Exposing the disability-related hidden curriculum in case-based learning: A qualitative study.

BACKGROUND: People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting. OBJECTIVE: Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism. METHODS: The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model. RESULTS: Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability. CONCLUSION: By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.

Sex hormones and the dry eye.

The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. This review aims to present evidence for how sex hormones may affect the ocular structures involved in the production, regulation and maintenance of the normal tear film. It is hypothesised that hormone changes alter the homeostasis of the ocular surface and contribute to dry eye. Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye. In contrast, reports of the effects of oestrogen and progesterone on these ocular structures and on the conjunctiva are contradictory and the mechanisms of action of these female-specific sex hormones in the eye are not well understood. The uncertainty of the effects of oestrogen and progesterone on dry eye symptoms is reflected in the controversial relationship between hormone replacement therapy and the signs and symptoms of dry eye. Current understanding of sex hormone influences on the immune system suggests that oestrogen may modulate a cascade of inflammatory events, which underlie dry eye.

Do not forget the oldest old: design principles for the 80+.

A significant amount of research has been conducted regarding the design of Internet applications for the elderly. Concomitantly, researchers have been applying online technologies to healthcare for older adults. The oldest old (for our purposes, defined as older adults aged 80+) are increasingly adopting the use of the Internet and likely have different needs than those who are between 55 and 80 years old. The main results from a literature review on the existing research in human factors and design for older adults is presented. These results highlight the need for more research in human factors and design in the much neglected population group, the oldest old.

What are the visual benefits of eyelid squinting?

PURPOSE: We propose that eyelid squint can reduce the impact of several conditions known to cause eyestrain such as uncorrected refractive error, accommodative dysfunction, presbyopia, and glare. Clinicians commonly accept that squint improves visual acuity (VA) in the presence of refractive error, and even though the benefit of eyelid squint in bright light seems self-evident, data are not available to support either benefit. The purpose of this study was to measure the effect of eyelid squint on VA in the presence of refractive blur and on visual field sensitivity. METHODS: Nineteen subjects with optimal refractive correction were tested, with and without squinting, as follows: (1) distance VA with induced refractive errors of +0.50, +1.00, +2.00, +3.00, +1.00 -1.00 x 90, and +1.00 -1.00 x 180; (2) near VA with induced refractive errors of -1.00 x 90 and -1.00 x 180; and (3) central and peripheral threshold visual fields with a Humphrey Field Analyzer. Differences in visual acuity between squinting and nonsquinting were tested for significance with repeated-measures analysis of variance, and differences in visual fields were tested using mixed model analysis of variance with repeated measures. RESULTS: Eyelid squint significantly improved (p < 00.016) distance VA measurements for 1.00 to 3.00 D of induced myopia. The squint-induced VA improvement increased from 0.06 logarithm of the minimum angle of resolution for 1.00 D to 0.24 logarithm of the minimum angle of resolution for 3.00 D of myopia. Eyelid squint also significantly reduced visual field sensitivity below the horizontal meridian by an average of 1.4 dB, by 1.6 dB on the horizontal meridian, and with increasing reductions in the vertical field up to 11.6 dB for measurements 40 degrees above fixation. This pattern of decreased superior field sensitivity would decrease visual discomfort from overhead glare. CONCLUSIONS: The results provide empirical support that eyelid squint improves visual acuity for subjects with refractive error and reduces glare in the superior visual field.