Feasibility of the Radner reading chards in low vision patients

Background: Being unable to read is a major problem for visually impaired patients. Since distance visual acuity (VA) does not adequately reflect reading ability, it is important to also evaluate near VA. The Radner Reading Charts (RRCs) are available to measure patients' reading performance. The present study tested the inter-chart and test-retest reliability of the RRCs in Dutch low-vision patients (i.e., visual acuity ≥0.3 logMAR) with various eye disorders. Methods: Thirty-eight patients read the three RRCs in random order. Then, about 1 month after the initial measurements, a test-retest procedure was performed in 15 of the 38 patients. Tested variables were reading acuity (logRAD), logRAD score, logRAD/logMAR ratio, maximum reading speed (MRS), and critical print size (CPS). Both MRS and CPS were calculated in two different ways. To determine the variability, a mixed-model analysis was used. Results: For all variables, the largest part of the variance was explained by the individual subject (86-89%) whereas the chart accounted for only 0-0.78% of the variability. Therefore, the inter-chart and test-retest reliability was high, except for the CPS which had a poor to moderate reliability (31-62%) when calculated in the two different ways. Conclusions: The inter-chart and test-retest results showed high reliability in patients with low vision due to various diseases; therefore, the charts are feasible to determine effects in large groups. © 2010 Springer-Verlag

Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548]

BACKGROUND: Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and practice in several management techniques, including relaxation, physical exercise, modification of negative thoughts, and goal setting. Few studies have examined the effectiveness of this therapy in older adult samples. METHODS/DESIGN: This is a randomized, controlled trial to assess the effectiveness of a pain self-management training group intervention, as compared with an education-only control condition. Participants are recruited from retirement communities in the Pacific Northwest of the United States and must be 65 years or older and experience persistent, noncancer pain that limits their activities. The primary outcome is physical disability, as measured by the Roland-Morris Disability Questionnaire. Secondary outcomes are depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain-related interference with activities (Brief Pain Inventory). Randomization occurs by facility to minimize cross-contamination between groups. The target sample size is 273 enrolled, which assuming a 20% attrition rate at 12 months, will provide us with 84% power to detect a moderate effect size of .50 for the primary outcome. DISCUSSION: Few studies have investigated the effects of multimodal pain self-management training among older adults. This randomized controlled trial is designed to assess the efficacy of a pain self-management program that incorporates physical and psychosocial pain coping skills among adults in the mid-old to old-old range

Multimorbidity in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis : Results From a Longitudinal, Multicenter Data Linkage Study

Objective: Antineutrophil cytoplasmic antibody–associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. This study was undertaken to characterize temporal trends in multimorbidity and report excess health care expenditures associated with multimorbidities in a national AAV cohort from Scotland. Methods: Eligible patients with AAV were diagnosed between 1997 and 2017. Each patient was matched with up to 5 general population controls. Linked morbidity and health care expenditure data were retrieved from a Scottish national hospitalization repository and from published national cost data. Multimorbidity was defined as the development of ≥2 disorders. Prespecified morbidities, individually and together, were analyzed for risks and associations over time using modified Poisson regression, discrete interval analysis, and chi-square test for trend. The relationship between multimorbidities and health care expenditure was investigated using multivariate linear regression. Results: In total, 543 patients with AAV (median age 58.7 years [range 48.9–68.0 years]; 53.6% male) and 2,672 general population controls (median age 58.7 years [range 48.9–68.0 years]; 53.7% male) were matched and followed up for a median of 5.1 years. AAV patients were more likely to develop individual morbidities at all time points, but especially <2 years after diagnosis. The highest proportional risk observed was for osteoporosis (adjusted incidence rate ratio 8.0, 95% confidence interval [95% CI] 4.5–14.2). After 1 year, 23.0% of AAV patients and 9.3% of controls had developed multimorbidity (P < 0.0001). After 10 years, 37.0% of AAV patients and 17.3% of controls were reported to have multimorbidity (P < 0.0001). Multimorbidity was associated with disproportionate increases in health care expenditures in AAV patients. Health care expenditure was highest for AAV patients with ≥3 morbidities (3.89-fold increase in costs, 95% CI 2.83–5.31; P < 0.001 versus no morbidities). Conclusion: These findings emphasize the importance of holistic care in patients with AAV, and may identify a potentially critical opportunity to consider early screening

The Geography of Logistics Firm Location: The Role of Accessibility

The organization of modern economies is built upon an efficient transport system and an increasing role is played by the logistics sector in overcoming the constraints of time and distance in modern supply chains. While a large body of literature is dedicated to the spatial distribution of firms and firm location choice in general, surprisingly little is still known about the location patterns of logistics firms, and more specifically about the role of accessibility in their location decisions. We use geo-referenced firm level data along with detailed information on transport infrastructure in order to investigate the geography of logistics firms in Spain. We place specific attention to the relationship between logistics firm location, accessibility, and urban structure. Our results show that these firms are located closer to highways and other transport infrastructure compared to other sectors and that the logistics sector is highly urbanized. Yet, they are also locating increasingly in suburban locations and to some extent in extra-urban locations with good accessibility while central cities of urban areas have experienced a declining share of logistics firms