A new measure of patient satisfaction with ocular hypotensive medications: The Treatment Satisfaction Survey for Intraocular Pressure (TSS-IOP)

PURPOSE: To validate the treatment-specific Treatment Satisfaction Survey for Intraocular Pressure (TSS-IOP). METHODS: Item content was developed by 4 heterogeneous patient focus groups (n = 32). Instrument validation involved 250 patients on ocular hypotensive medications recruited from ophthalmology practices in the Southern USA. Participants responded to demographic and test questions during a clinic visit. Standard psychometric analyses were performed on the resulting data. SAMPLE: Of the 412 patients screened, 253 consented to participate, and 250 provided complete datasets. The sample included 44% male (n = 109), 44% Black (n = 109) and 57% brown eyed (n = 142) participants, with a mean age of 64.6 years (SD 13.1) and a history of elevated IOP for an average of 8.4 yrs (SD 7.8). A majority was receiving monotherapy (60%, n = 151). RESULTS: A PC Factor analysis (w/ varimax rotation) of the 31 items yielded 5 factors (Eigenvalues > 1.0) explaining 70% of the total variance. Weaker and conceptually redundant items were removed and the remaining 15 items reanalyzed. The satisfaction factors were; Eye Irritation (EI; 4 items), Convenience of Use (CofU; 3 items), Ease of Use (EofU; 3 items), Hyperemia (HYP; 3 items), and Medication Effectiveness (EFF; 2 items). Chronbach's Alphas ranged from .80 to .86. Greater distributional skew was found for less common experiences (i.e., HYP & EI with 65% & 48.4% ceilings) than for more common experiences (i.e., EofU, CofU, EFF with 10.8%, 20.8% & 15.9% ceilings). TSS-IOP scales converged with conceptually related scales on a previously validated measure of treatment satisfaction, the TSQM (r = .36 to .77). Evidence of concurrent criterion-related validity was found. Patients' symptomatic ratings of eye irritation, hyperemia and difficulties using the medication correlated with satisfaction on these dimensions (r = .30-.56, all p < .001). Clinicians' ratings of IOP control, severity of side effects and problematic medication use correlated with patients' satisfaction scores on these dimensions (r = .13-.26, all p < .01). CONCLUSIONS: This study provides initial evidence that the TSS-IOP is a reliable and valid measure, assessing patients' satisfaction with ocular hypotensive medications

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand

<p>Abstract</p> <p>Background</p> <p>Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Māori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children.</p> <p>Methods</p> <p>A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis.</p> <p>Results</p> <p>Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Māori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families.</p> <p>Conclusions</p> <p>The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Māori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations.</p

Health seeking behaviour among caregivers of under-five children in Edo State, Nigeria

Aim: Timely and appropriate healthcare seeking behaviours if practiced by caregivers of under-five children can have a significant impact on child survival. This study assessed the knowledge of, and general health seeking practices among mothers of under-five children in Nigeria.Methods: This descriptive cross-sectional study was carried out among caregivers of under-five children in Edo State, Nigeria, in 2013. A multi-staged sampling technique was used to recruit respondents. Data collection was done by means of a structured interviewer-administered questionnaire adapted from UNICEF/IMCI household baseline survey questionnaire.Results: A total of 370 caregivers (mean age: 31.1±5.9 years) participated in the study. Almost all of them were females 368 (99.5%), 234 (63.2%) had secondary education and 283 (76.5%) were in the unskilled social class. Over 70%, 76%, 72%, 76% and 82% of participants did not know that being unable to eat/drink, fast breathing, blood in stool and convulsion, respectively, were symptoms of a child not feeling well. The place of primary care of children by caregivers was at home 142 (38.4%), chemist shop 91 (24.6%) and health facility 80 (21.6%). Cost and long waiting time were major reasons for not seeking care in health facilities.Conclusion: This study showed poor health seeking practices among caregivers of under-five children in Edo State, Nigeria. There should be continuous education of  caregivers on recognition of danger signs in children and the need to seek appropriate medical care in health facilities

The Potential of Walnut Seeds (Canarium Indicum L.) in Repairing the Genotoxicity Effect of Mercury on Mice Erythrocytes

Hydrargyrum (familiar as mercury) is a persistent transition metal element. They are known as bio-accumulative properties that are dangerous to the environment and has serious damaging effects on biota, including genetic changes or mutagenesis. Moreover, it can accumulate indirectly in the human body due to the consumption of products that have contaminated. Whereas, ellagic acid has reported as one of 13 flavonoid compounds that have potential as an anti-mutagen and anti-cancer in the walnuts seeds. This study was aimed to ensure the potential extent of ellagic acid extracts in walnut seeds to reducing and repairing the genotoxicity effects of mercury. Therefore, using the experimental method, this study was divided into several test treatments. Two controls treatment as a comparison of the presence of micronucleus with group tests that given a 20 ppm mercury dosage. Then continued with the addition of walnut seed extract with various dosage (10, 15, and 20 ppm) by oral injection continuously for two weeks as a recovery process to reducing and repairing the genotoxicity effect of mercury. The significant results showed that there are differences between pre and post-treatment. It indicated that the extract has the potential for improving and reducing the genotoxicity effect of mercury. The data were evaluated and obtained the total micronucleus from the smear of peripheral blood of mice by comparing the total micronucleus before and after giving of walnut extract

Structural and Tectonic Evolution of the Porgera Gold Mine; Highlands of Papua New Guinea

The Porgera Transfer Zone (PTZ) is a major crustal and probably lithospheric structure across Papua New Guinea recording >50 km offset of ophiolites and very different patterns of geology and topography on either side. In the Late Jurassic, the PTZ probably separated oceanic crust and thick Jurassic Om shales to the west from a continental promontory to the east. During the Late Miocene to Recent orogenesis, the differential compression of these features is interpreted to have created a dextral strike slip fault across the fold belt with pull-apart basins at sites of fault relays. This facilitated the ascent of intrusions and mineralization at Porgera. The acquisition of high-resolution LIDAR data semi-regionally around the Porgera Gold Mine greatly improved interpretation of the regional geology and particularly the recognition of normal faults. By correlating with sparse dip data and paly-dated samples, it was possible to create stratigraphic sections and interpret structural cross-sections using the LIDAR data. As the area involved strike–slip offsets, it was important to construct sections in multiple orientations in order to interpret the 3D geology. Both dips and fault orientation could be directly inferred from the LIDAR data such that sections could be constructed orthogonally to them. A balanced, restored and forward-modelled cross-section illustrates the interaction between thrust faults and normal faults during compression and that it was synchronous with the development of a pull-apart basin. A semi-regional 3D geological model, which was developed mainly from the LIDAR data, supports the hypothesis of inversion of the thick Om beds to the west before or during compression of the continental promontory to the east resulting in dextral strike–slip offsets across the PTZ. A jog or relay in the faults occurred and caused a pull-apart collapse basin to develop in the area of the Porgera mine. Similar pull-apart graben, or negative flower structures, were detected nearby and may be areas for future exploration