Serious Life Events in People with Visual Impairment Versus the General Population.
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ABSTRACT:
SUBMITTER: Brunes A
PROVIDER: S-EPMC8583190 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesAs key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end-of-life (EOL) care differs from the general population as was shown for physicians.DesignObservational propensity-matched cohort study.SettingFee-for-service Medicare.ParticipantsNurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital.MeasurementsCharacteristics of care during the first year after diagnosis and the last 6 months of life (EOL).ResultsAmong 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life-prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar.ConclusionsNurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582-1589, 2019.
| S-EPMC8559590 | biostudies-literature
Project description:BackgroundSerious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area.MethodsRecords of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data.ResultsCommonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific ('Z-code') causes. The five commonest specific ICD-10 diagnoses at discharge were 'chronic renal failure' (N18), a non-specific code (Z04), 'dental caries' (K02), 'other disorders of the urinary system' (N39), and 'pain in throat and chest' (R07), all of which were higher than expected (SARs ranging 1.57-6.66).ConclusionA range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.
| S-EPMC6236443 | biostudies-literature
Project description:BackgroundPeople with visual impairment have benefitted from recent developments of assistive technology that aim to decrease socio-economic inequality. However, access to post-secondary education is still extremelly challenging, especially for scientific areas. The under representation of people with visual impairment in the evolution research community is connected with the vision-based communication of evolutionary biology knowledge and the accompanying lack of multisensory alternatives for learning.ResultsHere, we describe the development of an inclusive outreach activity based on a multisensory phylogeny representing 20 taxonomic groups. We provide a tool kit of materials and ideas that allow both the replication of this activity and the adaptation of others, to include people with visual impairment. Furthermore, we provide activity evaluation data, a discussion of the lessons learned and an inclusive description of all figures and visual data presented.The presented baseline data show that people with visual impairment indeed have lack of access to education but are interested in and apt to understand evolutionary biology concepts and predict evolutionary change when education is inclusive.ConclusionsWe show that, with creative investment, basic evolutionary knowledge is perfectly possible to be transmitted through multisensory activities, which everyone can benefit from. Ultimately, we hope this case study will provide a baseline for future initiatives and a more inclusive outreach community.
| S-EPMC7952356 | biostudies-literature
Project description:Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians' attitudes may affect care provision or health outcomes. This review describes general medical clinicians' attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.
| S-EPMC7251232 | biostudies-literature
Project description:BackgroundKnowledge about the high rates of depression in people with visual impairment (VI) remains unclear. The study aimed to examine whether depressive symptoms in people with VI were associated with social isolation, perceived social support and lifetime exposure to bullying, physical abuse or sexual abuse.MethodsAn anonymous telephone survey was conducted from January to May 2017 in an age-stratified sample of adults with VI who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about social isolation, perceived social support, and past experiences with bullying and abuse. Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). We calculated unadjusted and full-adjusted exponentiated beta-values (Exp(?)) and corresponding 95% confidence intervals (CIs) using generalized linear models.ResultsOverall, 736 (61%) adults participated in the study. The mean depression scores were 5.24 (SD: 5.3, range: 0-27), 4.61 for men and 5.77 for women. Results from the full-adjusted model showed higher levels of depressive symptoms among participants who reported social isolation (Exp(?): 1.89, 95% CI: 1.63-2.20), lower levels of perceived social support (Exp(?): 1.55, 95% CI: 1.31-1.83), and past experiences of abuse (Exp(?): 1.41, 95% CI: 1.17-1.70). The strength of the associations between past exposure to bullying or abuse and depressive symptoms was similar for those with low and high levels of support.ConclusionSocial isolation, perceived support and experiences of adverse events appear to be independently associated with depressive symptoms. Thus, social integration may be appropriate for the promotion of mental health among people with VI.
| S-EPMC7216619 | biostudies-literature
Project description:BACKGROUND: Although the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV. METHODS: We used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin. RESULTS: Among the 3,019 participants aged 18-85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07-1.32), French-native women (aPRR: 1.32, 95% CI: 1.10-1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98-1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64-0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78-1.02) and women (aPRR: 0.84, 95% CI: 0.70-1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population. CONCLUSIONS: Smoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.
| S-EPMC4159331 | biostudies-other
Project description:The objective of this study was to evaluate the association between fluoroquinolone (FQ) use and the occurrence of aortic aneurysm/dissection (AA/AD), acute myocardial infarction (AMI), ventricular arrhythmias (VenA), and all-cause mortality vs other commonly used antibiotics. We conducted a self-controlled case series analysis of patients who experienced the outcomes of AA/AD, AMI, and VenA, based on diagnosis codes from emergency department visits and hospitalizations within Veterans Health Administration, and death in FY2014-FY2018. These Veterans also received outpatient prescriptions for FQs. Conditional Poisson regression models were used to estimate the association between FQs and each of the outcomes vs antibiotics of interest (ie amoxicillin or amoxicillin/clavulanate, azithromycin, doxycycline, cefuroxime or cephalexin, or sulfamethoxazole-trimethoprim), adjusted for time-varying covariates. Using a 30-day risk period after each antibiotic prescription, adjusted incidence rate ratios (aIRRs) for FQs vs each comparator antibiotic were not statistically different for outcomes of VenA or AMI. For AA/AD, incidence was higher during FQ risk periods vs amoxicillin [aIRR 1.50 (95% CI 1.01, 2.25)] and azithromycin [aIRR 2.15 (95% CI 1.27, 3.64)] risk periods. A significantly increased risk of mortality was observed with FQs vs each antibiotic of interest. FQs were associated with an increased risk of AA/AD vs amoxicillin and azithromycin and an increased risk of all-cause mortality vs multiple antibiotics commonly used for outpatient infections. Although the differences in event rates are small, FQ use should be limited to serious infections without appropriate alternatives.
| S-EPMC7550792 | biostudies-literature
Project description:Semantic cognition permits us to bring meaning to our verbal and nonverbal experiences and to generate context- and time-appropriate behavior. It is core to language and nonverbal skilled behaviors and, when impaired after brain damage, it generates significant disability. A fundamental neuroscience question is, therefore, how does the brain code and generate semantic cognition? Historical and some contemporary theories emphasize that conceptualization stems from the joint action of modality-specific association cortices (the "distributed" theory) reflecting our accumulated verbal, motor, and sensory experiences. Parallel studies of semantic dementia, rTMS in normal participants, and neuroimaging indicate that the anterior temporal lobe (ATL) plays a crucial and necessary role in conceptualization by merging experience into an amodal semantic representation. Some contemporary computational models suggest that concepts reflect a hub-and-spoke combination of information--modality-specific association areas support sensory, verbal, and motor sources (the spokes) while anterior temporal lobes act as an amodal hub. We demonstrate novel and striking evidence in favor of this hypothesis by applying rTMS to normal participants: ATL stimulation generates a category-general impairment whereas IPL stimulation induces a category-specific deficit for man-made objects, reflecting the coding of praxis in this neural region.
| S-EPMC2878637 | biostudies-literature
Project description:For over a century, stability of spatial context across related episodes has been considered a source of memory interference, impairing memory retrieval. However, contemporary memory integration theory generates a diametrically opposite prediction. Here, we aimed to resolve this discrepancy by manipulating local context similarity across temporally disparate but related episodes and testing the direction and underlying mechanisms of memory change. A series of experiments show that contextual stability produces memory integration and marked reciprocal strengthening. Variable context, conversely, seemed to result in competition such that new memories become enhanced at the expense of original memories. Interestingly, these patterns were virtually inverted in an additional experiment where context was reinstated during recall. These observations 1) identify contextual similarity across original and new memories as an important determinant in the volatility of memory, 2) present a challenge to classic and modern theories on episodic memory change, and 3) indicate that the sensitivity of context-induced memory changes to retrieval conditions may reconcile paradoxical predictions of interference and integration theory.
| S-EPMC8640928 | biostudies-literature
Project description:PurposeTo determine the prevalence, causes and associated demographic factors related to visual impairment amongst the urban population of New Delhi, India.MethodsA population-based, cross-sectional study was conducted in East Delhi district using cluster random sampling methodology. This Rapid Assessment of Visual Impairment (RAVI) survey involved examination of all individuals aged 40 years and above in 24 randomly selected clusters of the district. Visual acuity (VA) assessment and comprehensive ocular examination were done during the door-to-door survey. A questionnaire was used to collect personal and demographic information of the study population. Blindness and Visual Impairment was defined as presenting VA < 3/60 and < 6/18 in the better eye, respectively. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for visual impairment.ResultsOf 2421 subjects enumerated, 2331 (96.3%) were available for ophthalmic examination. Among those examined, 49.3% were males. The prevalence of visual impairment (VI) in the study population, was 11.4% (95% C.I. 10.1, 12.7) and that of blindness was 1.2% (95% C.I. 0.8, 1.6). Uncorrected refractive error was the leading cause of VI accounting for 53.4% of all VI followed by cataract (33.8%). With multivariable logistic regression, the odds of having VI increased with age (OR = 24.6[95% C.I.: 14.9, 40.7]; p < 0.001). Illiterate participants were more likely to have VI [OR = 1.5 (95% C.I.: 1.1,2.1)] when compared to educated participants.ConclusionsThe first implementation of the RAVI methodology in a North Indian population revealed that the burden of visual impairment is considerable in this region despite availability of adequate eye care facilities. Awareness generation and simple interventions like cataract surgery and provision of spectacles will help to eliminate the major causes of blindness and visual impairment in this region.
| S-EPMC4411096 | biostudies-literature