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Understanding the behavior and the challenges of visually impaired individuals in waste separation remains a significant research gap that affects the development of an inclusive and sustainable society. This research study aims to identify and analyze the factors influencing the waste separation behavior of visually impaired people and the key obstacles that these individuals face in public spaces. The study uses a quantitative approach, relying on surveys to gather data from a sample of 358 visually impaired individuals through the use of structured questionnaires. The data was then examined using multiple regression analysis. Results revealed that 91.1% possessed a moderate understanding of waste segregation, while 97.7% held generally positive attitudes toward the practice. Approximately 74.9% of the participants actively engaged in waste segregation at a moderate level. Motivation emerged as the most significant influence of proper waste management behavior, alongside attitude and knowledge. However, challenges persist in public settings, where 69.3% of participants discarded waste without regard to bin types, primarily due to difficulties in distinguishing bin colors and general ignorance. To better address their needs, participants recommended practical solutions, such as bins designed to be distinguishable by shape or sound, ensuring a more accessible and inclusive waste segregation system. This research can help in designing targeted interventions that promote sustainable waste management practices for visually impaired individuals. It can also provide valuable information to researchers, practitioners, and policymakers working towards creating inclusive and accessible waste management environments and processes for people with visual impairments.

Background To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults. Methods We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008. Conclusions Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

Study question Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety?Methods 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months’ follow-up.Study answer and limitations 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes.What this study adds Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety.Funding, competing interests, data sharing Funded by ZonMw InZicht, the Dutch Organisation for Health Research and Development-InSight Society. There are no competing interests. Full dataset and statistical code are available from the corresponding author.Study registration www.trialregister.nl NTR3296.

To report piloting and initial validation of the VQoL_CYP, a novel age-appropriate vision-related quality of life (VQoL) instrument for self-reporting by children with visual impairment (VI). Participants were a random patient sample of children with VI aged 10-15 years. 69 patients, drawn from patient databases at Great Ormond Street Hospital and Moorfields Eye Hospital, United Kingdom, participated in piloting of the draft 47-item VQoL instrument, which enabled preliminary item reduction. Subsequent administration of the instrument, alongside functional vision (FV) and generic health-related quality of life (HRQoL) self-report measures, to 101 children with VI comprising a nationally representative sample enabled further item reduction and evaluation of psychometric properties using Rasch analysis. Construct validity was assessed through Pearson correlation coefficients. Item reduction through piloting (8 items removed for skewness and individual item response pattern) and validation (1 item removed for skewness and 3 for misfit in Rasch) produced a 35-item scale, with fit values within acceptable limits, no notable differential item functioning, good measurement precision, ordered response categories and acceptable targeting in Rasch. The VQoL_CYP showed good construct validity, correlating strongly with HRQoL scores, moderately with FV scores but not with acuity. Robust child-appropriate self-report VQoL measures for children with VI are necessary for understanding the broader impacts of living with a visual disability, distinguishing these from limited functioning per se. Future planned use in larger patient samples will allow further psychometric development of the VQoL_CYP as an adjunct to objective outcomes assessment.

In this paper, we wanted to verify the hypothesis that extruding cartographic symbols on tactile maps to different heights might allow reducing the minimum (suggested in the literature) horizontal distances between them, without impacting the overall map’s legibility. This approach might allow preparing tactile maps in smaller scales and thus, reducing production cost, or putting additional spatial information on the same map sheet that would not fit otherwise. To verify the hypothesis we have prepared 6 different stimuli variants with or without height differentiation applied and different horizontal distances between tactile symbols adopted (1 mm, 2 mm and 3 mm). In the controlled study sessions with 30 participants with visual impairments we have measured the times required for solving 3 different spatial tasks on 3D printed tactile stimuli. We have also performed qualitative analysis to learn participants’ opinions about the proposed design and materials used. It turns out that applying height differentiation not only results in shorter times required for solving spatial tasks but is also considered by blind individuals as a convenient improvement in terms of use comfort and allows reduction of recommended minimum horizontal distances between symbols on tactile maps.

ObjectivesCompared with sighted individuals, people with visual impairment have a higher prevalence of chronic conditions and lower levels of physical activity. This review aims to systematically review physical activity interventions for those with a visual impairment and to assess their effectiveness.DesignA systematic review of articles reporting physical activity interventions in visually impaired individuals was conducted. Medline, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Physiotherapy Evidence Database were searched in August 2018. Meta-analyses were conducted on randomised controlled trials with the same outcome measure.SettingMost interventions were conducted in a group setting, with some including an at-home, self-directed component.ParticipantsFollowing identification of a recent systematic review of physical activity interventions in children, our review focused on adults aged 18 years and older with a visual impairment.Primary and secondary outcome measuresOutcomes included measures of balance, mobility, mental well-being (eg, quality of life), number of falls, muscle strength, flexibility and gait.ResultsEighteen papers from 17 studies met inclusion criteria. Physical activity components include falls prevention and/or balance-based activities, walking, tai chi, Alexander Technique, Yoga, dance, aerobics and core stability training. Significant results in favour of the intervention were reported most commonly in measures of functional capacity (9/17 studies) and in falls/balance-related outcomes (7/13 studies). The studies identified were generally small and diverse in study design, and risk of bias was high across several categories for most studies. Meta-analyses indicated non-significant effects of the included interventions on the Timed Up and Go, Chair Sit Test and Berg Balance Scale.ConclusionsPhysical activity interventions in individuals with visual impairment incorporating activities such as tai chi, Yoga and dance can have positive results, particularly in physical measures such as mobility and balance. However, when performing a meta-analysis of randomised controlled trials, the evidence for effectiveness is less clear. More studies with larger sample sizes, stronger designs and longer follow-up periods are needed.PROSPERO registration numberCRD42018103638.

Echolocation is a vital method of spatial orientation for many visually impaired individuals who are willing to and able to learn it. Blind echolocators use a variety of sounds, such as mouth clicks, cane taps, or specialized sound-emitting devices, to perceive their surroundings. In our study, we examined the effectiveness of several different sounds used in echolocation by conducting trials with 12 blind and 14 sighted volunteers. None of the participants had received formal training in echolocation, though a number identified as self-taught experts. The sounds tested included those played from a loudspeaker, generated by a mechanical clicker, or made by the participants themselves. The task given to the participants was to identify the direction and distance to an obstacle measuring 1x2 meters in an outdoor environment, with the obstacle placed in one of nine possible positions. Our findings indicated that the blind participants displayed significantly better echolocation skills when compared to the sighted participants. The results of the blind participants were also strongly divided into two distinct subgroups—totally blind participants performed much better than those which were legally blind, but had some residual vision. In terms of sound comparisons, we found that sounds with a center frequency near 3-4kHz and a wide spectrum provided higher accuracy rates than those with lower frequency peaks. Sighted participants performed best with 3kHz and 4kHz percussion sounds, while the blind group performed best with blue and pink noise. The loudspeaker generated tones generally yielded better results than those generated by the participant (using a mechanical clicker, mouth clicks or hand claps). These results may be useful in developing training programs that teach echolocation as well as artificial sounds to improve echolocation effectiveness.

BackgroundIt is well known that visual impairment (VI) has a detrimental effect on Quality of Life (QoL) in adults. Little is known about the effects of VI in childhood.AimsTo evaluate the effects of VI on QoL of children. To the authors' knowledge, this is the first study containing a comparison arm for children with VI.MethodsQoL in children with VI (n=24, age 10.13±2.89, 18 male, 6 female) was compared with an age-matched comparison group (n=24, age 9.83±2.81, 18 male, 6 female) using the Low Vision Quality of Life Questionnaire. Factors (distance and near visual acuity and age) that could be used as predictors of QoL were assessed. These were measured with standard clinical tests.ResultsChildren with VI had significantly lower QoL scores than the comparison group (p<0.001), resulting in a 35.6% reduction in total QoL score. QoL scores in children with VI were correlated with distance and near visual acuity (p<0.05). 38% of the variance could be predicted by these factors and age.ConclusionsConsideration of the effects of this reduced QoL must be made. Further studies are needed to establish the benefit to QoL of different habilitation strategies.

AimsTo assess the relationship between vision impairment (VI) and major eye diseases, with vision-specific emotional well-being in a Chinese population.MethodsIn this population-based cross-sectional study, 3353 Chinese participants aged 40–80 years answered the emotional well-being scale of the Impact of Vision Impairment questionnaire, validated using Rasch analysis. Participants underwent visual acuity testing and collection of sociodemographic and medical data from standardised questionnaires. The relationships between presenting bilateral VI, presence of major eye diseases (cataract, undercorrected refractive error, glaucoma, age-related macular degeneration and diabetic retinopathy) and emotional well-being were assessed using linear regression models. Stratified analyses for age, gender, education and immigration status were conducted to determine if change in β coefficients differed within each stratum.ResultsApproximately half of patients (n=1805) had normal vision, and 43% (n=1534) and 3.4% (n=114) had moderate and severe bilateral VI, respectively. Vision-specific emotional well-being systematically worsened as severity of bilateral VI increased (p<0.001). Compared with no VI and no eye diseases, respectively, severe bilateral VI (23%; β −1.84; 95% CI −2.23 to −1.43) and glaucoma (β −1.88; 95% CI −3.00 to −0.76) were associated with a clinically meaningful reduction in emotional well-being. The reduction in vision-related emotional well-being was substantially and significantly greater in men compared with women (p<0.05).ConclusionsSevere VI and glaucoma are associated with substantial decrements in vision-specific emotional well-being, highlighting the importance of preventing progression of vision loss. Evidence-based interventions to improve vision-related coping skills and emotional management for patients with severe VI and glaucoma are warranted.

SUMMARY POINTS Visual impairment can have adverse consequences for health and wellbeing, and its prevalence is increasing, especially among older people People with visual impairment are likely to have limited access to information and healthcare facilities, and to receive sub-optimal treatment because staff are unaware of specific needs related to vision Being aware that people may have problems with vision is an important pre-requisite for good healthcare Taking time to communicate effectively about access, facilities, diagnosis, and management plans is necessary; communications, in visual or audio format, should be tailored to individuals' needs Checking that personal resources are in place to facilitate compliance with treatment plans is essential for good clinical care