1
|
Schmidt-Sane M, Cele L, Bosire EN, Tsai AC, Mendenhall E. Flourishing with chronic illness(es) and everyday stress: Experiences from Soweto, South Africa. WELLBEING, SPACE AND SOCIETY 2023; 4:100144. [PMID: 37876611 PMCID: PMC10597576 DOI: 10.1016/j.wss.2023.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability. Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and non-communicable disease. Rather than drawing on Western-centric notions of flourishing (which place emphasis on an individual's capabilities or capacities to thrive), we draw on previous ethnographic work on flourishing in Soweto, South Africa, which described how ukuphumelela, or "becoming victorious," as a social or communal affair. This conceptualization reflects local values and priorities for people's lives and the ways in which their lives are deeply intertwined with each other. We contribute to a more robust understanding of flourishing in context, of how chronic illness is experienced, and of how the role of a patient is transcended in spaces where individuals are part of a social or faith community. As people living with chronic illness(es) actively pursue the good life, health care systems must consider these pursuits as valid parts of the human experience that also challenge narrow definitions of health.
Collapse
Affiliation(s)
| | - Lindile Cele
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N. Bosire
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Brain and Mind Institute, Aga Khan University, Kenya
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MAUSA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Mendenhall
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| |
Collapse
|
2
|
Steinman BA, Tabler J, Mittlieder CM, Whitlock B, Goodman CE. Self-Reported Sensory Impairments in Older Adults and their Association with Self-Rated Health and Mortality Outcomes. J Aging Health 2021; 34:693-704. [PMID: 34939470 DOI: 10.1177/08982643211059133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study assessed the relationship between self-reported impairments of vision, hearing, and dual sensory impairment, and change in self-rated health/mortality status over a 5-year period. METHODS Data came from the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries ages 65 and older. Analyses consisted of a series of ordinal logistic regressions stratified by sex. RESULTS For both women and men, self-reported sensory impairments were not statistical predictors of self-rated health/mortality, when other dimensions of health, such as physical functioning, participation, and activities of daily living functioning were included in models. DISCUSSION Understanding how self-reported sensory impairments impact self-rated health could assist in targeting rehabilitation strategies to older adults who experience sensory impairments.
Collapse
|
3
|
Chen SN, Xu ZG, Ma YX, Chen S, He GH, Han M, Gao X, Wang JH, Wu B, Wang J. Protective effect of LIF-huMSCs on the retina of diabetic model rats. Int J Ophthalmol 2021; 14:1508-1517. [PMID: 34667726 DOI: 10.18240/ijo.2021.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022] Open
Abstract
AIM To investigate the protective effect of human umbilical cord mesenchymal stem cells (hUCMSCs) modified by the LIF gene on the retinal function of diabetic model rats and preliminarily explore the possible mechanism. METHODS A stably transfected cell line of hUCMSCs overexpressing leukemia inhibitory factor (LIF) was constructed. Overexpression was verified by fluorescent quantitative polymerase chain reaction (qPCR). Forty-eight adult Sprague-Dawley rats were randomly divided into a normal control group (group A), streptozotocin-induced diabetic control group (group B), diabetic rats at 3mo injected with empty vector-transfected hUCMSCs (group C) or injected with LIF-hUCMSCs (group D). Four weeks after the intravitreal injection, analyses in all groups included retinal function using flash electroretinogram (F-ERG), retinal blood vessel examination of retinal flat mounts perfused with fluorescein isothiocyanate-dextran (FITC-dextran), and retinal structure examination of sections using hematoxylin and eosin staining. Expression levels of adiponectin (APN), high-sensitivity C-reactive protein (hs-CRP), and neurotrophin-4 (NT-4) in each group was detected using immunohistochemistry, PCR, Western blotting, and ELISA, respectively. RESULTS A stable transgenic cell line of LIF-hUCMSCs was constructed. F-ERG and FITC-dextran examinations revealed no abnormalities of retinal structure and function in group A, severe damage of the retinal blood vessels and function in group B, and improved retinal structure and function in group C and especially group D. qPCR, ELISA, and Western blot analyses revealed progressively higher APN and NT-4 expression levels in groups B, C, and D than in group A. hs-CRP expression was significantly higher in group B than in groups A, C, and D, and was significantly higher in group C than in group D (P<0.05). CONCLUSION LIF-hUCMSCs protect the retina of diabetic rats by upregulating APN and NT-4 expression and downregulating hs-CRP expression in the retina.
Collapse
Affiliation(s)
- Shan-Na Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China.,Xiamen Kehong Eye Hospital, Xiamen 361000, Fujian Province, China
| | - Zhi-Gang Xu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China.,Department of Ophthalmology, Baoan Central Hospital, Shenzhen 518000, China
| | - Ying-Xue Ma
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China.,Department of Ophthalmology, Tianjin First Central Hospital, Tianjin 300192, China
| | - Song Chen
- Department of Vitreous and Retinopathy, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Guang-Hui He
- Department of Vitreous and Retinopathy, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Mei Han
- Department of Ophthalmology, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Xiang Gao
- Studying for a Doctor of Medicine Degree from Nankai University, Tianjin 300000, China
| | - Jun-Hua Wang
- Department of Ophthalmology, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Bin Wu
- Department of Ophthalmology, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Jian Wang
- Department of Ophthalmology, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| |
Collapse
|
4
|
Cuadros J. The Real-World Impact of Artificial Intelligence on Diabetic Retinopathy Screening in Primary Care. J Diabetes Sci Technol 2021; 15:664-665. [PMID: 32329352 PMCID: PMC8120063 DOI: 10.1177/1932296820914287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study by Shah et al published in this issue of the Journal of Diabetes Science and Technology validates the IDx autonomous diabetic retinopathy (DR) screening program in a real-world setting. The study found high sensitivity (100%) but low specificity (82%) for referable DR. The resulting positive predictive value of 19% means that four out of five patients without referable DR would be referred to ophthalmology causing a significant burden to ophthalmologists, primary care clinics, and patients. Artificial intelligence programs that provide better specificity, multiple levels of DR, and annotations of where lesions are located in the retina may function better than a simple referral/no referral output. This will allow for better engagement of patients through the difficult process of adhering to treatment recommendations and control their diabetes.
Collapse
Affiliation(s)
- Jorge Cuadros
- Meredith Morgan Eye Center, University of
California, Berkeley, USA
- EyePACS LLC, Santa Cruz, CA, USA
- Jorge Cuadros, OD, PhD, Meredith Morgan Eye Center,
University of California, Minor Hall, Room 110C, Berkeley, CA 94720, USA.
| |
Collapse
|
5
|
Bresnick G, Cuadros JA, Khan M, Fleischmann S, Wolff G, Limon A, Chang J, Jiang L, Cuadros P, Pedersen ER. Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting. BMJ Open Diabetes Res Care 2020; 8:8/1/e001154. [PMID: 32576560 PMCID: PMC7312438 DOI: 10.1136/bmjdrc-2019-001154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients' adherence to postscreening recommendations. RESEARCH DESIGN/METHODS A retrospective record review was conducted in primary care clinics of a large county hospital in the USA. All patients with diabetes detected with VTDR in two time periods, differing in record type used, were included in the study: 2012-2014, paper charts only; 2015-2017, combined paper charts/electronic medical records (EMRs), or EMRs only. Adherence rates for keeping initial ophthalmology appointments, starting recommended treatments, and keeping follow-up appointments were determined. RESULTS Adequate records were available for 6046 patients; 408 (7%) were detected with VTDR and recommended for referral to ophthalmology. Only 5% completed a first ophthalmology appointment within recommended referral interval, 15% within twice the recommended interval, and 51% within 1 year of DRS. Patients screened in 2015-2017 were more likely to complete a first ophthalmology appointment than those in 2012-2014. Ophthalmic treatment was recommended in half of the patients, of whom 94% initiated treatment. A smaller percentage (41%) adhered completely to post-treatment follow-up. Overall, 28% of referred patients: (1) kept a first ophthalmology appointment; (2) were recommended for treatment; and (3) initiated the treatment. Most patients failing to keep first ophthalmology appointments continued non-ophthalmic medical care at the institution. EMRs provided more complete information than paper charts. CONCLUSIONS Reducing vision impairment from VTDR requires greater emphasis on timely adherence to ophthalmology referral and follow-up. Prevention of visual loss from VTDR starts with retinopathy screening, but must include patient engagement, adherence monitoring, and streamlining ophthalmic referral and management. Revision of these processes has already been implemented at the study site, incorporating lessons from this investigation.
Collapse
Affiliation(s)
- George Bresnick
- University of California Berkeley School of Optometry, Berkeley, California, USA
- EyePACS, Santa Cruz, California, USA
| | - Jorge A Cuadros
- University of California Berkeley School of Optometry, Berkeley, California, USA
- EyePACS, Santa Cruz, California, USA
| | - Mahbuba Khan
- Family Medicine, Riverside University Health System, Riverside, California, USA
| | | | | | | | - Jenny Chang
- Medicine, University of California Irvine College of Medicine, Irvine, California, USA
| | - Luohua Jiang
- Epidemiology, University of California Irvine, Irvine, California, USA
| | | | | |
Collapse
|
6
|
Fu Y, Tang M, Xiang X, Liu K, Xu X. Glucose affects cell viability, migration, angiogenesis and cellular adhesion of human retinal capillary endothelial cells via SPARC. Exp Ther Med 2018; 17:273-283. [PMID: 30651792 PMCID: PMC6307404 DOI: 10.3892/etm.2018.6970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023] Open
Abstract
The expression of secreted protein acidic and rich in cysteine (SPARC) has been recently identified to be associated with the pathology of diabetic retinopathy. Therefore, the present study aimed to evaluate the regulatory role of SPARC in human retinal capillary endothelial cells (HRCECs), following exposure to a high glucose environment in vitro. The cell viability, migration, angiogenesis, permeability and SPARC expression levels of HRCECs were measured following treatment with different concentrations of glucose (25, 50 or 100 mM). Lentiviral vectors (LV185-pL_shRNA_mKate2-SPARC-543; target sequence, GGATGAGGACAACAACCTTCT) that inhibit the expression of SPARC were constructed, and HRCECs were evaluated when infected by viruses carrying the lentiviral vectors. Cell viability was examined using the Cell Counting Kit-8 assay. The expression of SPARC in HRCECs increased as the concentration of glucose in the culture medium increased. Relatively high concentrations of glucose significantly inhibited cell proliferation (P<0.05), migration (P<0.05), angiogenesis (P<0.01), and the expression of ZO, occludin, claudin and JAM1 in tight junctions (P<0.01), gap junctions (Cx37 and Cx43; P<0.01) and adherens junctions (VE-cadherin, CTNNA1 and CTNNB1; P<0.05). However, when SPARC was downregulated by lentiviral vectors, the inhibitions induced by high concentrations of glucose were partially reversed. To conclude, the inhibitory effects on cell viability, migration, angiogenesis and cellular adhesion of HRCECs induced by high concentrations of glucose were reversed once the expression of SPARC was inhibited. These findings suggest that SPARC may serve an important role in pathogenesis of diabetic retinopathy.
Collapse
Affiliation(s)
- Yang Fu
- Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, P.R. China.,Shanghai Key Laboratory of Fundus Disease, Shanghai 200080, P.R. China
| | - Min Tang
- Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, P.R. China.,Shanghai Key Laboratory of Fundus Disease, Shanghai 200080, P.R. China
| | - Xiaoqiong Xiang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, P.R. China.,Shanghai Key Laboratory of Fundus Disease, Shanghai 200080, P.R. China
| |
Collapse
|
7
|
Bouskill K, Smith-Morris C, Bresnick G, Cuadros J, Pedersen ER. Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management. BMC Health Serv Res 2018; 18:617. [PMID: 30086743 PMCID: PMC6081904 DOI: 10.1186/s12913-018-3427-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/29/2018] [Indexed: 01/18/2023] Open
Abstract
Background Novel telemedicine platforms have expanded access to critical retinal screening into primary care settings. This increased access has contributed to improved retinal screening uptake for diabetic patients, particularly those treated in Federally Qualified Health Centers (‘safety net’ clinics). The aim of this study was to understand how the implementation of telemedical screening for diabetic retinopathy within primary care settings is improving the delivery of critical preventative services, while also introducing changes into clinic workflows and creating additional tasks and responsibilities within resource-constrained clinics. Methods A qualitative approach was employed to track workflows and perspectives from a range of medical personnel involved in the telemedicine platform for diabetic retinopathy screening and subsequent follow-up treatment. Data were collected through semi-structured interviews and participant observation at three geographically-dispersed Federally Qualified Health Centers in California. Qualitative analysis was performed using standard thematic analytic approaches within a qualitative data analysis software program. Results The introduction of telemedicine platforms, such as diabetic retinopathy screening, into primary care settings is creating additional strain on medical personnel across the diabetes eye care management spectrum. Central issues are related to scheduling patients, issuing referrals for follow-up care and treatment, and challenges to improving adherence to treatment and diabetes management. These issues are overcome in many cases through workarounds, or when medical staff work outside of their job descriptions, purview, and permission to move patients through the diabetes management continuum. Conclusions This study demonstrates how the implementation of a novel telemedical platform for diabetic retinopathy screening contributes to the phenomenon of workarounds that account for additional tasks and patient volume. These workarounds should not be considered a sustainable model of health care delivery, but rather as an initial step to understanding where issues are and how clinics can adapt to the inclusion of telemedicine and ultimately increase access to care. The presence of workarounds suggests that as telemedicine is expanded, adequate resources, as well as collaborative, cross-sectoral co-design of new workflows must be simultaneously provided. Systematic bolstering of resources would contribute to more consistent success of telemedicine screening platforms and improved treatment and prevention of disease-related complications. Electronic supplementary material The online version of this article (10.1186/s12913-018-3427-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kathryn Bouskill
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - George Bresnick
- Department of Optometry and Vision Science, University of California, Berkeley, California, USA
| | - Jorge Cuadros
- Department of Optometry and Vision Science, University of California, Berkeley, California, USA
| | | |
Collapse
|