•REFUGE, the first challenge on glaucoma assessment from fundus images.•A data set of 1200 images with reliable ground truth labels is publicly released.•An evaluation setup for glaucoma ...classification and optic disc/cup segmentation.•12 deep learning methods participating in the challenge are evaluated and discussed.•Good practices are identified based on the outcomes of the participating teams.
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Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations. Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders. However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (https://refuge.grand-challenge.org), held in conjunction with MICCAI 2018. The challenge consisted of two primary tasks, namely optic disc/cup segmentation and glaucoma classification. As part of REFUGE, we have publicly released a data set of 1200 fundus images with ground truth segmentations and clinical glaucoma labels, currently the largest existing one. We have also built an evaluation framework to ease and ensure fairness in the comparison of different models, encouraging the development of novel techniques in the field. 12 teams qualified and participated in the online challenge. This paper summarizes their methods and analyzes their corresponding results. In particular, we observed that two of the top-ranked teams outperformed two human experts in the glaucoma classification task. Furthermore, the segmentation results were in general consistent with the ground truth annotations, with complementary outcomes that can be further exploited by ensembling the results.
The coronavirus disease 2019 (COVID-19) and the imposed lockdowns in order to control the pandemic, had undoubtedly influenced the lifestyle of millions of people worldwide. The period of ...confinement, which was characterized by seizing most business activities and allowing only for e-classes at schools and universities, leading also to a lower physical activity, could have affected eating behaviors of people of all ages. In this study we aimed to investigate the impact of the first lockdown period (March–May 2020) on body weight (BW) and on body mass index (BMI) in both adults and adolescents (>16 years old). A systematic literature search was conducted in PubMed®, Scopus®, Web of Science® and EMBASE® databases and 36 observational (35 cross-sectional and one cohort) studies were included. BW and BMI changes after/during the lockdown period were examined. BW was stated as increased in a significant part of the individuals (11.1–72.4%), although a range of 7.2–51.4% of individuals reported weight loss. A significant higher BW was observed with a weighted mean between-group difference (WMD) 1.57 (95% CI 1.01 to 2.14) in the post-lockdown period compared to the before lockdown time and higher BMI, 0.31 WMD (95% CI, 0.17 to 0.45) was identified before the lockdown period. At variance with general trends, one study in older adults (>60 years old) notably reported a significant BW loss, suggesting a higher risk for lockdown-induced weight loss and potentially malnutrition in the elderly population. Overall increments in BW are an alarming effect of lockdown during the COVID-19 pandemic, leading to potential higher incidence of overweight, obesity and related health-risks as well as other noncommunicable diseases. Further studies are needed to assess potential group-specific impacts, with particular regard to weight gain in younger people and risk of weight loss, malnutrition and sarcopenia in older adults.
Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient’s CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that ...retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient’s CV risk profile in a non‐invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
The World Health Organization (WHO) encourages countries to undertake national dietary survey (NDS) but implementation and reporting is inconsistent. This paper provides an up-to-date review of adult ...macro and micronutrient intakes in European populations as reported by NDS. It uses WHO Recommended Nutrient Intakes (RNIs) to assess intake adequacy and highlight areas of concern. NDS information was gathered primarily by internet searches and contacting survey authors and nutrition experts. Survey characteristics and adult intakes by gender/age group were extracted for selected nutrients and weighted means calculated by region. Of the 53 WHO Europe countries, over a third (
= 19), mainly Central & Eastern European countries (CEEC), had no identifiable NDS. Energy and nutrient intakes were extracted for 21 (40%) countries but differences in age group, methodology, under-reporting and nutrient composition databases hindered inter-country comparisons. No country met more than 39% WHO RNIs in all age/gender groups; macronutrient RNI achievement was poorer than micronutrient. Overall RNI attainment was slightly worse in CEEC and lower in women and female elderly. Only 40% countries provided adult energy and nutrient intakes. The main gaps lie in CEEC, where unknown nutrient deficiencies may occur. WHO RNI attainment was universally poor for macronutrients, especially for women, the female elderly and CEEC. All countries could be encouraged to report a uniform nutrient set and sub-analyses of nationally representative nutrient intakes.
Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well ...addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations.
A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included.
Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24–0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load.
Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.
In 2013, the WHO recommended that all member states aim to reduce population salt intake by 30% by 2025. The year 2019 represents the midpoint, making it a critical time to assess countries' progress ...towards this target. This review aims to identify all national salt reduction initiatives around the world in 2019, and to quantify countries' progress in achieving the salt reduction target. Relevant data were identified through searches of peer-reviewed and gray literature, supplemented with responses from prefilled country questionnaires sent to known country leads of salt reduction or salt champions, WHO regional representatives, and international experts to request further information. Core characteristics of each country's strategy, including evaluations of program impact, were extracted and summarized. A total of 96 national salt reduction initiatives were identified, representing a 28% increase in the number reported in 2014. About 90% of the initiatives were multifaceted in approach, and 60% had a regulatory component. Approaches include interventions in settings (n= 74), food reformulation (n = 68), consumer education (n = 50), front-of-pack labeling (n = 48), and salt taxation (n = 5). Since 2014, there has been an increase in the number of countries implementing each of the approaches, except consumer education. Data on program impact were limited. There were 3 countries that reported a substantial decrease (>2 g/day), 9 that reported a moderate decrease (1–2 g/day), and 5 that reported a slight decrease (<1 g/day) in the mean salt intake over time, but none have yet met the targeted 30% relative reduction in salt intake from baseline. In summary, there has been an increase in the number of salt reduction initiatives around the world since 2014. More countries are now opting for structural or regulatory approaches. However, efforts must be urgently accelerated and replicated in other countries and more rigorous monitoring and evaluation of strategies is needed to achieve the salt reduction target.
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