Role of the School Eye Clinic in Modern Ophthalmology

Routine sight tests for children at intervals throughout their school career are clearly important; three-quarters of those referred to the school eye clinics in this area had some ocular defect. It is probably no longer necessary for myopic schoolchildren to be treated by a consultant ophthalmologist after their initial examination.Forty-five per cent. of children referred to the school eye clinics in this area were found to have squint and/or hypermetropic/anisometropic/astigmatic refractive errors. Priority should be given to this group because of the association of amblyopia with these conditions. Their treatment requires closer association with the hospital ophthalmic department, perhaps even complete unity. Transfer of children at present seen in the school eye clinic to a hospital-based “children''s eye clinic” would also fit in with a unified health service administration structure and be better placed to indicate, evaluate, and control future developments towards the prevention of amblyopia.     

A SURVEY OF THE RESULTS OF TREATMENT OF GASTRIC CANCER IN SAN FRANCISCO

A survey was made of all patients treated for gastric cancer on the clinic services of the Stanford University Hospital during the 30-year period 1919 to 1948. During the last decade of the survey there were impressive gains in the surgical treatment of this disease. It was possible from 1944 to 1948 to do a gastric resection on half the patients seen with cancer of the stomach. Also, there was a pronounced decrease in resection mortality so that from 1939 to 1948 the mortality rate for subtotal gastrectomy for cancer was 3 per cent.The over-all five-year survival rate was discouragingly low—4.6 per cent. On the other hand, 23 per cent of those surviving gastric resection lived for five years.A survey of the management of carcinoma of the stomach from 1939 to 1948 was made in 11 general hospitals in San Francisco. A wide range of resectability and resection mortality rates was observed. The cases from these hospitals were combined with those from Stanford for the same period to form a composite group of 1,128 patients. Analysis of this group of cases from 12 representative hospitals in San Francisco showed encouraging trends toward higher resectability rates with a lower resection mortality.     

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.     

Prevention of blindness by screening for diabetic retinopathy: a quantitative assessment.

Diabetic retinopathy is an important cause of blindness in the Western World. A review of the randomised trials of laser photocoagulation of the retina as a method of preventing blindness from this disorder showed that this treatment is very effective, reducing the risk of blindness by 61% in a treated eye. As only one eye is needed for sight the reduction in blindness in a population will be greater than 61% because the effect of treatment in one eye is not always identical with the effect in the other eye. For analysis this reduction was taken as 73%, representing the average of the minimum and maximum estimates (61% and 85%). The effectiveness of this treatment suggests that there is the potential for a national screening programme to bring about a major reduction in blindness from this cause. A quantitative assessment of the effect of screening indicated that a programme in which patients with diabetes mellitus are systematically referred to ophthalmic opticians for a retinal examination could detect 88% of all diabetics with serious retinopathy and that 87% of these cases would be treatable. Screening and early treatment of retinopathy would prevent deterioration of visual acuity and could reduce the risk of blindness due to diabetic retinopathy by an estimated 56% (0.73 X 0.88 X 0.87). The findings suggest that an effectively managed community based screening programme encompassing detection, referral, treatment, and follow up would prevent about 260 new cases of blindness in diabetics under the age of 70 each year in England and Wales. This would represent over 10% of all cases of blindness in adults in this age group.     

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。     

Visual problems in the elderly population and implications for services.

OBJECTIVE--To determine the prevalence of visual disability and common eye disease among elderly people in inner London. DESIGN--Cross sectional random sample survey. SETTING--Inner London health centre. SUBJECTS--Random sample of people aged 65 and over taken from practice''s computerised age-sex register. MAIN OUTCOME MEASURES--Presenting binocular Snellen 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence of blindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care. RESULTS--207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3.9% by American criteria. The prevalence of low vision (WHO criteria) was 7.7%. The prevalence of visual impairment (American criteria) was 10.6%. Cataract accounted for 75% of cases of low vision. Only eight out of 16 patients with low vision were known by their general practitioner to have an eye problem. 56 subjects (27%) would probably have benefited from refraction. Comparisons with studies in the United States and Finland suggested higher rates in this sample, mainly due to the prevalence of disabling cataract. CONCLUSION--There seems to be a considerable amount of undetected ocular disease in elderly people in the community.     

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 epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases presenting to deployed military hospitals, 2003-2009

Blast injuries are becoming increasingly common in military conflicts as the nature of combat changes from conventional to asymmetrical warfare and counter-insurgency. This article describes a retrospective database review of cases from the UK joint theatre trauma registry from 2003 to 2009, containing details of over 3000 patients, mainly injured in Iraq and Afghanistan. During this period, 1678 patients were injured by explosion of whom 113 had evidence of blast lung injury. Of the 50 patients who survived to reach a medical facility, 80 per cent required ventilatory support. Injuries caused by explosion are increasing when compared with those caused by other mechanisms, and blast lung represents a significant clinical problem in a deployed military setting. Management of these patients should be optimized from point of wounding to definitive care.     

DERMATITIS OF THE HANDS IN INDUSTRY

Three hundred and twenty-eight patients were referred for opinion as to whether a dermatologic condition was due to occupational causes. The answer was affirmative in two-thirds of the cases.Of 2,260 patients seen in ordinary private dermatological practice, about 9 per cent had lesions on the hands. Of 128 patients with contact dermatitis considered to be of industrial origin, 121, or 94.5 per cent, had lesions on the hands.Establishing industrial responsibility in cases of suspected occupational dermatitis of the hands is difficult, but in most cases a just conclusion can be reached by following certain guides.     

Ocular complications of the acquired immunodeficiency syndrome

The acquired immunodeficiency syndrome (AIDS) affects the ocular structures in several ways. Kaposi's sarcoma has been observed on the bulbar conjunctiva of the globe. Retinal complications, however, are of major concern. Cotton-wool spots are commonly seen in AIDS patients and are usually of no consequence, except that they must be distinguished from the early stages of cytomegalovirus (CMV) retinitis, seen in 20-40% of these patients. CMV causes a necrotic-type retinitis potentially leading to blindness. 9-[2-Hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (DHPG) has been found effective in the short-term treatment of this disorder. It is planned to use AS101 in the regimen to see if a long-term cure from this disease can be affected. Care must be taken in handling ocular tissue of AIDS patients or the re-use of ophthalmic instruments touching the eye of AIDS patients since the human immunodeficiency virus has been found in these structures.     

World Health Organization's programme on the prevention of blindness

The WHO Programme for the Prevention of Blindness was established in 1978, reflecting the need for action against the burden of avoidable blindness, which constitutes an increasingly serious socioeconomic problem in many countries. A vast majority of the world's blind live in developing countries, where unoperated cataract, trachoma, xerophthalmia and onchocerciasis are the main causes of visual loss. Thus, more than two-thirds of blindness encountered in such areas is either preventable or curable. The objectives of the WHO Programme for the Prevention of Blindness are to reduce the amount of avoidable blindness in developing countries, and to make essential eye care available to all. In order to achieve this, blindness prevention must form part of primary health care, which is the basic strategy of the World Health Organization to attain the overall goal of "Health for All by the Year 2000". Emphasis is placed on the establishment of national programmes for the prevention of blindness, geared to local needs and resources. This implies a need for a careful programming process, in relation to the general provision of health services.     

Cardiac screening procedures

Seven per cent of a sample group of civil service employees were found to have diagnosable heart disease. The diagnosis was made on the basis of a complete physical examination and history taken by a specialist in internal medicine and/or heart disease. In addition a questionnaire form related to symptoms of heart disease was filled out by the patient, and various laboratory tests were made. As a technique in cardiac case-finding, the electrocardiogram was the best single device. Of all the cases of heart disease in this survey 65 per cent were detected from tracings obtained by using all 12 leads, and 57 per cent if only the three standard limb leads were taken; but of the presumably normal persons, 13 per cent would be erroneously suspected of possible heart disease by this technique. Heart disease was detected in 50 per cent of the diagnosed cases on the basis of answers to three of the questions in the questionnaire. Eighteen per cent of normal persons would also have been suspected of having heart disease by this case-finding device. Although the survey reported did not develop a simple cardiac case-finding technique, the data presented indicated that a questionnaire history-form, if judiciously used and evaluated, may be of value to physicians who examine large numbers of patients who are unwilling to submit to a complete cardiac evaluation.     

Do Spanish Hospital Professionals Educate Their Patients About Advance Directives?

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.     

Competitive nodulation blocking of cv. Afghanistan pea is related to high levels of nodulation factors made by some strains of Rhizobium leguminosarum bv. viciae

Cultivar Afghanistan peas are resistant to nodulation by many strains of Rhizobium leguminosarum bv. viciae but are nodulated by strain TOM, which carries the host specificity gene nodX. Some strains that lack nodX can inhibit nodulation of cv. Afghanistan by strain TOM. We present evidence that this "competitive nodulation-blocking" (Cnb) phenotype may result from high levels of Nod factors inhibiting nodulation of cv. Afghanistan peas. The TOM nod gene region (including nodX) is cloned on pIJ1095, and strains (including TOM itself) carrying pIJ1095 nodulate cv. Afghanistan peas very poorly but can nodulate other varieties normally. The presence of pIJ1095, which causes increased levels of Nod factor production, correlates with Cnb. Nodulation of cv. Afghanistan by TOM is also inhibited by a cloned nodD gene that increases nod gene expression and Nod factor production. Nodulation of cv. Afghanistan can be stimulated if nodD on pIJ1095 is mutated, thus severely reducing the level of Nod factor produced. Repression of nod gene expression by nolR eliminates the Cnb phenotype and can stimulate nodulation of cv. Afghanistan. Addition of Nod factors to cv. Afghanistan roots strongly inhibits nodulation. The Cnb+ strains and added Nod factors inhibit infection thread initiation by strain TOM. The sym2A allele determines resistance of cv. Afghanistan to nodulation by strains of R. leguminosarum bv. viciae lacking nodX. We tested whether sym2A is involved in Cnb by using a pea line carrying the sym2A region introgressed from cv. Afghanistan; nodulation in the introgressed line was inhibited by Cnb+ strains. Therefore, the sym2A region has an effect on Cnb, although another locus (or loci) may contribute to the stronger Cnb seen in cv. Afghanistan.     

Causes of low vision and major low-vision devices prescribed in the low-vision clinic of Nepal Eye Hospital,Nepal

Visual impairment is a major public health problem. Identifying the main causes of low vision and the major low-vision devices prescribed will help to develop and implement the low-vision rehabilitation service. We find out the causes of low vision and the low-vision devices prescribed in the low-vision clinic of Nepal Eye Hospital. A retrospective cross-sectional review of all patients attending the low-vision clinic from 1 May 2009 to 31 April 2011. Patients having visual acuity less than 3/60 in the better eye with best refractive correction were excluded. Of the 137?patients, the mean age was 32.53?±?22.90?years; 71.5% were male and 67.88% were under 40. The major causes of low vision were nystagmus (30.70%), high refractive error (22.62%), cataract (15.30%), retinitis pigmentosa (15.30%) and age-related macular degeneration (13.10%); 78.10% patents were wearing glasses while telescopes were prescribed for 29.20% patients. Nystagmus, high refractive error and cataract are the main causes of low vision in Nepal. The majority of the low-vision patients seen in this clinic are of working age. Telescopes are the major low-vision device prescribed. We review approach the cause of low-vision problem in low-vision clinic Nepal Eye Hospital, Nepal.     

追踪物种丧失•聚焦生态超载•共享一个地球——《2006地球生命力报告》解读

世界自然基金会和环球足迹网络等2006年10月在中国北京联合发布《2006地球生命力报告》,用生命地球指数和生态足迹两个主要指标描绘了全球生物多样性的变化状态和人类所面临的环境压力。报告显示:生命地球指数1970～2003年总体下降约三分之一,其中陆栖指数减少约31%、海洋指数减少约27%、淡水指数减少约30%,生物多样性正快速持续地遭到损失;自1961年人类的生态足迹不断增加,1987年转入生态赤字下运行,此后生态超载不断加剧,2003年生态赤字达25.28%;化石燃料足迹增长最快,2003年几乎占到一半,达到48%;阿联酋、美国、加拿大等国家人均足迹最大,阿富汗最小,中国排名69位;北美、欧盟、中东和中亚、亚太区处于生态超载状态,非欧联盟、拉丁美洲和加勒比海地区、非洲处于生态盈余;过去40多年,人均足迹高收入国家增长2倍多,2003年达6.5gha,低收入国家一直在0.8gha以下徘徊,中收入国家也从未超过2.0gha。地球的经济怎样才可能在过度消耗中持续发展?3种预测情景也许会让我们走出生态超载的困境、走向可持续发展,共享"一个地球生活"的美好未来。整篇报告可以概括为4个主题:追踪物种丧失、聚焦生态超载、3种情景预测、一个地球生活。     

Rapid Assessment of Avoidable Blindness in India

Background

Rapid assessment of avoidable blindness provides valid estimates in a short period of time to assess the magnitude and causes of avoidable blindness. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population.

Methods and Findings

Sixteen randomly selected districts where blindness surveys were undertaken 7 to 10 years earlier were identified for a follow up survey. Stratified cluster sampling was used and 25 clusters (20 rural and 5 urban) were randomly picked in each district.. After a random start, 100 individuals aged 50+ were enumerated and examined sequentially in each cluster. All those with presenting vision <6/18 were dilated and examined by an ophthalmologist. 42722 individuals aged > = 50 years were enumerated, and 94.7% examined. Based on presenting vision,, 4.4% (95% Confidence Interval[CI]: 4.1,4.8) were severely visually impaired (vision<6/60 to 3/60 in the better eye) and 3.6% (95% CI: 3.3,3.9) were blind (vision<3/60 in the better eye). Prevalence of low vision (<6/18 to 6/60 in the better eye) was 16.8% (95% CI: 16.0,17.5). Prevalence of blindness and severe visual impairment (<6/60 in the better eye) was higher among rural residents (8.2%; 95% CI: 7.9,8.6) compared to urban (7.1%; 95% CI: 5.0, 9.2), among females (9.2%; 95% CI: 8.6,9.8) compared to males (6.5%; 95% CI: 6.0,7.1) and people above 70 years (20.6%; 95% CI: 19.1,22.0) compared to people aged 50–54 years (1.3%; 95% CI: 1.1,1.6). Of all blindness, 88.2% was avoidable. of which 81.9% was due to cataract and 7.1% to uncorrected refractive errors/uncorrected aphakia.

Conclusions

Cataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them. Most blindness and low vision burden is avoidable.     

Mass surveys and selective case-finding; two tools for tuberculosis control

The productivity and effectiveness of the traditional mass x-ray survey method of tuberculosis case-finding were compared with those of a selective use of mobile miniature x-ray equipment. In Tulare County, California, two mobile miniature x-ray units were operated independently of each other. One unit conducted community-wide, pre-planned surveys, while the other unit operated a regular weekly schedule of mobile screening clinics in four cities in the county. THE MAIN FEATURES OF THE SELECTIVE SCREENING PROGRAM WERE: (1) Extensive use of the physician referral method; (2) utilization of the unit for contact contact investigation; (3) interpretation of the minifilm and mailing of film and report to the family physician one day after the screening clinic.RESULTS: Mass survey found one case of tuberculosis per 2,200 minifilms taken; cost per case found, $475. Selective screening program found one case per 292 minifilms taken; cost per case found, $111. Of all cases of tuberculosis reported in 1953, 8 per cent were found by mass survey and 18 per cent by selective screening.     

Epidemiological survey of rhinosporidiosis in Kanyakumari district of Tamil Nadu

One hundred and twelve nasal polyps received along with full history from three different hospitals of Kanyakumari district of Tamil Nadu during the period 1983–1987 were found positive for rhinosporidiosis on histopathological examination. Among the four taluks (countries) the majority of the cases (41.1 per cent) came from Agastheeswaram, followed by Kalkulam (28.6 per cent), Thovalai (17.0 per cent) and Vilavancode (13.3 per cent). The 11–20 years age group found to be highly susceptible (60 per cent). There was no sex prepondence in contracting the disease as the cases were evenly distributed between both sexes. These findings exhibited the endemic nature of the disease in Kanyakumari district.Unreported cases to an extent of 9 to 40 per cent were encountered during the ENT disease diagnostic camps conducted in nine high incidence villages. Further 8 more cases were detected in addition to cases attended in the hospitals and ENT camps when a complete enumeration of cases was undertaken in Pallam village. Thus the actual number of cases found in the district need a stratified random sampling.     

Minority Veterans Are More Willing to Participate in Complex Studies Compared to Non-minorities

Background

Minorities are an underrepresented population in clinical trials. A potential explanation for this underrepresentation could be lack of willingness to participate. The aim of our study was to evaluate willingness to participate in different hypothetical clinical research scenarios and to evaluate the role that predictors (e.g. health literacy) could have on the willingness of minorities to participate in clinical research studies.

Methods

We conducted a mixed-methods study at the Miami VA Healthcare system and included primary care patients with hypertension. We measured willingness to participate as a survey of four clinical research scenarios that evaluated common study designs encountered in clinical research and that differed in degree of complexity. Our qualitative portion included comments about the scenarios.

Results

We included 123 patients with hypertension in our study. Of the entire sample, ninety-three patients were minorities. Seventy per cent of the minorities were willing to participate, compared to 60 per cent of the non-minorities. The odds ratio (OR) of willingness to participate in simple studies was 0.58; 95 per cent CI 0.18–1.88 p=0.37 and the OR of willingness to participate in complex studies was 5.8; 95 per cent CI 1.10–1.31 p=0.03. In complex studies, minorities with low health literacy cited obtaining benefits (47 per cent) as the most common reason to be willing to participate. Minorities who were not willing to participate, cited fear of unintended outcomes as the main reason.

Conclusions

Minorities were more likely to be willing to participate in complex studies compared to non-minorities. Low health literacy and therapeutic misconception are important mediators when considering willingness to participate in clinical research.