Contact lens fitting following corneal graft surgery

Contact lens fitting may be required following keratoplasty for either optical or thera‐peutic reasons. Optical indications for contact lens fitting include the correction of irregular astigmatism, high regular astigmatism, anisometropia and secondary aniseikonia, as well as simple ametropia, where the patient desires to wear contact lenses in preference to spectacles. Therapeutic lenses are not routinely fitted following kerate plasty, although this management is advised in certain cases, such as when there are protruding sutures or epithelial healing is impaired. Designing a contact lens for a patient who has undergone keratoplasty will require the practitioner to carefully assess all the relevant features of the corneal graft. In this regard, there are many factors that need to be considered including the diameter of the graft zone, the topographical relationship between the host cornea and donor cornea, the corneal (graft) toricity and the location of the graft. Special designs, such as reverse geometry lenses, or more complex contact lens modalities, such as piggyback contact lens systems, may be required to achieve success in fitting.     

Chronic Inhalation Toxicity and Carcinogenicity Testing of Respirable Fibrous Particles

On May 8–10, 1995, a workshop on chronic inhalation toxicity and carcinogenicity testing of respirable fibrous particles was held in Chapel Hill, North Carolina. The workshop was sponsored by the Office of Pollution Prevention and Toxics, U.S. Environmental Protection Agency (EPA), in collaboration with the National Institute of Environmental Health Sciences (NIEHS), the National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA). The goal of the workshop was to obtain input from the scientific community on a number of issues related to fiber testing. Major issues for discussion were: (i) the optimal design and conduct of studies of the health effects of chronic inhalation exposure of animals to fibers; (ii) preliminary studies which would be useful guides in designing the chronic exposure study; (iii) mechanistic studies which would be important adjuncts to the chronic exposure study to enable better interpretation of study results and extrapolation of potential effects in exposed humans; and (iv) available screening tests which can be used to develop a minimum data set for (a) making decisions about the potential health hazard of the fibers and (b) prioritizing the need for further testing in a chronic inhalation study. After extensive discussion and debate of the workshop issues, the general consensus of the expert panel is that chronic inhalation studies of fibers in the rat are the most appropriate tests for predicting inhalation hazard and risk of fibers to humans. A number of guidances specific for the design and conduct of prechronic and chronic inhalation studies of fibers in rodents were recommended. For instance, it was recommended that along with other information (decrease in body weight, systemic toxicity, etc.), data should be obtained on lung burdens and bronchoalveolar lavage fluid analysis to assist in establishing the chronic exposure levels. Lung burden data are also important for quantifying aspects of risk assessment related to dosimetric adjustments before extrapolation. Although mechanistic studies are not recommended as part of the standard chronic inhalation studies, the expert panel stressed the need for obtaining mechanistic information as far as possible during the course of subchronic or chronic inhalation studies. At present, no single assay and battery of short-term assays can predict the outcome of a chronic inhalation bioassay with respect to carcinogenic effects. Meanwhile, several short-termin vitroandin vivostudies that may be useful to assess the relative potential of fibrous substances to cause lung toxicity/carcinogenicity have been identified.     

Mediation Analysis of a Theory-Based Culture and Age-Appropriate HIV/STI Prevention

Few studies have investigated mediator effects of HIV prevention interventions on adolescents in sub-Saharan Africa. Herein, we report on a secondary analysis of an intervention that increased intentions to use condoms, abstain from sexual intercourse, and seek safe male circumcision among adolescents in Botswana. In a study conducted in Botswana, 806 grade 9 students from 21 public Junior Secondary Schools were randomly assigned to either the OWN THE FUTURE: Pulling Together We Will” ( PTWW) intervention group or a health promotion control group. Both conditions consisted of 12 1-h modules, with two modules delivered during each of the six sessions on six consecutive school days. The students in both groups completed confidential computer-based surveys at several time points: pre-, immediately post-, 3, 6, and 12 months post-intervention. Mediation was assessed using the product-of-coefficients approach in a generalized estimating equations (GEE) framework. The analyses showed that condom use beliefs were significant mediators of the intervention effect on the intention to consistently use condoms over time. Also, negative socio-cultural beliefs, prevention beliefs, and HIV/STI knowledge were significant mediators of the intervention’s effects on the intention to abstain from sex. Additionally, normative beliefs, prevention beliefs, parental negotiation, and circumcision knowledge were significant mediators of the intervention’s effect on intention to seek safe male circumcision. The mediation analysis delineated a theoretical model and isolated activities that positively impact condom use, abstinence from sex, and circumcision intentions of Batswana middle school adolescents.

     

Phase II trial of VP16-213 in non-small cell lung cancer (NSCLC)

Summary Fifty-one patients with non-small cell lung cancer (NSCLC) were treated, during a phase II trial, with 4 demethylepipodophyllotoxin--d-ethylidene glucoside (VP16-213). Forty-nine were evaluable for response, and of these two (4%) had partial responses lasting 5 and 6 months. Prior treatment with chemotherapy may have adversely affected response rate; none of the 24 previously treated patients had a major response. Myelosuppression was the dose limiting toxicity. Anorexia, nausea and vomiting, partial alopecia, and chills plus hypotension during drug infusion were the other toxic effects. We conclude that VP16-213 has only minimal activity as a single agent in NSCLC.Supported in part by NIH Grant No. CA-05826 and CA-09027, and by NCI Contract NO-1-CM 972744Demethylepipodophyllotoxin--d-Ethylidene Glucoside (NSC141540) was supplied by the Drug Evaluation Branch of the National Cancer Institute     

Mental health,financial, and social outcomes among older adults with probable COVID-19 infection: A longitudinal cohort study

We investigated the immediate and longer-term impact (over 4-6 months) of probable COVID-19 infection on mental health, wellbeing, financial hardship, and social interactions among older people living in England. Data were analysed from 5146 older adults participating in the English Longitudinal Study of Ageing who provided data before the pandemic (2018-19) and at two COVID-19 assessments in 2020 (June-July and November-December). The associations of probable COVID-19 infection (first COVID-19 assessment) with depression, anxiety, poor quality of life (QoL), loneliness, financial hardship, and social contact with family/friends at the first and second COVID-19 assessments were tested using linear/logistic regression and were adjusted for pre-pandemic outcome measures. Participants with probable infection had higher levels of depression and anxiety, poorer QoL, and greater loneliness scores compared with those without probable infection at both the first (OR_depression = 1.62, P-value = 0.005; OR_anxiety = 1.59, P-value = 0.049; b_poorQoL = 1.34, P < 0.001; b_loneliness = 0.49, P < 0.001) and second (OR_depression = 1.56, P-value = 0.003; OR_anxiety = 1.55, P-value = 0.041; b_poorQoL = 1.38, P-value < 0.001; b_loneliness = 0.31, P-value = 0.024) COVID-19 assessments. Participants with probable infection also experienced greater financial difficulties than those without infection at the first assessment (OR = 1.50, P-value = 0.011). Probable COVID-19 infection is associated with longer-term deterioration of mental health and wellbeing and short-term increases in financial hardship among older adults. It is important to monitor the mental health of older people affected by COVID-19 and provide additional support to those in need.

The coronavirus disease 2019 (COVID-19) pandemic has affected several aspects of people’s lives, including physical and mental health, employment and financial security, social connections, and access to healthcare (1). Despite a large body of research documenting the adverse psychosocial effects of the pandemic and its containment measures across the population, little is currently known regarding the impact that contracting COVID-19 itself may have on the individual’s mental health, personal finances, and social relationships.Several longitudinal studies have reported increases in depression, anxiety, and general psychological distress in the adult population during the COVID-19 pandemic compared with prepandemic levels (2, 3). People who have contracted COVID-19 might be particularly vulnerable to the psychological impact of the pandemic. Indeed, initial evidence suggests that the experience of COVID-19 symptoms is associated not only with adverse physical consequences, but also with long-term effects on mental health (4, 5). Various mechanisms could underlie the psychological effects of COVID-19 infection, including the potential neurotropic properties of the virus (6, 7); the presence of elevated proinflammatory cytokines (e.g., interleukin-6) in patients with severe COVID-19 symptoms (8), which are implicated in the development of psychiatric disorders such as depression (9); and the exposure to prolonged periods of social isolation and physical inactivity in people affected by COVID-19 (10), which in turn can increase mental distress and feelings of loneliness. Compounded by the widespread psychosocial effects of the pandemic across the population, these factors might further exacerbate the risk of mental health problems among individuals recovering from COVID-19 infection.Data from previous coronavirus epidemics demonstrate the potential psychiatric consequences of the virus in both the acute and postacute phases of the illness (11). Further, studies across different countries have found that individuals reporting COVID-19 symptoms and patients recovering from acute COVID-19 illness exhibit increased levels of anxiety, depression, suicidal ideation, loneliness, and poor quality of life (QoL) compared with healthy people (5, 12–19). Studies using data from electronic health records in the United States have also shown that COVID-19 patients with no previous psychiatric history are at increased risk of first-time diagnosis of psychiatric disorders compared with those affected by other health events (e.g., influenza) or healthy controls (20, 21). However, most studies to date are limited by small, nonrepresentative samples and short follow-up periods, and they lack longitudinal data on the participants’ mental health before COVID-19, as well as data on confounding factors. Since individuals with preexisting mental disorders seem particularly susceptible to COVID-19 infection (20, 22), it is unclear the extent to which reverse causality and confounding bias might contribute to the association between COVID-19 infection and psychological distress. In addition, studies involving electronic health records or clinical samples may not capture individuals with moderate COVID-19 symptoms and those with less severe mental health problems who do not present to health services.Longitudinal cohort studies are well suited to study the immediate and longer-term psychosocial consequences of COVID-19 infection in the general population, as they include comprehensive information on mental health before the infection and other confounding factors (e.g., sex, age, socioeconomic position). Results from the United Kingdom suggest that people with probable COVID-19 symptoms experience greater psychological distress up to 7 months following the start of the infection (23). In contrast, an online study in the United States found evidence only for short-term psychological effects that diminish as the symptoms subside (24). Notably, these studies have only focused on general psychological distress; therefore, the impact of COVID-19 infection on specific mental health and wellbeing outcomes (e.g., depression, anxiety, loneliness, and QoL) in the general population is unclear.Numerous studies have also highlighted the financial impact of the pandemic—including job losses, pay cuts, reductions in household income, fluctuations in stock markets and wealth held in risky assets, and widespread financial worries (25–27)—as well as its adverse consequences for various domains of social relationships, including social networks, social support, and social interaction (28, 29). However, these studies relate to the whole population rather than to people with COVID-19 infection. Empirical evidence regarding the impact that COVID-19 infection may have on a person’s financial situation and social relationships is limited. For instance, cross-sectional results suggest that adults who have experienced COVID-19 are more likely to report that their social relationships, work, and household finances have been adversely affected by the pandemic, compared with those who have not had COVID-19 (30). However, this analysis did not account for preexisting trends in social connections and economic outcomes, and it was unable to disentangle short-term versus longer-term psychosocial consequences of the infection.Older adults are at increased risk of social isolation and serious illness following COVID-19 infection (31), and they also are particularly vulnerable to the effects of chronic stress on the brain (32). A recent analysis of data from the English Longitudinal Study of Aging (ELSA) also demonstrates that the mental health and wellbeing of the older population deteriorated significantly as the pandemic progressed in 2020, compared with prepandemic levels (33). Given these factors, older people might be disproportionally affected by the psychosocial effects of COVID-19 infection. However, little research on COVID-19 has involved older adults who are also often unable to access online surveys (34). In addition, care-seeking behaviors changed considerably in the early stages of the pandemic, with large numbers of older adults with care needs not actively contacting health services and not seeking help (35). Therefore, older adults’ experiences of COVID-19 might be underrepresented in earlier studies.In the present analysis, we investigated the immediate and longer-term impact (over 4 to 6 months) of probable COVID-19 infection on mental health (i.e., depression and anxiety), wellbeing (i.e., QoL and loneliness), financial hardship, and social interactions in a large, representative sample of older adults from ELSA. In addition, we assessed whether the psychosocial impact of probable COVID-19 infection might vary across different sociodemographic groups. All outcomes were assessed before the pandemic began (i.e., 2018/2019) and on two occasions during the pandemic, which enabled us to test both short-term and longer-term associations. The data were collected online and by telephone interview to ensure coverage of those without internet access.     

Maternal Relationship Security as a Moderator of Home Visiting Impacts on Maternal Psychosocial Functioning

There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n?=?643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3 years. Outcome data were collected when children were 1, 2, and 3 years old and 7, 8, and 9 years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.