Background

Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults.

Methods

Between 2005 and 2008 residents aged 50 and older in seventeen states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization.

Results

The overall prevalence of difficulty with distance and near vision was 16.6% and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4%, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance.

Conclusion

The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and, perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results.

Purpose

To compare self-reported driving difficulty by persons with hemianopic or quadrantanopic field loss with that reported by age-matched drivers with normal visual fields; and to examine how their self-reported driving difficulty compares to ratings of driving performance provided by a certified driving rehabilitation specialist (CDRS).

Method

Participants were 17 persons with hemianopic field loss, 7 with quadrantanopic loss, and 24 age-matched controls with normal visual fields, all of whom had current drivers’ licenses. Information was collected via questionnaire regarding driving difficulties experienced in 21 typical driving situations grouped into 3 categories (involvement of peripheral vision, low visibility conditions, and independent mobility). On-road driving performance was evaluated by a CDRS using a standard assessment scale.

Results

Drivers with hemianopic and quadrantanopic field loss expressed significantly more difficulty with driving maneuvers involving peripheral vision and independent mobility, compared to those with normal visual fields. Drivers with hemianopia and quadrantanopia who were rated as unsafe to drive based upon an on-road assessment by the CDRS were no more likely to report driving difficulty than those rated as safe.

Conclusion

This study highlights aspects of driving that hemianopic or quadrantanopic persons find particularly problematic, thus suggesting areas that could be focused on driving rehabilitation. Some drivers with hemianopia or quadrantanopia may inappropriately view themselves as good drivers when in fact their driving performance is unsafe as judged by a driving professional.

Background

Heart failure (HF) patients often depend on driving for access to specialty care. We analyzed a public-use copy of the Cardiovascular Health Study (CHS) data to determine if HF is a risk factor for driving cessation and to identify other risk factors for driving cessation among those with HF.

Methods and results

Of the 5383 community-dwelling drivers ≥65 years (mean age, 73 years, 55% women, 13% African American), 839 had HF: 246 had baseline prevalent HF and 593 developed incident HF before driving cessation during 9 years of follow-up. Incident driving cessation occurred at rates of 3980 and 3709 per 10,000 person-years of follow-up for those with and without HF, respectively (unadjusted hazard ratio {HR} associated with HF as a time-varying variable, 2.13; 95% confidence interval {CI}, 1.83–2.47; p<0.001). This association remained unchanged after multivariable risk adjustment (HR, 1.43; 95% CI, 1.21–1.68; p<0.001). Among the 839 older drivers with HF, independent predictors for incident driving cessation were age ≥75 years (HR, 1.99; 95% CI, 1.44–2.73; p<0.001), female gender (HR, 1.93; 95% CI, 1.37–2.74; p<0.001), difficulty walking half a mile (HR, 1.47; 95% CI, 1.04–2.08; p=0.028), vision problems (HR, 1.47; 95% CI, 1.07–2.02; p=0.018), and stroke as a time-varying covariate (HR, 1.96; 95% CI, 1.38–2.79; p<0.001).

Conclusion

HF is an independent risk factor for incident driving cessation among community-dwelling older drivers. Several patient characteristics predicted driving cessation in older HF patients, which may be targets for interventions to prevent driving cessation among these patients.

Little is known about older drivers’ preferences and attitudes about instrumentation design in vehicles. Yet visual processing impairments are common among older adults and could impact their ability to interface with a vehicle’s dashboard. The purpose of this study is to obtain information from them about this topic, using focus groups and content analysis methodology. A trained facilitator led 8 focus groups of older adults. Discussion was stimulated by an outline relevant to dashboard interfaces, audiotaped, and transcribed. Using multi-step content analysis, a trained coder placed comments into thematic categories and coded comments as positive, negative, or neutral in meaning. Comments were coded into these categories: gauges, knobs/switches, interior lighting, color, lettering, symbols, location, entertainment, GPS, cost, uniformity, and getting information. Comments on gauges and knobs/switches represented half the comments. Women made more comments about getting information; men made more comments about uniformity. Positive and negative comments were made in each category; individual differences in preferences were broad. The results of this study will be used to guide the design of a population-based survey of older drivers about instrument cluster forma, which will also examine how their responses are related to their visual processing capabilities.

In geographic atrophy (GA), the non-neovascular end stage of age-related macular degeneration (AMD), the macular retinal pigment epithelium (RPE) progressively degenerates. Membrane cofactor protein (MCP, CD46) is the only membrane-bound regulator of complement expressed on the human RPE basolateral surface. Based on evidence of the role of complement in AMD, we hypothesized that altered CD46 expression on the RPE would be associated with GA development and/or progression. Here we report the timeline of CD46 protein expression changes across the GA transition zone, relative to control eyes, and relative to events in other chorioretinal layers. Eleven donor eyes (mean age 87.0 ± 4.1 yr) with GA and 5 control eyes (mean age 84.0 ± 8.9 yr) without GA were evaluated. Macular cryosections were stained with PASH for basal deposits, von Kossa for calcium, and for CD46 immunoreactivity. Internal controls for protein expression were provided by an independent basolateral protein, monocarboxylate transporter 3 (MCT3) and an apical protein, ezrin. Within zones defined by 8 different semi-quantitative grades of RPE morphology, we determined the location and intensity of immunoreactivity, outer segment length, and Bruch’s membrane calcification. Differences between GA and control eyes and between milder and more severe RPE stages in GA eyes were assessed statistically. Increasing grades of RPE degeneration were associated with progressive loss of polarity and loss of intensity of staining of CD46, beginning with the stages that are considered normal aging (grades 0–1). Those GA stages with affected CD46 immunoreactivity exhibited basal laminar deposit, still-normal photoreceptors, and concomitant changes in control protein expression. Activated or anteriorly migrated RPE (grades 2–3) exhibited greatly diminished CD46. Changes in RPE CD46 expression occur early in GA, before there is evidence of morphological RPE change. At later stages of degeneration, CD46 alterations occur within a context of altered RPE polarity. These changes precede degeneration of the overlying retina and suggest that therapeutic interventions be targeted to the RPE.

Background

Previous pediatric studies have observed a cross-informant variance in patient self-reported health-related quality of life (HRQoL) versus parent proxy-reported HRQoL. This study assessed in older children and adolescents with a variety of chronic pain conditions: 1) the consistency and agreement between pediatric patients’ self-report and their parents’ proxy-report of their child’s HRQoL; 2) whether this patient-parent agreement is dependent on additional demographic and clinical factors; and 3) the relationship between pediatric patient HRQoL and parental reported HRQoL.

Methods

The 99 enrolled patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed the PedsQLTM 4.0 and 36-Item Short-Form Health Survey Version 2 (SF-36v2) at the time of their initial appointment in a pediatric chronic pain medicine clinic. Patients’ and parents’ total, physical, and psychosocial HRQoL scores were analyzed via an intra-class correlation coefficient, Spearman’s correlation coefficient, Wilcoxon signed rank test, and Bland-Altman plot. A multivariable linear regression model was used to evaluate the association between clinical and demographic variables and the difference in patient and proxy scores for the Total Scale Score on the PedsQL™.

Results

With the exception of the psychosocial health domain, there were no statistically significant differences between pediatric patients’ self-report and their parents’ proxy-report of their child’s HRQoL. However, clinically significant patient-parent variation in pediatric HRQoL was observed. Differences in patient-parent proxy PedsQL™ Total Scale Score Scores were not significantly associated with patient age, gender, race, intensity and duration of patient’s pain, household income, parental marital status, and the parent’s own HRQoL on the SF-36v2. No significant relationship existed among patients’ self-reported HRQoL (PedsQL™), parental proxy-reports of the child’s HRQoL, and parents’ own self-reported HRQoL on the SF-36v2.

Conclusions

We observed clinically significant variation between pediatric chronic pain patients’ self-reports and their parents’ proxy-reports of their child’s HRQoL. While whenever possible the pediatric chronic pain patient’s own perspective should be directly solicited, equal attention and merit should be given to the parent’s proxy-report of HRQoL. To do otherwise will obviate the opportunity to use any discordance as the basis for a therapeutic discussion about the contributing dynamic with in parent-child dyad.

Objective

The overexpression of interferon (IFN)-inducible genes is a prominent feature of SLE, serves as a marker for active and more severe disease, and is also observed in other autoimmune and inflammatory conditions. The genetic variations responsible for sustained activation of IFN responsive genes are unknown.

Methods

We systematically evaluated association of SLE with a total of 1,754 IFN-pathway related genes, including IFN-inducible genes known to be differentially expressed in SLE patients and their direct regulators. We performed a three-stage design where two cohorts (total n=939 SLE cases, 3,398 controls) were analyzed independently and jointly for association with SLE, and the results were adjusted for the number of comparisons.

Results

A total of 16,137 SNPs passed all quality control filters of which 316 demonstrated replicated association with SLE in both cohorts. Nine variants were further genotyped for confirmation in an average of 1,316 independent SLE cases and 3,215 independent controls. Association with SLE was confirmed for several genes, including the transmembrane receptor CD44 (rs507230, P = 3.98×10−12), cytokine pleiotrophin (PTN) (rs919581, P = 5.38×10−04), the heat-shock DNAJA1 (rs10971259, P = 6.31×10−03), and the nuclear import protein karyopherin alpha 1 (KPNA1) (rs6810306, P = 4.91×10−02).

Conclusion

This study expands the number of candidate genes associated with SLE and highlights the potential of pathway-based approaches for gene discovery. Identification of the causal alleles will help elucidate the molecular mechanisms responsible for activation of the IFN system in SLE.

This study examines which consumer products are most commonly associated with pediatric eye injuries that are treated in emergency departments in the United States. The results demonstrate that, overall, boys experienced proportionally more consumer product–related eye injuries than girls, but eye injuries from specific product categories are more likely to be associated with one sex than the other. Age-specific patterns also revealed that certain product categories are more likely to be associated with eye injuries among different age groups. These findings are salient because children experience a disproportionate amount of ocular trauma, possibly resulting in visual disability or blindness and concomitant developmental delays. Given the heretofore lack of detailed information on products that may contribute to the burden of pediatric eye injuries in the United States, the results of the current study provide valuable information for identifying priorities for prevention and intervention.

Despite effective screening and treatment, amblyopia is still a very common cause of vision loss in children and adults. Primary care physicians miss many opportunities to screen vision using quantitative techniques like acuity, especially at preschool age. This article describes a web-based intervention developed to improve screening for amblyopia and strabismus in the medical home, and shows significantly improved knowledge by physician participants that was sustained 1 to 3 years later.

Purpose.

To evaluate the efficacy of a physician-targeted website to improve knowledge and self-reported behavior relevant to strabismus and amblyopia (“vision”) in primary care settings.

Methods.

Eligible providers (filing Medicaid claims for at least eight well-child checks at ages 3 or 4 years, 1 year before study enrollment), randomly assigned to control (chlamydia and blood pressure) or vision groups, accessed four web-based educational modules, programmed to present interactive case vignettes with embedded questions and feedback. Each correct response, assigned a value of +1 to a maximum of +7, was used to calculate a summary score per provider. Responses from intervention providers (IPs) at baseline and two follow-up points were compared to responses to vision questions, taken at the end of the study, from control providers (CPs).

Results.

Most IPs (57/65) responded at baseline and after the short delay (within 1 hour after baseline for 38 IPs). A subgroup (27 IPs and 42 CPs) completed all vision questions after a long delay averaging 1.8 years. Scores from IPs improved after the short delay (median score, 3 vs. 6; P = 0.0065). Compared to CPs, scores from IPs were similar at baseline (P = 0.6473) and higher after the short-term (P < 0.0001) and long-term (P < 0.05) delay.

Conclusions.

Significant improvements after the short delay demonstrate the efficacy of the website and the potential for accessible, standardized vision education. Although improvements subsided over time, the IPs' scores did not return to baseline levels and were significantly better compared to CPs tested 1 to 3 years later. (ClinicalTrials.gov number, NCT01109459.)

The thicknesses of 21 chorioretinal layers were measured in macula-wide histologic sections of normal human eyes, to provide a reference for clinical optical coherence tomography. A thickening of the Henle fiber layer in eyes older than 70 years was noted.

Purpose.

To provide a comprehensive description of chorioretinal layer thicknesses in the normal human macula, including two-layer pairs that can produce a combined signal in some optical coherence tomography (OCT) devices (ganglion cell [GCL] and inner plexiform [IPL] layers and outer plexiform [OPL] and outer nuclear [ONL] layers).

Methods.

In 0.8-μm-thick, macula-wide sections through the foveola of 18 donors (age range, 40–92 years), 21 layers were measured at 25 locations by a trained observer and validated by a second observer. Tissue volume changes were assessed by comparing total retinal thickness in ex vivo OCT and in sections.

Results.

Median tissue shrinkage was 14.5% overall and 29% in the fovea. Histologic laminar boundaries resembled those in SD-OCT scans, but the shapes of the foveolar OPL and ONL differed. Histologic GCL, IPL, and OPLHenle were thickest at 0.8. to 1, 1.5, and 0.4 mm eccentricity, respectively. ONL was thickest in an inward bulge at the foveal center. At 1 mm eccentricity, GCL, INL, and OPLHenle represented 17.3% to 21.1%, 18.0% to 18.5%, and 14.2% to 16.6% of total retinal thickness, respectively. In donors ≥70 years of age, the RPE and choroid were 17.1% and 29.6% thinner and OPLHenle was 20.8% thicker than in donors <70 years.

Conclusions.

In this study, the first graphic representation and thickness database of chorioretinal layers in normal macula were generated. Newer OCT systems can separate GCL from IPL and OPLHenle from ONL, with good agreement for the proportion of retinal thickness occupied by OPLHenle in OCT and histology. The thickening of OPLHenle in older eyes may reflect Müller cell hypertrophy associated with rod loss.

Driving is the primary means of personal travel in many countries and is relies heavily on vision for its successful execution. Research over the past few decades has addressed the role of vision in driver safety (motor vehicle collision involvement) and in driver performance (both on-road and using interactive simulators in the laboratory). Here we critically review what is currently known about the role of various aspects of visual function in driving. We also discuss translational research issues on vision screening for licensure and re-licensure and rehabilitation of visually impaired persons who want to drive.

Objective

To test the effects of cognitive training on subsequent motor vehicle collision (MVC) involvement of older drivers.

Design

Randomized controlled multi-site single-blind clinical trial.

Setting

Community-dwelling seniors across four U.S. sites: Birmingham, AL; Baltimore, MD; Indianapolis, IN and State College, PA.

Participants

908 older drivers (mean age 73.1 years; 18.6% African American) who were randomized to either one of three cognitive interventions or a control condition.

Interventions

Up to 10-sessions of cognitive training for memory, reasoning, or speed of processing.

Measurements

State-recorded MVC involvement up to 6-years following study enrollment.

Results

Speed of processing and reasoning training resulted in reduced at-fault collision involvement over the subsequent approximately 6-year period relative to controls. After adjusting for age, gender, race, education, mental status, health, vision, depressive symptoms and testing site, those randomized to the speed of processing and reasoning interventions had an approximately 50% lower rate (per person mile) of at-fault MVCs compared to the control group (rate ratio [RR]=0.57, 95% confidence interval [CI] 0.34–0.96 for speed of processing), and (RR=0.50, 95% CI 0.27-0.92 for reasoning). There was no significant reduction observed for the memory group.

Conclusion

Relative to controls, cognitive speed of processing and reasoning training transferred to decreased at-fault MVC rate among older drivers. Considering the importance of driving mobility, the costs of crashes, and the benefits of cognitive training, these interventions have great potential to sustain independence and quality of life of older adults. More research is needed to understand the effects of different types and quantities of training.

Objective

To determine the features predictive of time-to-integument damage in patients with systemic lupus erythematosus (SLE) from a multiethnic cohort (LUMINA).

Methods

SLE LUMINA patients (n=580), age ≥16 years, disease duration ≤5 years at baseline (T0), of African American, Hispanic and Caucasian ethnicity were studied. Integument damage was defined per the SLICC damage index (scarring alopecia, extensive skin scarring and skin ulcers lasting at least six months); factors associated with time-to-its occurrence were examined by Cox proportional univariable and multivariable (main model) hazards regression analyses. Two alternative models were also examined; in model 1 all patients, regardless of when integument damage occurred (n=94), were included; in model 2 a time-varying approach (GEE) was employed.

Results

Thirty-nine (6.7%) of 580 patients developed integument damage over a mean (SD) total disease duration of 5.9 (3.7) years and were included in the main multivariable regression model. After adjusting for discoid rash, nailfold infarcts, photosensitivity and Raynaud’s phenomenon (significant in the univariable analyses), disease activity over time [Hazard ratio (HR)=1.17; 95% Confidence interval (CI) 1.09–1.26)] was associated with a shorter time-to-integument damage whereas hydroxychloroquine use (HR=0.23, 95% CI 0.12–0.47) and Texan-Hispanic (HR=0.35; 95% CI 0.14–0.87) and Caucasian ethnicities (HR=0.37; 95% CI 0.14–0.99) were associated with a longer time. Results of the alternative models were consistent with those of the main model albeit in model 2 the association with hydroxychloroquine was not significant.

Conclusions

Our data indicate that hydroxychloroquine use is possibly associated with a delay in integument damage development in patients with SLE.

A retrospective, matched case-control study was conducted in Jamaica's Western Regional Health Authority (WRHA). Forty-three individuals developing clinical leptospirosis between January 2005 and December 2007 (i.e., cases) were age and neighborhood matched to 89 controls. Odds ratios (OR) and associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases had increased odds of contact with rodents OR 3.52, goats OR 3.38, and being engaged in outdoor labor OR 5.30. Knowledge of leptospirosis and indoor work was protective, OR 0.39 and OR 0.16, respectively. Positive RERI values were noted for joint exposure to rodents and goats (RERI 5.54), outdoor labor and goats (RERI 6.97), and outdoor labor and rodents (RERI 30.59). Our results suggest a synergistic effect of occupational and environmental exposures on clinical human leptospirosis from the WRHA. Knowledge of the disease and its risk factors allows for protection from the disease.

Objective. Thrombosis is an important cause of morbidity and mortality in SLE. We have explored the factors associated with time to the occurrence of thrombotic events in SLE patients to expand our cohort’s previous observations.

Method. SLE patients (ACR criteria), age ≥16 years, disease duration ≤5 years at enrolment (T0), African-American, Hispanic (Texan or Puerto Rican) or Caucasian ethnicity, from LUMINA, a longitudinal cohort, were studied. An event was defined as the presence of arterial or venous thrombosis. Time to the first thrombotic event was examined by univariable and multivariable (MV) Cox models adjusting for pertinent baseline clinical and socio-demographic variables.

Results. A total of 643 patients were studied; mean (s.d.) age was 36.4 (12.6) years and disease duration at T0 was 1.4 (1.3) years; 90% were female. After T0, 81 (12.6%) patients had developed a thrombotic event. In the MV model, age [hazard ratio (HR) = 1.06; 95% CI 1.03, 1.08; P < 0.0001], health insurance (HR = 0.53; 95% CI 0.30, 0.94; P = 0.029), smoking (HR = 1.85; 95% CI 1.01, 3.40; P = 0.048), damage (T0) (HR = 1.44; 95% CI 1.20, 1.71; P < 0.0001), aPL (HR = 2.12; 95% CI 1.19, 3.76; P = 0.011) and glucocorticoid (highest dose) (HR = 1.01; 95% CI 1.01, 1.02; P < 0.0001) were significant.

Conclusions. Age, poverty, smoking, damage accrual, aPL and higher doses of glucocorticoids were independently associated with a shorter time to the first thrombotic event; health insurance had a protective effect. Acting upon modifiable risk factors at the personal (smoking, high-dose glucocorticoids) and societal (poverty, health insurance) levels may prevent these events and improve the long-term outcome of SLE patients.

In this study the authors present novel data on how drivers with hemianopia and quadrantanopic field defects rated safe to drive by a certified driving rehabilitation specialist adopt compensatory strategies of eye and head movements, lane keeping, and vehicle control compared with those rated unsafe.

Purpose.

To compare eye and head movements, lane keeping, and vehicle control of drivers with hemianopic and quadrantanopic field defects with controls, and to identify differences in these parameters between hemianopic and quadrantanopic drivers rated safe to drive by a clinical driving rehabilitation specialist compared with those rated as unsafe.

Methods.

Eye and head movements and lane keeping were rated in 22 persons with homonymous hemianopic defects and 8 with quadrantanopic defects (mean age, 53 years) who were ≥6 months post-injury and 30 persons with normal fields (mean age, 53 years). All were licensed to drive and were current drivers or aimed to resume driving. Participants drove a 6.3-mile route along non-interstate city roads under in-traffic conditions. Vehicle control was assessed objectively by vehicle instrumentation for speed, braking, acceleration, and cornering.

Results.

As a group, drivers with hemianopic or quadrantanopic defects drove slower, exhibited less excessive cornering or acceleration, and executed more shoulder movements than the controls. Those drivers with hemianopic or quadrantanopic defects rated as safe also made more head movements into their blind field, received superior ratings regarding eye movement extent and lane position stability, and exhibited less sudden braking and drove faster than those rated unsafe.

Conclusions.

Persons with hemianopic and quadrantanopic defects rated as safe to drive compensated by making more head movements into their blind field, combined with more stable lane keeping and less sudden braking. Future research should evaluate whether these characteristics could be trained in rehabilitation programs aimed at improving driving safety in this population.

Objective

To examine the association between baseline bone mineral density (BMD) and radiographic damage at 3-year disease duration in a longitudinal cohort of African Americans (AAs) with recent-onset RA.

Methods

Participants (n=141) included AAs with < 2 years of disease duration. All patients underwent baseline BMD measurement (femoral neck and/or lumbar spine) using DXA. T-scores were calculated using AAs normative data. Patients were categorized as having osteopenia/osteoporosis (T score ≤ −1) or healthy. Hand/wrist radiographs, obtained at baseline and at 3-year disease duration, were scored using modified Sharp/van der Heijde method. The association between baseline BMD and total radiographic score at 3-year disease duration was examined using multivariable negative binomial regression.

Results

At baseline, the mean age and disease duration were 52.4 years and 14.8 months respectively (85.1% women). Average total radiographic scores at baseline and 3-year disease duration were 2.4 and 5.7. In the final reduced multivariable model adjusting for age, gender, anti-cyclic citrullinated peptide antibody positivity, and the presence of radiographic damage at baseline, the total radiographic score at 3-years of disease duration in patients with osteopenia/osteoporosis at the femoral neck was twice that in patients with healthy bone density and the difference was statistically significant (p=0.0084). No association between lumbar spine osteopenia/osteoporosis and radiographic score was found.

Conclusion

These findings suggest that reduced generalized BMD may be a predictor of future radiographic damage and support the hypothesis that radiographic damage and reduced generalized BMD in RA patients may share a common pathogenic mechanism.

Background

Although previous studies have identified an association between the transfusion of relatively older red blood cells (RBCs) (storage ≥14 days) and adverse outcomes, they are difficult to interpret because the majority of patients received a combination of old and fresh RBC units. To overcome this limitation, we compared in-hospital mortality among patients who received exclusively old versus fresh RBC units during the first 24 hours of hospitalization.

Methods

Patients admitted to a Level I trauma center between January 2000 and May 2009 who received ≥1 unit of exclusively old (≥14 days) vs. fresh (<14 days) RBCs during the first 24 hours of hospitalization were identified. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the association between mortality and RBC age, adjusted for patient age, Injury Severity Score, gender, receipt of fresh frozen plasma or platelets, RBC volume, brain injury, and injury mechanism (blunt or penetrating).

Results

One thousand six hundred forty-seven patients met the study inclusion criteria. Among patients who were transfused 1 or 2 RBC units, no difference in mortality with respect to RBC age was identified (adjusted RR, 0.97; 95% CI, 0.72–1.32). Among patients who were transfused 3 or more RBC units, receipt of old versus fresh RBCs was associated with a significantly increased risk of mortality, with an adjusted RR of 1.57 (95% CI, 1.14–2.15). No difference was observed concerning the mean number of old versus fresh units transfused to patients who received 3 or more units (6.05 vs. 5.47, respectively; p = 0.11).

Conclusion

In trauma patients undergoing transfusion of 3 or more RBC units within 24 hour of hospital arrival, receipt of relatively older blood was associated with a significantly increased mortality risk. Reservation of relatively fresh RBC units for the acutely injured may be advisable.

Background

African Americans (AA) disproportionately develop lupus nephritis (LN) relative to European Americans and familial clustering supports causative genes. Since MYH9 underlies approximately 40% of end-stage renal disease (ESRD) in AA, we tested for genetic association with LN.

Methods

Seven MYH9 single nucleotide polymorphisms (SNPs) and the E1 risk haplotype were tested for association with LN in three cohorts of AA.

Results

A preliminary analysis revealed that the MYH9 E1 risk haplotype was associated with ESRD in 25 cases with presumed systemic lupus erythematosus (SLE)-associated ESRD, compared to 735 non-SLE controls (odds ratio 3.1; p = 0.010 recessive). Replication analyses were performed in 583 AA with SLE in the PROFILE cohort (318 with LN; 265 with SLE but without nephropathy) and 60 AA from the NIH (39 with LN; 21 with SLE but without nephropathy). Analysis of the NIH and larger PROFILE cohorts, as well as a combined analysis, did not support this association.

Conclusions

These results suggest that AA with ESRD and coincident SLE who were recruited from dialysis clinics more likely have kidney diseases in the MYH9-associated spectrum of focal segmental glomerulosclerosis. PROFILE and NIH participants, recruited from rheumatology practices, demonstrate that MYH9 does not contribute substantially to the development of LN in AA.

Objectives

To present the bother subscales of the Nursing Home Vision-Targeted Health-Related Quality of Life Questionnaire (NHVQoL) and to examine their relationship to the original NHVQoL subscales and objective measures of visual function.

Methods

395 Nursing home residents completed the bother subscales. Associations between bother subscales and original subscales and objectively measured vision were evaluated.

Results

Mean bother scores ranged from 1.97 to 2.30, reflecting an average rating of “a little” bother. For 20 NHVQoL items, > 50% of participants reported “a lot” of bother. All NHVQoL original subscale scores were moderately correlated with bother subscales (p <0.0001). Bother subscales and visual acuity were not highly correlated.

Discussion

Nursing home residents are bothered by reductions in vision-targeted health-related quality of life. The NHVQoL bother subscales may probe the personal burden of visual problems in this population that is not captured by the original subscales or objectively measuring visual function.

Objective

To examine the extent to which drivers with hemianopia or quadrantanopia display safe driving skills when evaluated on-road, as compared to drivers with normal visual fields.

Method

22 persons with hemianopia, 8 with quadrantanopia, and 30 with normal vision were evaluated for driving skills under in-traffic conditions by an experienced occupational therapist who used a set of six 5-point rating scales.

Results

Over 90% of drivers with normal vision drove flawlessly or had only minor errors. Although drivers with hemianopia were more likely to receive poorer ratings for all skills evaluated, 59.1% to 81.8% performed without obvious errors (depending on the skill evaluated) or had only minor errors. The skill most commonly problematic for hemianopic drivers was lane keeping (40.9% of drivers exhibiting this problem). Seven of 8 (87.5%) quadrantanopic drivers drove without obvious errors or exhibited only minor errors.

Conclusions

This study on persons with hemianopia or quadrantopia with no lateral spatial neglect and MMSE scores of ≥ 24, highlights the need to individually provide them the opportunity for an on-road driving evaluation under a variety of natural traffic conditions if they are motivated to return to driving following brain injury.

Purpose

The purpose of this study was to evaluate the association between the federally mandated Minimum Data Set (MDS) Vision Patterns assessment for nursing home residents in the United States and an assessment of their vision-targeted quality of life as assessed by certified nursing assistants (CNAs).

Methods

Participants were 371 residents over the age of 55 from 17 nursing homes in the Birmingham, Alabama metropolitan area and the CNAs directly assigned to their care. CNAs assessed the vision-targeted quality of life of residents in their charge using the Nursing Home Vision-Targeted Health-Related Quality of Life (NHVQoL) questionnaire. MDS assessment categories assigned to each resident by the MDS nurse coordinator (“adequate”, “impaired”, “moderately impaired”, “highly impaired”, “severely impaired”) were obtained from the medical record. Visual acuity was measured using logMAR charts by trained research staff.

Results

CNA rated NHVQoL subscale scores decreased as the MDS rating indicated more vision impairment (all P’s for trend < 0.05). Almost all mean scores were in the 80s and 90s for those in the adequate, impaired, and moderately impaired categories. For those with MDS ratings of severely or highly impaired, NHVQoL subscale scores (except ocular symptoms) were dramatically lower (P ≤ 0.001) than those rated as moderately impaired.

Conclusions

Ratings by CNAs on the vision-targeted quality of life of nursing home residents under their care is in general agreement with the MDS category assigned by the nurse coordinator. However, CNA ratings are largely homogeneous in the adequate vision to moderately impaired categories.

Background

There is a survival disparity between African Americans and Caucasians with colon cancer. The aims of this study were to quantify the impact of comorbidity and body mass index (BMI) on survival and to assess whether these two variables account for the decreased survival among African Americans.

Methods

Data from patients (n = 496) who underwent surgery for first primary colon cancer at the University of Alabama at Birmingham Hospital from 1981-2002 were analyzed. Hazard ratios (HR) with 95% confidence intervals (CI) were obtained by Cox proportional hazards modeling for the association of race, comorbidity, BMI, and covariates with mortality. The confounding influence of comorbidity and BMI for the increased risk of death associated with African American race was evaluated. Effect modification by tumor stage for the association of comorbidity and BMI with mortality was also assessed.

Results

African Americans experienced an increased risk of death compared to Caucasians (HR=1.34; 95% CI, 1.06-1.68). The highest comorbidity burden was associated with an increased risk of all-cause mortality (HR=1.63; 95% CI, 1.24-2.15). For BMI, being underweight increased the risk of death (HR=1.54; 95% CI, 0.96-2.45), but being overweight/obese was protective (HR=0.77; 95% CI, 0.61-0.97). The effect of comorbidity was seen among those with early stage tumors while the effect of BMI was confined to patients with advanced tumors.

Conclusions

Although comorbidity and BMI impact post-surgery survival of colon cancer patients, they are not the contributing factors for the decreased survival observed among African Americans.

Background

Two recent studies reported over 70% of the patients with non‐arteritic anterior ischaemic optic neuropathy (NAION) had sleep apnoea syndrome (SAS) diagnosed by overnight polysomnography. The current study used the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA‐SDQ) to evaluate this association.

Methods

A matched case‐control study was conducted among 73 cases of NAION matched on age and gender to 73 controls without a history of NAION. Information regarding demographics, medical conditions, health behaviours and SAS was obtained via a telephone questionnaire that included the SA‐SDQ. Conditional logistic regression was used to calculate odds ratios (OR) and the 95% confidence intervals (CI) for the association between NAION and the SA‐SDQ.

Results

Cases were significantly more likely to report symptoms and characteristics consistent with SAS than controls (OR 2.62; 95% CI 1.03 to 6.60) when adjusted for medical and health behaviour characteristics.

Conclusions

The results of this study suggest that patients with SAS are at increased risk of NAION. Additional research in a larger population is needed to confirm the observed results and validate the use of the SA‐SDQ in patients with NAION.