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Purpose: To develop a nomogram for improving the accuracy of intraocular lens (IOL) power calculation at the time of cataract surgery based on the manifest refraction spherical equivalent (MRSE) change produced by laser in situ keratomileusis (LASIK). Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angeles, California, USA. Methods: This was a retrospective review of the records of consecutive patients who had cataract surgery after LASIK. Spherical equivalent refractive data before and after LASIK and cataract surgery were recorded. The differences between the targeted postoperative refractive errors after cataract surgery and the achieved refractive errors were plotted against the LASIK-induced MRSE change, yielding postoperative refractive errors to target during IOL power calculation to achieve emmetropia. Results: Thirty-two eyes of 23 patients were identified; 25 eyes had myopic LASIK and 7, hyperopic LASIK. Regression analysis yielded the following polynomial relationship: target postoperative refractive error (D) to achieve emmetropia during IOL power calculation = −0.018(MRSE Change)2 + 0.192(MRSE Change) − 0.062. The outcomes in 97% of eyes fell within ±1.00 D of the value predicted by this formula. Conclusions: A 2nd-order polynomial relationship was found between LASIK-induced MRSE change and the MRSE error after cataract surgery. From this equation, a simple adjustment nomogram was generated and put into a look-up table format. The formula and nomogram should improve IOL power calculation accuracy in post-LASIK eyes when the MRSE change is known. [Copyright &y& Elsevier]

OBJECTIVES: To evaluate the benefit of eyeglasses and magnifiers in elderly patients with uncorrected refractive errors. DESIGN: A single-center, randomized, prospective, controlled trial (September 2001 to August 2003). SETTING: Los Angeles County, California. PARTICIPANTS: One hundred thirty-one community-dwelling persons aged 65 and older who had habitual distance visual acuity of 20/32 or worse and whose distant visual acuity, near visual acuity, or both could be improved with eyeglasses, a magnifier, or both by two lines of acuity or more. INTERVENTION: Sixty-six were randomized to receive a prescription and voucher for free eyeglasses, a magnifier, or both immediately, and 65 were randomized to receive a prescription and voucher after the 3-month follow-up visit (the control group). MEASUREMENTS: Primary outcome was vision-specific functioning as measured using the 25-item National Eye Institute—Visual Functioning Questionnaire (NEI-VFQ). Secondary outcomes were distance and near visual acuity and overall functioning as measured using the Rosow-Breslau function questionnaire. RESULTS: In the intention-to-treat analysis of 3-month follow-up data, participants who received the eyeglasses prescription and voucher immediately had greater improvement in NEI-VFQ composite scores than the control group ( P<.01). They also had greater improvement in perceptions of their general vision ( P<.01), distance visual acuity ( P=.03), near visual acuity ( P=.04), and mental health ( P=.02). CONCLUSION: Correction of uncorrected refractive error, one of the leading causes of visual impairment in older people, improved the vision-specific quality of life of community-dwelling older persons. [ABSTRACT FROM AUTHOR]

In a randomized clinical trial to assess the effectiveness of different strategies for treating low-back pain in a managed-care setting, 681 adult patients presenting with low-back pain were randomized to four treatment groups: medical care with and without physical therapy; and chiropractic care with and without physical modalities. Follow-up information was obtained by questionnaires at two and six weeks, six, 12 and 18 months and by a telephone interview at four weeks. One outcome measurement at each follow-up is the patient's self-report on the perception of low-back pain improvement from the previous survey, recorded as 'A lot better,' 'A little better,' 'About the same' and 'Worse.' Since the patient's perception of improvement may be influenced by past experience, the outcome is analysed using a transition (first-order Markov) model. Although one could collapse categories to the point that logistic regression analysis with repeated measurements could be used, here we allow for multiple categories by relating transition probabilities to covariates and previous outcomes through a polytomous logistic regression model with Markov structure. This approach allows us to assess not only the effects of treatment assignment and baseline characteristics but also the effects of past outcomes in analysing longitudinal categorical data. [ABSTRACT FROM AUTHOR]

Evaluates the effect of carbon monoxide (CO) exposures during the last trimester of pregnancy on birth weight among neonates born between 1989-1993 to women living in the Los Angeles, California area. Increased incidence of low birth weight infants in areas with high levels of ambient CO: Mean birth weight; Confounding factors.

Background: A number of epidemiologic studies with a variety of exposure assessment approaches have implicated pesticides as risk factors for childhood cancers. Here we explore the association of pesticide exposure in pregnancy and early childhood with childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) utilizing land use and pesticide use data in a sophisticated GIS tool.Methods: We identified cancer cases less than 6 years of age from the California Cancer Registry and cancer-free controls from birth certificates. Analyses were restricted to those living in rural areas and born 1998-2011, resulting in 162 cases of childhood leukemia and 9,805 controls. Possible carcinogens were selected from the Environmental Protection Agency's classifications and pesticide use was collected from the California Department of Pesticide Regulation's (CDPR) Pesticide Use Reporting (PUR) system and linked to land-use surveys. Exposures for subjects were assessed using a 4000m buffer around the geocoded residential addresses at birth. Unconditional logistic and hierarchical regression models were used to assess individual pesticide and pesticide class associations.Results: We observed elevated risks for ALL with exposure to any carcinogenic pesticide (adjusted Odds Ratio (aOR): 2.83, 95% CI: 1.67-4.82), diuron (Single-pesticide model, adjusted (OR): 2.38, 95% CI: 1.57-3.60), phosmet (OR: 2.10, 95% CI: 1.46-3.02), kresoxim-methyl (OR: 1.77, 95% CI: 1.14-2.75), and propanil (OR: 2.58, 95% CI: 1.44-4.63). Analyses based on chemical classes showed elevated risks for the group of 2,6-dinitroanilines (OR: 2.50, 95% CI: 1.56-3.99), anilides (OR: 2.16, 95% CI: 1.38-3.36), and ureas (OR: 2.18, 95% CI: 1.42-3.34).Conclusion: Our findings suggest that in rural areas of California exposure to certain pesticides or pesticide classes during pregnancy due to residential proximity to agricultural applications may increase the risk of childhood ALL and AML. Future studies into the mechanisms of carcinogenicity of these pesticides may be beneficial. [ABSTRACT FROM AUTHOR]

Objectives: To examine (a) the influence of primary language on the receipt of influenza and pneumococcal immunizations and (b) the feasibility of being immunized in a nontraditional setting. Method: The population was multiethnic, linguistically diverse, community-dwelling, low income, older adults in California. Face-to-face interviews were conducted with 164 participants (response rate 82%). Questions from BRFSS and CHIS were used.The questionnaire was implemented in six languages. Results: Influenza vaccination within the past 12 months was reported by 75.3%, but only 50.6% reported ever receiving the pneumococcal vaccine. Immunization predictors: Influenza—insurance through MediMedi, rating one's health as excellent/good, living with another person, and English as a primary language; pneumococcal—insurance through MediMedi and English as a primary language. Majority were willing to be immunized in nontraditional setting, especially those with limited English proficiency. Discussion: Need exists for cultural and linguistically appropriate immunization outreach methods for older adults and practitioners. [ABSTRACT FROM AUTHOR]