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Studies about the evolution of SARS-CoV-2 lineages in different backgrounds such as naive populations, are still scarce, especially from South America. The aim of this work was to study the introduction and diversification pattern of SARS-CoV-2 during the first year of the COVID-19 pandemic in the Northwestern Argentina (NWA) region and to analyze the evolutionary dynamics of the main lineages found. In this study, we analyzed a total of 260 SARS-CoV-2 whole-genome sequences from Argentina, belonging to the Provinces of Jujuy, Salta and Tucumán, from March 31st, 2020, to May 22nd, 2021, which covered the full first wave and the early second wave of the COVID-19 pandemic in Argentina. In the first wave, eight lineages were identified: B.1.499 (76.9%), followed by N.5 (10.2%), B.1.1.274 (3.7%), B.1.1.348 (3.7%), B.1 (2.8%), B.1.600 (0.9%), B.1.1.33 (0.9%) and N.3 (0.9%). During the early second wave, the first-wave lineages were displaced by the introduction of variants of concern (VOC) (Alpha, Gamma), or variants of interest (VOI) (Lambda, Zeta, Epsilon) and other lineages with more limited distribution. Phylodynamic analyses of the B.1.499 and N.5, the two most prevalent lineages in NWA, revealed that the substitution rate of lineage N.5 (7.9 × 10−4 substitutions per site per year, s/s/y) was a ∼40% faster than that of lineage B.1.499 (5.9 × 10−4 s/s/y), although both are in the same order of magnitude than other non-VOC lineages. No mutations associated with a biological characteristic of importance were observed as signatures markers of the phylogenetic groups established in Northwestern Argentina, however, single sequences in non-VOC lineages did present mutations of biological importance or associated with VOCs as sporadic events, showing that many of these mutations could emerge from circulation in the general population. This study contributed to the knowledge about the evolution of SARS-CoV-2 in a pre-vaccination and without post-exposure immunization period.

The HCV evolutionary dynamics play a key role in the infection onset, maintenance of chronicity, pathogenicity, and drug resistance variants fixation, and are thought to be one of the main caveats in the development of an effective vaccine. Previous studies in HCV/HIV co-infected patients suggest that a decline in the immune status is related with increases in the HCV intra-host genetic diversity. However, these findings are based on single point sequence diversity measures or coalescence analyses in several virus-host interactions. In this work, we describe the molecular evolution of HCV-E2 region in a single HIV-co-infected patient with two clearly defined immune conditions. The phylogenetic analysis of the HCV-1a sequences from the studied patient showed that he was co-infected with three different viral lineages. These lineages were not evenly detected throughout time. The sequence diversity and coalescence analyses of these lineages suggested the action of different evolutionary patterns in different immune conditions: a slow rate, drift-like process in an immunocompromised condition (low levels of CD4+ T lymphocytes); and a fast rate, variant-switch process in an immunocompetent condition (high levels of CD4+ T lymphocytes). Fil: Culasso, Andrés Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina Fil: Monzani, María Cecilia. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Baré, Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Campos, Rodolfo Hector. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Fil: Bedoya-Pilozo, César. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Bedoya-Pilozo, César. Escuela Superior Politécnica del Litoral. Facultad de Ciencias de la Vida. Laboratorio de Biomedicina; Ecuador. Fil: Medina Magües, Lex Guillermo. Escuela Superior Politécnica del Litoral. Facultad de Ciencias de la Vida. Laboratorio de Biomedicina; Ecuador. Fil: Espinosa García, Maylen. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Sánchez, Martha. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Parrales Valdiviezo, Johanna. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Molina, Denisse. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Ibarra, María Alejandra. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Quimis Ponce, María. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: España, Karool. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Párraga Macias, Karla. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Cajas Flores, Nancy. Ecuador. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Narváez, Solon Orlando Alberto. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Narváez, Solon Orlando Alberto. Universidad Agraria del Ecuador; Ecuador. Fil: Robalino Penaherrera, Jorge Andrés. Ministerio de Salud Pública. Instituto Nacional de Investigación en Salud Pública. Dirección Técnica de Investigación, Desarrollo e Innovación; Ecuador. Fil: Chedraui, Peter. Hospital Gineco-Obstétrico “Enrique C. Sotomayor”; Ecuador. Fil: Escobar, Saul. Universidad Católica de Guayaquil. Facultad de Ciencias Médicas. Instituto de Biomedicina; Ecuador. Fil: Loja Chango, Rita Dolores. Universidad Católica de Guayaquil. Facultad de Ciencias Médicas. Instituto de Biomedicina; Ecuador. Fil: Ramirez Morán, Cecibel. Universidad Católica de Guayaquil. Facultad de Ciencias Médicas. Instituto de Biomedicina; Ecuador. El objetivo del presente estudio fue aportar información sobre la epidemiología molecular del virus del papiloma humano (human papillomavirus [HPV]) y los factores de riesgo asociados al desarrollo de lesiones cervicales y cáncer en mujeres de la costa del Ecuador. Además, se estudiaron la evolución de las variantes de los HPV más prevalentes y el marco temporal de su emergencia, para ayudar a rastrear la fuente de dispersión en la región. Se analizaron 166 muestras, incluyendo 57 y 95 casos de neoplasia intraepitelial cervical tipo 1 (CIN1) y tipo 2/3 (CIN2/3), respectivamente, y 14 de casos de cáncer. La detección/tipificación de HPV se realizó por PCR-secuenciación (MY09/MY11). La caracterización de variantes y la datación del ancestro común más reciente (tMRCA) se realizaron mediante filogenia y coalescencia. Se encontró ADN de HPV en el 54,4% de las muestras de CIN1, el 74,7% de las muestras de CIN2/3 y el 78,6% de las muestras de cáncer. Los tipos HPV16 (38,9%) y HPV58 (19,5%) fueron los más frecuentes. Los factores de riesgo para el desarrollo de lesiones cervicales/cáncer fueron 3 o más embarazos (OR = 4,3) e infección por HPV (O = 3,7 para HPV de alto riesgo, OR = 3,5 para HPV16), entre otros. En cuanto a la evolución viral, los aislados del HPV16 pertenecían a los linajes A (69%) y D (31%), mientras que los aislados del HPV58 pertenecían únicamente al linaje A. El período de emergencia del HPV16 estuvo asociado a poblaciones humanas (tMRCA = 91.052 años para HPV16A y 27.000 para HPV16D), mientras que el del HPV58A precedió a la evolución de Homo sapiens (322.257 años). Este estudio proporciona datos novedosos sobre la epidemiología y la evolución del HPV en Ecuador, los cuales serán fundamentales en la era de la vacuna. The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR = 4.3), HPV infection (OR = 3.7 for high-risk types; OR = 3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA = 91. 052 years for HPV16A and 27. 000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322. 257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.

In this study, the impact of customer agility and digitalisation in restructuring an automotive company and its daily operations was explored. Drawing on agility literature, we provide an empirical case study with the purpose of exploring how agility and digital transformation interconnect with one another. Our research confirms the importance of a digital mindset, flexible and agile company structure, and extensive digital skills for digital transformation. Furthermore, modern automotive companies must leverage strong IT infrastructures to maintain massive data gathered daily, both online and offline.Theoretically, our research highlights the interplay between digitalisation and customer agility and contributes to said literature stream, as it supports existing theories on organisational traits that favour agility and digitalisation. Specifically, this study extensively reveals how IT systems allow companies to interact with their environments quickly, manage real-time data streams and adapt accordingly. In practice, this study can serve as the best example for managers and practitioners, especially considering the context in which it occurred. In addition, the automotive industry is, until now, one of the most active, competitive and ever-changing sectors. Finally, this study's limitation lies within its scope; its implications may not be generalised since it focuses on the automotive industry.

Incorporation of direct acting antivirals (DAA) in the treatment of Hepatitis C Virus (HCV) significantly increases sustained virologic response rates. However, despite the greater potency offered by these antivirals, drug resistance plays a key role in patients with failure to DAA. Nevertheless, there is no information about the prevalence of resistance-associated substitutions (RASs) in Argentina. The aim of this study was to analyze HCV variants resistant to protease inhibitors (PI) in naïve patients infected with HCV genotype 1 from Argentina. In this retrospective cross-sectional study, 103 patients infected with HCV-1 were included. Eighteen positions related with RASs were analyzed by Sanger at baseline and phylogenetic analysis was performed to determine the diversification of this samples. The analyzed RASs were present in 38 out of 103 patients (36.9%) infected with HCV-1. Patients infected with subtype HCV-1b had higher prevalence of baseline RASs than patients infected with HCV-1a [51.6% vs. 12.8%, respectively (p < 0.001)]. The Q80K polymorphism was not found in HCV-1a samples, even when 51% of them belonged to cluster 1, which is associated with a high frequency of Q80K. Phylogenetic analysis showed that Argentinean samples were intermingled with sequences from other geographic regions. RASs to PI were highly prevalent and subtype dependent in treatment-naïve Argentinean patients. Surprisingly, Q80K polymorphism was not detected in our study population. The phylogenetic analysis showed no relationship between our samples and other samples from Brazil which also present a low prevalence of Q80K. This study supports the need for surveillance of resistance in patients who will be treated with DAA in each particular country since the observed RASs have very different prevalence worldwide. Fil: Martínez, Alfredo P.. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; Argentina Fil: Culasso, Andrés Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Pérez, Paula Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Romano, Vanesa. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; Argentina Fil: Campos, Rodolfo Hector. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Ridruejo, Ezequiel. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; Argentina Fil: García, Gabriel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Di Lello, Federico Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina

BACKGROUND: Human papillomavirus type 16 (HPV16) plays a central role in the development of cervical cancer. Worldwide studies indicate the existence of HPV16 variants that show different geographic distributions and oncogenic potential. OBJECTIVE: Our goal was to describe the genetic variation of HPV16 isolates identified in urban women with different grades of cervical lesions living in northeastern Argentina. STUDY DESIGN: We analyzed 116 HPV16-positive cervical samples (16 NLIM, 62 L-SIL, 16 H-SIL and 22 cervical cancer) from patients attending health centers in Misiones (Argentina) during 2006-13. HPV16 isolates were genetically characterized through PCR amplification and direct sequencing of 364 bp within the long control region, and the resulting sequences classified into variants based on phylogenetic analysis (lineages A, B, C and D). A potential association between HPV16 variants and lesion grade was evaluated through an odds ratio (OR) test. A temporal framework for the origin of HPV16 variants was assessed through coalescence analysis (BEAST v 1.7.5). RESULTS: Phylogenetic analysis of HPV16 sequences showed that 92.1% of the samples clustered with lineage A, and 6.9% to lineage D. HPV16 variants from lineage D were more frequently associated with high-grade lesions and cancer (HSIL+) than lineage A variants at an OR of 13.8 (1.6-117.0). The time to most common recent ancestor (tMCRA) of all variants was 119,103 years before present (HPD 95%=48,486-197,239), a date consistent with the time frame for modern human evolution. CONCLUSION: Our results suggest that HPV16 variants from lineage D may represent an additional risk factor for the development of cervical cancer in women living in northeastern Argentina. This study provides new information about viral isolates present in Argentina that will contribute to the monitoring of HPV16 infection in the vaccine era. Fil: Badano, Ines. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina Fil: Totaro, Maria Elina. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina Fil: Culasso, Andrés Carlos Alberto. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina Fil: Sanabria, Daiana Jimena. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina Fil: Schurr, Theodore G.. University of Pennsylvania; Estados Unidos Fil: Balette, Ileana Cristina. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina Fil: Roisman, Alejandro. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina Fil: Basiletti, Jorge. Dirección Nacional de Instituto de Investigación. Adm.nacional de Laboratorio E Instituto de Salud "dr.c.g.malbran". Departamento Virus; Argentina Fil: Picconi, María Alejandra. Dirección Nacional de Instituto de Investigación. Adm.nacional de Laboratorio E Instituto de Salud "dr.c.g.malbran". Departamento Virus; Argentina Fil: Campos, Rodolfo Hector. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina Fil: Liotta, Domingo Javier. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales. Laboratorio de Biología Molecular Aplicada; Argentina

The intra-host evolutionary process of hepatitis C virus (HCV) was analyzed by phylogenetic and coalescent methodologies in a patient co-infected with HCV-1a, HCV-2a, HCV-3a and human immunodeficiency virus (HIV) along a 13-year period. Direct sequence analysis of the E2 and NS5A regions showed diverse evolutionary dynamics, in agreement with different relationships between these regions and the host factors. The Bayesian Skyline Plot analyses of the E2 sequences (cloned) yielded different intra-host evolutionary patterns for each genotype: a steady state of a “consensus” sequence for HCV-1a; a pattern of lineage splitting and extinction for HCV-2a; and a two-phase (drift/diversification) process for HCV-3a. Each genotype evolving in the same patient and at the same time presents a different pattern apparently modulated by the immune pressure of the host. This study provides useful information for the management of co-infected patients and provides insights into the mechanisms behind the intra-host evolution of HCV. Fil: Culasso, Andrés Carlos Alberto. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Baré, Patricia. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Aloisi, N.. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Monzani, María Cecilia. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Corti, M.. Universidad de Buenos Aires. Facultad de Medicina; Argentina Fil: Campos, Rodolfo Hector. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Objectives The goal of this study was to define electrocardiographic (ECG) and echocardiographic characteristics of adolescent African athletes. Background Recent observations in African athletes reported large prevalence of left ventricular (LV) hypertrophy and ECG abnormalities. No data, so far, exist for adolescent Africans, which comprise a growing proportion of competitive/professional athletes. Methods The study included 154 soccer players participating at the 8th African Under-17 Championship of 2009, representing Algeria, Burkina Faso, Cameroon, Gambia, Guinea, Malawi, Nigeria, and Zimbabwe. For comparison, 62 Italian players with similar ages, sport achievements, and training schedules were included. Results African athletes showed higher R5/S1-wave voltages than Caucasian athletes (48.6 ± 12.1 mm vs. 34.1 ± 8.9 mm; p Conclusions African athletes displayed large proportion of ECG abnormalities, including a striking increase in R/S-wave voltage, ST-segment elevation, and deeply inverted or diffusely flat T waves by adolescence. LV remodeling in African athletes was characterized by a disproportionate wall thickening than in Caucasians but similar cavity size. Finally, distinctive peculiarities existed in African athletes according to the country (and ethnic) origin.

Ventricular tachyarrhythmias commonly occur in trained athletes during ambulatory Holter electrocardiography and are usually associated with a benign course. Such arrhythmias have been demonstrated to be sensitive to short periods of athletic deconditioning; however, their response to retraining is not known. Twenty-four hour Holter electrocardiographic monitoring was performed at peak training and after 3 to 6 months of deconditioning and was repeated in the present study after 2, 6, and 12 months of retraining in 37 athletes with frequent and complex ventricular tachyarrhythmias and without cardiovascular abnormalities. These subjects showed partial (101 to 500 ventricular premature complexes [VPCs]/24 hours) or marked (

ObjectivesIn the present study we assessed the distribution and clinical significance of left atrial (LA) size in the context of athlete's heart and the differential diagnosis from structural heart disease, as well as the proclivity to supraventricular arrhythmias.BackgroundThe prevalence, clinical significance, and long-term arrhythmic consequences of LA enlargement in competitive athletes are unresolved.MethodsWe assessed LA dimension and the prevalence of supraventricular tachyarrhythmias in 1,777 competitive athletes (71% of whom were males), free of structural cardiovascular disease, that were participating in 38 different sports.ResultsThe LA dimension was 23 to 50 mm (mean, 37 ± 4 mm) in men and 20 to 46 mm (mean, 32 ± 4 mm) in women and was enlarged (i.e., transverse dimension ≥40 mm) in 347 athletes (20%), including 38 (2%) with marked dilation (≥45 mm). Of the 1,777 athletes, only 14 (0.8%) had documented, symptomatic episodes of either paroxysmal atrial fibrillation (n = 5; 0.3%) or supraventricular tachycardia (n = 9; 0.5%), which together occurred in a similar proportion in athletes with (0.9%) or without (0.8%; p = NS) LA enlargement. Multivariate regression analysis showed LA enlargement in athletes was largely explained by left ventricular cavity enlargement (R2= 0.53) and participation in dynamic sports (such as cycling, rowing/canoeing) but minimally by body size.ConclusionsIn a large population of highly trained athletes, enlarged LA dimension ≥40 mm was relatively common (20%), with the upper limits of 45 mm in women and 50 mm in men distinguishing physiologic cardiac remodeling (“athlete's heart”) from pathologic cardiac conditions. Atrial fibrillation and other supraventricular tachyarrhythmias proved to be uncommon (prevalence

Purpose To study the incidence of blindness and low vision over a 7-year period. Design Population-based cohort study. Participants The survivors of the original cohort of 860 persons from Priverno, Italy, aged 45 to 69 years, were reexamined. Of the 760 eligible survivors, 619 (81.4%) had a 7-year follow-up visit. Methods Baseline and follow-up examinations included the collection of anamnestic and ophthalmologic data by the same observers using the same methods and classification criteria to minimize sources of variability. Main outcome measures Best-corrected visual acuity (VA) measured at 4 m by standardized logarithmic chart was expressed as the logarithm of the minimum angle of resolution (logMAR). World Health Organization definitions of blindness and low vision were adopted (respectively, VA > 1.3 logMar and VA > 0.6 to 1.3 logMar in the better eye or in either eye). Participants at risk for visual impairment were those without blindness or low vision in one or both eyes at baseline; participants at risk for one-eye visual impairment were those without blindness or low vision in both eyes at baseline. Results A total of 33 participants were defined as incident cases of visual impairment. The overall incidence figures for blindness, low vision, one-eye blindness, and one-eye low vision were respectively 0.2% (95% confidence interval [CI], 0.0–0.9), 1.3% (95% CI, 0.7–2.6), 1.2% (95% CI, 0.6–2.4), and 2.9% (95% CI, 1.8–4.6). Conclusions This study provides population-based estimates of the incidence of visual impairment in an adult, free-living European population. With respect to the younger participants, older subjects at baseline were at higher risk for incident visual impairment, the main causes of which were cataract, myopia, and diabetic retinopathy. The incidence of visual impairment in the subgroup aged 55 to 64 years at baseline was significantly higher than that found in Beaver Dam 5-year study and similar to that found in Beaver Dam 10-year Study, when the same definitions were adopted. This difference may be partially explained by social and cultural habits of the female samples, but many other factors may play a role.