Stefania M. Mojon-Azzi

Strabismus and employment: the opinion of headhunters

Purpose:  The aim of this study was to determine the influence of strabismus on an individual’s ability to find employment based on the opinion of Swiss headhunters.

Impact of Low Vision on Well-Being in 10 European Countries

Background: Because of the growing life expectancy in developed countries and the exponential increase in vision loss with increasing age, a growing number of elderly persons will eventually suffer from visual impairment and blindness. This paper describes the association between self-reported vision and well-being in individuals aged 50 years and older and their families. Methods: Using binary logistic regressions on data from the 2004 Survey of Health, Ageing and Retirement in Europe (SHARE), we analysed the association between self-reported corrected vision in general, corrected distance vision and corrected reading vision on 11 variables capturing emotional well-being, future hopes and perspectives, and concentration on daily activities. Results: For 22,486 individuals from 10 European countries, aged 64.23 ± 10.52 years, lower vision was associated with a highly significant negative impact on all measured aspects of well-being. Conclusions: These data from a large population base in Europe provide evidence that persons with low vision have a higher probability of concentration problems during reading and entertainment; losing interest and enjoyment in their activities; feeling fatigued, irritable, sad, and tearful; having less hope for the future; and wishing for death. Effective measures of early detection, prevention, rehabilitation, education and research, as well as a holistic view of a patient, could help counter these problems, thereby improving mental and physical health and reducing the economic impact of low vision.

Waiting times for cataract surgery in ten European countries: An analysis using data from the SHARE survey

Aims: To assess waiting times for cataract surgery and their acceptance in European countries, and to find explanatory, country-specific health indicators. Methods: Using data from the survey of health, ageing and retirement in Europe (SHARE), waiting times for cataract surgery of 245 respondents in ten countries were analysed with the help of linear regression. The influence of four country specific health indicators on waiting times was studied by multiple linear regression. The influence of waiting time and country on the wish to have surgery performed earlier was determined through logistic regression. Additional information was obtained for each country from opinion leaders in the field of cataract surgery. Results: Waiting times differed significantly (p<0.001) between the ten analysed European countries. The length of wait was significantly influenced by the total expenditure on health (p<0.01) but not by the other country specific health indicators. The wish to have surgery performed earlier was determined by the length of wait (p<0.001) but not by the country where surgery was performed. Conclusion: The length of wait is influenced by the total expenditure on health, but not by the rate of public expenditure on health, by the physician density or by the acute bed density. The wish to have surgery performed earlier depends on the length of wait for surgery and is not influenced by the country.

Opinion of Headhunters about the Ability of Strabismic Subjects to Obtain Employment

Background: Through the opinion of Swiss headhunters, we wanted to determine the influence of strabismus on the ability to obtain employment. Methods:Out of 31 randomly selected Swiss headhunters, 20 could be interviewed using a validated questionnaire. Results: Forty-seven percent of the headhunters judged that strabismic subjects have more difficulties in obtaining a job. Gender has no influence on discrimination (p > 0.1). Asked about six facial disfigurements, strabismus was found to have the second largest negative impact on employment directly after acne. Strabismus was estimated to decrease the attractiveness of job applicants (p < 0.0001) and to have a negative impact on the overall judgment of a potential employer (p < 0.05). Conclusions:Visible strabismus influences negatively the ability to obtain a job. Because of its impact on the employability of a person, we believe that strabismus surgery in adults cannot be considered to be only a beautifying procedure.

Scientific misconduct: from salami slicing to data fabrication.

Accessible online at: www.karger.com/oph The aim of peer-reviewed biomedical journals is to publish accurate, new and relevant information on which researchers, medical doctors or the larger public can rely and build upon. Authors, reviewers and editors of such journals have responsibility for monitoring and maintaining high ethical standards and for trying to avoid any form of misconduct. This is not an easy task and several studies suggest that research results are not always conveyed accurately. This problem is not new to science. Some illustrious scientists such as Galileo Galilei and Albert Einstein misrepresented their work in order to attain more convincing experimental results. Other famous scientists such as Claudius Ptolemy plagiarized the work of others. But it was only in 1981 that scientific misconduct came for the first time to public attention with the disclosure of four acts of misconduct occurring in the US [1]. Soon other cases appeared in several countries followed by the need to define misconduct and to develop guidelines and policies against it. Meanwhile many countries and large research institutions have introduced some type of scientific misconduct policy. However, too many countries and research organizations still lack such policies. Definitions of scientific misconduct differ from country to country and from one institution or government agency to another. But independent of definition, scientific misconduct includes at least the fabrication (reporting of experiments never performed), falsification (misrepresentation of results), and plagiarism (taking the writings or ideas of another and representing them as one’s own) of data or ideas. Honest errors or honest differences in interpretation or judgments of data are excluded from most definitions of scientific misconduct [1]. Often also other serious deviations from accepted research practice are included like irresponsible authorship, duplicate publication, salami slicing, bias and conflict of interest and/or intentional erroneous use of statistical methods. The incidence of scientific misconduct is difficult to determine and depends among other factors upon its definition. In comparison with the total number of individuals engaged in research the documented cases of scientific dishonesty are few in number. However, due to the difficulty of discovering and the reluctance of researchers to pursue cases of misconduct, the reported cases could only represent the tip of a large iceberg [2]. Even if the incidence of scientific misconduct might not be high, it is still high enough to warrant attention. One recent example from the US involved a former professor of ophthalmology at the Massachusetts Eye and Ear Infirmary and Harvard Medical School who admitted to having fabricated 21 chromatograms for a National Institute of Health grant application [3]. In order to prevent and fight such misconduct it is important to understand its causes. Reasons for scientific

Strabismus and discrimination in children: are children with strabismus invited to fewer birthday parties?

Aim To determine the social acceptance of children with strabismus by their peers and to determine the age at which the negative impact of strabismus on psychosocial interactions emerges. Methods Photographs of six children were digitally altered in order to create pictures of identical twins except for the position of the eyes (orthotropic, exotropic and exotropic) and the colour of the shirt. One hundred and eighteen children aged 3–12 years were asked to select, for each of the six twin pairs, one of the twins to invite to their birthday party. The grouping of the pictures and the composition of the twin pairs were determined by Latin squares. Results Children younger than 6 years old did not make any significant distinctions between orthotropic children and children with strabismus. Respondents aged 6 years or older invited children with a squint to their birthday parties significantly less often than orthotropic children. The authors found no impact (p>0.1) of gender, of the colour of the shirt or of the type of strabismus, but did find a highly significant impact of age on the number of invited children with strabismus. Conclusions Children aged 6 years or older with a visible squint seem to be less likely to be accepted by their peers. Because this negative attitude towards strabismus appears to emerge at approximately the age of 6 years, corrective surgery for strabismus without prospects for binocular vision should be performed before this age.

Impact of Low Vision on Employment

Background: We investigated the influence of self-reported corrected eyesight on several variables describing the perception by employees and self-employed persons of their employment. Methods: Our study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a multidisciplinary, cross-national database of microdata on health, socioeconomic status, social and family networks, collected on 31,115 individuals in 11 European countries and in Israel. With the help of ordered logistic regressions and binary logistic regressions, we analyzed the influence of perceived visual impairment – corrected by 19 covariates capturing socioeconomic and health- related factors – on 10 variables describing the respondents’ employment situation. Results: Based on data covering 10,340 working individuals, the results of the logistic and ordered regressions indicate that respondents with lower levels of self-reported general eyesight were significantly less satisfied with their jobs, felt they had less freedom to decide, less opportunity to develop new skills, less support in difficult situations, less recognition for their work, and an inadequate salary. Respondents with a lower eyesight level more frequently reported that they feared their health might limit their ability to work before regular retirement age and more often indicated that they were seeking early retirement. Conclusions: Analysis of this dataset from 12 countries demonstrates the strong impact of self-reported visual impairment on individual employment, and therefore on job satisfaction, productivity, and well-being.

Hypertension and life satisfaction: an analysis using data from the Survey of Health, Ageing and Retirement in Europe

This study examines the relationship between hypertension and life satisfaction using more objective measures of hypertension from the Survey of Health, Ageing and Retirement in Europe. Our results confirm the analysis in Blanchflower and Oswald (2008): there is a significant negative correlation between high blood pressure problems and life satisfaction.

The rate of outpatient cataract surgery in ten European countries: An analysis using data from the SHARE survey

BackgroundThe aim of this study was to determine the rates of outpatient cataract surgery (ROCS) in ten European countries and to find country-specific health indicators explaining the differences.MethodsUsing data from the Survey of Health, Ageing and Retirement in Europe (SHARE), 251 eligible respondents were identified for which cataract surgery was the last surgical procedure. The ROCS of ten countries were compared using logistic regression. The influence of the public expenditure on health as per cent of the total expenditure on health, of the number of acute care beds per 1,000 population, and of the number of practicing physicians per 1,000 population, was studied by multiple logistic regression. Additional information was obtained from country-specific opinion leaders in the field of cataract surgery.ResultsThe ROCS differed significantly between the ten analysed European countries where Denmark had the highest (100%) and Austria the lowest (0%) rate of day care surgery. A decrease in the density of acute care beds (p < 0.0000001) and in the density of practicing physicians (p < 0.05) and an increase in the public expenditure on health as per cent of the total health expenditure (p < 0.01) lead to an increase in the ROCS. According to the opinion leaders, regulations and financial incentives also have a strong influence on the ROCS.ConclusionsThe outpatient rate of cataract surgery in the ten European countries was mainly influenced by the acute-care beds density, but also by the density of practicing physicians, and by the public expenditure on health.

The perception of strabismus by children and adults

BackgroundVisible strabismus has been shown to have adverse psychosocial consequences. It remains controversial if esotropia or exotropia is perceived more negatively. The aim of this study was to determine if esotropia or exotropia and the eye (side) in which strabismus is present are perceived differently. We also asked our adult participants: (1) if they thought visible strabismus should be corrected by surgery, (2) if they thought that strabismus surgery should only be to improve the cosmesis, and (3) if they thought that the surgery should be paid for by health insurance.MethodsOne hundred adults and 61 children rated four photographs of a digitally altered picture of a boy and four of a girl, showing a large-angle esotropia or exotropia either in the left or on the right eye. The adults were additionally asked if a squint should be operated, if they considered strabismus surgery to be a cosmetic procedure, if in their opinion strabismus surgery should be covered by compulsory health insurance, and if children with strabismus are disadvantaged. Comparisons were performed using ANOVA and regression analysis.ResultsAdults perceived a squinting right eye as more disturbing than a squinting left eye p < 0.001). The direction of strabismus, the age, gender, and the number of persons with a squint among family and friends of the respondents did not influence the perception of strabismus by adults (p > 0.1 for each). Children also found that a squinting right eye is more disturbing (p < 0.001) than a left one. Additionally, children ranked esotropia worse than exotropia (p < 0.001). Neither age nor gender had an impact on the perception of strabismus by children. Of the adults, 94% would recommend surgery for all forms of strabismus, 18% thought that surgery is only cosmetic, and 94% found that health insurance should cover strabismus surgery for everybody. Problems of squinting children named by the adults included: being made fun of by other children (53%), problems with eyesight (39%), people looking strangely at them (21%), less acceptance by peers (17%), less self confidence (6%), problems judging distances (4%), and that they are perceived as less intelligent (3%).ConclusionsAdults and children rated a squinting right eye as worse compared to a left one. Children perceived esotropia as more disturbing than exotropia. Neither age, nor gender, nor the fact that the respondents have friends or family members with a squint, had an impact on this ranking. Almost all adults would correct all forms of strabismus, and think that surgery should be covered by compulsory health insurance.