Biomedical subjects

Joanne Wu

Publications and source records attributed to Joanne Wu.

10 recordsLinked to original sources

PubMed2006

Impact of severity and bilaterality of visual impairment on health-related quality of life.

OBJECTIVE: To assess the impact of unilateral and bilateral visual impairment (VI) and its severity on health-related quality of life (HRQOL) in Latinos 40 years and older. DESIGN: A cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES). PARTICIPANTS: Five thousand three hundred seventy-seven LALES participants. METHODS: Health-related quality of life was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). Visual acuity (VA) was measured by a standardized protocol. Based on the presenting VA, VI was classified as unilateral or bilateral impairment and as either mild (20/40-20/63) or moderate/severe (20/80 or worse). MAIN OUTCOME MEASURES: National Eye Institute VFQ-25 and SF-12 composite and subscale scores. RESULTS: The NEI VFQ mean composite score decreased from no VI (86) to bilateral moderate/severe VI (66) (P<0.006). Relative to participants with no VI, those with unilateral or bilateral VI at any severity level had significantly lower NEI VFQ-25 scores for 10 of the 12 subscales (P<0.05). The largest mean score differences between participants with and without VI were observed for subscales related to driving difficulties (42.5 points), vision-related dependency (29.1 points), distance vision (27.0 points), and vision-related mental health (24.5 points). No differences in SF-12 scores were found between participants with and without VI (P>0.05). CONCLUSION: Relative to persons with no VI, persons with bilateral mild and unilateral or bilateral moderate/severe VI report greater difficulties in performing most vision-dependent daily activities and experience vision-related dependency and poorer vision-related mental health. Because most visual function subscale scores were significantly lower in persons with bilateral mild and/or unilateral/bilateral moderate/severe VI, health care providers should consider intervention in these persons. Our findings provide further insight into the relationship between severity level, bilaterality of VI, and self-reported visual function. These data can be used to refine the determination of visual disability in persons with VI.

Adult↗

PubMed2006

Noncompliance with vision care guidelines in Latinos with type 2 diabetes mellitus: the Los Angeles Latino Eye Study.

OBJECTIVE: To determine the prevalence of and personal factors associated with noncompliance with American Diabetes Association (ADA) guidelines for vision care in a population-based sample of adult Latinos with type 2 diabetes mellitus (T2DM). DESIGN: Population-based cross-sectional study. PARTICIPANTS: Eight hundred twenty-one Los Angeles Latino Eye Study (LALES) participants with a history of T2DM and a history of treatment for T2DM. METHODS: Detailed interviews, physical examinations, and dilated eye examinations were performed on all participants. Interviews assessed sociodemographic factors, history of diabetes and eye disease, and utilization of health and eye care services. All participants with a self-reported history and treatment of diabetes were asked about health and vision care utilization and diabetes self-care. MAIN OUTCOME MEASURE: Compliance with ADA guidelines for vision care. Noncompliance was defined as having had no dilated eye examination in the previous 12 months. Logistic regression analyses were used to identify personal factors associated with noncompliance. RESULTS: Of 821 individuals who self-reported having T2DM and being on treatment for T2DM, 535 (65%) had not complied with ADA vision guidelines for persons with T2DM. When compared with those with T2DM who complied with ADA guidelines, noncompliers were more likely to be less educated (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.2), to lack health insurance (OR, 2.5; 95% CI, 1.7-3.7), to have had no routine physical examination in the 12 months before the LALES examination (OR, 1.8; 95% CI, 1.3-2.5), and to have a glycosylated hemoglobin level > or = 9.0% (OR, 1.7; 95% CI, 1.1-2.6). CONCLUSIONS: Because timely and appropriate vision care can delay the onset of ocular morbidity, visual impairment, and blindness associated with diabetic retinopathy, our data suggest the need to evaluate intervention programs aimed at a targeted group of Latinos with T2DM--those who have less than a high school education, lack health insurance, have had no routine physical examination in the previous year, and have poorly controlled T2DM.

Aged↗

PubMed2006

Smoking, alcohol intake, estrogen use, and age-related macular degeneration in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To assess the association between smoking, alcohol intake, estrogen use, and both early age-related macular degeneration (AMD) (soft indistinct drusen, retinal pigment abnormalities) and advanced AMD (exudative AMD, geographic atrophy) in the Latino community. DESIGN: Population-based, cross-sectional study. METHODS: Complete ophthalmic examination included stereoscopic macular photographs graded with a modified Wisconsin Age-related Maculopathy Grading System. A history of smoking, alcohol intake, and exogenous estrogen use was obtained by interview. Logistic regression was performed, and odds ratios (OR) were calculated with each AMD lesion as a dependent variable. RESULTS: There were 5875 participants (92.4%) with gradable photographs. Having ever smoked was associated with a higher risk of having advanced AMD (OR, 2.4). Heavy consumption of alcohol (>5 drinks per session) was significantly associated with a greater risk of having exudative AMD (OR, 5.8) and geographic atrophy (OR, 12.7) Beer drinking was associated with a higher risk of having advanced AMD (OR, 2.9), whereas wine drinking appeared to be protective for increased retinal pigment (OR, 0.7). Exogenous estrogen use also appeared to be protective from soft indistinct drusen (OR, 0.5) and increased retinal pigment (OR, 0.6), but power was limited in the assessment of its association with advanced AMD. CONCLUSION: Smoking and heavy alcohol consumption, particularly beer, was associated with a greater risk of having advanced AMD; exogenous estrogen use appeared to have a weak protective effect in Latino participants. Similar modifiable risk factors have been identified previously in non-Hispanic white patients, which suggests that common pathogenic mechanisms may be associated with AMD in persons of different ethnicities.

Adult↗

PubMed2005

Self-reported comorbidities and visual function in a population-based study: the Los Angeles Latino Eye Study.

OBJECTIVE: To assess the association of self-reported systemic and ocular comorbid disease and visual function in Latino subjects. METHODS: National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25) and eye examination data were obtained from 5380 participants in the Los Angeles Latino Eye Study, a population-based prevalence study of eye disease in Latino subjects 40 years and older. We developed and contrasted 5 comorbidity measures. One-way analysis of variance was used to assess the association between comorbidity and visual impairment and self-reported visual function. Regression analyses determined the association of sociodemographic variables, clinical variables, and the best measure of comorbidity with the NEI-VFQ-25 composite score. The main outcome measure was self-reported visual function as assessed by the NEI-VFQ-25 composite score. RESULTS: On average, visual function subscale scores were lowest for those participants with the most systemic comorbid conditions (P<.05). This was more evident in participants with moderate or severe visual impairment compared with those with mild or no visual impairment (P<.05). CONCLUSIONS: Self-reported systemic comorbidities were associated with self-reported visual function. This association was greater at more severe levels of visual impairment. Of the 5 comorbidity measures assessed, the measure that summed the number of self-reported systemic comorbidities correlated most with self-reported visual function.

Adult↗

PubMed2005

Sociodemographic factors and age-related macular degeneration in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To assess the association of various sociodemographic factors and early and advanced (geographic atrophy, exudative) age-related macular degeneration (AMD) in Latinos. DESIGN: Population-based, cross-sectional study METHODS: The study population included Latinos (primarily Mexican-American) aged 40 years and older living in La Puente, California. Sociodemographic factors, obtained from an interviewer-administered questionnaire, included age, sex, Native American ancestry, acculturation, country of birth, employment, income, marital status, health insurance, and education level. All participants underwent complete ophthalmic examination. AMD was diagnosed from stereoscopic macular photographs. Univariate and multivariable logistic regression was used to assess associations between sociodemographic factors and AMD. RESULTS: Gradable retinal photographs from 5875 participants were included. Mean participant age was 54.9 years, 42% were male, and 5% had Native American ancestry. Stepwise logistic regression analyses indicated that age, sex, and being born in the United States were associated with early AMD (odds ratio [OR] = 1.8, 1.8, and 0.80, respectively). Native American ancestry was the associated with any advanced AMD and geographic atrophy (OR = 3.8 and 16.4, respectively). Family history of AMD was also associated with geographic atrophy (OR = 28.1). Acculturation was not associated with AMD. CONCLUSION: Independent risk indicators for the various types of AMD include older age, male sex, being born outside of the United States, Native American ancestry, and a family history of AMD. These risk factors were independent of other possible behavioral factors such as smoking and alcohol consumption.

Adult↗

PubMed2004

The impact of visual impairment on self-reported visual functioning in Latinos: The Los Angeles Latino Eye Study.

OBJECTIVE: To assess the association between presenting binocular visual acuity (VA) and self-reported visual function as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). DESIGN: A population-based, prevalence study of eye disease in Latinos 40 years and older residing in La Puente, California (Los Angeles Latino Eye Study [LALES]). PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in La Puente. METHODS: All participants completed a standardized interview, including the NEI-VFQ-25 to measure visual functioning, and a detailed eye examination. Two definitions of visual impairment were used: (1) presenting binocular distance VA of 20/40 or worse and (2) presenting binocular distance VA worse than 20/40. Analysis of variance was used to determine any systematic differences in mean NEI-VFQ-25 scores by visual impairment. Regression analyses were completed (1) to determine the association of age, gender, number of systemic comorbidities, depression, and VA with self-reported visual function and (2) to estimate a visual impairment-related difference for each subscale based on differences in VA. MAIN OUTCOME MEASURES: The NEI-VFQ-25 scores in persons with visual impairment. RESULTS: Of the 5287 LALES participants with complete NEI-VFQ-25 data, 6.3% (including 20/40) and 4.2% (excluding 20/40) were visually impaired. In the visually impaired participants, the NEI-VFQ-25 subscale scores ranged from 46.2 (General Health) to 93.8 (Color Vision). In the regression model, only VA, depression, and number of comorbidities were significantly associated with all subscale scores (R(2) ranged from 0.09 for Ocular Pain to 0.33 for the composite score). For 9 of 11 subscales, a 5-point change was equivalent to a 1- or 2-line difference in VA. Relationships were similar regardless of the definition of visual impairment. CONCLUSION: In this population-based study of Latinos, the NEI-VFQ-25 was sensitive to differences in VA. A 5-point difference on the NEI-VFQ-25 seems to be a minimal criterion for a visual impairment-related difference. Self-reported visual function is essentially unchanged if the definition of visual impairment includes or excludes a VA of 20/40.

Adult↗

PubMed2004

Mapping the SF-12 to the HUI3 and VAS in a managed care population.

BACKGROUND: Transforming generic health-related quality of life (HRQOL) instruments to a summary utility index is useful for deriving quality-adjusted life years (QALY) in any cost/QALY analysis. OBJECTIVE: The purpose of this study was to investigate the role of the SF-12 in predicting utility scores derived from Health Utility Index (HUI3) and Visual Analog Scale (VAS). METHOD: Data were obtained from a survey of 6923 managed care patients in the United States, aged 18 to 93 years, selected by strata of medication usage (at least 1 medication in target year, 5 or more medications, target medications, and both). The SF-12 was used to assess self-reported HRQOL. Utility was measured by the HUI3 and a VAS. The SF-12 items were used to predict HUI3 and VAS scores using ordinary least square regressions, with sociodemographic covariates. A second model entered each SF-12 item as categorized responses. A third model used the Physical Composite and Mental Composite scores to predict HUI3 and VAS scores. RESULTS: The SF-12 items and sociodemographic covariates accounted for 35% to 55% of the variations in HUI3 and VAS scores, respectively. Age and most SF-12 items were significantly (P < 0.0001) associated with both utility scores in all 3 models. CONCLUSIONS: This research provides support that an algorithm can be derived from the SF-12 to estimate utility scores based on the HUI3 and VAS for studies in populations where utility has not or cannot be measured directly.

Adolescent↗

PubMed2004

Compliance with recommendations for follow-up care in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To determine rates of follow-up eye and health care in the Los Angeles Latino Eye Study (LALES), a population-based sample of Latinos. METHODS: Participants received a complete ophthalmic examination and were referred to a local healthcare provider for follow-up care, if ocular or systemic disease was found. Participants receiving referrals were later contacted by telephone and interviewed in their language of choice (English or Spanish) by a trained bilingual interviewer, to determine follow-up rates, and to discuss the barriers preventing follow-up care. RESULTS: Of 430 referred participants, 335 (78%) completed the follow-up survey; 278 (68%) of the responders obtained follow-up care. Among the 108 (32%) individuals who did not seek follow-up care, 54 (50%) cited cost of care as the main reason, while 30 (28%) indicated a lack of knowledge as to where to go for care, and 18 (17%) indicated the unavailability of health care. Logistic regression analyses (controlling for acculturation, co-morbid conditions, and patients' prior knowledge of their diagnoses) revealed that participants with insurance coverage, diagnosis with a systemic disease, and higher educational level were more likely to have received follow-up care. CONCLUSION: More than two thirds of the participants reported seeking the recommended follow-up care. Although cost, availability of services, and convenience of accessing care were found to be major barriers to obtaining health care, higher education, insurance coverage, and prior knowledge of the disease, were associated with receiving recommended care. Knowledge of barriers to seeking health care is important when developing community based healthcare programs directed toward the Latino population.

Acculturation↗

PubMed2003

Relationship between self-reported depression and self-reported visual function in Latinos.

OBJECTIVE: To validate and assess the relationship between self-reported depression as measured by a single item on the Medical Outcomes Study Short-Form 12 (SF-12) and self-reported visual function. METHODS: The Los Angeles Latino Eye Study is population-based and designed to assess the prevalence of visual impairment, ocular disease, and visual functioning in Latinos. Both the 25-item National Eye Institute-Visual Function Questionnaire (NEI VFQ-25) (self-reported visual function) and the SF-12 (health-related quality of life) were administered. A single item from the SF-12 was used to measure self-reported depression and validated against the Center for Epidemiologic Studies-Depression measure of depression. Covariate-adjusted NEI VFQ-25 subscale scores were contrasted across the 6 response choices of the SF-12, as well as across 3 combined response categories of the SF-12 using analysis of covariance. Covariate-adjusted regression analyses assessed the contribution of self-reported depression in explaining self-reported visual function. RESULTS: The sensitivity and specificity of the SF-12 single item with the Center for Epidemiologic Studies-Depression measure was 0.96 and 0.50, respectively. Using the 3 combined response categories of the SF-12 single item, it was found that (1) all covariate-adjusted subscales of the NEI VFQ-25 were statistically significantly different across the self-reported depression categories (P<.001) and (2) covariate-adjusted self-reported depression was a significant predictor of self-reported visual function (P<.001). CONCLUSIONS: A single SF-12 item may be used as a measure of self-reported depression. In addition, self-reported depression is an important covariate to consider when assessing self-reported visual function in Latinos.

Adult↗

PubMedDate not supplied

Copper deficiency as cause of unexplained hematologic and neurologic deficits in patient with prior gastrointestinal surgery.

Copper is a trace mineral essential to hematopoiesis and to the structure and function of the nervous system. Copper deficiency is a rare cause of anemia, leukopenia, and myeloneuropathy, but should be considered in the differential diagnosis in a patient with prior gastrointestinal surgery. We report the case of a 51-year-old woman admitted for nonspecific neurologic symptoms ultimately found to be due to copper malabsorption.

Copper↗