Co-morbidity and visual acuity are risk factors for health-related quality of life decline: five-month follow-up EQ-5D data of visually impaired older patients

<p>Abstract</p> <p>Background</p> <p>Co-morbidity is a common phenomenon in the elderly and is considered to be a major threat to quality of life (QOL). Knowledge of co-existing conditions or patient characteristics that lead to an increased QOL decline is important for individual care, and for public health purposes. In visually impaired older adults, it remains unclear which co-existing conditions or other characteristics influence their health-related QOL. Our aim was to present a risk profile of characteristics and conditions which predict deterioration of QOL in visually impaired older patients.</p> <p>Methods</p> <p>Analyses were performed on data from an observational study among 296 visually impaired older patients from four Dutch hospitals. QOL was measured with the EuroQol-5D (EQ-5D) at baseline and at five-month follow-up. Nine co-existing condition categories (musculoskeletal; diabetes; heart; hypertension; chronic obstructive pulmonary disease (COPD) or asthma; hearing impairment; stroke; cancer; gastrointestinal conditions) and six patient characteristics (age; gender; visual acuity; social status; independent living; rehabilitation type) were tested in a linear regression model to determine the risk profile. The model was corrected for baseline EQ-5D scores. In addition, baseline EQ-5D scores were compared with reference scores from a younger visually impaired population and from elderly in the general population.</p> <p>Results</p> <p>From the 296 patients, 50 (16.9%) were lost to follow-up. Patients who reported diabetes, COPD or asthma, consequences of stroke, musculoskeletal conditions, cancer, gastrointestinal conditions or higher logMAR Visual Acuity values, experienced a lower QOL. After five months, visual acuity, musculoskeletal conditions, COPD/asthma and stroke predicted a decline in QOL (R²= 0.20). At baseline, the visually impaired older patients more often reported moderate or severe problems on most EQ-5D dimensions than the two reference groups.</p> <p>Conclusion</p> <p>In visually impaired older patients, visual acuity, musculoskeletal conditions, COPD/asthma and stroke predicted a relatively rapid decline in health-related QOL. With this risk profile, a specific referral by the ophthalmologist to another sub-specialty may have a beneficial effect on the patient's health-related QOL. A referral by the ophthalmologist or optometrist to a multidisciplinary rehabilitation service seems appropriate for some patients with co-morbidity. The current results need to be confirmed in studies using pre-structured questionnaires to assess co-morbidity.</p

Pragmatists, Positive Communicators, and Shy Enthusiasts: Three Viewpoints on Web Conferencing in Health Sciences Education

Reviewer: Topps, DavidReviewer: Logan, Robert[This item is a preserved copy and is not necessarily the most recent version. To view the current item, visit http://www.jmir.org/2007/5/e39/ ] Background: Web conferencing is a synchronous technology that allows coordinated online audio and visual interactions with learners logged in to a central server. Recently, its use has grown rapidly in academia, while research on its use has not kept up. Conferencing systems typically facilitate communication and support for multiple presenters in different locations. A paucity of research has evaluated synchronous Web conferencing in health sciences education. Objective: McMaster University Faculty of Health Sciences trialed Wimba’s Live Classroom Web conferencing technology to support education and curriculum activities with students and faculty. The purpose of this study was to explore faculty, staff, and student perceptions of Web conferencing as a support for teaching and learning in health sciences. The Live Classroom technology provided features including real-time VoIP audio, an interactive whiteboard, text chat, PowerPoint slide sharing, application sharing, and archiving of live conferences to support student education and curriculum activities. Methods: Q-methodology was used to identify unique and common viewpoints of participants who had exposure to Web conferencing to support educational applications during the trial evaluation period. This methodology is particularly useful for research on human perceptions and interpersonal relationships to identify groups of participants with different perceptions. It mixes qualitative and quantitative methods. In a Q-methodology study, the goal is to uncover different patterns of thought rather than their numerical distribution among the larger population. Results: A total of 36 people participated in the study, including medical residents (14), nursing graduate students (11), health sciences faculty (9), and health sciences staff (2). Three unique viewpoints were identified: pragmatists (factor 1), positive communicators (factor 2A), and shy enthusiasts (factor 2B). These factors explained 28% (factor 1) and 11% (factor 2) of the total variance, respectively. The majority of respondents were pragmatists (n = 26), who endorsed the value of Web conferencing yet identified that technical and ease-of-use problems could jeopardize its use. Positive communicators (N = 4) enjoyed technology and felt that Web conferencing could facilitate communication in a variety of contexts. Shy enthusiasts (N = 4) were also positive and comfortable with the technology but differed in that they preferred communicating from a distance rather than face-to-face. Common viewpoints were held by all groups: they found Web conferencing to be superior to audio conferencing alone, felt more training would be useful, and had no concerns that Web conferencing would hamper their interactivity with remote participants or that students accustomed to face-to-face learning would not enjoy Web conferencing. Conclusions: Overall, all participants, including pragmatists who were more cautious about the technology, viewed Web conferencing as an enabler, especially when face-to-face meetings were not possible. Adequate technical support and training need to be provided for successful ongoing implementation of Web conferencing

Hypertrophy dependent doubling of L-cells in Roux-en-Y gastric bypass operated rats

BACKGROUND AND AIMS: Roux-en-Y gastric bypass (RYGB) leads to a rapid remission of type 2 diabetes mellitus (T2DM), but the underlying mode of action remains incompletely understood. L-cell derived gut hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) are thought to play a central role in the anti-diabetic effects of RYGB; therefore, an improved understanding of intestinal endocrine L-cell adaptability is considered pivotal. METHODS: The full rostrocaudal extension of the gut was analyzed in rats after RYGB and in sham-operated controls ad libitum fed or food restricted to match the body weight of RYGB rats. Total number of L-cells, as well as regional numbers, densities and mucosa volumes were quantified using stereological methods. Preproglucagon and PYY mRNA transcripts were quantified by qPCR to reflect the total and relative hormone production capacity of the L-cells. RESULTS: RYGB surgery induced hypertrophy of the gut mucosa in the food exposed regions of the small intestine coupled with a doubling in the total number of L-cells. No changes in L-cell density were observed in any region regardless of surgery or food restriction. The total gene expression capacity of the entire gut revealed a near 200% increase in both PYY and preproglucagon mRNA levels in RYGB rats associated with both increased L-cell number as well as region-specific increased transcription per cell. CONCLUSIONS: Collectively, these findings indicate that RYGB in rats is associated with gut hypertrophy, an increase in L-cell number, but not density, and increased PYY and preproglucagon gene expression. This could explain the enhanced gut hormone dynamics seen after RYGB