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PubMed2000

Medicaid and indigent care issue brief: youth access to tobacco.

Tobacco use is the single leading preventable cause of death in the United States. Annually, tobacco causes more than 430,000 deaths and costs the nation approximately $50 billion - $73 billion in medical expenses alone. Smoking among American adolescents increased 78 percent between 1988 and 1996. Each day, more than 6,000 youth under age 18 try their first cigarette, and more than 3,000 become daily smokers. State legislatures currently are pursuing a wide range of legislative proposals that are designed to limit youth access to tobacco products and to ensure that their state laws comply with current federal requirements. State laws vary in their approach, and are unevenly enforced. Until recently, current laws did not penalize minors for using or possessing tobacco; instead, punishment focused on retailers. These punishments, however, have proved ineffective because retailers rarely are prosecuted for breaking these laws. This document will highlight legislative approaches since 1992, the year the federal Synar Amendment was enacted.

Adolescent↗

PubMed2000

[When is surgery needed for minimally symptomatic or asymptomatic acquired valvulopathy?].

GENERAL PRINCIPLES: The first step is to determine the absence or the minimal nature of the functional impairment from history taking and, for doubtful cases, with an exercise test. Therapeutic indications differ depending on the valvular lesion. AORTIC STENOSIS: Surgery is indicated only for severe aortic stenosis or in cases with a particular risk. Indications for surgery are: false asymptomatic patients with a positive exercise test, patients with abnormal hemodynamic and/or rhythm response to an exercise test (decrease in systolic pressure > 10 mmHg, severe ventricular arrhythmia), aortic stenosis with left ventricular ejection fraction < 50%, aortic stenosis associated with severe coronary artery disease amendable with bypass surgery. MITRAL STENOSIS: The advent of percutaneous mitral commissurotomy has totally changed the treatment of mitral stenosis. This new method can be proposed for stenotic but flexible mitral valves with no major lesion of the lower valvular apparatus or for more advanced valve disease with a risk of hemodynamic failure or thromboembolism. MITRAL INSUFFICIENCY: When mitral leakage is the only valvular defect, surgery is indicated if the volume regurgitated is important as assessed clinically and by echocardiography. Conservative surgery is preferred due to the low risk and the high probability of good long term outcome. Factors to take into account include: the experience of the surgical team in this field, the etiology of mitral insufficiency, the impact on the cardiac condition. Surgery should be performed before the development of atrial fibrillation, major cardiomegaly, left ventricular dilatation (end systolic diameter > 45 mm), or an alteration of the ejection fraction (< 60%). AORTIC INSUFFICIENCY: Cases of the aortic insufficiency should be differentiated according to the state of the ascending aorta. Annuloaortic ectasia requires surgery when the diameter reaches = 50-55 mm (depending on the authors). For valve dysplasia with non aneurysmal cylindrical dilatation of the ascending aorta, the indication for surgery depends on the progressive aggravation of the aortic dilatation. For cases with unique valve lesions, the indication for surgical repair of aortic insufficiency depends on the impact on the left ventricle. Indications for surgery include major radiographic cardiomegaly (cardio-thoracic ratio > 0.58), echocardiographic evidence of major left ventricular dilatation (end diastolic diameter > 75 mm and end systolic diameter > 55 mm), or an alteration of the systolic function (ejection fraction < 0.50 or 0.55). SPECIAL SITUATIONS: In disease states associating stenosis and insufficiency, valve replacement is often the only possibility. Careful patient selection is the rule. Surgery is often needed for cases with multiple valve involvement where different therapeutic options can be used for the different valves. The dominant lesion and the degree of heart dilatation and dysfunction guide decision making.

Age Factors↗

PubMed2005

Health economics of renal replacement therapy: perspectives from Singapore.

The prevalence of end-stage renal disease (ESRD) in Singapore is high and projected to increase sharply due to the aging population and the high prevalence of diabetes. The number of patients treated with dialysis was projected to rise from 2633 in 1999 to nearly 6000 in the year 2010. The cost of dialysis provision was estimated to increase 2.5-fold from US dollar 90 million in 1999 to US dollar 241 million in 2010. To address this, the Singapore Ministry of Health launched three initiatives in the year 2000: First, to reduce the incidence of ESRD through (1) primary prevention of diabetes, (2) community-based screening to facilitate early detection of patients with diabetes, (3) improving glycemic and blood pressure (BP) control of diabetics in the primary care setting, and (4) the establishment of dedicated Renal Retardation clinics to optimize BP control (and glycemic control for diabetics), and reduce the level of proteinuria in patients at high risk of ESRD development. Second, to increase the percentage of ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD), which is a lower-cost modality compared with hemodialysis; and third, amendments to the existing opt-out legislation for organ procurement for transplantation to increase the supply of kidneys for cadaveric renal transplant.

Humans↗

PubMed2000

Large T-antigen double hexamers imaged at the simian virus 40 origin of replication.

The initial step of simian virus 40 (SV40) DNA replication is the binding of the large tumor antigen (T-Ag) to the SV40 core origin. In the presence of Mg(2+) and ATP, T-Ag forms a double-hexamer complex covering the complete core origin. By using electron microscopy and negative staining, we visualized for the first time T-Ag double hexamers bound to the SV40 origin. Image processing of side views of these nucleoprotein complexes revealed bilobed particles 24 nm long and 8 to 12 nm wide, which indicates that the two T-Ag hexamers are oriented head to head. Taking into account all of the biochemical data known on the T-Ag-DNA interactions at the replication origin, we present a model in which the DNA passes through the inner channel of both hexamers. In addition, we describe a previously undetected structural domain of the T-Ag hexamer and thereby amend the previously published dimensions of the T-Ag hexamer. This domain we have determined to be the DNA-binding domain of T-Ag.

Antigens, Viral, Tumor↗

PubMed2006

Tolerance of transgenic canola plants (Brassica napus) amended with plant growth-promoting bacteria to flooding stress at a metal-contaminated field site.

The growth of transgenic canola (Brassica napus) expressing a gene for the enzyme 1-aminocyclopropane-1-carboxylate (ACC) deaminase was compared to non-transformed canola exposed to flooding and elevated soil Ni concentration, in situ. In addition, the ability of the plant growth-promoting bacterium Pseudomonas putida UW4, which also expresses ACC deaminase, to facilitate the growth of non-transformed and transgenic canola under the above mentioned conditions was examined. Transgenic canola and/or canola treated with P. putida UW4 had greater shoot biomass compared to non-transformed canola under low flood-stress conditions. Under high flood-stress conditions, shoot biomass was reduced and Ni accumulation was increased in all instances relative to low flood-stress conditions. This is the first field study to document the increase in plant tolerance utilizing transgenic plants and plant growth-promoting bacteria exposed to multiple stressors.

Biomass↗

PubMed1997

Phase II trial of edatrexate plus carboplatin in metastatic non-small-cell lung cancer: a Southwest Oncology Group study.

BACKGROUND: Edatrexate and carboplatin are each active single agents in the treatment of non-small-cell lung cancer (NSCLC). Preclinical studies in NSCLC lines have demonstrated schedule-dependent synergy of edatrexate followed by carboplatin. In a phase I trial, we demonstrated the tolerability of this combination, the ability of ice-chip cryotherapy to ameliorate dose-limiting mucositis, and promising activity in NSCLC. This phase II trial (SWOG 9207) was undertaken to investigate the efficacy of this regimen in stage IV NSCLC. METHODS: A total of 24 patients with stage IV disease were accrued to this Southwest Oncology Group (SWOG) multicenter study. Treatment consisted of edatrexate 80 mg/m2 (50% dose on day 8) intravenously weekly for 5 weeks, then every other week, and carboplatin 350 mg/m2 every 28 days. RESULTS: Of the 24 patients, 23 were assessable for toxicity and response; one was ineligible for study entry. Myelosuppression was the most significant toxicity; grade 3-4 neutropenia was seen in 8/23 patients. Two patients died of neutropenic sepsis during the first cycle of therapy, in both instances associated with the presence of pleural effusions. Although mild mucositis was common, it was dose-limiting (grade 3) in only three patients. Objective response was observed in 3/23 patients (13%). The median survival time was 7 months, and 30% of patients remained alive at one year. CONCLUSIONS: This study suggests that ice-chip cryotherapy is effective in reducing the severity of mucositis typically associated with this edatrexate schedule of administration. However, unexpectedly severe myelosuppression resulted in death from neutropenic sepsis in two patients with third space fluid collections, leading to a protocol amendment to exclude such patients from study entry. Furthermore, response and median survival with this dose schedule of edatrexate and carboplatin do not appear to be improved compared to other chemotherapeutic regimens tested by SWOG in this patient population.

Adult↗

PubMed1995

Regulatory ozone modeling: status, directions, and research needs.

The Clean Air Act Amendments (CAAA) of 1990 have established selected comprehensive, three-dimensional, Photochemical Air Quality Simulation Models (PAQSMs) as the required regulatory tools for analyzing the urban and regional problem of high ambient ozone levels across the United States. These models are currently applied to study and establish strategies for meeting the National Ambient Air Quality Standard (NAAQS) for ozone in nonattainment areas; State Implementation Plans (SIPs) resulting from these efforts must be submitted to the U.S. Environmental Protection Agency (U.S. EPA) in November 1994. The following presentation provides an overview and discussion of the regulatory ozone modeling process and its implications. First, the PAQSM-based ozone attainment demonstration process is summarized in the framework of the 1994 SIPs. Then, following a brief overview of the representation of physical and chemical processes in PAQSMs, the essential attributes of standard modeling systems currently in regulatory use are presented in a nonmathematical, self-contained format, intended to provide a basic understanding of both model capabilities and limitations. The types of air quality, emission, and meteorological data needed for applying and evaluating PAQSMs are discussed, as well as the sources, availability, and limitations of existing databases. The issue of evaluating a model's performance in order to accept it as a tool for policy making is discussed, and various methodologies for implementing this objective are summarized. Selected interim results from diagnostic analyses, which are performed as a component of the regulatory ozone modeling process for the Philadelphia-New Jersey region, are also presented to provide some specific examples related to the general issues discussed in this work. Finally, research needs related to a) the evaluation and refinement of regulatory ozone modeling, b) the characterization of uncertainty in photochemical modeling, and c) the improvement of the model-based ozone-attainment demonstration process are presented to identify future directions in this area.

Air Pollution↗

PubMed1985

Canonical considerations in corporate restructuring.

Religious institutes sponsoring Catholic health facilities face competitive economic pressures that impel them to seek corporate restructuring and joint ventures to fulfill their mission to the poor. They especially must look to the Church's Code of Canon Law to protect ecclesiastical goods and maintain their Catholic identity when entering such ventures. The U.S. bishops directives also assist in guaranteeing patient expectations that the health facility will observe the Church's ethical principles. Institutes first must ensure that subsidiaries will operate according to Catholic mission and philosophy. The canons delineate proper protection of assets and identify ends toward which the religious must apply temporal goods, such as supporting clergy and performing charitable works. Alienation, or conveyance of goods, is a critical consideration in such financial transactions; canons specify the institute's administrative limits and require superiors' written permission along with their councils' consent. All involved must be "thoroughly informed concerning the economic situation," show "just cause" for the transaction, and obtain expert estimates of property values. Religious administrators retain certain faith and executive obligations, such as amending the charter, appointing the board, and merging or dissolving the corporation. With the canons they help to ensure that collaborative efforts preserve the institute's corporate mission and allow religious to carry out their responsibility for ecclesiastical goods. Though alternatives to corporate ventures may be limited, options regarding how to structure and with whom to affiliate do exist. Sponsoring bodies dedicated to providing high-quality care must explore these options

Catholicism↗

PubMed1977

Treatment of rhabdomyosarcoma in children with surgery, radiotherapy and chemotherapy.

From May, 1970 through December, 1972, Children's Cancer Study Group entered 112 patients on an amended treatment program for rhabdomyosarcoma and undifferentiated sarcoma in children. These patients had Group II disease with residual tumor remaining after surgery, or metastatic disease at onset. Another group consisted of patients who previously had treatment with surgery and radiotherapy and had recurrent disease. Cyclophosphamide was added to a previously used drug regimen which consisted of actinomycin D and vincristine. The drugs were given sequentially in repeated cycles for 18 months. Of 97 evaluable patients, there were 24 with microscopic residual disease, 37 with gross residual disease, 22 with metastatic disease at onset, and 14 patients who were treated with chemotherapy for the first time with recurrent or metastatic disease. All patients have been followed for 3 or more years. Survival in each group was 70.8%, 43.2%, 27.2%, and 28.2%, respectively. Although the number of complete remissions was greater than with two-drug therapy, survival with three-drug therapy was not significantly different than that seen in the earlier study.

Adolescent↗

PubMed2006

Developing a national tiger action plan for The Union of Myanmar.

A century ago, tigers were considered pests in Myanmar. Hunters claimed thousands, yet populations persisted. In the past century, because of habitat loss and prey depletion, coupled with the recent demand for traditional medicines, tiger populations have been reduced to a few hundred individuals. As a first step toward long-term planning for tigers, and to guide efforts to increase protected area coverage, the Myanmar government in 1998 initiated a project to develop a revised National Tiger Action Plan. Extensive surveys confirmed tigers in only 4 of 17 survey locations. Significant populations are thought to persist in the far North and far South of the country, where large, intact forests offer the potential for tiger recovery. With partnerships and collaborations, tiger populations can be protected in the short term (<5 years) by expanding protected areas and corridors, mobilizing enforcement staff to reduce poaching of tigers and prey, and amending existing wildlife legislation in accordance with international laws. Over the long term (5-20 years), recovery of Myanmar's tiger populations will depend on increasing support from local people, zoning tiger areas to reduce habitat loss and disturbance, and maintaining connectivity of existing national and transboundary forests. This article reviews the development of a new National Tiger Action Plan for the Union of Myanmar and discusses a blueprint for conservation measures aimed at saving tigers from extinction.

Animals↗

PubMed2004

Biodegradation of sediment-bound PAHs in field-contaminated sediment.

The biodegradation of polycyclic aromatic hydrocarbons (PAHs) has been reported to occur under aerobic, sulfate reducing, and denitrifying conditions. PAHs present in contaminated sites, however, are known for their persistence. Most published studies were conducted in systems where PAHs were freshly spiked, and biodegradation was often tested using pure cultures or enrichments. This paper investigated the degradation potentials of PAHs that were present in aged contaminated sediment by indigenous bacteria, where the limited bioavailability of PAHs due to aging played an important role. The sediment and the overlaying water were collected from a contaminated site to prepare sediment-water slurries, and the sediment served as both the media containing PAH substrates and the habitat for the indigenous microorganisms. Reduced sulfur compounds present in the sediment caused rapid oxygen depletion due to extensive activities of sulfur-oxidizing bacteria and could result in a dramatic pH drop. Once oxygen depletion and acidification problems were avoided, substantial removals of two-, three-, four-, and five-ring PAHs were achieved aerobically, though the extent of degradations was smaller than what was reported for freshly spiked PAHs. The amendment of inorganic N and P, co-substrates, or surfactant Triton X-100 did not enhance the level of degradations appreciably. Under denitrifying conditions, no distinct PAH degradation was observed, while the complete denitrification of nitrate to nitrogen occurred stoichiometrically with a concomitant increase in sulfate concentration, indicating the dominance of autotrophic denitrifiers. The addition of ethanol or acetic acid did not stimulate PAH degradation. Substantial PAH degradation attributed to sulfate reduction was only observed for phenanthrene, the low-ring PAH existing in a highest initial concentration. Addition of ethanol or acetic acid did not change this finding. This is the first study to our knowledge that revealed the importance of indigenous bacteria involved in natural sulfur cycling in determining degradation behavior of PAHs.

Aerobiosis↗

PubMed2004

Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation.

BACKGROUND: Surgery for undescended testes is recommended before the age of 2 years. However, boys are still undergoing surgery for undescended testes at a much later age than recommended. METHODS: An initial audit reviewed all orchidopexies performed at Northampton General Hospital between 1992 and 1994. This demonstrated that only 19% of boys had surgery by the age of 2 years, and the key reason for late surgery was late referral. Guidelines for referral of undescended testes were established in which referral to a surgeon was advised following the 8-month child health surveillance check if undescended testis was suspected. This would enable surgery before the age of 2 years. Audit results were disseminated and we implemented a package of measures based on evidence based change management techniques. These included written advice to general practitioners (GPs), a parent information leaflet and an amended personal child health record advising timing of referral. A reminder to the GP to refer following the 8-month check was generated using computer recall from the Child Health System records. Guideline implementation was monitored by annual audit and feedback. RESULTS: The baseline audit for the years 1992-94 found a median age at surgery of 4 years. Implementation of the new policies in 1998 resulted in a reduction in median age at surgery to 2.0 years in the 12 months ending September 2001. CONCLUSIONS: While concern about the age at orchidopexy has been highlighted in many previous studies, this is the first to show that improvement in the age at orchidopexy can be achieved. Implementing locally agreed guidelines with written information to GPs and parents combined with computerized recall from Child Health System records achieved the target within 3 years. Similar systems could be implemented nationally at minimal cost.

Age Factors↗

PubMed2006

Detection of mononucleotide repeat sequence alterations in a large background of normal DNA for screening high-frequency microsatellite instability cancers.

PURPOSE: Mutations in mononucleotide repeat sequence (MRS) are good indicators of high-frequency microsatellite instability (MSI-H) cancers, but it has been a challenge to detect such mutations in a large background of wild-type DNA; as in this setting, PCR errors often generate false positive mutant alleles. In this study, we developed a general strategy, referred to as probe clamping primer extension-PCR (PCPE-PCR), to detect MRS alterations in a large background of wild-type DNA. EXPERIMENTAL DESIGN: In PCPE-PCR, genomic DNA is first subjected to PCPE, in which mutant single-strand DNA molecules are preferentially produced. Next, genomic DNA is removed to enrich for the mutant DNA fraction. Thereafter, PCR is carried out using the remaining single-strand DNA molecules as templates. Finally, the PCR products are analyzed to reveal the MSI-H status. In this study, the sensitivity of this new method was first examined by spiking mutant DNA into wild-type DNA at specific ratios followed by studying whether this method is applicable to fecal DNA testing. RESULTS: We showed that PCPE-PCR could detect both mutated BAT26 and transforming growth factor-beta-RII (A)10 markers in the presence of 500-fold excess of normal DNA and that as few as three copies of mutated DNA could be detected. In addition, we showed that this technology could detect MSI-H colorectal cancer by fecal DNA analysis. CONCLUSION: PCPE-PCR is sensitive. In addition, PCPE-PCR is simple and amendable to a cost-effective and high-throughput screening operation. This technology may be applicable to noninvasive screening of MSI-H cancer.

Acetyltransferases↗

PubMed2003

Monitoring antitobacco sentiment among community leaders.

Two public health objectives, one methodological and the other substantive, are realized in the present study. First, average survey ratings are replaced by negated mean cumulative logits (MCLs), which have the advantage of interitem commensuration. Second, these negated MCLs improve the analysis of two Florida tobacco control surveys of community leaders. Because of their common logit metric, negated MCLs for different item types are compared on their expressed antitobacco sentiment. They are also averaged to construct a precise indicator of overall sentiment. These results show that in 1998 and 1999, community leaders were most averse to selling to minors, kids buying cigarettes, and restaurant and workplace smoking. The latter aversion anticipated voters' overwhelming support of the 2002 Florida constitutional amendment prohibiting smoking in restaurants and workplaces. The authors hope that this analysis for antitobacco programs will improve other substance-abuse monitoring with surveys whose items are yet unwritten.

Attitude to Health↗

PubMed2002

Use of animals in research: a science--society controversy? The American perspective: animal welfare issues.

My paper will focus on those events happening within the United States during the last year. The issue of including or excluding rats, birds and mice from inclusion under the Animal Welfare Act has been a difficult battle for both those that wish to exclude them and those that wish to include these animals under this legislation. As of the writing of this abstract, the Senate, which originally intended to include rats, birds and mice under the Animal Welfare Act, has passed an amendment which will permanently exclude their listing under this Act. During the last several years it has become clear that refinement, as one of the 3Rs, has and will become the most important set of activities to add humanness to animal experimentation. It is clear that refinement approaches provide the opportunity to possibly eliminate or significantly minimize any pain or distress in animal protocol. My presentation will focus on CAAT's (http://caat.jhsph.edu) activities in this important area. Understanding potential health hazards to environmental industrial chemicals has become a major focus of activity both in the US, Europe and Japan. These programs offer the first opportunity to provide information, in the public domain, on these chemicals. One of the consequences, however, is the potential requirement for large numbers of animals. In the presentation, I will focus on two approaches to significantly including the 3Rs in these important programs. Although it is common practice in Japan to recognize contributions of laboratory animals through a day of memorialization, this has not been the case in the United States. During the last year, several activities have been initiated to begin to institutionalize memorial services for animals used in research. As the host institution of Altweb (http://altweb.jhsph.edu), the alternative web site internationally, current statistics and accomplishments will be provided on its worldwide utilization.

Animal Experimentation↗

PubMed1983

Actuarial status of the Old-Age and Survivors Insurance and Disability Insurance Trust Funds.

This article summarizes the current financial and actuarial status of the Old-Age, Survivors, and Disability Insurance (OASDI) program. The data presented are from the 1983 Trustees Report for the program following enactment of the Social Security Amendments of 1983. The actuarial estimates show that benefits can be paid on time throughout the 1980's and for many years thereafter. However, trust fund levels are projected to be relatively low through 1987, and the program could again experience financial difficulties in the near future if economic conditions become worse than anticipated under the pessimistic Alternative III assumptions. After 1987, the program's ability to withstand economic downturns is projected to improve. On the basis of intermediate assumptions, the OASDI program is now in long-range actuarial balance. This actuarial balance reflects substantial year-by-year surpluses during the first half of the 75-year projection period that slightly outweigh substantial deficits later on.

Costs and Cost Analysis↗

PubMed2005

Redescription of Houssayela sudobim (Woodland, 1935) (Cestoda: Proteocephalidea), a parasite of Pseudoplatystoma fasciatum (Pisces: Siluriformes) from the River Amazon.

The proteocephalidean cestode Houssayela sudobim (Woodland, 1935), the type and only species of Houssayela Rego, 1987, is redescribed on the basis of re-examination of its type-specimens and freshly collected material found in the intestine of the barred sudobim Pseudoplatystoma fasciatum (Siluriformes: Pimelodidae) from the River Amazon in Peru. The validity of the genus is confirmed, but its diagnosis is amended because suckers possess four pairs of cone-shaped (papilla-like) projections on their anterior margins (rather than 16, as reported in the original description), the actual number of testes is more than 400 in a proglottis (not 150 as given by Woodland, 1935) and the vitelline follicles form one dorsolateral medullary band and one lateral cortical band on both sides of proglottides. In addition, the distal (terminal) portion of the vagina has a double sphincter and the cirrus-sac has very thick walls; neither of these characteristics was mentioned in the original description. The specimen collected in Peru represents the first record of the species since its original description in 1935.

Animals↗

PubMed2002

[Creating a specific quality-of-life questionnaire in patients with glaucoma: item generation].

The methods for developing Health-Related Quality-of-Life (HRQoL) measures and their application in medical research have demonstrated their utility in various chronic, progressive, or life-threatening diseases. The efforts made to allow the patient's perspective to be included in the methodological framework of evidence-based medicine have been successful. The assumption of a strong relationship between clinical status and daily life is certainly valid in ophthalmology. However, there is a lack of specific HRQoL measures dedicated to ophthalmic diseases. Our work aimed at creating the first Glaucoma-specific Quality of Life scale - the Glau-QoL questionnaire - to provide researchers and physicians with a comprehensive, practical, and validated tool. This article describes the first stage of the process, which consisted in generating items and formatting them in order to create a questionnaire that exhaustively covers the relevant concepts. The whole process was conducted by an expert committee including clinicians and methodologists. The standard recommendations in the development of a HRQoL questionnaire were followed: we first identified existing tools and performed a preliminary collection of concepts from the published literature; we then designed an interview guide with the help of clinicians; a trained psychologist interviewed 22 patients at various disease severity stages (from isolated hypertonic to severely impaired); the interviews were tape-recorded and scripted; general domains and related detailed concepts were identified from the script; they were then analyzed and organized; the format of the questionnaire was set up; and questions were derived from the patient's verbatim to capture the identified detailed concepts. The test questionnaire was applied to seven patients for cognitive debriefing. We finally amended the test questionnaire and designed the pilot questionnaire according to the patients' tests and the clinician's review. The test questionnaire was well accepted by the patients, despite a completion duration ranging from 14 to 35 minutes. The pilot questionnaire contained 151 items, grouped into 5 sections: (1) vision problems, physicians, and daily treatment (49 items); (2) activities of daily living (37 items); (3) self-expression (37 items); (4) vision problems and mood (14 items); and (5) other questions (14 items). The next step of our work will be the item reduction process and the psychometric validation of the Glau-QoL questionnaire.

Activities of Daily Living↗