Association between Comorbidities and Preserved Ratio Impaired Spirometry: Using the Korean National Health and Nutrition Examination Survey IV–VI

<b><i>Background:</i></b> Preserved ratio impaired spirometry (PRISm) patients have more frequent respiratory symptoms and an increased risk of mortality. However, studies on comorbidities in these patients are lacking. <b><i>Objectives:</i></b> We investigated the association between PRISm and comorbidities using the Korea National Health and Nutrition Examination Survey (KNHANES). <b><i>Method:</i></b> This cross-sectional study included participants aged ≥50 years from the KNHANES (2007–2015). Participants who did not undergo spirometry or performed inadequately were excluded. We classified participants into 3 groups according to spirometry: PRISm (forced expiratory volume in one second [FEV1] /forced vital capacity [FVC] ≥ 0.7 and FEV1 &#x3c;80%), chronic obstructive pulmonary disease (COPD) (FEV1/ FVC &#x3c;0.7), and normal. Multivariate logistic regression analyses were used to evaluate the risk of comorbidities in the PRISm group compared to that in the normal group. <b><i>Result:</i></b> The study included 17,515 participants: 12,777 (73.0%), 1,563 (8.9%), and 3,175 (18.1%) in normal, PRISm, and COPD groups, respectively. After adjustment for known risk factors of each disease, hypertension (adjusted odds ratio [95% confidence interval]; 1.31 [1.14–1.50]), diabetes (1.51 [1.29–1.78]), hypercholesterolemia (1.20 [1.04–1.37]), obesity (1.31 [1.15–1.48]), ischemic heart disease (1.58 [1.13–2.22]), chronic renal disease (2.31 [1.09–4.88]), and thyroid disease (1.41 [1.09–1.83]) risks were significantly higher in the PRISm group than in the normal group. The average number of comorbidities was 2.45 in the PRISm group, which was higher than that in the normal (2.1) and COPD (2.03) groups (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> The number of comorbidities was significantly higher in the PRISm group than in others. Hypertension, diabetes, obesity, ischemic heart disease, chronic renal disease, and thyroid disease were associated with PRISm after adjustment for risk factors.

Effect of Prism Adaptation Therapy on the Activities of Daily Living and Awareness for Spatial Neglect: A Secondary Analysis of the Randomized, Controlled Trial

Background: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is not fully proven. The Catherine Bergego Scale (CBS) was developed to identify problems with the activities of daily living (ADL) caused by USN. The CBS is composed of 10 observation assessments and a self-assessment questionnaire. To assess the self-awareness of USN, the anosognosia score is calculated as the difference between the observational scores and the self-assessment scores. To investigate how PA affects ADL and self-awareness in subacute USN patients during rehabilitation, we analyzed each item of the CBS and self-awareness from a randomized, controlled trial (RCT) that we previously conducted (Mizuno et al., 2011). Methods: A double-masked randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN in 8 hospitals in Japan. We compared each item of the CBS, anosognosia score, and absolute value of the anosognosia score between the prism group and the control group. Results: Two of ten items (gaze orientation and exploration of personal belongings) were significantly improved in the prism group compared with those in the control group. The absolute value of the anosognosia score was significantly improved by PA. Conclusions: Improvement of oculomotor exploration by PA may generalize the behavioral level in a daily living environment. This study suggested that PA could accelerate the self-awareness of neglect during subacute rehabilitation.

Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Surve

Background and Objectives: preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that causes respiratory symptoms, systemic inflammation, and mortality. However, its impact on health-related quality of life (HRQOL) and its associated factors remain unclear. We aimed to identify these HRQOL-related factors and investigate the differences in HROOL between persons with PRISm and those with normal lung function. Materials and Methods: we reviewed the Korea National Health and Nutrition Examination Survey data from 2008 to 2013 to evaluate the HRQOL of persons with PRISm, as measured while using the Euro Quality of Life-5D (EQ-5D) and identify any influencing factors. PRISm was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1 to forced vital capacity (FVC) ratio (FEV1/FVC) ≥0.7. Individuals with FEV1 ≥80% predicted and FEV1/FVC ≥0.7 were considered as Controls. Results: of the 27,824 participants over the age of 40 years, 1875 had PRISm. The age- and sex-adjusted EQ-5D index was lower in the PRISm group than in the control group (PRISm, 0.930; control, 0.941; p = 0.005). The participants with PRISm showed a significantly higher prevalence of hypertension (p < 0.001), diabetes (p < 0.001), obesity (p < 0.001), low physical activity (p = 0.001), ever-smoker (p < 0.001), and low income (p = 0.034) than those in the control group. In participants with PRISm, lower EQ-5D index scores were independently associated with old age (p = 0.002), low income (p < 0.001), low education level (p < 0.001), and no economic activity (p < 0.001). Three out of five EQ-5D dimensions (mobility, self-care, and usual activity) indicated a higher proportion of dissatisfied participants in the PRISm group than the control group. Conclusions: the participants with PRISm were identified to have poor HRQOL when compared to those without PRISm. Old age and low socioeconomic status play important roles in HRQOL deterioration in patients with PRISm. By analyzing risk factors that are associated with poor HRQOL, early detection and intervention of PRISm can be done in order to preserve patients’ quality of life.

Treatment of Younger Patients with Accommodative Esotropia

Background: Accommodative esotropia (AET) is a common disease during childhood. In this literature review, we analyze and discuss the different methods of treatment for Accommodative esotropia. Methods: Articles about accommodative esotropia from 2007 to 2017 were retrieved from the PubMed database. We study the articles by title/abstract/all fields, after applying the inclusion and exclusion criteria, finally 9 articles were retained. We compared the effectiveness between these approaches to treatment. Results: All the refraction methods had an effectivity rate of > 50%. The bifocal lenses group showed a higher failure rate (15.58%) than the single-vision lenses group (5.19%). Extraocular muscle surgery can significantly decrease deviation in patients who have AET with a high AC/A ratio (95.24%,71.30%,78.40%). After Botulinum toxin injection, the residual deviation was significantly lower than that before the injection (90.44%) and this rate held stable until 12 months after the injection (85.71%) and then decreased to 71.43% at 18 months. The effectivity rate in the prism builders group (surgery with prism group) was significantly higher than that in the prism non-builders group 100% vs. 56.25%). In this review, the average rate of Amblyopia in the accommodative esotropia patient is 41.36%. Conclusions：All the treatment were full or partly effective for accommodative esotropia patients. Early intervention using effective methods of treatment can improve accommodative esotropia patients’ alignment and improve their quality of life. Amblyopia is common in patients with partly accommodative esotropia. Keyword: Accommodative esotropia, Treatment, High AC/A ( accommodative convergence to accommodation ratio ), Amblyopia.