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Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care. Children with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child's vision was tested with pictures, shapes, or letters in the past 2 years; (2) child's vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care. [ABSTRACT FROM AUTHOR]

The article describes the results of the analysis by the U.S. Center for Disease Control and Prevention (CDC) of data from the National Health Interview Survey (NHIS) about self-reported visual impairment (VI) among persons with diagnosed diabetes in the U.S. from 1997-2010. The analysis indicated a significant decline in the age-adjusted percentage of adults with diagnosed diabetes with VI from 23.7 percent to 16.7 percent in 2010. The prevalence of self-reported VI declined in all age groups, males and females, Hispanic and non-Hispanic ethnic groups, in adults with high education or less, and those with self-reported diabetes regardless of current insulin use. The prevalence of self-reported diabetes remained constant among those with an eye care provider. INSET: Untitle.

Although traumatic brain injury (TBI) can happen to anyone at any time, the wars in Iraq and Afghanistan have brought it renewed attention. Fortunately, most cases of TBI from the recent conflicts are mild TBI (mTBI). Still, many physical, psychological, and social problems are associated with mTBI. Among the difficulties encountered are oculomotor and vision problems, many of which can impede daily activities such as reading. Therefore, correct diagnosis and treatment of these mTBI-related vision problems is an important part of patient recovery. Numerous eye care providers in the Department of Veterans Affairs, in military settings, and in civilian practices specialize and are proficient in examining patients who have a history of TBI. However, many do not have this level of experience working with and treating patients with mTBI. Recognizing this, we used a modified Delphi method to derive expert opinions from a panel of 16 optometrists concerning visual examination of the patient with mTBI. This process resulted in a clinical tool containing 17 history questions and 7 examination procedures. This tool provides a set of clinical guidelines that can be used as desired by any eye care provider either as a screening tool or adjunct to a full eye examination when seeing a patient with a history of mTBI. The goal of this process was to provide optimal and uniform vision care for the patient with mTBI. [ABSTRACT FROM AUTHOR]

Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes. • Experiencing more healthcare barriers is associated with internalized racism. • Internalized racism is associated with more negative health seeking attitudes. • Dental healthcare access barriers are related to dental health seeking attitudes. • Medical healthcare access barriers are related to medical health seeking attitudes. [ABSTRACT FROM AUTHOR]

Objectives: 1. To estimate the prevalence of preventive medication use among adults in the United States (US); 2. To identify the socioeconomic, demographic and clinical factors associated with preventive prescription medication use; 3. To identify the diagnoses associated with preventive prescription medication use. Methods: Data from two cycles of the National Health and Nutrition Examination Survey, 2015–2016 and 2017–2018, are analyzed. Results: Among US adults aged 40 years or older (N = 7634), 31% use a preventive medication. Specifically, 27% of them use aspirin and 9% use other preventive prescription medications. Among those who use other preventive prescription medications, 27% report using one of the cardiovascular agents and 24% reported using anticoagulants and/or antiplatelet agents. High percentages of preventive prescription medication users report using medications to prevent heart attacks/myocardial infarctions (25%) or blood clots (23%). Uninsured adults are less likely to use preventive medications (OR: 0.656; p-value = 0.009) as compared with their counterparts with private insurance. On the other hand, older adults and those with diabetes, heart disease, arthritis and hypertension are more likely to use preventive medications. Furthermore, past smokers and adults who never smoked are more likely to use preventive medications as compared with those who currently smoke. Conclusion: Policies are needed to increase access to preventive care for uninsured adults. Further research needs to review the benefits and harms of the chronic use of preventive medication among older adults in the US. [ABSTRACT FROM AUTHOR]

Introduction: Visual impairment among older adults has increasingly become one of the biggest challenges to public health and personal well-being in the United States. This study aims to examine whether the intersectionality hypothesis can be used in conjunction with the cumulative advantage (disadvantage), persistent inequality, or age-as-leveler to explain heterogeneity in low vision trajectories across birth cohorts, race or ethnicity, gender, and the level of education. Methods: Growth curve modeling was used to analyze data from the 2002–2014 Health and Retirement Study. Results: The type of trajectory (i.e., cumulative advantage or disadvantage, the persistent inequality, and the age-as-leveler) that characterize low vision is largely dependent upon the characteristics of an individual (i.e., race or ethnicity, gender, and education). Discussion: Trajectories of low vision are higher among females and those from ethnic minority groups with low levels of education. Implications for practitioners: Targeted interventions and attempts to close interethnic disparities in vision functioning should begin early on in life and should focus on racial ethnic minorities, females, and those with low education. [ABSTRACT FROM AUTHOR]

Secondary data analysis on the 2015 National Health Interview Survey was conducted to determine if having paid sick leave increases the odds of being able to afford specific health care goods and services, and not having access to paid sick leave increases the odds of being in poverty, being food insecure and having elevated medical costs among a representative sample of US workers age 18-64. We found a statistically significant association between paid sick leave and ability to afford dental care, eyeglasses and prescription medication. Workers who lack paid sick leave are more likely than those with paid sick leave to be in poverty and have high medical costs. In conclusion, we found a relationship between paid sick leave benefits and being able to afford needed healthcare services and goods and being more vulnerable to economic hardship. [ABSTRACT FROM AUTHOR]

Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were =18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to <4 hours, 4-10 hours, and >10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services. [ABSTRACT FROM AUTHOR]

Purpose Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. Methods We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Findings Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Conclusions Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. [ABSTRACT FROM AUTHOR]

We study how macroeconomic conditions during the Great Recession affected health care utilization and out-of-pocket expenditures of American households. We use two data sources: the Consumer Expenditure (CE) Survey and the Survey of Income and Program Participation (SIPP); each has its own advantages. The CE contains quarterly frequency variables, and the SIPP provides panel data at the individual level. Consistent evidence across the two datasets shows that utilization of routine medical care was counter-cyclical, whereas hospital care was pro-cyclical during the Great Recession. When we examine the pre-recession period, the relationship between macroeconomic conditions and health care use was either non-existent or in opposite directions, suggesting that this relationship may have been unique to the Great Recession. [ABSTRACT FROM AUTHOR]

North American optometry and ophthalmology faculty members and vision science librarians were surveyed online (14% response rate) about teaching evidence-based practice (EBP). Similar to studies of other health care programs, all five EBP steps (Ask, Acquire, Appraise, Apply, Assess) were taught to varying degrees. Optometry and ophthalmology EBP educators may want to place further emphasis on (1) the Apply and Assess steps, (2) faculty- and student- generated questions and self-assessment in clinical settings, (3) online teaching strategies, (4) programmatic integration of EBP learning objectives, and (5) collaboration between faculty members and librarians. [ABSTRACT FROM AUTHOR]

Few studies have focused on perceptions of healthcare among Vietnamese who came to the United States (US) as refugees. A 48-item survey that included information on demographics, health status, and satisfaction with healthcare [including the Patient Satisfaction Questionnaire-18 (PSQ-18)] was sent to 49 former Vietnamese military officers, who are now living in the US, based on their current geographic residence. A total of 22 of 49 delivered questionnaires were completed and returned, yielding a response rate of 45%. The survey was sent in Vietnamese and English, and all except one was completed in Vietnamese. In response to 'Language barriers have prevented me from accessing health care when I need it,' 77% of respondents acknowledged that this was 'sometimes' the case even today. Most respondents otherwise viewed the healthcare system favorably, but cost concerns were an issue: 28% strongly agreed or agreed with the statement, 'I have to pay for more of my medical care than I can afford.' In contrast, only 9% described that they would have strongly agreed or agreed to this statement upon first arriving to the US. Write-in comments revealed themes that centered on language barriers, favorable impressions of healthcare in the US, financial concerns, and patriotism towards the US. Further study of this aging population of Vietnamese Americans might help shed light on concerns faced by other refugee populations who have arrived more recently. [ABSTRACT FROM AUTHOR]

Purpose: To assess the level of ophthalmology resident interest in pediatric ophthalmology. Methods: An 18-item 5-point Likert scale was used to determine interest in pediatric ophthalmology among ophthalmology residents in the United States. Results: The response rate was 23% (316 of 1,341). Of the respondents, 74% agreed they had a clinical role model in pediatric ophthalmology, 66% perceived a good job market for this field, and 67% cited liking strabismus surgery. The majority of residents (56%) found pediatric patients difficult to examine and 50% stated income levels for pediatric ophthalmologists are low. Conclusions: Although most residents have an overall positive view about pediatric ophthalmology, few indicate interest in pursuing a fellowship. Specifically, most residents reported having a clinical role model in pediatric ophthalmology, perceiving a good job market, and liking strabismus surgery, whereas few residents had interest in further pediatric training and many found pediatric patients difficult to examine and income levels low. [ABSTRACT FROM AUTHOR]

Purpose: To determine if selected client characteristics were factors influencing the provision of provider advice for diet, exercise, smoking cessation, alcohol cessation, eye and foot care, and influenza and pneumonia vaccine for those told by a provider that they had diabetes. Data sources: Data from the 2001 National Health Interview Survey were used in a secondary analysis to answer the research question. This study used a subsample who self-reported having provider-diagnosed diabetes; the subsample comprised 2287 unweighted subjects that, when weighted, represent 6.38% of the civilian noninstitutionalized individuals with diabetes in the United States. Conclusions: This study suggests that many patients are not receiving all the eight processes of care studied, particularly those with new onset diabetes, elders, black people, and Hispanics. Implications for practice: This study suggests that the present paradigm is not early prevention but treatment of established disease. Changes in entrenched thinking about clinical care need to be addressed. Patients with diabetes need to have an awareness that there is a standard of optimal care, and they should be encouraged to seek those who provide this care. Further, system changes may be required to address changes that are not easily made at the provider level. [ABSTRACT FROM AUTHOR]

The West Virginia Survey of Visual Health was conducted to determine the types and frequency of barriers to vision treatment experienced by persons with visual health problems and low vision in West Virginia. The study used a Random Digit Dial (RDD) sample to gather information from 1026 households. Cross-tabulation of two variables were used to classify respondents or their family members as having low vision. Among the 1026 homes surveyed, 233 households reported having at least one or more persons with vision health problems. Out of the 233 households, 57 individuals were classified as having low vision. West Virginians who report vision health problems are older and tend to rate their physical health lower compared to those with normal vision. Treatment patterns illustrate that a large number of respondents see an eye doctor on an irregular basis. Economic barriers for the vision health population appear substantial. Transportation barriers are common among the low vision population. The impact of vision health problems on people's lives is substantial causing pain and frustration. Knowledge of rehabilitation is also a major barrier to treatment. No more than 18% of the vision health population reported knowledge of low vision rehabilitation. Vision health problems are frequent in West Virginia affecting about 23% of households. Economic, transportation, and psychosocial barriers affect the patterns and type of treatment sought and services obtained among West Virginia residents with low vision problems. [ABSTRACT FROM AUTHOR]

Purpose: To validate the treatment-specific Treatment Satisfaction Survey for Intraocular Pressure (TSSIOP). Methods: Item content was developed by 4 heterogeneous patient focus groups (n = 32). Instrument validation involved 250 patients on ocular hypotensive medications recruited from ophthalmology practices in the Southern USA. Participants responded to demographic and test questions during a clinic visit. Standard psychometric analyses were performed on the resulting data. Sample: Of the 412 patients screened, 253 consented to participate, and 250 provided complete datasets. The sample included 44% male (n = 109), 44% Black (n = 109) and 57% brown eyed (n = 142) participants, with a mean age of 64.6 years (SD 13.1) and a history of elevated IOP for an average of 8.4 yrs (SD 7.8). A majority was receiving monotherapy (60%, n = 151). Results: A PC Factor analysis (w/ varimax rotation) of the 31 items yielded 5 factors (Eigenvalues > 1.0) explaining 70% of the total variance. Weaker and conceptually redundant items were removed and the remaining 15 items reanalyzed. The satisfaction factors were; Eye Irritation (EI; 4 items), Convenience of Use (CofU; 3 items), Ease of Use (EofU; 3 items), Hyperemia (HYP; 3 items), and Medication Effectiveness (EFF; 2 items). Chronbach's Alphas ranged from .80 to .86. Greater distributional skew was found for less common experiences (i.e., HYP & EI with 65% & 48.4% ceilings) than for more common experiences (i.e., EofU, CofU, EFF with 10.8%, 20.8% & 15.9% ceilings). TSS-IOP scales converged with conceptually related scales on a previously validated measure of treatment satisfaction, the TSQM (r = .36 to .77). Evidence of concurrent criterion-related validity was found. Patients' symptomatic ratings of eye irritation, hyperemia and difficulties using the medication correlated with satisfaction on these dimensions (r = .30-.56, all p < .001). Clinicians' ratings of IOP control, severity of side effects and problematic medication use correlated with patients' satisfaction scores on these dimensions (r = .13-.26, all p < .01). Conclusions: This study provides initial evidence that the TSS-IOP is a reliable and valid measure, assessing patients' satisfaction with ocular hypotensive medications. [ABSTRACT FROM AUTHOR]

The recent burst of activity in eye disease epidemiology, occasioned by increases in the number of ophthalmologists with training in epidemiology and of epidemiologists interested in eye diseases, makes this an appropriate time for taking stock of methodological problems in this field. In this review, based largely on the author's personal encounter with five large epidemiologic studies (2, 7, 19, 30, 39) of the four major chronic eye diseases (senile cataract, senile macular degeneration, diabetic retinopathy, and glaucoma), the following methodological areas are discussed: quality assurance; disease definitions and classifications; reproducibility of observations; visual acuity and visual field tests; needed technologic advances; study design of case-control studies and clinical trials; and data analysis (shall we count subjects or eyes?). The chief weakness of blindness registers has been inadequate evaluation of the extent of underregistration and of the variability of underregistration according to socioeconomic and racial subgroups. The Health and Nutrition Examination Survey (HANES), conducted by the United States Public Health Service, is a potentially valuable source of descriptive and analytic epidemiologic information on eye diseases. It is an examination of a large probability sample of the US population and includes various histories, clinical and laboratory examinations, and a nutrition interview. In the early 1970s, HANES included eye examinations, but these were curtailed because of inability to get ophthalmologists as examiners. In future HANES studies, efforts should be made to minimize the involvement of ophthalmologists in the eye examinations and to increase the use of nonophthalmologists (e.g., optometrists, technicians) and instruments (e.g., cameras, densitometers, automated perimeters). The validity and reliability of any new procedures will need to be determined. Studies may need to be limited to certain major eye diseases and conditions. Population glaucoma surveys have tended to omit partially or entirely the time-consuming visual field test. Yet, without this test, the diagnostic examination for glaucoma is incomplete. The automated perimeter, with which visual fields can be more quickly measured, promises to be an important screening tool for glaucoma prevalence and case-finding surveys. It should be field-tested for epidemiologic use. The absence of standardized disease definitions, without which comparisons between studies are uncertain, has been a handicap to epidemiologic research in eye disease. A first constructive step toward the development of disease definitions would be the development of disease classifications.(ABSTRACT TRUNCATED AT 400 WORDS) [ABSTRACT FROM AUTHOR]

The article identifies communities, corporations and organizations which have adopted domestic partnership policies. Like many institutions, the American family has been subjected to numerous social and economic pressures that have not only had an impact on its basic structure but have also called into question its general definition. In an effort to keep pace with these changing demographics, particularly with respect to living arrangements, the United States Bureau of the Census revised its survey questionnaire in 1990. For the first time in American history, the Bureau permitted couples of the same or opposite sex to distinguish themselves from those who are not intimately involved. With a rise in cohabitation as a lifestyle, along with a greater acceptance of it by society as a whole, it is not surprising that the rights of so-called spousal equivalents have had to be classified more frequently before the courts. Because very little research has been conducted on domestic partnership laws to date, and because this concept may become a policy trend of the future, an exploratory research project was undertaken to examine the issue in greater detail.

The article presents information on the increasing prevalence of type 2 diabetes mellitus among young adults in the U.S. and highlights the increasing prevalence of visual impairment in the country. It reports that the prevalence of nonrefractive visual impairment increased by 21 percent between 1999 to 2008 and reports that surveys have highlighted that diabetes increases the risk of nonrefractive visual impairment. A study points out that an increasing incidence of type 2 diabetes contributes to visual impairment in younger people and reports the implication of visual impairment including increasing the health care costs.

Purpose: To assess the current burden of ocular toxocariasis (OT) and to gain knowledge regarding the diagnostic and treatment practices used in the ophthalmologic community in the United States. Design: Web-based, cross-sectional survey. Participants: Subspecialty ophthalmologists who are currently practicing in the United States. Methods: An electronic survey was sent to 3020 ophthalmologic subspecialists belonging to the American Uveitis Society (AUS), the American Society of Retina Specialists (ASRS), or the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) to capture demographic, clinical, diagnostic, and treatment data on patients with OT seen in their practices between September 2009 and September 2010. Main Outcome Measures: The demographic, epidemiologic, and clinical characteristics of each reported patient with OT. Results: A total of 159 patients with OT were reported by 559 respondents (19%). The median patient age was 11.5 years (range, 1–66 years). Seventy-two patients (45%) with OT lived in the Southern region of the United States. Thirty-one (69%) of 45 patients with OT owned a dog or cat. Vision loss was reported in 46 (85%) of 54 patients with OT; 32 (71%) of 45 patients had permanent vision loss, 13 patients (29%) had temporary vision loss, and duration of vision loss was unreported for 1 patient. Of the 32 patients with OT with permanent vision loss, 30 (94%) had a subretinal granulomatous mass/scar, peripheral granuloma with traction bands, or posterior pole granuloma noted on ophthalmologic examination. Subretinal granulomatous mass/scar, vitritis, and scotoma were the most common ophthalmologic signs found on examination of patients with OT. Conclusions: Ocular toxocariasis continues to occur in the United States, where it affects mainly children and causes permanent vision loss in many patients. Healthcare professionals should counsel patients and their family members about prevention strategies in an effort to decrease infection rates and morbidity due to Toxocara. Further improvement of diagnostic and treatment tools is needed to assist ophthalmologists in treating patients with OT. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]