Cross-cultural psychometric assessment of an appetite questionnaire for patients with cancer

Objective: To evaluate the psychometric properties, along with cross-cultural invariance analysis, of the Cancer Appetite and Symptom Questionnaire (CASQ). Method: Data from 555 United Kingdom (UK) cancer patients were used to evaluate the psychometric properties of the CASQ. Construct validity was assessed through factorial and convergent validity. We conducted a confirmatory factor analysis using as indices the chi-square ratio by degrees of freedom (χ2/df), the comparative fit index (CFI), the goodness of fit index (GFI), and the root mean square error of approximation (RMSEA). Convergent validity was estimated by the items’ average variance extracted (AVE). Reliability was estimated by composite reliability and internal consistency. Factorial invariance analysis of the CASQ was evaluated by multigroup analysis (∆χ2) using the UK and Brazilian samples. Results: All items showed adequate psychometric sensitivity in the UK sample. One item was removed and four correlations were included between errors with an appropriate fit of the model (χ2/df = 2.674, CFI = 0.966, GFI = 0.964, RMSEA = 0.055). The reliability of the CASQ was adequate and the convergent validity was low. The factorial structure of the CASQ differed across countries, and a lack of measurement invariance for the two countries was observed (λ: ∆χ2 = 64.008, p < 0.001; i: ∆χ2 = 3515.047, p < 0.001; Res: ∆χ2 = 4452.504, p < 0.001). Conclusion: The CASQ showed adequate psychometric properties in the UK sample. The ability to estimate loss of appetite and the presence of symptoms was different between UK and Brazilian patients

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis

Stress, cortisol, and periodontitis in a population aged 50 years and over

Periodontitis and its relationship with psychoneuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp's Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [ OR = 5.1, 95% CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [ OR = 6.9, 95% CI ( 1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [ OR = 10.7, 95% CI ( 1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.85432432

Oral status and its association with obesity in Southern Brazilian older people

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. A random sample of 872 independently living elderly was evaluated by means of a cross-sectional study. Socio-demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)(2)) data. Participants were categorised into non-obese (BMI 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18-4.27) and dentate participants with one to eight teeth wearing 0-to-1 prosthesis (OR = 2.96, 95% CI 1.68-5.19) were more likely to be obese. The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.2614652Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq