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      Preoperative Expectations and Postoperative Outcomes of Visual Functioning among Cataract Patients in Urban Southern China

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          Abstract

          Purpose

          To investigate the relationship between preoperative expectations and actual postoperative outcomes of visual function (VF) among patients undergoing first eye cataract surgery.

          Methods

          A longitudinal study of 182 patients from hospitals in urban Southern China were surveyed prior to surgery and 3 month after cataract surgery regarding their preoperative, expected postoperative and actual postoperative VF for each of the items on the Catquest-9SF and their satisfaction with cataract surgery. In addition, detailed clinical data were collected preoperatively and postoperatively.

          Results

          The majority of cataract patients in urban Southern China had high expectations for VF outcomes after cataract surgery and in most cases postoperative outcomes achieved the expected level of improvement. The mean (standard deviation, SD) preoperative Catquest-9SF score was 15.7 (5.86) and the mean (SD) expected postoperative score was 26.3 (2.93). The discrepancy between actual and expected improvement was significantly correlated with patients’ health literacy, presence of systemic and ocular comorbidity, preoperative visual acuity of the surgery eye, LOCS III nuclear opalescence and cortical cataract grading.

          Conclusion

          Cataract patients in urban Southern China had high expectations for surgery outcomes. Patients with low level of health literacy and the presence of systemic and ocular comorbidity may need a comprehensive counseling to decrease the discrepancy regarding expected and actual outcomes.

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          Most cited references21

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          Catquest-9SF patient outcomes questionnaire: nine-item short-form Rasch-scaled revision of the Catquest questionnaire.

          To assess and optimize the Catquest questionnaire for measuring patient-reported outcomes of cataract surgery using Rasch analysis. Fifty-eight ophthalmic surgical units in Sweden. Catquest questionnaires (n = 21364) from the Swedish National Cataract Register were selected and randomized to 2 groups. Data from 10486 questionnaires were comprehensively Rasch analyzed using a 4-Andrich rating scale model in Winsteps software. A revised version of Catquest was developed (Catquest-9SF) and tested in 10886 patients for validity and responsiveness to cataract surgery. Only the visual disability subscale formed a valid measurement scale. This could be enhanced through the addition of the 2 global assessment items; however, the symptoms and frequency of performing the activities items did not contribute to the measurement. The 9-item short-form version (Catquest-9SF) had ordered response thresholds and good person separation (2.65) and was largely free from differential item functioning. All items fit a single overall construct (infit range, 0.75 to 1.29; outfit range, 0.70 to 1.39) and unidimensional by principal components analysis. The items were well targeted to the preoperative participants (0.34 logit difference in means). The score correlated with visual acuity (r = 0.43 preoperatively; r = 0.48 postoperatively) and was highly responsive to cataract surgery (preoperatively -0.32 +/- 2.15 logits; postoperatively -3.21 +/- 2.50 logits (P<.0001). The 9-item Rasch-scaled Catquest-9SF was highly valid in measuring visual disability outcomes of cataract surgery. Its brevity makes it suited to routine clinical use, and a raw-data to Rasch-measure conversion simplifies application.
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            Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China

            Background China’s recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconomic status is increasing. We investigate inequality in service utilization among the mid-aged and elderly, with a special attention of health insurance. Methods This paper measures the income-related inequality and horizontal inequity in inpatient and outpatient health care utilization among the mid-aged and elderly in two provinces of China. The data for this study come from the pilot survey of the China Health and Retirement Longitudinal Study in Gansu and Zhejiang. Concentration Index (CI) and its decomposition approach were deployed to reflect inequality degree and explore the source of these inequalities. Results There is a pro-rich inequality in the probability of receiving health service utilization in Gansu (CI outpatient = 0.067; CI inpatient = 0.011) and outpatient for Zhejiang (CI = 0.016), but a pro-poor inequality in inpatient utilization in Zhejiang (CI = −0.090). All the Horizontal Inequity Indices (HI) are positive. Income was the dominant factor in health care utilization for out-patient in Gansu (40.3 percent) and Zhejiang (55.5 percent). The non-need factors’ contribution to inequity in Gansu and Zhejiang outpatient care had the same pattern across the two provinces, with the factors evenly split between pro-rich and pro-poor biases. The insurance schemes were strongly pro-rich, except New Cooperative Medical Scheme (NCMS) in Zhejiang. Conclusions For the middle-aged and elderly, there is a strong pro-rich inequality of health care utilization in both provinces. Income was the most important factor in outpatient care in both provinces, but access to inpatient care was driven by a mix of income, need and non-need factors that significantly differed across and within the two provinces. These differences were the result of different levels of health care provision, different out-of-pocket expenses for health care and different access to and coverage of health insurance for rural and urban families. To address health care utilization inequality, China will need to reduce the unequal distribution of income and expand the coverage of its health insurance schemes.
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              Correlation among lens opacities classification system III grading, visual function index-14, pentacam nucleus staging, and objective scatter index for cataract assessment.

              To investigate the relationship among Lens Opacities Classification System III (LOCS III) grading score, Visual Function Index-14 (VF-14) score, average lens density by the Pentacam Nucleus Staging system, and the objective scatter index measured by the Optical Quality Analysis System in age-related cataract patients.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                9 January 2017
                2017
                : 12
                : 1
                : e0169844
                Affiliations
                [1 ]State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
                [2 ]Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
                [3 ]Duke-National University of Singapore Medical School, Singapore
                [4 ]Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
                Soochow University Medical College, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: XL MY.

                • Data curation: ZC XL MY.

                • Formal analysis: LJ.

                • Funding acquisition: XL MY.

                • Investigation: BQ WG YZ WP.

                • Methodology: ZC XL MY.

                • Project administration: ZC XL MY.

                • Resources: BQ WG.

                • Software: YZ WP.

                • Supervision: ZC XL MY.

                • Validation: BQ WG YZ WP.

                • Visualization: ZC LJ.

                • Writing – original draft: ZC XL EL MY.

                • Writing – review & editing: ZC XL MY.

                Article
                PONE-D-16-45808
                10.1371/journal.pone.0169844
                5222503
                28068402
                1181eb59-087b-4b15-8258-d88e203d2afa
                © 2017 Chen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 November 2016
                : 24 December 2016
                Page count
                Figures: 0, Tables: 7, Pages: 14
                Funding
                Funded by: Guangdong Natural Science Foundation
                Award ID: 2015A030313171
                Funded by: Science and Technology Program of Guangdong Province, China
                Award ID: 2013B020400003
                Funded by: Science and Technology Program of Guangzhou, China
                Award ID: 15570001
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81200685
                This work is funded by Guangdong Natural Science Foundation (2015A030313171), Science and Technology Program of Guangdong Province, China (2013B020400003), Science and Technology Program of Guangzhou, China (15570001), and National Natural Science Foundation of China (81200685). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Ophthalmic Procedures
                Cataract Surgery
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Vision
                Visual Acuity
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Vision
                Visual Acuity
                Social Sciences
                Psychology
                Sensory Perception
                Vision
                Visual Acuity
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Ophthalmic Procedures
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Vision
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Vision
                Social Sciences
                Psychology
                Sensory Perception
                Vision
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Lens (Anatomy)
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Lens (Anatomy)
                Custom metadata
                All relevant data are within the paper.

                Uncategorized
                Uncategorized

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