To investigate changing patterns of practice of keratoplasty in Australia, graft survival, visual outcomes, the influence of experience, and the surgeon learning curve for endothelial keratoplasty.
...Observational, prospective cohort study.
From a long-standing national corneal transplantation register, 13 920 penetrating keratoplasties, 858 deep anterior lamellar keratoplasties (DALKs), and 2287 endokeratoplasties performed between January 1996 and February 2013 were identified.
Kaplan-Meier functions were used to assess graft survival and surgeon experience, the Pearson chi-square test was used to compare visual acuities, and linear regression was used to examine learning curves.
Graft survival.
The total number of corneal grafts performed annually is increasing steadily. More DALKs but fewer penetrating grafts are being performed for keratoconus, and more endokeratoplasties but fewer penetrating grafts are being performed for Fuchs' dystrophy and pseudophakic bullous keratopathy. In 2012, 1482 grafts were performed, compared with 955 in 2002, translating to a requirement for 264 extra corneal donors across the country in 2012. Comparing penetrating grafts and DALKs performed for keratoconus over the same era, both graft survival (P <0.001) and visual outcomes (P <0.001) were significantly better for penetrating grafts. Survival of endokeratoplasties performed for Fuchs' dystrophy or pseudophakic bullous keratopathy was poorer than survival of penetrating grafts for the same indications over the same era (P <0.001). Visual outcomes were significantly better for penetrating grafts than for endokeratoplasties performed for Fuchs' dystrophy (P <0.001), but endokeratoplasties achieved better visual outcomes than penetrating grafts for pseudophakic bullous keratopathy (P <0.001). Experienced surgeons (>100 registered keratoplasties) achieved significantly better survival of endokeratoplasties (P <0.001) than surgeons who had performed fewer grafts (<100 registered keratoplasties). In the hands of experienced, high-volume surgeons, endokeratoplasty failures occurred even after 100 grafts had been performed.
More corneal transplants, especially DALKs and endokeratoplasties, are being performed in Australia than ever before. Survival of DALKs and endokeratoplasties is worse than the survival of penetrating grafts performed for the same indications over the same timeframe. Many endokeratoplasties fail early, but the evidence for a surgeon learning curve is unconvincing.
To examine factors affecting penetrating corneal graft survival and visual outcomes in patients aged less than 20 years.
Large prospective, cohort study.
Records of 14 865 followed penetrating ...corneal grafts in 11 929 patients were searched to identify 765 grafts in 640 patients aged younger than 20 years of age at the time of graft.
Records submitted to the Australian Corneal Graft Registry by 381 ophthalmic surgeons and 253 follow-up practitioners from May 1985 to June 2009 were analyzed using Kaplan-Meier survival plots and Cox proportional hazards regression analysis.
Probability of corneal graft survival and Snellen acuity at the time of most recent follow-up and at defined intervals post-graft.
Infants (<5 years) exhibited poorer graft survival than children aged 5 to 12 years. Adolescents (13-19 years) exhibited better corneal graft survival than other age groups; 86% of grafts in adolescents were for keratoconus. Factors significantly affecting corneal graft survival in pediatric patients included indication for graft, graft inflammation, history of intraocular surgery, vascularization, rejection episodes, post-graft operative procedures, and refractive surgery. Fourteen percent of pediatric grafts failed, of which 65% failed within 2 years post-graft. Forty-four percent of failures were due to unknown causes (18) or irreversible rejection (30).
Corneal grafts for keratoconus in adolescents show excellent survival. Infants exhibit poor graft survival and visual outcomes, especially those undergoing transplantation for Peters' anomaly. Corneal graft survival and visual outcomes vary more by indication for graft than recipient age. The major reason for graft failure is irreversible rejection. Corneal transplantation improves overall bilateral vision in pediatric patients.
Abstract
Background
Cannabis poisonings among children are of public health concern. Existing evidence from the US and from four provinces in Canada (Quebec, Ontario, Alberta, British Columbia) ...indicate an increase in pediatric cannabis-related poisonings since the legalization of cannabis. This study evaluates trends in cannabis-related poisoning pediatric emergency department (ED) visits and hospitalizations in Canada and addresses a gap in literature by describing trends and context around cannabis edible-related poisoning cases using data from a Canadian sentinel surveillance system.
Methods
Mixed-methods using data from two administrative data sources and one injury/poisoning sentinel surveillance system to estimate age-specific rates of cannabis-related poisonings ED visits (Ontario and Alberta), edible-related events (sentinel surveillance Canada), and hospitalizations (Canada with the exception of Quebec) among children between the ages of 0 to 11 from 2015/2016 to 2021. Annual absolute changes were calculated to quantify the magnitude of change between each age-specific rate. Joinpoint regression was used for trend analysis. A thematic analysis was completed to gain a better understanding of cannabis edible-related poisoning cases in the ED.
Results
The pediatric age-specific rates for cannabis-related poisoning ED visits (average annual percent change (AAPC) Ontario: 98.2%, 95% CI: 79.1, 119.2; AAPC Alberta: 57.4%, 95% CI: 36.7, 81.2), hospitalizations (AAPC: 63.4%, 95% CI: 42.0, 87.9) and cannabis edible-related events (AAPC: 122.8%, 95% CI: 64.0, 202.6) increased significantly from 2015 to 2021. Almost half of all pediatric edible-related events involved gummy edible products (48.8%, n = 143). Based on the thematic analysis, 88% cannabis edible-related events were attributed to inadvertent ingestion due to access to such products or lack of safe storage practices.
Conclusion
Age-specific rates of cannabis-related poisoning ED visits (Ontario and Alberta) and hospitalizations (Canada with the exception of Quebec) have increased since cannabis legalization, with the largest increase in rates occurring from 2019 to 2020. A similar increase in the rate of cannabis edible-related cases from sentinel surveillance data underscores the importance of monitoring this outcome. Public health messaging and national public health promotion strategies targeted towards raising awareness on the risks associated with consuming illegal cannabis and safe storage of cannabis could help mitigate cannabis poisonings among children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Our aims were to examine graft survival and visual outcome after full-thickness corneal transplantation.
Records of 18,686 penetrating corneal grafts, 14,622 with archival follow-up from 1 to 22 ...years, were examined within a national database. Kaplan-Meier survival analysis indicated variables of interest for Cox proportional hazards regression analysis. A model clustered by patient to control intereye or intergraft dependence was constructed to identify variables best predicting penetrating corneal graft failure. Visual acuity in the grafted eye was measured by Snellen acuity.
Probability of corneal graft survival was 0.87, 0.73, 0.60, and 0.46 at 1, 5, 10, and 15 years, respectively. Reasons for graft failure included irreversible rejection (34%), corneal endothelial cell failure including cases of glaucoma (24%), and infection (14%). Variables predicting graft failure in multivariate analysis included transplant center, location and volume of surgeon's case-load, graft era, indication for graft, number of previous ipsilateral grafts, lens status, corneal neovascularization at transplantation, a history of ocular inflammation or raised intraocular pressure, graft diameter, and postoperative events including graft neovascularization and rejection. Best-corrected Snellen acuity of 6/12 or better was achieved by 45%, and of less than 6/60 by 26%, of grafted eyes at last follow-up.
The short-term survival of penetrating corneal transplants is excellent, but the eventual attrition rate appears inexorable and many factors that influence graft survival significantly are not amenable to change. Most penetrating grafts are performed for visual improvement, and excellent acuity will be achieved by approximately half of all grafts.
The economic burden of West Nile virus (WNV) infection is not known for Canada. We sought to describe the direct and indirect costs of WNV infection in the province of Quebec, Canada, up to 2 years ...after onset of signs and symptoms. We conducted a retrospective cohort study that included WNV cases reported during 2012 and 2013. For 90 persons infected with WNV, persons with encephalitis accounted for the largest proportion of total cost: a median cost of $21,332 per patient compared with $8,124 for West Nile meningitis (p = 0.0004) and $192 for West Nile fever (p<0.0001). When results were extrapolated to all reported WNV patients, the estimated total cost for 124 symptomatic cases was ≈$1.7 million for 2012 and that for 31 symptomatic cases was ≈$430,000 for 2013. Our study provides information for the government to make informed decisions regarding public health policies and infectious diseases prevention and control programs.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This article posits that conventional human capital development theory as applied to economic development lacks a consideration of cultural context. In developing regions of the world, life decisions ...at the postsecondary educational level are often less driven by individual choices and “rational” cost–benefit analyses and more by the continuing importance of family, community, and place‐based values. Results from an examination of postsecondary educational outcomes among rural, coastal peoples of Western Alaska demonstrate how human capital development stimulated through a regional economic development program is gendered: More women than men are pursuing higher education. They are often motivated by a desire to “give back” to both their families and their communities. The study also finds a lack of participation in formal vocational training programs despite the applicability of vocational skills to resource extraction–based industries in rural Alaska. Policy recommendations include economic development organizations creating value in postsecondary educational pathways that most benefit Bering Sea communities, such as those both in caring labor and in the skilled trades. This focus could help validate rural Alaskan commitments to family, community, and sense of place.
Increasing enclosure in fisheries, the rising cost of living in northern rural areas, and the single sector economies of many coastal communities have increased community vulnerability to short and ...long-term resource and market instabilities. This article situates Alaska coastal youth within the current economic uncertainty experienced by communities traditionally reliant upon commercial fishing. Focus group interviews conducted with youth aged 16-24 in Gulf of Alaska coastal communities demonstrate youth in this region possess strong, place-based social capital shaped by the small size and geographic remoteness of their communities as well as a connectedness to each other and to the physical environment of those communities. Key discourses emerged in the interviews concerning this “close-knit” nature of Alaska coastal communities, how their residents are “hands-on” people in the context of employment preferences and affinities, and that Alaska coastal youth perceive a “real world” beyond the borders of their communities offering them attractive amenities of modern, urban lifestyles. As opportunities in traditional occupations such as fishing diminish, coastal youth are encouraged to pursue higher education and in this context, young women are leaving more frequently than young men as gender roles change. Interviewees report many youth who do leave, however, often return home without completing their education and how others who do must sometimes leave home permanently to pursue careers unavailable at home. Including a youth perspective in policy discussions concerning local economic development would produce the following prescriptions: 1) investing in training coastal youth for culturally relevant and desirable work, 2) recognizing youth might want to return to their home communities in the future, particularly with their families, 3) giving youth a voice in community affairs and policymaking to cultivate future community leaders and stewards, and 4) committing to economic development strategies that encourage local ownership in coastal resources and industries.
BACKGROUND
During a major outbreak of West Nile virus (WNV) infection in the province of Quebec in 2012, public health authorities (PHAs) suspected underrecognition of West Nile neurologic disease ...(WNND). With data on acute infections detected in blood donors, an estimate of the degree of underrecognition was produced.
STUDY DESIGN AND METHODS
All 2012 donors were tested for WNV infection with the use of reverse transcription–polymerase chain reaction (RT‐PCR). With the number of cases detected, the number of donors tested, our estimate of the duration of viremia, an estimate of the population at risk, and the ratio of WNND to total cases, an expected number of WNND cases was calculated. A Monte Carlo simulation was used to estimate the range of several of these variables.
RESULTS
Seventeen RT‐PCR–positive donors were found among 52,309 donations tested. In the base case, the total number of cases was 16,095 and the expected number of WNND cases was 115. In the Monte Carlo simulation, the mean number of expected WNND cases was 136, and the median was 129. Since only 85 cases were reported to PHAs, it is estimated that between 26 and 37.5% of cases occurring in the province went undetected.
CONCLUSION
The observation that close to one‐third of cases of WNND went undetected because of the omission of appropriate laboratory testing indicates the need for improvement in the investigation of acute neurologic syndrome of suspected infectious etiology in Québec.
Introduction
There is evidence that some frontline and essential workers have increased their alcohol use during the COVID-19 pandemic; however, this has not been examined in Canada.
Methods
Using ...the Survey on COVID-19 and Mental Health 2020, weighted prevalence and 95% confidence intervals of self-reported increased alcohol consumption and heavy episodic drinking were calculated for each of the population groups: frontline workers, essential workers, and nonfrontline or essential workers (NFEW). Logistic regression was used to examine the associations between social determinants of health, mental health and alcohol use for each group.
Results
The prevalence of increased alcohol consumption and past-month heavy episodic drinking did not differ across frontline workers, essential workers and NFEW. For the three groups, nonracialized group members had significantly higher odds for both outcomes. Screening positive for either generalized anxiety disorder or mood disorder was significantly associated with increased alcohol consumption across the threegroups. For frontline and essential workers, females had significantly lower odds of heavy episodic drinking compared to males. For essential workers only, living in a rural area was significantly associated with lower odds of increased alcohol use, and screening positive for posttraumatic stress disorder was significantly associated with increased odds of heavy episodic drinking. For frontline workers only, living in a rural area was significantly associated with lower odds of heavy episodic drinking.
Conclusion
While frontline and essential workers were not more likely to report increased alcohol consumption and heavy episodic drinking compared to NFEW, there were some differences in factors associated with alcohol use. Such findings demonstrate the benefit of examining each group separately to provide information for targeted prevention strategies.
Summary The gastrointestinal tract contains a complex mix of microorganisms. Therefore, the finding of a particular microbe in the gastrointestinal tract or stools of a patient with intestinal ...disease does not necessarily indicate that the clinical state resulted from the presence of this organism. For this reason, extending from epidemiological association to causality is particularly challenging for gastrointestinal diseases. Most established agents of acute bacterial gastroenteritis (eg, Escherichia coli, Campylobacter jejuni ) have been shown to fulfil Koch's postulates of causality in human volunteer studies. For Helicobacter pylori , which can cause both acute and chronic disease, the organism was first linked to an acute syndrome through volunteer studies and then later assessed for a role in chronic disease by use of Hill's epidemiological criteria of causation. However, for agents of chronic intestinal disease, this approach is not ethical and risks overlooking events occurring long after the exposure. We examine the criteria used to judge causality (Koch's postulates and Hill's criteria) and their applicability for chronic gastrointestinal diseases (eg, Whipple's disease and Crohn's disease). We also identify crucial research questions required to advance towards assessing the causal role of candidate microbes in the aetiopathogenesis of Crohn's disease.
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