Ocular findings as predictors of carotid artery occlusive disease: is carotid imaging justified?

OBJECTIVES: Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD. METHODS: Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings. RESULTS: Amaurosis fugax was associated with a positive scan in 20.0% of carotid arteries (P =.022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2% of carotid arteries (P =.02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6%) had significant ipsilateral internal carotid artery stenosis (P =.022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0%). CONCLUSIONS: Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.     

Making use of a natural stress test: pregnancy and cardiovascular risk

The gestational period serves as a natural stress test that can be used to predict future cardiovascular health risks of female patients. Recent evidence confirms that mothers with hypertensive pregnancies have higher cardiovascular disease (CVD) risks compared to other women of similar age. In women with preeclampsia, those delivering before 37 weeks of gestation and mothers with recurring preeclampsia in subsequent pregnancies carry the greater risks. These sex-specific risks are of similar magnitude to traditional CVD risk factors, such as smoking and obesity. Unfortunately, none of the commonly used CVD risk stratification models make use of these sex-specific markers, which can powerfully predict future CVD outcomes. Because women have historically posed a greater diagnostic challenge than men in assessing CVD risks, better models for risk stratification in this sex group are needed. A history of hypertension in pregnancy should be included as a variable in cardiovascular risk stratification. In addition, screening women for a history of preeclampsia should become routine practice, with greater emphasis placed on therapies to modify adverse outcomes for these higher-risk women.     

Children with Special Physical Health Care Needs: Restraint Use and Injury Risk in Motor Vehicle Crashes

Physical disabilities may affect a child passenger’s fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007–2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0–15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0–8 and 9–15 years, respectively). A greater proportion of children with SPHCN aged 0–8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9–15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0–8 years: OR 1.27, 95% CI: 0.48–3.33; children aged 9–15 years: OR 1.51, 95% CI: 0.38–6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0–8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.     

Cultivating Passion through Collaborative Art: A Dialogic Exploration of Disability,Storytelling, and Social Change

ABSTRACT

This essay explores the role of art and storytelling in organizing expressive and vocational opportunities for individuals with developmental disabilities. Passion Works is a non-profit organization that fosters collaborative art-making among people with differing abilities. Guided by an asset-based approach titled the Creative Abundance Model, the studio challenges deficit-based narratives that guide traditional programming in sheltered workshops for individuals with developmental disabilities. The studio functions as an incubator of discovery, a process central to fostering individual well-being and social change.