The contribution of social cognition in predicting social participation following moderate and severe TBI in youth.

Youth with moderate or severe traumatic brain injury (TBI) are at risk for reduced social participation after the injury, and the contribution of social cognition to these changes in functioning has been little studied. This study aimed to examine social participation and to measure the contribution of social and non-social cognitive functions to social participation impairment in youth (ages 12-21) who sustained moderate or severe TBI. Youth with TBI (n = 23) were compared to typically developing (TD) controls on self- and parent-rated social participation questionnaires. Direct testing of social cognition (mentalising, social knowledge, emotion recognition) and higher order cognitive abilities (intellectual abilities, attention and executive functions) was also conducted. Significant differences were found between the TBI participants and TD controls on social participation measures. Mentalising and problem-solving abilities revealed to be significant correlates of social participation as reported by youth with brain-injury and their parents. Overall, these results corroborate previous findings by showing that social participation is significantly reduced after TBI, and further shows that mentalising, which is not always considered during rehabilitation, is an important contributing factor. In addition to executive function measures, social cognition should therefore be systematically included in assessment following youth TBI for intervention and prevention purposes.

Adapting the World Federation for Medical Education standards for use in a self-audit of an eye care training programme.

INTRODUCTION: In 2006, a Postgraduate Diploma in Eye Care (PGDEC) for mid-level health personnel was initiated in Papua New Guinea, in partnership with The Fred Hollows Foundation New Zealand, the local government and Divine Word University. In the absence of national accreditation and with limited resources, an interim evaluation was needed. METHODS: We adapted the World Federation for Medical Education (WFME) standards to use in a self-audit to evaluate nine areas and 38 subareas of programme structure, processes and implementation. We developed a rating system: each area and subarea was scored for partial or complete attainment of basic or quality development levels. Ratings were referenced with supporting documents. Data were gathered internally, through document census and meetings between stakeholders. FINDINGS: A qualitative and quantitative portrait emerged: all nine programme areas completely attained at least basic level and two completely attained the quality development level. Twenty-six (68%) subareas completely attained the quality development level. Key successes included the administration of the PGDEC, synergies between the partnership's stakeholders and its relationship with the public health system. DISCUSSION AND CONCLUSIONS: This self-audit adapted from WFME standards provided a simple, yet systematic and largely objective evaluation. It proved beneficial to further develop the programme, highlighting strengths and areas for improvement.

Facilitating the quality of care in a specialist Pacific ophthalmic nursing workforce.

BACKGROUND: Sufficient, appropriately trained health personnel need to be retained in the workforce, and their performance maintained, to achieve quality care. Mid-level ophthalmic personnel in Western Pacific Island Countries and Territories (WPICT) are no exception. AIM: The study aims to assess influences on the quality of care provided by specialist mid-level ophthalmic personnel in WPICT and devise strategies to train, retain and maintain performance of these personnel. METHODS: A situational assessment employed a checklist and semi-structured interviews with specialist mid-level ophthalmic personnel, nursing bodies and Ministry of Health representatives from seven WPICT. A selective literature review guided strategies to address the issues identified. RESULTS: Appropriate training allows nurses to fulfill a mid-level role in WPICT as specialist ophthalmic nurses. Resources generally do not restrict practice. Nursing structures have generally failed to support professionalism: scope and conditions of service, clinical supervision, career structures, professional recognition and opportunities for continuing professional development are rudimentary. Ophthalmic nurses were dissatisfied with the lack of specialty recognition, career progression and salary increase. Regional and local strategies tailored to each country have been devised to establish sustainable processes for support. CONCLUSION: Salary was a major cause of dissatisfaction. It should be addressed along with professional recognition and related processes. Without professional support, specialist and advanced cadres within nursing may cease to exist, nurses' performance may be affected or they may leave. Specialist ophthalmic nursing, recognized, situated within and properly supported by nursing structures can provide a model for specialist clinical care for other specialties and in other countries.

[Visual Impairment and Eye Diseases in St. Louis, Senegal]. / Déficience Visuelle et Pathologies Oculaires À Saint-Louis, Sénégal.

Background: Few epidemiological data describe the prevalence of blindness and visual impairment in Senegal. Data from West African studies estimate blindness prevalence between 1.2 - 3.4% and that of visual impairment between 10.4 - 17.1%. IRIS Mundial (IM) is a non-governmental organization collaborating with l'Association St-Louisienne pour la Vue (ASV) to develop eye care in Senegal. Objective: Describe the relative importance of and causes of blindness and visual impairment in a population consulting for vision problems in the Senegalese region of St. Louis, to assist in planning of relevant eye care programs. Methods: Results from eye exams carried out by a team from IM in 2018 have been complied and analyzed. Results: In all, 1944 patients were examined (56.5% female). Some 25.7% of patients presented a visual impairment (22.5% moderate; 3.2% severe). Regarding refractive error, 15.3% of patients had myopia, 10.7% had hyperopia, 54.8% had astigmatism and 55.8% were presbyopic. Clinically significant cataracts is present in 17.4% of patients and glaucoma in 2.5%. Conclusion: Our data give a glimpse of the prevalence of visual impairment and ocular disease in St. Louis, Senegal. Uncorrected refractive error, cataracts and glaucoma are present in this population and may guide the planning of relevant eye care interventions.

Body fat distribution modulates insulin sensitivity in post-menopausal overweight and obese women: a MONET study.

OBJECTIVE: Central fat mass (CFM) correlates with insulin resistance and increases the risk of type 2 diabetes and cardiovascular complications. On the other hand, increased peripheral fat mass (PFM) is associated with higher insulin sensitivity. Thus, we examined the contribution of adipose tissue distribution, as assessed by the PFM/CFM ratio, to insulin sensitivity in overweight and obese postmenopausal women. DESIGN AND METHODS: A total of 124 nondiabetic overweight and obese postmenopausal women underwent an oral glucose tolerance test (OGTT) and a hyperinsulinemic/euglycemic (HI) clamp. Body composition was determined using computed tomography for visceral adipose tissue (VAT) and dual X-ray absorptiometry for fat mass, lean body mass and their respective proportions. Participants were divided by tertiles of the PFM/CFM ratio. RESULTS: Participants with preferential CFM (group 1) had higher fasting insulin levels and insulin area under the curve (AUC) during OGTT, as well as lower glucose infusion rates during the HI clamp, whether it was expressed per kg of body weight (M) or per kg of fat-free mass (Mm), compared with the other two groups. The PFM/CFM ratio also correlated significantly with fasting insulin (r=-0.32, P<0.001), the insulin AUC (r=-0.42 P<0.001), M (r=0.39 P<0.001) and Mm (r=0.37 P<0.001). Using hierarchical regression, we demonstrated that the PFM/CFM ratio was an independent predictor of insulin AUC, M and Mm and that its sequential addition to CFM and VAT improved significantly the predictive value of the model for insulin sensitivity for all variables except fasting insulin. CONCLUSION: The PFM/CFM ratio, which integrates the antagonistic effects of both central and peripheral depots on insulin sensitivity, added substantially to the prediction of insulin sensitivity over VAT and CFM alone.

Prevalence of eye disease and visual impairment in Île de la Gonave, Haïti.

Epidemiological data describing the prevalence of blindness and visual impairment in Haiti are sparse. The Haitian National Committee for the Prevention of Blindness (CNPC) estimates the prevalence of blindness at 1 %. Other regional data estimate moderate and severe visual impairment at 5% and 22%, respectively. IRIS Mundial (IM) is a non-governmental organization collaborating with the CNPC to develop eye care infrastructure in Haiti. To estimate the prevalence and causes of blindness and visual impairment on the Haitian island of Gonâve, to assist in planning of relevant eye care infrastructure. Results from eye exams carried out by a team from IM in January 2013 have been compiled and analyzed. In all, 1724 patients were examined (38% men, 62% women). In the best eye, 87% of patients had visual acuity, 6% had moderate visual impairment, and 7% had severe visual impairment. Moreover, 1% of patients had high myopia, 1% high hyperopia, 1% high astigmatism, and 32% were presbyopic. Clinically significant binocular cataracts were found in 1.5 % of patients, while 2 % were diagnosed with probable glaucoma. Our data give a glimpse of the prevalence of visual impairment and ocular disease on Gonâve Island in Haiti. Uncorrected refractive error, cataracts, and glaucoma are confirmed as prevalent conditions in this population and their presence should guide the planning of relevant eye care interventions.

Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry.

The Quebec Pain Registry (QPR) is a large research database of patients suffering from various chronic pain (CP) syndromes who were referred to one of five tertiary care centres in the province of Quebec (Canada). Patients were monitored using common demographics, identical clinical descriptors, and uniform validated outcomes. This paper describes the development, implementation, and research potential of the QPR. Between 2008 and 2013, 6902 patients were enrolled in the QPR, and data were collected prior to their first visit at the pain clinic and six months later. More than 90% of them (mean age ± SD: 52.76 ± 4.60, females: 59.1%) consented that their QPR data be used for research purposes. The results suggest that, compared to patients with serious chronic medical disorders, CP patients referred to tertiary care clinics are more severely impaired in multiple domains including emotional and physical functioning. The QPR is also a powerful and comprehensive tool for conducting research in a "real-world" context with 27 observational studies and satellite research projects which have been completed or are underway. It contains data on the clinical evolution of thousands of patients and provides the opportunity of answering important research questions on various aspects of CP (or specific pain syndromes) and its management.

The influence of body configuration on motor imagery of walking in younger and older adults.

Motor imagery (MI) refers to the mental simulation of a movement. It is used as a tool to improve motor function in several populations. In young adults, it has been repeatedly shown that MI of upper-limb movements is facilitated when one's posture is congruent with the movement to simulate. As MI training is notably used for improving locomotor-related activities in older populations, it may be questioned whether subjects' body configuration could also influence MI of walking movements and whether this influence is preserved with age. In the present study, we examined the impact of one's body position (congruent with walking: standing/incongruent with walking: sitting) on the duration of walking simulation over two distances (3m/6m), in 26 young (21 females, 5 males; mean: 23.2 ± 2.4 years) and 26 elderly (18 females, 8 males; mean: 72.7 ± 5.5 years) healthy subjects. It was found that, in both age groups, walking simulation times while standing were shorter than while sitting. Furthermore, walking simulation times in the standing position were closer to actual walking times to cover the same distances. The present findings extend to walking movements the notion that adopting a posture congruent with the movement to imagine facilitates the simulation process. They also suggest that, at least for simple walking tasks, this effect is maintained across the lifespan. The implication of our findings for optimizing MI training of locomotor-related activities is underlined.