Childhood mortality remains high in sub-Saharan Africa. In this cluster-randomized, placebo-controlled trial, mortality among children younger than 5 years of age was lower among those who received ...azithromycin than among those who received placebo.
IMPORTANCE: Worsening vision and declining cognitive functioning are common conditions among elderly individuals. Understanding the association between them could be beneficial in mitigating ...age-related cognitive changes. OBJECTIVE: To evaluate the longitudinal associations between visual impairment and cognitive function over time in a population-based study of older US adults. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal population-based study of older adults in the greater Salisbury area in Maryland. Overall, 2520 community-residing adults aged 65 to 84 years were assessed at baseline between September 1993 and August 1995 (round 1) and 2 (round 2), 6 (round 3), and 8 (round 4) years later. MAIN OUTCOMES AND MEASURES: Visual acuity (VA) was measured using Early Treatment Diabetic Retinopathy Study charts, and cognitive status was assessed using the Mini-Mental State Examination (MMSE). RESULTS: Of 2520 individuals, the mean (SD) age was 73.5 (5.1) years, 1458 (58%) were women, and 666 (26%) were black. There were 2240 (89%), 1504 (61%), and 1250 (50%) participants in the second, third, and fourth round of study, respectively, with more than half of the loss being due to death. Both VA and MMSE score worsened over time. The mean biannual decline of VA was 0.022 logMAR (approximately 1 line during 8 years; 95% CI, 0.018-0.026), and the mean biannual worsening of MMSE score was −0.59 (95% CI, −0.64 to −0.54; both P < .001). Worse baseline VA was associated with worse baseline MMSE score (r = −0.226; 95% CI, −0.291 to −0.16; P < .001). The rate of worsening VA was associated with the rate of declining MMSE score (r = −0.139; 95% CI, −0.261 to −0.017; P = .03). Cross-lagged models indicated VA in the previous round was associated with MMSE score in the subsequent round (β = −0.995, P < .001), and MMSE score in the previous round was associated with VA in the following round (β = −0.003, P < .001). However, the standardized effect size of VA on MMSE score (β = −0.074; SE, 0.015; P < .001) is larger relative to the reverse effect (β = −0.038; SE, 0.013; P < .001), demonstrating VA is likely the driving force in these dynamic associations. CONCLUSIONS AND RELEVANCE: In a population-based sample of older US adults, visual impairment measured at distance is associated with declining cognitive function both cross-sectionally and longitudinally over time with worsening vision having a stronger association with declining cognition than the reverse. Worsening vision in older adults may be adversely associated with future cognitive functioning. Maintaining good vision may be an important interventional strategy for mitigating age-related cognitive declines.
Purpose
Trachoma, a chronic conjunctivitis that can result in vision loss from trichiasis, is targeted for global elimination by 2020. Several milestones in the long process towards elimination are ...noteworthy for the impact they have had on changing or accelerating progress. The purpose of this review is to describe the milestones and the impact they have had both for trachoma elimination and beyond.
Findings
Eight milestones are presented. They are discovery of the causative agent; development of a clinical grading scheme; establishment of the World Health Organization Alliance for the Global Elimination of Trachoma by 2020; setting targets that define elimination; building an evidence base for trichiasis surgery; azithromycin donation programme; use of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement); and The Global Trachoma Mapping Project.
Summary
These milestones have significantly pushed the progress towards elimination. Despite challenges to achieving the goal of elimination by 2020, there is continued commitment into the future to ensure that this preventable cause of blindness is no longer a threat.
Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which ...includes reducing trachomatous inflammation-follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation-follicular prevalence.
Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation-follicular prevalence was 5% at baseline and at follow-up in children aged 1-9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6-39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01-1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13-1.48, p = 0.0002).
The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As trachoma prevalence declines worldwide, performing field surveys with trained trachoma graders to validate its elimination becomes challenging. Graded conjunctival images could be used to train ...graders, validate field grades, and replace field grading. We review the use of photography to capture conjunctival images for the detection of trachomatous inflammation-follicular (TF) and -intense (TI), Trachomatous trichiasis (TT), and eyelid contour abnormalities. Literature searches were conducted between October 29, 2020 and February 15, 2021. We abstracted kappa scores for agreement between field and image graders, between field graders, and between image graders. The median kappa was calculated for studies discussing grading for TF and TI. Twenty-one studies were included - 19 described the use of imaging tools for grading TF and TI; 1 discussed TT; and 1 discussed eyelid contour abnormalities. For agreement between field and image graders, median kappa for TF was 0.71 (range: 0.57–0.92) and TI was 0.67 (0.37–0.74); between image graders, median kappa for TF was 0.65 (0.37–0.78) and TI was 0.76 (0.39–0.83); and between field graders, median kappa for TF was 0.86 (0.73–1) and TI was 0.82 (0.73–0.91). There is potential for the use of photography for trachoma prevalence surveys. Further research is warranted, particularly for TT and using newer smartphones.
Health promotion is essential to the SAFE strategy for trachoma elimination. Schools are a valuable venue for health promotion. However, there is little literature about the impact of health ...education and water infrastructure in schools on facial cleanliness and trachoma in the community. Our study aimed to describe the current state of school health promotion in Kongwa, Tanzania, and to examine the transferability of health messages from schools to the community at large.
A cross-sectional survey was carried out in all 92 villages in Kongwa district, which included 85 primary schools. Data were collected on health messages and water infrastructure in the schools. A random sample of 3084 children aged 0-5 were examined for facial cleanliness in all villages. In 50 villages, a random sample of 50 children aged 1-9 per village were examined for follicular trachoma (TF). Thirty-seven (44.6%) schools had educational materials on face-washing. Fifty (60.2%) schools had a washing station. The presence of a health teacher was correlated with having posters on face washing in classrooms. The presence of face-washing materials was correlated with the availability of washing stations. Neither teachers mentioning face-washing in health curricula nor educational materials in classrooms were associated with clean faces or trachoma in the community. Having a washing station in the school was associated with lower community rates of trachoma.
Primary school health messages and materials on trachoma were not associated with clean faces or lower rates of trachoma in the community. The target audience for primary school health promotion is likely the students themselves, without immediate rippling effects in the community. A long-term perspective should be considered during the implementation of health promotion in schools. The goal of school health promotion should be training the next generation of parents and community health leaders in combatting trachoma.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The simplified trachoma grading system, amended Solomon, Anthony W; Kello, Amir B; Bangert, Mathieu ...
Bulletin of the World Health Organization,
10/2020, Letnik:
98, Številka:
10
Journal Article
Recenzirano
Odprti dostop
A simplified grading system for trachoma was published by the World Health Organization (WHO) in 1987. Intended for use by non-specialist personnel working at community level, the system includes ...five signs, each of which can be present or absent in any eye: (i) trachomatous trichiasis; (ii) corneal opacity; (iii) trachomatous inflammation-follicular; (iv) trachomatous inflammation-intense; and (v) trachomatous scarring. Though neither perfectly sensitive nor perfectly specific for trachoma, these signs have been essential tools for identifying populations that need interventions to eliminate trachoma as a public health problem. In 2018, at WHO's 4th global scientific meeting on trachoma, the definition of one of the signs, trachomatous trichiasis, was amended to exclude trichiasis that affects only the lower eyelid. This paper presents the amended system, updates its presentation, offers notes on its use and identifies areas of ongoing debate.
Background Serologic testing for chlamydial antibodies is one potential tool for trachoma monitoring. Understanding the dynamics of seroconversion and seroreversion in low endemic districts is ...critical for determining the value of using serology. Methodology/Principal findings We surveyed a random sample of 2536 children aged 1-9 years in Kongwa, Tanzania, over three years; 1719 (67.8%) participants had all three follow-ups. Surveys assessed trachomatous inflammation-follicular (TF), Chlamydia trachomatis infection, and anti-pgp3 antibodies. Mass drug administration occurred immediately after the first and second follow-up surveys. The cohort was classified into trajectories of change in serostatus, and risk factors were evaluated for seroconversion and seroreversion. We found that 86.2% of seropositives remained seropositive throughout the study, whereas 12.1% seroreverted. Seroreverters were younger (Odds Ratio OR = 0.88 for every one-year increase in age, 95% CI = 0.79-0.99). 84.5% of seronegatives remained seronegative, and 13.0% seroconverted. Seroconverters were also younger (OR = 0.92, 95% CI = 0.87-0.98). Seroconversion and seroreversion were not explained by indeterminate values for the intensity of antibody response. Less than 1% of the cohort had unstable changes in serostatus, mostly explained by values in the indeterminate range. TF and infection in the cohort declined over time, while seropositivity increased from 31.5% to 36.4%. Conclusions/Significance Antibody status is relatively stable over time. Both seroconversion and seroreversion occurred over the three years in this low endemic district, especially in younger children. Modeling seroreversion is important for accurate determination of seroconversion. The use of serology as a monitoring tool should target the younger aged children as they will most likely capture recent changes in serostatus.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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