Demand incidence and episode rates of ophthalmic disease in a defined urban population.

OBJECTIVES--To estimate demand incidence and episode rates of ophthalmic disease in a defined urban population over one year. DESIGN--Study of patients presenting with eye problems to general practice and eye casualty department. SETTING--General practice and ophthalmic services in west Nottingham. SUBJECTS--36,018 people from the combined practice lists of 17 Nottingham general practitioners. MAIN OUTCOME MEASURES--Ophthalmic disorder, age and sex of patient, and where presented. RESULTS--587 consultations were recorded for ophthalmic problems, 1771 with general practitioners and 816 with eye casualty. Most consultations to general practice were by females (1066 (60%)), whereas men aged 15-44 accounted for most work in eye casualty. These men commonly presented with trauma. Infective conjunctivitis, the commonest condition, had an episode rate of 13.5/1000 population/year. Demand incidence for cataracts was 1.9/1000 population/year. Demand incidence for chronic conditions increased with age. CONCLUSIONS--As the average age of the population increases demand for ophthalmic services will rise. Planning and provision of resources to meet this increased demand should be considered now.     

Visual screening of pre-school children.

In an attempt to reduce the incidence of persistent amblyopia and related disorders, routine screening of the visual function of pre-school children has been introduced in Ayrshire, the tests being carried out by orthoptists. A pilot study confirmed the feasibility of the screening. Under the definitive scheme, whose first three months'' results are presented, the children are examined as near as possible to their homes and the average attendance rate has been 86%. Thirty-seven of 442 children were referred to an ophthalmic clinic with suspected abnormalities (only one of which was not confirmed) that had not been picked up by the GP or welfare clinic. It is concluded that visual screening of pre-school children is administratively feasible and welcomed by parents, and that it can detect abnormalities missed by traditional procedures-which according to these results may be more than half of the total.     

Cancer Risk in Children and Adolescents with Birth Defects: A Population-Based Cohort Study

Objective

Birth defects are an increasing health priority worldwide, and the subject of a major 2010 World Health Assembly Resolution. Excess cancer risk may be an added burden in this vulnerable group of children, but studies to date have provided inconsistent findings. This study assessed the risk for cancer in children and young adolescents with major birth defects.

Methods and Findings

This retrospective, statewide, population-based, cohort study was conducted in three US states (Utah, Arizona, Iowa). A cohort of 44,151 children and young adolescents (0 through 14 years of age) with selected major, non-chromosomal birth defects or chromosomal anomalies was compared to a reference cohort of 147,940 children without birth defects randomly sampled from each state’s births and frequency matched by year of birth. The primary outcome was rate of cancer prior to age 15 years, by type of cancer and type of birth defect. The incidence of cancer was increased 2.9-fold (95% CI, 2.3 to 3.7) in children with birth defects (123 cases of cancer) compared to the reference cohort; the incidence rates were 33.8 and 11.7 per 100,000 person-years, respectively. However, the excess risk varied markedly by type of birth defect. Increased risks were seen in children with microcephaly, cleft palate, and selected eye, cardiac, and renal defects. Cancer risk was not increased with many common birth defects, including hypospadias, cleft lip with or without cleft palate, or hydrocephalus.

Conclusion

Children with some structural, non-chromosomal birth defects, but not others, have a moderately increased risk for childhood cancer. Information on such selective risk can promote more effective clinical evaluation, counseling, and research.     

Intestinal Parasites in Immigrant Children From Central America

To begin to characterize the health needs of the growing number of refugees from Central America, we compiled the results of examinations for ova and parasites of a single stool specimen of each of 128 children of Central American and Mexican background who entered our health center during a four-month period. Among the 96 children who were born in Central America or Mexico, there was a 65% prevalence of parasitic infestation. Pathogens were found in 46% and multiple pathogens in 14%. Among the 32 American-born children there was a 13% prevalence of parasitic infection, but no pathogens were found. There was no correlation between symptoms and the presence of parasites. Screening Central American immigrant children for intestinal parasites is a high-yield procedure and should be part of their routine health care.     

Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario,Canada

Background:

Routine eye examinations for healthy adults aged 20–64 years were delisted from the Ontario Health Insurance Plan in 2004, but they continue to be insured for people with diabetes regardless of age. We sought to assess whether the delisting of routine eye examinations for healthy adults had the unintended consequence of decreasing retinopathy screening for adults with diabetes.

Methods:

We used administrative data to calculate eye examinations for people with diabetes ages 40–64 years and 65 years and older in each 2-year period from 1998 to 2010. We examined differences by sex, income, rurality and type of health care provider. We used segmented linear regression to assess the change in trend before and after 2004.

Results:

For people with diabetes aged 65 years and older, eye examinations rose gradually from 1998 to 2010, with no substantial change between 2004 and 2006. For people with diabetes aged 40–65 years, there was an 8.7% (95% confidence interval [CI] 6.3%–11.1%) decrease in eye examinations between 2004 and 2006. Results were similar for all population subgroups. Ophthalmologic examinations decreased steadily for both age groups during the study period, and there was a decline in optometry examinations for people ages 40–65 years after 2004.

Interpretation:

The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes. More research is needed to understand whether patients are being charged for an insured service or to what degree misunderstanding has prevented patients from seeking care.Diabetic retinopathy is the leading cause of new cases of blindness in people of working age.¹ In the United States, about 40% of adults with diabetes aged 40 years and older have retinopathy, and 8% have vision-threatening retinopathy.² Studies suggest that, if untreated, 50% of patients with proliferative diabetic retinopathy become legally blind within 5 years, compared with only 5% of patients who receive early treatment.³ Regular dilated eye examinations are effective for early detection and monitoring of asymptomatic retinopathy in people with diabetes⁴ and are recommended by clinical practice guidelines.^5,6In Ontario, Canada’s most populous province, medically necessary services are covered by the Ontario Health Insurance Plan (OHIP) for all permanent residents and Canadian citizens living in the province.⁷ Under OHIP, routine eye examinations were fully insured for all children and adults until November 1, 2004. At that time, routine eye examinations ceased being insured for healthy adults aged 20–64 years, but continued to be insured for children aged 19 years and younger and for adults aged 65 years and older.⁸ Regardless of age, adults with diabetes and some other medical conditions affecting the eye, as well as adults receiving social assistance, continued to have an annual eye examination covered by OHIP. Insured examinations are at no cost to the patient and are reimbursed to the provider at about Can$40. In contrast, healthy adults aged 20–64 years are required to pay out-of-pocket or through private insurance for a routine eye examination, with fees set at the discretion of the optometrist⁹ or physician.¹⁰Health policy experts suggest that delisting services from insurance schemes can have unpredictable effects.¹¹ Understanding the effect of delisting on care is particularly important as governments face fiscal pressures and contemplate further reductions in what is publicly insured.¹² We sought to assess whether delisting routine eye examinations for healthy middle-aged adults in Ontario had the unintended consequence of decreasing retinopathy screening for middle-aged adults with diabetes, even though eye examinations continued to be insured for this population.     

Reproductive performance in mares subjected to examination by diagnostic ultrasound

Mares were subjected to frequent examination by diagnostic ultrasound and data were compiled with respect to reproductive efficiency. The data were collected over a 3-yr period on 1032 light horse mares. The cummulative pregnancy rate at 35 d post-ovulation was 96.8% and the pregnancy rate per cycle was 76.0% as determined by ultrasound examination. The average number of cycles per conception was 1.43, with an average of 2.29 inseminations per cycle. The incidence of early embryonic death was 7.8%. Mares were subjected to an average of 5.04 scans during the follicular phase of the cycle. The average number of ultrasound examinations per mare (including pregnancy examinations) was 9.99. Although these data were obtained from an experiment that did not use both control and treated mares, there was no indication that preovulatory oocytes or embryos were damaged by routine ultrasound examination. Comparisons with existing data from commercial facilities are difficult to make concerning any improvement in reproductive efficiency resulting from the routine use of ultrasonography, but these data do suggest relative safety in equine reproductive management when ultrasound examinations are conscientiously used.     

Spontaneous ophthalmic diseases in 586 new zealand white rabbits.

The purpose of this study was to investigate spontaneous eye disease in New Zealand White (NZW) rabbits, which are commonly used for toxicity tests, and to provide reference materials for pharmaceutical companies and research centers. A total of 586 NZW rabbits were randomly chosen without sex preference and were examined using ocular equipment, including a direct ophthalmoscope, an indirect ophthalmoscope, a slit-lamp biomicroscope, a focal illuminator, and a fundus camera. This study showed that the incidence rate of temporary cataracts, regarded as a change within normal variation, was 0.5% in the NZW rabbits. Regarding abnormal ophthalmic disease, blepharitis was the most commonly observed ocular disease. Other findings included cataract, conjunctivitis, choroidal hypoplasia, keratitis, corneal scarring, eyelid laceration, posterior synechiae, uveitis, dacryocystitis, and persistent pupillary membrane. In total, the incidence rate of ophthalmic diseases was 9.6%. Based on sex and age distributions, females had more ocular diseases than males, and rabbits were less susceptible to eye diseases as they got older. In this study, photographs were taken to document findings, such as normal fundus, normal variations, ophthalmic disease, and histopathologic examination.     

Spontaneous ophthalmic lesions in young Swiss mice.

BACKGROUND AND PURPOSE: Outbred mice are frequently used in toxicity evaluation. Due to their small size, ophthalmologic examination of such animals is difficult with regard to restraint and use of instruments designed for human medicine. The clinical appearance and incidence of spontaneous ophthalmic lesions should be helpful in selecting mice for toxicity studies and allow distinction between intercurrent spontaneous ocular changes and those attributable to drugs or chemicals. METHODS: Pretest ophthalmologic examinations of about 3,000 4- to 5-week-old Swiss mice, Crl:CD1 (ICR)BR, conducted in 1995 and 1996, provided information about spontaneous ocular changes and their incidence. Eye evaluations were performed after pupil dilatation (0.5% tropicamide instillation), using indirect ophthalmoscopy, and when indicated, a portable slit lamp. RESULTS: Lenticular opacities and heterogeneity/prominence were the most common findings (up to 19%) in the anterior segment. Abnormalities of the cornea and iris were detected in up to 4% of mice. Hyaloid artery remnant, as well as isolated cases of floating bodies or hemorrhage, was observed in the vitreous of 12 to 17% of mice. Approximately 2 to 4% of mice had colobomatous fundus, retinal fold, or retinal atrophy. A few mice had chorioretinal atrophy, hemorrhage, or abnormal pattern of the retinal vasculature. Remaining findings consisted of incomplete palpebral fissure, microphthalmia, exophthalmia, ophthalmic hemorrhage, and scleral mass. CONCLUSIONS: Due to severity of the condition or interference with ocular examination, affected mice should be eliminated from experimental studies. Hence, pretest ocular examinations of mice are indicated in safety-assessment toxicity studies.     

The Role of Principal and Secondary Diagnoses of Hospitalized Eye Trauma: A Nationwide Cohort in Taiwan, 1996-2010

Purpose

To estimate the rate of hospitalized eye trauma in Taiwan and investigate the role between principal and secondary diagnoses of such trauma.

Methods

Nationwide fixed cohort study of 1,000,000 beneficiaries from the Taiwan Longitudinal Health Database was used and 4819 patients who were hospitalized for eye trauma during 1996-2010 were analyzed.

Results

During 1996-2010, the incidence rates of hospitalized eye trauma (per 100 000 person-years) were 35.0 (95% confidence interval (CI), 34.0 to 36.0) for total diagnosis, 9.8 (95% CI, 9.3 to 10.3) for a principal diagnosis, and 25.3 (95% CI, 24.4 to 26.1) for a secondary diagnosis. The sex risk ratio was 3.1 for a principal diagnosis and 2.1 for a secondary diagnosis. The main causes of eye trauma were traffic accident, work accident, assault (among males <60 years of age), and falls (among elderly men and women). The proportion admitted to an ophthalmic department among those with a principal diagnosis of eye trauma (64.8%) was significantly higher than among those with a secondary diagnosis (2.3%) (p<.0001). Patients with a principal diagnosis of eye trauma had shorter hospital stays (7.1±10.2 days) and lower fatality (0.07%) than those with a secondary diagnosis of eye trauma (10.0±31.6 days and 0.3%, respectively).

Conclusion

Data only from ophthalmic admissions tends to underestimate the true incidence rate of hospitalized eye trauma. Patients with a principal diagnosis of eye trauma had less severe injuries than did those with a secondary diagnosis.     

Health of Igloolik Eskimos and changes with urbanization

Medical examinations were carried out on 422 Igloolik Eskimos in 1969 and again on 485 two years later. In 130 adult men and women scen on both occasions body weight and skinfold thicknesses were relatively unchanged but there were significant increases of both systolic and diastolic blood pressure, the basis of which is not established but an increase in dietary salt is hypothesized. In 280 children the overall incidence of otitis media was approximately 30% but children breastfed for at least 4 months had less than half the incidence of nonbreastfed children. In multiparous women up to age 50 duration of breastfeeding of a child was directly related to the interval until the next conception.     

Current imaging of childhood urinary infections: prospective survey.

OBJECTIVES--To assess whether ultrasonography alone is adequate for routine screening of childhood urinary infection, whether clinical features determine the need for further investigations, and which investigations are most appropriate. DESIGN--Prospective survey of children with proved urinary infection and a preinvestigation record of clinical features. Ultrasonography and intravenous urography were routine, with choice of further studies determined by ultrasonographic findings. SETTING--A children''s hospital and two district general hospitals in Mersey region. MAIN OUTCOME MEASURES--Sensitivity and specificity of ultrasonography both generally and in relation to clinical features. Accuracy of intravenous urography compared with radioisotope examinations. RESULTS--Specificity of ultrasonography was good (99% (95% confidence interval 96% to 100%)) but sensitivity modest (43% (32% to 55%)), principally with respect to detecting vesicoureteric reflux and renal scarring. Among older children (aged 2-10 years) with positive ultrasound results and fever or vomiting the sensitivity in detecting reflux (with and without renal scarring) was 78% (62% to 89%) and the specificity 69% (60% to 78%); in detecting renal scarring (with and without reflux) the sensitivity was 100% (80% to 100%) and specificity 65% (56% to 74%). Renal scarring and obstructive uropathies were better assessed by radioisotope examinations than by intravenous urography. CONCLUSIONS--Ultrasonography alone is inadequate for routine screening of childhood urinary infection. Though further investigations remain advisable in infants, in older children they can be restricted to a minority who have positive ultrasound examinations or have had fever or vomiting. Radioisotope examinations largely eliminate the need for intravenous urography.     

Study on the ophthalmic diseases in ICR mice and BALB/c mice.

In pharmaceutical companies and research institutes, many toxicity tests are performed with laboratory animals. This study was performed to produce reference data for eye toxicity tests and to investigate the ophthalmic diseases of 408 ICR mice and 119 BALB/c mice, which are commonly used as subjects in toxicity tests. The experimental animals without clinical disorders were selected regardless of sex. The ophthalmic diseases were examined by using special ophthalmic instruments: direct ophthalmoscope, indirect ophthalmoscope, slit-lamp biomicroscope and focal illuminator. The most prevalent ocular variation within normal limits was hyaloid vessel remnant (ICR mice, 28.2%; BALB/c mice, 31.9%) and the incidence gradually decreased with age. The ocular diseases found in ICR mice were retinal degeneration (9.8%), corneal scar (4.2%), focal cataract (2.2%), anisocoria (1.2%), corneal ulcer (0.2%) and uveitis (0.2%). In BALB/c mice, corneal scar (9.2%), focal cataract (1.7%) and corneal ulcer (0.8%) were the ocular diseases found.     

Critical study of 5% guanethidine in ocular manifestations of Graves's disease

Assessment was made of 5% local guanethidine in treating eye manifestations in euthyroid patients with either treated thyrotoxicosis or ophthalmic Graves''s disease. In a double-blind crossover study guanethidine caused greater improvement in lid retraction than a control solution. A long-term study showed that this improvement was maintained. A much lower incidence of side-effects was noted with 5% guanethidine than with 10% solution.     

Child health clincs and inverse care laws: evidence from longitudinal study of 1878 pre-school children.

In a longitudinal study it was intended that 1878 children should receive periodic developmental examinations from the age of 6 weeks to 3 years. The children were divided into those with a high or low risk of developmental problems. Although clinic attendance rate of 85-89% were achieved in the catchment area 100% coverage was difficult because of population mobility and non-attendance at clinics. Children in families who moved away from the area were more difficult to trace and thus more likely to miss developmental examinations. This was a greater problem in the high-risk group. Altogether 683 home developmental examinations were carried out on 269 children who did not attend clinics. Thirty-five per cent of these children were in the high-risk group compared with 22% in the study population, and significantly more had developmental problems. Thus one possible way of reaching and helping such children is though home developmental examinations.     

脑电双频指数用于靶控瑞芬太尼输注在小儿眼科手术中的临床评价

目的:探讨脑电双频指数(BIS)对靶控瑞芬太尼输注在小儿眼科手术中的指导意义。方法:择期小儿眼科手术80例,随机均分为(A组)BIS反馈调控瑞芬太尼组,(B组)根据经验用药组,比较两组中瑞芬太尼的用量,血流动力学以及苏醒时间。结果:A组瑞芬太尼用量明显低于B组(P<0.05),B组血流动力学,BIS值波动明显大于A组(P<0.05),B组苏醒时间明显短于A组(P<0.05)。结论:小儿眼科手术中,BIS反馈调控瑞芬太尼靶控输注(TCI)技术可降低瑞芬太尼用量,有助于判断全麻深度,指导麻醉用药。     

Corneal alternations induced by topical application of benzalkonium chloride in rabbit

Benzalkonium chloride (BAC) is the most common preservative in ophthalmic preparations. Here, we investigated the corneal alternations in rabbits following exposure to BAC. Twenty-four adult male New Zealand albino rabbits were randomly divided into three groups. BAC at 0.01%, 0.05%, or 0.1% was applied twice daily to one eye each of rabbits for 4 days. The contralateral untreated eyes were used as control. Aqueous tear production and fluorescein staining scores of BAC-treated eyes were compared with those of controls. The structure of the central cornea was examined by in vivo confocal microscopy. Expression of mucin-5 subtype AC (MUC5AC) in conjunctiva was detected by immunostainig on cryosections. Corneal barrier function was assessed in terms of permeability to carboxy fluorescein (CF). The distribution and expression of ZO-1, a known marker of tight junction, and reorganization of the perijunctional actomyosin ring (PAMR) were examined by immunofluorescence analysis. Although there were no significant differences between control and BAC-treated eyes in Schirmer scores, corneal fluorescein scores and the number of conjunctival MUC5AC staining cells, in vivo confocal microscopy revealed significant epithelial and stromal defects in all BAC-treated corneas. Moreover, BAC at 0.1% resulted in significant increases in central corneal thickness and endothelial CF permeability, compared with those in control eyes, and endothelial cell damage with dislocation of ZO-1 and disruption of PAMR. Topical application of BAC can quickly impair the whole cornea without occurrence of dry eye. A high concentration of BAC breaks down the barrier integrity of corneal endothelium, concomitant with the disruption of PAMR and remodeling of apical junctional complex in vivo.     

Accuracy of McMonnies Questionnaire as a Screening Tool for Chinese Ophthalmic Outpatients

ObjectiveTo evaluate the accuracy of the McMonnies questionnaire (MQ) as a screening tool for dry eye (DE) among Chinese ophthalmic outpatients.MethodsWe recruited 27718 cases from 94 hospitals (research centers), randomly selected from 45 cities in 23 provinces from July to November in 2013. Only symptomatic outpatients were included and they were in a high risk of DE. Outpatients meeting the criteria filled out questionnaires and then underwent clinical examinations by qualified medical practitioners. We mainly evaluated sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver-operating characteristic curve (AUC) to evaluate the accuracy of the questionnaire in the diagnosis of dry eye.ResultsOf all the subjects included in the study, sensitivity, specificity, and DOR were 0.77, 0.86 and 20.6, respectively. AUC was 0.865 with a 95% CI (0.861, 0.869). The prevalence of DE among the outpatients claiming “constantly” as the frequency of symptom was over 90%. Scratchiness was a more accurate diagnostic indication than dryness, soreness, grittiness or burning. Different cut points of McMonnies Index (MI) scores can be utilized to optimize the screening results.ConclusionsMQ can be an effective screening tool for dry eye. We can take full advantage of MI score during the screening process.     

Chromosome abnormalities found among 34910 newborn children: results from a 13-year incidence study in Århus,Denmark

Summary As part of a larger prospective study of the influence of environmental factors on pregnancy, birth and the fetus, chromosome examinations have been made in 34910 newborn children in Århus over a 13-year period. Klinefelter's syndrome was found in 1 per 576 boys, XYY in 1 per 851 boys, triple-X in 1 per 947 girls and Turner's syndrome in 1 per 1893 girls. Other sex chromosome aberrations were found in 1 per 11637 children. The total incidence of sex chromosome abnormalities was 1 per 426 children or 2.34 per 1000. The most frequent autosomal abnormalities were that of Down's syndrome with 1 per 592 children, and reciprocal translocations with 1 per 712 children. The total incidence of autosomal abnormalities was 1 per 164 children. Chromosome abnormalities were found in 276 liveborn children and in 19 fetuses, who were aborted after prenatal chromosome examination. The combined incidence of sex chromosomal and autosomal abnormalities was 1 per 118 children or 8.45 per 1000 children.     

Diverticules acquis de l'appendice

During a recent ophthalmic survey of 780 Eskimos in the Canadian Eastern Arctic, 217 were found to have stigmata of phlyctenular keratoconjunctivitis, 198 of these being inactive and 19 active. Attention is drawn to the high incidence of pediculosis capitis in the Eskimos of this region, and it is suggested that there may be a relationship between this infestation and phlyctenulosis.     

Prevalence of intestinal parasitic infestation,salmonellosis, brucellosis,tuberculosis, and hepatitis B among immigrant children in Glasgow.

Two hundred Asian and 100 each of African, Chinese, and Scottish children were screened for intestinal parasitic infestations, salmonellosis, brucellosis, hepatitis B antigen (HBsAg), and tuberculosis. There was a fairly high incidence of Giardia lamblia among Asian and Scottish children and of Trichuris trichiura among the Chinese. Hookworm ova were seen only in Africa children. There were no chronic carriers of Salmonella or Brucella, and no one was suffering from salmonellosis or brucellosis. Tuberculin sensitivity was found in only 4% of immigrant and 1% of Scottish children: the difference was small and neither figure suggests a continuing high incidence of tuberculosis in Glasgow. Only seven immigrant children were found to be HBsAg carriers. Among the families of these carriers there was a high incidence (84%) of HBsAg or antibody (HBsAb). The survey shows that immigrant children in Glasgow do not constitute a health hazard to the indigenous population. Moreover, severe overcrowding is not a prominent feature among the immigrant families in Glasgow but is greatest among the local Scots.