The effects of female sex hormones on the human cornea across a woman's life cycle.

The cornea is a hormone-responsive tissue that responds to changing levels of female sex hormones. This review focuses on the structural and functional changes in the human cornea associated with the hormonal milestones of menarche, pregnancy, and menopause, as well as consequences stemming from the use of exogenous sex hormones for fertility control and replacement. Articles were identified by searching PubMed without language or region restrictions. The primary outcomes evaluated were changes in central corneal thickness (CCT), intraocular pressure (IOP), and quality of the ocular tear film. The potential impact of hormone-associated changes on the diagnosis and surgical management of common eye diseases, as well as the potential use of sex hormones as therapeutic agents is also considered. Understanding the physiological effects of female sex hormones on the cornea is important because that knowledge can shape the management decisions physicians and women face about ocular health across their life stages.

An initiative to improve follow-up of patients with diabetic retinopathy.

BACKGROUND: This study describes the implementation of an electronic medical record (EMR)-based initiative aimed at identifying and reducing the number of patients with diabetic retinopathy (DR) lost to follow-up (LTF). METHOD: Providers were enlisted to review the EMRs and re-engage patients with DR seen 1 year prior and who had not returned for care within the past 6 months. Binary logistic regression analysis was used to identify demographic, clinical and sociomedical factors associated with being LTF, as well as those predictive of re-engagement. RESULTS: Out of 673 patients with DR, 78 (12%) were identified as LTF. Patients LTF were more likely to be younger (p = 0.001) and have poorly controlled haemoglobin A1c (HbA1c ≥ 8%, p = 0.04) and cholesterol (LDL ≥ 100 mg/dL, p < 0.001) levels. These patients were also more likely to have completed fewer ophthalmology appointments (p < 0.001), and less likely to have had retinal imaging within the last year (p < 0.001). Charts reviewed 1 month after the EMR-based initiative revealed that 22 patients (28%) had been successfully re-engaged by providers, while 56 patients (72%) remained LTF. History of prior treatment for DR was associated with re-engagement by providers (p = 0.04). One month following the provider-based intervention, the LTF rate dropped to 8.3%, and by 1 year only 3.6% of the patients remained LTF. CONCLUSIONS: Electronic medical record-based tools can successfully identify DR patients as being LTF, offering an opportunity for providers to re-engage patients in a timely manner. Future studies are needed to determine the long-term impact of patient re-engagement on DR outcomes and efficiency of clinical practice.

Public health education at China's higher education institutions: a time-series analysis from 1998 to 2012.

BACKGROUND: Although China's modern education for public health was developing over the past 60 years, there is a lack of authoritative statistics and analyses on the nation's development of education for public health at higher education institutions (HEIs). Few quantitative studies on this topic have been published in domestic and international peer-reviewed journals. To address this knowledge gap, we aimed to use national data to quantitatively analyse the scale, structure, and changes of public health education in China's HEIs, and to compare the changes of public health education with those of other health science disciplines. METHODS: This study uses previously unreleased national data provided by the Ministry of Education of China that includes the number of health professional students by school and major. The data, which spans from 1998 to 2012, are descriptively analyzed. RESULTS: The number of HEIs for public health education per 100 million population increased from 7.2 in 1998 to 11.3 in 2012. The total enrolment, number of students, and number of graduates increased at rates of 7.3, 7.4, and 5.8% per year, respectively. The percentage of junior college students dropped drastically from 24.0 to 8.4% from 1998 to 2012. During that same period, the number of undergraduates, master and doctorate students increased. Undergraduates accounted for the majority of public health graduates (63.1%) in 2012, and master and doctorate students increased by 10.0 and 5.1 times, respectively, from 1998 to 2012. The relative percentage of public health enrollment, students, and graduates to all health education disciplines dropped from about 6.0% percent in 1998 to around 2% in 2012. CONCLUSIONS: The overall scale of public health education has clearly expanded, though at a slower pace than many other health science disciplines in China. The increase of public health graduates helped to address the previous shortage of public health professionals. Gradually adopting a modern model of education, public health education in China has undergone notable changes that may be informative to other developing countries though it still faces a complex situation in terms of graduates' adherence to public health, student recruitment, teaching and training, program planning and reform.

Parental perspectives on factors influencing eyeglass wear compliance in preschoolers from low-income families in San Francisco.

PURPOSE: To investigate factors associated with spectacle wear among low-income preschoolers who receive glasses through the See Well to Learn (SWTL) program. METHODS: Qualitative study of parental perceptions of factors contributing to compliance during a longitudinal study of eyeglass wear utilizing thematic analysis of a series of three scripted phone calls during the 2017-2018 school year. Participants were parents of 164 children ages 3-5, from 51 Head Start preschools in the greater San Francisco region. RESULTS: A total of 470 scripted parental telephone calls were successfully completed during the study period. Six major themes affecting glasses compliance in this group were identified including: (1) awareness of need and noted visual improvement; (2) continuous efforts to improve compliance by working with parent; (3) collaborative efforts between home and school such as parent-teacher encouragement; (4) child comfort and eyewear preferences; (5) the importance of two functional pairs of eyewear to achieve full-time wear; and (6) coordination of care offered by the SWTL program. CONCLUSIONS: This study offers insight into factors contributing to child eyewear compliance during critical years of vision development. These findings offer lessons to improve compliance and identify a need to adjust California's current policies on vision coverage for children.

Prevalence and Factors Associated With Eyeglass Wear Compliance Among Preschoolers From Low-Income Families in San Francisco, California.

IMPORTANCE: Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs. OBJECTIVE: To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program. EXPOSURES: Eyeglass distribution. MAIN OUTCOMES AND MEASURES: Eyeglass wear compliance, measured by a school-year's worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4). RESULTS: Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye. CONCLUSIONS AND RELEVANCE: This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.

Comparison of RN licensure examination: China and the United States.

Having the two largest nursing workforces across the globe, both China and the United States have implemented licensure examinations to standardize the qualifications of registered nurse. China established the National Nursing Licensure Examination (NNLE) in 1995. Like the National Council Licensure Examination for Registered Nurses (NCLEX-RN) in the United States, the NNLE has become an important link in the nurse registration process and contributed a lot in quality assurance and development of nursing profession. It may be necessary for the NNLE to learn from NCLEX-RN in several aspects, including increasing the frequency of exam, providing examinees with individualized services, and continuing reforming exam content and format. By better aligning the content and format of the examination with the current nursing paradigm and clinical requirements, nurses may enter the healthcare field better prepared to care for patients. Considering the magnitude of their nursing workforce, both China and the United States have great potential to serve as a role model for other developing countries as they look towards establishing national nursing education programs. As new policies around standardized nurse education in China take form, we urge that the NNLE be included alongside curricular reforms. As these reforms are implemented, continued research will be needed to evaluate the effectiveness of curriculum and licensure exam regulations upon nurse preparedness and quality of nursing care in China.

Should There Be a Disclosure Mandate for Physicians Caring for Perinatally Infected Adolescents Who Don't Know Their HIV Serostatus?

With advances in antiretroviral therapies, perinatally infected children are now living with HIV well beyond adolescence. Parents and health care practitioners thus face the challenge of deciding how best to disclose positive serostatus to children living with HIV. Although many adolescents living with HIV are sexually active, parents often delay disclosure, which presents US physicians with an ethical dilemma because there is no legal requirement to follow clinical guidelines recommending disclosure prior to adolescence. When they become adults, US adolescents could face criminal penalties if they fail to disclose their positive serostatus to needle-sharing or sex partners despite there being no legal mandates to ensure that adolescents are first properly informed of their own diagnoses. We argue that there is an urgent need to bridge this gap between adolescent and adult HIV serostatus disclosure policies.