Refractive associations with cataract: the Blue Mountains Eye Study.
(9/939)
PURPOSE: To assess the relationship between myopia and age-related cataract in a defined older population. METHODS: A cross-sectional study of 3654 people aged 49 to 97 years was conducted in the Blue Mountains near Sydney, Australia, from 1992 through 1994. General medical, eye, and refractive history and information about confounders were collected by questionnaire. Participants had a detailed determination of refraction, and the spherical equivalent refraction of each eye was calculated. The Wisconsin Cataract Grading System was used in masked grading of slit lamp and retroillumination lens photographs, to assess presence and severity of nuclear, cortical, and posterior subcapsular (PSC) cataract. Data from both eyes were analyzed by the generalized estimating equation method, adjusting for cataract risk factors. RESULTS: Included in the analysis were 7308 eyes. A history of wearing distance glasses, excluding eyes with current hyperopic refraction, was used as a proxy for myopia. Subjects who had worn distance glasses were more likely to have nuclear cataract (odds ratio [OR] 1.3; confidence interval [CI] 1.0-2.1). After stratification by age at first wearing distance glasses, this relationship remained only for people who first wore distance glasses after age 40 years (OR 1.3; CI 1.0-1.8), which suggested a myopic refractive shift from developing nuclear opacity and was supported by the weak association found between current myopic refraction and nuclear cataract (OR 1.3; CI 1.0-1.6). Eyes with onset of myopia before age 20 years had the greatest PSC cataract risk (OR 3.9; CI 2.0-7.9). This was supported by the finding of an association between current myopic refraction and PSC cataract (OR 2.5; CI 1.6-4.1). PSC cataract was inversely associated with hyperopia (OR 0.6; CI 0.4-0.9). Refraction-related increasing odds were found between PSC cataract and myopia: low myopia (OR 2.1; CI 1.4-3.5), moderate myopia (OR 3.1; CI 1.6-5.7), and high myopia (OR 5.5; CI 2.8-10.9). High myopia was associated with PSC, cortical, and late nuclear cataract. CONCLUSIONS: Early-onset myopia (before age 20 years) may be a strong and independent risk factor for PSC cataract. The findings suggest the possibility of a dose response between levels of myopia and PSC cataract. Nuclear cataract was associated with presumed acquired myopia, whereas high myopia was associated with all three types of cataract. (+info)
Psychosocial predictors of survival in metastatic melanoma.
(10/939)
PURPOSE: Research interest in psychosocial predictors of the onset and course of cancer has been active since the 1950s. However, results have been contradictory and the literature is noted for methodologic weaknesses. In this prospective study, we aimed to systematically obtain data on psychosocial factors associated with human response to illness. PATIENTS AND METHODS: One hundred twenty-five patients with metastatic melanoma completed questionnaires measuring cognitive appraisal of threat, coping, psychologic adjustment, perceived aim of treatment, social support, and quality of life (QOL). Questionnaires were completed, where possible, every 3 months for 2 years after diagnosis. Survival was measured from date of study entry to date of death or was censored at the date of last follow-up for surviving patients. RESULTS: In a multivariate Cox regression analysis of baseline data, which controlled for demographic and disease predictors, the psychologic variables of perceived aim of treatment (P <.001), minimization (P <. 05), and anger (P <.05) were independently predictive of survival. Patients who were married (P <.01) and who reported a better QOL (P <.05) also survived longer. CONCLUSION: The prognostic significance of psychologic and QOL scores remained after allowance for conventional prognostic factors. If these associations reflect an early perception by the patient or doctor of disease progression, then measures are at least valuable early indicators of such progression. If psychologic processes have a more direct influence on the course of the underlying illness, then it may be possible to manipulate them for therapeutic effect. We are now conducting a randomized controlled trial of a psychologic intervention to further elucidate these issues. (+info)
Effects of information framing on the intentions of family physicians to prescribe long-term hormone replacement therapy.
(11/939)
OBJECTIVE: To determine whether the way in which information on benefits and harms of long-term hormone replacement therapy (HRT) is presented influences family physicians' intentions to prescribe this treatment. DESIGN: Family physicians were randomized to receive information on treatment outcomes expressed in relative terms, or as the number needing to be treated (NNT) with HRT to prevent or cause an event. A control group received no information. SETTING: Primary care. PARTICIPANTS: Family physicians practicing in the Hunter Valley, New South Wales, Australia. INTERVENTION: Estimates of the impact of long-term HRT on risk of coronary events, hip fractures, and breast cancer were summarized as relative (proportional) decreases or increases in risk, or as NNT. MEASUREMENTS AND MAIN RESULTS: Intention to prescribe HRT for seven hypothetical patients was measured on Likert scales. Of 389 family physicians working in the Hunter Valley, 243 completed the baseline survey and 215 participated in the randomized trial. Baseline intention to prescribe varied across patients-it was highest in the presence of risk factors for hip fracture, but coexisting risk factors for breast cancer had a strong negative influence. Overall, a larger proportion of subjects receiving information expressed as NNT had reduced intentions, and a smaller proportion had increased intentions to prescribe HRT than those receiving the information expressed in relative terms, or the control group. However, the differences were small and only reached statistical significance for three hypothetical patients. Framing effects were minimal when the hypothetical patient had coexisting risk factors for breast cancer. CONCLUSIONS: Information framing had some effect on family physicians' intentions to prescribe HRT, but the effects were smaller than those previously reported, and they were modified by the presence of serious potential adverse treatment effects. (+info)
Possible associations between computed tomography scan and cataract: the Blue Mountains Eye Study.
(12/939)
OBJECTIVES: This study examined possible associations between the presence of cataract and a history of computed tomography (CT) scan of the head in an older population. METHODS: The Blue Mountains Eye Study examined 3654 people aged 49 to 97 years who lived west of Sydney, Australia. As part of a medical history, participants were asked whether they had ever had a head CT scan. Masked grading of lens photographs assessed cortical, nuclear, and posterior subcapsular cataracts. RESULTS: No significant associations were found between history of head CT scan and age- and sex-specific prevalence of any type of cataract. CONCLUSIONS: This study provided no evidence to support an association between routine head CT scans and development of cataract. (+info)
Vision and low self-rated health: the Blue Mountains Eye Study.
(13/939)
PURPOSE: To assess the relationship between reduced vision and low self-rating of global health, after taking into account many other related factors. METHODS: The Blue Mountains Eye Study examined 3654 residents aged > or =49 years (82.4% response) in an area west of Sydney, Australia. Presenting and best-corrected visual acuity (VA) were measured before and after refraction using a LogMAR chart. During a face-to-face interview, self-rated health was assessed by asking: "For someone of your age, how would you rate your overall health?: excellent, good, fair, or poor." Information about demography, socioeconomic status, need for assistance in daily living activities, medical history, and health risk behaviors was also collected. Logistic regression analyses were performed after dichotomizing self-rated health as poor or fair (low) versus good or excellent. RESULTS: Among persons without visual impairment (defined from best-corrected VA in the better eye), 24.5% rated their health as either poor or fair, compared with 35.5% and 48.8% of persons with mild or moderate-to-severe visual impairment, respectively. In multivariate logistic regression models that included 17 other related factors, reduced vision was statistically significantly associated with lower self-rated health in persons aged <80 years. For each one-line (5 letter) reduction in best-corrected VA, there was 20% increased likelihood of low self-rated health, after adjustment for other factors found associated with self-rated health (multivariate-adjusted odds ratio 1.2, 95% confidence interval 1.1-1.3). In persons aged 80 years or older, reduced vision had no impact on global health rating. CONCLUSIONS: Decreased vision was found to have an independent impact on global health ranking by persons younger than age 80 years, but not by older persons in this population. Taking into account many other factors affecting perceived health, people younger than age 80 years who see well are also more likely to say that they feel well! (+info)
Reproductive decisions after neonatal screening identifies cystic fibrosis.
(14/939)
AIMS: To document the reproductive choices made by women in New South Wales, Australia, after neonatal screening has identified cystic fibrosis (CF). METHODS: A sample of women attending cystic fibrosis clinics in New South Wales who had a child (or children) diagnosed by neonatal screening between 1981 and 1996 were interviewed. RESULTS: Two thirds of the women chose to avoid having another child with CF. The uptake of prenatal diagnosis was 66% in women who had a subsequent pregnancy; of these 69% terminated or would have terminated an affected fetus. Fifty nine per cent of the women who decided against a further pregnancy made this decision in order to avoid having another child with CF. CONCLUSIONS: These data show that having a child with CF influenced subsequent reproductive choices. In addition to the medical advantages of an early diagnosis offered by neonatal screening, this also allows informed future reproductive decisions. (+info)
Hip protectors improve falls self-efficacy.
(15/939)
OBJECTIVES: To investigate the effect of use of external hip protectors on subjects' fear of falling and falls self-efficacy (belief in their own ability to avoid falling). DESIGN: Randomized controlled trial. SETTING: Aged-care health services in Sydney, Australia. PARTICIPANTS: 131 women aged 75 years or older, who had two or more falls or one fall requiring hospital admission in the previous year and who live at home. Sixty-one subjects were in the intervention group and 70 in the control group. INTERVENTION: Use of external hip protectors and encouragement to use the protectors by an adherence nurse. MEASUREMENTS: At the time of enrolment into a wider study examining the effect of hip protectors on hip fractures, participants recruited at home completed an assessment of fear of falling and falls efficacy as measured by the Falls Efficacy Scale and the Modified Falls Efficacy Scale. At 4-month follow-up, these scales were readministered by an observer who was not aware of the allocation of the participant to intervention or control groups. RESULTS: Fear of falling and falls self-efficacy, as measured by the Falls Efficacy and Modified Falls Efficacy Scales, were similar at baseline in both groups. Fear of falling was present at follow-up in 43% of subjects using hip protectors and 57% of the control group (chi2 = 2.58, P = 0.11). Hip protector users had greater improvement in falls self-efficacy at follow-up as measured by the Falls Efficacy Scale (t = 2.44, P = 0.016) and the Modified Falls Efficacy Scale (t = 2.08, P = 0.039). CONCLUSION: Hip protectors improve falls self-efficacy. As users of hip protectors feel more confident that they can complete tasks safely, they may become more physically active and require less assistance with activities of daily living. (+info)
Hepatitis A in New South Wales, Australia from consumption of oysters: the first reported outbreak.
(16/939)
Between 22 January and 4 April 1997, 467 hepatitis A cases were reported to the New South Wales Health Department, Australia. To identify the cause of the outbreak, we conducted a matched case-control study, and an environmental investigation. Among 66 cases and 66 postcode-matched controls, there was a strong association between illness and consumption of oysters (adjusted odds ratio 42; 95 % confidence interval 5-379). More than two-thirds of cases reported eating oysters, including one third of cases and no controls who reported eating oysters in the Wallis Lake area. A public warning was issued on 14 February, and Wallis Lake oysters were withdrawn from sale. Hepatitis A virus was subsequently identified in oyster samples taken from the lake. Hepatitis A virus poses a special risk to consumers who eat raw oysters because it can survive for long periods in estuaries and cause severe disease. (+info)