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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Oral Health-Related Quality of Life after Dental Treatment among Disabled and Non Disabled Individuals in Saudi Arabia: A Cross-sectional Study
Correspondence Address :
Dr. Abdullah Ali H Alzahrani,
Associate Professor and Dean, Department of Dental Health, School of Applied Medical Sciences, Al-Baha University, Al-Baha-65731, Saudi Arabia.
E-mail: aahalzahrani@bu.edu.sa
Introduction: The quality of life based on oral health has been a vital factor affecting health outcomes. It is an overall factor that influences functional well-being, as disabled individuals may have predisposing factors that could impact their quality of life.
Aim: To assess Oral Health-Related Quality of Life (OHrQoL) in disabled and non-disabled individuals after receiving dental treatment in the Al-Baha region, Kingdom of Saudi Arabia.
Materials and Methods: A cross-sectional study was conducted between September and December 2023. A total of 86 disabled and 129 non-disabled participants underwent clinical examinations, and dental treatments were performed. The Oral Health Impact Profile (OHIP-14) was utilised to evaluate OHrQoL using a validated Arabic version of the questionnaire. Data related to all variables in OHIP-14 were analysed in association with oral diseases using Statistical Package for Social Sciences (SPSS) Software version 20.0.
Results: A total of 215 patients with and without disabilities were included in the study. Among these, 124 (57.5%) were females and 91 (42.3%) were males. Females reported significantly higher OHrQoL scores than males after dental therapy (p-value<0.001). No significant differences in OHrQoL were observed between patients with and without disabilities (p-value 0.389). However, quality of life significantly improved after dental treatment in disabled and non-disabled individuals across all sections or domains (p-value<0.05).
Conclusion: Oral disorders had a negative impact on quality of life, as post-treatment OHrQoL scores were significantly lower than pre-treatment scores.
Dental care, Dental public health, Dental service, Disability, Oral health
OHrQoL is a key predictor of overall health. It is a multi-dimensional construct that incorporates an individual’s qualitative assessment, with various ways of expressing (subjectively) their oral health. This assessment is based on emotional well-being, functional well-being, expectations, satisfaction with care, and sense of self (1). It highlights the effects of excellent or poor oral health and assists clinicians and public health advocates in understanding patients’ concerns, expectations, and satisfaction with dental care received. Over the last few decades, psychometrically validated measures for assessing OHrQoL have been created (2),(3).
The OHIP is an index based on a questionnaire commonly accepted and widely used to assess OHRQoL in children, adults, and the demented elderly [4-9]. The OHIP-14 is a 14-item abbreviated version of the OHIP that is based on Locker’s conceptual model for measuring oral health. It provides a complete measure of self-reported oral dysfunction, discomfort, and impairments. These effects were designed to provide indicators based on epidemiological principles of clinical disease, which give information about the impact of illness in the population, as well as the effectiveness of health interventions in lowering the impact of illness (9),(10),(11).
Dental care is medically required to prevent and treat orofacial disorders, infections, and pain; restore dentition structure and function; and cure facial disfigurement or dysfunction. However, oral health is one of the most underserved areas of patient care since it is challenging to maintain the best oral and dental health in people, particularly those with disabilities (12). Moreover, significant dental challenges frequently result in anxiety and cooperation problems, owing to physical restrictions, mental disability, or behavioural management issues (13). In dental practice, dental professionals face challenges in conventional dental examinations and treatment, which might require general anaesthesia for better ease and quality treatment (14). The outcome of poor oral health transcends further than the physical implications to severe social and intellectual associations with quality of life linked with foul odour, altered dental appearance, and altered speech, which have an adverse effect on self-confidence and esteem (15),(16),(17).
Individuals with disabilities are among the most marginalised and excluded categories of the population, with frequent abuse of their rights. Discrimination originates not from the inherent character of individuals’ disabilities, but rather from a lack of knowledge and understanding of causes and implications, phobias of discrimination or difference, phobias of contagion or contamination, or adverse religious or cultural attitudes about disability and its conditions. Economic burden (poverty), social deprivation, humanitarian needs (emergencies), a lack of essential services for needs and assistance, and a hostile and inaccessible environment all contribute to this problem. Individuals with disabilities typically have poorer health, less education, fewer economic opportunities, and higher rates of poverty than people without disabilities (18),(19). Unfortunately, these individuals suffer greatly due to various pharmaceutical drugs’ innervation, recommended diet associated with motor function of dysphagia, sucking lips, or tongue positioning, which may create dental issues (20). Consequently, the lack of dental care affects oral health, and limited access to dental services results in an unnecessary disease burden and can have negative oral health consequences.
Research has been conducted to evaluate OHrQoL in Saudi Arabia and worldwide (9),(11),(12),(21). However, it can be emphasised that there is no study in the literature that has examined OHrQoL in the Al-Baha region, Saudi Arabia, particularly among both disabled and non-disabled individuals. Examining this research area may highlight the significance of this study. This study is part of a larger funded project and aims to evaluate OHrQoL among both disabled and non-disabled individuals after dental treatment in the Al-Baha region in the Kingdom of Saudi Arabia.
A cross-sectional transverse study was conducted between September and December 2023 in the Al-Baha region, Saudi Arabia, among disabled and non-disabled individuals. The present study is part of a project funded by the King Salman Centre for Disability Research (research group number: KSRG-2023-169). The institutional review board of the university observed and reviewed the research code based on the Declaration of Helsinki, with final approval from the Deanship of Innovation and Scientific Research at Al-Baha University, Saudi Arabia (approval number: 1445-45103810), and the Institutional Review Board of the Saudi Ministry of Human Resources and Social Development (approval number: 1444-305040).
Procedure
A total of 215 patients aged 12 years and above of both genders, seeking dental care, were included. Patients were classified into two groups:
• the case group included patients with a disability (n=86, 40%),
• the control group included patients who had no disability (n=129, 60%).
The disabled patients were either physically or mentally disabled. Physical disabilities include those who have lost part of their bodies for different reasons, such as car accidents or disease complications like gangrene. Mental disabilities include cerebral palsy, Down syndrome, autism, and bipolar syndrome. All patients were provided with sufficient details regarding the study before they consented to participate. Physically disabled patients were asked the questions, and their responses were filled in by the healthcare provider, while questionnaires of mentally disabled patients and children under 18 years of age were filled out by either guardians or parents of the patient, as well as the supervising healthcare provider. Subjects who were unwilling to participate or absent on the day of the examination or did not meet the inclusion criteria were excluded.
The center for rehabilitation had 152 residents with disabilities, of which only 86 residents were identified as eligible to be included in the study. The sample size was 44.7% of the total inmates of the institution. A percentage of 55.5% was excluded as they did not meet the inclusion criteria, and a few subjects had serious medical conditions that made them unavailable for the study.
The participants were clinically examined to evaluate various diseases using the World Health Organisation (WHO)-recommended clinical examination format of 2013 (22). Oral examinations and dental treatments were performed in accordance with the Saudi Dental Guidelines and Protocol. All participants were assigned to the dental center for their first visit before dental treatment. A comprehensive oral treatment plan, based on the oral findings of patients with and without disabilities, was prepared by the treating oral clinician. Participants were asked to complete the questionnaire while waiting at the center. Oral treatment was provided on the same day. The patients were then given basic oral health instructions by the primary investigator and recalled after four weeks. Participants were then asked to complete the questionnaire.
The questionnaire was divided into two parts. The first part comprised demographic details of the patients, including age, sex, social status, smoking habits, health problems, and frequency of dental visits. The second part involved measuring quality of life using the OHIP-14 scale, which incorporates 14 scales to cover seven dimensions in a validated Arabic language format (9).
13These seven dimensions of the OHIP-14 scale were physical pain, functional limitations, psychological discomfort, handicap, social impact, physical disabilities, and psychological disabilities. Each dimension was assessed through two questions, with participants asked to report the frequency of adverse experiences related to these dimensions over the previous month. A five-point Likert scale ranging from 0 to 4 was used, where responses were indicated as follows: never=0, hardly ever=1, occasionally=2, fairly often=3, and very often=4. All responses were recorded, and mean scores for each item were evaluated and compared before and four weeks after treatment. Total scores for the 14 items were summed up to provide an overall OHIP-14 score ranging from 0 to 56, with higher scores indicating poorer Oral Health-related Quality of Life (OHrQoL). The Cronbach’s alpha coefficient in this study was 0.789, indicating acceptable internal consistency. The questionnaire was distributed digitally using Google Forms.
Statistical Analysis
The collected data were analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. The analysis aimed to check statistical significance, with a p-value less than 0.05 indicating significance. A two-tailed test was applied to test significance, along with frequency distribution for descriptive analysis. The Wilcoxon signed-rank test, a non-parametric test, was used to compare before and after treatment. The Mann-Whitney U and Kruskal-Wallis tests were used to compare OHIP-14 scores after treatment with respect to demographic variables.
In total, 215 patients with and without disabilities were included in this study. Of those, 57.5% were females and 42.3% were males. The majority were single, with no history of smoking, and undergoing regular dental check-ups. The OHIP-14 scores after treatment were comparable across age, social status, smoking status, health problems, and visits to dentists (p-value=0.473, p-value =0.471, p-value=0.277, p-value=0.311, and p-value=0.793, respectively). Based on gender, females reported significantly higher scores than males after treatment (p-value=0.021). (Table/Fig 1) describes the patients’ demographic characteristics and OHIP-14 scores after treatment.
The mean OHIP-14 score of the studied population before treatment for disabled and non-disabled individuals was found to be 16.74±10.34 and 19.98±9.56, respectively. While the mean OHIP-14 score after treatment for disabled and non-disabled individuals was found to be 7.09±4.98 and 9.21±4.99, respectively, indicating a significant reduction in the mean OHIP-14 scores across all the 14 items after dental treatment. (Table/Fig 2) describes the average mean OHIP scores based on pre and post-treatment in disabled and non-disabled individuals. Moreover, a significant reduction in the mean OHIP-14 scores across all the seven domains (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) after dental treatment was noticed and described in (Table/Fig 3).
The mean OHIP-14 scores after treatment were found to be statistically significantly different between the various treatments. The OHIP-14 scores were significantly higher in patients undergoing restoration, and the lowest scores were observed in patients undergoing endodontic treatment (p-value=0.005). (Table/Fig 4) shows a comparison of the mean OHIP-14 scores after treatment.
The current study was a cross-sectional study that aimed to evaluate the oral health-associated quality of life of individuals pre- and post-dental treatment. The age group studied ranged from 10 to 60 years old, and a shorter version of the OHIP-14 was used, which supports characteristic variables. The study showed a clinically and statistically significant reduction in OHIP-14 scores after treatment. The improved OHrQoL is with in agreement with similar findings reported by Rollon-Ugalde V et al., who reported an improvement of OHrQoL after dental treatment in oral symptoms (p-value=0.001 significant), daily life problems (p-value=0.018), parents’ perceptions (p-value=0.013), and the overall score of the Franciscan Hospital for Children OHrQoL questionnaire (FHCOHRQOL-Q´s) (p-value=0.001) (23). (Table/Fig 5) tabulates similar studies from the literature (23),(24),(25),(26),(27),(28). Jiménez-Lobo J et al., stated that the mean child OHIP-Short Form (COHIP-SF)-19 total score decreased from 53.7±7.8 pre-dental treatment to 31.4±4.2 post-treatment with overall improvements in all subdomains (25).
The present study showed that the physical pain and psychological discomfort domains were the most affected before treatment. Additionally, the disability status showed no statistically significant difference in OHIP-14 scores between disabled and non-disabled patients (p-value=0.389). However, a significant reduction in scores was observed for all domains after treatment. These findings summarize the impact on Health-Related Quality of Life (HRQoL), which is associated with both biological and psychological aspects as one dimension of health (Bio-psychological). This dimension includes symptoms related to physical, cognitive functioning, emotional reasoning, and social well-being(12). During this period, subjects experience challenges to their physical and psychological well-being due to their internal and external environments. They are conscious of their appearance, emotions, and perceptions of the inside and outside world. Patients may have experienced positive feelings about themselves after treatment in terms of pain relief, improved function, and enhanced social interactions (28).
Quality of life is a dynamic construct that evolves with age (29),(30). The OHIP-14 ratings after therapy were shown to be equivalent across age, social status, education, and smoking in the current study. Females, on the other hand, reported considerably higher scores following treatment than males. Patients who had undergone conservative treatment showed higher scores compared to other treatment modalities. There was a significant result in all subscales, including oral symptoms and functional problems, both statistically and clinically.
Despite the requirements and obligations to guarantee that children with disabilities have equal access to quality healthcare, their access and services to dental health services have barriers, resulting in health disparities unrelated to their impairments. Preventive procedures with prompt early treatment will prevent the development of new oral diseases and stabilise the deterioration of existing ones, leading to better health outcomes in children and young people with disabilities. Education of patients and their parents or carers about oral disease prevention and treatment must begin early. This will reduce disease and operative intervention, as extractions and surgical operations, in particular, frequently cause substantial issues. Dental healthcare workers frequently need to work in this direction.
Limitation(s)
The limitation of the study could have been that further analysis on the association between socio-demographic factors and OHIP-14 responses was not conducted. Additionally, the time for reassessment of the questionnaire was insufficient.
The study revealed no significant differences in OHrQoL between disabled and non-disabled groups. The OHrQoL scores after the treatment were lower, which could be attributed to the elimination of symptoms and challenges before the treatment. It confirmed that oral disorders have a negative impact on the quality of life. Thus, dental treatment may improve self-perception and quality of life in the short-term. Further clinical research focusing on evidence-based practices is necessary for the betterment of disabled individuals. Strategic planning is recommended in institutional homes for further day-to-day oral care.
The authors render their happiness for the support and appreciation to the King Salman Centre for Disability Research for funding this study (research group number: KSRG-2023-169). The authors give gratefulness and recognition to the Saudi Ministry of Health (‘Al-Baha Branch’) and Saudi Ministry of Human Resources and Social Development (‘Al-Baha Branch’) for their gratitude for cooperation and assistance in facilitating this study.
Funding: The authors extend their interest and thank with appreciation to the King Salman Centre for Disability Research for support and funding this study (research group number: KSRG-2023-169).The funding was given for the project and this paper is one of the part of funded project.
DOI: 10.7860/JCDR/2024/71347.19705
Date of Submission: Apr 17, 2024
Date of Peer Review: Apr 23, 2024
Date of Acceptance: Jun 28, 2024
Date of Publishing: Aug 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: Yes
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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