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PurposeTo evaluate the epidemiological trends and associated risk factors of disease burden due to trachoma.MethodsData for the country-specific disability-adjusted life year (DALY) number, rate and age-standardised rate of trachoma together with related data of other common eye diseases were acquired from the Global Burden of Disease Study 2019 database. The Socio-Demographic Index (SDI), Human Development Index (HDI), inequality-adjusted HDI and other related indices were obtained from published data or publicly available databases. Regression analyses were conducted to evaluate the associations between potential risk factors and the age-standardised DALY burden of trachoma.ResultsThe global DALY burden due to trachoma decreased by 37% from 1990 to 2019 and decreased by 69.8% after adjusting for age and population growth, and, in available 1990–2019 data, had the greatest reduction in attributable DALYs of all common eye disease, with the others analysed being cataract, glaucoma, refractive disorders and age-related macular degeneration. Women had higher age-standardised DALY burden due to trachoma than men (p<0.001). The African region (p<0.001) had the heaviest burden among global regions. The age-standardised DALY rate was higher in countries with lower income (p<0.001) and lower SDI (p<0.001). Higher disease burden due to trachoma was associated with lower HDI (β=−48.102, 95% CI −86.888 to −9.316, p=0.016), lower SDI (β=−48.063, 95% CI −83.702 to −12.423, p<0.001) and lower expected years of schooling (β=−2.352, 95% CI −3.756 to −0.948, p=0.002).ConclusionsThe global disease burden due to trachoma decreased from 1990 to 2019 and it had the greatest reduction compared with other common eye diseases. Lower HDI, socioeconomic status and educational level were related to a higher national disease burden of trachoma. Our findings could provide necessary information for trachoma control and prevention.

PurposeTo investigate the burden of near vision loss (NVL) in China by year, age and gender from 1990 to 2019.MethodsWe used estimates from the Global Burden of Disease (GBD) 2019 study to report the prevalence and disability-adjusted life-years (DALYs) due to NVL in China. Estimates of crude counts and age-standardised rates per 100 000 population are accompanied by 95% uncertainty intervals (UIs). We summarised the age-specific and sex-specific patterns and trends regarding the burden of NVL in China, compared with seven neighbouring countries.ResultsFrom 1990 to 2019, the all-age number and rate for NVL prevalence and DALYs increased significantly in China (all p<0.001). The age-standardised rate decreased from 7538.1 (95% UI 6946.3 to 8075.1) to 7392.9 (95% UI 6855.8 to 7890.5) per 100 000 population for NVL prevalence (p=0.107), and from 74.9 (95% UI 69.6 to 79.9) to 73.8 (95% UI 70.6 to 80.1) per 100 000 population for DALYs (p=0.388). Women had higher NVL prevalence (t=170.1, p<0.001) and DALYs (t=192.5, p<0.001) than men. Higher disease burden of NVL was observed in the middle-aged and elderly population. The age-standardised prevalence and DALY rate attributable to NVL in China were lower than in India, North Korea, Pakistan (all p<0.001), but higher than Russia, South Korea, Singapore and Japan (all p<0.001).ConclusionsDespite a small decrease in age-standardised prevalence and DALYs due to NVL in China in the past two decades, the existing burden is still considerable and significantly higher compared with neighbouring developed countries. An approach that includes all stakeholders is needed to further reduce this burden.

PurposeTo estimate the disease burden due to intraocular foreign bodies (IOFBs) and evaluate contributions of various risk factors to IOFB-associated disability-adjusted life-years (DALYs).MethodsGlobal, regional and country-level number, rate and age-standardised rate of DALYs due to IOFBs were acquired from the Global Burden of Disease Study 2017 database. The Human Development Index (HDI) and other region and country-level data were obtained from open databases. Time trends for number, rate and age-standardised rate of DALYs due to IOFBs were calculated. Regression analysis was used to evaluate associations between age-standardised rate of DALYs and potential predictors.ResultsGlobal DALYs due to IOFBs rose by 43.7% between 1990 (139 (95% CI 70.8 to 233) thousand) and 2017 (202 (95% CI 105 to 335) thousand). The DALY rate remained stable while the age-standardised rate decreased during this period. Higher disease burden due to IOFBs was associated with higher glaucoma prevalence (β=0.006, 95% CI 0.003 to 0.09, p<0.001), lower refractive error prevalence (β=−0.0005, 95% CI −0.0007 to −0.0002, p<0.001), and lower income (β=−0.020, 95% CI −0.035 to −0.006, p=0.007).ConclusionPredictors of a greater burden of IOFB disability generally point to lower socioeconomic level. The association with glaucoma may reflect a complication of IOFB, increasing risk of vision loss and disability.

PurposeTo investigate the prevalence of myopic macular degeneration (MMD) in the global population.MethodsAll published literature of population-based studies on MMD prevalence worldwide were searched and only those with clear definitions to diagnose and classify MMD lesions by standardised grading methods were selected. Meta-analysis methods were used to calculate the pooled prevalence of MMD and its 95% CI in a random-effects model. The prevalence of MMD lesions would also be reported, together with the subgroup analysis of age, region and gender. Correlation between MMD prevalence and spherical equivalent levels and axial length were also evaluated.Results12 studies with 58 558 subjects were included in this meta-analysis. The pooled prevalence of MMD in the world population was 2.1% (95% CI: 1.3% to 3.3%). In the subgroup analysis, people with the following characteristics were at higher risk of developing MMD: female, urban life, living in Asia, older age, longer axial length and severer myopia.ConclusionsMMD is a serious public health concern worldwide, particularly in subjects who are women, subjects living in urban areas, subjects living in Asia, and subjects with longer axial lengths and severer myopia. Further studies from other continents/ethnicities are needed for comprehensive estimates of the prevalence of MMD globally.

Metadiaphyseal proximal radius fractures blur the distinction between the radial neck and radial shaft fractures. Operative management presents unique technical challenges both in terms of surgical approach and fixation method. We discuss relevant anatomy, safe surgical approach, and options and techniques for fracture fixation. We describe 6 patients who achieved satisfactory functional outcomes, even in cases of severe bone loss secondary to ballistic trauma. An extensile dorsal approach with exposure of the posterior interosseous nerve is recommended when normal soft tissue intervals have not already been extensively disrupted. Robust fixation can be achieved by contouring and repurposing a variety of plates such as a variety of mini fragment plates (2.4 mm T or Y-plates), flexible nails, or even distal radius plates.

This paper discusses findings from a commissioned evaluation of an Australian government COVID-19 health campaign that utilised third-party influencers to increase the reach of health communication messages among culturally and linguistically diverse young people. Although the campaign was successful, interviews with select influencers and target audience members indicated that the ‘serious’ tone of the health messaging was less effective and less likely to be shared and that messages should be more ‘entertaining’. Analyses of data indicated three themes providing insights into how future campaigns may benefit from a focus that draws together health information and entertainment using models already constructed in the entertainment–education field: (1) Entertaining health messages have a stronger fit with influencers who are known for their entertainment value; (2) Entertaining messages are more memorable and more likely to be shared; (3) A balance between entertainment and the signifiers of trust and credibility such as government health authority logos overcomes trust issues in the context of current health disinformation and misinformation.

To evaluate the efficacy of metformin versus a placebo in the treatment of patients with simple obesity without obesity related diseases. A search was done on Pub-Med, EMBASE, Cochrane, and Science Citation Index Expanded databases. The main inclusion criteria included the following:(1) randomized controlled trials. (2) patients diagnosed as being overweight or obese. (3) patients were randomly assigned to receive metformin or control. Exclusion criteria included the following: patients diagnosed with an obesity related disease, such as diabetes mellitus (DM) or polycystic ovary syndrome (PCOS). Compared with the placebo, weighted mean difference (WMD) was 2.33 (95% CI 0.31, 4.35) kg higher with metformin (p= 0.02). Compared with the placebo, WMD was 0.57 (95% CI 0.35, 0.79) kg/m² higher with metformin(p< 0.00001). There was no significant difference in the reduction of waist circumference between the metformin group and the control group (p= 0.05). The fasting blood glucose levels were significantly lower in the metformin group than in the control group (p< 0.00001). However, no hypoglycemia was noted in the metformin group or the control group. Metformin is effective in reducing body weight of simple obesity patients, and metformin does not induce hypoglycemia as a side effect.

Objective To investigate the relationship between inflammatory factors, oxidative stress and type 1 deiodinase (DIO-1) concentration in patients with chronic renal failure (CRF) with or without euthyroid sick syndrome (ESS).Methods This study recruited patients with CRF and divided them into two groups: group 1 had low free triiodothyronine (FT3) levels; and group 2 had normal FT3 levels. Group 3 consisted of healthy volunteers. Serum levels of interleukin (IL)-6, IL-1β, tumour necrosis factor (TNF)-α, 8-isoprostane and DIO-1 were measured using enzyme-linked immunosorbent assays. Multiple regression analysis was used to analyse correlations between parameters.Results Sixty patients were enrolled into each group and the groups were comparable in terms of vital signs, white blood cell count, free thyroxine and thyroid stimulating hormone concentrations. The serum DIO-1 concentration was significantly higher in group 2 than in groups 1 and 3. Multivariate regression analysis revealed that the DIO-1 concentration was inversely correlated with the TNF-α concentration.Conclusions Patients with CRF without ESS showed higher concentrations of DIO-1 than patients with ESS. The DIO-1 concentration was inversely correlated with the TNF-α concentration, which might indicate that the inflammatory response was milder in the patients with CRF without ESS than in those with ESS.

ABSTRACTLiposomal amphotericin B (LAMB) and caspofungin (CAS) are important antifungal agents in allogeneic hematopoietic stem cell transplant (aHSCT) recipients. Little is known, however, about the pharmacokinetics (PK) of both agents and their combination in this population. The PK of LAMB and CAS and the potential for PK interactions between both agents were investigated within a risk-stratified, randomized phase II clinical trial in 53 adult aHSCT recipients with granulocytopenia and refractory fever. Patients received either LAMB (n= 17; 3 mg/kg once a day [QD]), CAS (n= 19; 50 mg QD; day 1, 70 mg), or the combination of both (CAS-LAMB; n= 17) for a median duration of 10 to 13 days (range, 4 to 28 days) until defervescence and granulocyte recovery. PK sampling was performed on days 1 and 4. Drug concentrations in plasma (LAMB, 405 samples; CAS, 458 samples) were quantified by high-pressure liquid chromatography and were analyzed using population pharmacokinetic modeling. CAS concentration data best fitted a two-compartment model with a proportional error model and interindividual variability (IIV) for clearance (CL) and central volume of distribution (V1) (CL, 0.462 liter/h ± 25%; V1, 8.33 liters ± 29%; intercompartmental clearance [Q], 1.25 liters/h; peripheral volume of distribution [V2], 3.59 liters). Concentration data for LAMB best fitted a two-compartment model with a proportional error model and IIV for all parameters (CL, 1.22 liters/h ± 64%; V1, 19.2 liters ± 38%; Q, 2.18 liters/h ± 47%; V2, 52.8 liters ± 84%). Internal model validation showed predictability and robustness of both models. None of the covariates tested (LAMB or CAS comedication, gender, body weight, age, body surface area, serum bilirubin, and creatinine clearance) further improved the models. In summary, the disposition of LAMB and CAS was best described by two-compartment models. Drug exposures in aHSCT patients were comparable to those in other populations, and no PK interactions were observed between the two compounds.

ABSTRACTThe combination of liposomal amphotericin B (LAMB) and caspofungin (CAS) holds promise to improve the outcome of opportunistic invasive mycoses with poor prognosis. Little is known, however, about the safety and pharmacokinetics of the combination in patients at high risk for these infections. The safety and pharmacokinetics of the combination of LAMB and CAS were investigated in a risk-stratified, randomized, multicenter phase II clinical trial in 55 adult allogeneic hematopoietic stem cell recipients (aHSCT) with granulocytopenia and refractory fever. The patients received either CAS (50 mg/day; day 1, 70 mg), LAMB (3 mg/kg of body weight/day), or the combination of both (CASLAMB) until defervescence and granulocyte recovery. Safety, development of invasive fungal infections, and survival were assessed through day 14 after the end of therapy. Pharmacokinetic sampling and analysis were performed on days 1 and 4. All three regimens were well tolerated. Premature study drug discontinuations due to grade III/IV adverse events occurred in 1/18, 2/20, and 0/17 patients randomized to CAS, LAMB, and CASLAMB, respectively. Adverse events not leading to study drug discontinuation were frequent but similar across cohorts, except for a higher frequency of hypokalemia with CASLAMB (P< 0.05). Drug exposures were similar for patients receiving combination therapy and those randomized to monotherapy. There was no apparent difference in the occurrence of proven/probable invasive fungal infections and survival through day 14 after the end of therapy. CASLAMB combination therapy in immunocompromised aHSCT patients was as safe as monotherapy with CAS or LAMB and had similar plasma pharmacokinetics, lending support to further investigations of the combination in the management of patients with invasive opportunistic mycoses.

The nursing profession is developing educational resources to improve their response to victims of nuclear, biological, and chemical terrorism. Future nurses may differ from practicing nurses in their perspective of what is critical information. The purpose of this study was to identify student nurses' major concerns in relation to working with victims of terrorism.

Actual performance of the homemaker in feeding her family was found to be considerably better than her the oretical knowledge on the subject. However, the food groups about which knowledge was weakest were also those most poorly used. The adequacy of food used appeared to be related to nutritional knowledge.

Magazines and newspapers are reported most frequently by homemakers as sources of information on foods and nutrition. The most common food problems with which they want help are those related to meal planning and budgeting.

The relation of fat intake to atherosclerosis is still an unsolved question. With it comes the problem of the proportional number of calories in the diet from fat, carbohydrate, and protein. In this study data on dietary intake of college men have been broken down to supply such information.

Do food dislikes seriously interfere with adequate nutrition?

The effect of stepwise weight reduction on the nitrogen, calcium and phosphorus metabolism of 8 obese young men was studied by means of the balance technic. Seven-day balances were performed during pre-reduction weight maintenance and during the last week of each reduction period.

Moderately obese young college men pursuing their usual activities were studied first during a 3-week prereduction weight maintenance period and subsequently were distributed into three isocaloric, isoprotein diet subgroups, which varied as to level of carbohydrate in the diet. On the 1,800-kcal reduction diet consumed over a 9-week period, diet Acontained 104 g carbohydrate/day; diet B, 60 g; diet C,30 g. The three-man subgroups were matched as closely as possible on the basis of maintenance caloric requirement and percent body weight as fat.Weight loss, fat loss, and percent weight loss as fat appeared to be inversely related to the level of carbohydrate in the isocaloric, isoprotein diets. No adequate explanation can be given for weight loss differences.There were no outstanding differences in nitrogen, sodium, or potassium balances among the diet groups. The little effect on blood lipids that was observed was probably most favorable to the highest carbohydrate diet group A.The outstanding difference among diet groups was in the daily urinary excretion of ketone bodies. Although initially all subjects showed some ketone bodies in the urine, the bodies increased with decreasing carbohydrate and the urine continued to show them longer (throughout the 9-week period) and in greater abundance on the most restricted carbohydrate intake.Any of the low carbohydrate levels in the reduction diet under study were effective in controlling hunger.From a practical point of view, it would appear that of the low carbohydrate diets used, the one at the 104-g level would be most suitable for long-term use for the reasons cited.From the appearance of ketone bodies in the urine over a more than transient period, it would appear that the carbohydrate level on the 1,800-kcal, 115-g protein diet should be slightly above 60 g.