.

BACKGROUND: Adolescents with fixed orthodontic appliances are at high risk of developing dental caries. To date, new smartphone technologies have seldom been used to support them in the preventive behavior that can help prevent dental caries. After an intervention-mapping process, we developed a smartphone application (the WhiteTeeth app) for preventing dental caries through improved oral-health behavior and oral hygiene. The app, which is intended to be used at home, will help adolescents with fixed orthodontic appliances perform their oral self-care behavior. The app is based on the Health Action Process Approach (HAPA) theory, and incorporates several behavior-change techniques that target the psychosocial factors of oral-health behavior. This article describes the protocol of a randomized controlled trial (RCT) to evaluate the effects of the WhiteTeeth app on oral-health behavior and oral-hygiene outcomes (presence of dental plaque and gingival bleeding) compared with those of care as usual, in patients aged 12-16 with fixed orthodontic appliances. METHODS/DESIGN: The RCT has two conditions: an experimental group that will receive the WhiteTeeth app in addition to care as usual, and a control group that will only receive care as usual. Care as usual will include routine oral-health education and instruction at orthodontic check-ups. In the western part of the Netherlands 146 participants will be recruited from four orthodontic clinics. Data will be collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1) and 12 weeks of follow-up (T2). The primary study outcomes are the presence of dental plaque (measured with a modified Silness and Loë Plaque Index); and gingival bleeding (measured with the Bleeding on Marginal Probing Index). Secondary outcomes include changes in self-reported oral-health behaviors and its psychosocial factors identified by the HAPA theory, such as outcome expectancies, intention, action self-efficacy, coping planning and action control. DISCUSSION: Since the intervention was designed to target psychosocial factors in the motivational and volitional components of the behavior-change process, we hypothesize that the app will cause greater improvements in oral-health behavior and oral hygiene more than traditional oral-health-promotion programs (i.e., care as usual). TRIAL REGISTRATION: The trial has been registered with the Dutch Trial Register ( NTR6206 : 20 February 2017).

Quality of Life in Late-Treated Patients With Disorders of Sex Development: Insights for Patient-Centered Care.

Background: Patients with a disorder of sex development (DSD) are born with atypical genitals or may develop atypical genitals and atypical body appearance, if left untreated. Health related quality of life (HRQoL) was assessed in Indonesian patients to whom diagnostic procedures and medical intervention had been delayed. Method: Comparison of 118 patients born with DSD, aged 6-41 years (60 children, 24 adolescents, and 34 adults) and 118 healthy control subjects matched for gender, age, and residential setting. HRQoL was measured using a translation of the TACQOL/TAAQOL. Results: According to parental and children's report, children with DSD reported more problems in social functioning and had less positive moods. Girls, in particular, reported problems in cognitive functioning. Adult patients reported more depressive moods, especially women, who reported more anger. No differences were found between in the adolescent groups. Conclusion: The data suggest that Indonesian children with DSD experienced more problems in social contact than non-affected Indonesian children, whereas Indonesian adults with DSD suffered from negative emotions more often than non-affected Indonesians. These findings on HRQoL are in line with findings on emotional functioning.

An application of the Health Action Process Approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances.

BACKGROUND: The Health Action Process Approach (HAPA) model addresses health behaviours, but it has never been applied to model adolescents' oral hygiene behaviour during fixed orthodontic treatment. AIM: This study aimed to apply the HAPA model to explain adolescents' oral hygiene behaviour and dental plaque during orthodontic treatment with fixed appliances. METHODS: In this cross-sectional study, 116 adolescents with fixed appliances from an orthodontic clinic situated in Almere (the Netherlands) completed a questionnaire assessing oral health behaviours and the psychosocial factors of the HAPA model. Linear regression analyses were performed to examine the factors associated with dental plaque, toothbrushing, and the use of a proxy brush. RESULTS: Stepwise regression analysis showed that lower amounts of plaque were significantly associated with higher frequency of the use of a proxy brush (R2 = 45%), higher intention of the use of a proxy brush (R2 = 5%), female gender (R2 = 2%), and older age (R2 = 2%). The multiple regression analyses revealed that higher action self-efficacy, intention, maintenance self-efficacy, and a higher education were significantly associated with the use of a proxy brush (R2 = 45%). CONCLUSION: Decreased levels of dental plaque are mainly associated with increased use of a proxy brush that is subsequently associated with a higher intention and self-efficacy to use the proxy brush.

Neonatal treatment philosophy in Dutch and German NICUs: health-related quality of life in adulthood of VP/VLBW infants.

PURPOSE: Although survival after very preterm birth (VP)/very low birth weight (VLBW) has improved, a significant number of VP/VLBW individuals develop physical and cognitive problems during their life course that may affect their health-related quality of life (HRQoL). We compared HRQoL in VP/VLBW cohorts from two countries: The Netherlands (n = 314) versus Germany (n = 260) and examined whether different neonatal treatment and rates of disability affect HRQoL in adulthood. METHOD: To analyse whether cohorts differed in adult HRQoL, linear regression analyses were performed for three HRQoL outcomes assessed with the Health Utilities Index 3 (HUI3), the London Handicap Scale (LHS), and the WHO Quality of Life instrument (WHOQOL-BREF). Stepwise hierarchical linear regression was used to test whether neonatal physical health and treatment, social environment, and intelligence (IQ) were related to VP/VLBW adults' HRQoL and cohort differences. RESULTS: Dutch VP/VLBW adults reported a significantly higher HRQoL on all three general HRQoL measures than German VP/VLBW adults (HUI3: .86 vs .83, p = .036; LHS: .93 vs. .90, p = .018; WHOQOL-BREF: 82.8 vs. 78.3, p < .001). Main predictor of cohort differences in all three HRQoL measures was adult IQ (p < .001). CONCLUSIONS: Lower HRQoL in German versus Dutch adults was related to more cognitive impairment in German adults. Due to different policies, German VP/VLBW infants received more intensive treatment that may have affected their cognitive development. Our findings stress the importance of examining effects of different neonatal treatment policies for VP/VLBW adults' life.

Psychosocial correlates of oral hygiene behaviour in people aged 9 to 19 - a systematic review with meta-analysis.

OBJECTIVES: This systematic and meta-analytic review aimed to quantify the association of psychosocial correlates with oral hygiene behaviour among 9- to 19-year olds. METHODS: A systematic search up to August 2015 was carried out using the following databases: PubMed, PsycInfo, Embase, CINAHL and Web of Science. If necessary, authors of studies were contacted to obtain unpublished statistical information. A study was eligible for inclusion when it evaluated the association between the psychosocial correlates and oral hygiene behaviour varying from self-reports to clinical measurements, including plaque and bleeding scores. A modified New Castle Ottawa Scale was applied to examine the quality of the included studies. RESULTS: Twenty-seven data sets (k) presented in 22 publications, addressing nine psychosocial correlates, were found to be eligible for the meta-analysis. For both tooth brushing and oral hygiene behaviour, random effect models revealed significant weighted average correlation (r+ ) for the psychosocial factors: 'intention', 'self-efficacy', 'attitude' (not significant for tooth brushing), 'social influence', 'coping planning' and 'action planning' (r+ ranging from 0.18 to 0.57). Little or no associations were found for 'locus of control', 'self-esteem' and 'sense of coherence' (r+ ranges from 0.01 to 0.08). CONCLUSIONS: The data at present indicates that 'self-efficacy', 'intention', 'social influences', 'coping planning' and 'action planning' are potential psychosocial determinants of oral health behaviour. Future studies should consider a range of psychological factors that have not been studied, but have shown to be important psychosocial determinants of health behaviours, such as 'self-determination', 'anticipated regret', 'action control' and 'self-identity'. Effectiveness of addressing these potential determinants to induce behaviour change should be further examined by intervention trials.

Modelling community, family, and individual determinants of childhood dental caries.

This cross-sectional study empirically tested a theoretical model of pathways and inter-relationships among community, family, and individual determinants of childhood dental caries in a sample of 630, 6-year-old children from the Netherlands. Children's decayed, missing, and filled teeth (dmft) scores were extracted from dental records. A validated parental questionnaire was used to collect data on sociodemographic characteristics, psychosocial factors, and oral hygiene behaviours. Data on neighbourhood quality were obtained from the Dutch Central Bureau of Statistics. Structural equation modelling indicated that the model was valid after applying a few modifications. In the revised model, lower maternal education level was related to poorer family organization, lower levels of social support, lower dental self-efficacy, and an external dental health locus of control. These, in turn, were associated with poorer oral hygiene behaviours, which were linked to higher levels of childhood dental caries. In addition, lower maternal education level and poorer neighbourhood quality were directly associated with higher caries levels in children. This model advances our understanding of determinants of childhood dental caries and the pathways in which they operate. Conception of these pathways is essential for guiding the development of caries-preventive programmes for children. Clues for further development of the model are suggested.

Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in the Netherlands.

BACKGROUND: It is important to know the impact of Very Preterm (VP) birth or Very Low Birth Weight (VLBW). The purpose of this study is to evaluate changes in Health-Related Quality of Life (HRQoL) of adults born VP or with a VLBW, between age 19 and age 28. METHODS: The 1983 nationwide Dutch Project On Preterm and Small for gestational age infants (POPS) cohort of 1338 VP (gestational age <32 weeks) or VLBW (<1500 g) infants, was contacted to complete online questionnaires at age 28. In total, 33.8% of eligible participants completed the Health Utilities Index (HUI3), the London Handicap Scale (LHS) and the WHOQoL-BREF. Multiple imputation was applied to correct for missing data and non-response. RESULTS: The mean HUI3 and LHS scores did not change significantly from age 19 to age 28. However, after multiple imputation, a significant, though not clinically relevant, increase of 0.02 on the overall HUI3 score was found. The mean HRQoL score measured with the HUI3 increased from 0.83 at age 19 to 0.85 at age 28. The lowest score on the WHOQoL was the psychological domain (74.4). CONCLUSIONS: Overall, no important changes in HRQoL between age 19 and age 28 were found in the POPS cohort. Psychological and emotional problems stand out, from which recommendation for interventions could be derived.