Peggy Pc Chiang

Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy.

To examine the association of diabetes and diabetic retinopathy (DR) with retinal ganglion cell (RGC) loss.

Assessing disutility associated with diabetic retinopathy, diabetic macular oedema and associated visual impairment using the Vision and Quality of Life Index

Background:  Use of generic multi‐attribute utility instruments (MAUI) to assess the impact of diabetic retinopathy (DR) on health‐related quality of life (HRQoL) has produced inconsistent findings. Therefore, we assessed the impact of DR, diabetic macular oedema (DME) and associated visual impairment on vision‐related QoL (VRQoL) using a vision‐specific MAUI.

Global burden of disease and visual impairment.

Alan Lopez and colleagues (May 27, p 1747) rank the top ten causes of burden of disease in terms of disability-adjusted life-years (DALYs) in low-income, middle-income, and high-income countries. However, they did not include visual impairment. Lopez and colleagues used data from the World Bank publication Global burden of disease and risk factors, which lists causes of visual impairment separately as onchocerciasis, trachoma, vitamin A defi ciency, glaucoma, cataract and age-related visual disorders. The sum of DALYs from these conditions is 53 692 000 (3·5%), ranking seventh. Assuming that visual impairment is also responsible for half the diabetes burden, vision-related DALYs rise to 66 290 000 (4·3%), ranking six—just below HIV/AIDS at 71 460 000 (4·7%). The number of people aff ected by HIV/AIDS is 42 million, compared with the 161 million with visual impairment. With increasing diabetes, especially in low-income and middle-income countries, and the global increase in the proportion of elderly people, loss of quality of life from visual impairment will escalate. This issue was recognised when the 59th World Health Assembly adopted a resolution “to ensure that prevention of blindness and visual impairment are included in the implementation and monitoring of WHO’s Eleventh General Programme of Work”. Lopez and colleagues’ work emphasises the importance of using morbidity, measured by DALYs, in understanding the eff ects of health on quality of life. That is not obtained when only mortality data are used.

Frequency and risk factors of non-retinopathy ocular conditions in people with diabetes: the Singapore Malay Eye Study.

To investigate the frequency and risk factors of non‐retinopathy ocular conditions in persons with diabetes.

Glaucoma and Associated Visual Acuity and Field Loss Significantly Affect Glaucoma-Specific Psychosocial Functioning

OBJECTIVE To examine the impact of glaucoma and visual acuity (VA) and visual field (VF) losses on psychosocial functioning (PF). DESIGN Cross-sectional study. PARTICIPANTS We compared PF between 192 participants with bilateral glaucoma with VA or VF losses and 40 controls from a tertiary eye hospital clinic in Singapore. METHODS Glaucoma was defined using the Hodapp-Anderson-Parish criteria. Four psychosocial outcomes of the Glaucoma Quality of Life 36 questionnaire were psychometrically assessed using Rasch analysis. Multivariate regression was performed to determine the independent impact of glaucoma and VA and VF losses on PF. The impact of VA and VF on PF were evaluated by restricted cubic spline analysis. MAIN OUTCOME MEASURES Anxiety, self-image, psychological well-being, and confidence in health care. RESULTS The mean age of participants was 66.2±11.0 years, and 63% were male. In the better eye, VA and mean deviation were Snellen 20/25 and -8.89±6.52 dB, respectively. In multivariate models, glaucoma patients had 63.0% greater anxiety (95% confidence interval [CI], -66.0% to -61.2%; P<0.001), 71.0% lower self-image (95% CI, -74.1% to -68.5%; P<0.001), 38.3% less psychological well-being (95% CI, -37.4% to -39.0%; P<0.001), and 32.4% reduced confidence in health care than patients without glaucoma. The worst VA and VF categories had the most reduced PF (range, 26.0% to 81.5%; P<0.001 for all associations) compared with controls. With worsening VA, there was a linear increase in anxiety (P=0.009) and decrease in self-image (P=0.005). With worsening VF from 0 to -12.1 dB (P=0.003), anxiety increased before plateauing. Self-image decreased as VF worsened from 0 to -10 dB (P<0.001), and confidence in health care decreased when VF worsened from 0 to -9.3 dB (P=0.008). However, self-image and confidence in health care actually improved at greater levels of VF loss beyond these thresholds. CONCLUSION Glaucoma negatively affects PF. Early stage glaucoma with mild VF loss adversely affects anxiety, self-image, and confidence in health care. As VA worsens in advanced glaucoma, anxiety further increases and self-image deteriorates. Ophthalmologists and glaucoma patients need to be aware that both VA and VF losses at different stages of glaucoma negatively impact PF.

Low vision service provision: a global perspective

Changing global population demographics and effective eye care programs are tipping the scale towards an increase in nonpreventable and nontreatable vision disorders that can lead to low vision. Comprehensive low vision services are important to maintain or improve the quality of life of people with low vision. However, globally, coverage and access to services is estimated to be 5–10%. Research regarding the effectiveness of services has emerged in recent decades. This paper provides an overview of the effectiveness of international low vision models of service delivery. It presents a history of service evolution, an overview of the epidemiology of low vision, and a critique of past and present models concluding with a discussion of models of best practice.

Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies.

People from ethnic minorities often experience poorer cancer outcomes, possibly due to later presentation to healthcare and later diagnosis. We aimed to identify common cancer beliefs in minority populations in developed countries, which can affect symptom appraisal and help seeking for symptomatic cancer. Our systematic review found 15 relevant qualitative studies, located in the United Kingdom (six), United States (five), Australia (two) and Canada (two) of African, African-American, Asian, Arabic, Hispanic and Latino minority groups. We conducted a meta-synthesis that found specific emotional reactions to cancer, knowledge and beliefs and interactions with healthcare services as contributing factors in help seeking for a cancer diagnosis. These findings may be useful to inform the development of interventions to facilitate cancer diagnosis in minority populations.

Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

PURPOSE We conducted this review to identify published randomized controlled trials (RCTs) of cancer risk assessment tools used in primary care and to determine their impact on clinical utility (clinicians), screening uptake (patients), and psychosocial outcomes (patients). METHODS We searched EMBASE, PubMed and the Cochrane databases for RCTs of cancer risk assessment tools in primary care up to May 2014. Only studies set in primary care, with patients eligible for screening, and English-language articles were included. RESULTS The review included 11 trials of 7 risk tools. The trials were heterogeneous with respect to type of tool that was used, type(s) of cancer assessed, and outcomes measured. Evidence suggested risk tools improved patient risk perception, knowledge, and screening intentions, but not necessarily screening behavior. Overall, uptake of a tool was greater if initiated by patients, if used by a dedicated clinician, and when combined with decision support. There was no increase in cancer worry. Health promotion messages within the tool had positive effects on behavior change. Trials were limited by low-recruitment uptake, and the heterogeneity of the findings necessitated a narrative review rather than a meta-analysis. CONCLUSIONS Risk tools may increase intentions to have cancer screening, but additional interventions at the clinician or health system levels may be needed to increase risk-appropriate cancer screening behavior.

Cultural beliefs about cancer influencing help-seeking and symptom appraisal: a meta-synthesis of qualitative findings

Background - Primary brain tumours are rare among adults, but patients often experience physical, cognitive, neurological and psychosocial morbidity. Research has documented high rates of unmet supportive care needs among subgroups, such as patients receiving specific treatments or those receiving palliative care, but the needs of patients in the period soon after diagnosis are not known. Aim - To describe the unmet supportive care needs of adults recently diagnosed with primary brain tumours and change in needs over the early diagnosis/treatment period. Methods - A representative population-based sample of 40 patients was recruited approximately three months after diagnosis through a state cancer registry in Queensland, Australia. Patients or carer proxies completed surveys of supportive care needs in six domains (physical/daily living, psychological, patient care and support, sexuality, health system and information needs, and brain tumour-specific needs) at baseline and three months later. Mean supportive care needs scores (scale 0-100, with higher scores indicating higher levels of need) were calculated and compared over time. Results - The highest mean supportive care needs score at each time point was for physical needs (baseline 47.9, SD 26.3), closely followed by psychological needs (baseline 45.8, SD 35.6). Mean scores for other domains ranged from 30.4 to 37.9. Mean scores in all domains except for sexuality significantly declined over time, with the greatest decline for the patient care and support needs domain (mean 15.9 point decrease). Conclusions - Adults with primary brain tumours experience high levels of unmet physical and psychological needs early in the disease trajectory. However, levels of needs, particularly for patient care, decline over time, perhaps with the completion of primary treatments. Further research is needed to confirm these findings in a larger sample and investigate reasons for the decline seen.Programme/Policy Process: Once a VHL develops its activities through a cooperative network of institutions which are users and producers of information, it was essential to structure such a network within the field of cancer control and develop a governance model that could allow its sustainable operation. The model is composed of Executive Secretary, Advisory Committee, Executive Committee and Responsibility Matrix. The institutions which are part of this collaborative network have been selected in order to represent the regional diversity present in Brazil and also the diverse profiles of institutions related to cancer control, such as research, academia, government, scientific societies and organizations representing patients.Background: Smoking rates in Aboriginal Australians are gradually reducing in some age groups, but not for people in the peak reproductive years.¹ Smoking cessation is vital for cancer prevention.² Many regional programs avoid the use of threat messages when targeting Australian Aboriginal smokers.³ Aim: To assess, for the first time, the responses of Aboriginal smokers, 18–45 years, to Risk Behaviour Diagnosis scales (RBD)⁴ and intentions to quit smoking, including gender differences. Methods: We interviewed 121 Aboriginal smokers, using a structured questionnaire including adapted RBD scales. The RBD measured perceived threat (susceptibility and severity of threat) and perceived efficacy (self-efficacy and response efficacy) on Likert scales. Intentions to quit were assessed. Scales were recoded into high-low responses. Face validity was assessed via an Aboriginal panel, and scales assessed for reliability. Chi-square tests investigated the associations between intention to quit, efficacy/threat and gender. Results: Among men, intention to quit was associated with perceived efficacy (X² = 15.23;df = 1; p < 0.0001), but not with perceived threat. For women, intention to quit was neither associated with efficacy nor threat. Both genders were more likely to have high intention to quit, with high efficacy and high threat (n = 54;45%:maleX² = 12.6;df = 1; p < 0.001:femaleX²= 5.6;df = 1; p < 0.05). There was no difference in intention to quit with low efficacy-high threat for either gender (n = 39;32%). In contrast, all of the men with low threat-high efficacy (n = 5;4%) intended to quit, whereas all of the women with low threat-low efficacy (n = 6;5%) intended to quit. Conclusions: High-perceived threat was associated with high intention to quit smoking only when perceived efficacy was high. Gender differences may be a consideration. The RBD scales could be used to tailor messages to the level of efficacy and threat in clinical consultations, and in regional programs. All Aboriginal Australian smokers may benefit from increased efficacy to quit smoking.Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australia