Construct validation of the Amblyopia and Strabismus Questionnaire (A&SQ) by factor analysis

Background: The Amblyopia and Strabismus Questionnaire (A&SQ) was previously developed to assess quality of life (QoL) in amblyopia and/or strabismus patients. Here, factor analysis with Varimax rotation was employed to confirm that the questions of the A&SQ correlated to dimensions of quality of life (QoL) in such patients. Methods: Responses on the A&SQ from three groups were analyzed: healthy adults (controls) (n = 53), amblyopia and/or strabismus patients (n = 72), and a historic cohort of amblyopes born between 1962-1972 and occluded between 1968-1974 (n = 173). The correlations among the responses to the 26 A&SQ items were factor-analysed by Principal Component Analysis (PCA). As the development of the A&SQ was intuitive-deductive, it was expected that the pattern of correlation could be explained by the five a priori hypothesized dimensions: fear of losing the better eye, distance estimation, visual disorientation, diplopia, and social contact and cosmetic problems. Distribution of questions along the factors derived by PCA was examined by orthogonal Varimax rotation. Results: Data from 296 respondents were analyzed. PCA provided that six factors (cutoff point eigenvalue >1.0) accumulatively explained 70.5% of the variance. All A&SQ dimensions but one matched with four factors found by Varimax rotation (factor loadings >0.50), while two factors pertained to the fifth dimension. The six factors explained 33.7% (social contact and cosmetic problems); 10.3% (near distance estimation); 8.7% (diplopia); 7.2% (visual disorientation); 6.3% (fear of losing the better eye); and 4.3% (far distance estimation), together 70.48% of the item variance. Conclusion: The highly explained variance in the A&SQ scores by the factors found by the PCA confirmed the a priori hypothesized dimensions of this QoL instrument

Pigment epithelium-derived factor protects retinal ganglion cells

BACKGROUND: Retinal ganglion cells (RGCs) are responsible for the transmission of visual signals to the brain. Progressive death of RGCs occurs in glaucoma and several other retinal diseases, which can lead to visual impairment and blindness. Pigment epithelium-derived factor (PEDF) is a potent antiangiogenic, neurotrophic and neuroprotective protein that can protect neurons from a variety of pathologic insults. We tested the effects of PEDF on the survival of cultured adult rat RGCs in the presence of glaucoma-like insults, including cytotoxicity induced by glutamate or withdrawal of trophic factors. RESULTS: Cultured adult rat RGCs exposed to glutamate for 3 days showed signs of cytotoxicity and death. The toxic effect of glutamate was concentration-dependent (EC(50 )= 31 μM). In the presence of 100 μM glutamate, RGC number decreased to 55 ± 4% of control (mean ± SEM, n = 76; P < 0.001). The glutamate effect was completely eliminated by MK801, an NMDA receptor antagonist. Trophic factor withdrawal also caused a similar loss of RGCs (54 ± 4%, n = 60, P < 0.001). PEDF protected against both insults with EC(50 )values of 13.6 ng/mL (glutamate) and 3.4 ng/mL (trophic factor withdrawal), respectively. At 100 ng/mL, PEDF completely protected the cells from both insults. Inhibitors of the nuclear factor κB (NFκB) and extracellular signal-regulated kinases 1/2 (ERK1/2) significantly reduced the protective effects of PEDF. CONCLUSION: We demonstrated that PEDF potently and efficaciously protected adult rat RGCs from glutamate- and trophic factor withdrawal-mediated cytotoxicity, via the activation of the NFκB and ERK1/2 pathways. The neuroprotective effect of PEDF represents a novel approach for potential treatment of retinopathies, such as glaucoma

Preconditioning-induced ischemic tolerance: a window into endogenous gearing for cerebroprotection

Ischemic tolerance defines transient resistance to lethal ischemia gained by a prior sublethal noxious stimulus (i.e., preconditioning). This adaptive response is thought to be an evolutionarily conserved defense mechanism, observed in a wide variety of species. Preconditioning confers ischemic tolerance if not in all, in most organ systems, including the heart, kidney, liver, and small intestine. Since the first landmark experimental demonstration of ischemic tolerance in the gerbil brain in early 1990's, basic scientific knowledge on the mechanisms of cerebral ischemic tolerance increased substantially. Various noxious stimuli can precondition the brain, presumably through a common mechanism, genomic reprogramming. Ischemic tolerance occurs in two temporally distinct windows. Early tolerance can be achieved within minutes, but wanes also rapidly, within hours. Delayed tolerance develops in hours and lasts for days. The main mechanism involved in early tolerance is adaptation of membrane receptors, whereas gene activation with subsequent de novo protein synthesis dominates delayed tolerance. Ischemic preconditioning is associated with robust cerebroprotection in animals. In humans, transient ischemic attacks may be the clinical correlate of preconditioning leading to ischemic tolerance. Mimicking the mechanisms of this unique endogenous protection process is therefore a potential strategy for stroke prevention. Perhaps new remedies for stroke are very close, right in our cells

Utilisation of eye care services by urban and rural Australians

First published by BMJ Publishing Group who hold exclusive publishing rights.AIM: To investigate factors related to the use of eye care services in Australia. METHODS: Health, eye care service use, and sociodemographic data were collected in a structured interview of participants in a population based study. All participants had a standard eye examination. RESULTS: Men (OR 1.3 CL 1.02, 1.7), those who spoke Greek (OR 2.1 CL 1.1, 3.8) or Italian (OR 1.9 CL 1.0, 3.3), and those without private health insurance (OR 1.59 CL 1.22, 2.04) were more likely to have not used eye care services. Ophthalmology services were utilised at lower rates in rural areas (OR 0.14 CL 0.09, 0.2). Approximately 40% of participants with undercorrected refractive error, cataract, and undiagnosed glaucoma had seen either an ophthalmologist, optometrist, or both within the last year. CONCLUSION: Despite the similarity in prevalence of eye disease in urban and rural areas, significant differences exist in the utilisation of eye care services. Sex, private health insurance, urban residence, and the ability to converse in English were significant factors associated with eye healthcare service use. Many participants had undiagnosed eye disease despite having seen an eye care provider in the last year

Clinical Skills Labs in Medical Education in Germany, Austria and German Speaking Switzerland

Introduction: Following the reform of the medical licensure law in 2002 German medical faculties have started implementing clinical skills labs. This survey aims to present a review about the stage of development in this domain in Germany as well as in Austria and in German-speaking Switzerland. Method: In the period between August and December 2007 all the 43 medical faculties in Germany, Austria and in German-speaking Switzerland were interviewed with a questionnaire covering 7 topics. The further analysis included skills labs where more than one medical specialty was involved ("central" skills labs) Results: The response rate was 100 %. By the time of the survey 33 of the existing 43 faculties maintained a skills lab, 24 of them entered the overview. 22 skills labs were managed by physicians. The number of employees varied between 1 and 8, the number of student tutors between 0 and 40. The size of the existing skills labs varied between below 100 m² and 2500 m². Most of the skills labs (19) based their tuition upon instruction manuals, and 19 worked with simulated patients (mostly using both). In 15 skills labs simulated patients were also set in for assessment. 17 skills labs taught with problem based learning, 16 taught with computer based learning. Questions about personal costs, acquisition cost and current costs were answered scarcely and inhomogeneously. Discussion: The foundation of clinical skills labs in Germany was furthered by the medical licensure law reform and by the recent introduction of tuition fees. Marked similarities amongst the skills labs existed in teaching methods and content and in assessment. The increasing number of new skills labs since tuition fees have been introduced suggests that medical faculties use such resources for the improvement of practical competencies in medical education. Conclusion: In order to save resources we suggest an exchange and co-operation between existing medical skills labs. This would facilitate the development of common quality standards and guidelines for medical skills labs. It also seems to be necessary to define the term "central skills lab" accurately. The authors recommend the Committee on Practical Skills of the Gesellschaft für Medizinische Ausbildung (GMA) as a platform for such co-operation.Zielsetzung: Seit der Novellierung der ÄAppO im Jahr 2002 werden im deutschsprachigen Raum an den medizinischen Universitäten zunehmend Medizinische Trainings- und Prüfungszentren eingerichtet. Die vorliegende Erhebung soll einen Überblick über den Stand der Entwicklung in diesem Bereich in Deutschland, Österreich und der deutschsprachigen Schweiz bieten. Methodik: In der Zeit von August bis Dezember 2007 wurden alle 43 medizinischen Fakultäten in Deutschland, Österreich und der deutschsprachigen Schweiz schriftlich befragt. Der Fragebogen umfasste 7 Themenbereiche. Die weitere Auswertung bezieht sich auf Trainingszentren, in denen mehr als eine Disziplin unterrichtet wird ("zentrale" Trainingszentren). Ergebnisse: Der Rücklauf betrug 100%. Von 43 Fakultäten verfügten 33 zum Zeitpunkt der Befragung über ein Trainingszentrum, 24 davon gingen in die weitere Auswertung ein. 22 Trainingszentren waren ärztlich geleitet, die Zahl der Mitarbeiter lag zwischen 1 bis 8, die der studentischen Tutoren zwischen 0 und 40. Das Spektrum der zur Verfügung stehenden Grundfläche reichte von unter 100 Quadratmetern bis zu 2500 Quadratmetern. An den meisten Trainingszentren wurde mit strukturierten Arbeitsanleitungen gearbeitet (19 Einrichtungen), in 18 Einrichtungen unterrichteten Ärzte und studentische Tutoren. In der Mehrheit der Fälle (13) war der Unterricht curricular integriert. An 19 Zentren wurden OSKE1 durchgeführt. An 19 Zentren wurde mit Simulationspatienten gearbeitet, die in 15 Zentren auch für Prüfungen eingesetzt wurden. 17 Zentren arbeiteten mit problemorientiertem Lernen, 16 setzten computerbasiertes Lernen ein. Die Fragen zu Personalkosten, laufenden Kosten und Anschaffungskosten wurden nur von sehr wenigen Zentren und sehr inhomogen beantwortet. Diskussion: Die Einrichtung von Medizinischen Trainingszentren im deutschsprachigen Raum ist durch die neue ÄAppO und durch die Erhebung von Studiengebühren deutlich vorangetrieben worden. Große Ähnlichkeiten zwischen den Zentren zeigten sich in den Bereichen Lehrinhalte, -methoden und Prüfungen. Es fand sich keine Korrelation zwischen der Größe des Trainingszentrums und seinem Gründungszeitpunkt oder den Anschaffungs- bzw. Personalkosten. Der deutliche Anstieg von neu eröffneten TZ in zeitlichem Zusammenhang mit der Einführung der Studiengebühren legt nahe, dass hiermit eine konkrete Verbesserung der Ausbildungssituation durch die Studiengebühren beabsichtigt wird. Schlussfolgerung: Um Ressourcen zu sparen, wird eine enge Zusammenarbeit der bestehenden Trainingszentren und eventuell die Entwicklung gemeinsamer Qualitätsstandards oder einer Leitlinie für medizinische Trainingszentren empfohlen. Auch erscheint eine genaue Klärung des Begriffes "zentrales Trainingszentrum" notwendig. Als Plattform für eine solche Zusammenarbeit empfehlen die Autoren den GMA Ausschuss Praktische Fertigkeiten

Clinical Skills Labs in Medical Education in Germany, Austria and German Speaking Switzerland

Introduction: Following the reform of the medical licensure law in 2002 German medical faculties have started implementing clinical skills labs. This survey aims to present a review about the stage of development in this domain in Germany as well as in Austria and in German-speaking Switzerland. Method: In the period between August and December 2007 all the 43 medical faculties in Germany, Austria and in German-speaking Switzerland were interviewed with a questionnaire covering 7 topics. The further analysis included skills labs where more than one medical specialty was involved ("central" skills labs) Results: The response rate was 100 %. By the time of the survey 33 of the existing 43 faculties maintained a skills lab, 24 of them entered the overview. 22 skills labs were managed by physicians. The number of employees varied between 1 and 8, the number of student tutors between 0 and 40. The size of the existing skills labs varied between below 100 m² and 2500 m². Most of the skills labs (19) based their tuition upon instruction manuals, and 19 worked with simulated patients (mostly using both). In 15 skills labs simulated patients were also set in for assessment. 17 skills labs taught with problem based learning, 16 taught with computer based learning. Questions about personal costs, acquisition cost and current costs were answered scarcely and inhomogeneously. Discussion: The foundation of clinical skills labs in Germany was furthered by the medical licensure law reform and by the recent introduction of tuition fees. Marked similarities amongst the skills labs existed in teaching methods and content and in assessment. The increasing number of new skills labs since tuition fees have been introduced suggests that medical faculties use such resources for the improvement of practical competencies in medical education. Conclusion: In order to save resources we suggest an exchange and co-operation between existing medical skills labs. This would facilitate the development of common quality standards and guidelines for medical skills labs. It also seems to be necessary to define the term "central skills lab" accurately. The authors recommend the Committee on Practical Skills of the Gesellschaft für Medizinische Ausbildung (GMA) as a platform for such co-operation.Zielsetzung: Seit der Novellierung der ÄAppO im Jahr 2002 werden im deutschsprachigen Raum an den medizinischen Universitäten zunehmend Medizinische Trainings- und Prüfungszentren eingerichtet. Die vorliegende Erhebung soll einen Überblick über den Stand der Entwicklung in diesem Bereich in Deutschland, Österreich und der deutschsprachigen Schweiz bieten. Methodik: In der Zeit von August bis Dezember 2007 wurden alle 43 medizinischen Fakultäten in Deutschland, Österreich und der deutschsprachigen Schweiz schriftlich befragt. Der Fragebogen umfasste 7 Themenbereiche. Die weitere Auswertung bezieht sich auf Trainingszentren, in denen mehr als eine Disziplin unterrichtet wird ("zentrale" Trainingszentren). Ergebnisse: Der Rücklauf betrug 100%. Von 43 Fakultäten verfügten 33 zum Zeitpunkt der Befragung über ein Trainingszentrum, 24 davon gingen in die weitere Auswertung ein. 22 Trainingszentren waren ärztlich geleitet, die Zahl der Mitarbeiter lag zwischen 1 bis 8, die der studentischen Tutoren zwischen 0 und 40. Das Spektrum der zur Verfügung stehenden Grundfläche reichte von unter 100 Quadratmetern bis zu 2500 Quadratmetern. An den meisten Trainingszentren wurde mit strukturierten Arbeitsanleitungen gearbeitet (19 Einrichtungen), in 18 Einrichtungen unterrichteten Ärzte und studentische Tutoren. In der Mehrheit der Fälle (13) war der Unterricht curricular integriert. An 19 Zentren wurden OSKE1 durchgeführt. An 19 Zentren wurde mit Simulationspatienten gearbeitet, die in 15 Zentren auch für Prüfungen eingesetzt wurden. 17 Zentren arbeiteten mit problemorientiertem Lernen, 16 setzten computerbasiertes Lernen ein. Die Fragen zu Personalkosten, laufenden Kosten und Anschaffungskosten wurden nur von sehr wenigen Zentren und sehr inhomogen beantwortet. Diskussion: Die Einrichtung von Medizinischen Trainingszentren im deutschsprachigen Raum ist durch die neue ÄAppO und durch die Erhebung von Studiengebühren deutlich vorangetrieben worden. Große Ähnlichkeiten zwischen den Zentren zeigten sich in den Bereichen Lehrinhalte, -methoden und Prüfungen. Es fand sich keine Korrelation zwischen der Größe des Trainingszentrums und seinem Gründungszeitpunkt oder den Anschaffungs- bzw. Personalkosten. Der deutliche Anstieg von neu eröffneten TZ in zeitlichem Zusammenhang mit der Einführung der Studiengebühren legt nahe, dass hiermit eine konkrete Verbesserung der Ausbildungssituation durch die Studiengebühren beabsichtigt wird. Schlussfolgerung: Um Ressourcen zu sparen, wird eine enge Zusammenarbeit der bestehenden Trainingszentren und eventuell die Entwicklung gemeinsamer Qualitätsstandards oder einer Leitlinie für medizinische Trainingszentren empfohlen. Auch erscheint eine genaue Klärung des Begriffes "zentrales Trainingszentrum" notwendig. Als Plattform für eine solche Zusammenarbeit empfehlen die Autoren den GMA Ausschuss Praktische Fertigkeiten

Vision impairment and older drivers: who's driving?

First published by BMJ Publishing Group who hold exclusive publishing rights.AIM: To establish the association between impaired vision and drivers' decisions to stop driving, voluntarily restrict driving, and motor vehicle accidents. METHODS: Driving related questions were included in a population based study that determined the prevalence and incidence of eye disease. Stratified random cluster samples based on census collector districts were selected from the Melbourne Statistical Division. Eligible participants aged 44 years and over were interviewed and underwent a comprehensive ophthalmic examination. The outcomes of interest were the decision to stop driving, limiting driving in specified conditions, and driving accidents. The associations between these outcomes and the legally prescribed visual acuity (0.9). Older drivers with impaired vision, more so than younger adults, restrict their driving in visually demanding situations (p31 000 km) but not with age. CONCLUSION: There was no greater likelihood of self reported driving accidents for drivers with impaired vision than those with good vision. While many older drivers with impaired vision limit their driving in adverse conditions and some drivers with impaired vision stop driving, there are a significant number of current drivers with impaired vision