Barriers in older adults' decision-making process to use routine eye examinations in Hong Kong.

CLINICAL RELEVANCE: The decision to have a routine eye examination involves individual- and service-level judgement. A deeper understanding of patient access barriers and expectations could facilitate the design of better-aligned service models in optometric practice, improving the utilisation rate of an important facet of primary healthcare services. BACKGROUND: Routine eye examinations achieve several health objectives, including mitigation of sight-threatening risk factors. However, there are barriers to service uptake. Through the qualitative approach, a deeper understanding of these barriers can be realised and enhanced strategies designed to improve the uptake of the routine eye examination. A qualitative study was conducted to identify the factors influencing the decision-making process of older adults to use the routine eye examination service. METHODS: This study was guided by the grounded theory approach. Participants were purposively recruited from six community elderly centres. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis. RESULTS: Difficulty in prioritising and including the routine eye examination in the existing health service utilisation was the central theme associated with its lower use. Four sub-themes were identified to explain this phenomenon: (1) previous health care service utilisation as a reference for judging primary eye care; (2) low perceived primary eye care service needs; (3) low perceived self-efficacy on routine eye care utilisation; (4) service expectations. CONCLUSION: Multiple modifiable factors influence decision-making by older adults, suggesting that their routine eye care seeking behaviour might be altered through behaviour change intervention. The context in which services are delivered requires further study, with a focus on exploring the factors influencing service experience and its subsequent impact on regular eye care seeking behaviour.

Psychometric properties of Upper-body Dressing Scale in people with stroke.

OBJECTIVES: To investigate the psychometric properties of the Upper-Body Dressing Scale (UBDS), a tool for evaluating upper-body dressing performance in stroke patients. DESIGN: Cross-sectional study. SUBJECTS: Seventy-six chronic stroke patients and 49 healthy older adults. METHODS: UBDS, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), Limit of Stability (LOS) test, Motor Activity Log (MAL-30), Arm Activity Measure (AAM), 12-item Short Form Health Survey, and Community Integration Measure - Cantonese version were assessed Results: UBDS time and UBDS score demonstrated good to excellent inter-rater and test-retest reliabilities for chronic stroke patients (intraclass correlation coefficient 0.759-1.000). UBDS time correlated significantly with FMA Upper and Lower Extremity, WMFT, and BBS scores, TUGT time, LOS Movement Velocity (affected side), LOS Maximal Excursion (composite), MAL-30 Amount of Use and Quality of Movement (affected side), and AAM (section B) scores (r = -0.61 to 0.63). The minimal detectable changes in UBDS time and UBDS score were 28.67 s and 0, respectively. The cut-off UBDS time and UBDS score were 37.67 s and 7.50, respectively. CONCLUSION: UBDS time is a reliable, sensitive, and specific measurement for assessing upper-body dressing performance in chronic stroke patients.

Transforming growth factor-beta1 gene polymorphism in renal transplant recipients.

BACKGROUND: Cytokine transforming growth factor (TGF) is involved in regulation of tissue repair after injury. More recently, TGF-beta1 codon 10 gene polymorphism has been shown to be associated with circulating TGF-beta levels. We tested whether TGF-beta1 genotype polymorphism was predictive of renal allograft function decline. PATIENTS AND METHODS: The study population consisted of 129 consecutive cadaveric or living related renal transplant recipients at our center between 1985 and 2001. The recipient TGF-beta1 genotype polymorphism was determined from peripheral blood leucocytes DNA. The primary endpoint was rate of glomerular filtration rate decline between the first year and the third year of transplant. RESULTS: Baseline glomerular filtration rate as estimated by MDRD study equation at 1 year measured 50+/-17 mL/min/1.73 m2. At the end of the 3-year follow-up period, 52 patients (40%) experienced biopsy-confirmed acute rejections. Frequency and severity of allograft rejection did not differ with TGF-beta genotypes. However, the decline in glomerular filtration rate was significantly greater in Leu/Leu (TT) than Leu/Pro (CT) recipients, 6.3+/-16.9 mL/min/1.73 m2 versus 0.1+/-10.2 mL/min/1.73 m2, p=0.04. CONCLUSION: Our results demonstrate that recipient TGF-beta1 codon 10 Leu/Leu homozygosity is a potential risk factor of kidney allograft function decline.