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Background. Tobacco smoking and use of smokeless tobacco are the most preventable cause of death in Bangladesh. The prevalence of psychological distress is increasing globally. This paper reports the smoking status and their association with psychological distress and other factors in a rural district, Narail, of Bangladesh. Materials and Methods. Data were collected from 2425 adults of age 18–90 years. Smoking status along with sociodemographic characteristics and measures of psychological distress using the Kessler 10-item questionnaire were collected using a face-to-face data collection method. Results. The crude (age-standardized) prevalence of ever smoking was 27.1 (24.3)% that includes current 25.6 (23.7) and smoker 1.5 (0.6)%, and the prevalence of smokeless tobacco (SLT) was 23.5 (13.4)%. The prevalence of ever smoking was the highest in daily labourers (62.9%) and SLT use was the highest in widowed people (47.2%). After adjustment for covariates, no education (odds ratio (OR): 3.78, 95% confidence interval (CI): 1.57–9.07 for females and OR: 2.69, 95% CI: 1.87–3.87 for males) compared to at least secondary level of education and daily labours (OR: 6.66, 95% CI: 1.67–26.6 for females and OR: 5.12, 95% CI: 1.30–20.19 for males) compared to housework were associated with higher prevalence of ever smoking. Any level of psychological distress, such as mild psychological distress, was associated with at least double the prevalence of tobacco smoking in females (OR: 2.12, 95% CI: 1.67–3.83) but not in males (OR: 1.12, 95% CI: 0.80–1.56). Psychological distress was not associated with SLT use. Conclusions. Prevalence of both smoking and SLT use was high, particularly in daily labourers, people with no education, and females with psychological distress in rural Bangladesh. Appropriate intervention programs should especially target those of low levels of education and laborious occupations for increasing awareness for the cessation of smoking in rural Bangladesh.

Background The use of digital interventions for managing chronic diseases is significantly increasing. The aim of this study was to estimate the proportion of ownership of a mobile phone, and factors associated with the ability to read and access SMS delivered health information, and willingness to pay for it among people with hypertension in a rural area in Bangladesh. Methods Data were collected from 307 participants aged 30 to 75 years with hypertension from a rural area in Bangladesh from December 2020 to January 2021. Outcome measures included ownership of a mobile phone, ability to read SMS, willingness to receive and pay for health information by SMS. Associated factors included age, gender, level of education, occupation, and socioeconomic status. We used regression analysis to identify variables associated with the outcome variables. Results Overall, 189 (61.6%) people owned a mobile phone which was higher in men (73.3% vs. 50%, p p Conclusion A significant proportion of people are unable to read SMS. However, people are willing to receive and pay to receive SMS for health information. Education and awareness programs should be conducted among targeted groups, including people with low education and women.

The health benefits of physical activity (PA) are well recognized, and PA levels vary in different populations. The study aimed to investigate PA levels and associated sociodemographic factors among people with hypertension in a rural area in Bangladesh. Baseline data were part of a cluster randomized controlled trial of 307 adults aged 30–75 years to study the effectiveness of PA and lifestyle changes in lowering blood pressure. The outcome variables were PA at work, commuter, recreation, metabolic equivalent task (MET)-minute per week and sitting time. Total 68 (22.1%) people participated in vigorous-intensity activity, 23 (7.5%) participated in moderate-intensity sports. Overall, 83% of people were physically active more than 600 MET-min. Women (OR 2.95, 95% CI, 1.36–6.39) compared to men, and people with no education (OR 4.47, 95% CI, 1.62–12.33) compared to people with secondary school certificates or above were less physically active. Of total PA, 63% were work-related, and 1% were recreation-related for women, and these figures were 55% and 3% for men. The study reports that vigorous-intensity PA is low, and recreation time is minimal. Routine PA, especially for women and people with low education levels, should be encouraged to increase PA to manage hypertension.

Aims Endothelial dysfunction is a precursor to the development of symptomatic atherosclerosis. Retinal microvascular reactivity to flicker light stimulation is a marker of endothelial function and can be quantified in vivo. We sought to determine whether retinal microvascular endothelial dysfunction predicts long-term major adverse cardiovascular events (MACE). Methods and results In a single center prospective observational study, patients with coronary artery disease (CAD) or cardiovascular risk factors underwent dynamic retinal vessel assessment in response to flicker light stimulation and were followed up for MACE. Retinal microvascular endothelial dysfunction was quantified by measuring maximum flicker light-induced retinal arteriolar (FI-RAD) and venular dilatation (FI-RVD). In total, 252 patients underwent dynamic retinal vessel assessment and 242 (96%) had long-term follow-up. Of the 242 patients, 88 (36%) developed MACE over a median period of 8.6 years (IQR 6.0-9.1). After adjustment for traditional risk factors, patients within the lowest quintile of FI-RAD had the highest risk of MACE (OR 5.21; 95% CI 1.78, 15.28). Patients with lower FI-RAD were also more likely to die (OR 2.09; 95% CI 1.00, 4.40, per standard deviation decrease in FI-RAD). In Kaplan-Meier analysis, patients with FI-RAD responses below the cohort median of 1.4% exhibited reduced MACE-free survival (55.5 vs. 71.5%; log-rank p = 0.004). FI-RVD was not predictive of MACE. Conclusions Retinal arteriolar endothelial dysfunction is an independent predictor of MACE in patients with CAD or cardiovascular risk factors. Dynamic retinal vessel analysis may provide added benefit to traditional risk factors in stratifying patients at risk for cardiovascular events. Translational perspective Subclinical endothelial dysfunction precedes cardiovascular diseases and can be assessed non-invasively using the retinal microvascular network. Retinal arteriolar endothelial dysfunction is an independent predictor of MACE and all-cause mortality in patients with established coronary artery disease or cardiovascular risk factors. Validation studies and investigation into the lifestyle and pharmacological modifiability of endothelial dysfunction could enhance risk prediction and guide intensification of therapy.

BackgroundThis investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh.MethodThe cross-sectional investigation collected 300 adults aged 18–85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses.ResultsResults showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni correctedpvalues, for physical ($$ {\upchi}_{(20)}^2 $$χ202=32.13,p = 0.041), psychological ($$ {\upchi}_{(16)}^2 $$χ162=14.93,p = 0.529), social ($$ {\upchi}_{(16)}^2 $$χ162=12.62,p = 0.397), and environmental ($$ {\upchi}_{(20)}^2 $$χ202=22.01,p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach’s Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions.ConclusionThe 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.

ObjectivesThis investigation expected to validate the psychometric properties of the modified seven-item Kessler psychological distress scale (K7) for measuring psychological distress in healthy rural population of Bangladesh.DesignCross-sectional study.SettingNarail district, Bangladesh.ParticipantsA random sample of 300 adults of age 18–90 years were recruited. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application known as CommCare.Outcome measureValidation of the K7 was the major outcome. Sociodemographic factors were measured to assess for Differential Item Functioning to check if the tool functions equally in different factors. Rasch analysis was carried out for the validation of the K7 scale in the healthy rural population of Bangladesh. RUMM2030 was used for the analyses.ResultsResults showed good overall fit, as indicated by a non-significant item-trait interaction (χ2=44.54, df=28, p=0.0245) compared with a Bonferroni adjusted p value of 0.007. Both item fit (mean=0.30, SD 1.22) and person fit residuals (mean=–0.18, SD 0.85) showed perfect fit. Reliability was very good as indicated by a Person Separation Index=0.85 and Cronbach’s alpha=0.89. All individual items were ordered thresholds. The K7 scale showed adequate reliability, unidimensionality and was free from local dependency. The K7 scale also showed similar functioning for adults and older adults, males and females, no education and any level of education, and at least some financial instability versus no financial instability.ConclusionsValidation of K7 scale confirmed that the tool is suitable for measuring psychological distress among the rural Bangladeshi population. Further research should validate the K7 scale in different rural settings in Bangladesh to determine a valid cut-off score for assessment of severity levels of psychological distress. The K7 scale should also be tested in other developing countries where sociodemographic characteristics are similar to those of Bangladesh.

Introduction The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP. Methods A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs. Results The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2–52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81–3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75–5.11). Of the total participants, 81.3% (95% CI: 79.1–83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6–77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9–41.9), 59.1% (95% CI: 55.9–62.3), and 46.0% (95% CI: 42.3–49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting. Conclusion Malaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.

High prevalence of blindness coupled with low public awareness of eye diseases is a severe problem in Pakistan. The objective of this study was to evaluate the awareness, attitude and practices related to common ocular problems and eye care use among general population of Punjab, Pakistan. Data were collected cross-sectionally, using random selection of participants from five districts of Punjab, Pakistan. A pre-tested questionnaire was used to collect the data from January to March 2017. The ordinal data were converted to interval--based data by Rasch analysis, which is termed as &ldquo, knowledge score&rdquo, and ranges from &minus, 3 to +3. Descriptive statistics, linear regression, binary logistic regression and chi square analysis were performed to evaluate the data. Of the 2073 people contacted, 96.4% (2019) responded the interviewer. The mean (SD) age was 39.9 (11.4) years, majority were males (64.8%) and only 3.1% were illiterate. The majority (68.1%) of respondents were aware that blindness can be prevented and are least aware of age-related macular degradation (31.4%). Multivariate analysis to knowledge scores demonstrated that male gender (&beta, = 0.53 95%CI = 0.39, 0.66, p &lt, 0.001), higher education (&beta, = 0.31 95%CI = 0.25, 0.37, p &lt, 0.001) were significantly associated with knowledge score. Eighty-two percent of our respondents had a positive attitude towards health-seeking behavior and those who had adequate income on most of occasions were 1.82 (AOR = 1.82 95%CI = 1.26, 2.62 p = 0.001) times more prone towards health-seeking behavior than those who had insufficient income. Out of all respondents, 21.5% had an eye examination at least once a year and this frequency was significantly higher in lower age, females, high education and high Socio Economic Status level (p &lt, 0.05). Among the general population of Pakistan, awareness about prevention of blindness and refractive error was optimum, while awareness of blindness causing eye conditions, like age-related macular degradation was low. Intensive improvements in the health literacy and public interventions&mdash, specifically in old age people, males and respondents with lower education&mdash, are urgently needed.

Background This study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh. Methods This cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May–July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental. Results The original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(20)}^2 $$\end{document}χ202 = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(16)}^2 $$\end{document}χ162 = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(20)}^2 $$\end{document}χ202 = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions. Conclusions The modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level. Electronic supplementary material The online version of this article (10.1186/s12913-019-4026-0) contains supplementary material, which is available to authorized users.

ObjectivesUtility of CT coronary angiography (CTA) and coronary artery calcium (CAC) scoring in risk stratification prior to non-cardiac surgery is unclear. Although current guidelines recommend stress testing in intermediate-high risk individuals, over one-third of perioperative major adverse cardiovascular events (MACE) occur in patients with a negative study. This systematic review and meta-analysis evaluates the value of CTA and CAC score in preoperative risk prognostication prior to non-cardiac surgery.MethodsMEDLINE, PubMed and EMBASE databases were searched for articles published up to June 2018. Summary ORs for degree of coronary artery disease (CAD) and perioperative MACE were pooled using a random-effects model.ResultsEleven studies were included. Two hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive multivessel 23.1%, pConclusionsSeverity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The ‘rule-out’ capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery.Trial registration numberCRD42018100883

Assess the correlation between optical coherence tomography findings and change in vision for patients receiving "treat and extend" protocol ranibizumab for neovascular age-related macular degeneration.Optical coherence tomography analysis and best-corrected visual acuity (BCVA) change: mild = 5 to 9 letters, moderate = 10 to 14 letters, and severe ≥15 letters.A total of 103 eyes (99 patients, 63% female, 65-91 years) followed for 20.8 ± 4.9 months. By 12 months, there were 1.38 ± 0.59 instances of intraretinal fluid (IRF)/subretinal fluid recurrence on optical coherence tomography and 1.25 ± 1.00 instances of BCVA loss (≥5 letters) per patient. When BCVA was lost, IRF/subretinal fluid was present in 37.3% of cases. Occurrences of severe BCVA loss were less likely to recover vision than when BCVA loss was mild (5.9% vs. 75.6%, P = 0.001). New occurrence of IRF (33.9%) or subretinal fluid (29.6%) was more likely to lead to BCVA loss, compared with dry (16.6%) or persistent IRF (11.9%) or persistent subretinal fluid (14%, P0.001). With persistent fluid, any new loss of vision had a lower chance of recovery than when fluid was new in onset (64.3% vs. 85.3%, P = 0.04).During ranibizumab treatment, vision can decrease without signs of fluid. When fluid is present, IRF is associated with poorer vision. New occurrence of any fluid on optical coherence tomography is likely to lead to vision loss, but small amounts of persistent fluid can be tolerated without compromising vision.

Background To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh. Methods We recruited 2425 adult samples (18–90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs. Results Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58–1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67–0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26–0.61) and severe MHCs (β 0.25, 95% CI: 0.13–0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling. Conclusions Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education. Electronic supplementary material The online version of this article (10.1186/s12913-019-4385-6) contains supplementary material, which is available to authorized users.

Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18&ndash, 90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0&ndash, 9, a score &ge, 6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents&rsquo, mean age was 32.92 &plusmn, 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored &ge, 6 (adequate awareness). Being female (&beta, = 0.37, 95% confidence interval [CI]: 0.16, 0.05, p = 0.001), socioeconomic status (&beta, = 0.24, 95% CI: 0.12, 0.36, p &lt, 0.001), being diabetic (&beta, = 0.82, 95% CI: 0.53, 1.10, 0.001), and higher education (&beta, = 0.25, 95% CI: 0.17, 0.33, 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan&rsquo, s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

BackgroundPsychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.MethodsA total of 2425 adults (1249 women) aged 18-90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants' socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.ResultsThe overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, pConclusionsIn this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh.

Aim Diabetic retinopathy (DR) screening is one of the keys in successful diabetes care, but the participation in DR screening is sub-optimal. This study aims to assess the factors associated with participation in a DR screening program in a rural district of Bangladesh. Method 213 persons with diabetes identified in a population-based assessment of over 3000 persons ≥ 40 years were offered free of cost screening for DR. Awareness, attitudes and practice about diabetes and common eye diseases along with socio-demographic factors were assessed. Results 68 (32%) patients participated in the screening program. After multivariate adjustment, awareness related to diabetes causes eye disease (odds ratio (OR) 8.47, 95% confidence interval (CI) 3.95–18.18), awareness of DR (OR 5.15, 95% CI 1.89–14.01) and awareness of the possibility to prevent DR-related vision loss (OR 3.15, 95% CI 1.53–6.51) were associated with higher proportion of participation. Lack of confidence upon skills of ophthalmic assistants and fear of complications were barriers but socio-economic condition was not a barrier in attending the screening program. Conclusions The major factor associated with participation in DR screening is diabetes-related health literacy in rural Bangladesh. Public health promotion program should be designed to provide health education to increase participation in the screening program.

BACKGROUND: The number of adults with diabetes is increasing worldwide and also the number of people with diabetic retinopathy (DR), a major complication of diabetes. Task sharing in eye care for people with diabetes could address the shortage in the number of ophthalmologists and increase access to eye care services. This study investigated the opinion of eye care professionals for a checklist of tasks, which are involved in DR management, to be possibly shared by optometrists and mid-level eye and health care workers with ophthalmologists. METHODS: The study used a purposive sampling technique. All available eye and health care workers from five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey was conducted to investigate the potential roles of various cadres in eye care delivery for people with diabetes. RESULTS: Ninety-six (79%) participants including doctors (n = 56), optometrists (n = 29), and mid-level eye care workers (n = 11) responded to the survey. Two-thirds of the participants suggested mid-level eye care workers, while 88.5% stated that lady health workers could provide education and health promotion to people with diabetes. Most of the participants (88.5%) suggested that optometrists could share the task of dilated ophthalmoscopy with ophthalmologists for detection of DR and make referrals to ophthalmologists if needed. Ophthalmologists remained the recommended cadre to undertake the eye examinations of patients with proliferative DR and diabetic macular edema. CONCLUSION: This research provided an insight on how task sharing in DR management can be implemented by optimizing the roles of eye care workers.

Hypertension is mainly asymptomatic and remains undiagnosed until the disease progresses. The objective of the study was to determine the prevalence of and risk factors for hypertension in rural Bangladesh. Using a population-based cluster random sampling strategy, 3096 adults aged ⩾30 years were recruited from a rural district in Bangladesh. Data collected included two blood pressure (BP) measurements, fasting blood glucose, socio-demographic and anthropometric measurements. Hypertension was defined as systolic BP (SBP) ⩾140 mm Hg or diastolic BP (DBP) ⩾90 mm Hg or self-reported diagnosed hypertension. Logistic regression techniques were used for data analyses. The crude prevalence of hypertension was 40% (95% confidence interval (CI) 38–42%) of which 82% were previously undiagnosed. People from lower socio-economic status (SES) had a significantly higher percentage of undiagnosed hypertension compared with people with higher SES (P

The shortage of ophthalmologists in many countries is a major barrier to timely provision of eye care. A team work approach to screen, detect and manage diabetic retinopathy (DR) could achieve greater screening coverage of people with diabetes to prevent vision loss. This study aimed to assess the attitudes and perceptions of eye care workers and health administrators regarding task sharing for management of DR.Using purposive sampling, 121 eye and health care workers in five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey explored the possibility for involvement of optometrists and mid-level eye care workers to share tasks with ophthalmologists for DR management and the potential outcomes of task sharing, through multiple choice and open-ended questions.Ninety-six (79%) participants-doctors (n = 56), optometrists (n = 29) and mid-level eye care workers (n = 11) responded to the survey. All participants supported task sharing in screening and detection for management of DR. There was no significant difference among the groups with respect to their positive attitude towards task sharing (p = 0.22). The majority in each group believed that the task sharing would not degrade the quality of care (p = 0.48). Two potential major outcomes of task sharing in the eye care system included the benefits for people with diabetes and potential DR and the strengthening of the health care system.Task sharing among various cadres of eye care workers has the potential to improve screening coverage of people with diabetes to prevent visual loss from DR.

Background To evaluate the accuracy and reliability of fundus retinal photos graded by local graders in Bangladesh with those graded by an expert at the Centre for Eye Research Australia (CERA) in the context of mass scale diabetic retinopathy (DR) screening in Bangladesh. Methods A population-based cross-sectional study of 3,104 adults identified 213 (7.2%) eligible patients with diabetes of age ≥ 40 years in 2012–2013. Retinal photographs were collected using a non-mydriatic digital fundus retinal camera and a two-field imaging protocol. The photos were graded by two remote graders (G1 and G2) who were trained by a retinal specialist (RS) in Bangladesh, by the RS himself, and by a Centre for Eye Research Australia (CERA) grader. The local graders up skilled their grading ability by comparing 30% of the photos graded by the CERA grader with their own grades. Learning from that exercise was applied to the remaining 70% of photos, which were re-graded. Reliability and accuracy of grading amongst the graders were reported using cross tabulation, inter- and intra-grader reliability, and with sensitivity and specificity. Results Of 122 eyes from 61 patients, the mild (R1) DR was estimated to be 14 to 25%, pre-proliferative (R2) DR 4–8%, and proliferative (R3) DR 0.8 to 1.6%, whereas 25%, 8%, 18%, and 15% were found to be ungradable by CERA, RS, G1, and G2, respectively. Of 8 (6.6%) eyes identified as R2 by the CERA grader, 5 (63%), 3 (38%) and 3 (38%) were correctly classified as R2, whereas the rest were classified either as R1 or R3 but none were classified as no DR (R0) or ungradable by the RS, G1 and G2, respectively. After getting experience reviewing the 30% test set graded by the CERA grader, the local graders graded moderate and severe DR with 100% accuracy. After excluding ungradable photos, the sensitivity (specificity) relative to the CERA grader was 82% (88%) before and 80% (93%) after training for G1 and 56% (87%) before and 77% (90%) after training for G2. In case of maculopathy, the CERA grader reported 11.2% eyes with maculopathy, which included 100% of the 4.9% by RS, 6.6% by G1, and 7.4% by G2. Conclusions Local graders in Bangladesh are able to grade retinal photos with high accuracy if the DR is at least of a moderate level. With appropriate training and experience, local graders have the ability to contribute significantly to the grading of millions of retinal photos, which required grading in resource- poor countries.

Background To assess factors associated with disability in a rural district of Bangladesh. Methods Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability. Results The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p

Objective The aim of this study was to translate, adapt and validate the Kessler 10-item questionnaire (K10) for measuring psychological distress in rural Bangladesh. Design Cohort study. Setting Narail district, Bangladesh. Participants A random sample of 2425 adults of age 18–90 years was recruited. Outcome measure Validation of the K10 was the major outcome. Sociodemographic factors were measured to assess if the K10 needed adjustment for factors such as age or gender. The Rasch measurement model was used for the validation, and RUMM 2030 and SPSS V.24 software were used for analyses. Results Initial inspection of the total sample showed poor overall fit. A sample size of 300, which is more satiated for Rasch analysis, also showed poor overall fit, as indicated by a significant item–trait interaction (χ2= 262.27, df=40, p

Aims/hypothesis: The fractal dimension (D f) of the retinal vasculature is a global measure of its branching pattern complexity. We examined the relationship of retinal D f with diabetes. Methods: We conducted a cross-sectional study of 1,577 participants with diabetes and impaired glucose metabolism and normal controls from the population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Retinal D f was quantified from fundus photographs using a computer-based programme and diabetes status was determined by oral glucose tolerance test based on the WHO criteria. Results: After adjustment for age, sex and vascular risk factors, persons with higher retinal D f were more likely to have diabetes (OR 1.56; 95% CI 1.14-2.14, highest vs lowest fractal tertile). This relationship remained with further adjustment for retinal arteriolar calibre and presence of retinopathy (OR 1.64; 95% CI 1.19-2.27), and after excluding participants with retinopathy (OR 1.60; 95% CI 1.16-2.21). Retinal D f was not related to impaired glucose tolerance or impaired fasting glucose (OR 1.19; 95% CI 0.85-1.67). Conclusions/interpretation: Individuals with diabetes, but not with impaired glucose metabolism, have greater retinal D f, reflecting greater complexity of the retinal vasculature. Our findings suggest the presence of early microvascular changes in the retinal vasculature of persons with diabetes, even in the absence of overt retinopathy.

IntroductionOrientation and mobility (O&M) specialists assess the functional vision and O&M skills of people with mobility problems, usually relating to low vision or blindness. There are numerous O&M assessment checklists but no measures that reduce qualitative assessment data to a single comparable score suitable for assessing any O&M client, of any age or ability, in any location. Functional measures are needed internationally to align O&M assessment practices, guide referrals, profile O&M clients, plan appropriate services and evaluate outcomes from O&M programmes (eg, long cane training), assistive technology (eg, hazard sensors) and medical interventions (eg, retinal implants). This study aims to validate two new measures of functional performance vision-related outcomes in orientation and mobility (VROOM) and orientation and mobility outcomes (OMO) in the context of ordinary O&M assessments in Australia, with cultural comparisons in Malaysia, also developing phone apps and online training to streamline professional assessment practices.Methods and analysisThis multiphase observational study will employ embedded mixed methods with a qualitative/quantitative priority: corating functional vision and O&M during social inquiry. Australian O&M agencies (n=15) provide the sampling frame. O&M specialists will use quota sampling to generate cross-sectional assessment data (n=400) before investigating selected cohorts in outcome studies. Cultural relevance of the VROOM and OMO tools will be investigated in Malaysia, where the tools will inform the design of assistive devices and evaluate prototypes. Exploratory and confirmatory factor analysis, Rasch modelling, cluster analysis and analysis of variance will be undertaken along with descriptive analysis of measurement data. Qualitative findings will be used to interpret VROOM and OMO scores, filter statistically significant results, warrant their generalisability and identify additional relevant constructs that could also be measured.Ethics and disseminationEthical approval has been granted by the Human Research Ethics Committee at Swinburne University (SHR Project 2016/316). Dissemination of results will be via agency reports, journal articles and conference presentations.

To describe the relationship of retinal vascular calibre with diabetes and diabetic retinopathy in an Asian population.A total of 3280 (78.7% response) subjects, aged 40-80 years, of Malay ethnicity residing in Singapore participated in this population-based, cross-sectional study. Retinal vascular calibre was measured and summarized using a validated computer programme from digital retinal photographs. Diabetic retinopathy signs were graded from photographs using the modified Airlie House classification.Of the 3004 subjects with data for this analysis, 682 (22.7%) had diabetes, of whom 194 (28.4%) had retinopathy. After multivariable adjustment, retinal arteriolar calibre was significantly wider in persons with diabetes (141 vs139 microm, P0.001); venular calibre was not associated with diabetes (P=0.93). Among participants with diabetes, venular calibre increased from 218.7 microm in those without retinopathy to 231.1 microm in those with moderate and 231.4 microm in those with severe retinopathy (Pfor trend=0.001); arteriolar calibre was not associated with diabetic retinopathy.This study shows wider retinal arterioles in diabetes and wider venules in those with diabetic retinopathy in an Asian population. These findings confirm earlier data on white population, supporting the concept that a quantitative assessment of retinal vasculature may provide further insights into early diabetic microvascular damage.

Smartphone-based Snellen visual acuity charts has become popularized; however, their accuracy has not been established. This study aimed to evaluate the equivalence of a smartphone-based visual acuity chart with a standard 6-m Snellen visual acuity (6SVA) chart.First, a review of available Snellen chart applications on iPhone was performed to determine the most accurate application based on optotype size. Subsequently, a prospective comparative study was performed by measuring conventional 6SVA and then iPhone visual acuity using the 'Snellen' application on an Apple iPhone 4.Eleven applications were identified, with accuracy of optotype size ranging from 4.4-39.9%. Eighty-eight patients from general medical and surgical wards in a tertiary hospital took part in the second part of the study. The mean difference in logMAR visual acuity between the two charts was 0.02 logMAR (95% limit of agreement -0.332, 0.372 logMAR). The largest mean difference in logMAR acuity was noted in the subgroup of patients with 6SVA worse than 6/18 (n=5), who had a mean difference of two Snellen visual acuity lines between the charts (0.276 logMAR).We did not identify a Snellen visual acuity app at the time of study, which could predict a patients standard Snellen visual acuity within one line. There was considerable variability in the optotype accuracy of apps. Further validation is required for assessment of acuity in patients with severe vision impairment.

To determine and compare the prevalence of age-related macular degeneration (AMD) in older Australians of Anglo-Celtic and Southern European origin.A total of 21,132 participants of the Melbourne Collaborative Cohort Study, aged 47-86 years, were assessed for AMD in 2003-2007 with non-mydriatic fundus photography. Of these, 14% were born in Southern Europe (Greece, Italy or Malta), with the remaining 86% of Anglo-Celtic origin, born in Australia, the United Kingdom or New Zealand.Overall, 2694 participants (12.7%) had early stages of AMD, defined as either one or more drusen ≥ 125 μm (with or without pigmentary abnormalities) or one or more drusen 63-124 μm with pigmentary abnormalities in a 6000-μm diameter grading grid, in the absence of late AMD in either eye. A total of 122 participants (0.6%) had late AMD, defined as either geographic atrophy or neovascular AMD. In logistic regression analysis, adjusted for age, sex, smoking, education and physical activity, Southern Europeans compared to Anglo-Celts had a higher prevalence of the early stages of AMD (odds ratio, OR, 1.15, 95% confidence interval, CI, 1.00-1.34), and lower prevalence of late AMD (OR 0.36, 95% CI 0.17-0.78).Australians of Southern European origin have a higher prevalence of the early stages of AMD and lower prevalence of late AMD compared to those of Anglo-Celtic origin. Although AMD prevalence in the older age group(s) of Southern Europeans could be underestimated due to disparity in participation rates, it is likely that both lifestyle and genetic factors play their parts in differential AMD prevalence in these ethnic groups.

Purpose To determine age-related macular degeneration (AMD) phenotypes associated with mutually exclusive homozygotic risk variants in rs1061170 (CFH) and rs11200638 (HTRA1). Methods Nested case-control study of 2,982 eyes (2,129 control, 809 drusen ≥125 μm, 44 advanced AMD) homozygous for CFH [TT or CC] and HTRA1 [GG or AA] were analyzed using logistic regression and generalized estimating equations specifically regards to homozygous risk variants in one but homozygous no-risk in the other gene. Results In early AMD, [CFH HTRA1] and [CFH HTRA1] were associated with central drusen (odds ratio [95% confidence interval] = 4.13 [2.97-5.73] and 3.65 [1.88-7.09], respectively). However, only [CFH HTRA1] was associated with central drusen occupying ≥50% area (13.9 [2.97-64.7]). In advanced AMD, [CFH HTRA1] was associated with geographic atrophy (4.04 [1.57-10.4]), whereas [CFH HTRA1] was associated with neovascular AMD (36.5 [8.3-160.9]). In doubly homozygous risk groups [CFH HTRA1], odds ratios were multiplicative. Conclusion Central but not peripheral drusen location was strongly associated with both [CFH HTRA1] and [CFH HTRA1]. Only [CFH HTRA1] was significantly associated with increased central drusen area.

The aim of the present study was to determine the prevalence and risk factors of prediabetes and diagnosed and undiagnosed diabetes mellitus (DM) in rural Bangladesh.Using a population-based cluster random sampling strategy, 3104 adults aged ≥30 years were recruited. Fasting capillary blood glucose, blood pressure, height, weight, waist circumference, and knowledge, attitudes, and practice related to diabetes were recorded. Diabetes was defined as fasting glucose (FG) ≥7.0 mmol/L or a self-reported diagnosis of diabetes; impaired FG (IFG) was defined as FG ≥ 6.1 and7.0 mmol/L.The overall crude prevalence of DM was 7.2% (95% confidence interval [CI] 6.3%-8.1%; n = 222), of which 55% (n = 123) was previously undiagnosed (UDM). The prevalence of IFG was 5.3% (95% CI 4.5%-6.1%; n = 163). The age-standardized prevalence of DM and IFG was 6.6% and 5.0%, respectively. The prevalence of UDM was higher in people of lower socioeconomic status (59% vs. 31%; P 0.001). Of those with known DM, 56% had poor glycemic control (FG ≥ 7.0 mmol/L) and 37% were not on medication. Overall knowledge of DM was poor; only 16.3%, 17.8%, and 13.4% of those with UDM, IFG, and normal FG knew that diabetes causes eye disease, compared with 55.6% of those with known DM (Ptrend 0.001).In this rural Bangladeshi community, UDM was high. Lower socioeconomic status was associated with a higher risk of UDM. Overall knowledge of DM was poor. Public health programmes should target those of low socioeconomic status and aim to increase knowledge of DM in rural Bangladesh.

Background To assess the Knowledge, Attitudes and Practice (KAP) amongst the general community regarding type 2 diabetes mellitus (DM) in rural Bangladesh. Methods Data was collected using cluster random sampling from 3104 adults residing in a rural district in Bangladesh. Participants underwent a KAP questionnaire survey regarding assessing diabetes, socio-demographic and medical history. Descriptive, Chi-square and regression analyses were performed. Results Participants were aged between 30 and 89 years (M = 51, SD = 11.8) and 65.5% were female. The prevalence of diabetes was found to be 8.3%. The majority (93%) reported to have heard of diabetes, yet only 4% knew what a glucose tolerance test was. Only 50% reported that they knew physical inactivity was a risk factor. Age, gender, level of education and socio-economic status (SES) were significantly associated with KAP. A lower proportion (41%) of older participants (aged ≥65 years) reported that they knew that dietary modifications assist in diabetes control compared to those aged less than 35 years (69%), p

The objective of this study was to characterize the causes of ocular trauma and determine the risk factors for infection and vision loss following ocular trauma in the Solomon Islands.A prospective clinic-based study.A total of 507 patients with ocular trauma who were reviewed at the National Referral Hospital in Honiara or one of five provincial eye clinics were included.An interview-based questionnaire to determine the circumstances of ocular trauma, and an ocular examination to elicit the trauma sustained,infectious sequelae and the visual outcome.Visual acuity.Males were significantly more likely to have ocular trauma than females (P = 0.01). The major cause of ocular trauma in young boys and girls was being poked by a stick, followed by lime burns in young boys. For both genders, physical violence resulted in most injuries across all adult age groups. Microbial keratitis complicated 4.4% of ocular trauma. Monocular vision impairment (6/18) occurred in 5.5% of participants and was more likely to occur if female (P = 0.02).Ocular trauma is a significant cause of visual morbidity in the Solomon Islands. The results from this prospective study provide a basis for planning blindness prevention programmes in the Western Pacific.

Background: Previous reports suggest that the outcome of age-related macular degeneration treatment is dependent on variants in the apolipoprotein E (APOE) gene. We wish to establish if variants in this gene are associated with anatomical location of fluid within the macula on optical coherence tomography imaging before and after three anti-vascular endothelial growth factor treatments. Methods: Patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration were prospectively enrolled and monitored over a 12-month period. Main outcome measures were logMAR best-corrected visual acuity and correlation of qualitative optical coherence tomography features (intraretinal fluid [IRF] and/or subretinal fluid) at baseline and after three anti-vascular endothelial growth factor injections with genetic variants of the APOE gene. Results: One hundred and eighty-six eyes of 186 patients aged 79.4 years (range, 58–103 years). Subjects with an e2 allele were more likely to have IRF at baseline compared with the eyes without (odds ratio: 2.98, 95% confidence interval: 1.22–7.29, P = 0.02). After 3 injections, 184 eyes remained. Of these, 114 of eyes (62.0%) were classified as “dry” on optical coherence tomography, whereas 48 eyes (26.1%) still had a component of IRF, and 22 (12.0%) had subretinal fluid alone. There was no statistically significant association between APOE variants and presence of persistent IRF, although there were almost double the number of subjects with e2 (40%) who had persistent fluid compared with those with e3/e4 (23%) (P = 0.06). Conclusion: In patients with neovascular age-related macular degeneration, the presence of the e2 allele of the APOE gene was associated with having IRF at baseline. Larger studies are required to determine if a greater proportion of those with the e2 allele retain this fluid after three initial injections.

Background The Rapid Assessment of Disability (RAD) questionnaire measures the magnitude and impact of disability and aims to inform the design of disability inclusive development programs. This paper reports the psychometric evaluation of the RAD. Methods The initial version of the RAD comprised five sections: 1) demographics, 2) functioning, 3) rights awareness, 4) well-being, and 5) access to the community. Item functioning and construct validity were assessed in a population-based study in Bangladesh. Data were analysed using descriptive statistics (sections 2 and 5) and Rasch modelling (sections 3 and 4). A subsequent case–control study in Fiji tested the refined questionnaire in a cross-cultural setting and assessed the sensitivity and specificity of the RAD section 2 to identify people with disability. Results 2,057 adults took part in the study (1,855 in Bangladesh and 202 in Fiji). The prevalence of disability estimated using RAD section 2 in Bangladesh was 10.5% (95% CI 8.8-12.2), with satisfactory sensitivity and specificity (62.4% and 81.2%, respectively). Section 3 exhibited multidimensionality and poor differentiation between levels of rights awareness in both Bangladesh (person separation index [PSI] = 0.71) and Fiji (PSI = 0.0), and was unable to distinguish between people with and without disability (Bangladesh p = 0.786, Fiji p = 0.403). This section was subsequently removed from the questionnaire pending re-development. Section 4 had good ability to differentiate between levels of well-being (PSI = 0.82). In both countries, people with disability had significantly worse well-being scores than people without disability (p < 0.001) and also access to all sectors of community except legal assistance, drinking water and toilets (p < 0.001). Conclusions Filed-testing in Bangladesh and Fiji confirmed the psychometric robustness of functioning, well-being, and community access sections of the RAD. Information from the questionnaire can be used to inform and evaluate disability inclusive development programs.

To evaluate the association between dietary patterns and age-related macular degeneration (AMD).Food frequency data were collected from Melbourne Collaborative Cohort Study (MCCS) participants at the baseline study in 1990-1994. During follow-up in 2003-2007, retinal photographs were taken and evaluated for AMD.At baseline, 41514 participants aged 40 to 70 years and born in Australia or New Zealand (69%), or who had migrated from the United Kingdom, Italy, Greece, or Malta (31%) were recruited. Of these, 21132 were assessed for AMD prevalence at follow-up.Principal component analysis was used to identify dietary patterns (Factors F1-6) among the food items. Logistic regression was used to assess associations of dietary patterns with AMD.Odds ratios (ORs) for early stages and advanced AMD in association with dietary patterns.A total of 2508 participants (12.8%) had early stages of AMD, and 108 participants (0.6%) had advanced AMD. Six factors characterized by predominant intakes of fruits (F1); vegetables (F2); grains, fish, steamed or boiled chicken, vegetables, and nuts (F3); red meat (F4); processed foods comprising cakes, sweet biscuits, and desserts (F5); and salad (F6) were identified. Higher F3 scores were associated with a lower prevalence of advanced AMD (fourth vs. first quartile) (OR, 0.49; 95% confidence interval [CI], 0.28-0.87), whereas F4 scores greater than the median were associated with a higher prevalence of advanced AMD (OR, 1.46; 95% CI, 1.0-2.17).Rather than specific individual food items, these factors represent a broader picture of food consumption. A dietary pattern high in fruits, vegetables, chicken, and nuts and a pattern low in red meat seems to be associated with a lower prevalence of advanced AMD. No particular food pattern seemed to be associated with the prevalence of the earliest stages of AMD.

Purpose Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. Methods A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. Results Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. Conclusion Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

SummaryThis paper evaluates exposure to mass media family planning (FP) messages among the Garo, an indigenous community in Bangladesh. A sample of 223 currently married Garo women were selected purposively from two districts where most of the Garo population live. The analysis demonstrated that television was the most significant form of mass media to disseminate FP messages among the recipients – more so than radio and newspapers. About 80·6% of the respondents had heard of FP messages through television, while for the radio and newspapers the percentages were 55·3% and 22·7% respectively. The contraceptive prevalence rate is much higher (79·5%) in the study area than the national level (55·8%). A linear logistic regression model was employed to identify the confluence of different demographic and socioeconomic characteristics on mass media FP messages. Regarding exposure to FP messages, four independent variables out of six had significant effects on the exposure to FP messages through any one of the types of media, i.e. radio, television and newspapers. These independent variables were age, level of education, occupation and number of children.

AIM: To describe the prevalence and risk factors of retinal vein occlusion (RVO) in an Asian population. METHODS: The Singapore Malay Eye Study is a population-based, cross-sectional study of 3280 (78.7%) Malay adults (aged 40-80 years) living in Singapore. All participants underwent retinal photography, standardised interview, clinical examinations and laboratory investigations. RVO (central or branch) was graded based on the Blue Mountains Eye Study (BMES) protocol from retinal photographs. RESULTS: The overall prevalence of RVO was 0.7% (n = 22) (95% CI 0.4 to 1.0) (18 branch and five central RVO cases). There was no significant gender difference in RVO prevalence. RVO was associated with higher systolic blood pressure (age-adjusted odds ratio (OR) per SD increase 1.54, CI 1.02 to 2.31), ocular perfusion pressure (OR per SD increase 1.49, CI 1.03 to 2.16), a history of angina (OR 5.18, CI 1.49 to 18.0) and heart attack (OR 4.26, CI 1.47 to 12.3), and higher total cholesterol (OR per SD increase 1.55, CI 1.07 to 2.24) and LDL (OR per SD increase 1.47, CI 1.02 to 2.12) cholesterol levels. CONCLUSIONS: The prevalence of RVO in this Asian population was lower than Caucasians in the BMES, although the systemic associations of RVO were largely similar to BMES and other studies.

Objective: It was the aim of this study to assess the role of birth weight in the development of myopia using a large cohort of Caucasian monozygotic (MZ) and dizygotic (DZ) twins that took part in the Genes in Myopia (GEM) twin study. Methods: The recruitment of all twins in the GEM twin study was facilitated by the Australian Twin Registry. Each twin underwent a standard questionnaire and a comprehensive ocular examination, which included a dilated objective refraction through autorefraction. Myopia was defined as spherical equivalent equal to or worse than –0.50 diopters. Birth weight was determined through self-report as part of the standard questionnaire. Results: A total of 1,224 twins (690 MZ and 534 DZ twins) aged between 18 and 86 years (mean age 52.36 years) were recruited into the GEM study. The mean birth weight was similar between MZ (2.34 kg) and DZ twins (2.46 kg; p > 0.05). Logistic regression showed no significant association with birth weight and myopia for all twins (p = 0.26), as well as for MZ (p = 0.18) and DZ twins (p = 0.70) separately, with no gender effect (p = 0.23). Moreover, there was no significant difference in mean birth weight between discordant (presence/absence) MZ (myopes = 2.33 kg, non-myopes = 2.39 kg) and DZ twin pairs (myopes = 2.39 kg, non-myopes = 2.43 kg; p = 0.91 and 0.95, respectively). Conclusion: Birth weight appears to have little to no role in the development of myopia. In addition, birth weight was not a predictor of the discordance of myopia in MZ and DZ twin pairs.

To examine the relationship of retinal vascular caliber to incident diabetes in a population-based cohort.The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study recruited adults aged 25+ years across Australia in 1999-2000, with a follow-up 5 years later in 2004-2005. Participants' glycemic status was classified using fasting plasma glucose (FPG) and 2-h oral glucose tolerance (2-h plasma glucose [2hPG]) tests. Diabetes was diagnosed if FPG wasor=7.0 mmol/l or 2hPG wasor=11.1 mmol/l. Retinal vascular caliber was measured from baseline retinal photographs using a computer-assisted program.Of the 803 participants without diabetes at baseline, 108 (13.4%) developed diabetes at follow-up: 7 (2.8%) of 246 participants with normal glucose tolerance, 9 (13.6%) of 66 participants with impaired fasting glucose, and 92 (18.7%) of 491 participants with impaired glucose tolerance. After multivariate analysis, participants with narrower retinal arteriolar caliber had a higher risk of diabetes (odds ratio 2.21 [95% CI 1.02-4.80], comparing smallest versus highest arteriolar caliber tertiles, P = 0.04 for trend). There was no association between retinal venular caliber and incident diabetes.Narrower retinal arteriolar caliber predicted risk of diabetes. These data provide further evidence that microvascular changes may contribute to the pathogenesis of diabetes.

To examine the relationship of retinal vascular caliber with diabetes, glycemia, and diabetic retinopathy.Population-based study using data from the Multi-Ethnic Study of Atherosclerosis (MESA), comprising 5,976 individuals (whites, blacks, Hispanics, and Chinese) residing in six U.S. communities who were free of clinical cardiovascular disease at baseline. Retinal vascular caliber was measured from digital retinal photographs.There were 4,585 individuals with normal fasting glucose (NFG), 499 with impaired fasting glucose (IFG), 165 with diabetes with retinopathy signs, and 727 with diabetes without retinopathy signs. After multivariate analysis, retinal arteriolar caliber increased from 143.8 microm in subjects with NFG to 144.5 microm in IFG and 146.1 microm in diabetes (P0.001 for trend). Retinal venular caliber increased from 214.4 microm in NFG to 216.7 microm in IFG and 218.0 microm in diabetes (P0.001 for trend). Retinal venular caliber was significantly larger with increasing levels of fasting glucose and A1C. In a subgroup analysis by ethnicity, the association between wider arteriolar caliber and diabetes was evident in whites only, whereas wider venular caliber and diabetes was evident in Hispanics and Chinese only. In people with diabetes, eyes with retinopathy had larger retinal venular but not arteriolar caliber.Retinal arteriolar and venular calibers are larger in individuals with diabetes, but the pattern of associations appears to vary by ethnicity. Retinal venular caliber is additionally associated with retinopathy signs. These findings add further to the concept that variations in retinal vascular caliber may reflect early diabetic microvascular damage.

PURPOSE: To compare the vision-related quality of life among emmetropes, myopes who had refractive surgery, and myopes who wore spectacles and/or contact lenses. METHODS: This cross-sectional study assessed vision-related quality of life using the Vision Quality of Life Index. Participants were age 18 years or older with a presenting visual acuity of 20/40 or better and no other ocular pathology. Responses were compared among three groups: emmetropes (spherical equivalent [SE] -0.50 diopters [D]), myopes (SE ≤ -0.50 D) who wore spectacles and/or contact lenses, and myopes who had refractive surgery. RESULTS: The study population included 64 emmetropes, 66 myopes who wore spectacles and/or contact lenses, and 65 myopes who had refractive surgery. No significant differences were found between the refractive surgery and emmetropic groups. In contrast, the spectacle and/or contact lens group had significantly increased odds of having concerns about injuring themselves (odds ratio=11.5, 95% confidence interval [CI] 2.3, 57.1), difficulties coping with demands in life (odds ratio=23.6, 95% CI 23.8, 198.1), difficulties fulfilling roles (odds ratio=5.6, 95% CI 1.4, 22.1), and less confidence joining in everyday activities (odds ratio=30.6, 95% CI 3.2, 292.3) compared to emmetropes. CONCLUSIONS: Myopia corrected with spectacles or contact lenses had a negative impact on some areas of vision-related quality of life. However, individuals with myopia who had refractive surgery enjoyed the same vision-related quality of life as those with emmetropia. The potential improvement in vision-related quality of life should be considered when recommending treatment for myopia. [J Refract Surg, 2007;23:752-759.]

To determine whether local nutritional or ischemic factors are involved in cataract pathogenesis, we aimed to assess whether narrowed retinal vessel caliber predicted the long-term incidence of age-related cataract, as shown in 1 previous report.Population-based cohort study.The Blue Mountains Eye Study examined 3654 baseline participants (1992-1994), 2335 (75.1% of survivors) after 5 years, and 1952 (75.6% of survivors) after 10 years.Retinal vessel caliber was measured from baseline retinal photographs using computer-assisted techniques. Mean arteriolar and venular diameters of each eye were summarized as central retinal arterial (CRAE) and venular (CRVE) equivalents. Cataract was assessed from lens photographs of both eyes using the Wisconsin grading system.Nuclear cataract was defined as opacityWisconsin standard photograph 3, cortical cataract defined as opacityor=5% of the lens area, and posterior subcapsular (PSC) cataract as any present. Eye-specific data were analyzed using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (CI) are reported.After adjusting for age, gender, smoking, hypertension, diabetes, body mass index, and inhaled steroid use, reduced incidence of nuclear cataract was associated with the narrowest compared with the widest quintile of CRAE and CRVE (for CRAE: OR, 0.62; 95% CI 0.42-0.92; for CRVE: OR, 0.70; 95% CI, 0.47-1.05) but a higher incidence of PSC cataract (for CRAE: OR, 2.40; 95% CI, 1.34-4.29; for CRVE: OR, 3.17; 95% CI, 1.62-6.20) and cataract surgery (for CRAE: OR, 1.52; 95% CI, 1.06-2.17; for CRVE: OR, 1.58; 95% CI, 1.08-2.32). These associations were not maintained when both CRAE and CRVE were included simultaneously in the same models. Path analysis suggested that age was the most important contributor to nuclear cataract incidence, and CRAE and CRVE, as markers of a latent age-related variable, were only indirectly associated with its incidence (for CRAE: OR, 0.61; 95% CI, 0.41-0.91; for CRVE: OR, 0.62; 95% CI, 0.41-0.94).Retinal vessel narrowing predicted greater risk of long-term incidence of PSC cataract and cataract surgery, and was indirectly linked to a lower incidence of nuclear cataract. Retinal vessel narrowing could be a marker of age-related factors associated with risk of PSC and nuclear cataract.

Age-related macular degeneration (AMD) is the leading cause of poor vision in the developed world, and its pathogenesis remains unknown. The most devastating form of end stage disease is neovascular or wet AMD, where there is abnormal growth of new blood vessels under the retina. Vascular endothelial growth factor (VEGF) is thought to be a major player in the stimulus of this abnormal growth of blood vessels. We undertook a case-control association study to investigate the VEGF-A gene, a known angiogenic gene that has previously been associated with AMD.We recruited 577 individuals with AMD (early, atrophic, and neovascular AMD) and 173 ethnically matched controls for our study. We employed a tag-single nucleotide polymorphisms (tSNP) approach to investigate this gene using a series of seven tSNPs that encompassed the coding region of the VEGF gene as well as its promoter. Alleles were determined by a MALDI-TOF based approach followed by statistical analysis.One SNP (rs3024997) showed evidence of departure from Hardy-Weinberg equilibrium in only the AMD cases. Therefore, it was retained for further analysis. All other SNPs in our study showed no departure from Hardy-Weinberg equilibrium. No association was found between any of the VEGF tSNPs analyzed in our study and AMD nor any of its sub-types.Using a tSNP approach, we found no evidence of an association of these SNPs within the VEGF-A gene being associated with either AMD or any of its subtypes in our population.

This study sought to examine the relationships of retinal vascular signs with left ventricular (LV) mass, volume, and concentric remodeling.Microvascular disease, reflected as retinopathy lesions, has been shown to predict clinical congestive heart failure. Whether these retinal vascular changes are related to early structural alterations and remodeling of the heart in asymptomatic individuals is unknown.A cross-sectional, population-based study of 4,593 participants ages 45 to 85 years, free of clinical cardiovascular disease. Retinal vascular calibers and retinopathy were graded from retinal photographs according to standardized protocols. The LV mass and volume were measured from cardiac magnetic resonance imaging. Extent of LV concentric remodeling was determined by the ratio of LV mass to end-diastolic volume (M/V ratio).After controlling for age, gender, race, center, past and current systolic blood pressure, body mass index, smoking, antihypertensive medications, diabetes, diabetes duration, glycosylated hemoglobin, lipid profile, and C-reactive protein, narrower retinal arteriolar caliber was associated with concentric (highest quintile of M/V ratio) remodeling (odds ratio [OR] 2.06, 95% confidence interval 1.57 to 2.70). This association was seen in men and women, and was present even in those without diabetes, without hypertension, and without significant coronary calcification. In multivariate analysis, the presence of retinopathy (OR 1.31, 95% confidence interval 1.08 to 1.61) was also associated with concentric remodeling.Narrower retinal arteriolar caliber is associated with LV concentric remodeling independent of traditional risk factors and coronary atherosclerotic burden, supporting the hypothesis that microvascular disease may contribute to cardiac remodeling.

Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p

The methanolic extract of Leonurus sibiricus aerial parts injected intraperitoneally at dose of 250 and 500 mg/kg showed a significant analgesic effect in acetic acid-induced writhing in mice. Moreover, when given orally to rats at dose of 200 and 400 mg/kg, it showed a significant anti-inflammatory activity against carrageenin induced rat paw edema in rats.

Purpose The Retinoic Acid Receptor Alpha (RARA) gene is a potential candidate gene for myopia due to its differential expression in animal models during experimentally induced myopia. To test for whether RARA is associated with myopia we have undertaken a case-control study assessing for associations between RARA and myopia, hypermetropia, and ocular biometric measures. Methods A total of 802 Anglo-Celtic individuals were genotyped. Five tag single nucleotide polymorphisms (tSNPs) in RARA with an r2 of 0.8 and a minor allele frequency greater than 5% were selected for genotyping. Genotype frequencies of these 5 tSNPs were compared between individuals with emmetropia and those with myopia or hypermetropia. A quantitative analysis was also performed to assess associations with ocular biometric measures including axial length, corneal curvature and anterior chamber depth. Results We did not identify any significant association between tSNPs in RARA with either myopia or hypermetropia as qualitative traits. Neither did we identify any significant associations of these tSNPs with the quantitative traits of axial length, corneal curvature and anterior chamber depth. Conclusions This is the first study to assess for associations between RARA and myopia, hypermetropia, and ocular biometric measures. Our findings suggest that variations in the nucleotide sequence of RARA are not associated with myopia, hypermetropia, or ocular biometric measures in our population.