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Background: Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling. Aim: To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample. Study Design: This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112‐cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. Results: First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13–1.78, p =.002), 1.46 (95% CI 1.17–1.81, p <.001) and 0.49 (95% CI 0.39–0.63, p <.001), respectively. The majority (87%–95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%–9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34–5.13, p <.001) and 3.11 (95% CI 2.51–3.86, p <.001), respectively. Conclusions: Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings. Relevance to Clinical Practice: The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity is rising globally and effective strategies to treat obesity are needed. Intermittent fasting, a dietary intervention for weight management, has received growing interest from the general public, as well as healthcare professionals, as a form of lifestyle intervention. Methods: We executed a rapid review using PUBMED database to identify systematic reviews that examined the impact of intermittent fasting on metabolic indices, published between 2011 and 2022. Results: Intermittent fasting leads to weight loss of a similar magnitude to continuous energy restriction. Most of the evidence shows that intermittent fasting leads to greater fat loss as measured by fat mass (kg) or body fat percentage compared to an ad libitum diet, but fat loss attained during intermittent fasting is not significantly different to continuous energy restriction, although recent evidence shows intermittent fasting to be superior. There is mixed evidence for the impact of intermittent fasting on insulin resistance, fasting glucose and lipid profile. Some studies focused on populations of Muslim people, which showed that Ramadan fasting may lead to weight loss and improvement of metabolic parameters during fasting, although the effects are reversed when fasting is finished. Conclusions: Intermittent fasting is more effective than an ad libitum dietary intake, and equally or more effective as continuous energy restriction, for weight management. However, there is inconclusive evidence on whether intermittent fasting has a clinically beneficial effect on glucose and lipid metabolism. Key points: Intermittent fasting (IF) encompasses time restricted eating, alternate day fasting and intermittent energy restrictionIF is more effective for weight loss and reduction with respect to body mass index than ad libitum dietary intakeIF is equally or more effective as continuous energy restriction for weight management [ABSTRACT FROM AUTHOR]

Purpose: To investigate the agreement between an online nurse‐assisted eye‐screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. Methods: Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye‐screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye‐screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. Results: A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye‐screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye‐screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye‐screening tool, although remarks for further improvements were made. Conclusions: The eye‐screening tool is promising for nurse‐assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye‐screening tool in practice, cost‐effectiveness needs to be investigated. [ABSTRACT FROM AUTHOR]

Purpose: To determine which demographic and clinical characteristics are predictive of vision‐related quality of life (VrQoL) and quality of life (QoL) in patients with macular oedema receiving intravitreal anti‐vascular endothelial growth factor (VEGF) treatment. Methods: Vision‐related quality of life (VrQoL) and quality of life (QoL) were measured in 712 patients with retinal exudative disease receiving anti‐VEGF treatment at baseline, 6 and 12 months. VrQoL was measured using an item‐response theory based 47‐question item bank (EyeQ), whereas QoL was measured using the EuroQol Five Dimensions (EQ‐5D) questionnaire. The EQ‐5D score was dichotomized into a perfect score of 1 and a suboptimal score of <1. Demographic and clinical patient characteristics were considered as possible predictors of (Vr)QoL. Prediction models for (Vr)QoL were created with linear mixed models and generalised estimating equations, using a forward selection procedure. Results: A worse VrQoL was predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, longer length of anti‐VEGF treatment at baseline and the presence of non‐ocular and ocular comorbidities. Suboptimal EQ‐5D scores were predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, the presence of non‐ocular comorbidities and a lower educational background. Conclusions: Along with visual acuity of the better eye, which is the main factor used in clinical decision making, other patient characteristics should also be considered for the risk assessment of (Vr)QoL, such as sex, age, civil status, comorbidities and length of anti‐VEGF treatment. [ABSTRACT FROM AUTHOR]

Purpose: To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands. Methods: A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio‐demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time. Results: A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio‐economic status and lived in urban areas (68%). Between 2015–2018, significant downward trends were found for treatment with intravitreal injections and lens‐related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time. Conclusion: The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens‐related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non‐users further. [ABSTRACT FROM AUTHOR]

Purpose: To investigate interrater reliability and agreement between children with visual impairment (VI) and their parents on participation and quality of life and factors associated with disagreement. Methods: Children 7–17 years and their parents completed the PAI‐CY 7–12 (n = 180) and 13–17 (n = 65), the KIDSCREEN‐27 (n = 250) and the CASP (n = 70). Mean scores of children and parents were compared, with effect sizes for the differences. Interrater reliability was evaluated using intraclass correlation coefficients (ICCs), whereas agreement was assessed using the Bland–Altman limits of agreement. Linear regression analyses examined child‐ and proxy‐related factors associated with discrepancies. Results: On average, children rated their participation and quality of life as significantly better than their parents on most (sub)scales, but with wide range of disagreement. Effect sizes were large for the PAI‐CY 7–12 (0.86) and 13–17 (0.86) and small for the CASP (0.36) and KIDSCREEN‐27 (0.18–0.28). Interrater reliability was poor for the PAI‐CY 7–12 (ICC = 0.29) and most KIDSCREEN‐27 subscales (ICC =0.18–0.32), moderate for the PAI‐CY 13–17 (ICC =0.43) and the KIDSCREEN‐27 Physical Wellbeing subscale (ICC = 0.46) and good for the CASP (ICC = 0.63). Comorbidity was significantly associated with greater discrepancies on participation scales. Conclusion: Children with VI and their parents have different perspectives on the child's participation and quality of life. Disagreement was largest on participation scales and smallest on quality of life subscales, while opposite results were found for interrater reliability. Reports of children and parents seem to be complementary and are both relevant to obtain a complete picture of the burden of VI and relevant to inform healthcare decisions. [ABSTRACT FROM AUTHOR]

Purpose: This study was developed to explain the extraordinary rise in myopia prevalence beginning after 1950 in Indigenous Arctic communities considering recent findings about the risk factors for school myopia development. Myopia prevalence changed drastically from a historical low of less than 3% to more than 50% in new generations of young adults following the Second World War. At that time, this increase was attributed to concurrent alterations in the environment and way of life which occurred in an aggressive programme of de‐culturalization and re‐acculturation through residential school programmes that introduced mental, emotional and physical stressors. However, the predominant idea that myopia was genetic in nature won the discussion of the day, and research in the area of environmental changes was dismissed. There may have also been an association between myopia progression and the introduction of extreme mental, emotional and physical stressors at the time. Recent findings: Since 1978, animal models of myopia have demonstrated that myopiagenesis has a strong environmental component. Furthermore, multiple studies in human populations have shown since 2005 how myopia could be produced by a combination of limited exposure to the outdoors and heavy emphasis on academic subjects associated with intense reading habits. This new knowledge was applied in the present study to unravel the causes of the historical myopia epidemics in Inuit communities. Summary: After reviewing the available published data on myopia prevalence in circumpolar Inuit populations in the 20th century, the most likely causes for the Inuit myopia epidemic were the combination of increased near work (from almost none to daily reading) and the move from a mostly outdoor to a much more indoor way of life, exacerbated by fewer hours of sunshine during waking hours, the lower illuminance in the Arctic and the extreme psychophysical stress due to the conditions in the Residential Schools. [ABSTRACT FROM AUTHOR]

Objective: Improving shared decision‐making (SDM) enables more tailored cancer treatment decisions. We evaluated a Time Out consultation (TOC) with the general practitioner (GP), between cancer diagnosis and treatment decision, which aims at supporting SDM and improving continuity of primary care. This study aims to evaluate the effects of a TOC on perceived SDM, information provision and self‐efficacy. Methods: This randomised controlled trial included newly diagnosed patients with curable cancer (breast, lung, colorectal, gynaecologic and melanoma) from four Dutch hospitals. Primary outcome is perceived SDM and secondary outcomes are information provision and self‐efficacy. Results: One hundred fifty‐four patients (control n = 77, intervention n = 77) – female: 75%, mean age: 61 (SD ± 11.9). In the intervention group, 80.5% (n = 62) had a TOC, of which 82.3% (n = 51) took place after treatment decision. Perceived SDM was lower in the intervention group (−8.9 [95% CI: 0.6–17.1]). Among those with a TOC before treatment decision (n = 11), perceived SDM was comparable to the control group (66.5 ± 27.2 vs. 67.9 ± 26.1). Conclusion: Even though patients are motivated to have a TOC, implementing a TOC between diagnosis and treatment decision is challenging. Effects of a timely TOC could not be established. Non‐timely TOC decreased perceived SDM. Planning of the TOC should be optimised, and future research should establish if adequately timed TOC results in improved SDM in cancer patients. [ABSTRACT FROM AUTHOR]

Background: Treadmill animal models are commonly used to study effects of exercise on bone. Since mechanical loading induces bone strain, resulting in bone formation, exercise that induces higher strains is likely to cause more bone formation. Our aim was to investigate the effect of slope and additional load on limb bone strain. Methods: Horizontal and vertical ground reaction forces on left fore-limb (FL) and hind-limb (HL) of twenty 23-week old female Wistar rats (weight 279 ± 26 g) were measured for six combinations of SLOPE (−10°, 0°, +10°) and LOAD (0 to 23% of body mass). Peak force (Fmax), rate of force rise (RC), stance time (Tstance) and impulse (Fint) on FLs and HLs were analyzed. Results: For the FL, peak ground reaction forces and rate of force rise were highest when walking downward −10° with load (Fmax = 2.09±0.05 N, FLRC = 34±2 N/s) For the HL, ground reaction forces and rate of force rise were highest when walking upward +10°, without load (Fmax = 2.20±0.05 N, HLRC = 34±1 N/s). Load increased stance time. Without additional load, estimates for the highest FL loading (slope is −10°) were larger than for the highest HL loading (slope is +10°) relative to level walking. Conclusions: Thus, walking downward has a higher impact on FL bones, while walking upward is a more optimal HL exercise. Additional load may have a small effect on FL loading. [ABSTRACT FROM AUTHOR]

Aim To provide an overview of factors influencing the flow rate in intravenous (IV) therapy for newborns. Methods We conducted a review of the literature from 1980 to 2011 in Pub Med and Web of Knowledge. Articles focusing on flow-rate variability and possible complications due to flow-rate variability were included. Results Forty-one articles were selected for this review. IV therapy in (preterm) neonates is prone to significant start-up delays and flow-rate variability. The sudden changes in the volume delivered to (preterm) neonates may have serious consequences. Low preprogrammed flow rates, total compliance, and volume of the IV administration set, the presence or absence of antisiphon valves or inline filters and the vertical displacement of syringe pumps all contribute to flow-rate variability in IV therapy for neonates. Conclusions Flow-rate variability in IV therapy and its clinical relevance are due to the preprogrammed flow rate, the hydrostatic pressure changes, the complete IV administration set compliance and the type of substances supplied to the patient. To improve IV therapy, the internal compliance of the complete IV administration set should be minimized and the highest possible preprogrammed flow rate should be used in combination with small syringes and low-resistance valves. [ABSTRACT FROM AUTHOR]

A bstract Background: To evaluate the visual outcome after cataract surgery in a population of Nepal. Design: Population-based cross-sectional study. Participants: Forty years and above residing in Bhaktapur district. Methods: Subjects were selected from 30 clusters using cluster sampling procedure. All underwent a detailed examination at the base hospital, including logarithm of minimal angle of resolution visual acuity, refraction, applanation tonometry, cataract grading, retinal examination and perimetry when indicated. Main Outcome Measures: Visual acuity after cataract surgery. Results: Out of 4003 subjects examined, 151 had undergone cataract surgery. Pseudophakia was present in 142 (94.0%), aphakia in nine (6%). Presenting and best-corrected visual acuity ≥6/18 was achieved in 123 (54.4%) and 164 (72.4%) eyes, respectively. Among the pseudophakic eyes, at presentation 122 (57.5%), 72 (33.9%), 18 (8.5%) and after best correction 162 (76.2%), 33 (15.8%), 17 (8.0%) had visual acuity of ≥6/18, <6/18-≥6/60 and <6/60, respectively. Retinal disease (35.5%), surgical complications (27.4%) and posterior capsular opacification (14.5%) were the principle causes of visual impairment after best correction in all eyes. There was no significant association in visual outcome based on age, sex, literacy and the duration of surgery. Conclusion: Correction of refractive errors, preoperative screening of coincidental diseases, reduction in surgical complication rates and monitoring of postoperative follow-up care has to be addressed seriously in order to improve the outcome of cataract surgery to meet standards proposed by the World Health Organization. In the future, longitudinal studies need to be undertaken to provide specific information on the outcomes of cataract surgery in this community. [ABSTRACT FROM AUTHOR]

To describe the methodology and baseline data of a population-based study designed to determine the prevalence of glaucoma and to study the risk factors for glaucoma development in a Nepali population. Population-based cross-sectional study Subjects 40 years and above residing in Bhaktapur District. Power calculations suggest that a sample size of 4758 is required. Thirty clusters were randomly selected from the 2 municipalities and 16 Village Development Committees of Bhaktapur District in Nepal. A door-to-door census was conducted in the selected clusters to identify citizens 40 years of age and older. Demographic details were collected and a structured interview, regarding awareness for cataract and glaucoma was taken. All individuals fulfilling the eligibility criteria were recruited and referred to the Tilganga Institute of Ophthalmology in Kathmandu for a detailed clinical examination including glaucoma diagnostic procedures. Peripheral blood samples were taken to facilitate future genetic analysis. Prevalence of glaucoma, risk factors and genetic screening. A total of 4800 people were selected. The mean age of participants was 55.4 ± 12.3 years (range: 40-99) and 51.8% were female. In total, 64.8% of our cohort was aged less than 59 years and 60.5% were illiterate. Among the various ethnic races, 69.7% belonged to the Newar ethnic group. This study will determine the prevalence of glaucoma and allow for an increased understanding of the risk factors for glaucoma development in this region. [ABSTRACT FROM AUTHOR]

The article discusses research on a framework for scientific inquiry lessons in chemistry for upper secondary school students. The two research cycles include a hypothetical framework and the main study among researchers and teachers based on the framework. It explains teaching principles in science inquiry and the development of knowledge. It notes the pilot study on the first cycle, the main study on the second cycle and the conclusion on the ability of students along with the need to be directed through the process of scientific inquiry.

Birt–Hogg–Dubé syndrome is a hereditary syndrome characterized by benign disease of skin and lungs and a risk of malignant renal tumors. We describe a clinical and genetic study of a large Dutch family with a novel mutation in the FLCN gene. Renal cancer at very young age occurred in one branch of this family, while in other branches, cutaneous and pulmonary symptoms predominated. A variety of congenital anomalies and connective tissue abnormalities were observed, possibly associated with the gene mutation. [ABSTRACT FROM AUTHOR]

Consecutive patients ( n = 215) who were referred to optometric (55%) or multidisciplinary (45%) low-vision services and above 50 years of age were recruited from four hospitals in the Netherlands. They completed two vision-related quality of life questionnaires, the Vision Quality of Life Core Measure (VCM1) and the Low Vision Quality of Life Questionnaire (LVQOL), before their first visit with low-vision services and 1 year later. At follow-up, patients referred to multidisciplinary low-vision services had lower scores on the mobility subscale of the LVQOL than patients referred to optometric low-vision services [5.3 points; 95% confidence interval (CI): 0.2–10.5]. Paired sample t-tests for the two groups of patients taken together show improvement for the VCM1 (3.1 points; 95% CI: 0.6–5.6) and deterioration for the basic aspects of vision (3.5 points; 95% CI: 1.1–5.9) and the mobility (6.6 points; 95% CI: 3.7–9.5) subscales of the LVQOL. In conclusion, people referred to optometric services showed less deterioration in mobility than those referred to multidisciplinary services. No differences were observed for any of the other subscales of the LVQOL and the VCM1. Future research in this field should include randomized controlled designs comparing low-vision services with no treatment or placebo. [ABSTRACT FROM AUTHOR]

The increased attention for quality of life (QOL) as an outcome measure has led to the development of numerous questionnaires to assess this construct in the field of ophthalmology. This article presents a systematic review on QOL questionnaires for people with vision impairments. We systematically searched and selected the literature. Furthermore, a rating list with descriptive aspects (e.g. target population) and psychometric aspects (e.g. reproducibility) was developed. The 31 questionnaires that were included in the review were rated on the basis of criteria stated in this rating list. The questionnaires were mostly targeted at cataract patients or visually impaired persons in general. Only a few of the questionnaires demonstrated sufficient psychometric quality. A recent development is the (re-)evaluation of questionnaires with Rasch analysis. This is one of the most important issues to which future research in this field should be directed. [ABSTRACT FROM AUTHOR]

Emiliania huxleyi (Lohmann) Kamptner, belonging to a group of marine unicellular algae, the Coccolithophoridae, possesses a cell wall containing calcified structures called coccoliths. These coccoliths contain a water-soluble acid polysaccharide. The polysaccharide contains ester sulphate and uronic acid groups and binds Ca2+ preferentially from a medium also containing Na+ and Mg2+ It is thought to perform a regulatory function in the calcification process. In the present paper we describe a series of studies in vivo intended to give a preliminary characterization of a number of metabolic steps leading to coccolith formation. In view of the putative role of the acid poly- saccharide in coccolith synthesis, we have concentrated on the incorporation of polysaccharide precursors by calcifying cells. As a second approach we investigated the differences between cal- cifying ceils and cells of the same species that have lost the capability to produce coccoliths (non-calcifying cells). Calcifying cells were offered radioactive calcium, bicarbonate, galactose and sulphate in the light. Most of the calcium label and a small part of the label of galactose and bicarbonate was incorporated into extracellular coccoliths. The label of galactose was detected in at least seven of the constituent monosaccharides of the coccolith-associated polysaccharide. Radioactive sulphate was also incorporated into the extracellular coccolith polysaccharide. In contrast to the label of bicarbonate and galactose that of calcium reached a steady-state concentration intracellularly within 2 h. A technique was developed for the isolation of intracellular CaCO3, presumably coccoliths in statu nascendi. About 10% of the label of bicarbonate and galactose was incorporated into an intracellular acid polysaccharide, resembling the coccolith-associated macromolecule. Non- calcifying cells fail to take up Ca2+ and galactose. We demonstrated that non-calcifying cells produce an acid polysaccharide, resembling the coccolith-associated macromolecule. The former polysaccharide is shed into the surrounding medium and can be labelled by offering the non- calcifying cells radioactive bicarbonate. [ABSTRACT FROM AUTHOR]

Purpose: A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants., Methods: In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined., Results: Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12)., Conclusion: This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate the prevalence of potential age-related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied., Methods: Cross-sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50-96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires., Results: Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self-reported outcomes., Conclusion: Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age-related vision loss, contributing to the joint World Health Organization - VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To compare health-related quality of life and participation of visually impaired young adults with normative groups, and to explore severity of vision loss and its association with participation and quality of life., Methods: Young adults aged 18-25 years (n = 172) registered at two Dutch low vision rehabilitation organizations completed the Short Form Health Survey (SF-36), EuroQol-5 Dimensions (EQ-5D), Impact on Participation and Autonomy (IPA) and Low Vision Quality of Life questionnaire (LVQOL). EQ-5D and SF-36 scores were compared to age-specific norms. IPA scores were compared to norms of a population having three chronic diseases simultaneously. Linear regression was used to assess the association between severity of vision loss (mild VI, moderate VI and severe VI/blindness), and quality of life and participation., Results: Participants scored significantly worse on almost all (sub)scales compared with relevant norms. Effect sizes for the EQ-5D and SF-36 (sub)scales were mostly small; moderate and large effect sizes were found for the IPA. Compared to young adults with mild VI, corrected models showed a significant association between having moderate VI and the physical component score of the SF-36, and between severe VI/blindness and the LVQOL., Conclusion: VI has a moderate impact on some aspects of quality of life and a large impact on participation of young adults when compared with relevant normative populations. Severity of vision loss is associated with worse physical functioning and vision-related quality of life. The results contribute to a better understanding of the impact of VI and might lead to improved low vision services., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: This study aimed to examine the controllability of cylinder-shaped and dome-shaped magnifiers in young children with visual impairment., Methods: This study investigates goal-directed arm movements in low-vision aid use (stand and dome magnifier-like object) in a group of young children with visual impairment (n = 56) compared to a group of children with normal sight (n = 66). Children with visual impairment and children with normal sight aged 4-8 years executed two types of movements (cyclic and discrete) in two orientations (vertical or horizontal) over two distances (10 cm and 20 cm) with two objects resembling the size and shape of regularly prescribed stand and dome magnifiers., Results: The visually impaired children performed slower movements than the normally sighted children. In both groups, the accuracy and speed of the reciprocal aiming movements improved significantly with age. Surprisingly, in both groups, the performance with the dome-shaped object was significantly faster (in the 10 cm condition and 20 cm condition with discrete movements) and more accurate (in the 20 cm condition) than with the stand-shaped object., Conclusion: From a controllability perspective, this study suggests that it is better to prescribe dome-shaped than cylinder-shaped magnifiers to young children with visual impairment., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Although the prevalence of depression in visually impaired older persons is high, the association between vision loss and depression seems to be influenced by factors other than visual impairment. In this study, the role of vision loss, functional limitations and social network characteristics in relation to depressive symptoms was investigated., Methods: Cross-sectional data (N = 1237) from the Longitudinal Aging Study Amsterdam were used to investigate the prevalence of depression (Center of Epidemiological Studies-Depression scale) within subgroups with increasing vision loss. In linear regression models, functional limitations and social network characteristics were examined as possible mediators in the association between vision loss and depression. Having a partner was considered to be a potential moderator., Results: Although a significant linear trend was found in the presence of depressive symptoms with 14% in normally sighted, 23% in mild and 37% in severe vision loss (χ(2)(1) = 14.9; p < 0.001), vision loss was not an independent determinant of depression. Mediators were functional limitations (p < 0.001) and social network size (p = 0.009). No interaction with partner status was found., Conclusion: In the presence of depression, a trend was found with increasing severity of vision loss, indicating the need for more attention in (mental) health care and low-vision rehabilitation. In the general older population, vision loss was not an independent determinant of depression but was mediated by functional limitations and social network size. Rather than receiving actual social support, the idea of having a social network to rely on when needed seemed to be associated with lower levels of depression., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To gain qualitative insight into the rehabilitation needs of visually impaired young adults (18-25 years) and how these needs relate to the International Classification of Functioning, Disability and Health (ICF) and patient characteristics., Methods: Rehabilitation needs and patient characteristics of young adults (N = 392) who applied for multidisciplinary services in 2012 and 2013 were obtained from structured and semi-structured intake records. Linking rules were used to assess how the needs related to Environmental Factors, Body Functions, Body Structures, and Activity and Participation (A&P) ICF components. The relationship between the type of rehabilitation goal and patient characteristics was assessed using multivariate logistic regression analyses., Results: Most rehabilitation needs (67.6%; N = 510) were found on the A&P component of the ICF. Most prevalent needs were related to 'major life areas' (e.g. finding internship or job), followed by the chapters: 'mobility' (e.g. self-reliance in travelling), 'communication' (e.g. using communication devices and techniques), 'general tasks and demands' (e.g. psychological aspects of vision loss) and 'domestic life' (e.g. household tasks). Patients in one of the multidisciplinary rehabilitation centres (odds ratio (OR) = 7.07; 95% confidence interval (CI) [2.97-16.83]) and patients with comorbidity (OR = 3.82; 95% CI [1.62-9.02]) were more likely to report rehabilitation needs related to chapter E3 'support and relationships'., Conclusion: 'Major life areas' prevail in the content of rehabilitation needs, but tend to overshadow topics regarding peer interaction and social, community and civic life. A suitable survey method for young adults with visual impairments is required that contains rehabilitation domains and goals relevant to their lives and development., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To gain qualitative insight into the rehabilitation goals of visually impaired children and how these goals relate to the structure of the International Classification of Functioning, Disability and Health (ICF) and patient characteristics., Methods: A patient record study was conducted, analysing rehabilitation goals and characteristics of children with a suspected visual impairment in the Netherlands (<18 years) who applied for multidisciplinary services in 2012 (N = 289). Chi-square analyses for trend in rehabilitation content across age bands and additional analyses were performed., Results: The three most common diagnoses were nystagmus (21.2%), cerebral visual impairment (16.2%) and albinism (6.1%). Rehabilitation goals for children aged <7 years were mostly aimed at 'physical (visual) functioning' (36.7%) and 'environmental factors' (36.7%). For children ≥7 years, significantly more goals were identified on activity and participation (A&P) domains (52.2%). Three A and P domains presented a significant linear trend on the number of rehabilitation goals across age bands: (1) 'Learning and applying knowledge' (13.042, p < 0.001), (4) 'Mobility' (31.340, p < 0.001) and (8) 'Major life areas' (5.925, p = 0.015). Regression analysis showed that both age and visual acuity significantly contributed to the number of A and P goals., Conclusion: Although analyses were based on a selection of patient records, the number and nature of rehabilitation goals differ significantly with age. Many A and P goals seem underrepresented at the intake procedure, for example: communication, peer interaction and participating in leisure activities. A systematic, standardized procedure is required to catalogue all existing goals and to be able to evaluate progress and potential new or other important goals., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)