The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p < 0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p < 0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p < 0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p < 0.01) less likely to have a functional limitation due to vision.     

我国眼视光学近五年十大研究进展

中华医学会眼科学分会眼视光学组通过学组委员投票的方式遴选出代表我国近5年(2009至2013年)眼视光学临床和基础研究领域最突出的10项研究进展,主要集中于近视眼临床和基础研究、屈光手术和视觉质量研究、角膜接触镜的研发和临床应用、视觉认知和低视力康复研究的开展及临床推广、新型技术和检查设备的应用等5个方面.这些研究在一定程度上代表了目前我国眼视光学在国际同领域的水平和影响力,部分研究成为我国眼视光学者在国际学术领域的标志性成果.     

Advances in understanding the molecular basis of the first steps in color vision

Serving as one of our primary environmental inputs, vision is the most sophisticated sensory system in humans. Here, we present recent findings derived from energetics, genetics and physiology that provide a more advanced understanding of color perception in mammals. Energetics of cis–trans isomerization of 11-cis-retinal accounts for color perception in the narrow region of the electromagnetic spectrum and how human eyes can absorb light in the near infrared (IR) range. Structural homology models of visual pigments reveal complex interactions of the protein moieties with the light sensitive chromophore 11-cis-retinal and that certain color blinding mutations impair secondary structural elements of these G protein-coupled receptors (GPCRs). Finally, we identify unsolved critical aspects of color tuning that require future investigation.     

注意缺陷多动障碍共患数学学习困难儿童韦氏儿童智力结构特征

目的探讨合并数学困难(mathematical difficulties,MD)的注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童在韦氏儿童智力量表第四版(Wechsler Intelligence Scale for Children-The Fourth Vision,WISC-Ⅳ)中的智力结构特征。方法选取根据美国《精神障碍诊断和统计手册第四版》(Diagnostic and Statistical Manual,DSM-Ⅳ)诊断标准确诊为ADHD且数学成绩低于同年级P10、语文成绩不低于同年级P50的儿童30名,并按性别、年龄匹配抽取确诊为ADHD且语文、数学成绩不低于同年级P25的30名作为对照组。使用WISC-Ⅳ对两组儿童的智力结构特点进行比较。结果研究组儿童总智商及四指数均低于对照组儿童(P0.05),两组儿童在字母-数字排序、背数、译码、矩阵推理、积木、理解等分测验的差异有统计学意义(P0.05)。结论 WISC-Ⅳ可以全面评估儿童的一般认知功能,MD-ADHD儿童有独特认知特点,应根据与数学能力相关的认知缺陷进行个体化的科学干预。     

The degree of kinship and its association with reciprocity and exchange in the relationships of visually impaired older adults

This study draws on an evolutionary model of exchange in relationships to examine the nature of perceived reciprocity in the context of kin and non-kin relationships among a sample of visually impaired older adults (age 63–99). Further, we examined the direct and moderating impact of functional impairment and adaptation to visual impairment on the nature of perceived reciprocity. Results showed that the greater the degree of genetic relatedness the more imbalanced the exchange. It was also found that degree of adaptation to visual impairment moderated the association between genetic relatedness and perceived exchange, such that the greater the degree of genetic relatedness the more people reported they gave rather than received except at very low levels of adaptation, when people received more than they gave the greater the degree of genetic relatedness. Thus, an evolutionary model was supported such that imbalanced exchange was found more with greater degrees of genetic relatedness, but the direction of exchange was different for high versus low levels of adaptation to vision impairment.     

Functional MT + lesion impairs contralateral motion processing

Human motion processing region MT + is retinotopically organized with perception of and attention to motion in the right visual field preferentially associated with left MT + activity and vice versa. However, the degree to which MT + is crucial for motion processing is uncertain. We report an epilepsy patient with visual symptoms early in his seizure evolution and a left temporal-occipital seizure onset electrographically in whom we hypothesized a functional left MT + lesion. The patient was impaired in his right but not left visual field on a hemifield motion attention task and demonstrated worse performance on a hemifield picture identification task when pictures implying motion were presented in the right as opposed to the left visual field. Functional MRI (fMRI) during a full-field motion detection task activated right MT + but failed to activate left MT + despite activating both left and right MT + in each of 10 controls. Furthermore, fMRI during a hemifield motion attention task also showed a lack of left MT + attention effects in the patient. Together these results suggest that MT + is necessary for normal motion processing.     

Rapid and highly resolving associative affective learning: Convergent electro- and magnetoencephalographic evidence from vision and audition

Various pathway models for emotional processing suggest early prefrontal contributions to affective stimulus evaluation. Yet, electrophysiological evidence for such rapid modulations is still sparse. In a series of four MEG/EEG studies which investigated associative learning in vision and audition using a novel MultiCS Conditioning paradigm, many different neutral stimuli (faces, tones) were paired with aversive and appetitive events in only two to three learning instances. Electrophysiological correlates of neural activity revealed highly significant amplified processing for conditioned stimuli within distributed prefrontal and sensory cortical networks. In both, vision and audition, affect-specific responses occurred in two successive waves of rapid (vision: 50–80 ms, audition: 25–65 ms) and mid-latency (vision: >130 ms, audition: >100 ms) processing. Interestingly, behavioral measures indicated that MultiCS Conditioning successfully prevented contingency awareness. We conclude that affective processing rapidly recruits highly elaborate and widely distributed networks with substantial capacity for fast learning and excellent resolving power.     

Artificial Organs 2014: A Year in Review

In this Editor's Review, articles published in 2014 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of the International Federation for Artificial Organs, the International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.     

单眼发病的原发性开角型青光眼黄斑脉络膜厚度及影响因素初探

目的初步探讨原发性开角型青光眼(POAG)单眼发病患者黄斑中心凹下脉络膜厚度(SFCT)与其对侧眼和健康人的差异及其影响因素。方法横断面研究。收集2018年9月至2019年9月就诊于首都医科大学附属北京同仁医院青光眼门诊确诊为POAG的单眼发病、对侧眼正常的患者(POAG组)以及健康志愿者(健康对照组)。对所有参与者进行系统眼科检查,应用高分辨率频域的相干光层析成像术测量SFCT及距黄斑中心凹鼻侧和颞侧500、1000、2000μm共7个位置的脉络膜厚度。应用配对t检验比较脉络膜厚度在POAG组患眼与对侧眼的差异。应用协方差分析比较POAG组患眼与健康对照组之间脉络膜厚度的差异。应用多元线性回归分析年龄、性别、等效球镜度数、视野平均缺损值对POAG组患眼黄斑各个位置脉络膜厚度的影响。结果POAG组纳入75例患者(平均年龄46岁,男性48例,女性27例),健康对照组纳入61名(61只右眼)健康受试者(平均年龄44岁,男性34名,女性27名)。POAG组患眼SFCT为(244.41±83.18)μm,其对侧眼SFCT为(254.28±88.92)μm,二者差异无统计学意义(P>0.05)。健康对照组SFCT为(272.98±55.87)μm,校正年龄、性别和等效球镜度数后,POAG组患眼与健康对照组SFCT差异无统计学意义(P>0.05)。POAG组患眼在距离黄斑中心凹鼻侧2000μm处的脉络膜厚度为(167.84±70.44)μm,其对侧眼为(188.84±89.06)μm,二者差异有统计学意义(t=-3.55;P<0.01)。POAG组患眼与其对侧眼及健康对照组在距黄斑中心凹鼻侧和颞侧其他距离处的脉络膜厚度差异均无统计学意义(均P>0.05)。POAG患眼的SFCT变薄与视野平均缺损值下降(β=14.66,P<0.05)和近视屈光度数增高(β=14.95,P<0.01)有关,与年龄和性别无关(均P>0.05)。结论单眼发病的POAG患眼SFCT较对侧眼和健康人未见明显变薄,仅黄斑鼻侧2000μm的脉络膜薄于对侧眼。视野缺损的严重程度及近视屈光度数程度与SFCT变薄相关,提示脉络膜变薄可能参与青光眼的发生、发展过程。(中华眼科杂志,2021,57:194-200)