Poor oral health and age-related health outcomes : epidemiological cohort studies of older people in the United Kingdom and United States of America

PhD ThesisOral health problems have been found to be associated with disability, poor physical function, and mortality. However, cross-sectional and prospective associations are not well-established in older people, especially for self-reported oral health problems. Diet and inflammation are potential mediators in the association between poor oral health and risk of disability. However, evidence is limited. Additionally, gaps exist in the associations of poor oral health with different inflammatory markers. Inconsistent findings have also been reported for the associations between oral health and diet in older people. This thesis uses data from two population-based studies of older people, the British Regional Heart study (BRHS) and the US Health, Aging and Body Composition (HABC) Study. Data have been used to investigate cross-sectional associations of oral health problems with disability, physical function, inflammatory, haemostatic, and cardiac biomarkers, diet quality and dietary intake, and prospective associations of oral health with risk of disability, all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. Oral health problems included objective (tooth loss, periodontal disease), and subjective (dry mouth, self-rated oral health) assessments and accumulation of oral health problems. Causal mediation was performed to test mediation through diet and inflammation. The main findings are that oral health problems were cross-sectionally associated with disability and poor physical function. Poor oral health (tooth loss, periodontal disease, dry mouth, cumulative oral health problems) was also associated prospectively with greater risk of developing disability, and all-cause, CVD and respiratory mortality. Some oral health problems were associated with increased inflammation, poor diet quality and poor nutritional intake. However, inflammation and diet did not appear to mediate the association of poor oral health with risk of developing disability. Finally, poor oral health is potentially an important risk factor for the onset of disability and all-cause and cause specific mortality in older people.British Heart Foundation, Dunhill Medical Trust, National Institute on Aging, National Institute of Nursing Research, and National Institute of Dental and Craniofacial Research

Willingness to vaccinate among adults, and factors associated with vaccine acceptance of COVID-19 vaccines in a nationwide study in Poland between March 2021 and April 2022

IntroductionDespite the availability, safety and effectiveness of COVID-19 vaccines, Poland remains one of the six countries of the European Union with the lowest cumulative uptake of the vaccine's primary course in the general population. This study examined willingness to vaccinate and the associated factors in samples of unvaccinated and vaccinated adults between March 2021 and April 2022.MethodsData were collected using OBSER-CO, a nationwide, repeated cross-sectional study, conducted at four different time points (rounds). Data on willingness to vaccinate among the unvaccinated (at all rounds) and willingness to receive another dose in the vaccinated (at 2 rounds-after booster introduction), reasons for reluctance, sociodemographic, health, and behavioral factors were collected using a uniform questionnaire via computer-assisted telephone interviewing. In each round, more than 20,000 respondents were interviewed. To assess associations between factors and willingness to vaccinate, separate multivariable logistic regression models were fitted for each factor at each round and adjusted for confounders.ResultsBetween rounds 1 and 4 (March 2021–April 2022), in the unvaccinated, willingness to vaccinate declined from 73 to 12%, whereas in the vaccinated, willingness to receive another dose declined from 90 to 53%. The highest magnitude of decline between subsequent rounds occurred during the Omicron wave. Overall, concerns about side effects, effectiveness, and vaccine adverse effects were common but decreased over time. Age, gender, employment, place of residence, COVID-19 diagnosis or exposure, hospitalization, and participation in social activities were among the factors associated with willingness. However, associations changed over rounds highlighting the influence of different pandemic waves and variants.ConclusionWe observed a declining and multifactorial willingness to vaccinate in Poland, with vaccine attitudes dynamically changing across subsequent rounds. To address vaccine concerns, sustained health communication about COVID-19 vaccines is essential, especially after the emergence of new variants

Highly Concentrated LiTFSI-EC Electrolytes for Lithium Metal Batteries

Concentrated electrolytes have the potential to increase the stability for batteries with lithium metal anodes. In this study, liquid electrolytes were created by mixing ethylene carbonate (EC), a solid at room temperature, with a high concentration of LiTFSI salt. The binary LiTFSI-EC highly concentrated electrolytes have the benefit of extremely low volatility as compared to conventional organic electrolytes and also allow for cycling vs Li metal anodes. Using a LiTFSI-EC electrolyte with molar ratio 1:6, the Coulombic efficiency for Li plating/stripping on Cu is 97% at a current density of 1 mA cm-2 with a 2 mAh cm-2 capacity, pointing to a practically useful performance. In a full cell setup using a commercial LiFePO4 (LFP) cathode, the efficiency is maintained, proving compatibility. In comparison to other carbonate-based electrolytes, there is less accumulation of decomposition products on the surface of a cycled Li film, which in part explains the improved cycle life. In all, this electrolyte system shows promise in terms of electrochemical stability and may allow for safe Li metal batteries due to the inherent physical stability.\ua0\ua9 2019 American Chemical Society

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

Background: Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. Methods: We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. Results: In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94). Conclusions: Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States.

BACKGROUND: Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. METHODS: We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. RESULTS: In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94). CONCLUSIONS: Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging

Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA.

Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71-80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age

Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA.

We aimed to investigate the associations of poor oral health cross-sectionally with diet quality and intake in older people. We also examined whether change in diet quality is associated with oral health problems. Data from the British Regional Heart Study (BRHS) comprising British males aged 71-92 years and the Health, Aging and Body Composition (HABC) Study comprising American males and females aged 71-80 years were used. Dental data included tooth loss, periodontal disease, dry mouth and self-rated oral health. Dietary data included diet quality (based on Elderly Dietary Index (BRHS) and Healthy Eating Score (HABC Study)) and several nutrients. In the BRHS, change in diet quality over 10 years (1998-2000 to 2010-2012) was also assessed. In the BRHS, tooth loss, fair/poor self-rated oral health and accumulation of oral health problems were associated with poor diet quality, after adjustment. Similar associations were reported for high intake of processed meat. Poor oral health was associated with the top quartile of percentage of energy content from saturated fat (self-rated oral health, OR 1·34, 95 % CI 1·02, 1·77). In the HABC Study, no significant associations were observed for diet quality after adjustment. Periodontal disease was associated with the top quartile of percentage of energy content from saturated fat (OR 1·48, 95 % CI 1·09, 2·01). In the BRHS, persistent low diet quality was associated with higher risk of tooth loss and accumulation of oral health problems. Older individuals with oral health problems had poorer diets and consumed fewer nutrient-rich foods. Persistent poor diet quality was associated with oral health problems later in life

Poor oral health and inflammatory, haemostatic and cardiac biomarkers in older age: Results from two studies in the UK and USA.

BACKGROUND: We examined the association of objective and subjective oral health markers with inflammatory, haemostatic and cardiac biomarkers in older age. METHODS: Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n=2147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n=3075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high sensitivity Troponin T (hsTnT) and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS. RESULTS: In both studies, tooth loss, was associated with the top tertile of CRP - odds ratios (95%CI) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR (95%CI) =1.42 (1.01-1.99)). In the BRHS, complete and partial tooth loss were associated with haemostatic factors, in particular with the top tertile of fibrin D-dimer (OR (95%CI) = 1.64 (1.16-2.30) and 1.37 (1.05-1.77) respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT. CONCLUSIONS: Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, haemostatic and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, haemostatic and cardiac biomarkers

Investigation of novel, redox-active organic materials for lithium-ion and lithium-oxygen batteries

This thesis encompasses the successful synthesis, characterization (NMR, IR, TGA) and electrochemical testing of novel, potentially redox-active organic materials. These were destined as electrodes for Li-organic cells and/or as catalysts for Li–O2 cells. The electrochemical performance of the dilithiated and tetralithiated salts of 2,5-dialkylamide hydroquinones (with ethyl, isopropyl or benzyl as the alkyl group) and of a partially lithiated polymer with a backbone of alternating 2,5-dicarbonylhydroquinone and 1,4-benzyl diaminophenylene units was evaluated. The small organicsalts exhibited redox-activity around 1.0 V vs Li/Li+ (the terephthaloyl redox system) and 2.8 V vs Li/Li+ (the quinone redox system). These values drifted depending on lithiation degree and alkyl substituent. Redox irreversibility featured these materials which decomposed and dissolved. The polymer exhibited multiple redox-activity in the region of 2.5-3.6 V vs Li/Li+, which was however also irreversible. Further on, the small organic salts were tested as to their impact on the dischargeproduct (Li2O2) yield in Li-O2 cells. Discharge profiles of cells with and without the inclusion of the salts were contrasted to each other; the former having a jagged appearance, indicative of side-reactions. The O2 electrode was studied by XRD todetect the formed products and the amount of Li2O2 present was quantified throug htitration and UV-vis spectroscopy. Organic salt inclusion was found to negatively affect the Li2O2 formation and also attack the Li-electrode