[Pharmacotherapeutics for Older Adults].

Older adults are likely to develop adverse drug events owing to age-related changes in pharmacokinetics and polypharmacy. In terms of pharmacokinetics, the drug should be prescribed at a reduced dose, which should be reconsidered and reduced during long-term use. For polypharmacy, "List of drugs to be prescribed with special caution" should be referred and deprescription should be practiced in consideration of the priority of treatment. Because older adults often show reduced ability to manage their medication due to cognitive dysfunction, low visual acuity, and hearing loss, measures should be taken to maintain their adherence.

Prevalence of Mental Ill-Health among Visually Impaired Patients in a Tertiary Institution in Southwestern Nigeria.

BACKGROUND: To study the mental health status of patients with visual impairment in a tertiary institution in Southwestern Nigeria. OBJECTIVES: To determine the mental health status of individuals with loss of vision in Ogbomoso and associated factors. METHODOLOGY: A descriptive cross-sectional study. Questionnaires were administered to obtain information on the socio-demographic characteristics and mental health status. Test for association was done. A total score greater than or equal to 4 out of the 28 items of the General Health Questionnaire was considered a case of mental ill-health. RESULTS: 250 subjects were studied, out of which 126 (50%) were found to have mental ill-health. Statistically significant association was found between age, level of education, occupation, duration of loss of vision, and pattern of loss of vision (p-values < 0.001, 0.020, 0.001, and 0.001 respectively) in bivariate analysis, however, age and pattern of vision loss were not significantly associated with loss of vision in multivariate analysis. Those who lost their vision less than two years from the time of the study had a higher risk of mental health morbidity. Those with sudden vision loss were 3.48 times more likely to have mental health morbidity in bivariate analysis, compared with those with progressive visual loss. CONCLUSION: The prevalence of mental ill-health among people with vision loss is high. Associated factors included level of education, occupation and duration of loss of vision. Predictors of good mental health included younger age group, higher level of education, being employed, longer duration of loss of vision and progressive pattern of vision loss.

CONTEXTE: Étudier l'état de santé mentale des patients atteints de déficience visuelle dans un établissement tertiaire du sud-ouest du Nigeria. OBJECTIFS: Déterminer l'état de santé mentale des personnes souffrant d'une perte de vision à Ogbomoso et les facteurs associés. MÉTHODOLOGIE: Étude descriptive transversale. Des questionnaires ont été administrés pour obtenir des informations sur les caractéristiques sociodémographiques et l'état de santé mentale. Un test d'association a été effectué. Un score total supérieur ou égal à 4 sur les 28 items du General Health Questionnaire a été considéré comme un cas de mauvaise santé mentale. RÉSULTATS: 250 sujets ont été étudiés, dont 126 (50 %) présentaient une mauvaise santé mentale. Une association statistiquement significative a été trouvée entre l'âge, le niveau d'éducation, la profession, la durée de la perte de vision et le type de perte de vision (valeurs p < 0,001, 0,020, 0,001 et 0,001 respectivement) dans l'analyse bivariée, cependant, l'âge et le type de perte de vision n'étaient pas significativement associés à la perte de vision dans l'analyse multivariée. Les personnes ayant perdu la vue moins de deux ans après le début de l'étude présentaient un risque plus élevé de morbidité mentale. Les personnes ayant subi une perte soudaine de la vue étaient 3,48 fois plus susceptibles de souffrir de morbidité mentale dans l'analyse bivariée, par rapport à celles ayant subi une perte progressive de la vue. CONCLUSION: La prévalence de la mauvaise santé mentale chez les personnes souffrant d'une perte de vision est élevée. Les facteurs associés sont le niveau d'éducation, la profession et la durée de la perte de vision. Les facteurs prédictifs d'une bonne santé mentale sont le groupe d'âge le plus jeune, le niveau d'éducation le plus élevé, le fait d'avoir un emploi, la durée la plus longue de la perte de vision et le modèle progressif de la perte de vision. Mots-clés: Déficience visuelle, Mauvaise santé mentale.

A tactile pain evaluation scale for persons with visual deficiencies.

OBJECTIVE: Pain evaluation scales often rely on the sense of sight. There is so far no pain assessment scale designed specifically for persons with visual impairment. DESIGN: This study aims to validate a tactile pain evaluation scale, Visiodol (Copyright Prof Pickering), in blind or visually impaired persons, by correlation with a numeric pain scale. SETTING: The study took place at University Hospital Clermont-Ferrand, France. METHODS: Pain intensity for a range of thermal stimuli (Pathway Medoc) was evaluated with Visiodol and a numeric pain scale. Secondary outcomes, including pain thresholds, catastrophizing, emotion, and quality of life, were compared in persons who were blind or visually impaired and in sighted persons. Lin's concordance correlation coefficient was estimated. Weighted Cohen's κ accounted for degrees of disagreement between scales with 95% confidence intervals (95% CI). SUBJECTS: Sixteen healthy sighted and 21 healthy nonsighted volunteers (n = 13 congenital, n = 8 acquired) were included. RESULTS: Lin's correlation coefficient for repeated data was 0.967 (95% CI, 0.956-0.978; P < 0.001) for visually impaired participants, with a good agreement at each temperature plateau. A weighted Cohen's κ of 0.90 (95% CI, 0.84-0.92) and 92.9% percentage of agreement for visually impaired participants were satisfactory. Pain perception, psychological components, and quality of life were more impaired in persons who were blind or visually impaired than in sighted persons. CONCLUSIONS: This study validates Visiodol, a tactile scale for persons who are blind or visually impaired, and addresses health care inequalities in the context of pain evaluation. Visiodol will now be tested in a larger population of patients to give the millions of persons worldwide who are blind or visually impaired an option for pain intensity evaluation in clinical situations. TRIAL REGISTRATION: French National Agency for the Safety of Medicines and Healthcare Products (2018-A03370-55) and www.ClinicalTrials.gov (NCT03968991).

Emotion regulation in blind and visually impaired children aged 3 to 12 years assessed by a parental questionnaire.

Emotion regulation develops from the earliest years of a child's life and mostly through visual information. Considering the importance of emotion regulation in daily life situations, it is important to study the effect of visual experience on the development of this ability. This study is the first to examine the effect of visual experience and age in emotion regulation by comparing groups of children with different visual status and age. For this purpose, after testing the reliability and consistency of the French version of Emotion Regulation Checklist (ERC-vf) with 245 parents of blind, visually impaired and sighted children aged 3-5, 6-8 or 9-12 years, we conducted analyses on the effect of visual status and age on emotion regulation composite scores. The first result confirmed that the ERC-vf can be reliably used on populations of blind and visually impaired children. The second result revealed an effect of visual status on ER composite scores of emotion regulation: Blind children and visually impaired children each had significantly lower composite scores than sighted children. Moreover, the effect of age and the interaction between age and visual status were not significant on ER composite scores. The ER subscale results suggest, however, that age may have a variable effect for blind and visually impaired children as blind children's scores become lower and those of visually impaired children become equal to sighted children with age. The results of our study may help the children's entourage to better adapt their interactions in a context of visual impairment.

Applying height differentiation of tactile symbols to reduce the minimum horizontal distances between them on tactile maps.

In this paper, we wanted to verify the hypothesis that extruding cartographic symbols on tactile maps to different heights might allow reducing the minimum (suggested in the literature) horizontal distances between them, without impacting the overall map's legibility. This approach might allow preparing tactile maps in smaller scales and thus, reducing production cost, or putting additional spatial information on the same map sheet that would not fit otherwise. To verify the hypothesis we have prepared 6 different stimuli variants with or without height differentiation applied and different horizontal distances between tactile symbols adopted (1 mm, 2 mm and 3 mm). In the controlled study sessions with 30 participants with visual impairments we have measured the times required for solving 3 different spatial tasks on 3D printed tactile stimuli. We have also performed qualitative analysis to learn participants' opinions about the proposed design and materials used. It turns out that applying height differentiation not only results in shorter times required for solving spatial tasks but is also considered by blind individuals as a convenient improvement in terms of use comfort and allows reduction of recommended minimum horizontal distances between symbols on tactile maps.

General self-efficacy in individuals with visual impairment compared with the general population.

BACKGROUND: Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction. METHODS: A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril's Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females). RESULTS: People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population. CONCLUSIONS: People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life.

Human click-based echolocation: Effects of blindness and age, and real-life implications in a 10-week training program.

Understanding the factors that determine if a person can successfully learn a novel sensory skill is essential for understanding how the brain adapts to change, and for providing rehabilitative support for people with sensory loss. We report a training study investigating the effects of blindness and age on the learning of a complex auditory skill: click-based echolocation. Blind and sighted participants of various ages (21-79 yrs; median blind: 45 yrs; median sighted: 26 yrs) trained in 20 sessions over the course of 10 weeks in various practical and virtual navigation tasks. Blind participants also took part in a 3-month follow up survey assessing the effects of the training on their daily life. We found that both sighted and blind people improved considerably on all measures, and in some cases performed comparatively to expert echolocators at the end of training. Somewhat surprisingly, sighted people performed better than those who were blind in some cases, although our analyses suggest that this might be better explained by the younger age (or superior binaural hearing) of the sighted group. Importantly, however, neither age nor blindness was a limiting factor in participants' rate of learning (i.e. their difference in performance from the first to the final session) or in their ability to apply their echolocation skills to novel, untrained tasks. Furthermore, in the follow up survey, all participants who were blind reported improved mobility, and 83% reported better independence and wellbeing. Overall, our results suggest that the ability to learn click-based echolocation is not strongly limited by age or level of vision. This has positive implications for the rehabilitation of people with vision loss or in the early stages of progressive vision loss.

Influence of swimming on sleep and quality of life of people with visual impairments / Influencia de la práctica de natación en el sueño y en la calidad de vida de personas con discapacidad visual / Influência da prática de natação no sono e na qualidade de vida de pessoas com deficiência visual

ABSTRACT Introduction: Physical exercise can bring important benefits in the areas of physical and psychological health and behavioral aspects. However, there have been few studies that link physical exercise and sleep in people with disabilities. Objective: This study aims to analyze the benefits promoted by swimming in the health and quality of sleep of visually impaired people of different levels of physical fitness. Methods: Thirty male volunteers, visually impaired, aged 16-60 years, took part in the study. The volunteers were divided into three groups: irregularly active (G1), swimming twice a week (G2), and swimming five times a week (G3). Questionnaires related to sleep pattern (Pittsburgh), sleepiness (Epworth), chronotype (Horne and Östberg) and quality of life (SF-36) were applied. Results: The main results showed that G3 presented better quality of sleep, as well as more effective sleep, compared to the other two groups. In addition, G1 showed poorer scores for quality of life compared to G3 in the domains general health, vitality, and social aspect. Conclusion: We suggest that more frequent physical activity (swimming) has a positive effect on quality of sleep and quality of life of people with visual impairments. Level of evidence III, case control study .

RESUMEN Introducción: La práctica del ejercicio físico puede traer beneficios importantes en el ámbito físico, psicológico y comportamental. Sin embargo, la literatura es escasa al relacionar ejercicio físico y sueño en las personas con discapacidad. Objetivo: Este estudio tuvo como objetivo analizar los beneficios que la natación promueve en la salud y en la calidad del sueño de discapacitados visuales con diferentes niveles de aptitud física. Métodos: Participaron en la investigación 30 voluntarios del sexo masculino, discapacitados visuales, con edad entre 16 y 60 años, divididos en tres grupos, a saber, irregularmente activos (G1), practicantes de natación 2 veces por semana (G2) y practicantes de natación 5 veces por semana (G3). Fueron aplicados los cuestionarios relacionados con el patrón de sueño (Pittsburgh), somnolencia (Epworth), cronotipo (Horne y Östberg) y calidad de vida (SF-36). Resultados: Los principales resultados mostraron que G3 presentó mejor calidad de sueño, bien como mayor eficiencia del sueño con relación a los otros dos grupos. Además, G1 demostró peores puntajes para calidad de vida con relación a G3 en los dominios estado general de salud, vitalidad y aspecto social. Conclusión: De esa forma, podemos sugerir que la frecuencia mayor en la práctica de actividad física (natación) actuó positivamente sobre la calidad del sueño y la calidad de vida de las personas con discapacidad visual. Nivel de evidencia III; Estudio de caso control .

RESUMO Introdução: A prática do exercício físico pode trazer benefícios importantes no âmbito físico, psicológico e comportamental. No entanto, a literatura é escassa ao relacionar exercício físico e sono nas pessoas com deficiência. Objetivo: Este estudo teve como objetivo analisar os benefícios que a natação promove na saúde e na qualidade do sono de deficientes visuais com diferentes níveis de aptidão física. Métodos: Participaram da pesquisa 30 voluntários do sexo masculino, deficientes visuais, com idade entre 16 e 60 anos distribuídos em três grupos, a saber, irregularmente ativos (G1), praticantes de natação 2 vezes por semana (G2); e praticantes de natação 5 vezes na semana (G3). Foram aplicados os questionários relacionados ao padrão de sono (Pittsburgh), sonolência (Epworth), cronotipo (Horne e Östberg) e qualidade de vida (SF-36). Resultados: Os principais resultados mostraram que o G3 apresentou melhor qualidade de sono, bem como maior eficiência do sono com relação aos outros dois grupos. Além disso, o G1 demonstrou piores escores para qualidade de vida com relação ao G3 nos domínios estado geral de saúde, vitalidade e aspecto social. Conclusão: Dessa forma, podemos sugerir que a frequência maior na prática da atividade física (natação) atuou positivamente sobre a qualidade do sono e a qualidade de vida de pessoas com deficiência visual. Nível de evidência III, Estudo de caso controle .

Arts activity and well-being for visually impaired military veterans: a narrative discussion of current knowledge.

OBJECTIVES: The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans. STUDY DESIGN: A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge. RESULTS: While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans. CONCLUSIONS: Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.

Caring for Older Adults With Self-Reported Vision Impairment: Findings from the National Study of Caregiving.

PURPOSE: The purpose of this study was to examine caregiving relationships for older adults with vision impairment (VI). DESIGN: Cross-sectional study with a nationally representative sample. METHODS: Setting: the National Health and Aging Trends Study linked to the National Study of Caregiving, Year 2011. STUDY POPULATION: 1,776 family or unpaid caregivers to community-dwelling Medicare beneficiaries age ≥65 years old. OUTCOME MEASUREMENT: in the preceding month, 1) the number of hours of care provided; 2) the valued activities affected by caregiving; and 3) the odds of experiencing substantial emotional, financial, and physical difficulty related to providing care. EXPOSURE: VI was defined as a report of blindness or difficulty with distance or near vision. RESULTS: Among 1,776 caregivers, 428 caregivers spent an average ± standard error (SE) of 111 ± 9.1 hours per month assisting older adults with VI, whereas 1,348 spent an average of 72 ± 3.3 hours assisting older adults without VI. In fully adjusted negative binomial regression analyses, caregivers of older adults with VI spent 36% more hours (incident rate ratio [IRR]: 1.36; 95% confidence interval [CI]: 1.15-1.60) providing care and reported having 61% more valued activities affected (IRR: 1.61; 95% CI: 1.23-2.10) than caregivers of older adults without VI. In fully adjusted logistic regression analyses, caregivers of older adults with VI had greater odds of emotional (odds ratio [OR]: 1.46; 95% CI: 1.04-2.03) but not financial (OR: 1.33; 95% CI: 0.87-2.03) or physical (OR: 1.13; 95% CI: 0.74-1.74) difficulty related to providing care than caregivers of older adults without VI. CONCLUSIONS: These results suggest that caring for older adults with VI places different demands on time and emotional wellbeing than caring for older adults without VI, but no differences in financial or physical difficulties.

[Diabetes Self-Management Experience of Patients with Diabetes: Focused on the Visually Impaired].

PURPOSE: This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes. METHODS: Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. RESULTS: Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly. CONCLUSION: It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.

What do blind people "see" with retinal prostheses? Observations and qualitative reports of epiretinal implant users.

INTRODUCTION: Retinal implants have now been approved and commercially available for certain clinical populations for over 5 years, with hundreds of individuals implanted, scores of them closely followed in research trials. Despite these numbers, however, few data are available that would help us answer basic questions regarding the nature and outcomes of artificial vision: what do recipients see when the device is turned on for the first time, and how does that change over time? METHODS: Semi-structured interviews and observations were undertaken at two sites in France and the UK with 16 recipients who had received either the Argus II or IRIS II devices. Data were collected at various time points in the process that implant recipients went through in receiving and learning to use the device, including initial evaluation, implantation, initial activation and systems fitting, re-education and finally post-education. These data were supplemented with data from interviews conducted with vision rehabilitation specialists at the clinical sites and clinical researchers at the device manufacturers (Second Sight and Pixium Vision). Observational and interview data were transcribed, coded and analyzed using an approach guided by Interpretative Phenomenological Analysis (IPA). RESULTS: Implant recipients described the perceptual experience produced by their epiretinal implants as fundamentally, qualitatively different than natural vision. All used terms that invoked electrical stimuli to describe the appearance of their percepts, yet the characteristics used to describe the percepts varied significantly between recipients. Artificial vision for these recipients was a highly specific, learned skill-set that combined particular bodily techniques, associative learning and deductive reasoning in order to build a "lexicon of flashes"-a distinct perceptual vocabulary that they then used to decompose, recompose and interpret their surroundings. The percept did not transform over time; rather, the recipient became better at interpreting the signals they received, using cognitive techniques. The process of using the device never ceased to be cognitively fatiguing, and did not come without risk or cost to the recipient. In exchange, recipients received hope and purpose through participation, as well as a new kind of sensory signal that may not have afforded practical or functional use in daily life but, for some, provided a kind of "contemplative perception" that recipients tailored to individualized activities. CONCLUSION: Attending to the qualitative reports of implant recipients regarding the experience of artificial vision provides valuable information not captured by extant clinical outcome measures.

Associations between adult attachment and vision-related quality of life in visually impaired individuals.

PURPOSE: An attachment theory framework approach may allow insight into how social and psychosocial factors interact to impact vision-related quality of life (QoL). In this pilot study, we investigated potential associations between adult attachment style and visual function QoL of visually impaired individuals. METHODS: We recruited 38 visually impaired individuals (15 females, 23 males; 51.8 ± 16.0 years). Visual function measures included distance and near visual acuity (VA) and contrast sensitivity. All participants completed: the 25-item National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ 25) and the Experiences in Close Relationships-Relationships Structures questionnaire. RESULTS: Presenting conditions included inherited retinal dystrophy (n = 10), nystagmus (n = 9), glaucoma (n = 7) and other eye conditions (n = 12). There was a statistically significant negative correlation between the NEI-VFQ-25 composite score (45.5 ± 14.7) and attachment-related anxiety (r = -0.352, p = 0.033). The latter correlation still held when controlling for participants' level of vision (r = -0.352, p = 0.035). Despite the range of conditions and wide age range, these were not significantly correlated with any variable of interest in the current study. CONCLUSION: Attachment-related anxiety ought to be taken into account when managing a visually impaired individual. Attachment-based approaches could be used to improve access to support services for visually impaired individuals, as well as self-management of their condition.

Distance support and online intervention to blind and visually impaired children during the pandemic COVID-19.

The COVID-19 pandemic imposed dramatic changes to everyone's daily routines, but especially to children with developmental disabilities. The Robert Hollman Foundation decided not to interrupt its service to all the visually impaired children and initiated a Distance Support Project. It was an online process covering all aspects of support for the children and involving audio-video calls, videos and tailored-made multisensory material created specifically for each child. A questionnaire, carried out after the 5-month project duration, was created to collect feedback from parents and professionals to understand the impact this project had on everyone involved. Overall both parents and professionals indicated high levels of satisfaction, but in a significant number of questions parents reported consistently higher levels of satisfaction (p-value <0.001). It was shown that parents felt reassured at this otherwise very difficult time because their children were able to continue their treatment, even if in a very different way. This fact encourages us to consider enriching our existing programmes of support and care, integrating this online approach when necessary. At the same time, it seems clear that the responses of the professionals indicate their belief that the benefits of the traditional ways of working remain of unquestionable importance for children with sight deprivation.

Enhanced Odorant Localization Abilities in Congenitally Blind but not in Late-Blind Individuals.

Although often considered a nondominant sense for spatial perception, chemosensory perception can be used to localize the source of an event and potentially help us navigate through our environment. Would blind people who lack the dominant spatial sense-vision-develop enhanced spatial chemosensation or suffer from the lack of visual calibration on spatial chemosensory perception? To investigate this question, we tested odorant localization abilities across nostrils in blind people compared to sighted controls and if the time of vision loss onset modulates those abilities. We observed that congenitally blind individuals (10 subjects) outperformed sighted (20 subjects) and late-blind subjects (10 subjects) in a birhinal localization task using mixed olfactory-trigeminal stimuli. This advantage in congenitally blind people was selective to olfactory localization but not observed for odorant detection or identification. We, therefore, showed that congenital blindness but not blindness acquired late in life is linked to enhanced localization of chemosensory stimuli across nostrils, most probably of the trigeminal component. In addition to previous studies highlighting enhanced localization abilities in auditory and tactile modalities, our current results extend such enhanced abilities to chemosensory localization.

Feasibility of using patient-reported outcome measures with visually impaired children/young people attending paediatric ophthalmology clinics.

OBJECTIVE: To explore feasibility of using child/young person patient-reported outcome measures (PROMs) routinely in practice, using vision-specific instruments and paediatric ophthalmology as the exemplar. METHODS: Participants comprised patients aged 8-17 years, with visual impairment or low vision (visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.3 in the better eye), attending the Department of Ophthalmology at Great Ormond Street Hospital, London, UK. All participants completed age-appropriate PROMs before attending their outpatient appointment. Half were randomly assigned to completion at home, with the choice of paper-and-pencil or electronic format. The other half were invited to complete PROMs during their hospital appointment, and randomly assigned to completion format. All participants completed a face-to-face survey exploring their attitudes and preferences. Analysis comprised survival analysis, and direct comparisons of proportions, with complementary qualitative data analysis. RESULTS: 93 patients participated. 48 (98%) completing PROMs at home chose the paper-and-pencil format. Completion at home took longer than at hospital (median=20, vs 14 min, p<0.001). Visual acuity was associated with completion time (p=0.007) and missing data (p=0.03). Overall, 52 (60%) reported a preference for completion at home but there was no clear preference for format (37 (43%) preferred either format). CONCLUSION: PROM completion at home ahead of hospital appointments may be preferable for collecting complete, high-quality datasets. Despite equipoise on preference for format, the majority of those completing at home chose the traditional paper-and-pencil format, despite impaired sight. These findings should inform implementation of child/young person PROMs into routine practice.

Sensory impairment and all-cause mortality among the elderly adults in China: a population-based cohort study.

With age-related functional deterioration, sensory impairment including vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) usually occurred among the elderly population, causing a decrease in functional capacity and quality of life. The study aimed to explore how sensory impairment is associated with the risk of all-cause mortality among the elderly adults in China. We prospectively investigated the association among 37,076 participants enrolled from 1998 to 2019 in the Chinese Longitudinal Healthy Longevity Survey. We also, as a sensitivity analysis, explored the association among 11,365 newly incident sensory impairment participants. Cox regression model with sensory impairment as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with participants without sensory impairment, those with VI (HR=1.20, 95% CI: 1.15-1.24), HI (HR=1.26, 95% CI: 1.21-1.31), and DSI (HR: 1.46, 95% CI=1.41-1.52) had significant higher risk of all-cause mortality after adjusting for potential confounders. These associations were robust among subgroup analyses stratified by sex and entry age, and sensitivity analyses performed among newly incident sensory impairment participants. In conclusion, sensory impairment was associated with higher mortality risk among the elderly adults in China.

Impact of rational emotive behavioral therapy on personal value system of students with visual impairment: A group randomized control study.

BACKGROUND: Visually impaired students have been reported to struggle with value system and rash decision making process. This study examined the impact of rational emotive behavioral therapy (REBT) in reducing negative personal value system of visually impaired people. METHOD: A group-randomized trial design was adopted using 56 students with visual impairment. The participants received a value-based rational emotive behavior progamme and were assessed at 3 points using PVS and ABS-2-AV. RESULTS: The result of analysis of covariance showed that there was no significant difference between the treatment and control groups in initial personal value in Nigerian as measured by PVS. At the post-treatment the effect of V-REBP was significant in personal value and follow-up assessment respectively in favour of treatment group. CONCLUSION: We concluded that there is significant impact of rational emotive behavioral therapy on reduction of negative personal value system of students with visual impairment.

Dual Sensory Impairment and Perceived Everyday Discrimination in the United States.

Importance: Perceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality. Objective: To assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination. Design, Setting, and Participants: Cross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019. Exposures: Participants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI. Main Outcomes and Measures: Perceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis). Results: The sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (ß [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (ß = 0.07; 95% CI, 0.02-0.11), and DSI (ß = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone. Conclusions and Relevance: Older adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.