A longitudinal study of medication exposure and xerostomia among older people

Objective: To describe the incidence of xerostomia among a population of older people over a 6‐year period, with particular attention to medications as risk factors. Background: Understanding the natural history of xerostomia requires longitudinal epidemiological research, but only one study has examined changes in xerostomia over time. While medication is a recognised risk factor for dry mouth, the role of particular medication categories continues to be controversial. Materials and methods: Older South Australians (aged 60+) underwent an interview and dental examination at baseline, and these assessments were repeated 2, 5 and 11 years afterward. Medication data were collected at baseline, 5 and 11 years. Xerostomia data were collected at 5 and 11 years using the Xerostomia Inventory (XI) and a standard question. Results: Of the 1205 dentate participants assessed at baseline, 669 remained after 5 years, and 246 were assessed at 11 years. Medication prevalence increased over the observation period, such that 94.8% of the cohort were taking at least one medication by 11 years. The prevalence of xerostomia increased from 21.4% to 24.8% between 5 and 11 years (p > 0.05), and the mean XI score increased from 20.0 (SD, 6.7) to 21.5 (SD, 7.9; p < 0.001). Some 14.7% of participants were incident cases of xerostomia, while 11.4% were remitted cases; 10.1% were cases at both 5 and 11 years. After controlling for gender and ‘baseline’ xerostomia severity (represented by the XI score at 5 years), participants who commenced taking daily aspirin after 5 years had over four times the odds of becoming incident cases, while those who commenced taking a diuretic after 5 years had nearly six times the odds of doing so. Conclusions: While the overall prevalence of xerostomia increased during the observation period, there was considerable instability, with one‐quarter of the cohort changing their status. Medication exposure was strongly associated with the incidence of the condition, with recent exposure to diuretics or daily aspirin strongly predicting it.     

Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia

doi:10.1111/j.1741‐2358.2009.00344.x
Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia Objective: To explore the differences in oral status, dental attendance and dry mouth problems between patients with long‐term disease with high and low scores on Oral Health Impact Profile 14 (OHIP 14) and how patients cope with oral problems such as xerostomia and a reduced ability to brush their teeth. Background: There has been a lack of studies of oral health and oral health‐related quality of life in the frail elderly within the community services. Materials and methods: A cross‐sectional questionnaire study was conducted with 137 patients receiving home‐care nursing. Structured interviews were conducted by student nurses using OHIP‐14, items from the Xerostomia Inventory and questions concerning dental visit habits, brushing of teeth and data from medical records. Results: Eighty‐three per cent of patients had natural teeth and 60% had only natural teeth. ‘Natural teeth only’ indicated a low score on OHIP‐14. Problems with brushing and items concerning xerostomia indicated a high score on OHIP‐14. Contrasts in the assessments concerning brushing of teeth and xerostomia indicated low priority from the patients themselves and the nursing staff. Conclusion: Community health services should focus upon oral health. Both patients and nurses should assess the need for regular brushing of teeth carried out by home‐care nurses. Assessment and treatment of dry mouth problems should have higher priority.     

Validity and reliability of the Oral Impacts on Daily Performance (OIDP) scale in the elderly population of Bosnia and Herzegovina

doi: 10.1111/j.1741‐2358.2011.00584.x Validity and reliability of the Oral Impacts on Daily Performance (OIDP) scale in the elderly population of Bosnia and Herzegovina Objectives: To adapt the Oral Impacts on Daily Performance (OIDP) index for elderly people in Bosnia and Herzegovina and test its validity, reliability and responsiveness to change. Background: Clinical measures alone may not be adequate for assessing the oral health of individuals. Subjective oral health indicators tested within a particular cultural context may not be relevant across cultures. Materials and methods: The study population comprised 231 free‐living adults aged 65 years or older. The OIDP was cross‐culturally adapted from English into the Serbian language and its psychometric properties were tested. Data were collected using a clinical examination and a questionnaire containing the OIDP. Results: In terms of reliability, Cronbach’s alpha coefficient was 0.82 and the intraclass correlation coefficient 0.88. The very high correlation of OIDP with self‐rated oral health (r = 0.78) verified criterion validity, while construct validity was demonstrated through its significant and graded associations with other subjective health measures. OIDP change scores on a treated subsample showed moderate effect size (0.59) and were associated with perceptions of oral health change, providing evidence for its responsiveness to change. Conclusion: The Bosnian version of the OIDP showed satisfactory validity, reliability and responsiveness to change confirming its appropriateness for use among older populations in Bosnia and Herzegovina.     

Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index

doi: 10.1111/j.1741‐2358.2011.00609.x Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index Purpose: To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India. Materials and Method: After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio‐demographic characteristics and self‐reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Result: Mean GOHAI score was 40.9 (SD, 10.6; range, 12–60). Cronbach’s alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test–retest correlation coefficient for add‐GOHAI scores was 0.72, indicating good stability. Add‐GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. Conclusion: It could therefore be used as a valuable instrument for measuring oral health–related quality of life for people in this region.     

Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years

doi: 10.1111/j.1741‐2358.2010.00420.x Self‐reported dry mouth in Swedish population samples aged 50, 65 and 75 years Background: Reduced salivary flow may have a negative impact on general well‐being, quality of life and oral health. Objectives: To examine xerostomia in 50‐, 65‐ and 75‐year‐olds, background factors and effect on Oral Impacts on Daily Performances (OIDP). Methods: In 1992, a questionnaire was sent to all 50‐year‐old persons (n = 8888) in two Swedish counties. In 2007, the same questionnaire was sent to all 65‐year‐olds (n = 8313) in the two counties and to all 75‐year‐olds (n = 5195). Response rate was for the 50, 65 and 75 year olds 71.4, 73.1 and 71.9%, respectively. Results: Xerostomia was higher in women than in men in all age groups. There was higher prevalence of xerostomia with increasing age in both sexes and it was more frequent at night than during daytime. ‘Often mouth dryness’ was 2.6–3.4 times more prevalent in those who reported an impact from OIDP. The highest odd ratios were for daytime xerostomia and for the variables burning mouth (17.1), not feeling healthy (4.5), daily smoking (4.4), and medication (4.1). Conclusions: The dramatic increase of xerostomia between age 50 and 75, especially amongst women, needs to be considered in the management of this age group.     

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): Reliability,initial validity and normative scores in higher education students

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n?=?1654), the items were developed based on part of a larger survey on higher education sleep–wake patterns. The test–retest study was conducted in an independent small group (n?=?33) with a 2–8 week gap. In study/sample 2 (n?=?360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n?=?2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale’s validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test–retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r?=?0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p?<?0.0001, d?=?0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.     

Assessing weight-related quality of life in adolescents

Objective : The development of a new weight‐related measure to assess quality of life in adolescents [Impact of Weight on Quality of Life (IWQOL)‐Kids] is described. Research Methods and Procedures : Using a literature search, clinical experience, and consultation with pediatric clinicians, 73 items were developed, pilot tested, and administered to 642 participants, 11 to 19 years old, recruited from weight loss programs/studies and community samples (mean z‐BMI, 1.5; range, ?1.2 to 3.4; mean age, 14.0; 60% female; 56% white). Participants completed the 73 items and the Pediatric Quality of Life Inventory and were weighed and measured. Results : Four factors (27 items) were identified (physical comfort, body esteem, social life, and family relations), accounting for 71% of the variance. The IWQOL‐Kids demonstrated excellent psychometric properties. Internal consistency coefficients ranged from 0.88 to 0.95 for scales and equaled 0.96 for total score. Convergent validity was demonstrated with strong correlations between IWQOL‐Kids total score and the Pediatric Quality of Life Inventory (r = 0.76, p < 0.0001). Significant differences were found across BMI groups and between clinical and community samples, supporting the sensitivity of this measure. Participants in a weight loss camp demonstrated improved IWQOL‐Kids scores, suggesting responsiveness of the IWQOL‐Kids to weight loss/social support intervention. Discussion : The present study provides preliminary evidence regarding the psychometric properties of the IWQOL‐Kids, a weight‐related quality of life measure for adolescents. Given the rise of obesity in youth, the development of a reliable and valid weight‐related measure of quality of life is timely.     

Psychosocial predictors of 4‐year BMI change in overweight and obese children in primary care

Objective:

This study aimed to determine whether (( 1 ) ) initial and/or (( 2 ) ) changes in psychosocial functioning predict body mass index (BMI) z‐score change over 4 years in overweight/mildly obese 5‐ to 9‐year old children presenting to primary care.

Design and Methods:

Eligible participants (n = 258) were overweight/mildly obese children (IOTF criteria) recruited into the LEAP2 trial (ISRCTN52511065) from 3,958 children visiting general practitioners in Melbourne, Australia from May 2005 to July 2006. Predictors were change scores calculated from repeated measures of parent‐ and child‐reported child health‐related quality of life (PedsQL) and self‐esteem; child‐reported desire to be thinner; and parent‐reported child weight concern. Outcome was measured BMI z‐score change from baseline to 4 years.

Results:

The 189 respondents (61% female; 73% retention) showed little mean change in BMI z‐score (?0.08) but wide variation (standard deviation 0.50, range ?1.32 to 1.20). Only one baseline measure (better parent‐reported PedsQL School Functioning) predicted improving BMI z‐score. However, parents and children consistently reported that changes in psychosocial functioning (i.e., PedsQL Social and Global Self‐esteem) were inversely related to BMI z‐score change scores. The strongest predictors of decreases in BMI z‐scores were changes in child‐reported body‐image variables, i.e., improvements in Physical Appearance Self‐esteem (β =0.40, 95% CI ?0.98 to ?0.15, P < 0.01) and declines in Desire to be Thinner (β = 0.33, 95% CI 0.04 to 0.23, P < 0.01).

Conclusions:

At presentation to primary care, it seems unlikely that targeting the psychosocial factors measured in this study would influence BMI z‐score change in overweight/mildly obese children. Subsequent change in psychosocial well‐being covaries with BMI z‐score change and may have important adolescent ramifications; the causal directions for these associations require further research.

     

Development and evaluation of an electromagnetic hypersensitivity questionnaire for Japanese people

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self‐selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin‐related, head‐related, auditory and vestibular, musculoskeletal, allergy‐related, sensory, and heart/chest‐related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test–retest analysis, and high Cronbach's α coefficients (0.853–0.953) from each subscale. A comparison of scores of each subscale between self‐selected EHS subjects and age‐ and sex‐matched controls using bivariate logistic regression analysis, Mann–Whitney U‐ and χ² tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353–372, 2016. © 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.     

Reliability and validity of a Japanese version of the Oral Health Impact Profile for edentulous subjects

doi: 10.1111/j.1741‐2358.2011.00606.x Reliability and validity of a Japanese version of the Oral Health Impact Profile for edentulous subjects Objective: To evaluate the reliability and validity of the Japanese version of the Oral Health Impact Profile for edentulous (OHIP‐EDENT‐J) patients. Background: Oral Health Impact Profile for edentulous is an appropriate instrument for assessing the Quality of life (QOL) in edentulous patients. However, the reliability and validity of the Japanese version had not been evaluated. Methods: The study was conducted on 116 edentulous patients (Group A, requiring new dentures, n = 61; Group B, already having dentures, n = 55). Cronbach’s alpha (α) was used to measure internal consistency of the summary scores for OHIP‐EDENT‐J and various subscales in Groups A and B. The interclass correlation coefficient (ICC) and 95% confidence interval of the summary scores for OHIP‐EDENT‐J and subscales were calculated. The summary scores for OHIP‐EDENT‐J in Groups A and B were compared with evaluate content validity. The Spearman’s correlation coefficient between the summary scores for OHIP‐EDENT‐J and the satisfaction with dentures (100 mm VAS) was calculated for Groups A and B to evaluate concurrent validity. Results: The reliability of the summary scores for OHIP‐EDENT‐J was good (α = 0.93). The ICC of the summary scores for OHIP‐EDENT‐J was 0.85. Summary scores for OHIP‐EDENT‐J were significantly different (p = 0.027) between Group A and Group B, with Group A having the higher value. The Spearman’s correlation coefficient for the degree of satisfaction with dentures and the summary scores for OHIP‐EDENT‐J, calculated for Groups A and B (n = 107), was ?0.609. Conclusion: The OHIP‐EDENT‐J, a questionnaire on oral health–related QOL comprising 19 items, showed good reliability and validity for edentulous patients.     

Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women

doi: 10.1111/j.1741‐2358.2010.00403.x Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women Objectives: To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women. Background: A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established. Methods: A case–control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard‐sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student’s t‐test and Spearman correlation was used. Results: The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol. Conclusions: It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.     

Development and Validation of the Food-Craving Inventory

Objective: The primary aim of this study was to develop and validate the Food-Craving Inventory (FCI), a self-report measure of specific food cravings. Research Methods and Procedures: In a preliminary study, participants (n = 474) completed the initial version of the FCI. The results from this study were used in developing the revised FCI. Participants (n = 379) completed the revised FCI in the primary study designed to develop a self-report measure of specific food cravings. Results: Common factor analysis yielded four conceptual factors (subscales) that were interpreted as high fats, sweets, carbohydrates/starches, and fast-food fats. Confirmatory factor analysis found that the four factors could be modeled as dimensions (or first-order factors) of a higher order construct—food craving. Test–retest and internal consistency analyses indicated good reliability for the total score and each of the subscales. Subscale scores were compared with scores on the Three Factor Eating Questionnaire and a conceptual measure of food craving. We found support for the content, concurrent, construct, and discriminant validity of the FCI. Discussion: The FCI was found to be a reliable and valid measure of general and specific food cravings. The FCI can be used in research related to overeating and binge eating. Also, it may be useful in treatment studies that target obesity and/or food cravings.     

The effect of attachment type and implant number on satisfaction and quality of life of mandibular implant-retained overdenture wearers

doi: 10.1111/j.1741‐2358.2011.00531.x The effect of attachment type and implant number on satisfaction and quality of life of mandibular implant‐retained overdenture wearers Objective: The aim of this study was to compare the quality of life and patient satisfaction outcomes of two attachment systems in mandibular overdentures with different numbers of supporting implants. Materials and methods: Sixty‐two edentulous patients with either splinted or single attachments in mandibular implant overdentures with different numbers of supporting interforaminal implants were investigated for patient satisfaction and quality of life in this retrospective study. Comparisons between groups were perceived by the Mann–Whitney U test. Relations among the parameters were investigated by Spearman’s rho correlation analysis. The results were evaluated statistically at a significance level of p < 0.05. Results: No statistically significant association is found between visual analogue scales scores and attachment type as well as implant number (p > 0.05), whereas Oral Health Impact Profile (OHIP)‐14 total scores for patients with 4‐implant‐supported bars were significantly lower than all the other attachment types (p < 0.05). Additionally, a negative (rate = 32.2%), statistically significant association between period of edentulism and total OHIP‐14 scores was detected (p < 0.05). Conclusions: A mandibular implant‐retained overdenture supported with four implants and bar attachments shows the highest ‘quality of life’ score and patient satisfaction is not influenced by the number of implants or attachment type.     

Development of a Brief Measure to Assess Quality of Life in Obesity

Objective: Obesity researchers have a growing interest in measuring the impact of weight and weight reduction on quality of life. The Impact of Weight on Quality of Life questionnaire (IWQOL) was the first self‐report instrument specifically developed to assess the effect of obesity on quality of life. Although the IWQOL has demonstrated excellent psychometric properties, its length (74 items) makes it somewhat cumbersome as an outcome measure in clinical research. This report describes the development of a 31‐item version of the IWQOL (IWQOL‐Lite). Research Methods and Procedures: IWQOLs from 996 obese patients and controls were used to develop the IWQOL‐Lite. Psychometric properties of the IWQOL‐Lite were examined in a separate cross‐validation sample of 991 patients and controls. Results: Confirmatory factor analysis provided strong support for the adequacy of the scale structure. The five identified scales of the IWQOL‐Lite (Physical Function, Self‐Esteem, Sexual Life, Public Distress, and Work) and the total IWQOL‐Lite score demonstrated excellent psychometric properties. The reliability of the IWQOL‐Lite scales ranged from 0.90 to 0.94 and was 0.96 for the total score. Correlations between the IWQOL‐Lite and collateral measures supported the construct validity of the IWQOL‐Lite. Changes in IWQOL‐Lite scales over time correlated significantly with changes in weight, supporting its sensitivity to change. Significant differences in IWQOL‐Lite scale and total scores were found among groups differing in body mass index, supporting the utility of the IWQOL‐Lite across the body mass index spectrum. Discussion: The IWQOL‐Lite appears to be a psychometrically sound and clinically sensitive brief measure of quality of life in obese persons.     

Arabic version of the Geriatric Oral Health Assessment Index

Objectives: The purpose of this study was to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into an Arabic version, and to test the validity and reliability of the translated instrument (GOHAI‐Ar) for use among the elderly in Saudi Arabia. Methods: The 12‐item GOHAI was translated into Arabic using the back‐translation technique and performing a preliminary test to determine the comprehensibility and readability of the Arabic language version. A total of 156 elderly patients answered the questionnaire, and underwent a clinical examination by one calibrated dentist. Information on subjects’ socio‐demographic background and oral health conditions was collected. Convergent validity was evaluated by identifying the associations between perceived oral health status, general health status, perceived need for dental care and GOHAI‐Ar scores. Discriminant validity was examined by comparing the GOHAI‐Ar scores and six oral health parameters. Internal consistency was measured by Cronbach’s alpha. Test–retest reliability was assessed by intra‐class correlation coefficient (ICC) and weighted kappa. Factor structure of GOHAI‐Ar was evaluated using principal component factor analysis. Results: The mean GOHAI‐Ar was 32.1 (SD 12.2; range 11–59). Mean GOHAI‐Ar scores were higher for the elderly who rated their oral and general health as good. Subjects with perceived dental treatment needs had a lower mean GOHAI‐Ar score than those without any such needs. The caries experience, number of missing teeth, OHI‐S score, number of pathologically mobile teeth and number of oral lesions were negatively correlated with the GOHAI‐Ar score. The Cronbach’s alpha (0.93) indicated a high degree of internal consistency and homogeneity between items. The ICC for GOHAI‐Ar was 0.95, the weighted kappa coefficient for individual items varied between 0.42 and 0.71, and the correlation coefficients for the 12 items were above 0.70. Factor analysis didn’t support the expected dimensions of the index, and only one factor was found at eigenvalue greater than 1. Conclusions: The findings suggest an excellent reliability and validity of GOHAI‐Ar. Further research is needed to assess the value of this instrument in oral health‐related quality of life studies in Arabic elderly population.     

Impact of new prostheses on the oral health related quality of life of edentulous patients

Objective: A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI). Background: Oral health quality of life indicators can be used to evaluate the effects of dental treatments. Material and methods: The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients’ satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group. Results: At baseline, the impact of oral health problems was apparent; the mean GOHAI‐Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI‐Add scores was negatively correlated with the initial GOHAI‐Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants’ satisfaction with the new dentures and change in GOHAI scores (p < 0.05). Conclusion: The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.     

Change in weight‐for‐length status during the first three months: Relationships to birth weight and implications for metabolic risk

Weight‐for‐length during the early postnatal period is a critical predictor of subsequent body composition and metabolic risk. This study was designed to analyze change in weight‐for‐length status according to birth weight in early infancy. Data were collected for 267 infants enrolled in the Jackson County Women, Infants, and Children (WIC) program. Postnatal measurements were collected at a clinic visit between birth and 12 weeks of age (mean = 5.7 weeks). Changes inWHO z‐scores (weight, length, weight‐for‐length) between birth and the clinic visit were calculated. Infants were classified as exclusively breastfed or as formula‐fed. Ethnicity was coded as Hispanic or non‐Hispanic. Infants were classified based on birth weight z‐score as lower ( +1 SD). Multiple regression models tested birth weight, demographic factors, and feeding as predictors of z‐score change measures. Demographic factors and feeding were also tested as moderators of the effects of birth weight. Lower birth weight infants displayed an increase in weight‐for‐length z‐score between birth and the clinic visit. Change in weight‐for‐length was associated with significant increase in weight z‐score but not in length z‐score. Higher birth weight predicted decrease in weight and length z‐scores but did not predict change in weight‐for‐length. Hispanic ethnicity predicted decrease in length z‐score and increase in weight‐for‐length z‐score but did not moderate effects of birth weight. Increase in weight‐for‐length among lower birth weight infants and persistence of high weight‐for‐length among higher birth weight infants may reflect phenotypic adjustments that are maladaptive in adverse dietary environments. Am J Phys Anthropol, 2013. © 2012 Wiley Periodicals, Inc.     

Relationship of number of remaining teeth to health-related quality of life in community-dwelling elderly

Objective: The aim of this study was to evaluate the relationship between number of remaining teeth and health‐related quality of life in community‐dwelling elderly. Subjects: A total of 207 participants who were community‐dwelling, 85 years of age. Data were from a population‐based study of age‐related general and oral health in Fukuoka Prefecture, Japan. Measurements: The Japanese version of the Short Form 36 Health Survey (SF‐36). Results: The mental component score for the participants, from the SF‐36, was higher than the Japanese national norm for those aged ≥70 years. There were no significant differences in the mean of any scores on the SF‐36 by having spouse, living with family, or education level. The mean of the SF‐36 scores of physical functioning (PF) and of the physical component scores were significantly higher in the 85‐year‐old participants with ≥20 teeth than in those with ≤19 teeth (p < 0.05 and p < 0.01 respectively). In addition, a significant difference (p < 0.05) was observed between the mean of participants with ≥20 teeth and those with ≤19 teeth after adjustment for region where the participant lived, activities of daily living (ADL), and sex. The PF (p < 0.001), role‐physical (p < 0.005), bodily pain (p < 0.001), vitality (p < 0.001), social functioning (p < 0.05), and physical component (p < 0.001) scores were significantly higher in participants with a good activities of daily living (ADL) assessment. However, ADL was not associated with the number of teeth. Conclusions: The findings of the present study indicated that 85‐year‐old participants with ≥20 teeth had better subjective physical health than those with ≤19 teeth.     

Quality of Life after Lap‐Band Placement: Influence of Time,Weight Loss,and Comorbidities

Objective: To assess the quality of life (QOL) in severely obese subjects before and after Lap‐Band gastric restrictive surgery and identify factors that may influence change. Research Methods and Procedures: All patients, over a 3‐year period, attending for preoperative assessment (n = 459) or annual review after surgery (n = 641) have completed the Short Form‐36 (SF‐36) health survey. Eight domain and physical component summary (PCS) and mental component summary (MCS) scores were calculated. Scores were analyzed in groups based on time after surgery and compared with community normal (CN) values. Paired preoperative and 1‐year scores (n = 218) data were used to find predictors of QOL change. Results: All preoperative mean scores (n = 459) were lower than CN values, with greater impairment in the PCS (36.8 ± 9.5 vs. CN: 51.3 ± 8.3, p < 0.001) than in the MCS (45.7 ± 8.2 vs. CN: 48.8 ± 9.5, p < 0.001) scores. After 1 year, scores were closer to CN scores (PCS: 52.4 ± 8.2 and MCS: 48.4 ± 7.7), and these remained closer for 4 years. Preoperative obesity comorbidity, especially physical disability, was the best predictor of poor preoperative SF‐36 scores and of improvement in scores at 1 year. The percentage of excess weight loss at 1 year (46 ± 16%) was of little predictive value of improved QOL. Discussion: Severely obese subjects have poor health‐related QOL as measured by the SF‐36 health survey. Lap‐Band surgery for this group has provided a dramatic and sustained improvement in all measures of the SF‐36. Improvement is greater in those with greater preoperative disability, and the extent of weight loss is not a good predictor of improved QOL.     

Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study

Objective: This multicenter study examined whether inpatient rehabilitation outcomes following total knee arthroplasty (TKA) were influenced by BMI. Methods and Procedures: This was a retrospective, comparative study conducted using a computerized medical database and medical records derived from TKA patients, at 15 independent rehabilitation hospitals (N = 5,428). Patients were separated into four groups based on BMI: non‐obese (BMI < 25 kg/m²), overweight (25–29.9 kg/m²), moderately obese (30–40 kg/m²), severely obese (BMI ≥ 40 kg/m²). All patients completed an interdisciplinary inpatient rehabilitation program post‐TKA. Total and individual functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores, itemized hospital charges, and discharge disposition location, were collected. Results: The percentage of total FIM change was 7.5% greater by the time of discharge in the non‐obese than in the very severely obese (P < 0.05). FIM efficiency was lowest in the severely obese as compared to the remaining groups (3.7 points (pts)/day vs. 4.0–4.3 pts/day; P = 0.044). The change in the motor FIM score from admission to discharge was 6.7–15.6% greater in the non‐obese than in the remaining groups (P < 0.05). The changes in cognition FIM, toilet transfer and walking without assistance scores were higher in the non‐obese as compared to the severely obese group (P < 0.05). The severely obese group had higher total, physical and occupational therapy and pharmacy charges than the remaining groups (P < 0.05). Discussion: An excessive BMI does not prevent gains during inpatient rehabilitation; however, these gains are made less efficiently and at a higher cost than those made when the BMI is low.