Reduced visual function and its association with physical functioning in the Finnish adult population : Prevalence, causes, and need for eye care services

The purpose of this study was to estimate the prevalence and distribution of reduced visual acuity, major chronic eye diseases, and subsequent need for eye care services in the Finnish adult population comprising persons aged 30 years and older. In addition, we analyzed the effect of decreased vision on functioning and need for assistance using the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) as a framework. The study was based on the Health 2000 health examination survey, a nationally representative population-based comprehensive survey of health and functional capacity carried out in 2000 to 2001 in Finland. The study sample representing the Finnish population aged 30 years and older was drawn by a two-stage stratified cluster sampling. The Health 2000 survey included a home interview and a comprehensive health examination conducted at a nearby screening center. If the invited participants did not attend, an abridged examination was conducted at home or in an institution. Based on our finding in participants, the great majority (96%) of Finnish adults had at least moderate visual acuity (VA ≥ 0.5) with current refraction correction, if any. However, in the age group 75–84 years the prevalence decreased to 81%, and after 85 years to 46%. In the population aged 30 years and older, the prevalence of habitual visual impairment (VA ≤ 0.25) was 1.6%, and 0.5% were blind (VA < 0.1). The prevalence of visual impairment increased significantly with age (p < 0.001), and after the age of 65 years the increase was sharp. Visual impairment was equally common for both sexes (OR 1.20, 95% CI 0.82 – 1.74). Based on self-reported and/or register-based data, the estimated total prevalences of cataract, glaucoma, age-related maculopathy (ARM), and diabetic retinopathy (DR) in the study population were 10%, 5%, 4%, and 1%, respectively. The prevalence of all of these chronic eye diseases increased with age (p < 0.001). Cataract and glaucoma were more common in women than in men (OR 1.55, 95% CI 1.26 – 1.91 and OR 1.57, 95% CI 1.24 – 1.98, respectively). The most prevalent eye diseases in people with visual impairment (VA ≤ 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%), and DR (7%). One-half (58%) of visually impaired people had had a vision examination during the past five years, and 79% had received some vision rehabilitation services, mainly in the form of spectacles (70%). Only one-third (31%) had received formal low vision rehabilitation (i.e., fitting of low vision aids, receiving patient education, training for orientation and mobility, training for activities of daily living (ADL), or consultation with a social worker). People with low vision (VA 0.1 – 0.25) were less likely to have received formal low vision rehabilitation, magnifying glasses, or other low vision aids than blind people (VA < 0.1). Furthermore, low cognitive capacity and living in an institution were associated with limited use of vision rehabilitation services. Of the visually impaired living in the community, 71% reported a need for assistance and 24% had an unmet need for assistance in everyday activities. Prevalence of ADL, instrumental activities of daily living (IADL), and mobility increased with decreasing VA (p < 0.001). Visually impaired persons (VA ≤ 0.25) were four times more likely to have ADL disabilities than those with good VA (VA ≥ 0.8) after adjustment for sociodemographic and behavioral factors and chronic conditions (OR 4.36, 95% CI 2.44 – 7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95% CI 2.38 – 9.76 and OR 5.37, 95% CI 2.44 – 7.78, respectively) and self-reported mobility limitations were three times as likely (OR 3.07, 95% CI 1.67 – 9.63) as in persons with good VA. The high prevalence of age-related eye diseases and subsequent visual impairment in the fastest growing segment of the population will result in a substantial increase in the demand for eye care services in the future. Many of the visually impaired, especially older persons with decreased cognitive capacity or living in an institution, have not had a recent vision examination and lack adequate low vision rehabilitation. This highlights the need for regular evaluation of visual function in the elderly and an active dissemination of information about rehabilitation services. Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limited functioning. Thus, continuous efforts are needed to identify and treat eye diseases to maintain patients’ quality of life and to alleviate the social and economic burden of serious eye diseases.

Specific language impairment in pre-adolescence, adolescence, and adulthood with special emphasis on health-related quality of life

This clinical study focused on effects of childhood specific language impairment (SLI) on daily functioning in late life. SLI is a neurobiological disorder with genetic predisposition and manifests as poor language production or comprehension or both in a child with age-level non-verbal intelligence and no other known cause for deficient language development. The prevalence rate of around 7% puts it among the most prevalent developmental disorders in childhood. Negative long-term effects, such as problems in learning and behavior, are frequent. In follow-up studies the focus has seldom been on self-perception of daily functioning and participation, which are considered important in the International Classification of Functioning, Disability, and Health (ICF). To investigate the self-perceived aspects of everyday functioning in individuals with childhood receptive SLI compared with age- and gender-matched control populations, the 15D, 16D, and 17D health-related quality of life (HRQoL) questionnaires were applied. These generic questionnaires include 15, 16, and 17 dimensions, respectively, and give both a single index score and a profile with values on each dimension. Information on different life domains (rehabilitation, education, employment etc.) from each age-group was collected with separate questionnaires. The study groups comprised adults, adolescents (12-16 years), and pre-adolescents (8-11 years) who had received a diagnosis of receptive SLI and had been examined, usually before school age, at the Department of Phoniatrics of Helsinki University Central Hospital, where children with language deficits caused by various etiologies are examined and treated by a multidisciplinary team. The adult respondents included 33 subjects with a mean age of 34 years. Measured with 15D, the subjects perceived their HRQoL to be nearly as good as that of their controls, but on the dimensions of speech, usual activities, mental functioning, and distress they were significantly worse off. They significantly more often lived with their parents (19%) or were pensioned (26%) than the adult Finnish population on average. Adults with self-perceived problems in finding words and in remembering instructions, manifestations of persistent language impairment, showed inferior every day functioning to the rest of the study group. Of the adolescents and pre-adolescents, 48 and 51, respectively, responded. The majority in both groups had received special education or extra educational support at school. They all had attended speech therapy at some point; at the time of the study only one adolescent, but every third pre-adolescent still received speech therapy. The 16D score of the adolescent or the 17D score of the pre-adolescents did not differ from that of their controls. The 16D profiles differed on some dimensions; subjects were significantly worse off on the dimension of mental functioning, but better off on the dimension of vitality than controls. Of the 17D dimensions, the study group was significantly worse off on speech, whereas the control group reported significantly more problems in sleeping. Of the childhood performance measures investigated, low verbal intelligence quotient (VIQ), which is often considered to reflect receptive language impairment, was in adults subjects significantly associated with some of the self-perceived problems, such as problems in usual activities and mental functioning. The 15D, 16D, and 17D questionnaires served well in measuring self-perceived HRQoL. Such standardized measures with population values are especially important in confirming with the ICF guidelines. In the future these questionnaires could perhaps be used on a more individual level in follow-up of children in clinics, and even in special schools and classes, to detect those children at greatest risk of negative long-term effects and perhaps diminished well-being regarding daily functioning and participation.

Hyvän kuntoutuskäytännön perusta.Käytännön ja tutkimustiedon analyysistä suosituksiin vaikeavammaisten kuntoutuksen kehittämishankkeessa.

Laki Kelan kuntoutuksesta määrittää, että kuntoutuksen tulee olla hyvän kuntoutuskäytännön mukaista. Tämän Vaikeavammaisten kuntoutuksen kehittämishankkeeseen (VAKE) kuuluvan tutkimuksen tavoitteena oli kolmen diagnoosiryhmän – aivoverenkiertohäiriön (AVH), multippeliskleroosin (MS) ja Cerebral Palsyn (CP) – avulla kuvata Kelan järjestämän vaikeavammaisten lääkinnällisen kuntoutuksen nykytilaa, sen kehittämistarpeita ja eri kuntoutustoimenpiteiden vaikuttavuutta sekä laatia suositukset hyvästä kuntoutuskäytännöstä. Tutkimus toteutettiin laajassa tutkimusyhteistyössä vuosina 2007–2009. Kirjan toisessa osassa kuvataan AVH-, MS- ja CP-kuntoutuksen nykykäytännöt, jotka perustuvat kuntoutusalan ammattilaisille ja asiantuntijoille tehtyihin kysely- ja haastattelututkimuksiin, sekä esitellään Kelalle lähetettyjen kuntoutussuunnitelmien analyysit. Kirjan kolmas osa käsittelee kuntoutuksen arviointikäytäntöjä. Tulokset perustuvat nykykäytäntöjä selvittäneisiin kysely- ja haastatteluaineistoihin sekä vaikuttavuustutkimuksissa käytettyihin arviointimenetelmiin. Neljännessä osassa esitetään järjestelmällisiin katsauksiin perustuva vaikuttavuusnäyttö AVH-, MS- ja CP-kuntoutujien fysio-, puhe- ja toimintaterapiasta sekä MS:n osalta neuropsykologisesta kuntoutuksesta. Näytön asteen määrittely perustuu Käypä hoito -suosituksen kriteereihin. Kirjan viidennessä osassa esitetään tunnistettujen ongelmien sekä tutkimustulosten perusteella laaditut suositukset hyvistä kuntoutuskäytännöistä Kelan järjestämisvelvollisuuteen kuuluvan vaikeavammaisten lääkinnällisen kuntoutuksen osalta. Suositukset perustuvat edellä mainittuihin tutkimuksiin ja Asiakkaan äänellä -tutkimukseen. Suositusten tavoitteena on mahdollistaa tämänhetkisen tiedon mukainen asiakaslähtöinen, oikea-aikainen, oikein kohdennettu ja vaikuttava kuntoutus vaikeavammaisille kuntoutujille. Kuntoutujan sujuva ja yksilöllinen kuntoutusprosessi edellyttää suomalaisessa kuntoutusjärjestelmässä eri organisaatioiden välistä, moniammatillista sekä osaavaa yhteistyötä, kuntoutujan näkemyksen ja elämän kokonaistilanteen ymmärtämistä, joustavaa tiedonvälitystä sekä pitkäaikaista ohjausta, tukea ja seurantaa. Kuntoutuksen viitekehyksenä tulee käyttää ICF-luokitusta. Hyvien kuntoutuskäytäntöjen edelleen kehittämiseksi on saatava lisätietoa nykyisistä kuntoutuskäytännöistä, kuntoutuksen vaikuttavuudesta ja sen osoittamiseen soveltuvista arviointimenetelmistä.

Minimizing total completion time on batch processing machines

We study the problem of minimizing total completion time on single and parallel batch processing machines. A batch processing machine is one which can process up to B jobs simultaneously. The processing time of a batch is equal to the largest processing time among all jobs in the batch. This problem is motivated by burn-in operations in the final testing stage of semiconductor manufacturing and is expected to occur in other production environments. We provide an exact solution procedure for the single-machine problem and heuristic algorithms for both single and parallel machine problems. While the exact algorithms have limited applicability due to high computational requirements, extensive experiments show that the heuristics are capable of consistently obtaining near-optimal solutions in very reasonable CPU times.

Syntheses, spectroscopy, structures, and conformations of .lambda.3-cyclotriphosphazanes: role of negative hyperconjugation

The reactions of As-chlorocyclotriphosphazane [EtNPCl], with phenols or trifluoroethanol yield the respective aryloxy- or trifluoroethoxy-containingX 3-cyclotriphosphazanes [EtNP(OR)]3 (R = C6H4Br-4 (2),C 6H5 (3C,6 H3-Mez-3,5 (4), C6H3Mez-2,6 (5), CH2CF3 (6)) as their cis-transisomericmixtures. The products have beencharacterized by IRand NMRspectroscopy. Thecrystalstructuresofboth thecis (2a) and trans(2b) isomer_softhep-bromophenoxy derivative have been determined by X-ray diffraction. Crystal data for 2a: triclinic, P1, a = 9.872(4) A, b = 13.438(6) A, c = 13.548(8) A, CY = 117.02(5)', 0 = 96.00(6)', y = 105.38(4)O, Z = 2, final R = 0.080. Crystal data for 2b: monoclinic, P21/n, a = 12.721(6) A, b = 13.468(7) A, c = 17.882(5) A, /3 = 101.62(3)O, Z = 4, final R = 0.066. The cis isomer exhibits a chair-triaxial conformation and the trans isomer a boat-triaxial conformation. Conformational preferences of X3-cyclotriphosphazanes have been probed by both MNDO and ab initio calculations on model systems [HNPXIp (X = H, F). In addition to vicinal lone pair repulsions, negative hyperconjugative interactions involving the nitrogen lone pairs and adjacent P-X Q* orbitals are found to be important (especially when X is an electronegative substituent) in determining the conformational preferences of X3-cyclotriphosphazanes. The calculations also show that the axial - equatorial conversion at phosphorus has a large activation barrier in these systems

An ethnobotanical survey of medicinal plants in the Eastern Himalayan zone of Arunachal Pradesh, India

Aim of the study: The medicinal plants are integral source of easily available remedy used in rural healthcare system. This study was conducted among three major ethnic groups namely the Nocte, the Nyishi and the Adi in the Eastern Himalayan region of Arunachal Pradesh to evaluate their comparative knowledge on medicinal plants. Materials and methods: The three remote districts of Arunachal Pradesh namely the Tirap, the Dibang Valley and the Papum Pare were surveyed through interviewing of randomly selected 237 participants using semi-structured questionnaire and regular field visits to selected districts. Results: We recorded the traditional use of 74 medicinal plants species belonging to 41 taxonomic plant families used for treating a total of 25 different diseases/ailments. The informant consensus factor (ICF) values demonstrated that local people tend to agree more with each other in terms of the plants used to treat malaria (0.71), jaundice (0.62), urological problems (0.56), dermatological disorders (0.45), pain (0.30), and respiratory disorder (0.33), and while the general health (0.15) and gastro-intestinal disorders category (0.28) were found low ICF values. Conclusion: Of the total 74 species recorded, the highest number of medicinal plants (36 species) was reported from the Adi of Lower Dibang Valley followed by the Nocte of the Tirap (25 species) and the Nyishi ethnic groups of Papum Pare districts (13 species). In the present study, we found that the men, elder people and illiterate ones had better knowledge on medicinal plants as compared to women, younger and literate people. Findings of this documentation study can be used as an ethnopharmacological basis for selecting plants for future phytochemical and pharmaceutical studies. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

CO oxidation by CeO(2)-Al(2)O(3)-CeAlO(3) hybrid oxides

A modified solution combustion technique was successfully used to synthesize sub-10 nm crystallites of hybrid CeO(2)-Al(2)O(3)-CeAlO(3). The fuel in the solution combustion was tuned to obtain mixed oxides and solid solutions of the compound. The compounds were characterized by X-ray diffraction, transmission electron microscopy and X-ray photoelectron spectroscopy. XRD and TEM analysis showed the substitution of Al(3+) ions in the CeO(2) matrix when a combination of glycine, urea, hexamine and oxalyl dihydrazide was used as fuel for the synthesis. The compounds showed high activity for CO oxidation and the activity of the compounds was dependent upon the composition of the oxide.

Kinetics of carbon monoxide oxidation with Sn(0.95)M(0.05)O(2-delta) (M = Cu, Fe, Mn, Co) catalysts

Base metal substituted Sn(0.95)M(0.05)O(2-delta) (M = Cu, Fe, Mn, Co) catalysts were synthesized by the solution combustion method and characterized by XRD, XPS, TEM and BET surface area analysis. The catalytic activities of these materials were investigated by performing CO oxidation. The rates and the apparent activation energies of the reaction for CO oxidation were determined for each catalyst. All the substituted catalysts showed high rates and lower activation energies for the oxidation of CO as compared to unsubstituted SnO(2). The rate was found to be much higher over copper substituted SnO(2) as compared to other studied catalysts. 100% CO conversion was obtained below 225 degrees C over this catalyst. A bifunctional reaction mechanism was developed that accounts for CO adsorption on base metal and support ions and O(2) dissociation on the oxide ion vacancy. The kinetic parameters were determined by fitting the model to the experimental data. The high rates of the CO oxidation reactions at low temperatures were rationalized by the high dissociative chemisorption of adsorbed O(2) over these catalysts.

Minimization of the effects of harmonics and voltage dip caused by electric arc furnace

This study examines the thermal efficiency of the operation of arc furnace and the effects of harmonics and voltage dips of a factory located near Bangkok. It also attempts to find ways to improve the performance of the arc furnace operation and minimize the effects of both harmonics and voltage dips. A dynamic model of the arc furnace has been developed incorporating both electrical and thermal characteristics. The model can be used to identify potential areas for improvement of the furnace and its operation. Snapshots of waveforms and measurement of RMS values of voltage, current and power at the furnace, at other feeders and at the point of common coupling were recorded. Harmonic simulation program and electromagnetic transient simulation program were used in the study to model the effects of harmonics and voltage dips and to identify appropriate static and dynamic filters to minimize their effects within the factory. The effects of harmonics and voltage dips were identified in records taken at the point of common coupling of another factory supplied by another feeder of the same substation. Simulation studies were made to examine the results on the second feeder when dynamic filters were used in the factory which operated the arc furnace. The methodology used and the mitigation strategy identified in the study are applicable to general situation in a power distribution system where an arc furnace is a part of the load of a customer

The X-C---Y (X = O/F, Y = O, S, F, Cl, Br, N, P,) Carbon bond and hydrophobic interactions

While the tetrahedral face of methane has an electron rich centre and can act as a hydrogen bond acceptor, substitution of one of its hydrogens with some electron withdrawing group (such as -F/OH) can make the opposite face electron deficient. Electrostatic potential calculations confirm this and high level quantum calculations show interactions between the positive face of methanol/methyl fluoride and electron rich centers of other molecules such as H2O. Analysis of the wave functions of atoms in molecules shows the presence of an unusual C···Y interaction, which could be called 'carbon bonding'. NBO analysis and vibrational frequency shifts confirm the presence of this interaction. Given the properties of alkyl groups bonded to electronegative elements in biological molecules, such interactions could play a significant role, which is yet to be recognized. This and similar interactions could give an enthalpic contribution to what is called the 'hydrophobic interactions'.