General Health Indicators Research Articles

Associations Between Obesity and Comorbid Mental Health, Developmental, and Physical Health Conditions in a Nationally Representative Sample of US Children Aged 10 to 17

ObjectiveThis large population-based study of US children considered the association of obesity with a broad range of comorbidities. This study examined relationships between weight status and health for US children. MethodsWe performed cross-sectional analysis of data on 43,297 children aged 10 to 17 from the 2007 National Survey of Children’s Health. Weight status was calculated from parent report of child height and weight. Logistic regression models assessed associations between weight status and 21 indicators of general health, psychosocial functioning, and specific health disorders, adjusting for sociodemographic factors. ResultsUsing body mass index (BMI) percentiles for age and sex, 15% of US children were considered overweight (BMI 85th to <95th percentile), and 16% were obese (BMI ≥95th percentile). Compared with children classified as not overweight, obese children were more likely to have reported good/fair/poor health (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI] 1.76–2.69), activity restrictions (AOR 1.39, 95% CI 1.10–1.75), internalizing problems (AOR 1.59, 95% CI 1.04–2.45), externalizing problems (AOR 1.33, 95% CI 1.07–1.65), grade repetition (AOR 1.57, 95% CI 1.24–1.99), school problems, and missed school days. Attention deficit/hyperactivity disorder, conduct disorder, depression, learning disability, developmental delay, bone/joint/muscle problems, asthma, allergies, headaches, and ear infections were all more common in obese children. ConclusionsObese children have increased odds of worse reported general health, psychosocial functioning, and specific health disorders. Physicians, parents, and teachers should be informed of the specific comorbidities associated with childhood obesity to target interventions that could enhance well-being. Future research should examine additional comorbidities and seek to confirm associations using longitudinal data and clinical measures of height and weight.

Dragonflies: climate canaries for river management

AbstractAimFreshwater ecosystems are highly vulnerable to the effects of climate change. Where long‐term datasets are available, shifts in species phenology, species distributions and community structure consistent with a climate change signal have already been observed. Identifying trends across the wider landscape, to guide management in response to this threat, is limited by the resolution of sampling. Standard biomonitoring of macroinvertebrates for water‐quality purposes is currently not well suited to the detection of climate change effects, and there are risks that substantial changes will occur before a management response can be made. This study investigated whether dragonflies, frequently recommended as general indicators of ecological health, are also suitable as indicators of climate change.LocationData were analysed from standard bio‐assessment monitoring at over 850 sites spanning a 9° latitudinal gradient in eastern Australia.MethodsUsing variation partitioning, we analysed the proportion of assemblage turnover in dragonflies and other macroinvertebrate assemblages that can be explained by climate and other environmental drivers. We also tested whether the utility of dragonflies as indicators improved at higher taxonomic resolution and whether the turnover of dragonfly assemblages was congruent with that of other groups.ResultsClimate explained three times as much variation in turnover of dragonfly species than dragonfly and other macroinvertebrate assemblages at family level. The dissimilarity of dragonflies and varying turnover in each macroinvertebrate assemblage meant surrogacy amongst groups were low.Main conclusionsOn the basis of the influence of climate on turnover of macroinvertebrate assemblages, dragonfly species distribution appears highly sensitive to climatic factors, making this taxon a potential useful indicator of climate change responses. However, the low surrogacy amongst assemblages also suggests that a shift in the focus of conservation management from specific taxa to the functional composition of assemblages across a diverse range of habitats is needed.

Mutual Interactions between Depression/Quality of Life and Adherence to a Multidisciplinary Lifestyle Intervention in Obesity

There is scarce knowledge of the interaction between depression/health-related quality of life (HRQOL) and lifestyle intervention in obesity. The aim of the study was to establish whether baseline mood status or HRQOL affects attendance to educational or exercise sessions and whether attendance to these two components of the intervention affects mood and/or HRQOL in obesity. A total of 282 overweight/obese subjects (body mass index, 33.4 ± 5.9 kg/m(2); 103 males, 179 females; age, 53.8 ± 13.0 yr, mean ± sd) were consecutively enrolled in a multidisciplinary lifestyle intervention program. During the intensive phase of the intervention (3 months) patients were invited to attend eight educational sessions and 26 exercise group sessions. Poor adherence to exercise sessions is predicted by baseline depressive mood (P =0.006) and by low levels of HRQOL (domains of Vitality, Physical Role Functioning, Social Functioning, Mental Composite, Physical Composite Scores) (P < 0.05). Attendance to the educational sessions is associated with beneficial effects of the lifestyle intervention on depressive symptoms (P < 0.013) and on several mental domains of HRQOL (P < 0.041); attendance to the exercise sessions predicted the beneficial effects on perceived general health (P < 0.021) and body mass index (P < 0.011). Attendance to both educational and exercise components is associated (P < 0.05) with the reductions in waist circumference, fat mass, and blood pressure observed after the intensive phase of the intervention. Measurement of depressive mood and HRQOL before lifestyle intervention allows identification of patients at increased risk of attrition with exercise and educational sessions. Both the exercise and the educational sessions are essential for gaining the full spectrum of psychological and clinical benefits from multidisciplinary lifestyle intervention in obesity.

Quality-of-life assessment in the treatment of iatrogenic bile duct injuries: hepaticojejunostomy versus end-to-end biliary reconstructions

Assessment and comparison of quality of life (QOL) in patients treated for iatrogenic bile duct injuries (IBDI) with Roux-en-Y hepaticojejunostomy (HJ) or end-to-end ductal anastomosis (EE). The Medical Outcomes Study Short Form 36v2 (SF-36v2) Health Survey and the Karnofsky score were used. Comparative analysis of QOL was performed in 41 patients following reconstructive surgery for IBDI between 1990 and 2005: 22 - HJ and 21 - EE. Seven of eight values were comparable in both analysed groups: role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health index. Physical functioning was significantly better in patients following EE (P = 0.04). Physical component summary (P = 0.11) and mental component summary (P = 0.92) in both groups were comparable. QOL according to the Karnofsky scale was comparable in both groups (P = 0.294). Physical functioning was significantly better in patients after EE. Other values of QOF according to the SF-36v2 and the Karnofsky score were comparable in both groups.

Hypertension in Pakistan: What arewe going to do about it?

Ever since the very early population surveys done by the National Institue of Cardiovascular Diseases Karachi in the sixties, there has been data available suggesting the very high prevalence of hypertension in Pakistan. These initial surveys were supplemented by other surveys done three decades ago by the PMRC and other individual workers, also suggesting the high prevalence of hypertension being around 10% of the general adult population of Pakistan. The surveys in school children and m special populations like shopkeepers and armed forces personnel added important information and again subscribed to the high prevalence of hypertension in the general public in Pakistan.The recent PMRC Pakistan health survey has come outwith, for the first time in the history of the country, definitive and representative data from all parts of Pakistan. The prevalence ofhypertension seen in variaus populations and sub-populations has reconfirmed the impressions by the earlier surveys that hypertension is a very common disorder im Pakistan.Where do we go from here? The problem and the challenge has been identified, the resources and limitations of the health delivery system and the general health and social indicators of Pakistan are well-known. What then is going to be the strategy to address this epidemic that is upon us?It is apparent that within the resources available to us, curative efforts to control the disease once established will never be adequate. It is imperative especially for poor country like Pakistan to launch a mass preventive effort. Sporadic effortshave been made in the past towards general population education, however, these are very inadequate. It is high time that the Government ofPakistan and each and every medical and citizen body play its irt in the mass . education effort that will be needed to create an awareness about i:-pertension, its prevention, its detection and, its adequate treatment. The recent effort to bring the entire citizenry and the medical community ofPakistan on a single platform to fight this epidemic has been made by the organization ofthe Pakistan Hypertension League.

Characteristics of the Million Women Study participants who have and have not worked at night

The aim of this study was to compare the characteristics of women who had and had not worked at night in terms of their risk factors for common disease, indicators of general health, social activities, employment, and sleep behavior. The Million Women Study is a large prospective cohort study of women's health in the United Kingdom with 1.3 million women recruited during 1996-2001 (aged 50-64 years) through 66 National Health Service breast screening centers. We analyzed the data from a random sample of 41 652 participants who, in 2009-2010, reported their history of night work. Of the participants, 1 in 8 women (13%) reported that they had ever worked at night and 1 in 50 (2%) reported working at night for ≥20 years. For 33 sociodemographic, behavioral, reproductive, and hormonal factors examined, 20 showed highly significant differences between "ever" and "never" night workers (P<0.0001); 12 showed significant trends by duration of night work (P<0.01). In particular, compared to women who had never worked at night, women who had worked at night were more likely to (i) be of lower socioeconomic status [the odds ratio (OR) for ever versus never night workers of being in the lowest third of socioeconomic status was 1.15, 99% confidence interval (95% CI) 1.06-1.25]; (ii) have ever used hormone replacement therapy (HRT) for the menopause (OR 1.43, 99% CI 1.33-1.55); (iii) be current smokers (OR 1.37, 99% CI 1.19-1.58); and (iv) be obese (OR 1.26, 99% CI 1.15-1.37). Compared to women who had never worked at night, women who had worked at night for ≥20 years were more likely to be (i) of lower socioeconomic status (OR 1.28, 99% CI 1.04-1.57); (ii) nulliparous (OR 1.47, 99% CI 1.12-1.91); (iii) current smokers (OR 1.63, 99% CI 1.18-2.25); and (iv) obese (OR 1.55, 99% CI 1.25-1.93). Former night workers were more likely than never night workers to report a range of sleep disturbances, including poor quality of sleep (OR 1.15, 99% CI 1.01-1.31) and having to take medication to sleep (OR 1.35, 99% CI 1.15-1.60). Women who reported having worked at night were substantially different from those who reporting never having worked at night and many of the differences would put "ever night workers" at increased risks of cancer, vascular disease, and many other common conditions.

Assessment of PTSD in Older Veterans: The Posttraumatic Stress Disorder Checklist: Military Version (PCL-M)

The Posttraumatic Stress Disorder (PTSD) Checklist: Military Version (PCL-M) is a 17-item, self-report measure of PTSD symptomatology in military veterans and provides one total score and four subscale scores for older veterans’ PTSD (re-experiencing, avoiding, numbing, and hyperarousal symptoms). Study subjects are 456 male veterans over 55-years old with deployed experiences selected from a larger survey data by Veterans’ Affairs Canada (VAC). This study found that overall scale reliability was excellent with alpha of .93 and subscale alphas ranging from .81 to .90. Confirmatory Factor Analysis (CFA) confirmed the best fit of four first-order factor models. Criterion validity was confirmed through significant associations of the PCL-M scores with well-established measures of depression, substance abuse, and general health indices. The PCL-M is recommended as a reliable and valid tool for the clinical and empirical assessment of screening PTSD symptomatology, specifically related to older veterans military experiences.

Health in working-aged Americans: adults with high school equivalency diploma are similar to dropouts, not high school graduates.

We compared health outcomes for adults with the General Equivalency Diploma (GED) and regular high school diploma to determine whether GED recipients are equivalent to regular graduates despite research that documents their disadvantages in other outcomes. We used 1997 to 2009 National Health Interview Survey cross-sectional data on high school dropouts, graduates, and GED recipients aged 30 to 65 years (n = 76,705). Five general health indicators and 20 health conditions were analyzed using logistic models. GED recipients had a significantly higher prevalence of every health outcome compared with high school graduates (odds ratios = 1.3-2.7). The GED-high school differences attenuated but remained evident after controlling for health insurance, economic status, and health behaviors. For most conditions, the 95% confidence interval for GED earners overlapped with that for high school dropouts. The high school equivalency diploma was associated with nonequivalent health: adults with a GED had health comparable to that of high school dropouts, not graduates. GED recipients were at increased risk for many health conditions, and their health should be viewed as distinct from regular graduates. The findings have implications for health and educational policies.

Genetic, Physiological, and Lifestyle Predictors of Mortality in the General Population

We investigated the quality of 162 variables, focusing on the contribution of genetic markers, used solely or in combination with other characteristics, when predicting mortality. In 5974 participants from the Rotterdam Study, followed for a median of 15.1 years, 7 groups of factors including age and gender, genetics, socioeconomics, lifestyle, physiological characteristics, prevalent diseases, and indicators of general health were related to all-cause mortality. Genetic variables were identified from 8 genome-wide association scans (n = 19,033) and literature review. We observed 3174 deaths during follow-up. The fully adjusted model (C-statistic for 15-year follow-up [C15y] = 0.80; 95% confidence interval [CI] = 0.79, 0.81) predicted mortality well [corrected]. Most of the additional information apart from age and sex stemmed from physiological markers, prevalent diseases, and general health. Socioeconomic factors and lifestyle contributed meaningfully to mortality risk prediction with longer prediction horizon. Although specific genetic factors were independently associated with mortality, jointly they contributed little to mortality prediction (C(15y) = 0.56; 95% CI = 0.55, 0.57). Mortality can be predicted reasonably well over a long period. Genetic factors independently predict mortality, but only modestly more than other risk indicators.

A Physician's Guide to the Physical Examination of the Shoulder

Shoulder pain is the third most frequent musculoskeletal complaint presented to physicians. Often considered a benign entity by patients and even their physicians, shoulder disorders can have a devastating effect on a patient's ability to function, as well as serve as an indicator of poor general health. For these reasons, it is important for the physician to be able to identify the etiology of a patient's shoulder problem(s). However, making a correct diagnosis is often difficult because there can be many causes for a patient's shoulder pain, weakness, or loss of function. Moreover, the shoulder girdle is an intricate group of structures that work together to allow for the largest range of motion in the body. This complexity makes it difficult to diagnose a patient's condition(s) based on history alone. A thorough and well-performed physical examination is the key to making a correct diagnosis and helping to distinguish different etiologies of shoulder dysfunction. In this article, we review relevant shoulder anatomy and biomechanics, and general shoulder examinations with special tests for various shoulder pathologies. We provide an effective and methodical approach to the physical examination of the shoulder.

Use of Fluorogenic Probes To Differentiate between Hydrophilic and Lipophilic Antioxidant Activity in a Fish Cell Line

In finfish aquaculture, dietary antioxidants have been shown to improve indicators of general fish health and to inhibit the oxidative deterioration of polyunsaturated fatty acids. To facilitate the characterization of novel antioxidants or antioxidant mixtures, we developed assays for antioxidant activity in a fish cell line. We used 2',7'-dichlorodihydrofluorescein diacetate (H(2)DCFDA) to determine the protective effects of a panel of representative antioxidant compounds against the formation of reactive oxygen species (ROS) under conditions that promote oxidative stress, whereas protective effects against lipid peroxidation were measured using the thiobarbituric acid reactive substances (TBARS) assay and a novel implementation of 4,4-difluoro-5-(4-phenyl-1,3-butadienyl)-4-bora-3a,4a-diaza-s-indacene-3-undecanoic acid (C(11)-BODIPY(581/591)). We found that the highly hydrophilic antioxidant, sodium ascorbate, inhibited H(2)DCFDA oxidation but had no effect on lipid peroxidation, whereas the highly hydrophobic antioxidant, α-tocopherol, potently inhibited lipid peroxidation but did not prevent H(2)DCFDA oxidation. The data suggest that a single assay is not sufficient for estimating antioxidant activity in cultured fish cells.

Monitoring heart disease and diabetes with mobile internet communications.

A telemedicine system is described for monitoring vital signs and general health indicators of patients with cardiac and diabetic conditions. Telemetry from wireless sensors and readings from other instruments are combined into a comprehensive set of measured patient parameters. Using a combination of mobile device applications and web browser, the data can be stored, accessed, and displayed using mobile internet communications to the central server. As an extra layer of security in the data transmission, information embedded in the data is used in its verification. The paper highlights features that could be enhanced from previous systems by using alternative components or methods.

Clinical study of single-catheter radiofrequency ablation in treatment of refractory premature ventricular contractions

ObjectiveTo evaluate the single-catheter radiofrequency ablation for treatment of refractory premature ventricular contractions after ablation, and assess the quality of life in patients with refractory premature ventricular contractions.Methods52 patients with...

Ecology and evolution of mammalian biodiversity.

Mammals have incredible biological diversity, showing extreme flexibility in eco-morphology, physiology, life history and behaviour across their evolutionary history. Undoubtedly, mammals play an important role in ecosystems by providing essential services such as regulating insect populations, seed dispersal and pollination and act as indicators of general ecosystem health. However, the macroecological and macroevolutionary processes underpinning past and present biodiversity patterns are only beginning to be explored on a global scale. It is also particularly important, in the face of the global extinction crisis, to understand these processes in order to be able to use this knowledge to prevent future biodiversity loss and loss of ecosystem services. Unfortunately, efforts to understand mammalian biodiversity have been hampered by a lack of data. New data compilations on current species' distributions, ecologies and evolutionary histories now allow an integrated approach to understand this biodiversity. We review and synthesize these new studies, exploring the past and present ecology and evolution of mammalian biodiversity, and use these findings to speculate about the mammals of our future.

The Relationship of Self-Reported Health to other Indices of Physical Health and Performance among Soldiers

A single question on self-reported health (SRH) is often used as part of Behavioral Risk Factor Surveillance to describe populations and as an indicator of general health. However, little information exists on whether a single question of SRH is related to other indices of a person’s health and fitness. The objective of this paper is to examine the relationship between SRH and other health-related self-disclosures, as well as physical performance. Demographic, self-report, and physical fitness data were collected from 579 US Army Health Care Specialist Trainees during their first two weeks of Advanced Individual Training. Physical fitness data was collected again after approximately 8 weeks and 16 weeks. Spearman Rho correlation coefficients were used to analyze the data. SRH was positively correlated with self reports of past and current physical activity and physical abilities, and with the physical fitness portion of the Banderet Life Experiences Questionnaire (p < .05). SRH was positively correlated w...

Disfunción temporomandibular, discapacidad y salud oral en una población geriátrica semi-institucionalizada

Introduction: Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD). Objectives: To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a community-dwelling elderly population. Methods: An observational study was performed. Ninety-four persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment). Results: In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in oro-facial activities. Also, there was a statistically significant association (p<0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD. Conclusions: In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception.

Temporomandibular joint dysfunction, disability and oral health in a community-dwelling elderly population

Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD). To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a communitydwelling elderly population. An observational study was performed. Ninetyfour persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment). In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in orofacial activities. Also, there was a statistically significant association (p<0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD. In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception.

Beneficios de la terapia cognitivo-conductual y la presoterapia en pacientes obesos: ensayo clínico aleatorizado

Introduction: Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD). Objectives: To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a community-dwelling elderly population. Methods: An observational study was performed. Ninety-four persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment). Results: In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in oro-facial activities. Also, there was a statistically significant association (p<0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD. Conclusions: In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception.

Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning

BackgroundSelf-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.MethodsThe study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF.ResultsUnivariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, p < 0.001), upper extremity capacity (adjOR = 1.13, p = 0.040), household physical activity (adjOR = 1.01, p = 0.016), and older age (adjOR = 1.09, p = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, p < 0.001).ConclusionsThe results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

Relationship between subjective assessment of oral health and medical expenses in community‐dwelling elderly persons

ObjectivesThe increasing medical expenses of elderly persons in Japan’s rapidly ageing society have become a major concern. It is therefore important to elucidate the factors associated with such escalation. Here, we focused on the relationship between subjective self-assessment of oral health, as an index of general health, and medical expenses (excluding dental repair) under the hypothesis that oral health contributes to general medical expenses. Several studies have shown that oral health status is correlated with general health status among elderly persons. We speculated that oral health status might show a relation with medical costs among elderly persons. However, few studies have investigated this relationship to date.Materials and MethodsParticipants were 259 elderly subjects (range: 65–84 years; 120 men, 139 women) residing independently. Subjective assessment of oral health was evaluated by their responses (‘Good’, ‘Not good’ and ‘Not at all good’) on a survey questionnaire. The correlation between subjective assessment of oral health and medical expenditure was analysed using Spearman’s rank method, the Mann–Whitney U-test and the Kruskal–Wallis test. Medical expenses were used as the dependent variable in multinomial logistic regression analysis with background and intraoral factors as independent variables.ResultsA slight yet statistically significant correlation was observed between subjective assessment of oral health and outpatient treatment fees.ConclusionThe findings revealed that subjective assessment of oral health is significantly and independently related to the medical expenses of community-dwelling elderly persons after adjusting for social background, living environment and physical factors.