進階搜尋


   電子論文尚未授權公開,紙本請查館藏目錄
(※如查詢不到或館藏狀況顯示「閉架不公開」,表示該本論文不在書庫,無法取用。)
系統識別號 U0026-1701201416281400
論文名稱(中文) 居家口腔照護訓練計畫對家庭主要照顧者及腦血管意外存活者之成效
論文名稱(英文) Effects of a Home-based Oral Care Training Programmed (HOCP) for Family Caregivers with Cerebral Vascular Accidents Survivors
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 102
學期 1
出版年 103
研究生(中文) 郭雅雯
研究生(英文) Ya-Wen Kuo
學號 TA8951034
學位類別 博士
語文別 英文
論文頁數 103頁
口試委員 指導教授-顏妙芬
召集委員-李宗海
口試委員-徐亞瑛
口試委員-蔣立琦
口試委員-馬慧英
中文關鍵字 家庭照顧者  口腔照護  教育  居家護理  隨機試驗  中風存活者  舌苔  牙菌斑  呼吸道感染症狀 
英文關鍵字 Family caregiver  Oral care  Education  Home care  Randomized controlled tria  Stroke survivors  Tongue coating  Dental plaque  Symptom of respiratory infection 
學科別分類
中文摘要 腦血管意外會影響個案之基本口腔功能,也會導致口腔健康的問題。於家庭照顧者之角色中,一般家庭照顧者多數支持中風存活者於家中接受照顧,但是他們卻極少接受口腔照護之訓練;因此,當中風存活者由醫院出院回到社區中,將經歷並導致較差的口腔衛生狀況。
此研究的目的主在評值以居家為基礎的口腔訓練計畫,對於中風存活個案之家庭照顧者於知識、態度、自我效能及執行行為之成效;本研究也將評估家庭照顧者於居家為基礎的口腔訓練下,家庭照顧者於知識、態度、自我效能及行為間之關係。於中風存活者部分,本研究將了解於居家為基礎的口腔訓練計畫下,中風存活者於舌苔、牙菌斑及呼吸感染症狀之成效;另研究也將進一步了解家庭照顧者之]過程指標對於中風存活者之結果指標相關之影響因子及成效。
本研究以單盲隨機分派於台灣之居家環境中進行2個月的試驗。資料由2012年9月至2013年2月進行收集,經隨機分派到實驗組及對照組之家庭照顧者及個案總數分別各為94位。48位中風存活者與家庭照顧者接受以居家為中心的口腔照護訓練;46位中風存活者與家庭照顧者接受常規的口腔照護訓練。本研究以實證文獻之自擬結構性問卷進行研究資料之收集,於過程指標上,針對中風存活個案之家庭照顧者以口腔照護知識問卷、口腔照護態度問卷、口腔照護自我效能問卷及口腔照護行為問卷進行家庭照顧者之知識、態度、自我效能及行為分數之資料收集;於中風存活個案之結果指標上則透過Winkel tongue coating index (WTCI), plaque index (PI) 及Symptoms of Respiratory Infection (SRI) scale進行舌苔、牙菌斑及呼吸道感染症狀分數的資料收集,介入之成效比較將透過混和模式之統計以決定介入組及對照組於基礎分數、介入第一個月及第二個月後之差異程度。本研究之所有資料皆透過SPSS 19.0之套裝軟體進行資料的分析。
.結果顯示,家庭照顧者之態度及自我效能與口腔照護行為具有正相關,於介入組,態度可以成為自我效能的預測因子,而自我效能可以顯著的預測口腔照護行為。家庭照顧者於自我效能及口腔照護的行為指標於介入口腔照護訓練後於分數上皆有持續性成長之趨勢;當比較介入組及對照組時,.經過時間的變化,於口腔照護的知識、自我效能及口腔照護行為之結果上都有顯著的差異;結果顯示,經過1個月及2個月之介入,於介入組比對照組有較好的知識 (t = 8.80, p < .001、,較佳的自我效能 (self-efficacy: t = 3.53, p < .01) 及較好的口腔照護行為 (t = 11.93, p < .001) 。
中風存活者於初次評估口腔照護之分數偏低,中風存活者多數呈現較差的口腔衛生,且忽略了整體的口腔照護。比較介入組與對照組之成效,介入組於接受了以居家為基礎的口腔照護計畫後比對照組擁有較低之舌苔及牙菌斑;經過時間的變化,於介入組之整體舌苔分數具有較大的改變,且與對照組相比具有顯著的差異 (t = -13.98, p < 0.01);於牙菌斑部分,介入組具有較低的牙菌斑分數,且與對照組相比具有顯著的差異 (t = -9.21, p < 0.01);於呼吸道感染症狀上,介入組雖然分數有些微的降低,但是與對照組相比並沒有顯著的差異。於家庭照顧者之過程指標上,口腔照護行為可以作為中風存活者舌苔(t =-2.428, p < 0.05)及牙菌斑(t =--2.197, p < 0.05)之結果指標之預測因子。
本研究之實證顯示,以居家為基礎的口腔照護訓練可以顯著的提升中風存活個案之家庭照顧者之知識、態度、自我效能進而可以修正於居家環境中家庭照顧者之口腔照護行為;此居家為基礎的口腔照護訓練也可以有效的降低中風存活者之舌苔、牙菌斑分數;而於中風存活者之呼吸道感染上仍需要進一步更長期的研究來看介入對於中風存活者之成效。本研究建議,健康照護提供者應重視以居家為基礎的口腔照護訓練,並應對於家庭照顧者提供適當的口腔照護訓練教育,本研究以居家為基礎的口腔照護訓練結果應被執行於家庭照顧者並運用於出院返家的中風存活個案上。
英文摘要 Cerebral Vascular Accidents (CVA) affects basic oral functions and can contribute to oral health problems. Family caregivers support stroke survivors at home but receive little oral care training for the family caregiver role. Therefore, the CVA survivors experience a poorer oral health when discharge from hospital to community.
The aim of this study was to evaluate the effectiveness of a home-based oral care training program (HOCP) on knowledge, attitudes, self-efficacy and practice behaviors for family caregivers of stroke survivors, to assess the determine the relationship between knowledge, attitudes, self-efficacy and practices behavior related to oral care training promoting factors among family caregivers attending home-based training program, to evaluate the effectiveness of a home-based oral care for stroke survivor with tongue coating (TC), dental plaque (DP) and symptoms of respiratory infection (SRI), and to investigated the factors that affect outcome indicator of stroke survivors.
Single-blind randomized controlled trial was conducted over 2 months in home-based settings in Taiwan. Between September, 2012 and February, 2013, the data were collected from 94 family caregivers of stroke survivors randomized to two groups. Forty-eight stroke survivors and their family caregivers received home-based oral care training. Forty-six stroke survivors and family caregivers received routine oral care. Data were collected through self-administered questionnaire addressing aspects of knowledge, attitude, self-efficacy and practices behavior of oral care training factors in family caregiver of CVA survivors. The outcome measures of tongue coating, dental plaque and symptoms of respiratory infection of CVA survivor were assessed by the Winkel tongue coating index (WTCI), plaque index (PI) and Symptoms of Respiratory Infection (SRI) scale at baseline, one and two months using analysis with Mixed Model to determine differences between intervention and comparison group outcomes. All data were analysed using the Statistical Package for the social Sciences edition 19.0.
The outcome indicator of self-efficacy and oral care behaviors continued to improve. When the groups were compared, the results showed statistically significant differences in oral care knowledge, self-efficacy and behavior outcome variables between the intervention and comparison groups over time. The findings demonstrated that the intervention group had more knowledge (t = 8.80, p < .001), greater self-efficacy (self-efficacy: t = 3.53, p < .01), and better oral care behavior (t = 11.93, p < .001) than the comparison group at one and two months, with statistically significant differences in oral care knowledge, self-efficacy and behavior outcome over time. The treatment interaction effect was significant for caregivers’ behavior of oral care at one and two months of the intervention for both groups. A positive correlation was found between AOC, self-efficacy and BOC. Linear regression modeling revealed that at two months for the intervention group, knowledge and self-efficacy predicted attitude, attitude predicted self-efficacy and behavior, and self-efficacy was a significant predictor of behavior.
Poor oral hygiene and an overall neglect of oral care practices were observed at baseline for CAV survivors. Reductions in TC scores and DP were significantly in the intervention group receiving the home-base oral care training program compared to the routine oral care group (p <.001). The total TC scores showed significantly more change in the experimental group compared to the comparison group over time (t = -13.98, p < 0.01). These results indicated that stroke survivors in the experimental group had significantly lower DP total scores compared to the comparison group (t = -9.21, p < 0.01). The SRI scores were not significantly different between the two groups (t = -0.99, p > 0.05). The process indicators with BOC was the predict factor for TC (t =-2.428, p < 0.05) and DP (t =--2.197, p < 0.05) of outcome indicators.

Evidence has shown that a home-based oral care training program can achieve significant improvement in oral care knowledge, attitude and self-efficacy among family caregivers with stroke survivors, sufficient to empower them to modify oral care practices behavior in the home health care environment. A home-based oral care training program also has a beneficial effect on oral health of stroke survivors as measured by TC and DP scores. The effect on SRI requires further longitudinal study. The health care providers should emphasize the importance of home-based oral care and provide adequate oral care education to the family caregivers of stroke survivors. A home-based oral care training program should be implemented for family caregivers when stroke survivors are discharged home.
論文目次 Abstract………………………………………………………………………I
Acknowledgements…………………………………………………VII
Table of Contents ……………………………………………VIII
List of Figure………………………………………………………X
List of Table ………………………………………………………XI
CHAPTER ONE: INTRODUCTION ………………………1
Background………………………………………………………………1
Purpose………………………………………………………………………5
Research Question……………………………………………6
Research Hypothesis………………………………………6
Definition of Terms………………………………………7
CHAPTER TWO: LITERATURE REVIEW……………8
Cerebral Vascular Accidents ………………8
Oral Care and Cerebral Vascular
Accidents…………………………………………………………………10
Oral Care, Tongue Coating, Dental
Plaque and Pneumonia……………………………………11
Self-efficacy Theory …………………………………13
Family Caregiver’s Knowledge, Attitude
and Oral Care behavior………………………………15
Family Caregiver’s Self-Efficacy
and Oral Care Behavior………………………………17
Social Support and Caregivers……………19
Oral Care Education………………………………………20
CHAPTER THREE: METHODS…………………………………23
Framework of Research…………………………………23
Study Design…………………………………………………………25
Subjects and Setting……………………………………25
Intervention Procedures …………………………26
Home-based Oral Care Training Program
(HOCP) ………………………………………………………………………28
Instrument and Outcome Measures………34
Statistical Analysis……………………………………38
Ethic Considerations……………………………………38
CHAPTER FOUR: RESULTS……………………………………39
Demography Characteristics of Stroke
Survivors ………………………………………………………………39
The Characteristics of Family
Caregiver…………………………………………………………………40
Descriptive Characteristics for
Family Caregivers’ Knowledge,
Attitude, and self-efficacy…………………42
Descriptive the Correlation for
Family Caregivers’ Knowledge, Attitude,
Self-efficacy and Behavior……………………45
The Mixed Model Analysis for Family
Caregivers’ Knowledge, Attitude,
and self-efficacy …………………………………………48
Descriptive Characteristics for
Stroke Survivors’ Tongue Coating,
Dental Plaque and Symptom of Respiratory
Infection…………………………………………………………………50
The Mixed Model Analysis for Stroke
Survivors’ Tongue Coating, Dental
Plaque and Symptom of Respiratory
Infection…………………………………………………………………52
The Relationship Between Process
Indicators and Outcome indicators 54
CHAPTER FIVE: DISCUSSION……………………………57
Family Caregivers’ Knowledge,
Attitude, Self-efficacy and Behaviors
related to the Oral Care…………………………57
Stroke Survivors’ Tongue Coating,
Dental Plaque, and Symptom of
Respiratory Infection…………………………………60
Limitations………………………………………………………………64
CHAPTER SIX: CONCLUSION and
IMPLICATIONS FOR RESEARCH…………………………65
REFERENCES…………………………………………………………………66

LIST of APPENDICES
A: Approval Letter
B: Consent Form to Participate in Interview
C: Questionnaire
D: Bartheal Index
E: Interview Training
F: List of Expert
G: Permission Letter
參考文獻 Abe, S., Ishihara, K, Adachi, M.,& Okuda, K. (2008). Tongue-coating as risk indicator for aspiration pneumonia in edentate elderly. Archives of Gerontology and Geriatrics, 47(2), 267-275.
Almståhl, A., Kareem, K. L., Carlén, A., Wårdh, I., Lingström, P., &Wikström, M. (2012). A prospective study on oral microbial flora and related variables in dentate dependent elderly residents. Gerodontology, 29(2), e1011-e1018.
Australian Institute of Health and Welfare (2013). Stroke and its management in Australia: an update. Cardiovascular Disease Series, 37, CVD 61.
Awano, S., Ansai, T., Takata, Y., Soh, I., Akifusa, S., Hamasaki, T.,…Takehara, T. (2008). Oral health and mortality risk from pneumonia in the elderly. Journal of Dental Research, 87(4), 334-339. doi: 10.1177/154405910808700418
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change.
Psychological Review, 84(2), 191–215.
Bandura, Albert (1977). Social Learning Theory. Alexandria, VA: Prentice Hall, p. 247, ISBN 0-13-816744-3
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist,
37, 122–147.
Bandura, A. (1988). Organizational Application of Social Cognitive Theory. Australian Journal of Management, 13(2), 275-302.
Brady, M. C., Furlanetto, D. L. C., Hunter, R.V., Lewis, S. L., & Milne, V. (2007). Improving Oral Hygiene in Patients After Stroke. Stroke, 38, 1115-1116.
British Society of Gerodontology (2012). Guidelines for the Oral Healthcare of Stroke Survivors. Retrieved from www.gerodontology.com/ forms/stroke_guidelines.pdf.
Bucher, J. A., Loscalzo, M., Zabora, J., Houts, P. S., Hooker, C., & BrintzenhofeSzoc, K. (2001). Problem-solving cancer care education for patients and caregivers. Cancer Practice, 9(2), 66–70. doi: 10.1046/j.1523-5394.2001.009002066.x
Chen, C. C., Chen, C. S., Liu, T. C., & Lin, Y. T. (2012). Stock or stroke? Stock market movement and stroke incidence in Taiwan. Social Science & Medicine, 75(11), 1974-1980. doi: 10.1016/j.socscimed.2012.07.008
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159.
Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In B. R. Sarason & I. G. Sarason (Eds.), Social Support: Theory, Research, & Applications (pp.73-94).
Coombs, U. E. (2007). Spousal caregiving for stroke survivors. The Journal of Neuroscience Nursing, 39(2), 112-119.
Cornejo-Ovalle, M., Costa-de-Lima, K., Pérez, G., Borrell, C., & Casals-Peidro, E. (2013). Oral health care activities performed by caregivers for Institutionalized elderly in Barcelona-Spain. Medical Oral Patooiaia Oral Cirugia Bucal, 18(4), e641- e649. doi:10.4317/medoral.18767
Danser, M. M., Gómez, S. M., & Van der Weijden, G. A. (2003). Tongue coating and tongue brushing: a literature review. International Journal of Dental Hygiene, 1(3), 151-158. doi: 10.1034/j.1601-5037.2003.00034.x
de Mata, C., McKenna, G., & Burke, F. M. (2011). Caries and the older patient. Dent Update, 38 (6), 376-378.
de Oliveira, C., Watt, R., & Hamer, M. (2010). Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ, 340, c2451.
Dewey, H. M., Thrift, A. G., Mihalopoulos, C., Carter, R., Macdonell, R. A., McNeil, J. J., Donnan, G. A. (2002). Informal care for stroke survivors: results from the North East Melbourne stroke incidence study (NEMESIS). Stroke, 33(4), 1028-1033. doi:10.1161/01.STR.0000013067.24300.B0.
Dickinson, H. (2012). Maintaining oral health after stroke. Nursing Standard, 26(49), 35-39.
Drinka, P. J., & El-Solh, A. A. (2010). The tongue, oral hygiene, and prevention of pneumonia in the institutionalized elderly. Journal of the American Medical Directors Association, 11(7), 465-446. doi: 10.1016/j.jamda.2010.01.009
El-Solh, A. A. (2011). Association between pneumonia and oral care in nursing home residents. Lung, 189(3),173-180.
Ellekjær, H., Holmen, J., Indredavik, B., & Terent, A.(1997). Epidemiology of Stroke in Innherred, Norway, 1994 to 1996 : Incidence and 30-Day Case-Fatality Rate. Stroke, 28 (11), 2180–2184. doi:10.1161/01.STR.28.11.2180. PMID 9368561. Retrieved 2008-01-22.
Evirgen, S., & Kamburoğlu, K. (2013). Effects of tongue coating and oral health on halitosis among dental students. Oral Health & Preventive Dentistry, 11(2), 169-173.
Farrell, S., Baker, R. A, Somogyi-Mann, M., Witt, J. J., & Gerlach, R. W. (2006). Oral malodor reduction by a combination of chemotherapeutical and mechanical treatments. Clinical Oral Investigations, 10(2), 157-163.
Faveri,M., Feres, M, Shibli, J. A., Hayacibara, R. F., Hayacibara, M. M., & de Figueiredo, L. C. (2006). Microbiota of the dorsum of the tongue after plaque accumulation: an experimental study in humans. Journal of Periodontology, 77(9), 539-546.
Feigin, V. L., Lawes, C. M., Bennett, D. A., Barker-Collo, S. L., & Parag, V. (2009). Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurology, 8(4), 355-369. doi: 10.1016/S1474-4422(09)70025-0
Frenkel, H. F., Harvey, I., & Needs, K. M. (2002). Oral health care education and its effect on caregiver’s knowledge and attitudes: a randomized controlled trial. Community Dentistry and Oral Epidemiology, 30(2), 91-100.
Freda, C., & Libby, F. (2000). Draft definitions for surveillance of infections in home health care. American Journal of Infection Control, 28(6), 449-453.
Glader EL, Stegmayr B, Norrving B, Terént A, Hulter-Asberg K, Wester PO, & Asplund K. (2003). Riks-Stroke Collaboration: Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke, 34, 1970-1975.
Glassman, P., & Miller, C. E. (2006). Effect of preventive dentistry training program for caregivers in community facilities on caregiver and client behavior and client oral hygiene. The New York StateDental Journal, 72(2), 38-46.
Green, L., & Kreuter, M. (2005). Health program planning: An educational and ecological approach. 4th edition. New York, NY: McGrawhill.
Godwin, K. M., Ostwald, S. K., Cron, S.G., & Wasserman, J. (2013). Long-term health-related quality of life of stroke survivors and their spousal caregivers. The Journal of Neuroscience Nursing, 45(3), 147-154.
Gondhalekar, R., Richard, K. M., Jayachandra, M. G., Aslam, S., Reddy, V. N., & Barabde, A. S. (2013). Effect of tongue cleaning methods and oral mutans streptococci level. Journal of Contemporary Dental Practice, 14(1), 119-122.
Haas, A. N., Silveira, E. M., & Rösing, C. K. (2007). Effect of tongue cleansing on morning oral malodour in periodontally healthy individuals. Oral Health & Preventive Dentistry, 5(2), 89-94. 10.1111/j.1741-2358.2011.00577.x
Harnacke, D., Mitter, S., Lehner, M., Munzert, J., & Deinzer, R. (2012). Improving oral hygiene skills by computer-based training: a randomized controlled comparison of the modified Bass and the Fones techniques. PLoS One, 7(5), e37072. doi: 10.1371/journal.pone.0037072
Haumschild, M. S., & Haumschild, R. J. (2009). The importance of oral health in long-term care. Journal of American Directors Association, 10(9), 667-671. doi: 10.1016/j.jamda.2009.01.002.
Heitzmann, C. A., & Kaplan, R. M. (1988). Assessment of methods for measuring social
support. Health Psychology, 7(1), 75-109.
Jones, S. P., Auton, M. F., Burton, C. R., & Watkins, C. l. (2008). Engaging service users in the development of stroke services: an action research study. Journal of Clinical Nursing, 17(10), 1270–1279.
Junges, R., Portella, F. F., Hugo, F. N., Padilha, D. M. P, & Samuel, S. M. W. (2012). Caregivers’ attitudes regarding oral health in a long-term care institution in Brazil. Gerodontology, 7. doi: 10.1111/ger.12019
Kakudate, N., Morita, M., Fukuhara, S., Sugai, M., Nagayama, M., Kawanami, M., & Chiba, I. (2010). Application of self-efficacy theory in dental clinical practice. Oral Disease, 16(8), 747-752. doi: 10.1111/j.1601-0825.2010.01703.x.
Kelly, T. (2010). Review of the evidence to support oral hygiene in stroke patients. Nursing Standard, 24(37), 35-38. doi: 10.7748/ns2010.05.24.37.35.c7778
Kleinberg, I.,Wolff,M. S.,& Codipilly, D.M. (2002). Role of saliva in oral dryness, oral feel and oral malodour. International Dental Journal, 52(3), 236-240.
Kneckt, M. C., Syrjälä, A. M., Laukkanen, P., & Knuuttila, M. L. (1999). Self-efficacy as a common variable in oral health behavior and diabetes adherence. European journal of oral sciences, 107(2), 89-96
Kwok, T., Wong, B., Ip, I., Chui, K., Young, D., & Ho, F. (2013). Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: a single-blinded randomized controlled trial. Clinical Intervention Aging, 8, 1191-1197. doi: 10.2147/CIA.S48264. Epub 2013 Sep 16.
Lam, O. L., Zhang, W., Samaranayake, L. P., Li, L. S., & McGrath, C. (2011). A systematic review of the effectiveness of oral health promotion activities among patients with cardiovascular disease. International Journal of Cardiology, 151(3), 261-267.
Lam, O. L., Zhang, W., Samaranayake, L. P., Li, L. S., & McGrath, C. (2013). Randomized clinical trial of oral health promotion interventions among patients following stroke. Archives of physical medicine and rehabilitation, 94(3), 435-443.
Luszczynska, A., & Schwarzer, R. (2005). Social cognitive theory. In M. Conner & P. Norman (Eds.), Predicting health behaviour (2nd ed. rev., pp. 127-169). Buckingham, England: Open University Press.
Macnee, C. L. & Talsma, A. (1995). Predictors of progress in smoking cessation. Public Health Nursing, 12(4), 242–248.
McCurry, S. M., Gibbons, L. E., Logsdon, R. G., Vitiello, M. V., & Teri, L. (2005). Nighttime insomnia treatment and education for Alzheimer’s disease: A randomized, controlled trial. Journal of American Geriatrics Society, 53(5), 793-802. doi: 10.1111/j.1532-5415.2005.53252.x
Millns, B., Gosney, M., Jack, C. I., Martin, M. V., & Wright, A. E. (2003). Acute stroke predisposes to oral gram-negative bacilli – a cause of aspiration pneumonia? Gerontology, 49(3), 173-176.
National Stroke Association (2011, Sep 13). Rehabilitation therapy after stroke. Retrieved from http://www.stroke.org/site/PageServer?pagename=REHABT
National Stroke Foundation (2012a). What is a stroke? Retrieved from
.
National Stroke Foundation (2012b). Effects of a stroke. Retrieved from http://strokefoundation.com.au/what-is-a-stroke/effects-of-stroke/
National Stroke Foundation (2012c). Types of stroke. Retrieved from .
Nedkoff, L., Briffa, T., Knuiman, M., Hung, J., Norman P, Hankey G ... Hobbs, M. (2012).. Temporal trends in the incidence and recurrence of hospitalised atherothrombotic disease in an Australian population, 2000–07: data linkage study. Heart, 98(19),1449-1456.
Niesten, D., van Mourik, K., & van der Sanden, W. (2013). The impact of frailty on oral care behavior of older people: a qualitative study. BMC Oral Health 2013, 13(1), 61
O’Donnell, M. J., Xavier, D., Liu, L., Zhang, H., Chin, S. L., Rao-Melacini, P... Yusuf, S. (2010). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet, 376(9735), 112–123.
Ormrod, J. E. (2006). Educational psychology: Developing learners (5th ed.). Upper Saddle River, N.J.: Pearson/Merrill Prentice Hall.
Ostuni, E. (1994). Stroke and the dental patient. JADA, 125, 721–727.
Ostwald, S. K., Wasserman, J., & Davis, S. (2006). Medications, comorbidities, and medical complications in stroke survivors: the CAReS study. Rehabilitation Nursing, 31(1), 10-14. doi: 10.1002/j.2048-7940.2006.tb00004.x
Outhouse, T. L., Fedorowicz, Z., Keenan, J. V., & Al-Alawi, R. (2006). A Cochrane systemic review finds tongue scrapers have short-term efficacy in controlling halitosis. General Dentistry, 54(5), 352-359.
Pedrazzi, V., Sato, S., deMattosM. d. G.C.,Lara, E.H.,& Panzeri,H. (2004). Tongue-cleaning methods: A comparative clinical trial employing a toothbrush and a tongue scraper. Journal of Periodontology, 75(7), 1009-1012.
Pow, E. H., Leung, K. C., Wong, M. C., Li, L. S., & McMillan, A. S. (2005). A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community. International Dental Journal, 55(5), 319-324. doi: 10.1111/j.1875-595X.2005.tb00330.x
Quirynen, M., Mongardini, C., & Van Steenberghe, D. (1998). The effect of an one-stage full-mouth disinfection on oral malodor and microbial colonization of the tongue in periodontitis patients. A pilot study. Journal of Periodontology, 69(3), 374-382.
Scannapieco, F. A., Bush, R. B., & Paju, S. (2003). Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Annals of periodontology, 8(1), 54-69.
Schrijvers, E. M., Schürmann, B., Koudstaal, P. J., van den Bussche, H., Van Duijn, C. M., Hentschel, F.,... Ikram, M.A. (2012). Genome-wide association study of vascular dementia. Stroke, 43(2), 315–319.
Schumacher, K. L., Stewart, B. J.,Archbold, P. G., Dodd, M. J., & Dibble, S. L. (2000). Family caregiving skill: Development of the concept. Research in Nursing & Health, 23(3), 191–203. doi: 10.1002/1098-240X (200006)
Seemann, R., Kison, A., Bizhang, M., & Zimmer, S. (2001). Effectiveness of mechanical tongue cleaning on oral levels of volatile sulfur compounds. The Journal of the American Dental Association, 132, 1263-1267.
Senelick, R. C., Rossi, P. W., & Dougherty, K. (1994). Living with Stroke: A Guide for Families. Contemporary Books:Chicago. ISBN 0-8092-2607-3. OCLC 40856888 42835161.
Shannon, J., Kirkley, B., Ammerman, A., Keyserling, T., Kelsey, K., DeVellis, R. & Simpson, R. J. (1997). Self-efficacy as a predictor of dietary change in a low-socio-
economic-status southern adult population. Health Education & Behavior, 24(3), 357–368.
Shi, Z., Xie, H., Wang P, Zhang Q, Wu Y, Chen E.,.. Furness, S. (2013). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Systetatic Review, 8:CD008367. doi: 10.1002/14651858.CD008367.pub2.
Sims, N. R., & Muyderman, H. (2009). Mitochondria, oxidative metabolism and cell death in stroke. Biochimica et Biophysica Acta,1802 (1), 80–91. doi:10.1016/j.bbadis.2009.09.003
Simons, D., Baker, P., Jones, B., Kidd, E. A., & Beighton, D. (2000). An evaluation of an oral health training programme for carers of the elderly in residential homes. British Dental Journal, 188(4), 206-210.
Sloane, P. D., Zimmerman, S., Chen, X., Barrick, A. L., Poole, P., Reed, D., ..Cohen, L. W. (2013). Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes. Journal of the American Geriatrics Society, 61(7), 1158-1163.
Smiech-Slomkowska, G., & Jablonska-Zrobek, J. (2007). The effect of oral health education on DP development and the level of caries-related Streptococcus mutans and Lactobacillus spp. European journal of orthodontics, 29(2), 157-160.
Sörensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. Gerontologist, 42(3), 356–372
Stetson, B. A. (2000). Influence of behavioral science research on oral health promotion. Compendium of Continuing Education in Dentistry. Supplement, 30, 24-30. quiz 66.
Stewart, J. E., Strack, S., & Graves, P. (1997). Development of oral hygiene self-efficacy and outcome expectancy questionnaires. Community Dentistry and Oral Epidemiology, 25(5), 337-342. doi:10.1111/j.1600-0528.1997.tb00951.x
Stonecypher, K. (2010). Ventilator-associated pneumonia: the importance of oral care in intubated adults. Critical care nursing quarterly, 33(4), 339-347. doi: 10.1097/CNQ.0b013e3181f649a6.
Suarez, F. L., Furne, J. K., Springfield, J., & Levitt, M. D. (2000). Morning breath odor: Influence of treatments on sulfur gases. Journal of Dental Research, 79(10), 1773-1777.
Taani, D. Q., Habashneh, R., Hammad, M. M., & Batieha, A. (2003). The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables. Journal of Oral Rehabilitation, 30(4), 440-445.
Takeshita, T., Tomioka, M., Shimazaki, Y., Matsuyama, M., Koyano, K., Matsuda, K., & Yamashita, Y. (2010). Microfloral characterization of the tongue coating and associated risk for pneumonia-related health problems in institutionalized older adults. Journal of the American Geriatrics Society, 58(6), 1050-1057. doi: 10.1111/j.1532-5415.2010.02867.x
Talbot, A, Brady, M., Furlanetto, D. L., Frenkel, H., & Williams, B. O. (2005).Oral care and stroke units. Gerodontology, 22(2), 77–83.
Tashiro, K., Katoh, T., Yoshinari, N., Hirai, K., Andoh, N., Makii, K.,…Ogasawara, T. (2012). The short-term effects of various oral care methods in dependent elderly: comparison between toothbrushing, tongue cleaning with sponge brush and wiping on oral mucous membrane
ten Cate, J. M. (2006). Biofilms, a new approach to the microbiology of Denyal Plaque. Odontology, 94(1),1-9.
Tran, P., & Mannen, J. (2009). Improving oral healthcare: improving the quality of life for patients after a stroke. Special Care in Dentistry, 29(5), 218-221. doi: 0.1111/j.1754-4505.2009.00096.x
Tsai, C. C., Chou, H. H.,Wu, T. L.,Yang, Y. H.,Ho, K. Y.,Wu, Y. M., & Ho, Y. P. (2008). The levels of volatile sulfur compounds in mouth air from patients with chronic periodontitis. Journal of Periodontal Research, 43(2), 186-193.
van den Broek, A., Feenstra, L.,&de Baat, C. (2008). A review of the current literature on management of halitosis. Oral Diseases, 14(1), 30-39.
Van der Sleen, M. I., Slot, D. E., Van Trijffel, E., Winkel, E. G., & Van der Weijden, G. A. (2010). Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review. International Journal of Dental Hygiene, 8(4), 258-268. doi: 10.1111/j.1601-5037.2010.00479.x.
Van Tornout, M., Dadamio, J., Coucke, W., & Quirynen, M. (2013). Tongue coating: related factors. Journal of Clinical Periodontology, 40(2), 180-185. doi: 10.1111/jcpe.12031
Winkel, E. G., Roldán, S., Van Winkelhoff, A. J., Herrera, D., & Sanz, M. (2003). Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. Journal of Clinical Periodontology, 30(4), 300-306.
White, G. E., &Armaleh, M. T. (2004). Tongue scraping as a means of reducing oral mutans streptococci. Journal of Clinical Pediatric Dentistry, 28(2), 163–166.
Wise, M. P., & Williams, D. W. (2013). Oral care and pulmonary infection - the importance of plaque scoring. Critical Care, 17(1), 101. doi: 10.1186/cc11896
Willumsen, T., Fjaera, B., & Eide, H. (2010). Oral health-related quality of life in patients receiving home-care nursing: Associations with aspects of dental status and xerostomia. Gerodontology, 27(4), 251-257.
Winter, L., & Gitlin, L. N. (2006). Evaluation of a telephone-based support group intervention for female caregivers of community-dwelling individuals with dementia. American journal of Alzheimer's disease and other dementias, 21(6), 391–397.
World Health Organization (2008). The global burden of disease : 2004 update. Geneva, Switzerland: World Health Organization. p. 4. ISBN 9789241563710.
World Health Organization (2013). The top 10 causes of death. Retrieved from http://who.int/mediacentre/factsheets/fs310/en/
Ya-Wen Kuo, Miaofen Yen, Susan Fetzer, & Jiann-Der Lee (2013). Toothbrushing Versus Toothbrushing Plus Tongue Cleaning in Reducing Halitosis and Tongue Coating. Nursing Research, 62(6), 422-429. doi: 10.1097/NNR.0b013e3182a53b3a
Yonezawa, H., Takasaki, K., Teraoka, K., Asaka, T., Sato, C., & Tsuchiya, K. (2003). Effects of tongue and oral mucosa cleaning on oral Candida species and production of volatile sulfur compounds in the elderly in a nursing home. Journal of Medical and Dental Sciences, 50(1), 1-8. doi: 10.1111/j.1741-2358.2006.00125.x
Yoneyama, T., Yoshida, M., Matsui, T., & Sasaki, H. (1999). Oral care and pneumonia. Lancet
354(9177), 515.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2019-01-27起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw