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1. Discord between presence of follicular conjunctivitis and Chlamydia trachomatis infection in a single Torres Strait Island community: a cross‐sectional survey

Author: Kathleen D. Lynch, Garry Brian, Tomasina Ahwang, Tomi Newie, Victoria Newie, Christine Perrett, Ghislaine Wharton, Anthony Brown, Sarah Tozer, John M. Kaldor, Lisa J. Whop, Ross M. Andrews, and Stephen B. Lambert
Subjects: trachoma, ocular Chlamydia trachomatis, chlamydial conjunctivitis, Queensland, neglected tropical disease, Public aspects of medicine, RA1-1270
Abstract: Abstract Objective: Recent surveys identified trachomatous inflammation – follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross‐sectional survey involving eye examination and microbiological testing to better understand this disconnect. Methods: We examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed. Results: TF prevalence in children aged 5–9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis. Conclusions: Follicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non‐chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community. Implications for public health: In similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys.
Published: 2022
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2. Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: a microsimulation model

Author: Sanjay Basu, MD, David Flood, MD, Pascal Geldsetzer, MD, Michaela Theilmann, MA, Maja E Marcus, MA, Cara Ebert, PhD, Mary Mayige, MBChB, Roy Wong-McClure, MD, Farshad Farzadfar, MD, Sahar Saeedi Moghaddam, MS, Kokou Agoudavi, MD, Bolormaa Norov, MSc, Corine Houehanou, PhD, Glennis Andall-Brereton, PhD, Mongal Gurung, PhD, Garry Brian, MD, Pascal Bovet, MD, Joao Martins, PhD, Rifat Atun, ProfFRCP, Till Bärnighausen, ProfMD, Sebastian Vollmer, ProfPhD, Jen Manne-Goehler, MD, and Justine Davies, ProfMD
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data—specifically from the subset of people who were defined as having any type of diabetes by WHO standards—from nationally representative, cross-sectional surveys (2006–18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of
Published: 2021
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3. The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults

Author: David Flood, MD, Jacqueline A Seiglie, MD, Matthew Dunn, MPH, Scott Tschida, MPhil, Michaela Theilmann, MA, Maja E Marcus, MA, Garry Brian, MBChB, Bolormaa Norov, MD, Mary T Mayige, PhD, Mongal Singh Gurung, PhD, Krishna K Aryal, PhD, Demetre Labadarios, ProfMBChB, Maria Dorobantu, ProfFESC, Bahendeka K Silver, MBChB, Pascal Bovet, MD, Jutta M Adelin Jorgensen, MD, David Guwatudde, ProfPhD, Corine Houehanou, MD, Glennis Andall-Brereton, PhD, Sarah Quesnel-Crooks, MSc, Lela Sturua, PhD, Farshad Farzadfar, ProfMD, Sahar Saeedi Moghaddam, MSc, Rifat Atun, ProfFRCP, Sebastian Vollmer, ProfPhD, Till W Bärnighausen, ProfMD, Justine I Davies, ProfMD, Deborah J Wexler, MD, Pascal Geldsetzer, ScD, Peter Rohloff, MD, Manuel Ramírez-Zea, MD, Michele Heisler, ProfMD, and Jennifer Manne-Goehler, MD
Subjects: Geriatrics, RC952-954.6, Medicine
Abstract: Summary: Background: Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment. Methods: We did a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based on population-level monitoring indicators recommended in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. Surveys were included if they were done in 2008 or after in an LMIC, as classified by the World Bank in the year the survey was done; were nationally representative; had individual-level data; contained a diabetes biomarker (fasting glucose, random glucose, or glycated haemoglobin); and had data on one or more diabetes treatments. Our sample included non-pregnant individuals with an available diabetes biomarker who were at least 25 years of age. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographical region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, body-mass index, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. Findings: The final pooled sample from the 55 LMICs included 680 102 total individuals and 37 094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9·0% (95% CI 8·7–9·4), with 43·9% (41·9–45·9) reporting a previous diabetes diagnosis. Overall, 4·6% (3·9–5·4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50·5% (48·6–52·5); antihypertensive medication was 41·3% (39·3–43·3); cholesterol-lowering medication was 6·3% (5·5–7·2); diet counselling was 32·2% (30·7–33·7); exercise counselling was 28·2% (26·6–29·8); and weight-loss counselling was 31·5% (29·3–33·7). Countries at higher-income levels tended to have greater coverage. Female sex and higher age, body-mass index, educational attainment, and household wealth were also associated with greater coverage. Interpretation: Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, are urgent global diabetes priorities. Funding: National Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy & Innovation, National Institute of Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and National Center for Advancing Translational Sciences of the National Institutes of Health.
Published: 2021
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4. Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data.

Author: Justine I Davies, Sumithra Krishnamurthy Reddiar, Lisa R Hirschhorn, Cara Ebert, Maja-Emilia Marcus, Jacqueline A Seiglie, Zhaxybay Zhumadilov, Adil Supiyev, Lela Sturua, Bahendeka K Silver, Abla M Sibai, Sarah Quesnel-Crooks, Bolormaa Norov, Joseph K Mwangi, Omar Mwalim Omar, Roy Wong-McClure, Mary T Mayige, Joao S Martins, Nuno Lunet, Demetre Labadarios, Khem B Karki, Gibson B Kagaruki, Jutta M A Jorgensen, Nahla C Hwalla, Dismand Houinato, Corine Houehanou, David Guwatudde, Mongal S Gurung, Pascal Bovet, Brice W Bicaba, Krishna K Aryal, Mohamed Msaidié, Glennis Andall-Brereton, Garry Brian, Andrew Stokes, Sebastian Vollmer, Till Bärnighausen, Rifat Atun, Pascal Geldsetzer, Jennifer Manne-Goehler, and Lindsay M Jaacks
Subjects: Medicine
Abstract: BackgroundCardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.Methods and findingsWe did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01-1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12-2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01-1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09-1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01-1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes.ConclusionIn this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care.
Published: 2020
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5. Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys.

Author: Jennifer Manne-Goehler, Pascal Geldsetzer, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K Aryal, Brice Wilfried Bicaba, Pascal Bovet, Garry Brian, Maria Dorobantu, Gladwell Gathecha, Mongal Singh Gurung, David Guwatudde, Mohamed Msaidie, Corine Houehanou, Dismand Houinato, Jutta Mari Adelin Jorgensen, Gibson B Kagaruki, Khem B Karki, Demetre Labadarios, Joao S Martins, Mary T Mayige, Roy Wong McClure, Omar Mwalim, Joseph Kibachio Mwangi, Bolormaa Norov, Sarah Quesnel-Crooks, Bahendeka K Silver, Lela Sturua, Lindiwe Tsabedze, Chea Stanford Wesseh, Andrew Stokes, Maja Marcus, Cara Ebert, Justine I Davies, Sebastian Vollmer, Rifat Atun, Till W Bärnighausen, and Lindsay M Jaacks
Subjects: Medicine
Abstract: BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS:We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS:The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
Published: 2019
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6. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact

Author: Edward W Gregg, James Buckley, Mohammed K Ali, Justine Davies, David Flood, Roopa Mehta, Ben Griffiths, Lee-Ling Lim, Jennifer Manne-Goehler, Jonathan Pearson-Stuttard, Nikhil Tandon, Gojka Roglic, Slim Slama, Jonathan E Shaw, Kokou Agoudavi, Krishna K. Aryal, Rifat Atun, Silver Bahendeka, Brice Wilfried Bicaba, Pascal Bovet, Garry Brian, Albertino Damasceno, Justine I. Davies, Maria Dorobantu, Farshad Farzadfar, Pascal Geldsetzer, Mongal Singh Gurung, David Guwatudde, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Lindsay Jaacks, Bahadur Khem Karki, Demetre Labadarios, Nuno Lunet, Maja E. Marcus, Joao Martins, Theodory Mary Mayige, Bolormaa Norov, Sahar Saeedi Moghaddam, Sarah Quesnel-Crooks, Abla M. Sibai, Lela Sturua, Michaela Theilmann, Lindiwe Tsabedze, Sebastian Vollmer, and Zhaxybay Zhumadilov
Subjects: General Medicine
Published: 2023

7. Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross‐sectional study

Author: Kathleen D Lynch, Wendy Morotti, Garry Brian, Lenore Ketchup, Kozue Kingston, Mitchell Starr, Robert S Ware, Beth Everill, Nazihah Asgar, Anne O'Keefe, Lisa J Whop, John M Kaldor, and Stephen B Lambert
Subjects: Trachoma, Inflammation, Australia, Infant, Chlamydia trachomatis, General Medicine, Anti-Bacterial Agents, Gonorrhea, Cross-Sectional Studies, Child, Preschool, Prevalence, Humans, Female, Queensland, Child
Abstract: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community.Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing.Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists.Children aged 1-14 years; opportunistic screening of people aged 15 years or more.Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein.During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies.Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.
Published: 2022

8. Data Resource Profile: The Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC)

Author: Jennifer Manne-Goehler, Michaela Theilmann, David Flood, Maja E Marcus, Glennis Andall-Brereton, Kokou Agoudavi, William Andres Lopez Arboleda, Krishna K Aryal, Brice Bicaba, Pascal Bovet, Luisa Campos Caldeira Brant, Garry Brian, Grace Chamberlin, Geoffrey Chen, Albertino Damasceno, Maria Dorobantu, Matthew Dunn, Cara Ebert, Farshad Farzadfar, Mongal Singh Gurung, David Guwatudde, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta M Adelin Jorgensen, Khem B Karki, Demetre Labadarios, Nuno Lunet, Deborah Carvalho Malta, João S Martins, Mary T Mayige, Roy Wong McClure, Sahar Saeedi Moghaddam, Kibachio J Mwangi, Omar Mwalim, Bolormaa Norov, Sarah Quesnel-Crooks, Sabrina Rhode, Jacqueline A Seiglie, Abla Sibai, Bahendeka K Silver, Lela Sturua, Andrew Stokes, Adil Supiyev, Lindiwe Tsabedze, Zhaxybay Zhumadilov, Lindsay M Jaacks, Rifat Atun, Justine I Davies, Pascal Geldsetzer, Sebastian Vollmer, and Till W Bärnighausen
Subjects: Metabolic Syndrome, Risk Factors, Cardiovascular Diseases, Epidemiology, Humans, General Medicine, Global Health, Health Services Accessibility
Published: 2022

9. Development of a high field vibrating sample magnetometer

Author: Ferguson, Garry Brian
Subjects: 530.41, Superconducting magnets
Published: 1990

10. Effective refractive error coverage in adults aged 50 years and older: estimates from population-based surveys in 61 countries

Author: Rupert Richard Alexander Bourne, Maria Vittoria Cicinelli, Tabassom Sedighi, Ian H Tapply, Ian McCormick, Jost B Jonas, Nathan G Congdon, Jacqueline Ramke, Kovin S Naidoo, Timothy R Fricke, Matthew J Burton, Andreas Müller, Mukharram M Bikbov, João M Furtado, Fatima Kyari, Mingguang He, Ya Xing Wang, Lingam Vijaya, Vinay Nangia, Garry Brian, Mohammad Hassan Emamian, Akbar Fotouhi, Hassan Hashemi, Rajiv B Khandekar, Srinivas Marmamula, Solange Salomão, Ronnie George, Gyulli Kazakbaeva, Tasanee Braithwaite, Robert J Casson, Aiko Iwase, Noopur Gupta, Mohammad H Abdianwall, Rohit Varma, Tien Y Wong, Ningli Wang, Hugh R Taylor, Seth R Flaxman, Stuart Keel, Serge Resnikoff, Alain Bron, Ching-Yu Cheng, Arthur Fernandes, David Friedman, Andrew Gazzard, Rim Kahloun, John Kempen, Moncef Khairallah, Van C Lansingh, Janet Leasher, Nicolas Leveziel, Hans Limburg, Michal Nowak, Konrad Pesudovs, Tunde Peto, Luca Rossetti, Nina Tahhan, Wondu Alemayehu, Aries Arditi, Reza Dana, Monte Del Monte, jenny Deva, Laura Dreer, Josh Ehrlich, Leon Ellwein, Billy Hammond, Mary E Hartnett, April Ingram, Rohit Khanna, Judy Kim, Jennifer Lim, Alan Morse, David Musch, Maurizio B Parodi, Pradeep Ramulu, Alan Robin, Janet Serle, Tueng Shen, Rita S Sitorus, Dwight Stambolian, Fotis Topouzis, Miltiadis Tsilimbaris, Gianni Virgili, Sheila West, Jafer K Ababora, Heba AlSawahli, Hery Harimanitra Andriamanjato, Rosario Barrenechea, Juan F Batlle, Anthea M Burnett, Robert P Finger, Marcelo Gallarreta, Pedro A Gomez-Bastar, Reeta Gurung, Elesh Jain, George E Kabona, Khumbo Kalua, Levi Kandeke, Jefitha Karimurio, Susan A Kikira, Sucheta Kulkarni, Wanjiku Mathenge, Sailesh Kumar Mishra, Seyed Farzad Mohammadi, Manfred Mörchen, Nasiru Muhammad, Grace C Mutati, Maria Eugenia Nano, János Németh, Ala Paduca, Alexander Páez, M Mansur Rabiu, Lutfah Rif'ati, Mohamad Aziz Salowi, Yuddha D Sapkota, Nicholas Sargent, Ubeydulla Thoufeeq, Astrid V Villalobos, Biaxiang Xiao, Mariano Yee Melgar, and Xiu Juan Zhang
Subjects: Adult, Male, Europe, Humans, General Medicine, Middle Aged, Global Health, Refractive Errors, Africa South of the Sahara, Aged, Global Burden of Disease
Abstract: In 2021, WHO Member States endorsed a global target of a 40-percentage-point increase in effective refractive error coverage (eREC; with a 6/12 visual acuity threshold) by 2030. This study models global and regional estimates of eREC as a baseline for the WHO initiative.The Vision Loss Expert Group analysed data from 565 448 participants of 169 population-based eye surveys conducted since 2000 to calculate eREC (met need/[met need + undermet need + unmet need]). A binary logistic regression model was used to estimate eREC by Global Burden of Disease (GBD) Study super region among adults aged 50 years and older.In 2021, distance eREC was 79·1% (95% CI 72·4-85·0) in the high-income super region; 62·1% (54·7-68·8) in north Africa and Middle East; 49·5% (45·0-54·0) in central Europe, eastern Europe, and central Asia; 40·0% (31·7-48·2) in southeast Asia, east Asia, and Oceania; 34·5% (29·4-40·0) in Latin America and the Caribbean; 9·0% (6·5-12·0) in south Asia; and 5·7% (3·1-9·0) in sub-Saharan Africa. eREC was higher in men and reduced with increasing age. Global distance eREC increased from 2000 to 2021 by 19·0%. Global near vision eREC for 2021 was 20·5% (95% CI 17·8-24·4).Over the past 20 years, distance eREC has increased in each super region yet the WHO target will require substantial improvements in quantity and quality of refractive services in particular for near vision impairment.WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, Brien Holden Vision Institute, Lions Clubs International Foundation.
Published: 2022

11. Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: a microsimulation model

Author: Sebastian Vollmer, Pascal Geldsetzer, Jennifer Manne-Goehler, Mary T Mayige, Joao S Martins, Roy A Wong-McClure, Rifat Atun, Garry Brian, Maja-Emilia Marcus, Mongal Singh Gurung, Cara Ebert, Till Bärnighausen, Bolormaa Norov, Michaela Theilmann, David Flood, Kokou Agoudavi, Glennis Andall-Brereton, Pascal Bovet, Justine Davies, Sanjay Basu, Sahar Saeedi Moghaddam, Corine Houehanou, and Farshad Farzadfar
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Population, 030209 endocrinology & metabolism, Global Health, Corrections, Diabetes Complications, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, 030212 general & internal medicine, Myocardial infarction, education, Stroke, Developing Countries, Dialysis, Aged, Aged, 80 and over, education.field_of_study, Ejection fraction, business.industry, General Medicine, Articles, Middle Aged, Models, Theoretical, medicine.disease, 3. Good health, Cross-Sectional Studies, Blood pressure, Cardiovascular Diseases, Heart failure, Female, Public aspects of medicine, RA1-1270, business, Delivery of Health Care
Abstract: Summary: Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data—specifically from the subset of people who were defined as having any type of diabetes by WHO standards—from nationally representative, cross-sectional surveys (2006–18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of
Published: 2021

12. Assessing the Prevalence of Trachoma: Lessons from Community Screening with Laboratory Testing in Australia's Torres Strait Islands

Author: Kathleen D. Lynch, Garry Brian, Tomisina Ahwang, Wendy Morotti, Ghislaine Wharton, Tomi Newie, Victoria Newie, Christine Perrett, Wagie Ware, Lucy Mosby, Shelley Walters, Anthony Brown, Lisa J. Whop, and Stephen B. Lambert
Subjects: Ophthalmology, Epidemiology
Abstract: We undertook a screening program between 2016 and 2019 to determine if trachoma was endemic in the Torres Strait Islands of Queensland, Australia. Eleven screening surveys assessing trachoma prevalence were undertaken in seven communities using the World Health Organization (WHO) simplified grading tool. Additionally, an ophthalmologist performed a detailed clinical assessment including examination for Herbert’s pits and corneal pannus and, where clinically indicated, collection of conjunctival specimens to investigate the presence of Chlamydia trachomatis nucleic acid. Prevalence of trachomatous inflammation—follicular (TF) in children aged 5–9 years for the aggregated first survey across all communities was 6% (17/284). No child had trachomatous inflammation—intense, trachomatous scarring, corneal pannus, or Herbert’s pits. Of the 66 times any child was tested for C. trachomatis by polymerase chain reaction (PCR), the result was negative. No cicatricial trachoma was identified amongst the adults (n = 186) who were opportunistically offered examination. Whilst TF was present, the lack of intense inflammatory thickening in any child examined, the lack of end-stage trachomatous disease, and the lack of ocular C. trachomatis detection by PCR indicate trachoma is not endemic in the Torres Strait Islands, and no ongoing public health intervention is required. These findings add to a growing body of evidence suggesting that use of the WHO simplified grading tool alone in the peri-elimination setting may overestimate the community burden of trachoma.
Published: 2022

13. Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults

Author: Utibe R. Essien, Mohammed K. Ali, David Guwatudde, Dismand Houinato, Lela Sturua, Cara Ebert, Joseph Kibachio Mwangi, Deborah J. Wexler, Demetre Labadarios, Pascal Geldsetzer, Sarah Crooks, Roy Wong McClure, Felix Teufel, Jacqueline A. Seiglie, Corine Houehanou, Garry Brian, Chea Stanford Wesseh, Michaela Theilmann, Kokou Agoudavi, Mary T Mayige, Omar Mwalim, Bahendeka K Silver, Brice Wilfried Bicaba, Maria Dorobantu, James B. Meigs, Mongal Singh Gurung, Maja E Marcus, William Andres Lopez Arboleda, Pascal Bovet, Andrew Stokes, Rifat Atun, Sebastian Vollmer, Bolormaa Norov, Farshad Farzadfar, Jennifer Manne-Goehler, Sahar Saeedi Moghaddam, Khem Bahadur Karki, Jan-Walter De Neve, Joao S Martins, Jutta M Adelin Jorgensen, Till Bärnighausen, Krishna Kumar Aryal, Glennis Andall-Brereton, Justine Davies, and Gibson B. Kagaruki
Subjects: Adult, Male, medicine.medical_specialty, Diabetes risk, Cross-sectional study, 030209 endocrinology & metabolism, Overweight, Global Health, Article, Body Mass Index, BMI, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Diabetes mellitus, Diabetes Mellitus, Prevalence, medicine, Humans, Obesity, 030212 general & internal medicine, Poisson regression, Developing Countries, Poverty, Glycated Hemoglobin, 2. Zero hunger, OVERWEIGHT, business.industry, Public health, 1. No poverty, General Medicine, Middle Aged, medicine.disease, Health Surveys, 3. Good health, Cross-Sectional Studies, OBESITY, Income, symbols, Female, medicine.symptom, business, WAIST CIRCUMFERENCE, Body mass index, Demography
Abstract: Summary Background The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. Methods In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. Findings Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. Interpretation The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Funding Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.
Published: 2021

14. The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults

Author: Justine Davies, Michaela Theilmann, Deborah J. Wexler, Lela Sturua, David Flood, Maria Dorobantu, Michele Heisler, Sahar Saeedi Moghaddam, Rifat Atun, Pascal Bovet, Garry Brian, Sarah Quesnel-Crooks, Bahendeka K Silver, Jennifer Manne-Goehler, Scott Tschida, Maja E Marcus, Matthew Dunn, David Guwatudde, Glennis Andall-Brereton, Mongal Singh Gurung, Jutta M Adelin Jorgensen, Mary T Mayige, Bolormaa Norov, Farshad Farzadfar, Demetre Labadarios, Krishna Kumar Aryal, Manuel Ramírez-Zea, Pascal Geldsetzer, Sebastian Vollmer, Jacqueline A. Seiglie, Till Bärnighausen, Peter Rohloff, and Corine Houehanou
Subjects: Adult, Health (social science), Cross-sectional study, Psychological intervention, 030204 cardiovascular system & hematology, Logistic regression, DISEASE, Article, POOLED ANALYSIS, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Diabetes mellitus, MANAGEMENT, Diabetes Mellitus, medicine, QUALITY, Humans, 030212 general & internal medicine, Developing Countries, Poverty, business.industry, MORTALITY, RC952-954.6, 1. No poverty, Guideline, CARE, medicine.disease, Educational attainment, 3. Good health, Psychiatry and Mental health, Cholesterol, Cross-Sectional Studies, Glucose, Gross national income, Geriatrics, RISK-FACTORS, Income, Medicine, Female, Geriatrics and Gerontology, Translational science, pooled analysis, risk-factors, mortality, care, intervention, management, quality, disease, Geriatrics & Gerontology, Family Practice, business, INTERVENTION
Abstract: Summary Background Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment. Methods We did a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based on population-level monitoring indicators recommended in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. Surveys were included if they were done in 2008 or after in an LMIC, as classified by the World Bank in the year the survey was done; were nationally representative; had individual-level data; contained a diabetes biomarker (fasting glucose, random glucose, or glycated haemoglobin); and had data on one or more diabetes treatments. Our sample included non-pregnant individuals with an available diabetes biomarker who were at least 25 years of age. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographical region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, body-mass index, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. Findings The final pooled sample from the 55 LMICs included 680 102 total individuals and 37 094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9·0% (95% CI 8·7–9·4), with 43·9% (41·9–45·9) reporting a previous diabetes diagnosis. Overall, 4·6% (3·9–5·4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50·5% (48·6–52·5); antihypertensive medication was 41·3% (39·3–43·3); cholesterol-lowering medication was 6·3% (5·5–7·2); diet counselling was 32·2% (30·7–33·7); exercise counselling was 28·2% (26·6–29·8); and weight-loss counselling was 31·5% (29·3–33·7). Countries at higher-income levels tended to have greater coverage. Female sex and higher age, body-mass index, educational attainment, and household wealth were also associated with greater coverage. Interpretation Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, are urgent global diabetes priorities. Funding National Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy & Innovation, National Institute of Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and National Center for Advancing Translational Sciences of the National Institutes of Health.
Published: 2021

15. Rural-Urban Differences in Diabetes Care and Control in 42 Low-and Middle-Income Countries:A Cross-sectional Study of Nationally Representative Individual-Level Data

Author: David Flood, Pascal Geldsetzer, Kokou Agoudavi, Krishna K. Aryal, Luisa Campos Caldeira Brant, Garry Brian, Maria Dorobantu, Farshad Farzadfar, Oana Gheorghe-Fronea, Mongal Singh Gurung, David Guwatudde, Corine Houehanou, Jutta M. Adelin Jorgensen, Dimple Kondal, Demetre Labadarios, Maja E. Marcus, Mary Mayige, Mana Moghimi, Bolormaa Norov, Gastón Perman, Sarah Quesnel-Crooks, Mohammad-Mahdi Rashidi, Sahar Saeedi Moghaddam, Jacqueline A. Seiglie, Silver K. Bahendeka, Eric Steinbrook, Michaela Theilmann, Lisa J. Ware, Sebastian Vollmer, Rifat Atun, Justine I. Davies, Mohammed K. Ali, Peter Rohloff, and Jennifer Manne-Goehler
Subjects: Male, Rural Population, Advanced and Specialized Nursing, Cross-Sectional Studies, Urban Population, Endocrinology, Diabetes and Metabolism, Diabetes Mellitus, Income, Prevalence, Internal Medicine, Humans, Female, Developing Countries
Abstract: OBJECTIVE Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15–30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5–22%) lower relative risk of glycemic control, 6% (95% CI −5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2–39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
Published: 2022

16. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. Jacobs, Kenneth James, Elena Sacchini, Pascal Bovet, Mahboubeh Parsaeian, Tania Lopez, Ya Xing Wang, Wojciech Drygas, Jody C Miller, Svetlana A. Shalnova, Maria Elisa Zapata, Chung T Nguyen, Nimmathota Arlappa, Edwige Landais, Thorkild I. A. Sørensen, Jeannette Klimont, Amirabbas Momenan, Erik J. Timmermans, Mari-Liis Tammesoo, Jost B. Jonas, Stefania Toselli, Maria Teresa Anselmo Olinto, Bahman Cheraghian, Kouamelan Doua, Esteban Carmuega, Marjeta Mišigoj-Duraković, Bo Werner, M. Arfan Ikram, Breige A. McNulty, Christa Meisinger, Clara Homs, Namuna Shrestha, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Alicia Matijasevich, Alison J Price, Ala'a Alkerwi, Kristine H. Allin, Lorenza Pilotto, Mohannad Al Nsour, Ingunn Holden Bergh, Marianna Noale, Heba Fouad, Vilnis Dzerve, Novie O. Younger-Coleman, Peter Willeit, Andrea R. V. R. Horimoto, Freda Pitakaka, Habiba Ben Romdhane, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Cristina Padez, Sarah P. Garnett, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tien Yin Wong, Rosa Haghshenas, Jonathan Giovannelli, Christina Howitt, Marleen E. Hendriks, Fadia AlBuhairan, Huashuai Chen, Gretchen A Stevens, Luís B. Sardinha, David Goltzman, Jenny M. Kindblom, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Rajendra Pradeepa, Yi-Ting Lin, Martin Neovius, Juan Francisco Miquel, Ellis Owusu-Dabo, Anil Poudyal, Marzieh Katibeh, Tanja Stocks, Veronica Mocanu, Ulla Roggenbuck, Robespierre Ribeiro, Gabriele Eiben, Mary Simon, Christine Cameron, Hamid Hakimi, Kamel Ajlouni, Jakub Stokwiszewski, Iulia Jurca Simina, Pietro Amedeo Modesti, Frederick C. W. Wu, Peter Kristensen, Charles Mondo, Felix Gutzwiller, Mariana Sbaraini, Martijn Huisman, Betina H. Thuesen, Queenie Chan, Antonisamy Belavendra, Artur Mazur, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Marcos André Moura-dos-Santos, Jean Ferrières, Farhad Zamani, Shina Avi, Yves Kameli, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Thomas Meinertz Dantoft, Hossein Poustchi, Farid Najafi, Giovanni de Gaetano, Azaliia M Tuliakova, Vera Lanska, Tint Swe Latt, Matthias Bopp, Abbas Rezaianzadeh, Rod Jackson, Johan Van der Heyden, Reecha Sofat, Koen Van Herck, Allan G. Hill, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Stela McLachlan, Ulrike Gehring, Ranko Stevanovic, Nagalla Balakrishna, Lekhraj Rampal, Marjolijn C. E. Bragt, Saeid Eslami, Napoleón Pérez-Farinós, G. K. Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. Gonzalez, Ying-Wei Wang, Rob M. van Dam, Ryutaro Ohtsuka, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Lynell V Maniego, Fariborz Mansour-Ghanaei, Maria Dorobantu, Giovanni Viegi, Xiaoguang Yang, Honor Bixby, Prakash C. Gupta, Ofra Kalter-Leibovici, Eugene Sobngwi, Ričardas Radišauskas, Jurate Medzioniene, Roy A Wong-McClure, Kim F. Michaelsen, Antonia Trichopoulou, Tania Tello, Francesco Branca, Johanna Gunnlaugsdottir, Els Clays, Wei-Yen Lim, Suzanne C. Ho, Toomas Veidebaum, Rebecca Goldsmith, Margot González-León, Matthias Nauck, Alibek Mereke, Marta Buoncristiano, Jakob Tarp, Rosalba Rojas-Martínez, Maya Tanrygulyyeva, Reza Malekzadeh, Abdonas Tamosiunas, Dimitrios Poulimeneas, Pedro Ordunez, Isabelle Herter-Aeberli, Khanh Le Nguyen Bao, Anne Juolevi, Vassilis Zafiropulos, Emanuela Gualdi-Russo, Jordi Sunyer, Manu Raj, Chaoqiang Jiang, Sofia Malyutina, Efthymios Kapantais, Maria Lazo-Porras, Maung Maung Than Htike, Michael Hobbs, Ranjit Mohan Anjana, Merike Liivak, Johan G. Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. 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Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing 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Lind , Allan Linneberg , Lauren Lissner , Mieczyslaw Litwin , Lijuan Liu , Wei-Cheng Lo , Helle-Mai Loit , Khuong Quynh Long , Luis Lopes , Oscar Lopes , Esther Lopez-Garcia , Tania Lopez , Paulo A Lotufo , José Eugenio Lozano , Janice L Lukrafka , Dalia Luksiene , Annamari Lundqvist , Robert Lundqvist , Nuno Lunet , Charles Lunogelo , Michala Lustigová , Edyta Łuszczki , Guansheng Ma , Jun Ma , Xu Ma , George Ll Machado-Coelho , Aristides M Machado-Rodrigues , Luisa M Macieira , Ahmed A Madar , Stefania Maggi , Dianna J Magliano , Sara Magnacca , Emmanuella Magriplis , Gowri Mahasampath , Bernard Maire , Marjeta Majer , Marcia Makdisse , Päivi Mäki , Fatemeh Malekzadeh , Reza Malekzadeh , Rahul Malhotra , Kodavanti Mallikharjuna Rao , Sofia K Malyutina , Lynell V Maniego , Yannis Manios , Jim I Mann , Fariborz Mansour-Ghanaei , Enzo Manzato , Paula Margozzini , Anastasia Markaki , Oonagh Markey , Eliza Markidou Ioannidou , Pedro Marques-Vidal , Larissa Pruner Marques , Jaume Marrugat 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Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

17. Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Zahra Mohammadi, Abdul Basit, Helena I. S. Nogueira, Soile E. Puhakka, Hongsheng Bi, Ari Voutilainen, Davood Khalili, Bin Zhou, Dermot O'Reilly, Natascia Rinaldo, Paulo A. Lotufo, Bahareh Kheiri, Thein Thein Htay, Simona Giampaoli, Goodarz Danaei, M. Fernanda Lima-Costa, Simona Bo, Peter Schnohr, Jerzy Chudek, Francesco Panza, Ling Yang, Katia Vergetti Bloch, Vincenzo Capuano, Holly E. Syddall, Dong Zhao, Indah Suci Widyahening, Maria Lorenza Muiesan, Leng Huat Foo, Mohsen Azimi-Nezhad, Merete Osler, Laura Torres-Collado, Manu Raj, Adroaldo Cesar Araujo Gaya, Susi Kriemler, Ali Akbar Shayesteh, Aneta Grajda, Anette Varbo, Kazem Mohammad, Leila Beltrami Moreira, Shu Ti Chiou, Iuliia A Rusakova, Jyh Eiin Wong, Torben Jørgensen, Lela Sturua, Lubica Ticha, Hamid Hakimi, Hazzaa M. Al-Hazzaa, Yanina Zócalo, Freda Pitakaka, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Marie Kunešová, Johanna M. Geleijnse, Elysée Claude Bika Lele, Yannis Manios, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Sibel Gogen, Viviane Cunha Cardoso, Kristine H. Allin, Ana Azevedo, Line Tang Møllehave, Vincent Jr DeGennaro, Novie O. Younger-Coleman, Gretchen A Stevens, Dickman Gareta, Holger Theobald, Anja Schienkiewitz, Bekbolat Zholdin, Janice Luisa Lukrafka, Adela Chirita-Emandi, Ulla Roggenbuck, Kenisha Russell Jonsson, Robespierre Ribeiro, Gabriele Eiben, Eero Kajantie, Sounnia Mediene Benchekor, Fariborz Mansour-Ghanaei, Mary Simon, Prakash C. Gupta, Mohammad Esmaeel Motlagh, Emanuela Gualdi-Russo, María Elena Díaz-Sánchez, Pilar Guallar-Castillón, Bee Koon Poh, Cristina Padez, Azaliia M Tuliakova, Sarah P. Garnett, William R. Tebar, Yingfeng Zheng, Suhad Bahijri, Christina Mavrogianni, Mihaela Vladulescu, Jan A. Staessen, Paula Duarte de Oliveira, Rui Ornelas, Michael Sjöström, Charles Agyemang, Slawomir Koziel, Shohreh Naderimagham, Jari Jokelainen, Stephen T. McGarvey, Patrick Pasquet, Farnam Mohebi, Nader Saki, Aida Pilav, Azim Nejatizadeh, Marianna Noale, Habiba Ben Romdhane, Luís B. Sardinha, Laura Lauria, Jun Hata, Kodanda R Kanala, Gert B. M. Mensink, Nils Lehmann, Elio Riboli, Carolina Tarqui-Mamani, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Luis Serra-Majem, Martina Müller-Nurasyid, Felipe Vogt Cureau, Lekhraj Rampal, Zhamilya Battakova, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Fikru Tullu, Aung Soe Htet, Angel R. Gonzalez, Annette J. Dobson, Kavumpurathu Raman Thankappan, Hélène Delisle, Francisco J. Félix-Redondo, Ramón Suárez-Medina, Annika Rosengren, Sania Nishtar, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Maria Cecília Formoso Assunção, Kazi M. Jamil, Stefano Marventano, Wenbin Wei, Norsyamlina Che Abdul Rahim, Shukri F. Mohamed, Bente Sparboe-Nilsen, Soon-Woo Park, Ana Isabel Rito, David Goltzman, W. M. 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Goya Wannamethee, Alison J Price, Gregorio Varela-Moreiras, Ali Reza Safarpour, Erfan Ghasemi, Janine Clarke, René Charles Sylva, Wan Nazaimoon Wan Mohamud, Zhamyila Usupova, Chaoqiang Jiang, Julio Zuñiga Cisneros, Freja B Kampmann, Wei Cheng Lo, Reza Mohammadpourhodki, Kaspar Staub, Mojtaba Farjam, Vincenzo Solfrizzi, Garry L. Jennings, Fabio Galvano, Monika Zuziak, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Emmanuel Cohen, Snehalatha Chamukuttan, Maria Ruiz-Castell, Karen Sparrenberger, Pedro Plans-Rubio, Wei Zheng, Eldridge Ferrer, Martijn Huisman, Maria Hassapidou, Iris Pigeot, Jakub Stokwiszewski, Domenico Palli, Ewelina Czenczek-Lewandowska, Ramiro Guerrero, Farzad Hadaegh, Han Cg Kemper, Saeid Safiri, Ivan Pećin, Arnaud Chiolero, Niels Møller, Jorge Bezerra, Ulrike Gehring, Iná S. Santos, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Marie Moitry, Nizal Sarrafzadegan, Jacqueline F. Price, Ranko Stevanovic, Sai Yin Ho, Georg Lappas, Alberto Palloni, Malay K. Mridha, Elaine M. Dennison, Jeonghee Lee, Saeid Eslami, Rahman Shiri, Japhet Killewo, Juergen Breckenkamp, Mathilde Kersting, Y Nikitin, Iqbal Bata, Geetha R Menon, Maria Avdicova, Sanjay Rampal, Antônio Augusto Moura da Silva, Kirsten Mehlig, Chien-An Sun, Ramin Heshmat, Violeta Iotova, Stefaan Demarest, Mette Rasmussen, Dirk De Bacquer, San-Lin You, Suzanne N Morin, Martin Gulliford, Maties Torrent, Luc Dauchet, Fred Paccaud, Paibul Suriyawongpaisal, Sherali Rakhmatulloev, Hyeon Chang Kim, Markku Peltonen, Ruth Frikke-Schmidt, Vera Musil, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Gowri Mahasampath, Ulrich Keil, Sérgio Viana Peixoto, Haiquan Xu, Helle-Mai Loit, Valérie Deschamps, Ilpo Huhtaniemi, Lijuan Liu, Marialaura Bonaccio, Altan Onat, Rody G. Sy, José María Huerta, Ko Ko Zaw, Akihiro Yoshihara, Peter Ueda, Belgin Ünal, Rachel Dankner, Andrzej Wiecek, Eman Aly, Ruzena Kubinova, Justina Vaitkeviciute, Hanna Tolonen, Priscilla Duboz, Orn Olafsson, Yin Guo, Chiara Donfrancesco, Salim Mohanna, Dusan Grafnetter, Daniel Weghuber, Ali Ahmadi, Rosemary B. Duda, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Liis Nelis, Badreya Al-Lahou, J. Jaime Miranda, Lèlita Santos, Aroor Bhagyalaxmi, Mohamed Bamoshmoosh, Børge G. Nordestgaard, Jeannette Lee, Ahmad Reza Dorosty, Alain Morejon, Ying-Wei Wang, Jakob Tarp, Rosalba Rojas-Martínez, Luxia Zhang, Bahram Mohajer, Maja Bæksgaard Jørgensen, Jurate Klumbiene, Zhengming Chen, Ambady Ramachandran, Andrea Rodriguez-Martinez, Alisha N. Wade, Suyeon Park, Janne Schurmann Tolstrup, Lucjan Szponar, Krishna Kumar Aryal, Tahir Aris, Mahfuzar Rahman, Dorja Vočanec, Juan P. González-Rivas, Rob M. van Dam, Daniel Bia, Oonagh Markey, Ryutaro Ohtsuka, Kumiko Ohara, Ričardas Radišauskas, Jurate Medzioniene, Tiina Vlasoff, Tania Tello, Suzanne C. Ho, Kodavanti Mallikharjuna Rao, May Soe Aung, Vesselka Duleva, Michael Hobbs, Lutgarde Thijs, Marjolein Visser, Parasmani Dasgupta, Inge Huybrechts, Raimund Erbel, Alice Bonilla-Vargas, Hermann Brenner, Mohammad Reza Fattahi, Jolanda Hyska, Roman Topor-Madry, Ranjit Mohan Anjana, Merike Liivak, Eruke E. Egbagbe, Mathilde Savy, Herculina S. Kruger, Neil Murphy, Vinay Nangia, Cesar G. Victora, Mostafa K. Mohamed, H. Bas Bueno-de-Mesquita, Gabriella Gruden, Marcos André Moura-dos-Santos, Mohammed Rasoul Tarawneh, Maria Teresa Menzano, Francesco Branca, Abdonas Tamosiunas, Elena Bogova, Niveen M E Abu-Rmeileh, Maroje Sorić, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Tatjana Hejgaard, Yves Kameli, Margarita Samoutian, Andreia N. Pizarro, Jin Soo Moon, Frank Claessens, Zulfiqar A Bhutta, Frank Tanser, Nor Azwany Yaacob, Vanina Bongard, Gregor Jurak, Johan G. Eriksson, Christina-Paulina Lambrinou, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Thomas Meinertz Dantoft, Wichai Aekplakorn, Anwar Batieha, Eduardo Capuano, Teresa Haugsgjerd, Jeremy M. Jacobs, Paola Russo, Nguyen D Nguyen, Luis Revilla, Hossein Poustchi, Farid Najafi, Giovanni de Gaetano, Wan Mohamad Wan Bebakar, Paul Elliott, Denise Eldemire-Shearer, Angela Döring, Giovanni Viegi, Xiaoguang Yang, María-Elena González-Villalpando, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Tomasz Zdrojewski, Carlos P. Boissonnet, Mohamad Hasnan Ahmad, Mahmudur Rahman, Günther Fink, Marcia Makdisse, Dragana P Jovic, Aline Wagner, Coimbatore Subramaniam Shanthirani, Pascal Bovet, Dong Wook Kim, Tom Wilsgaard, Anders Grøntved, Thirunavukkarasu Sathish, Antonia Trichopoulou, Noushin Mohammadifard, Igor Spiroski, Natasja M. van Schoor, Cláudia S. Minderico, Betina H. Thuesen, Queenie Chan, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Line Lund Kårhus, Cihangir Erem, Amina Barkat, Maria Paula Santos, Fernanda Cunha Soares, Constanta Huidumac Petrescu, Allan G. Hill, Honor Bixby, Benoît Salanave, Joana Carvalho, Maigeng Zhou, Ofra Kalter-Leibovici, Roy A Wong-McClure, Kim F. Michaelsen, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, José R. Banegas, Quang Ngoc La, Uruwan Yamborisut, Parinaz Mehdipour, Farhad Pourfarzi, Sudha Ramachandra Rao, Katsuyasu Kouda, Chien-Jen Chen, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Ronald D. Gregor, Rudolf Kaaks, Maria do Carmo Franco, Marta García-Solano, Beata Gurzkowska, Bahman Cheraghian, Stefaan De Henauw, Daniel Ferrante, Johanna A. Otero, Jamila Abubakar Garba, Antonio Pedro Graça, Sumit Bharadwaj, Shiqi Zhen, Xiu-Hua Guo, Prashant Mathur, Raphael Mendes Ritti-Dias, Kouamelan Doua, Esteban Carmuega, Majid Shirani, Przemyslaw Slusarczyk, Petra Rust, Visnja Djordjic, Farahnaz Joukar, Johanna Gunnlaugsdottir, Leila Houti, Nayu Ikeda, Imperia Brajkovich, Amirabbas Momenan, Erik J. Timmermans, Marcin Rutkowski, Biruta Velika, Joana Araújo, Jostein Steene-Johannessen, Christa L. Lilly, Per Tynelius, Michael Tornaritis, Anne Juolevi, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Espen Bjertness, Ana P. Ortiz, Joel G. R. Roy, Himanshu K. Chaturvedi, Michelle Holdsworth, Niels Wedderkopp, Johan Van der Heyden, Mukharram M. Bikbov, Hsien-Ho Lin, Eva Corpeleijn, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tuyen D Le, Teresa Norat, Hana Zamrazilová, Garry Brian, Tien Yin Wong, Rosa Haghshenas, Clive Osmond, Diego Giulliano Destro Christofaro, Mahmood Moosazadeh, Vilma Irazola, Olli T. Raitakari, Marco Aurélio Peres, Terho Lehtimäki, Shuohua Chen, Dimitrios Papandreou, Robert J. Adams, Sigmund A. Anderssen, Peter T. Katzmarzyk, Luisa M Macieira, Félicité Tchibindat, Lital Keinan Boker, Toshiharu Ninomiya, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, N Capkova, Zumin Shi, Maria Turley, Zbigniew Gaciong, Giovanni Veronesi, Martin McKee, Veikko Salomaa, Gilad Twig, Elisabetta L. Romeo, Peter Kristensen, Grazyna Jasienska, Victor Guillermo Sequera, Mario V. Capanzana, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Jonathan Giovannelli, Stela McLachlan, Ellis Owusu-Dabo, Stefania Toselli, Maria Teresa Anselmo Olinto, Senthil K Vasan, Sara Schramm, Xenophon Theodoridis, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Dongfeng Gu, Tomas Vega, Hynek Pikhart, Päivi Mäki, Heba Fouad, Vilnis Dzerve, Christina Howitt, Seyed Mohammad Hashemi-Shahri, Jenny M. Kindblom, Marjolijn C. E. Bragt, G. K. Mini, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Vilmundur Gudnason, Loreto Santa Marina, Kairat Davletov, Afshin Ostovar, Niloofar Peykari, Nicholas J. Wareham, Wilma M. Hopman, Karl-Heinz Jöckel, Jussi Kauhanen, Breige A. McNulty, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Stefan Kiechl, Alicia Matijasevich, Boban Mugoša, Srinivasan Kannan, Jyrki K. Virtanen, Mohan Deepa, Mangesh S. Pednekar, Shahla AlDhukair, Cynthia M. Pérez, Vera Lanska, Tint Swe Latt, Dominique Hange, João Luiz Bastos, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Maya Tanrygulyyeva, Reza Malekzadeh, Dimitrios Poulimeneas, Pedro Ordunez, Thomas Waldhör, Ioannis Pagkalos, Carlo M. Barbagallo, Abla M. Sibai, Peter Vollenweider, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Santosh K. Bhargava, Patrick Kolsteren, Aya Mostafa, Fangfang Chen, Flavio Nervi, Imre Janszky, Arvind Pandey, Renata Cifkova, Alexandre C. Pereira, Alejandro Diaz, Alireza Ansari-Moghaddam, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Rusidah Selamat, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paul Korrovits, Paola Nardone, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Alberto Barceló, Camilla T. Damsgaard, Constance Schultsz, Frank J Rühli, Santiago F. Gomez, Tara Coppinger, Muhammad Islam, Pierre Traissac, Eleonora d'Orsi, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Daniela Pierannunzio, Cristina Taddei, Wen-Harn Pan, Gregor Starc, Abdullah Alkandari, Saeed Dastgiri, Lien Braeckevelt, Gustavo Velasquez-Melendez, Sudhir Kowlessur, Bagher Larijani, Cynthia Robitaille, Mohamed M. Ali, Steiner Krokstad, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Abhijit Sen, Sergej M. Ostojic, Silvana Donoso, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Hanan F. Abdul Rahim, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Bethlehem D. Solomon, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Miquel Porta, Vesna Jureša, Alexander D. Deev, Son Thai Pham, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, David Faeh, Antonio Bernabe-Ortiz, Giota Touloumi, Maryam Kavousi, Sanja Musić Milanović, Jalila El Ati, Sauli Herrala, Liang Xu, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Yi Song, Jianfeng Wu, Jeannette Klimont, Jean Ferrières, Farhad Zamani, Shina Avi, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Reecha Sofat, Koen Van Herck, Hoang Van Minh, Enrique Gutiérrez-González, Martine Vrijheid, Susana Cararo Confortin, Antonis Zampelas, Bogdan Wojtyniak, Ausra Petrauskiene, Juha Auvinen, Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Young-Ho Khang, Ellina Rakhimova, Magdalena Klimek, Luís Lopes, Erkin M. Mirrakhimov, Maria Lc Iurilli, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Rainford J. Wilks, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Li Juan Wu, Adrian Richter, Licia Iacoviello, Hanno Ulmer, Deepak Amarapurkar, Mohsen Ibrahim, Hamed Pouraram, Massimo Salvetti, Hung-Kwan So, Yonghua Hu, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Sabina Zambon, Angelika Schaffrath Rosario, Lauren Lissner, Kamarul Imran Musa, Deepa Weerasekera, Bihungum Bista, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Irene G. M. van Valkengoed, Anna Fijałkowska, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Nasheeta Peer, Radka Taxová Braunerová, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Eliza Cinteza, Ha Tp Do, and Alison J. Hayes
Subjects: education.field_of_study, business.industry, Population, Distribution (economics), medicine.disease, Obesity, Geography, medicine, Underweight, medicine.symptom, education, business, Body mass index, Demography
Published: 2020

18. Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries

Author: Deborah J. Wexler, Omar Mwalim, Nikolaos Prodromidis, Maja-Emilia Marcus, Gibson B. Kagaruki, Michaela Theilmann, Corine Houehanou, Krishna Kumar Aryal, Roy A Wong-McClure, Joseph Kibachio Mwangi, Demetre Labadarios, Pascal Geldsetzer, Garry Brian, Glennis Andall-Brereton, Joao S Martins, Rifat Atun, Khem Bahadur Karki, Jacqueline A. Seiglie, Lela Sturua, Cara Ebert, Sarah Quesnel-Crooks, Brice Wilfried Bicaba, Mohamed Msaidie, Pascal Bovet, Justine Davies, James B. Meigs, Sebastian Vollmer, Lindsay M. Jaacks, Jutta Mari Adelin Jorgensen, Mongal Singh Gurung, Kokou Agoudavi, Mary T Mayige, Till Bärnighausen, Bolormaa Norov, David Guwatudde, Dismand Houinato, Andrew Stokes, Bahendeka K Silver, Jennifer Manne-Goehler, Lindiwe Tsabedze, Gladwell Gathecha, Maria Dorobantu, and Chea Stanford Wesseh
Subjects: Adult, Male, Diabetes risk, Cross-sectional study, Social Determinants of Health, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Body Mass Index, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Diabetes mellitus, Internal Medicine, medicine, Nutrition transition, Diabetes Mellitus, Prevalence, Humans, 030212 general & internal medicine, Poisson regression, Epidemiology/Health Services Research, Socioeconomic status, Developing Countries, Poverty, Aged, Advanced and Specialized Nursing, Aged, 80 and over, business.industry, 1. No poverty, Middle Aged, medicine.disease, 3. Good health, Cross-Sectional Studies, Social Class, Socioeconomic Factors, Relative risk, symbols, Income, Educational Status, Female, business, Body mass index, Demography
Abstract: OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1–8.0) and of undiagnosed diabetes 4.9% (4.6–5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5–8.1), lower-middle-income economies (LMIs) 7.1% (6.6–7.6), and upper-middle-income economies (UMIs) 8.2% (7.5–9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22–1.78], LMIs 1.14 [1.06–1.23], and UMIs 1.28 [1.02–1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.
Published: 2020

19. Dry Matter Intake and In Vivo Digestibility of Grass-Only and Grass-White Clover in Individually Housed Sheep in Spring, Summer and Autumn

Author: Hurley, MaryAnne, primary, Lewis, Eva, additional, Beecher, Marion, additional, Garry, Brian, additional, Fleming, Christina, additional, Boland, Tommy, additional, and Hennessy, Deirdre, additional
Published: 2021
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20. Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data

Author: David Guwatudde, Glennis Andall-Brereton, Rifat Atun, Dismand Houinato, Nuno Lunet, Pascal Bovet, Joao S Martins, Jutta Mari Adelin Jorgensen, Roy A Wong-McClure, Gibson B. Kagaruki, Demetre Labadarios, Garry Brian, Joseph Kibachio Mwangi, Jacqueline A. Seiglie, Lindsay M. Jaacks, Justine Davies, Till Bärnighausen, Sumithra Krishnamurthy Reddiar, Khem Bahadur Karki, Nahla Hwalla, Krishna Kumar Aryal, Adil Supiyev, Omar Mwalim Omar, Zhaxybay Zhumadilov, Cara Ebert, Andrew Stokes, Brice Wilfried Bicaba, Mohamed Msaidie, Sebastian Vollmer, Jennifer Manne-Goehler, Pascal Geldsetzer, Abla M. Sibai, Mary T Mayige, Sarah Quesnel-Crooks, Maja E Marcus, Corine Houehanou, Lisa R. Hirschhorn, Bahendeka K Silver, Mongal Singh Gurung, Bolormaa Norov, Lela Sturua, and Instituto de Saúde Pública da Universidade do Porto
Subjects: Economics, Social Sciences, Blood Pressure, 030204 cardiovascular system & hematology, Logistic regression, Global Health, Vascular Medicine, 0302 clinical medicine, Endocrinology, Medical Conditions, Risk Factors, Surveys and Questionnaires, Per capita, Global health, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, 10. No inequality, 1. No poverty, General Medicine, 3. Good health, Cardiovascular Diseases, Preparedness, Hypertension, Income, Medicine, Research Article, Endocrine Disorders, 03 medical and health sciences, Health Economics, Diagnostic Medicine, Diabetes mellitus, Environmental health, medicine, Diabetes Mellitus, Humans, Human Development Index, Noncommunicable Diseases, Developing Countries, Poverty, Quality of Health Care, Health economics, Health Care Policy, business.industry, Health Services Administration and Management, Odds ratio, medicine.disease, Health Care, Cross-Sectional Studies, Metabolic Disorders, Diabetes Diagnosis and Management, business
Abstract: Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases (‘NCD readiness indicators’ from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08–3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09–4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02–1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06–1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11–1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01–1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12–2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01–1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09–1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01–1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. Conclusion In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries’ preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care., Author summary Why was the study done? Diseases such as high blood pressure and diabetes are becoming increasingly common in low- and middle-income countries (LMICs). Treatment for these conditions is simple and cheap. However, without treatment, sufferers are at high risk of adverse consequences, such as heart attacks and strokes. It is important therefore to be able to measure whether patients who need treatment are getting it. Currently, LMICs’ progress towards being able to treat patients with hypertension and diabetes is measured using proxies, for example, whether policies, guidelines, funding, structures, or human resources are in place. What did the researchers find? We measured whether 187,552 people with hypertension living in 43 LMICs and 40,795 people with diabetes living in 28 LMICs had their high blood pressure or diabetes treated well; i.e., they had these conditions diagnosed, treated, or controlled. We found that most proxy measures were not reflective of whether patients had their condition treated well. What do these findings mean? To judge countries’ progress towards ability to treat hypertension and diabetes requires directly assessing whether people with these diseases are getting the treatment that they need. The main limitation of the study was that a one-time measurement of blood pressure or blood glucose was used to define whether participants had high blood pressure or diabetes. To make a concrete clinical diagnosis requires more detailed investigation.
Published: 2019

21. Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys

Author: Bolormaa Norov, Lindiwe Tsabedze, Gladwell Gathecha, Mary T Mayige, Till Bärnighausen, Garry Brian, Rifat Atun, Gibson B. Kagaruki, Maria Dorobantu, Cara Ebert, Andrew Stokes, Chea Stanford Wesseh, Lindsay M. Jaacks, Bahendeka K Silver, Pascal Bovet, Lela Sturua, Jennifer Manne-Goehler, Pascal Geldsetzer, Glennis Andall-Brereton, Corine Houehanou, David Guwatudde, Demetre Labadarios, Jutta Mari Adelin Jorgensen, Kokou Agoudavi, Roy Wong McClure, Dismand Houinato, Justine Davies, Sarah Quesnel-Crooks, Krishna Kumar Aryal, Maja E Marcus, Brice Wilfried Bicaba, Mohamed Msaidie, Sebastian Vollmer, Joseph Kibachio Mwangi, Joao S Martins, Khem Bahadur Karki, Omar Mwalim, Mongal Singh Gurung, Institute of Social and Preventive Medicine, Lausanne university hospital, Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), University of Abomey Calavi (UAC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), and Université de Limoges (UNILIM)-Université de Limoges (UNILIM)
Subjects: Male, Cross-sectional study, Social Sciences, 030204 cardiovascular system & hematology, Surveys, Diabetes treatment, Biochemistry, Health Surveys/economics, 0302 clinical medicine, Endocrinology, Sociology, Delivery of Health Care/economics, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, Young adult, Health Services Needs and Demand/economics, Pharmaceutics, 1. No poverty, General Medicine, Diabetes mellitus therapy, Middle Aged, Socioeconomic Aspects of Health, 3. Good health, Poverty/economics, Income/trends, Research Design, Adolescent, Adult, Cross-Sectional Studies, Delivery of Health Care/trends, Diabetes Mellitus/economics, Diabetes Mellitus/epidemiology, Diabetes Mellitus/therapy, Female, Health Services Needs and Demand/trends, Health Surveys/trends, Humans, Poverty/trends, Young Adult, Income, Medicine, Research Article, Endocrine Disorders, MEDLINE, Research and Analysis Methods, Education, 03 medical and health sciences, Drug Therapy, Diagnostic Medicine, Diabetes mellitus, Environmental health, medicine, Diabetes Mellitus, Drug therapy, Educational attainment, Diabetes diagnosis and management, Biomarkers, Health services administration and management, Socioeconomic aspects of health, Poverty, Educational Attainment, Health Services Needs and Demand, Survey Research, business.industry, Health Services Administration and Management, Biology and Life Sciences, medicine.disease, Health Surveys, Health Care, Low and middle income countries, Metabolic Disorders, Diabetes Diagnosis and Management, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Delivery of Health Care
Abstract: Background The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. Methods and findings We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. Conclusions The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured., Using individual participant data from a large cohort study, Jennifer Manne-Goehler and colleagues reveal poor healthcare provision for diabetes patients in 28 LMICs., Author summary Why was this study done? Diabetes is a growing problem in low-income and middle-income countries, which already carry about 75% of the global diabetes burden, but there is limited evidence to guide policymaking in these settings. Prior studies have analyzed the cascade of care for diabetes in single-country or subnational contexts, but to our knowledge there have been no prior multi-country analyses on this subject. This study analyzes nationally representative data regarding health system performance for people who have diabetes, as defined by biological criteria, across a spectrum of levels of economic development. What did the researchers do and find? We harmonized nationally representative population-based survey data from 28 low-income and middle-income countries in 4 geographic regions, and used these data to construct the diabetes care cascade stratified by individual factors and national income. In this sample of over 800,000 adults, the overall prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), of which 4.8% (95% CI: 4.5%–5.2%) was undiagnosed. In this study, we found that health system performance for diabetes showed large losses to care at the stage of detection (63.4% [95% CI: 56.7%–69.6%]) and low rates of diabetes control (22.8% [95% CI: 20.9%–24.9%]). Total unmet need for diabetes care (defined as the sum of undetected, detected but undiagnosed, diagnosed but untreated, and treated but not controlled diabetes) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was better in upper-middle-income countries, but across all World Bank income groups, only 16%–25% of those with diabetes achieved diabetes control. Increasing age, educational attainment, and overweight or obesity were associated with higher odds of being tested, treated, and achieving control. What do these findings mean? There is a large unmet need for diabetes care that reflects the need for a greater investment of health resources to strengthen systems of care for this disease. Given that diabetes is considered a tracer condition for examining health systems, these findings also indicate that many countries face challenges in achieving universal health coverage.
Published: 2019

22. Comparison of Automated and Partial Coherence Keratometry and Resulting Choice of Toric IOL

Author: Jit B. Ale Magar, Garry Brian, and Frank Cunningham
Subjects: medicine.medical_specialty, Cylindrical power, Biometry, genetic structures, medicine.medical_treatment, Intraocular lens, Astigmatism, Prosthesis Design, Refraction, Ocular, law.invention, Cornea, law, Ophthalmology, medicine, Humans, Postoperative Period, Dioptre, Retrospective Studies, Mathematics, Lenses, Intraocular, Keratometer, Corneal curvature, Corneal Topography, Reproducibility of Results, medicine.disease, eye diseases, sense organs, Corneal astigmatism, Partial coherence, Follow-Up Studies, Optometry
Abstract: PURPOSE Consistent astigmatism correction with implantation of a toric intraocular lens (IOL) requires accurate preoperative keratometry. This article compares corneal astigmatism determined by an autokeratometer (Topcon KR-7100) and a partial coherence interferometry keratometer (IOLMaster 500) and considers if any discrepancy ultimately alters in final cylindrical power of the toric IOL for implantation. METHODS Keratometry of 235 eyes was performed using both instruments. Corneal astigmatism was transformed into vector components J0 and J45 and cylindrical power at the IOL plane calculated. Comparisons were made using paired t test and correlation and Bland-Altman analyses. RESULTS Although interinstrument differences for J0 (p = 0.013), J45 (p = 0.012), and toric IOL cylindrical power (p < 0.001) were statistically significant, a high correlation for these (R = 0.96, 0.90, and 0.90, respectively) was observed. IOLMaster tended to overestimate corneal astigmatism by 0.13 (±0.31) diopters and toric IOL cylinder by 0.11 (±0.18) diopters. Difference in calculated toric IOL cylindrical power correlated poorly with corneal curvature (R = 0.007) and astigmatism (R = -0.004). CONCLUSIONS The two keratometers were generally concordant in measuring corneal astigmatism. However, the resultant choice of toric IOL cylinder power differed appreciably in 40% of eyes examined. Therefore, postoperative visual outcome with toric IOL implantation may be optimized by a thorough analysis of biometry data before IOL selection, paying special attention to any difference in corneal astigmatism as measured by more than one instrument.
Published: 2013

23. Using a Rights-Based Approach to Avoid Harming Health Systems: A Case Study from Papua New Guinea

Author: Garry Brian and Carmel Williams
Subjects: History, Sociology and Political Science, Political science, Political Science and International Relations, New guinea, Gender studies, Criminology, Law, Healthcare system
Published: 2013

24. Optic Neuropathy among a Prison Population in Papua New Guinea

Author: Garry Brian, Bernard J. Venn, Camilla Gould, Robert McKay, Sheila M. Williams, and Benoit Tousignant
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, genetic structures, Homocysteine, Epidemiology, alpha-Tocopherol, Visual impairment, Vision Disorders, Riboflavin, Folic Acid Deficiency, Optic neuropathy, Papua New Guinea, Selenium, chemistry.chemical_compound, Folic Acid, Risk Factors, Surveys and Questionnaires, Optic Nerve Diseases, Prevalence, medicine, Humans, Vitamin A, business.industry, Prisoners, Lutein, New guinea, beta Carotene, medicine.disease, Confidence interval, Surgery, Vitamin B 12, Ophthalmology, Cross-Sectional Studies, Peripheral neuropathy, chemistry, Optic nerve, Female, medicine.symptom, business
Abstract: To estimate the prevalence of optic neuropathy (ON) among prisoners in a provincial prison in Papua New Guinea, and to explore risk factors for this condition among this population.Cross-sectional observation study of 148 male prisoners aged ≥18 years using an interview-based questionnaire, assessment of visual and nervous system function, ocular examination, and blood analysis (α-tocopherol, β-carotene, lutein, folate, homocysteine, holotranscobalamin II, riboflavin, selenium, thiamin, and vitamins A, B(12) and C). Likelihood of the presence of ON was based on ordered groups determined by weighted combination of optic nerve head appearance and visual dysfunction (acuity, field, color perception). Main outcome measures were prevalence and associations of ON.Sample prevalence of clinical ON was 10.4% (95% confidence interval [CI], 6.2-16.8). No cases were found of unexplained non-visual nervous system dysfunction, including peripheral neuropathy. Increasing age (p = 0.001), length of current (p = 0.002) and lifetime (p = 0.03) incarceration, and duration of smoking by current smokers (p = 0.001) were associated with increased ON likelihood. However, when age-controlled, the smoking duration association was not maintained (p = 0.6). Prisoners were folate deficient. Adjusting for age and duration of current incarceration, whole blood (p = 0.02) and red blood cell (p = 0.04) folate concentrations were inversely associated with ON likelihood. No association was found for any other assessed demographic, lifestyle or biochemical measure.A cluster of ON associated with folate deficiency has been identified. Recommendations for dietary change and micronutrient supplementation have been made.
Published: 2013

25. Spectacle Dispensing in Timor-Leste: Tiered-pricing, Cross-subsidization and Financial Viability

Author: Anna Palagyi, Jacqueline Ramke, and Garry Brian
Subjects: Adult, Male, Rural Population, Financing, Government, Financing, Personal, Timor leste, Adolescent, National Health Programs, Cross subsidization, Epidemiology, Visual Acuity, Cost recovery, Urban services, Profit (economics), Young Adult, Humans, Medicine, Child, Aged, Finance, business.industry, Spectacle, Infant, Subsidy, Presbyopia, Middle Aged, Refractive Errors, Ophthalmology, Eyeglasses, Fees and Charges, Indonesia, Child, Preschool, Health Care Surveys, Female, Rural area, business
Abstract: To examine the financial viability of the Timor-Leste National Spectacle Program as it increases spectacle availability, affordability and uptake, particularly for Timor's poor.In rural areas, three models of ready-made spectacles were dispensed according to a tiered pricing structure of US$3.00, 1.00, 0.10 and 0.00. In addition, custom-made spectacles were available in the capital, Dili. Spectacle costs, dispensing data and income for the National Spectacle Program for 18 months from March 2007 were analyzed.Rural services dispensed 3415 readymade spectacles: 47.1% to women, and 51.4% at subsidized prices, being 39.8% at US$0.10 and 11.6% free. A profit of US$1,529 was generated, mainly from the sale of US$3.00 spectacles. Women (odds ratio, OR, 1.3, 95% confidence interval, CI, 1.1-1.4) and consumers aged ≥65 years (OR 2.1; 95% CI 1.7-2.6) were more likely to receive subsidized spectacles. Urban services dispensed 2768 spectacles; mostly US$3.00 readymade (52.8%) and custom-made single vision (29.6%) units. Custom-made spectacles accounted for 36.7% of dispensing, but 73.1% of the US$12,264 urban profit. The combined rural and urban profit covered all rural costs, leaving US$2,200 to meet administration and other urban expenses.It is instructive and encouraging that a national spectacle dispensing program in one of the ten poorest countries of the world can use tiered-pricing based on willingness-to-pay information to cover spectacle stock replacement costs and produce profit, while using cross-subsidization to provide spectacles to the poor.
Published: 2012

26. Eye Care in Fiji: A Population-based Study of Use and Barriers

Author: Jacqueline Ramke, Garry Brian, Anna Palagyi, and Louise Maher
Subjects: Adult, Male, Rural Population, Health Knowledge, Attitudes, Practice, Urban Population, Epidemiology, Population, Developing country, Eye care, Health Services Accessibility, Poor vision, Surveys and Questionnaires, Complaint, Fiji, Humans, Medicine, education, Developing Countries, Aged, education.field_of_study, business.industry, Health Care Costs, Health Services, Middle Aged, Health Surveys, Medical services, Population based study, Ophthalmology, Cross-Sectional Studies, Patient Satisfaction, Multistage sampling, Optometry, Female, business, Demography
Abstract: To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care.An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island.Participation rate was 73.0% (n = 1381). A current vision or eye problem was reported by 931 participants, and a further 235 recalled a previous difficulty. Urban dwellers (P = 0.002) and those aged ≥50 years (P = 0.017) were more likely to report a problem. Gender was not predictive (P = 0.215). "Blurred/poor vision" was the most common complaint (78.5%). Over half (53.3%) had not sought care for the problem most important to them. For current problems, being younger (P 0.001) and from a household without paid income (P = 0.007) were predictive of being less likely to seek treatment. Gender was not (P = 0.416). The most frequently cited principal reason for not seeking care was "able to manage/accept the problem" (66.5%; of whom 84.7% claimed vision problems). Direct and indirect costs were mentioned as deterrents. "Thought nothing could be done" (P = 0.032) and "lack of awareness of service availability" (P = 0.026) were more common among rural dwellers. Of participants who sought care, 75.6% used government services. Most participants requiring spectacles or medication incurred costs for these. Satisfaction with overall care was independent of provider (P = 0.062) and user gender (P = 0.851).With expanding service delivery, increased eye health promotion, and attention to the financing of treatments, improved service use ought to be possible in Fiji.
Published: 2012

27. Using health rights to improve programme design: a Papua New Guinea case study

Author: Garry Brian and Carmel Williams
Subjects: Economic growth, Right to health, Human rights, business.industry, Health Policy, media_common.quotation_subject, International health, Public relations, Organizational Case Studies, Global health, Health education, Quality (business), Sociology, business, Health policy, media_common
Abstract: The non-state sector is becoming increasingly influential in funding and implementing global health programmes. However, their disease-specific focus and vertical interventions have led to criticism that these programmes can be unsustainable and unable to achieve long-term goals. This paper demonstrates that health rights can inform programme design to guide the design of appropriate and sustainable aid-funded health programmes. It draws on UN General Comment 14, which clarified the right to health duties of states and their international partners, and which determined that 'core obligations' in health must become progressively available, accessible, acceptable and of good quality. A rights-based tool assessed the design of activities proposed for Papua New Guinea by a consortium of Australian non-government organisations. The tool revealed that none of the 36 indicators was addressed in full. Five of the 12 indicators pertaining to availability were addressed partially, as were three of 10 relating to accessibility and one of six concerning human rights concepts. As shown by the case study, failure to address the indicators in this tool will result in simplistic programme designs that can win political or financial support, but will fail to respect health rights or deliver a quality health service, available, accessible and acceptable to all.
Published: 2012

28. Prevalence and causes of blindness and low vision among adults in Fiji

Author: Jacqueline Ramke, Garry Brian, Mundi Qalo Qoqonokana, John Szetu, and Louise Maher
Subjects: education.field_of_study, Refractive error, Multivariate analysis, Visual acuity, genetic structures, business.industry, Cross-sectional study, Population, medicine.disease, eye diseases, Confidence interval, Ophthalmology, Medicine, Optometry, Cluster sampling, medicine.symptom, Risk factor, education, business, Demography
Abstract: Background: To estimate the prevalence and causes of blindness and low vision among adults aged ≥40 years in Fiji. Design: Population-based cross-sectional study. Participants: Adults aged ≥40 years in Viti Levu, Fiji. Method: A population-based cross-sectional survey used multistage cluster random sampling to identify 34 clusters of 40 people. A cause of vision loss was determined for each eye with presenting vision worse than 6/18. Main Outcome Measures: Blindness (better eye presenting vision worse than 6/60), low vision (better eye presenting vision worse than 6/18, but 6/60 or better). Results: Of 1892 people enumerated, 1381 participated (73.0%). Adjusting sample data for ethnicity, gender, age and domicile, the prevalence of blindness was 2.6% (95% confidence interval 1.7, 3.4) and low vision was 7.2% (95% confidence interval 5.9, 8.6) among adults aged ≥40 years. On multivariate analysis, being ≥70 years was a risk factor for blindness, but ethnicity, gender and urban/rural domicile were not. Being Indo-Fijian, female and older were risk factors for vision impairment (better eye presenting vision worse than 6/18). Cataract was the most common cause of bilateral blindness (71.1%). Among participants with low vision, uncorrected refractive error caused 63.3% and cataract was responsible for 25.0%. Conclusion: Strategies that provide accessible cataract and refractive error services producing good quality outcomes will likely have the greatest impact on reducing vision impairment.
Published: 2012

29. BMI among Timorese aged ≥40 years

Author: Garry Brian and Jacqueline Ramke
Subjects: Male, Rural Population, Multivariate analysis, Urban Population, media_common.quotation_subject, Population, Medicine (miscellaneous), Distribution (economics), Overweight, Literacy, Body Mass Index, Sex Factors, Thinness, Prevalence, medicine, Humans, Obesity, education, Functional illiteracy, media_common, Family Characteristics, education.field_of_study, Nutrition and Dietetics, business.industry, Age Factors, Public Health, Environmental and Occupational Health, Indonesia, Multivariate Analysis, Income, Educational Status, Household income, Female, Underweight, medicine.symptom, business, Demography
Abstract: ObjectiveTo determine the distribution and sociodemographic associations of BMI (kg/m2) among adults aged ≥40 years living in Timor-Leste.DesignBMI was calculated for participants of a population-based cross-sectional survey.SettingUrban and rural Timor-Leste.SubjectsAdults aged ≥40 years living in Timor-Leste.ResultsOf those enumerated, 2014 participated (89·5 %). Male gender, rural domicile, older age, illiteracy and source of household income were associated with BMI < 18·5 kg/m2 on multivariate analysis. Female gender, urban domicile and literacy were associated with BMI ≥25·0 and ≥30·0 kg/m2. Adjusting for gender, age and domicile, and extrapolating to those aged ≥40 years across Timor-Leste, 9·9 %, 36·0 %, 6·6 % and 0·8 % had BMI 2, respectively.ConclusionsAt this time, being ‘underweight’ or ‘severely thin’ is more prevalent in the Timorese adult population than being ‘overweight’ or ‘obese’.
Published: 2012

30. Serum Retinol and Xerophthalmia Among a Prison Population in Papua New Guinea

Author: Camilla Gould, Robert McKay, Benoit Tousignant, Garry Brian, and Bernard J. Venn
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, genetic structures, Epidemiology, Cross-sectional study, Pilot Projects, Fundus (eye), Gastroenterology, Nyctalopia, Papua New Guinea, Young Adult, chemistry.chemical_compound, Night Blindness, Surveys and Questionnaires, Internal medicine, Xerophthalmia, parasitic diseases, medicine, Humans, Young adult, Vitamin A, Aged, Prison population, Vitamin A Deficiency, business.industry, Retinol, Middle Aged, medicine.disease, Surgery, Vitamin A deficiency, Ophthalmology, Cross-Sectional Studies, chemistry, Prisons, medicine.symptom, business, Biomarkers
Abstract: To estimate the prevalence of vitamin A deficiency (VAD) and one of its clinical manifestations, xerophthalmia, and examine the predictive value of nyctalopia and ocular signs for serum retinol concentrations among a prison population in Papua New Guinea.A cross-sectional study of 148 prisoners and 9 guards; all males aged ≥18 years. Interview-based questionnaire; ocular examination; serum retinol concentration determination.Two guards had marginal (retinol1.05-≥0.70 µmol/L) VAD. For prisoners: mean retinol was 0.84 ± 0.49 µmol/L; 43.9% (95% CI 35.9, 52.2) had VAD (retinol0.70 µmol/L); 9.6% (95% CI 5.1, 17.0) self-reported nyctalopia prior to, and 36.1% (95% CI 27.7, 45.5) after incarceration; 10.9% (95% CI 6.7, 17.0) exhibited at least one sign of xerophthalmia (2 had fundus changes; all 4 with more than conjunctival xerosis alone had severe [0.35 µmol/L] retinol deficiency). Prisoners with ocular signs were more likely than those without to have VAD (OR 10.4; 95% CI 2.5, 70.3; P 0.001) and severe retinol deficiency (OR 19.1; 95% CI 5.5, 77.2; P 0.001). Positive (PPV) and Negative (NPV) Predictive Values: of nyctalopia for any (PPV 62.9%; NPV 32.8%) and severe (PPV 25.7%; NPV 85.9%) retinol deficiency; of ocular signs for any (PPV 93.3%; NPV 38.2%) and severe (PPV 73.1%; NPV 87.8%) retinol deficiency, and VAD (PPV 86.5%, NPV 38.2%).VAD and xerophthalmia were present in this prison population. There may be VAD in the wider community. The former needs remedy and the latter deserves investigation. Self-reported nyctalopia was not a useful indicator of retinol deficiency. Absence of ocular signs was unhelpful for ruling out VAD.
Published: 2011

31. Diabetic eye disease among adults in Fiji with previously undiagnosed diabetes

Author: Konstanze Fischer-Harder, Jacqueline Ramke, Biu Sikivou, Mundi Qalo Qoqonokana, Garry Brian, and John Szetu
Subjects: education.field_of_study, medicine.medical_specialty, Pediatrics, Cross-sectional study, business.industry, Eye disease, Population, Diabetic retinopathy, medicine.disease, Diabetic Eye Disease, Surgery, Ophthalmology, Diabetes mellitus, Cohort, medicine, education, business, Retinopathy
Abstract: Background: To determine the prevalence and severity of diabetic eye disease among adults aged ≥40 years with unrecognized diabetes in Fiji. Design: Population-based cross-sectional survey using multistage cluster random sampling. Participants: 1381 (=73.0% participation). Methods: Interview-based questionnaire; visual acuity measured; dilated ocular examination performed; glycosylated haemoglobin (HbA1c) concentration determined. Main Outcome Measures: Prevalence and grade of diabetic retinopathy/maculopathy. Results: Sample prevalence of diabetes was 44.8% (95%CI 42.2–47.5%), with 63.4% (95%CI 59.5–67.1%) previously undiagnosed (384/606). Predictors of undiagnosed compared with previously diagnosed diabetes were female gender (P = 0.001), rural residence (P = 0.049) and not having a relative with known diabetes (P 50 years), this was vision-threatening (1.0%; 95%CI 0.3–2.8). Mean HbA1c (10.7 ± 2.6%) of participants undiagnosed and with diabetes eye disease was higher (P
Published: 2011

32. Refractive Error and Presbyopia Among Adults in Fiji

Author: Garry Brian, Jacqueline Ramke, and Matthew G Pearce
Subjects: Adult, Male, Rural Population, Refractive error, Binocular distance, Urban Population, Epidemiology, Cross-sectional study, Population, Visual Acuity, Near vision, Age Distribution, Surveys and Questionnaires, Prevalence, medicine, Fiji, Humans, Sex Distribution, education, Developing Countries, Aged, Health Services Needs and Demand, Vision, Binocular, education.field_of_study, business.industry, Presbyopia, Middle Aged, Refractive Errors, medicine.disease, Ophthalmology, Cross-Sectional Studies, Eyeglasses, Optometry, Female, Age distribution, Cluster sampling, business
Abstract: To characterize refractive error, presbyopia and their correction among adults aged ≥ 40 years in Fiji, and contribute to a regional overview of these conditions.A population-based cross-sectional survey using multistage cluster random sampling. Presenting distance and near vision were measured and dilated slitlamp examination performed.The survey achieved 73.0% participation (n=1381). Presenting binocular distance vision ≥ 6/18 was achieved by 1223 participants. Another 79 had vision impaired by refractive error. Three of these were blind. At threshold 6/18, 204 participants had refractive error. Among these, 125 had spectacle-corrected presenting vision ≥ 6/18 ("met refractive error need"); 79 presented wearing no (n=74) or under-correcting (n=5) distance spectacles ("unmet refractive error need"). Presenting binocular near vision ≥ N8 was achieved by 833 participants. At threshold N8, 811 participants had presbyopia. Among these, 336 attained N8 with presenting near spectacles ("met presbyopia need"); 475 presented with no (n=402) or under-correcting (n=73) near spectacles ("unmet presbyopia need"). Rural residence was predictive of unmet refractive error (p=0.040) and presbyopia (p=0.016) need. Gender and household income source were not. Ethnicity-gender-age-domicile-adjusted to the Fiji population aged ≥ 40 years, "met refractive error need" was 10.3% (95% confidence interval [CI] 8.7-11.9%), "unmet refractive error need" was 4.8% (95%CI 3.6-5.9%), "refractive error correction coverage" was 68.3% (95%CI 54.4-82.2%),"met presbyopia need" was 24.6% (95%CI 22.4-26.9%), "unmet presbyopia need" was 33.8% (95%CI 31.3-36.3%), and "presbyopia correction coverage" was 42.2% (95%CI 37.6-46.8%).Fiji refraction and dispensing services should encourage uptake by rural dwellers and promote presbyopia correction. Lack of comparable data from neighbouring countries prevents a regional overview.
Published: 2011

33. Cataract and its surgery in Fiji

Author: Mundi Qalo Qoqonokana, Jacqueline Ramke, John Szetu, and Garry Brian
Subjects: medicine.medical_specialty, education.field_of_study, Visual acuity, genetic structures, Blindness, Cross-sectional study, business.industry, medicine.medical_treatment, Population, Intraocular lens, Odds ratio, medicine.disease, eye diseases, Confidence interval, Surgery, Ophthalmology, Diabetes mellitus, medicine, medicine.symptom, business, education
Abstract: Background: To characterize cataract and its surgery among adults aged ≥40 years in Fiji. Design: Population-based cross-sectional survey using multistage cluster random sampling. Participants: 1381 (= 73.0% participation); eight provinces on Viti Levu. Methods: Interview-based questionnaire; visual acuity measured; autorefraction; dilated ocular examination. Main Outcome Measures: Prevalence; predictors; surgical outcomes. Results: Being Indian (P = 0.001), elderly (P
Published: 2011

34. Population-based study of self-reported ocular trauma in Fiji

Author: Garry Brian, Jacqueline Ramke, John Szetu, and Renee du Toit
Subjects: Pediatrics, medicine.medical_specialty, education.field_of_study, Visual acuity, genetic structures, Cross-sectional study, business.industry, Population, Poison control, Odds ratio, eye diseases, Confidence interval, Occupational safety and health, Surgery, Ophthalmology, Injury prevention, medicine, medicine.symptom, business, education
Abstract: Background: To characterize causes, risk factors and outcomes for ocular trauma among adults aged ≥40 years in Fiji. Design: Population-based cross-sectional survey; multistage cluster random sampling. Participants: 1381 (= 73.0% participation); eight provinces on Viti Levu. Methods: Interview-based questionnaire. Visual acuity measurement. Dilated ocular examination. Main Outcome Measures: Circumstances, management and consequences of self-reported ocular trauma. Results: Of participants, 20.6% recalled ocular trauma: being Melanesian (P 15 years: 38.5% occurred inside the home, most by sharp objects (51.6%) and domestic violence (28.4%); agricultural activities caused 20.6% of injuries; non-agricultural workplace incidents caused 16.2%, with chemicals responsible for 27.5% of these; public alcohol consumption was associated with 13.8% of injuries, mostly by assault (91.2%). Conventional medical services were the primary source of care for 47.2% of injured participants: 61.9% attended on injury day. For trauma: sample prevalence of vision impairment in at least one eye was 1.7% (95% confidence interval 1.1–2.4%), and 0.1% (95% confidence interval 0.02–0.5) for bilateral blindness. Injury at ≤15 years (P = 0.008) and at the workplace (P = 0.044) were predictive of ongoing vision impairment. Of visually impaired eyes, 36% had corneal opacity that may have been caused by relatively minor trauma. Conclusions: Ophthalmic service strengthening (including minor corneal trauma management) and specific injury prevention strategies (including behaviour change education and advocacy for legislation) are required to decrease the ocular trauma burden in Fiji.
Published: 2011

35. Diabetic eye disease among adults in Fiji with self-reported diabetes

Author: Jacqueline Ramke, Mundi Qalo Qoqonokana, Biu Sikivou, Konstanze Fischer-Harder, Garry Brian, and John Szetu
Subjects: education.field_of_study, medicine.medical_specialty, Visual acuity, genetic structures, business.industry, Eye disease, Population, Diabetic retinopathy, medicine.disease, eye diseases, Diabetic Eye Disease, Ophthalmology, Diabetes mellitus, Medicine, Maculopathy, medicine.symptom, business, education, Retinopathy
Abstract: Background: To characterize diabetic eye disease and its management among adults aged ≥40 years with self-reported diabetes in Fiji. Methods: During a population-based cross-sectional survey using multistage cluster random sampling, participants reported health information, including whether a doctor had diagnosed diabetes. HbA1c and visual acuity were measured. Diabetic eye disease was assessed using 90-dioptre lens dilated funduscopy. Results: Of those enumerated, 1381 (73.0%) participated, with 222 reporting diabetes. Twenty fundi were not examined (19 due to cataract). Of the remaining 424 eyes, 75.5% had no diabetic disease, 1.2% had proliferative retinopathy, 7.5% had active significant maculopathy and 0.7% had burnt-out/treated disease. By person, 27.2% had retinopathy and/or maculopathy in at least one eye. Mean HbA1c (9.9 ± 2.3%) for this group was significantly higher (P = 0.004) than for those without eye disease. Vision-threat occurred in at least one eye of 11.5%. Diabetes (predominantly maculopathy) caused pinhole acuity 10 years ago was predictive of any (odds ratio [OR] 8.13; 95% confidence interval [CI] 3.28–20.21; P
Published: 2010

36. Training and using mid-level eye care workers: early lessons from Timor-Leste

Author: Anna Palagyi, Garry Brian, and Jacqueline Ramke
Subjects: Ophthalmology, Nursing, business.industry, Software deployment, Best practice, Cohort, Curriculum development, Medicine, Eye care, business, Training (civil), Curriculum, Graduation
Abstract: Background: A 12-month Diploma of Eye Care course for mid-level eye care workers was initiated in 2007 as part of Timor-Leste’s National Eye Health Strategy. This paper reports the development and implementation of this course, examines its initial results and makes suggestions for improvements to the training and deployment of these workers. Methods: Course curriculum development and delivery, trainee selection and candidate assessment were examined. Graduate clinical knowledge retention at 6 months after course completion was investigated using clinical vignettes to determine diagnosis, management and patient counselling knowledge for common primary eye health conditions. Graduate workplace environments and activities were appraised. Results: Development of the course curriculum and its delivery were in response to local circumstance, and according to education best practice teaching and learning strategies. Four rural nurses successfully completed the inaugural course. Although all remained in rural eye care services at 6 months after graduation, there was considerable variation in activity. Substantial depletion of clinical competency was revealed across the cohort. Conclusions: Adherence to current best practice in the design and delivery of the curriculum and course was insufficient to ensure productive graduates of ongoing clinical competency, positioned to make an impact on eye health. Attention needs to be directed to postgraduation integration into the workplace, and continuing support once there. The efficacy of this mid-level cadre and its impact on eye health requires further evaluation.
Published: 2010

37. The Incidence of Contact Lens–Related Microbial Keratitis in Australia

Author: Thomas Naduvilath, John K G Dart, Garry Brian, Fiona Stapleton, Brien A. Holden, Katie Edwards, and Lisa Keay
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Contact Lenses, Population, Eye Infections, Bacterial, Risk Factors, Internal medicine, Ophthalmology, medicine, Humans, Prospective Studies, Risk factor, Corneal Ulcer, Prospective cohort study, education, education.field_of_study, Bacteria, business.industry, Incidence, Incidence (epidemiology), Australia, Absolute risk reduction, Middle Aged, Eye infection, Health Surveys, Confidence interval, Contact lens, Population Surveillance, Female, business
Abstract: Objective To establish the absolute risk of contact lens (CL)-related microbial keratitis, the incidence of vision loss and risk factors for disease. Design A prospective, 12-month, population-based surveillance study. Participants New cases of CL-related microbial keratitis presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners (numerator). Case detection was augmented by records' audits at major ophthalmic centers. The denominator (number of wearers of different CL types in the community) was established using a national telephone survey of 35 914 individuals. Testing Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Visual outcomes were determined 6 months after the initial event. Annualized incidence and confidence intervals (CI) were estimated for different severities of disease and multivariable analysis was used in risk factor analysis. Main Outcome Measures Annualized incidence (with CI) of disease and vision loss by CL type and wear modality and identification of independent risk factors. Results We identified 285 eligible cases of CL-related microbial keratitis and 1798 controls. In daily wear rigid gas-permeable CL wearers, the annualized incidence per 10 000 wearers was 1.2 (CI, 1.1–1.5); in daily wear soft CL wearers 1.9 (CI, 1.8–2.0); soft CL wearers (occasional overnight use) 2.2 (CI, 2.0–2.5); daily disposable CL wearers 2.0 (CI, 1.7–2.4); daily disposable CL wearers (occasional overnight use) 4.2 (CI, 3.1–6.6); daily wear silicone hydrogel CL wearers 11.9 (CI, 10.0–14.6); silicone hydrogel CL wearers (occasional overnight use) 5.5 (CI, 4.5–7.2); overnight wear soft CL wearers 19.5 (CI, 14.6–29.5) and in overnight wear of silicone hydrogel 25.4 (CI, 21.2–31.5). Loss of vision occurred in 0.6 per 10 000 wearers. Risk factors included overnight use, poor storage case hygiene, smoking, Internet purchase of CLs, Conclusions Incidence estimates for soft CL use were similar to those previously reported. New lens types have not reduced the incidence of disease. Overnight use of any CL is associated with a higher risk than daily use. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
Published: 2008

38. Public sector refraction and spectacle dispensing in low-resource countries of the Western Pacific

Author: Carmel Williams, Anna Palagyi, Jacqueline Ramke, Renee du Toit, and Garry Brian
Subjects: Economic growth, media_common.quotation_subject, Population, Legislation, Pacific Islands, computer.software_genre, Systems management, Humans, Medicine, Quality (business), Health Workforce, education, media_common, education.field_of_study, Public Sector, Community engagement, business.industry, Health Policy, Public sector, Health Services, Refractive Errors, Checklist, Outreach, Ophthalmology, Eyeglasses, Health Resources, Optometry, business, computer
Abstract: Background: Given that uncorrected refractive error is a frequent cause of vision impairment, and that there is a high unmet need for spectacles, an appraisal of public sector arrangements for the correction of refractive error was conducted in eight Pacific Island countries. Methods: Mixed methods (questionnaire and semi-structured interviews) were used to collect information from eye care personnel (from Fiji, Papua New Guinea, Solomon Islands, Vanuatu, Cook Islands, Samoa, Tonga and Tuvalu) attending a regional eye health workshop in 2005. Results: Fiji, Tonga and Vanuatu had Vision 2020 eye care plans that included refraction services, but not spectacle provision. There was wide variation in public sector spectacle dispensing services, but, except in Samoa, ready-made spectacles and a full cost recovery pricing strategy were the mainstay. There were no systems for the registration of personnel, nor guidelines for clinical or systems management. The refraction staff to population ratio varied considerably. Solomon Islands, Tuvalu and Vanuatu had the best coverage by services, either fixed or outreach. Most services had little promotional activity or community engagement. Conclusions: To be successful, it would seem that public sector refraction services should answer a real and perceived need, fit within prevailing policy and legislation, value, train, retain and equip employees, be well managed, be accessible and affordable, be responsive to consumers, and provide ongoing good quality outcomes. To this end, a checklist to aid the initiation and maintenance of refraction and spectacle systems in low-resource countries has been constructed.
Published: 2008

39. Evaluation of the first 5 years of a national eye health programme in Vanuatu

Author: John Szetu, Carmel Williams, Jacqueline Ramke, Renee du Toit, Garry Brian, and Anna Palagyi
Subjects: Male, Rural Population, Eye Diseases, National Health Programs, genetic structures, Referral, Diabetic Eye Disease, Vanuatu, Humans, Medicine, Revenue, Human resources, Retrospective Studies, business.industry, Rural health, Medical record, medicine.disease, eye diseases, Outreach, Ophthalmology, Optometry, Female, Medical emergency, Rural area, business, Delivery of Health Care
Abstract: Purpose: To evaluate against its objectives the achievements of the first 5 years of a national eye health programme in Vanuatu. Methods: Programme clinical activity data were collated from surgical logs, clinic and outreach reports, and patient register books. Cataract surgical outcomes were retrieved from monitoring software. Programme annual reports provided information about management, infrastructure improvements, equipment supplied, repaired or replaced, the supply and use of consumables, and human resource development and deployment. Costs were determined from project budgets and acquittals. Results: The programme promoted eye health, including through the integration of eye care into existing health services; established adequate facilities, at referral hospitals, provincial hospitals and rural health clinics, with equipment and manpower to provide eye care appropriate to the location; established a primary eye care programme; strengthened cataract services, although its effect on any cataract backlog is unknown; developed a diabetic eye disease diagnosis and treatment service, but its reach and effectiveness are unknown; provided accessible comprehensive eye care, but its effect on the prevalence of vision impairment is unknown; and established medical records and data collection systems, but these need more attention. Discussion: This programme achieved much. However, the evaluation highlighted the limitations of inadequate project design and that, without addressing further human resource development and the Ministry of Health's wavering financial commitment, there are potential risks to ongoing services. That revenue generating capacity was not incorporated into this programme may prove to be a flaw that will limit ongoing access to eye care, especially in rural areas.
Published: 2008

40. Eye care in Timor-Leste: a population-based study of utilization and barriers

Author: Anna Palagyi, Garry Brian, Jacqueline Ramke, and Renee du Toit
Subjects: Adult, Male, Rural Population, Timor leste, Cross-sectional study, Population, Vision Disorders, Eye care, Severity of Illness Index, Health Services Accessibility, Poor vision, Blurred vision, Surveys and Questionnaires, Severity of illness, Humans, Medicine, education, Aged, education.field_of_study, business.industry, Agriculture, Middle Aged, Population based study, Ophthalmology, Cross-Sectional Studies, Indonesia, Unemployment, Educational Status, Optometry, Female, medicine.symptom, business, Attitude to Health, Delivery of Health Care, Demography
Abstract: Background: To determine utilization ofWestern-style conventional health services for eye problems in Timor-Leste, and barriers to seeking that care. Methods: An interview-based questionnaire was administered as part of a population-based cross-sectional survey of 50 clusters (urban and rural) of 30 people aged 40years. Results: Of 1470 people enumerated,1414 were examined (96.2%). A total of 1293 (91.4%) reported at least one previous or present eye problem, mostly (88.6%) blurred/ poor vision, for near and/or distance. Men (OR 1.6, 95% CI 1.1–2.3), literates (OR 2.1, 95% CI 1.4–3.5), urban dwellers (OR 4.1, 95% CI 2.6–6.4) and those in paid employment comparedwithbeingafarmer(OR3.0,95%CI1.5–5.9)were more likely to have reported a problem. A total of 858 (66.4%) sought Western-style care for its remedy. Nonutilizationwasassociatedwithbeingilliterate(OR3.7,95%CI 2.9–4.8), a rural dweller (OR 3.8, 95% CI 3.0–4.9), unemployed (OR 1.6,95% CI 1.1–2.2) or a farmer (OR 5.2,95% CI 3.5–7.6) compared with being in paid employment, having moderately impaired compared with non-impaired near vision (OR 1.4, 95% CI 1.1–1.8), and red/itchy/painful eyes compared with blurred vision (OR 2.3,95% CI 1.6–3.2),but not age,gender or poor distance vision.Lack of awareness of service availability was the most frequent reason for not seeking treatment (32.9%), especially for rural respondents. Attitudinal reasons were also prevalent (32.5%), with social (11.8%),economic (11.5%) and service-related (9.0%) issues less so. Conclusions: If eye health is to improve in Timor-Leste, there must be better appreciation of it, and increased availability, accessibilty and awareness of services.
Published: 2008

41. Prevalence and causes of blindness and low vision in Timor-Leste

Author: Thomas Naduvilath, Garry Brian, Jacqueline Ramke, Renee du Toit, and Anna Palagyi
Subjects: Adult, Male, Refractive error, Visual acuity, genetic structures, Eye disease, Population, Vision, Low, Rural Health, Blindness, Cataract, Vision disorder, Cellular and Molecular Neuroscience, Age Distribution, medicine, Humans, Sex Distribution, Risk factor, education, Functional illiteracy, Aged, education.field_of_study, business.industry, Urban Health, World View, Middle Aged, Refractive Errors, medicine.disease, eye diseases, Sensory Systems, Ophthalmology, Indonesia, Optometry, Female, medicine.symptom, Rural area, Epidemiologic Methods, business, Demography
Abstract: Aim: To estimate the prevalence and causes of blindness and low vision in people aged ⩾40 years in Timor-Leste. Method: A population-based cross-sectional survey using multistage cluster random sampling to identify 50 clusters of 30 people. A cause of vision loss was determined for each eye presenting with visual acuity worse than 6/18. Results: Of 1470 people enumerated, 1414 (96.2%) were examined. The age, gender and domicile-adjusted prevalence of functional blindness (presenting vision worse than 6/60 in the better eye) was 7.4% (95% CI 6.1 to 8.8), and for blindness at 3/60 was 4.1% (95% CI 3.1 to 5.1). The adjusted prevalence for low vision (better eye presenting vision of 6/60 or better, but worse than 6/18) was 17.7% (95% CI 15.7 to 19.7). Gender was not a risk factor for blindness or low vision, but increasing age, illiteracy, subsistence farming, unemployment and rural domicile were risk factors for both. Cataract was the commonest cause of blindness (72.9%) and an important cause of low vision (17.8%). Uncorrected refractive error caused 81.3% of low vision. Conclusion: Strategies that make good-quality cataract and refractive error services available, affordable and accessible, especially in rural areas, will have the greatest impact on vision impairment.
Published: 2007

42. Cataract and its surgery in Papua New Guinea

Author: Carmel Williams, Garry Brian, Sethu Sheeladevi, Praveen K Nirmalan, Jambi Garap, and BR Shamanna
Subjects: Male, medicine.medical_specialty, Visual acuity, Blinding, genetic structures, Cross-sectional study, medicine.medical_treatment, Population, Visual Acuity, Cataract Extraction, Blindness, Cataract, Papua New Guinea, Prevalence, medicine, Humans, education, Aged, Aged, 80 and over, education.field_of_study, business.industry, New guinea, Middle Aged, Cataract surgery, medicine.disease, eye diseases, Confidence interval, Surgery, Ophthalmology, Cross-Sectional Studies, Treatment Outcome, Population Surveillance, Female, sense organs, medicine.symptom, business
Abstract: Purpose: To determine the prevalence of visually significant cataract, unoperated blinding cataract, and cataract surgery for those aged 50 years and over in Papua New Guinea. Also, to determine the characteristics, rate, coverage and outcome of cataract surgery, and barriers to its uptake. Methods: Using the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 39 clusters of 30 people were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. Results: Of the 1191 people enumerated, 98.6% were examined. The 50 years and older age-gender-adjusted prevalence of cataract-induced vision impairment (presenting acuity less than 6/18 in the better eye) was 7.4% (95% confidence interval [CI]: 6.4, 10.2, design effect [deff] = 1.3). That for cataract-caused functional blindness (presenting acuity less than 6/60 in the better eye) was 6.4% (95% CI: 5.1, 7.3, deff = 1.1). The latter was not associated with gender (P = 0.6). For the sample, Cataract Surgical Coverage at 6/60 was 34.5% for Eyes and 45.3% for Persons. The Cataract Surgical Rate for Papua New Guinea was less than 500 per million population per year. The age-gender-adjusted prevalence of those having had cataract surgery was 8.3% (95% CI: 6.6, 9.8, deff = 1.3). Vision outcomes of surgery did not meet World Health Organization guidelines. Lack of awareness was the most common reason for not seeking and undergoing surgery. Conclusion: Increasing the quantity and quality of cataract surgery need to be priorities for Papua New Guinea eye care services.
Published: 2006

43. Cataract and its surgery in Timor-Leste

Author: Garry Brian, Thomas Naduvilath, Jacgueline Ramke, Anna Palagyi, and Rence du Toit
Subjects: Adult, Male, medicine.medical_specialty, Blinding, Timor leste, Visual acuity, Urban Population, genetic structures, medicine.medical_treatment, Population, Visual Acuity, Pilot Projects, Cataract Extraction, Astigmatism, Blindness, Cataract, Prevalence, medicine, Humans, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Middle Aged, Cataract surgery, medicine.disease, eye diseases, Surgery, Ophthalmology, Cross-Sectional Studies, Indonesia, Population Surveillance, Capsulotomy, Optometry, Female, sense organs, medicine.symptom, business, Follow-Up Studies
Abstract: Purpose: To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor-Leste. Methods: Based on the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 50 clusters of 30 people aged 40 years and older were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. Results: Of the 1470 people enumerated, 96.2% were examined. Of the eyes examined, 11.5% were blind (presenting vision less than 6/60). Cataract caused 66.3% of this, and 40.2% of vision impairment (presenting vision less than 6/18). For those people who were blind (7.7%; presenting vision less than 6/60 in the better eye), cataract was the most frequent cause (76.1%). Cataract surgery had occurred in 2% of participants. Gender and domicile were not associated with cataract blindness or surgery. Cataract Surgical Coverage (6/60) was 16.3% for Eyes and 20.2% for Persons. Surgical outcomes were poor, falling well short of World Health Organization guidelines. Astigmatism and posterior capsule opacity were important contributors to this. Conclusions: Until census data are available, age-gender-domicile correction of sample findings cannot be calculated. In the meantime, it is estimated there are 11 500 cataract blind in Timor-Leste. Long-term, indigenous cataract surgical services need to be capable of significantly increased output. Better surgical outcomes are required to ensure scarce resources are well used. Laser capsulotomy needs to be planned for as surgical numbers increase.
Published: 2006

44. Quantification of Refractive Error: Comparison of Autorefractor and Focometer

Author: Jacqueline Ramke, Katherine Soong, Garry Brian, and Renee du Toit
Subjects: Adult, Male, Refractive error, Visual acuity, Spherical equivalent, Diagnostic Techniques, Ophthalmological, Astigmatism, Refraction, Ocular, Severity of Illness Index, medicine, Humans, Mathematics, Vision Tests, Reproducibility of Results, Equipment Design, Repeatability, Middle Aged, Refractive Errors, medicine.disease, Refraction, Ophthalmology, Autorefractor, Optometry, Female, medicine.symptom, Axis determination
Abstract: PURPOSE The advantages of a focometer (FOCOMETER) over other methods of refraction for use in developing countries are that it is lightweight, compact, relatively inexpensive, fairly quick, and easy to use with minimal training. This clinical trial compared the repeatability, validity, and ease of use of the focometer with an autorefractor. METHODS The refractive status of the right eye of 80 participants was determined with an autorefractor (Canon RK3). Three measurements were also taken with the focometer. RESULTS The spherical equivalent (M) of the focometer was 0.25 D more positive than the autorefractor (p < 0.001) and 84% of measurements were within 0.75 D of the autorefractor. The autorefractor detected astigmatism in 91% (73) of the eyes, whereas the focometer identified only 32% (26). The design of the clock target restricts cylinder axis accuracy to the nearest 15 degrees . There was evidence of a learning effect for the focometer: the second and third measurements were more repeatable in the untrained group. There were no differences between the mean (1.03 +/- 2.28) and third focometer (-1.05 +/- 2.32) measurements (p = 0.34). However, using the third focometer measurement, 94% of participants had visual acuities of at least 6/12(-2). CONCLUSIONS This study highlighted the focometer's restricted power range, inaccuracy of astigmatism and axis determination, and dependence on subject understanding and compliance. Therefore, in most clinical settings, the focometer would not be adequate for quantifying refractive error, but the focometer spherical equivalent was within acceptable limits of the autorefractor, and the visual acuity with lenses determined by the focometer indicates its potential usefulness in public health settings, especially where only spherical ready-made spectacles are dispensed. There may be more cost-effective ways to determine refractive error in these circumstances. A potentially important enhancement in focometer methodology that improves its ease of use was identified: use only the third measurement for each eye.
Published: 2006

45. Towards standards of outcome quality: a protocol for the surgical treatment of cataract in developing countries

Author: David Moran, Jacqueline Ramke, Richard Le Mesurier, Renee du Toit, Garry Brian, and John Szetu
Subjects: Protocol (science), medicine.medical_specialty, Quality Assurance, Health Care, business.industry, media_common.quotation_subject, Developing country, Cataract Extraction, Outcome (game theory), Ophthalmology, Practice Guidelines as Topic, medicine, Physical therapy, Humans, Quality (business), Practice Patterns, Physicians', Surgical treatment, Intensive care medicine, business, Delivery of Health Care, Developing Countries, media_common
Published: 2006

46. Evaluation of surveillance methods for an epidemiological study of contact lens related microbial keratitis

Author: Garry Brian, Lisa Keay, Katie Edwards, Thomas Naduvilath, and Fiona Stapleton
Subjects: Adult, medicine.medical_specialty, Adolescent, Contact Lenses, MEDLINE, Surveillance Methods, Pilot Projects, Rural Health, Eye Infections, Bacterial, Epidemiology, medicine, Humans, Corneal Ulcer, Response rate (survey), Internet, business.industry, Incidence, Incidence (epidemiology), Australia, Urban Health, Middle Aged, Eye infection, Contact lens, Ophthalmology, Population Surveillance, Family medicine, Optometry, The Internet, Epidemiologic Methods, business, New Zealand
Abstract: To evaluate surveillance methods in a pilot epidemiological study of contact lens related microbial keratitis (MK) cases identified by ophthalmic practitioners in Australia and New Zealand between May and August 2003 inclusive.Twelve ophthalmologists and 55 optometrists from rural and metropolitan locations were sent a study information pack with postal reporting forms. After 2 months, practitioners were emailed a link to a website for Internet reporting. After 4 months, practitioners were prompted by email and then by telephone if a response was not received. Passive response rates were the rate of returns after posting information and emailing the website link. Active response rates included personalized email and telephone follow-up.Ten cases of MK were identified by optometrists and five by ophthalmologists. The passive response rates were 79% and 58% for the first and second reporting periods, respectively. There was a lower response rate in the second reporting period compared to the first (P = 0.02). With active surveillance the response rate increased to 97% and 96%. A large proportion of optometrists (62%) and ophthalmologists (55%) used the website for at least one reporting period. Internet reporting was used by all New Zealand practitioners (5/5).A surveillance study to estimate the incidence of contact lens related MK in Australia and New Zealand is feasible and acceptable. Internet-based reporting offers a reliable, rapid and cost-effective means of running a large scale, international surveillance study. Active surveillance methods are necessary to enhance reporting rates.
Published: 2004

47. Process integration, improvements, and testing of Si interposers for embedded computing applications

Author: Garry Brian Cunningham, Erik Vick, Dorota Temple, Matthew Lueck, Dean Malta, Scott Goodwin, Alan Huffman, Allan Hilton, Christopher Gregory, and John Lannon
Subjects: Materials science, business.industry, Copper interconnect, Die (integrated circuit), law.invention, Capacitor, law, Etching (microfabrication), Embedded system, Process integration, Interposer, Wafer, Routing (electronic design automation), business
Abstract: A high performance embedded computing module was enabled and demonstrated with the implementation of a 3D Si interposer. The interposer contained front and backside multilevel metallization (MLM) with through-Si vias (TSVs) on 150mm wafers. The front-side MLM (5 levels) was fabricated with a dual damascene process. Four 2 um thick Cu routing layers with 2 um oxide dielectric layers and one pad layer were used in the front-side MLM. The TSVs were fabricated using a vias-last, unfilled via process. Due to improved process modules, contact chain test structures between the front-side MLM layers with 20,064 vias had electrical yields as high as 100%. Etching process conditions for the TSV process flow were also optimized to result in 100% yield on contact chains that contain up to 540 TSVs. These optimized etching conditions produced low TSV resistances ( 100MQ/via at 3.3V) for the embedded computing module (ECM). Two die from the 1 st generation interposer (3.97 cm × 3.67 cm die size) showed good continuity and isolation for 99% of the functional circuit path nets. A second generation design was recently fabricated that, through a combination of design changes and process optimizations, resulted in improved test capacitor performance, higher via chain yields, and increased power plane yields. Design changes were also implemented to enhance the high speed signal propagation properties of the TSVs. Specifically, the selection of 80 μm TSV diameters in 500 μm thick 100 Ω-cm substrates was made to improve the S 11 and S 21 properties of the TSVs over the frequency range of 1-4 GHz. Details of the design changes and process improvements implemented on the completed second generation ECM die and test die are discussed, along with test results from each type of die.
Published: 2014

48. Are readymade spectacles sufficient in developing countries?

Author: Jacqueline Ramke and Garry Brian
Subjects: Ophthalmology, Economic growth, Eyeglasses, Indonesia, business.industry, Humans, Medicine, Developing country, Refractive Errors, business, Developing Countries
Published: 2009

49. Ophthalmic interventions in the Developing World: Insights for successful outcomes

Author: Geoffrey Cohn, Richard Le Mesurier, Gillian M Cochrane, Garry Brian, Peter Cooper, and Richard L. Cooper
Subjects: Ophthalmology, Nursing, business.industry, Psychological intervention, Developing country, Medicine, business
Published: 1999

50. Measuring vision-specific quality of life among adults in Fiji

Author: Sheila M. Williams, Renee du Toit, and Garry Brian
Subjects: Adult, Male, Epidemiology, Population, Vision Disorders, Visual Acuity, Pilot Projects, Likert scale, Quality of life, Sickness Impact Profile, Surveys and Questionnaires, Criterion validity, medicine, Fiji, Humans, education, Vision, Ocular, Aged, education.field_of_study, business.industry, Presbyopia, Middle Aged, medicine.disease, Ophthalmology, Cross-Sectional Studies, Scale (social sciences), Multistage sampling, Quality of Life, Female, business, Clinical psychology, Relative validity
Abstract: To evaluate an 18-item vision-specific quality-of-life questionnaire designed for use with adults in Fiji.Participants in a population-based cross-sectional survey selected by multistage random sampling from those aged ≥40 years living on Fiji's main island had distance and near visual acuity measured. Those with presenting vision impairment (6/18) and/or presbyopia (N8) and every third participant with normal presenting distance vision answered an interview-based questionnaire.Of 1381 participants, 928 were eligible to answer the questionnaire. Of these, 921 provided valid responses to more than half the items and were the subject of analysis. The questionnaire conformed with a rating scale model: with the possible exception of one item, a single scale was formed, which had considerable range and many items well spaced. Estimates of relative validity suggested that rating and Likert scales constructed from the data had similar criterion validity discriminating between those with and without vision problems. The spacing and hierarchy of a three-response category model ("no problem," "little/moderate difficulty," "lot of difficulty/unable to do because of my vision"), were little influenced by sex, ethnicity or urban versus rural residence. Near vision tasks associated with print and very small objects, mobile phone use, sewing/weaving, and preparing lentils/rice/grains were ranked most difficult.Although the analysis showed the 18-item questionnaire to be an adequate tool for assessing the impact of vision reduction on quality of life among adults in Fiji, further community consultation and item modification would likely deliver a more efficacious instrument.
Published: 2012

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