INTRODUCTION

The World Health Organization (WHO) has defined quality of life (QoL) as “an individual’s perception of his position in life in the context of the culture and value system in which he lives and in relation to his goals,expectations and standards and concerns”[1]. In recent years, OHRQoL has become increasingly important in patient care and extensively applied as a part of daily practice[2]. A healthy oral cavity empowers an individual to perform routine daily activities without any physical and psycho-social limitations. However, any disturbance related with the oral cavity may disturb normal oral functions. Persistent discomfort and a functionally impaired oral cavity may subsequently result in decreased self-confidence and social communication of the individual, compromising his or her QoL. It is wellknown that OHRQoL remains an essential element of people’s health and well-being and helps in assessment of patients’ needs and to monitor treatment responses[3,4]. Even though the impacts of oral diseases can be assessed by traditional methods, there is growing trend of availing patients’ perspectives. Therefore,the new era demands QoL assessment using patient reported outcomes (PROs) and experiences (PREs) as a part of day-to-day practice[5]. Moreover, deciding proper treatment protocols and measuring treatment outcomes based on PROs and PREs is definitely helpful and has changed the tradition of clinical practice, surveys and research in recent years.

Oral potentially malignant disorders (OPMDs) are a group of chronic disorders with increased morbidity and mortality due to cancerous changes[6]. Per recent literature,the values of the malignant potential of oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) are 3.5% (range, 0.13-34.0%)[7], 1.1%[8]and 7%-13%[9], respectively. Careful monitoring of these lesions by an experienced specialist is highly recommended to identify any malignant changes in the early stages to reduce the cancer burden. It has been documented that patients with OPMDs experience significant health-related symptoms affecting their QoL[10].Moreover, OPMD patients shown psychological impairment due to their fear of developing cancer[11]. These patients also reported to have social and emotional imbalance.Although oral cancer (OC) and OPMDs presents relatively similar health comorbidities; compromising the QoL[12],the available OHRQoL instruments are OC/head and neck cancer speci fi c, and thus, the OHRQoL of patients suffering from OPMDs is seldom assessed. Moreover, the literature on QoL assessment in this population is scanty in contrast to the plentiful literature on QoL in OC/head and neck cancer patients[13,14].

此外中国企业文化测评中心（CCMC）从2002年起，在借鉴OCAI量表的基础上，经过多家中国企业文化的实践，已经逐步建立起自己的测评体系，共包括六大部分：企业文化类型、企业文化理念导向、企业文化核心价值观、企业文化环境、企业文化领导力、个人价值与职业倾向性测评。此套量表的优点在于可以结合中国本土企业的实际情况，从企业和员工两个角度来分别评估和考察企业文化，从而为中国企业文化建设提供客观的基础。目前此套量表已在中国企业内广泛使用。

OSF is an OPMD that is highly prevalent in Indian subcontinents and South-East Asia, affecting 5 million people in India alone[9]. Its etiology is multifactorial but arecoline in the areca nut is the main causative agent in initiating the disease process. OSF is clinically characterized by a early sign and a symptoms of burning sensation, vesiculation and ulceration in the oral cavity and lately followed by blanching of the oral mucosa.This results in to increasing stiffeness and marked rigidity of the tissues leading to reduced mouth opening,significantly compromising the patient’s QoL. It is evident that OSF have detrimental effects on OHRQoL and the worsening of QoL has been associated with advanced stages of OSF[15].

OLP is a chronic in fl ammatory disorder with etiopathogenesis that is still poorly understood. OLP affects approximately 1%-2% of the population worldwide[16]and is more prevalent in middle-aged females. It is characterized by outbreaks or flares of different types of clinical presentations, which has been categorized by Eisen[17] into three subtypes: (1) reticular form; (2)erosive/atrophic form; and (3) ulcerative form. Even though the reticular form is asymptomatic, erosive and ulcerative forms are often painful and disabling and are variants with burning sensations of the oral mucosa.The persistent painful symptoms can have a signi fi cant negative impact on daily life activities including eating,swallowing or speaking. Moreover, OLP has been linked with impaired psychosocial morbidity and QoL[4,18].

The prevalence of OL is approximately 1%, with a greater number of cases seen in adults. The etiology of OL includes chewing or smoking of tobacco and related products. Clinically, OL can be classi fi ed into homogenous and non-homogenous subtypes, with the highest malignant potential reported in proliferative verrucous leukoplakia and speckled leukoplakia. OHRQoL of patients with OL was evaluated in a few past studies[19,20].

Our recent systematic review demonstrated that the QoL of patients affected by different OPMDs has been studied and successfully assessed by various authors using different QoL instruments in European countries. However, most of these studies have focused on QoL in patients with OLP, which is not at all applicable to all OPMDs[21]. Despite the fact that habit-related OPMDs, such as OSF and OL are highly prevalent in Southern Asian countries[22], surprisingly, only a few studies have assessed QoL in patients with OSF and OL in this population to our knowledge. Moreover, all these studies administered QoL instruments, namely the Oral Health Impact Profile (OHIP), University of Washington Quality of Life Questionnaire (UW-QOL),Chronic Oral Mucosal Disease Questionnaire (COMDQ)and Oral Health Related Quality of Life-UK (OHQoL-UK).However, these instruments are generic to a range of chronic oral mucosal diseases and are not conditionspeci fi c. The generic questionnaires offer less sensitivity to clinical changes than disease-speci fi c tools[23], as they are applicable to a wide variety of population and disease states. In contrast, it is well-known that conditionspecific instruments allow for better measurement of QoL than generic questionnaires, as they evaluates the effects of a concerned disease on life quality of an individual. A condition specific QoL tool for OPMD,i.e., the OPMDQoL questionnaire study, observed a signi fi cant impact of OLP and OSF compared to OL on the QoL of affected patients especially in the subscales of “physical impairment and functional limitations”[24].Recently, we developed and validated a condition-speci fi c instrument for OSF patients. This was found reliable in QoL evaluation tool in an Indian population[25].

We believe that QoL assessment has become a necessity to determine the feelings and perceptions of patients as well as to increase effective communication between health care professionals and patients. This de fi nitely provides clues not only to better understand the in fl uence of oral diseases on the patients and their families but also to monitor the outcomes of the treatments provided. Currently, increased incidence of OPMDs specifically OSF and OL in South Asian countries, is an alarming situation as far as oral cancer is concerned. This might be due to the increased popularity of commercially available areca nut and tobacco preparations, especially in India. In addition, an increasing number of young people are becoming addicted to this ancient, socially acceptable habit due to easy access, effective price changes and marketing strategies. In view of the scarcity of research on QoL assessment in OPMDs, there is a dire need for more studies to better understand this situation.It is evident that researchers have been continuously focusing on improving the QoL of affected individuals.Therefore, it is a foremost pre-requisite to employ the best available QoL instrument in OPMDs. Furthermore,due to differences in their pathogenesis and clinical presentations and thus, differing impacts on OHRQoL, the development and validation of a QoL instrument speci fi c to each clinical entity of OPMD separately is needed. Such condition-speci fi c instruments can become tools of choice in future researches and help to improve QoL of affected individuals.

滥用政府信息公开申请权行为的法律规制——兼论国外实践对中国的启示 ………………………………………………… 王学栋，赵小静（1．41）

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