| 17811. |
- Hernández-Moreno, Laura, et al.
(författare)
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The Basic VRS-Effect Study : Clinical Trial Outcomes and Cost-Effectiveness of Low Vision Rehabilitation in Portugal
- 2023
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Ingår i: Ophthalmology and Therapy. - : Springer. - 2193-8245 .- 2193-6528. ; 12, s. 307-323
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was twofold: (1) to investigate the clinical impact of vision rehabilitation in patients with vision impairment and (2) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal.MethodsThe trial recruited patients diagnosed with age-related macular degeneration or diabetic retinopathy (DR) and visual acuity in the range 0.4–1.0logMAR in the better-seeing eye. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality of life and costs were measured. Economic analysis was performed to evaluate whether the intervention was cost-effective. The trial compared the outcomes 12 weeks after the start in both arms.ResultsOf the 46 participants, 34 (74%) were diagnosed with DR, 25 (54%) were female, and mean age was 70.08 years (SD = 8.74). In the immediate intervention arm visual ability increased a mean of 0.523 logits (SE = 0.11) (p < 0.001). Changes in the delayed intervention arm were not statistically significant (p = 0.95). Acuity in the better-seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was €118.79 (SD = 24.37). The incremental cost-effectiveness ratio using the EQ-5D-5L was 30,421€/QALY and 1186€/QALY when using near acuity.ConclusionThe current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and shows that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services.Trial RegistrationRetrospectively registered, 21/01/2019. ISRCTN10894889, https://www.isrctn.com/ISRCTN10894889
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| 17812. |
- Hernández-Moreno, Laura, et al.
(författare)
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The Portuguese version of the activity inventory
- 2015
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 56:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To characterize interventions needed by the population with visual impairment or to assess interventions in vision rehabilitation validated and standardized instruments used in different cultural contexts are necessary. The aim of this work was to characterize the functional status of a sample of people with visual impairment with the Portuguese version of the activity inventory (AI)Methods: A group of participants in the study Prevalence and Costs of Visual Impairment in Portugal (PC-VIP) was recruit to face-to-face interviews and the activity inventory was administered. The AI examines 50 goals split between three objectives: social functioning, recreation and daily living. Goals rated ‘not important’ were skipped, but for all other goals the participant was asked to rate its difficulty on a five point scale ranging from ‘not difficult’ to ‘impossible without help’. The difficulty responses were Rasch analysed (Winsteps v3.81.0) to produce a continuous measure of visual ability (AI score). Additional information about distance and near visual acuity (ETDRS scale), contrast sensitivity (MARS test) and critical print size (MNREAD test) was collected.Results: A total of 94 persons participated in this study. Some participants were not able to read or recognize letters due to their poor vision or poor literacy and were excluded from further analysis. Data reported here are from 62 participants, median age 63y (range=12-85) and the most common cause of visual impairment were retinal diseases. Mean presenting acuity in the better eye was 0.93logMAR (SD=0.5). The mean difficulty (item measure) in the AI was -0.33 logits (SD=0.96). The most difficult items were "sew or do needlework", "read the newspaper", "drive" and the easiest items were "provide care for a pet", "eat your meals", "use the restroom in a public place". The mean ability score (person measures) was 1.11 logits (SD=2.04). The ability measures in the AI were correlated with distance visual acuity (r=-0.57, p<.001), near visual acuity (r=-0.66, p<0.001), contrast sensitivity (r=0.62, p<.001) and critical print size (r=-0.60, p<.001).Conclusions: Our results indicate that the AI scores in a sample of people Portuguese people with visual impairment were in line with what has been found in other cultural contexts. The visual ability measured by the AI was correlated with visual function assessed by different visual tests, which shows that this instrument can be used with confidence.
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| 17813. |
- Hernández-Yumar, Aránzazu, et al.
(författare)
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Impact of the Economic Crisis on Body Mass Index in Spain : An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective
- 2023
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Ingår i: Population Research and Policy Review. - : Springer. - 0167-5923 .- 1573-7829. ; 42:4
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Tidskriftsartikel (refereegranskat)abstract
- The Great Recession hit Spain deteriorating the living conditions of many Spanish people, increasing the prevalence of several chronic health issues, including obesity, and affecting health inequalities. We analyse the impact of this economic crisis on body mass index (BMI) disparities in Spain, from two perspectives: the socioeconomic and the territorial, through the application of an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. We use data from the Spanish National Health Surveys of 2006/2007, 2011/2012 and 2016/2017 to build multilevel linear regression models and estimate BMI averages and components of variance. We find a greater increase in the overall average BMI and a widening of the socioeconomic disparities during the hardest years of the crisis. However, these differences decreased when the economic situation in the country began to improve. Both socioeconomic and geographical information contribute to mapping the distribution of BMI in the population. However, according to the ICC values, considering the regional perspective provides a better understanding of the distribution of the BMI, during the period of economic crisis, in the Spanish population. Therefore, regional policies can play an important role in counteracting obesity in times of crisis.
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| 17814. |
- Hernández Yumar, Aranzazu, et al.
(författare)
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Socioeconomic differences in body mass index in Spain : An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy
- 2018
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Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.
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| 17815. |
- Herndl, Gerhard J., et al.
(författare)
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Regulation of aquatic microbial processes: the ‘microbial loop’ of the sunlit surface waters and the dark ocean dissected
- 2008
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Ingår i: Aquatic Microbial Ecology. - : Inter-Research Science Center. - 0948-3055 .- 1616-1564. ; 53:Sp. Iss. 1, s. 59-68
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Tidskriftsartikel (refereegranskat)abstract
- Our understanding of microbial food web interactions in the ocean is essentially based on research performed in the euphotic layer, where the interactions between phytoplankton and prokaryotic plankton, mainly heterotrophic Bacteria, are well established. In the euphotic layer, particularly in meso- and eutrophic waters, prokaryotic plankton are mainly top-down controlled by bacterivorous flagellates and viruses, affecting metabolically active, fast growing populations more than dormant stages. In the meso- and bathypelagic realm of the ocean, however, prokaryotic plankton are thought to be mainly bottom-up controlled, because the heterotrophic component of the prokaryotic community is limited by the availability of organic carbon. However, deep-water prokaryotes exhibit a number of peculiarities compared to prokaryotes in the euphotic layer, among which are a large genome size and a gene repertoire indicative of a predominately surface-attached mode of life. This indicates that deep-water prokaryotic activity might be primarily associated with particles. Our present knowledge indicates that the microbial communities and their interactions in the deep ocean are likely very different from those known from surface waters. Increasing efforts to shed light on the microbial biota of the ocean's interior will likely lead to the discovery of novel metabolic pathways in prokaryotes and to the resolution of the current discrepancy between the geochemical evidence of remineralization rates of organic matter and actual measurements.
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| 17816. |
- Herrera Jiménez, María, et al.
(författare)
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Ethical profiles in the Spanish and Swedish Emergency Medical Services
- 2013
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Ingår i: Prehospital vård för att värma om patientens hälsa.
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Konferensbidrag (refereegranskat)abstract
- The ambulance crew faces in their daily work different kinds of ethical problems, such as conflicts between ethical values and standards that are critical for the health care. This gives a complexity of the situations and becomes a constant challenge in the care practice for these professionals. Sandman and Nordmark (2006) describe that decision-making in this area of care often creates high pressure and discomfort among the ambulance personnel. Adams, Arnold, Siminoff and Wolfson (1992) identified ethical conflicts in 14.4% of the alerts made by the ambulance crews. In Sweden, Sandman and Nordmark (2006) found ethical conflicts in out-of-hospital care regarding the care relationship, the patient’s autonomy, the patient’s best interest, professional ideals, the professional role and self-identity, family members and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. In Spain, Jiménez (2009) presented some ethical problems that arouse during CPR, pain relief, death and in situations when the right to autonomy was at stake. None of these studies are presenting tools for mapping or help for understand the different situation. The ethical value profile is a help to create tools for mapping and understanding. The first part of this project aims to translate, adapt and test a previous used instrument to map the ethical profile among ambulance crew in Spain and Sweden and in a pilot compare ethical values among the professionals. Result: The Managerial Value Profile (MVP) was translated from English to Swedish and Spanish. The translation was made forward and backward and then subjected to a psychometric test. To adapt the questions in regard to cultural aspects a pilot study was made in both countries (Sweden n=26, Spain n=20). In the pilot we found that ambulance personnel in Sweden and Spain tended to stress the value of individual rights and partly social justice while an utilitaristic approach was regarded as less important. On three items we found a huge difference between the two groups. In those items the Spanish professionals tended to consider social justice more often than the Swedish ambulance personnel that considered individual rights.
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| 17817. |
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| 17818. |
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| 17819. |
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| 17820. |
- Herrlin, Katarina
(författare)
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Evaluering
- 2007
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Ingår i: Evaluering.
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Konferensbidrag (populärvet., debatt m.m.)
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