We cross-culturally adapted the Dizziness Handicap Inventory (DHI) into Central Kurdish dialect (DHI − CK) and verified its reliability and validity. A cross-sectional study was utilised to measure the impacts of vestibular disorders. Along with the DHI − CK, two comparators were introduced: the Visual Analogue Scale and the Clinical Test of Sensory Interaction and Balance. External and internal reliability were tested with intraclass correlation coefficient (ICC) and Cronbach’s alpha/composite reliability, respectively. Patients (n = 301; mean age = 44.5 ± 15.2 years; 59.8% women) presenting with vestibular symptoms for at least 30 days who were diagnosed with a vestibular disorder and healthy participants (n = 43; mean age = 42 ± 17.9 years; 62.8% women) (N = 344). The DHI − CK and its three sub-scales—Physical, Emotional, Functional—exhibited good to excellent external reliability: ICCs in the test-retest were 0.93, 0.88, 0.91, and 0.92, respectively. Cronbach’s alphas were 0.87, 0.71, 0.75, and 0.73, respectively. Convergent validity was supported by Spearman’s correlations between the DHI − CK and the comparators. The receiver operating characteristic curve analysis confirmed discriminating validity. The DHI − CK was cross-culturally validated. It is a reliable and valid tool that can be used by clinicians and researchers to quantify vestibular disorder outcomes in Kurdish - speaking populations.

Background Core vestibular symptoms are vague, hard for patients to describe, and difficult for examiners to quantify. Reliable and validated patient-reported outcome measures (PROMs) have obtained acceptance and popularity in the specialty of vestibular disorders. In Kurdish, there is a critical shortage of such measures. The aim of this survey was to assess the psychometric properties of a central Kurdish version (VSS − SF − CK) of the Vertigo Symptom Scale−Short Form (VSS − SF). Methods The study utilized a regulated process of cross-cultural adaptation to produce the VSS − SF − CK. We examined its psychometric properties by using a cross-sectional survey. Owing to a non-normal distribution, both principal axis factoring and polychoric correlation were used to examine the structure. The internal consistency of the scales was evaluated using Cronbach’s alpha coefficient (α) and composite reliability. The discriminant validity was evaluated using the heterotrait–monotrait ratio of correlations (HTMT .85 ) and the Fornell-Larcker criterion. To assess convergent validity, the instrument was correlated with two comparators. Results The participants ( n = 195) were composed of 165 patients with vestibular symptoms (mean − age 45 ± 15.8, range 61 years; 56.4% women) and 30 healthy participants (mean − age 35 ± 18.6; range 52 years; 60% women). Based on the scree plot, along with other criteria such as Horn’s parallel analysis and minimum average partial, two factors were extracted: vestibular (VSS − V) and autonomic-anxiety (VSS − AA). Both constructs showed a robust structure in terms of adequate loadings and weak cross-loadings. The scales’ αs were 0.81, 0.81, and 0.87 for VSS-V, VSS-AA, and the total scale (VSS − T), respectively. Discriminant validity was established with a value of 0.71 for HTMT (< 0.85). Spearman’s correlation supported the study’s hypotheses and confirmed the convergent validity. Intraclass correlation coefficients revealed high external reliability: test-retest results were 0.93, 0.94, and 0.97 for VSS-V, VSS − AA, and VSS − T, respectively. Conclusion Given a critical shortage in PROMs for the vestibular field, the psychometric properties of VSS − SF − CK were evaluated. The results were promising, as they revealed external consistency and construct validity. The goodness of fit indices showed that the VSS − SF − CK is a reliable and validated PROM that can be used by clinicians and researchers in the Kurdish-speaking population. Electronic supplementary material The online version of this article (10.1186/s12955-019-1168-z) contains supplementary material, which is available to authorized users.

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Background/objectives The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese. Subjects/methods A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded. Interventions/methods The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment. Results Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value = 0.3415, 95% confidence interval = 11.43924–29.67085), avoidance of sex by partner (P Value = 0.0143, 95% confidence interval = 04.11537–17.08480), low self-esteem (P Value = 0.0100, 95% confidence interval = 10.66794–28.44776), teasing by others and negative thoughts (P Value = 0.4013, 95% confidence interval = 11.43924–29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value = 0.0143, 95% confidence interval = 04.11537–17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most. Conclusions The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis.

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