A comparative study to evaluate factors that influence survival in multidisciplinary predialysis educated patients and "Crashlanders".

Integrated multidisciplinary predialysis education (MPE) is usually provided to support and prepare the pre-end-stage renal disease (ESRD) patients before the initiation of renal replacement therapy (RRT). However, the impact of MPE is not known in our population, which is comprised patients of Asian origins and recipients of a totally subsidized health-care system. This research compared the survival probability, sociodemographic, and clinical characteristics of MPE patients and non-MPE patients (or crashlanders). A retrospective cohort study was conducted to investigate ESRD patients who started RRT in Brunei Darussalam from January 2013 to December 2014. Data were extracted from the computerized clinical database and dialysis records. A total of 351 new cases of ESRD patients who started on hemodialysis during the study period were included in the study. The median age was 56.0 years, with a slight male preponderance (56.6%). The MPE group was significantly older (P = 0.001) and more likely to have a history of diabetes mellitus (P = 0.013), ischemic heart disease (P = 0.014), and hypertension (P = 0.016). Despite being older and having more comorbidities (P = 0.028), MPE patients have a better survival probability (P = 0.028) and a 34% decreased risk of dying. Of those who died, older age (P = 0.001), higher serum creatinine (P = 0.01), and lower hemoglobin level (P = 0.017) were significant prognostic indicators. MPE before the initiation of RRT contributed to greater survival probability in near ESRD patients. The survival benefits were evident despite the presence of inherent risks (older age and presence of comorbidities) in the MPE population in comparison with the non-MPE cohort.

Relating vision status to academic achievement among year-2 school children in Malaysia.

BACKGROUND: Vision affects daily activities, but of particular importance is the impact upon the learning process. Many studies have been conducted to establish the relationship between vision problems and academic performance. The results are varied, however, and suggest additional research is needed with particular care given to study design. METHODS: This study included 1,103 year-2 school children enrolled in 7 public schools in the Klang Valley region of Malaysia. There were an equal proportion of males (50.6%) and females (49.4%). The testing battery was designed to assess visual acuity, ocular muscle balance, visual analysis skills, visual-spatial skills, and visual-motor integration skills. RESULTS: Children with average and above-average achievement showed a different visual performance profile from those children with low academic achievement. They had a statistically significant better pass rate in physical aspects (visual acuity), physiological aspects (ocular motor balance), and perceptual aspects (visual-motor integration/visual-spatial and visual-analysis skills). CONCLUSION: Children with low academic achievement are more likely to exhibit problems in visual acuity, ocular motor balance, visual-motor integration and most all components of visual analysis skills. This finding supports the concept that visual performance is key to learning and therefore of chief concern as to school achievement.