Impaired Insight Research Articles

Prevalence and predictors of internet use among Ghanaian older adults: evidence from the Ghana 2021 Population and Housing Census

Internet use among older adults has several beneficial impacts on their health and general wellbeing. However, there are limited studies on internet use among older adults in low- and middle-income countries, including Ghana. Also, studies on internet use among older adults have used surveys rather than census data, which minimises the potential for sampling bias and improves representativeness. Therefore, this study used census data to examine the prevalence and predictors of internet use among Ghanaian older adults. This study utilised the Ghana 2021 Population and Housing Census. The data were analysed using Pearson’s chi-square test and binary logistic regression. Overall, 52.9% of older adults used the internet 3 months preceding the census. Older adults mainly use mobile phones to access the internet. The significant predictors of internet use were age, sex, educational status, marital status, religious affiliation, place of residence, sight and hearing impairment, household wealth status, and ecological zone. Internet use among Ghanaian older adults was relatively high. Policymakers should consider these intrapersonal (age, sex, educational status, and sight and hearing impairments), interpersonal (marital status and household wealth), institutional (religious affiliation), and community (place of residence and ecological zone) level factors when developing interventions to promote internet use among older adults.

Use of immunomodulators in non-infectious uveitis: lights and shadows.

Non-infectious uveitis (NIU) is one of the leading causes of sight impairment worldwide. Corticosteroids are the mainstay treatment for acute NIU, although their known systemic and ocular side effects limit their long-term use. The most common types of immunosuppressants used as steroid-sparing treatment are non-biologic drugs, particularly antimetabolites (methotrexate, mycophenolate mofetil, and azathioprine) and biologic drugs, mainly TNF-α inhibitors such as Adalimumab or Infliximab. Antimetabolites have shown their effectiveness in the treatment of NIU in individual and comparative studies, being methotrexate and mycophenolate mofetil usually preferred over azathioprine. The choice of which antimetabolite to use at first is not well defined, and decisions usually depend on the patient's characteristics and the physician's preferences. Treatment of NIU with biologic drugs, and particularly TNF-α inhibitors, has significantly increased in the last years and is considered an important alternative in patients not responding to first-line immunomodulators such as antimetabolites. However, data regarding how different immunomodulators or biologic drugs perform in different NIU is still limited, and little is known about the optimization of both biologic and non-biologic drugs when used in NIU. Further randomized clinical trials and comparative studies are required to achieve more understanding and better results when addressing complicated NIU. The purpose of this review is to provide a comprehensive overview of the use of non-biologic and biologic drugs in NIU, which may be useful for clinicians in their daily practice, and to address those aspects that are less known about these treatments as well as their weaknesses.

Exome-wide association study identifies KDELR3 mutations in extreme myopia

Extreme myopia (EM), defined as a spherical equivalent (SE) ≤ −10.00 diopters (D), is one of the leading causes of sight impairment. Known EM-associated variants only explain limited risk and are inadequate for clinical decision-making. To discover risk genes, we performed a whole-exome sequencing (WES) on 449 EM individuals and 9606 controls. We find a significant excess of rare protein-truncating variants (PTVs) in EM cases, enriched in the retrograde vesicle-mediated transport pathway. Employing single-cell RNA-sequencing (scRNA-seq) and a single-cell polygenic burden score (scPBS), we pinpointed PI16 + /SFRP4+ fibroblasts as the most relevant cell type. We observed that KDELR3 is highly expressed in scleral fibroblast and involved in scleral extracellular matrix (ECM) organization. The zebrafish model revealed that kdelr3 downregulation leads to elongated ocular axial length and increased lens diameter. Together, our study provides insight into the genetics of EM in humans and highlights KDELR3’s role in EM pathogenesis.

Modeling impaired insight after drug use in rodents.

Impaired insight in substance use disorder has been argued to reflect a global deficit in using cognitive models to mentally simulate possible future outcomes. The process of mentally simulating outcomes allows us to understand our beliefs about their causes, that is, to have insight and thereby avoid potentially negative outcomes. However, work in humans cannot address whether impaired insight and its neural/neurochemical sequalae are present prior to the development of a substance use disorder, a consequence of substance use, or a combination of both. This is because baseline measurements prior to drug use are not possible in humans. However, if these changes can be directly caused by drug use, then in animal models, a history of drug use should cause impairments in behavioral tasks designed to assess such inferences. Focusing on cocaine use, here we will review several lines of research from our laboratory that have tested this question using learning-theory tasks designed to isolate insight. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Consciousness in non-REM-parasomnia episodes.

Sleepwalking and related parasomnias are thought to result from incomplete awakenings out of non-rapid eye movement (non-REM) sleep. Non-REM parasomnia behaviours have been described as unconscious and automatic, or related to vivid, dream-like conscious experiences. Similarly, some observations have suggested that patients are unresponsive during episodes, while others that they can interact with their surroundings. To better grasp and characterise the full spectrum of consciousness and environmental (dis)connection associated with behavioural episodes, 35 adult patients with non-REM sleep parasomnias were interviewed in-depth about their experiences. The level of consciousness during parasomnia episodes was reported to be variable both within and between individuals, ranging from minimal or absent consciousness and largely automatic behaviours (frequently/always present in 36% of patients) to preserved conscious experiences characterised by delusional thinking to varying degrees of specificity (65%), often about impending danger, variably formed, uni- or multisensory hallucinations (53%), impaired insight (77%), negative emotions (75%), and variable, but often pronounced, amnesia (30%). Patients described their experiences as a dream scene during which they felt awake ("awake dreaming"). The surroundings were either realistically perceived, misinterpreted (in the form of perceptual illusions or misidentifications of people), or entirely hallucinated as a function of the prevailing delusion. These observations suggest that the level of consciousness, amnesiaand sensory disconnection during non-REM parasomnia episodes is variable and graded. In their full-fledged expression, non-REM parasomnia experiences feature several core features of dreams. They therefore represent a valuable model for the study of consciousness, sleep-related sensory disconnection and dreaming.

Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study.

This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals. The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention. Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals. The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.

Involving stakeholders in designing a mental health curriculum for staff in the vision impairment sector

Depression and anxiety are common in people with congenital and acquired vision impairment but often go unaddressed. Staff from a variety of professions and roles in the sight impairment sector are well-placed to identify mental health issues and signpost individuals for support. However, many of these individuals need training to do this competently. The aim of this project was to develop a mental health training curriculum for staff. We used a seven-step method involving staff and service users from national sight loss charities and local authorities, and university researchers. The result was a curriculum containing five modules covering an introduction to mental well-being, the use of a standardised depression and anxiety screening tool, referral and support options and implementation issues to consider. Future work involves developing the curriculum into an online training programme for wide dissemination across the sight loss sector.

Treatment adherence and insight in schizophrenia spectrum disorders

IntroductionLack of adherence to antipsychotic medication in patients with schizophrenia spectrum disorders is a major risk factor for relapse and rehospitalizations which contributes to major social and economic consequences. A high proportion of patients with schizophrenia are partially or completely unaware of their mental disorder.ObjectivesThe aim of this study was to investigate the association between insight and medication adherence.MethodsA total number of 30 outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria who were attending the department of psychiatry A Razi hospital between august and September 30, 2023 were included in this study. Patients’ insight was measured by the birchwood insight scale. The degree of medication adherence was measured by using Medication Adherence Rating Scale (MARS).ResultsPatients enrolled in the study had a mean (SD) age of 43.2 .There was no significant correlation between patients’ insight and patients’ ages, duration of illness and hospitalization times. In addition, there was no significant association between medication adherence and age, duration of illness, number of hospitalization or social level. Impaired insight was associated with poor antipsychotic medication adherence in patients with schizophrenia spectrum disorders .Higher insight was correlated to higher therapeutic adherence. Our results showed that the level of insight and compliance to treatment are positively correlated.Conclusions The results of this study support the hypothesis that insight and treatment adherence are closely related. Interventions to enhance insight may be helpful in improving medication adherence.Disclosure of InterestNone Declared

Insight into Illness Among Inpatients in a National Forensic Mental Health Service: A Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)

IntroductionForensic psychiatric services serve a dual purpose: treatment of mental disorders and prevention of associated violent reoffending. Progression along the secure care pathway is often impeded by impaired insight, mainly as a result of treatment-resistant psychoses.ObjectivesWe assessed levels of insight among patients in Ireland’s National Forensic Mental Health Service before and after its relocation from the historic 1850 campus in Dundrum to a modern facility in Portrane, Dublin.MethodsThe VAGUS insight scale was used in this repeated measures study before and after the relocation at two time points 42 months apart. All inpatients were invited to participate in completing the self-report (VAGUS-SR) and clinician-rated (VAGUS-CR) versions on both occasions. Total scores of both versions were averaged to obtain a combined VAGUS insight score. Corresponding Positive and Negative Syndrome Scale (PANSS) scores were used to ascertain correlations between the insight and symptomatology scales. This study is part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)Results40 pairs of observations were available for legal capacity to consent to medication, combined VAGUS-CR and VAGUS-SR assessments of insight (Cronbach’s alpha=0.927), and PANSS. VAGUS-CR insight and PANSS scores were progressively better from admission and high dependency wards through medium-term medium secure wards to rehabilitation and pre-discharge wards. Mean scores did not change significantly over this time interval. Those legally certified fit to give or withhold consent by their treating consultant psychiatrists scored significantly better on the VAGUS combined insight scale: 8.3 (SD 1.7) v 5.3 (2.2) at baseline, paired t=25.9, p<0.001; and also 42 months later: 8.2 (1.4) v 5.7 (3.9), paired t=5.2, p=0.022. PANSS subscales were all significantly better for those assessed as being capacitous. Change in combined VAGUS score correlated with change in all PANSS subscales. Binary logistic regression with legal capacity as the dependent variable yielded a model in which combined VAGUS score and PANSS positive symptom score were independent determinants of assessed capacity status. Receiver operating characteristic area under the curve was 0.873, 95% CI 0.760-0.986, at baseline and 0.856, 95% CI 0.720-0.991, at 42 months. A score of 7.3 yielded a sensitivity of 0.8 and a specificity of 0.8.ConclusionsThe combined VAGUS score is a reliable and valid measure of insight relevant to functional mental capacity to consent to treatment with sensitivity and specificity sufficient to guide but not bind clinical decision-making. It measures a quality that varies with symptom severity but is also partly independent of symptom severity; the constructive inclusion of self-reported insight is notable.Disclosure of InterestNone Declared

Psychometric evaluation of the Arabic language version of the Birchwood Insight Scale in patients with schizophrenia

BackgroundClinical insight (i.e., impaired insight into illness) is increasingly recognized by the scientific community as a significant contributor to an array of psychological and clinical outcomes in schizophrenia. Therefore, its assessment using a reliable, rapid, easy and economic tool is important for clinical practice. This study proposes to investigate the psychometric properties of an Arabic translation of the Birchwood Insight Scale (BIS) in Arabic-speaking chronic patients with schizophrenia. Our objectives were to identify the most adequate factor structure of the BIS among the several measurement models previously proposed in the literature, verify the reliability and measurement invariance of the BIS across sex groups, and explore the concurrent validity of the BIS through examining its patterns of correlations with psychotic symptoms.MethodOne hundred seventeen Arabic-speaking chronic, remitted patients with schizophrenia took part in this study. An Arabic translated version of the BIS and the Positive and Negative Syndrome Scale (PANSS) were administered to participants.ResultsConfirmatory factor analyses (CFA) showed that, after omitting two items with low loadings (items 1 and 2), the unidimensional factor model of the BIS showed good fit indices and a reliability of α = 0.68 and ω = 0.68. However, analyses failed to show good fit for the full-length one-, two-, and three-factor models of the BIS in its Arabic version. Measurement invariance of the Arabic 6-item one-factor BIS was established between males and females at the configural, metric and scalar levels; no statistically significant difference between males and females was found in terms of BIS scores. Finally, BIS scores correlated significantly with the PANSS scores in our sample, thus demonstrating adequate concurrent validity.ConclusionThis study offers valuable additional psychometric information about the BIS based on results of CFA and other analyses in schizophrenia from a non-Western cultural environment. We believe that making the BIS available in Arabic might benefit clinicians working with Arabic-speaking patients with schizophrenia, open new avenues of research and gain a better knowledge into the nature of clinical insight and its relevance to psychopathology.

Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they?

Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes. The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1=154; N2=300; N3=194). A qualitative chart review of a subsample of non-endorsers (N4=32) extracted reports of disordered eating behaviours observed by the treatment team. The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers. Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.

Prediction of Diabetic Retinopathy using Deep Learning with Preprocessing

INTRODUCTION: When Diabetic Retinopathy (DR) is not identified promptly; it frequently results in sight impairment. To properly diagnose and treat DR, preprocessing of picture methods and precise prediction models are essential. With the help of numerous well-liked filters and a Deep CNN (Convolutional Neural Network) model, the comprehensive method for DR image preparation and prognosis presented in this research is described. Using the filters that focus boundaries and contours in the ocular pictures is the first step in the initial processing stage. This procedure tries to find anomalies linked to DR. By the usage of filters, the excellence of pictures can be developed and minimize disturbances, preserving critical information. The Deep CNN algorithm has been trained to generate forecasts on the cleaned retinal pictures following the phase of preprocessing. The filters efficiently eliminate interference without sacrificing vital data. Convolutional type layers, pooling type layers, and fully associated layers are used in the CNN framework, which was created especially for image categorization tasks, to acquire data and understand the relationships associated with DR.
 OBJECTIVES: Using image preprocessing techniques such as the Sobel, Wiener, Gaussian, and non-local mean filters is a promising approach for DR analysis. Then, predicting using a CNN completes the approach. These preprocessing filters enhance the images and prepare them for further examination. The pre-processed images are fed into a CNN model. The model extracts significant information from the images by identifying complex patterns. DR or classification may be predicted by the CNN model through training on a labeled dataset.
 METHODS: The Method Preprocessing is employed for enhancing the clarity and difference of retina fundus picture by removing noise and fluctuation. The preprocessing stage is utilized for the normalization of the pictures and non-uniform brightness adjustment in addition to contrast augmentation and noise mitigation to remove noises and improve the rate of precision of the subsequent processing stages.
 RESULTS: To improve image quality and reduce noise, preprocessing techniques including Sobel, Wiener, Gaussian, and non-local mean filters are frequently employed in image processing jobs. For a particular task, the non-local mean filter produces superior results; for enhanced performance, it may be advantageous to combine it with a CNN. Before supplying the processed images to the CNN for prediction, the non-local mean filter can assist reduce noise and improve image details.
 CONCLUSION: A promising method for DR analysis entails the use of image preprocessing methods such as the Sobel, Wiener, Gaussian, and non-local mean filters, followed by prediction using a CNN. These preprocessing filters improve the photos and get them ready for analysis. After being pre-processed, the photos are sent into a CNN model, which uses its capacity to discover intricate patterns to draw out important elements from the images. The CNN model may predict DR or classification by training it on a labeled dataset. The development of computer-aided diagnosis systems for DR is facilitated by the integration of CNN prediction with image preprocessing filters. This strategy may increase the effectiveness of healthcare workers, boost patient outcomes, and lessen the burden of DR.

Effective AAV-mediated gene replacement therapy in retinal organoids modeling AIPL1-associated LCA4

Biallelic variations in the aryl hydrocarbon receptor interacting protein-like 1 (AIPL1) gene cause Leber congenital amaurosis subtype 4 (LCA4), an autosomal recessive early-onset severe retinal dystrophy that leads to the rapid degeneration of retinal photoreceptors and the severe impairment of sight within the first few years of life. Currently, there is no treatment or cure for AIPL1-associated LCA4. In this study, we investigated the potential of adeno-associated virus-mediated AIPL1 gene replacement therapy in two previously validated human retinal organoid (RO) models of LCA4. We report here that photoreceptor-specific AIPL1 gene replacement therapy, currently being tested in a first-in-human application, effectively rescued molecular features of AIPL1-associated LCA4 in these models. Notably, the loss of retinal phosphodiesterase 6 was rescued and elevated cyclic guanosine monophosphate (cGMP) levels were reduced following treatment. Transcriptomic analysis of untreated and AAV-transduced ROs revealed transcriptomic changes in response to elevated cGMP levels and viral infection, respectively. Overall, this study supports AIPL1 gene therapy as a promising therapeutic intervention for LCA4.

Sight impairment registration in Trinidad: trend in causes and population coverage in comparison to the National Eye Survey of Trinidad and Tobago

BackgroundLittle was known about the population coverage and causes of sight impairment (SI) registration within the Caribbean, or the extent to which register studies offer insights into population eye health.MethodsWe compared causes of SI registration in the Trinidad and Tobago Blind Welfare Association (TTBWA) register with findings from the 2014 National Eye Survey of Trinidad and Tobago (NESTT), and estimated registration coverage. Cross-sectional validation studies of registered clients included interviews, visual function and cause ascertainment in July 2013, and interviews and visual function in July 2016.ResultsThe TTBWA register included 863 people (all ages, 48.1%(n = 415) male) registered between 1951 and 2015. The NESTT identified 1.1%(75/7158) people aged ≥5years eligible for partial or severe SI registration, of whom 49.3%(n = 37) were male. Registration coverage was approximately 7% of the eligible population of Trinidad. Nevertheless, there was close agreement in the causes of SI comparing the register and population-representative survey. Glaucoma was the leading cause in both the register (26.1%,n = 225) and population-based survey (26.1%, 18/69 adults), followed by cataract and diabetic retinopathy. In the validation studies combined, 62.6%(93/151) clients had severe SI, 28.5%(43/151) had partial SI and 9.9%(15/151) did not meet SI eligibility criteria. SI was potentially avoidable in at least 58%(n = 36/62) adults and 50%(n = 7/14) children.ConclusionWe report very low register coverage of the SI population, but close agreement in causes of SI to a contemporaneous national population-based eye survey, half of which resulted from preventable or treatable eye disease.

Seeing Feelingly: A Sight‐Impaired Observer's Reflections on an Infant Observation during the Covid‐19 Pandemic

The author reflects on the experience of conducting an infant observation from their perspective of having a sight impairment encapsulated in the phrase ‘seeing feelingly’ taken from Shakespeare's play King Lear. The multi‐sensory and somatic world of the infant is explored where sight is secondary to touch in early infancy and how this reflects something of the observer's way of experiencing the world. The impact of disability on how the author sees themselves and is seen by others is discussed in terms of the defences of projection, projective identification and disavowal. The COVID‐19 pandemic and the necessity of remote observations via video link add another angle from which emotional connection is explored, leading the author to conclude that, although greater visual clarity was gained, emotional contact was diminished. The paradox of a sight‐impaired person ‘observing’ challenges the privileging of the sense of sight, suggesting that a more multi‐sensory approach could be of benefit to the conduct of infant observations. In addition, the very title ‘infant observation’ might deter others with sight impairment from participation.

Accessibility Evaluation of an Assistive Social Robotic Platform for Rehabilitation and Its Improvement by Means of Haptic Devices

The use of robotic platforms with social capabilities is becoming increasingly common to support people’s daily lives. Such systems are commonly referred to as Socially Assistive Robots (SAR). Many SARs focus on a human-machine interaction based on visual and sound information, which could limit access for users with sight, hearing, or cognitive impairments, as it is usual in health environments. In this paper, we report a qualitative evaluation of the accessibility of Inrobics Rehab platform, arehabilitation platform based on the NAO robot. From the main outcomes, we propose to augment communication channels in social rehabilitation robots with haptic devices. The main aim of this proposal is to increase the accessibility of the platforms by combining multimodal information provided by visual, sound, and tactil channels.

Impaired insight and error-monitoring deficits among outpatients with attenuated psychosis syndrome and first-episode psychosis

We aimed to determine the relationship between electrophysiological signatures of error monitoring and clinical insight among outpatients with attenuated psychosis syndrome (APS) and first-episode psychosis (FEP). Error-related negativity (ERN), error positivity (Pe), and correct response negativity (CRN) were recorded during a modified flanker task for patients with FEP (n = 32), APS individuals (n = 58), and healthy controls (HC, n = 49). Clinical insight was measured using the Schedule of Assessment of Insight (SAI) and included awareness of illness (SAI-illness), relabeling of specific symptoms (SAI-symptoms), and treatment compliance (SAI-treatment). Compared with HC, patients with FEP showed smaller ERN (p < 0.001) and Pe (p = 0.011) amplitudes and individuals with APS showed smaller ERN amplitude (p = 0.009). No significant difference in CRN amplitude was observed among the groups. A smaller negative amplitude of ERN correlated with a lower score on SAI-symptoms (b = −0.032, 95% CI: 0.062 to −0.002, p = 0.035) and a decreased total score of SAI (b = −0.096, 95% CI: 0.182 to −0.010, p = 0.029). This links were adjusted for age, education, and diagnosis (a dummy variable with FEP = 1 and APS = 0), and was independent of positive symptoms. SAI-illness was predominantly influenced by diagnosis, whereas SAI-treatment was additionally affected by disorganized communications. Neither Pe nor CRN amplitude exhibited an association with clinical insight. Unconscious error detection, as indicated by ERN, may aid individuals at the preliminary stage of psychosis in recognizing the unusual symptoms.

The blind leading the blind: Co-production of medication safety solutions for people with sight impairment in community pharmacy

Abstract Introduction Around 237 million medication errors occur each year in England, with an estimated cost of £98 million1. We carried out a scoping review identified that people with sight impairments were a group at high risk of errors (under review). Aim To improve medication safety for people with sight impairments by developing an ‘App’ to help them manage medications. Methods We attended an initial in-person ‘Tea and Tech’ stakeholder group led by Henshaws Sight Loss charity in Manchester, UK and sought feedback from people with sight impairments about their experiences of medication. Ethical approval for this study was granted by The University of Manchester Research Ethics Committee (Ref: 2021-11098-18381). Co-design workshops – Due to the ongoing COVID-19 pandemic, we held two online workshops, minimising the need for travel and face to face meetings2. Workshops were promoted by RNIB amongst their ‘Community Connectors’. Community Pharmacists who were part of our NIHR Greater Manchester Patient Safety Translational Research Centre were also invited to participate to provide their perspective as healthcare professionals. Sessions were co-facilitated by patient safety researchers and researchers acting as notetakers. The first workshop (June 2021), focussed on the experiences of people with sight impairment around using medication, and potential solutions to these. The second workshop (July 2021), ranked these potential solutions, prioritising ideas for development. Results Those attending the Tea and Tech group warned against developing ‘another App’, highlighting problems caused by their sight impairment around installing and using ‘Apps’ generally. Co-design workshops were attended by six people with sight impairment and six community pharmacists. The difficulties reported included inability to distinguish between medications, to access dosing instructions (on medication labels) and safety information within product information leaflets. The solutions ranked as most important were 1) one to one consultations with pharmacists 2) improving medication packaging and 3) the need for pharmacist training. Discussions highlighted the lack of a system for pharmacists to reliably identify people with sight impairments. This led us to develop a pharmacy software system called Find Logo And Give Medication advice (FLAG-Me Vision) which identifies people with sight impairments using existing data within the electronic health record. An on-screen alert (shown as a logo) on the patient medication record, prompts pharmacy staff to offer a one-to-one consultation. Resources available on our website (www.flag-me.org) supports consultations and meets the remit for pharmacist training. Our prototype software created by Imago Student Software company at The University of Manchester, was tested using dummy NHS records and Hospital Run (open-source software). Discussion/Conclusion Market discovery and testing for FLAG-Me Vision has been undertaken via iCURe DISCOVER programme3. Feedback is that FLAG-Me Vision is well received by people with sight impairments and pharmacists alike. Future plans include piloting this software with pharmacy software suppliers within one community pharmacy chain in Greater Manchester.

Face-down positioning or posturing after macular hole surgery.

Face-down positioning or posturing after macular hole surgery.

Conceptualising social inclusion and examining its relationship with social competence

Previous research has attempted to examine specific social aspects of the school inclusion of students with vision impairment, such as the development of social relationships with their teachers and peers and their participation in school activities. Based on Bronfenbrenner’s ecological system theory, this article presents a socio-ecological model that aims to embrace the different elements of social inclusion in school. Considering the components of this socio-ecological model, the findings of an empirical study that examined the school engagement of adolescents with vision impairment and its effect on their social competence are presented. Thirty-seven adolescents, with and without vision impairment, aged 12–14 years, participated in this study. Adolescents were divided into three groups: adolescents with severe sight impairment (previously ‘blindness’), adolescents with sight impairment (previously ‘low vision’) and sighted adolescents. Participants completed a questionnaire about their school engagement and disengagement, and their parents completed a quantitative scale about their children’s social competence. There were no significant differences found between the three participant groups in terms of school engagement, disengagement and social competence. Neither school engagement nor disengagement was a significant predictor of social competence. The findings of this empirical study revealed remarkable similarities in school engagement and social competence between adolescents with and without vision impairment. These findings may also suggest that other clinical and social factors, independent of visual functioning, affect the school inclusion and social competence of adolescents with vision impairment. Overall, the socio-ecological model developed for the purposes of this research can lead to the development of evidence-based interventions that will aim to improve the social inclusion of adolescents with vision impairment. Furthermore, the rationale of the empirical study may promote further investigation of the critical role of promoting less-intrusive classroom interventions to facilitate the school inclusion of students with vision impairment.