Chewing the fat over statins: Consumer concerns about lipid-lowering medication.

BACKGROUND: The objective of this article was to explore the information needs of consumers using statins. METHODS: Calls made to a national medicines call centre in Australia were analysed. Where question narratives were available electronically (n = 1486), the main concerns were identified using a coding scheme. Subsequently, we evaluated whether these concerns were addressed in the medication leaflet. RESULTS: The most common concerns were about side effects (36%) and interactions (28%). Concerns about side effects related to musculoskeletal (27%), gastrointestinal (12%) and skin problems (5%). Concerns about interactions included other medicines (49%), complementary and alternative medicines (CAMs; 39%) and grapefruit (6%). Additional questions related to differences between treatments (12%) and dosage (8%). Most topics were mentioned in the medication leaflet, but strategies to manage these concerns were lacking. DISCUSSION: When prescribing statins, information about common side effects, when symptoms require action, and interactions with other medicines, especially CAMs, should be addressed and tailored to the patient.

Your questions about complementary medicines answered: gingko biloba.

This is the fourth article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

Your questions about complementary medicines answered.

This is the first article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

Your questions about complementary medicines answered: glucosamine.

This is the second article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

Your questions about complementary medicines answered: fish oil.

This is the third article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds.

BACKGROUND: Australia is a culturally diverse nation with one in seven Australians born in a non-English speaking country. Culturally and Linguistically Diverse (CALD) populations are at a high risk of developing preventable chronic diseases such as cardiovascular disease, type 2 diabetes mellitus, renal disease, and chronic respiratory disease, especially communities from the Pacific Islands, the Middle East, North Africa, the Indian subcontinent and China. Previous studies have shown that access to services may be a contributing factor. This study explores the experiences, attitudes and opinions of immigrants from different cultural and linguistic backgrounds and their health care providers with regard to chronic disease care. METHODS: Five focus groups were conducted comprising participants from an Arabic speaking background, or born in Sudan, China, Vietnam or Tonga. A total of 50 members participated. All focus groups were conducted in the participants' language and facilitated by a trained multicultural health worker. In addition, 14 health care providers were interviewed by telephone. Interviews were digitally recorded and transcribed. All qualitative data were analysed with the assistance of QSR NVivo 8 software. RESULTS: Participants were generally positive about the quality and accessibility of health services, but the costs of health care and waiting times to receive treatment presented significant barriers. They expressed a need for greater access to interpreters and culturally appropriate communication and education. They mentioned experiencing racism and discriminatory practices. Health professionals recommended recruiting health workers from CALD communities to assist them to adequately elicit and address the needs of patients from CALD backgrounds. CONCLUSIONS: CALD patients, carers and community members as well as health professionals all highlighted the need for establishing culturally tailored programs for chronic disease prevention and management in CALD populations. Better health care can be achieved by ensuring that further investment in culturally specific programs and workforce development is in line with the number of CALD communities and their needs.

Multifocal pupillographic visual field testing in glaucoma.

PURPOSE: This preliminary study investigated a means of concurrently assessing the visual field defects of both eyes by recording pupillary responses to multifocal stimuli. METHODS: Twenty normal subjects and 26 primary open angle glaucoma patients, age and sex matched, were examined by slit-lamp, Humphrey Field Analyser II achromatic 24-2 perimetry and fundus photography. The patients had moderate to severe fields in at least one eye. Two stereoscopically arranged displays presented an array of 24 stimulus regions per eye extending from fixation to 30 degrees eccentricity. Pupil responses were recorded by video cameras under infrared illumination. Four stimulus conditions were tested: each stimulus region containing either a single or a 2 x 2 array of patches, presented either steadily for 133 ms or flickered at 15 Hz for 266 ms. Mean presentation rate was 1/s/region. The 4-min duration stimuli were presented in 8 segments of 30 s. Segments did not need to be repeated unless more than 15% of a segment record was lost as a result of blinks or fixation losses. RESULTS: The 48 stimuli produced 96 direct and consensual responses per subject. The single patch, non-flickered stimulus condition produced the best diagnostic performance, an area under the curve of 84%. The contraction amplitudes for that stimulus gave a median z-score of 3.2. CONCLUSIONS: The method produced diagnostic accuracy approaching that of automated perimetry, but unlike perimetry provides standard errors for every point in each field as well as information on response delay and efferent defects. Only one pupil needs to function to measure both visual fields.

Stimulus parameters for multifocal pupillographic objective perimetry.

PURPOSE: We compared the diagnostic power of 10 stimulus variants that assessed the visual fields of both eyes by recording pupillary responses to multifocal stimuli. The 10 variants comprised 6 initial tests, and 4 subsequent variants whose design was informed by the initial results. METHODS: Two study groups containing 16 normal and 22 primary open angle glaucoma subjects, and 15 normal and 20 primary open angle glaucoma subjects had their diagnostic status verified by a slit-lamp investigation, applanation tonometry, 3 forms of perimetry, and Stratus OCT. Stereoscopically arranged displays presented multifocal stimulus arrays having 24 stimulus regions/eye within the central 60 degrees. Pupil responses were recorded by video cameras under infrared illumination. The 10 stimulus conditions varied in presentation rate, duration, stimulus luminance, and flicker rate. Stimuli were 4 minutes in duration, presented in 8 segments of 30 seconds. Up to 15% of the data of a segment could be lost owing to blinks and fixation losses without repeating the segment. RESULTS: Each recording gave 96 direct and consensual responses/subject. The best performing stimulus method gave a sensitivity of 1.0 ± 0.0 (mean ± SE) for moderate and severe glaucomatous fields combined at a false positive rate of 0.05. Median signal to noise ratios for peak response amplitude expressed as t-statistics exceeded 4 for several variants. CONCLUSIONS: Stimulus delivery rates of about 1 presentation/region/s and test luminance around 150 cd/m performed best diagnostically. Unlike automated perimetry, the mfPOP method provides information on response delays and afferent and efferent defects at each region of the visual field.

Low-spatial-frequency channels and the spatial frequency-doubling illusion.

PURPOSE: This study examined the number and nature of spatiotemporal channels in the region where the frequency-doubling (FD) illusion would be expected to occur at eight locations spanning the central 30 degrees of the visual field. METHODS: The probability of seeing the FD illusion was examined in 17 subjects. Stimuli were presented at 5 octaves of low spatial frequencies, at each of seven flicker frequencies in the range 5.65 to 27.95 Hz. In a single trial, subjects matched the apparent spatial frequency of the flickering test pattern using a two-alternative, forced-choice method. Thirteen subjects were examined for stimuli presented at contrast 0.95. Three or four subjects were examined at each of the contrasts 0.2, 0.4, and 0.8. A factor analysis was conducted on the psychometric functions, quantifying the number and possible spatiotemporal tuning of neural channels present. RESULTS: At contrast 0.95, three factors were able to explain 79.3% of the total variance in the psychometric responses to the 35 test conditions. This simple form of three broad spatiotemporal channels was also found at the other contrasts and in different subjects. The factor scores showed differential distribution of the factors onto the eight different visual field locations. Thus the expression of the three channels differed somewhat across the visual field. CONCLUSIONS: The results support earlier reports, that there are several low-spatial-frequency channels below 1 cyc/deg in the periphery. The results may have implications for the FDT and matrix perimeters.