Findings from a rapid assessment of avoidable blindness (RAAB) in Southern Malawi

Background

Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community.

Methodology

A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling “E” chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery.

Results

A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5–4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%.

Conclusion

The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi.     

The detection of viral hepatitis markers in HIV-infected patients

The determination of markers of virus hepatitides B, C and D in 63 registered HIV-infected persons was made. The use of Russian and foreign EIA systems permitted the detection of markers of virus hepatitides 30.1% of HIV-infected persons, including 26.3% of children. Markers of hepatitis B virus were found to occur in children and adults with the same frequency. Out of 65 persons registered in the Center, 3 persons (4.6%) were drug addicts; of these, 2 were found to have antibodies to antigens of hepatitis viruses. Such persons constituted 3.8% of the total number of HIV-infected persons. Among 8 newly detected and registered HIV-infected adults, 2 were found to have antibodies to hepatitis B virus (of these, 1 used drugs intravenously).     

哈尔滨医科大学第一临床医学院

目的：调查哈尔滨市盲校生目前致盲情况及致盲性原因。方法：应用眼科常规方法时99名盲校学生（去除无眼球者共196眼）进行全面检查。时致盲原因进行分析。结果：致盲性眼病中居第一位为先天性白内障手术后仍未脱盲者,未脱盲原因包括：术后严重并发症、手术时机太晚形成严重弱视者,共45眼（占22．96％）;居第二位为视网膜、黄斑变性,共32眼（占16．33％）;居第三位为视神经萎缩,共24眼（占12．25％）。结论：本次对哈尔滨市盲校学生致盲原因调查表明,第一位为先天白内障术后由于合并症及并发症仍未脱盲者;第二位为为视网膜、黄斑变性;第三位为视神经萎缩。提示眼病的早期诊断和得当治疗的重要性。     

Cataract in the chronically exposed residents of the Techa riverside villages

The present study is based on a retrospective analysis of archive data of the Clinical Department of the Urals Research Center for Radiation Medicine that has been established to examine and treat accidentally exposed residents of the Urals Region. All individuals included in this study were examined by an ophthalmologist. The study of cataract incidence has been conducted retrospectively for the period from 1951 till 2000 among chronically exposed residents of the Techa riverside villages (6343 persons). Individual accumulated absorbed doses to soft tissues (analogue of eye dose) reached 1.18 Gy (mean 0.12 Gy) while for 88.9% of the study group the dose did not exceed 0.1 Gy. There was no evidence of the influence of low-dose and low-dose rate on cataract incidence. Excess relative risk of cataract formation per 1 Gy was 0.40 (95% CI ?0.43; 1.47). It is noted that 15% of all excess cases were registered in persons with soft tissue dose above 0.3 Gy, though their fraction among all examined persons was only 4.1%. Risk of cataract development significantly increased in exposed individuals with retinal angiosclerosis, diabetes and arterial hypertension.     

The prevention of HIV infection and other blood-contact diseases among intravenous narcotic users in Nizhniy Novgorod within the framework of the Harm Reduction program

The results of the development and realization principles of the project on the decrease of harm, envisaging work in three directions (the determination of the technology of using drugs, the exchange of syringes/needles and other accessories, as well as laboratory examination for the presence of antibodies to HIV, hepatitis B and hepatitis C viruses and consultations of narcologists). 1075 injecting drug users took part in this project. Out of 611 participants filling-in the questionnaires, 338 persons underwent tests for HIV and 3 of them were found to be HIV-infected; out of 305 persons screened for the presence of markers of hepatitis B virus, positive results were obtained in 98 (32% of cases); in 218 (65%) out of 335 persons antibodies to hepatitis C virus were found (49 persons, i.e. 14%, had hepatitis C registered in the medical history and in the rest antibodies were detected for the first time). The preventive program of the decrease of harm was assessed as effective.     

Liver cirrhosis and liver cancer associated with viral hepatitis B and C in republic of Tatarstan

Clinical and epidemiological data on 93 patients with liver cirrhosis, treated in the Gastroenterological Department of the Republican Clinical Hospital of the of the Republic of Tatarstan MoH in 1998-2000 were analyzed. The retrospective analysis of 856 cases of the liver cancer, diagnosed in the Republic of Tatarstan in 1996-2000, was made. In 20.4% of patients with liver cirrhosis and 16.2% of patients with liver cancer, registered in the Republic of Tatarstan, the serological markers of hepatitis B (HB) and hepatitis C (HC) were detected. The domination of HC markers was observed in the liver cirrhosis and that of HB markers in the cancer of the liver. The liver cirrhosis with HC markers was more often registered in the age group of 45-60 years and with HB markers at the age over 60 years, while the cancer of the liver was more often registered in persons aged 75 years and older. The necessity of introducing the official registration of the liver cirrhosis and cancer associated with chronic infection caused by hepatoviruses B and C is confirmed.     

Comparison of the Restriction Endonuclease Digestion Patterns of Mitochondrial DNA from Normal and Male Sterile Cytoplasms of ZEA MAYS L

High resolution gel electrophoresis has allowed the assignment of fragment number and molecular weight to EcoRI, SalI and PstI restriction fragments of mitochondrial DNA from B37 normal (N) and B37 T, C and S male sterile cytoplasmic types of maize. A minimum complexity of 450-475 kb has been established. Hybridization of cloned EcoRI fragments to restriction digests of total mitochondrial DNA suggests that at least 80% of the genome is composed of unique sequences. Restriction fragments of identical size in N, T, C and S contain similar sequence information as evidenced by their hybridization behavior.—The total SalI digest and the larger PstI fragments representing 80% of the total complexity were used to calculate the fraction of shared fragments of each pairwise combination of cytoplasmic types. The C type mtDNA is most closely allied with the other mtDNAs and shares 67% of fragments with S, 65% with N, and 60% with T. The S type mtDNA is quite divergent from N (53% shared fragments) and T (56% shared fragments). N and T share 59% of the fragments. These results are discussed in terms of the origin of mtDNA diversity in maize.     

The First Rapid Assessment of Avoidable Blindness (RAAB) in Thailand

Background

The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand.

Methods

A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists.

Results

The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but ≥20/400), and moderate visual impairment (VA <20/70 but ≥20/200) were 0.6% (95% CI: 0.5–0.8), 1.3% (95% CI: 1.0–1.6), 12.6% (95% CI: 10.8–14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively.

Conclusion

Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system.     

The epidemic spread of Salmonella typhimurium phage type 10 in Canada (1970-1979)

The frequency of Salmonella typhimurium phage type 10 across Canada was monitored during the period 1970-1979. Phage type 10 isolations increased from 1.2% in 1970 to 68.8% in 1979 among isolates from human sources and from 1.5 to 30.6% in isolates from nonhuman sources. Examination of food-poisoning outbreaks and a study of the animal-host associations of phage type 10 revealed that contaminated poultry products appear to be the most common sources of human infections. The majority (89.3%) of S. typhimurium phage type 10 strains were sensitive to antibiotics. Of the resistant strains, 73.3% were resistant to single antibiotics and 26.7% were multiresistant. Thirty-three different patterns of antibiotic resistance were observed. A number of the resistance determinants were transferable by conjugation and the R plasmids were found to belong to the incompatibility groups HI1, FII, N, I alpha, and C.     

Seroepidemiological characterization of virus hepatitis in the Republic of Armenia

The survey of the population immunological structure with respect to parenteral hepatitis showed awide circulation of hepatitis B (HB) and hepatitis C (HC) viruses among the adult population of Armenia. During the 5 year period of observation the number of persons having antibodies to HC virus increased 2.7-fold. High occurrence of antibodies to HBsAg of HB virus among the healthy population in 2002 (12.0%) in comparison with 1997 (5.4%) reflected a decreased infection rate with HB virus as well. Antibodies to hepatitis A (HA) virus were isolated, on the average, in 64 % of persons. Simultaneously with a decrease in the proportion of HA cases an increased number of HC patients was registered. No circulation of hepatitis E virus was detected. A high percentage of hepatitis cases of mixed etiology was established, as well as an increased number of combined parenteral hepatitis cases was registered (57.1%).     

The Temporal Trend of Influenza-Associated Morbidity and the Impact of Early Appearance of Antigenic Drifted Strains in a Southeast Asian Country

Globally, influenza infection is a major cause of morbidity and mortality in the elderly, who are suggested to be the major target group for trivalent influenza vaccine (TIV) vaccination by World Health Organization. In spite of an increasing trend in vaccine coverage rates in many countries, the effect of vaccination among the elderly in reducing hospitalization and mortality remains controversial. In this study, we conducted a historical cohort study to evaluate the temporal pattern of influenza-associated morbidity among persons older than 64 years over a decade. The temporal patterns of influenza-associated morbidity rates among the elderly older than 64 years indicated that Taiwan''s elderly P&I outpatient visits have been decreasing since the beginning of the 1999–2000 influenza season; however, hospitalization has been increasing despite significant increases in vaccine coverage. The propensity score logistic regression model was implemented to evaluate the source of bias and it was found that the TIV-receiving group had a higher propensity score than the non-receiving group (P<0.0001). In order to investigate the major factors affecting the temporal pattern of influenza-associated morbidity, we then used the propensity score as a summary confounder in a multivariate Poisson regression model based on the trimmed data. Our final models suggested that the factors affected the temporal pattern of morbidity differently. The variables including co-morbidity, vaccination rate, influenza virus type A and B isolation rate were associated with increased outpatient visits and hospitalization (p<0.05). In contrast, variables including high propensity score, increased 1°C in temperature, matching vaccine strains of type A/H1N1 and type B were associated with decreased outpatient visits and hospitalization (p<0.05). Finally, we assessed the impact of early appearance of antigenic-drifted strains and concluded that an excess influenza-associated morbidity substantial trends toward higher P&I hospitalization, but not outpatient visits, during the influenza season with early appearance of antigenic-drifted strains.     

The impact of nitrogen deposition on carbon sequestration in European forests and forest soils

An estimate of net carbon (C) pool changes and long‐term C sequestration in trees and soils was made at more than 100 intensively monitored forest plots (level II plots) and scaled up to Europe based on data for more than 6000 forested plots in a systematic 16 km × 16 km grid (level I plots). C pool changes in trees at the level II plots were based on repeated forest growth surveys At the level I plots, an estimate of the mean annual C pool changes was derived from stand age and available site quality characteristics. C sequestration, being equal to the long‐term C pool changes accounting for CO₂ emissions because of harvest and forest fires, was assumed 33% of the overall C pool changes by growth. C sequestration in the soil were based on calculated nitrogen (N) retention (N deposition minus net N uptake minus N leaching) rates in soils, multiplied by the C/N ratio of the forest soils, using measured data only (level II plots) or a combination of measurements and model calculations (level I plots). Net C sequestration by forests in Europe (both trees and soil) was estimated at 0.117 Gton yr^?1, with the C sequestration in stem wood being approximately four times as high (0.094 Gton yr^?1) as the C sequestration in the soil (0.023 Gton yr^?1). The European average impact of an additional N input on the net C sequestration was estimated at approximately 25 kg C kg^?1 N for both tree wood and soil. The contribution of an average additional N deposition on European forests of 2.8 kg ha^?1 yr^?1 in the period 1960–2000 was estimated at 0.0118 Gton yr^?1, being equal to 10% of the net C sequestration in both trees and soil in that period (0.117 Gton yr^?1). The C sequestration in trees increased from Northern to Central Europe, whereas the C sequestration in soil was high in Central Europe and low in Northern and Southern Europe. The result of this study implies that the impact of forest management on tree growth is most important in explaining the C pool changes in European forests.     

Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey

Objective To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan.Design Cross sectional population based survey.Setting 221 rural and urban clusters selected randomly throughout Pakistan.Participants Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate).Main outcome measures Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services.Results 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001).Conclusion Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.     

Depression in Persons with Diabetes by Age and Antidiabetic Treatment: A Cross-Sectional Analysis with Data from the Hordaland Health Study

BackgroundPersons with diabetes have increased risk of depression, however, studies addressing whether the risk varies by age and type of antidiabetic treatment have yielded conflicting results. The aim of this study was to investigate if the association between diabetes and depression varied by type of antidiabetic treatment in a large community based sample of middle-aged (40–47 years) and older adults (70–72 years).MethodsData from 21845 participants in the Hordaland Health Study (HUSK) were analyzed in a cross-sectional design. Diabetes was assessed by self-report and classified as un-medicated, treated by oral antidiabetic agents or by insulin. Depression was defined as a score ≥8 on the depression subscale of the Hospital Anxiety and Depression Scale and/or self-reported use of antidepressant agents. Associations between diabetes and depression were estimated using logistic regression.ResultsPersons in their forties with diabetes had a doubled prevalence of depression (OR: 1.96 (95% C.I.: 1.35, 2.83)) compared to persons without diabetes, while a lower and non-significant association was found among persons in their seventies. Persons in their forties with orally treated diabetes had about three times higher prevalence of depression (OR: 2.92 (95% C.I.: 1.48, 5.77)) after adjustment for gender, BMI, physical activity, alcohol consumption and education, compared to non-diabetic persons in the same age-group. No association between depression and insulin or un-medicated diabetes was found.ConclusionsClinicians should be aware that persons in their forties with orally treated diabetes are at a marked increased risk of depression.     

Human botulism in Canada (1919-1973)

Since 1919, in Canada, 62 authenticated outbreaks of human botulism have affected 181 persons, with 83 deaths, a fatality rate of 46%. Among these, 41 outbreaks were bacteriologically determined (31 in one laboratory) as six type A, four type B, one both A and B, and 30 type E. About two thirds of the total outbreaks, cases and deaths involved Eskimos and Pacific coast Indians consuming raw marine mammal products and salmon eggs, respectively. Other parts of Canada recorded seven occurrences due to miscellaneous vehicles, three being type B. Since January 1961 there have been 38 outbreaks, involving 94 cases with 33 deaths. These include 18 outbreaks among Eskimos, affecting 51 persons (of whom 24 died) in Labrador, southern Baffin Island, northern Quebec, and the Mackenzie area. Also, putrid salmon eggs caused 15 outbreaks among Pacific coast Indians, totalling 35 cases, of whom only six died, the low fatality rate reflecting the introduction of type E botulinus antitoxin during 1961.     

山东临朐人群HLA等位基因多态性 与幽门螺杆菌感染关系的研究

为了研究山东临朐地区健康人白细胞抗原（HLA）Ⅰ类等位基因多态性与幽门螺杆菌（Hp）感染的关系,运用序列特异性引物聚合酶链反应（PCR SSP）的方法,检测Hp阳性人群（90例）和Hp阴性人群（49例）的HLA Ⅰ类和Ⅱ类等位基因。结果在HLA Ⅰ类（A、B、CW）的共68个等位基因多态中,发现在感染及非感染人群中存在4个显著性差异的位点;在HLA Ⅱ类（DRB1、DQB1和DRB3、DRB4、DRB5）的共22个等位基因多态中,没有发现显著性差异的位点。A*02等位基因频率,Hp阳性低于阴性人群（OR,0.56;95%CI,0.33～0.94;P,0.029）;B*48等位基因频率,Hp阳性低于阴性人群（OR,0.15;95%CI,0.03～0.72;P,0.007）;CW*08〖STBZ〗等位基因频率,Hp阳性低于Hp阴性人群（OR,0.32;95% CI,0.15～0.69;P,0.003）;CW*15等位基因频率,Hp阳性高于Hp阴性人群（OR,5.11;95%CI,0.63～40.90;P,0.024）。结果表明HLA Ⅰ类等位基因的多态性可能与山东临朐地区Hp的易感性有关;HLA Ⅱ类等位基因的多态性可能与其无关。HLA Ⅰ类等位基因中,CW*15可能是Hp感染的易感基因;A*02、B*48和CW*08可能是保护性基因。Abstract: In order to analyze the relationship of HLA polymorphisms and the infection of H.pylori in the population of Linqu County in Shandong Province,polymerase chain reaction with sequence specific primers(PCR SSP) was used to determine the alleles of HLA typeⅠand Ⅱ in 90 Hp positive persons and 49 Hp negative controls.The results showed that among the 68 alleles of HLA typeⅠ,4 alleles were found significantly different between Hp positive and Hp negative population,while no significant difference was found among the 22 alleles of HLA typeⅡ.Hp positive persons had a lower allele frequency of A*02（OR=0.56,95% CI=0.33～0.94;P=0.029）, B*48（OR=0.15,95% CI=0.03～0.72;P=0.007）,CW*08（OR=0.32,95% CI=0.15～0.69;P=0.003）and a higher allele frequency of CW*15（OR=5.11,95% CI=0.63～40.90;P=0.024）compared with Hp negative controls.Our results indicated that the polymorphisms of HLA typeⅠis involved in the genetic susceptibility of Hp infection in Linqu County,while the polymorphisms of HLA typeⅡ may have no relationship with the genetic susceptibility of Hp infection.It was shown that among the alleles of HLA typeⅠ,CW*15might be a susceptible gene of Hp infection while A*02,B*48 and CW*08might be protective genes.     

Natural variation, functional divergence, and local adaptation of nucleotide binding site sequences in Rhododendron (Ericaceae)

To further understand natural variation and local adaptation in the evolution of plant defense, we analyzed polymorphism data of nucleotide-binding site (NBS) sequences of Rhododendron at both the species and population levels. Multiple duplication events were found in NBS sequence evolution in Rhododendron genomes, which resulted in six clades: A–F. Our results of several NBS clade pair comparisons showed significant evolutionary rate changes based on differences in substitution rates between NBS-encoding protein clades (type I functional divergence). Pairwise comparisons of NBS clades further revealed that many amino acids displayed radical biochemical property changes causing a shift in amino acid preferences between NBS-encoding protein clades (type II functional divergence). Such divergent evolution of NBSs is likely a consequence of positive selection related to differentiation of recognition signals in response to different pathogens. Primers specific to clades B and C, which differed in the number of radical amino acid changes causing type II functional divergence and levels of nucleotide diversities, were further used to amplify population clades B and C NBS sequences of Rhododendron formosanum populations. Higher levels of net nucleotide divergences (measured by D _a) between R. formosanum populations were found based on NBS sequences of population clade B compared to population clade C, suggesting local adaptation of population clade B NBS sequences. Local adaptation can be further inferred for R. formosanum population clade B NBS sequences because of significant Φ _ST based on variation in nonsynonymous substitutions. Furthermore, local adaptation was also suggested by no significant correlation of population pairwise F _ST between population clades B and C in R. formosanum.     

The epidemic spread of the influenza A and B viruses in the USSR in 1985-1986

The data on the spread of influenza A and B in the autumn and winter of 1985-1986 are given. Three epidemics caused by all presently circulating viruses, B, A (H3N2) and A (H1N1), were registered in the USSR. Of these, the greatest one was the epidemic of influenza B; morbidity rate among the adult population during this epidemic was at the level with the morbidity rate characteristic of the epidemics registered at the period of 1962-1972, and morbidity rate among children, especially school children, was even higher.     

The verification of the results of screening antibodies to hepatitis C virus in blood donors

6,744 persons were examined for the presence of antibodies to hepatitis C virus (HCV) before blood donation (4,219 persons in Moscow and 2,525 persons in St. Petersburg). The serum samples found to contain antibodies to HCV were additionally studied by the immunoblot techniques. The positive results of antibody screening were registered in 78 persons: 26 persons in Moscow (0.62%) and 52 in St. Petersburg (2.05%). In both cities the positive results of screening were confirmed in 62% of cases. Different occurrence of the profile with the presence of antibodies to all fragments of the virus: 52% in Moscow, 12% in St. Petersburg (chi2 = 12.11; p < 0.001). Considerable differences were also registered in the spread of individual antibodies.