Health information needs of visually impaired people: a systematic review of the literature

Access to, and provision of, information is key to reducing health inequalities in health and social care. However, information is not always accessible and does not always meet the needs of specific groups. One such group is people who are visually impaired. The aim of the present study was to identify the health information needs of visually impaired people, and highlight major gaps in the literature. A systematic review of the literature was undertaken following, where possible, the NHS Centre for Reviews and Dissemination framework. Modifications included the sources searched, the critical appraisal checklist used (Critical Skills Training in Appraisal for Librarians) and the method of data synthesis. Out of the 1114 references identified, only 16 met the inclusion criteria. Quality of reporting of the literature was poor, and this must be taken into consideration when interpreting the findings of this review. The majority of studies were concerned with information for healthy living (e.g. health promotion). The focus of the remaining studies was on information about visual impairment or coping with visual impairment, and about accessing health services (e.g. medication labels and appointment letters). The majority of studies conducted to date have concentrated on the format of information. There are surprisingly few empirical studies which have examined the health information needs of this group. A number of gaps in the literature have been identified. These relate to the types of health information, non-format aspects of information (e.g. content and timing), sources of health and social care information, treating visually impaired people as a heterogeneous group, and recognising the value of actively involving visually impaired people in the research process. Although this review has identified a number of implications for practice, the paucity of evidence places a heavier onus on future research. Visually impaired people are likely to have unique health and social care information needs which are worthy of exploration in their own right

When Self-Presentation Trumps Access: Why Older Adults with Low Vision Go without Low Vision Services

Reasons were sought for low-vision service nonuse in a group of Canadian seniors with self-reported low vision. Audio-recorded semistructured interviews were completed with 34 seniors with low vision: age range (70 to 94 years; mean: 82 years); 16 urban dwellers (12 women); 18 rural dwellers (14 women). Qualitative content analysis and template analytic techniques were applied to transcriptions. Informant nonuse of low-vision services involved: insufficient knowledge, managing for now, and practitioner behavior (inadequate rehabilitation education and management). Underlying seniors’ attitudes that shaped their self-presentation and service nonuse included a strong need for independence, a contextualization of vision loss relative to other losses, and an acceptance of vision loss in life. Service delivery strategies should consider not only knowledge access and healthcare practitioner behavior but also senior self-presentation strategies (e.g., viewing aids as counterproductive to independence). Subtle rural-urban attitudinal differences may further delay access for rural seniors; further research is advised

Early changes in biochemical markers of bone turnover and their relationship with bone mineral density changes after 24 months of treatment with teriparatide

Summary: We report the changes in biochemical markers of bone formation during the first 6 months of teriparatide therapy in postmenopausal women with osteoporosis according to previous antiresorptive treatment. Prior therapy does not adversely affect the response to teriparatide treatment. Similar bone markers levels are reached after 6 months of treatment. Introduction: The response of biochemical markers of bone turnover with teriparatide therapy in subjects who have previously received osteoporosis drugs is not fully elucidated. We examined biochemical markers of bone formation in women with osteoporosis treated with teriparatide and determined: (1) whether the response is associated with prior osteoporosis therapy, (2) which marker shows the best performance for detecting a response to therapy, and (3) the correlations between early changes in bone markers and subsequent bone mineral density (BMD) changes after 24 months of teriparatide. Methods: We conducted a prospective, open-label, 24-month study at 95 centers in 10 countries in 758 postmenopausal women with established osteoporosis (n?=?181 treatment-naïve) who had at least one post-baseline bone marker determination. Teriparatide (20 ?g/day) was administered for up to 24 months. We measured procollagen type I N-terminal propeptide (PINP), bone-specific alkaline phosphatase (b-ALP), and total alkaline phosphatase (t-ALP) at baseline, 1 and 6 months, and change in BMD at the lumbar spine, total hip and femoral neck from baseline to 24 months. Results: Significant increases in formation markers occurred after 1 month of teriparatide regardless of prior osteoporosis therapy. The absolute increase at 1 month was lower in previously treated versus treatment-naïve patients, but after 6 months all groups reached similar levels. PINP showed the best signal-to-noise ratio. Baseline PINP correlated positively and significantly with BMD response at 24 months. Conclusions: This study suggests that the long-term responsiveness of bone formation markers to teriparatide is not affected in subjects previously treated with antiresorptive drugs. <br/