Comparison of 10-2 and 24-2 Perimetry to Diagnose Glaucoma Using OCT as an Independent Reference Standard.

PURPOSE: To compare the performance of the 10-2 test versus 24-2 standard automated perimetry (SAP) test for the diagnosis of glaucoma using OCT as an independent standard for glaucomatous damage. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 1375 pairs of 10-2 and 24-2 SAP tests from 569 eyes of 339 subjects were used for the analysis. A total of 440 (77%) eyes had a diagnosis of glaucoma, and 129 (23%) eyes were normal. All participants underwent 10-2 and 24-2 SAP tests within 30 days. METHODS: Glaucomatous severity was quantified based on OCT macula ganglion cell layer (mGCL) and circumpapillary retinal nerve fiber layer. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare 10-2 and 24-2 metrics for discriminating healthy eyes from those of glaucoma, at different levels of disease severity. MAIN OUTCOME MEASURES: Areas under the ROC curves and sensitivities at fixed specificities of 80% and 95%. RESULTS: The overall AUC for mean deviation (MD) for the 24-2 test (0.808) was significantly higher than that of the 10-2 test (0.742; P < 0.001). When compared at different stages of the disease, the 24-2 test performed generally better than the 10-2 test, notably in the earlier stages of the disease. For early damage (first quartile), the 24-2 MD had an AUC of 0.658 versus 0.590 for 10-2 MD (P = 0.018). For advanced damage (fourth quartile), corresponding values were 0.954 vs. 0.903 (P = 0.013). Similar trends were observed when glaucoma severity was defined based on structural macular damage with mGCL thickness. CONCLUSIONS: The 24-2 SAP test had better diagnostic accuracy compared with that of the 10-2 test for detecting equivalent levels of glaucomatous damage, as measured by quantitative assessment of retinal nerve fiber layer and macula by OCT. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Multimodal imaging in pediatric uveitis.

Pediatric uveitis accounts for up to 10% of all uveitis cases, so special attention must be paid to ensure early diagnosis as well as treatment and follow-up of these young patients in order to decrease the risk of possible ocular complications and consequently vision loss. Multimodal imaging has been an effective and important adjunct in the diagnoses and management of uveitis, especially in children. Reviewed here are the currently utilized modalities, advances, as well as their applications in juvenile idiopathic arthritis-associated uveitis, pars planitis, retinal vasculitis, tubulointerstitial nephritis and uveitis syndrome, Behçet disease, Blau syndrome, and Vogt-Koyanagi-Harada syndrome.

First Case of Subretinal Ocular Angiostrongyliasis Associated with Retinal Detachment in the United States.

Angiostrongylus cantonensis, commonly known as the rat lungworm, is mostly found in Asia, the Pacific Basin, and the Caribbean, but is also endemic in Hawai'i, especially on the Island of Hawai'i. Ocular angiostrongyliasis is an uncommon but previously reported complication associated with permanent vision loss. This is the first reported case of ocular angiostrongyliasis involving the retina or posterior segment of the eye in the US. A 24-year-old male from Chicago visited the Island of Hawai'i, where he worked on a farm and ate a vegetarian diet. When he returned to Chicago, he became sick and was hospitalized for eosinophilic meningitis. One month later, he developed a retinal detachment which required surgical repair involving a pars plana vitrectomy. During the reattachment of the retina during surgery, a live motile was identified nematode in the subretinal space. An endolaser probe immobilized and killed the nematode, and it was subsequently extracted through the sclerotomy. Thermal scars around all retinal holes including the retinotomy site were made to stabilize the retina, and perfluoropropane gas was injected to achieve temporary tamponade. Thereafter, the patient's cerebrospinal fluid returned positive for angiostrongylus cantonensis antibodies. During extended follow-up, the patient eventually lost all vision in the affected eye due to recurrent retinal detachment. This case of ocular angiostrongyliasis demonstrates the importance of obtaining travel history from endemic areas, knowing the risk of developing eosinophilic meningitis, and understanding the risk of permanent vision loss in cases involving the retina.

Long term observation of hydrogel buckle intrusion without vision loss.

Hydrogel buckle intrusion due to progressive swelling is a known complication, which usually requires surgical intervention due to vitreous hemorrhage, retinal detachment, or progressive encroachment into the optic nerve or macula. Hydrogel buckle surgery with successful retinal detachment repair was performed in this one-eyed physician in 1990, and there was slow progressive intrusion towards the macula and optic nerve without surgical intervention for 30 years and with visual acuity maintained at 20/40.

Demographic, Social, and Mental Health Aspects of American Indian and Alaska Native Adolescents in Hawai'i.

American Indians and Alaska Natives (AI/ANs) constitute 2.2% of Hawai'i's population. Unfortunately, very little is known about the mental health of AI/AN youth in Hawai'i. The purpose of this study (N = 7,214; 1992-1996) was to describe AI/AN adolescents versus non-AI/AN youth regarding demographic, social, and mental health variables. The results suggested that AI/AN adolescents were more open to different types of social-emotional supports, had relatively more non-traditional families with a smaller social network, and may be more vulnerable to academic and health difficulties, with particular risk for mental health issues for mixed AI/AN-Native Hawaiians. Implications are discussed, including intervention, socio-political issues, and future research.

Longitudinal Prediction of Suicide Attempts for a Diverse Adolescent Sample of Native Hawaiians, Pacific Peoples, and Asian Americans.

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

Social Smoking and Mental Health Among Chinese Male College Students.

PURPOSE: China has a high prevalence of smoking, but the characteristics of social smoking in Chinese college students have not been investigated. We examined the pattern of social smoking and explored the association between social smoking and personal cessation efforts and mental health factors among Chinese male college students. DESIGN: Study design was a cross-sectional survey. SETTING: P. R. China was the setting of the study. SUBJECTS: Participants were a random sample of 1327 male college students. MEASURES: All participants completed a self-administered questionnaire that examined their smoking behaviors and a group of specific mental health factors (loneliness, self-harm, suicide, depression, and anxiety). ANALYSIS: Analysis was conducted using descriptive statistics, χ2 analysis, and multivariate logistic regression. RESULTS: Of a total of 207 current smokers, 102 (49.3%) were identified as social smokers. Compared with nonsmokers, social smokers had increased risks for depression (odds ratio, 1.74; 95% confidence interval, 1.15-2.65). Among daily smokers, social smokers were less likely to have an intention to quit smoking than nonsocial smokers (odds ratio, .08; 95% confidence interval, .01-.57). CONCLUSION: This study reveals unique psychologic characteristics related to social smoking. College students are a particular group of interest because unhealthy behaviors initiated during adolescence may continue through adulthood. Our findings provide evidence for future tobacco control intervention among this population.

Urban-Rural Differences in Cardiovascular Disease Risk Factors: A Cross-Sectional Study of Schoolchildren in Wuhan, China.

BACKGROUND: China's rapid population growth and urban migration has developed healthcare inequity across the urban-rural divide. Past studies comparing cardiovascular disease (CVD) risk factor prevalence amongst urban-rural Chinese children are sparse and conflicting. We examined the association between urban-rural residence and risk of offspring CVD in Chinese children. METHODS: A cross-sectional study was conducted in Wuhan, China, during May and June 2010. CVD risk factors include; waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, body mass index (BMI), cardiorespiratory fitness (CRF), metabolic syndrome (MetS), and metabolic risk score (MRS). Analysis of covariance and multivariable logistic regression were used to estimate associations between urban-rural residence and offspring CVD risks. FINDINGS: A total of 579 Chinese children (338 boys and 241 girls) aged 9.6 (0.7) years participated in this study. Rural boys had significantly lower CRF and higher FBG, TG, and MRS, while urban boys had significantly higher LDL and DBP. Rural girls had significantly higher BMI, FBG, and TG, as well as lower CRF. Rural children were at increased risks for decreased CRF, elevated MRS, and TG, (OR:2.04, 95%CI:1.29-3.25), (OR:2.33, 95%CI:1.50-3.62), and (OR:2.40, 95%CI:1.62-3.57), respectively. Rural girls and mothers were at increased risks for overweight(OR:7.19, 95%CI:1.64-31.6)/obesity (OR:1.683, 95%CI:1.01-2.82). However, rural boys and fathers were less likely to have overweight(OR:0.62, 95%CI:0.34-1.12)/obesity (OR:0.68, 95%CI:0.48-0.97). CONCLUSIONS: Rural residence was significantly associated with increased CVD risks amongst Chinese children. It is important to provide interventions aiming at China's urban-rural healthcare inequity and community-based approaches that reduce familial CVD risk.

Using Photovoice with youth to develop a drug prevention program in a rural Hawaiian community.

INTRODUCTION: Substance use represents a significant and persistent health disparity among Native Hawaiian youth and communities. A community-university participatory action research project was conducted to develop a Native Hawaiian model of drug prevention. METHODS: Ten youth participated in eight Photovoice focus groups. Focus group transcripts and the youths' SHOWED (see, happening, our, why, empower, do) worksheets were analyzed. RESULTS: Emergent analyses are described regarding focus group theme identification and the meaning of each theme. Youth-selected exemplary photographs and researcher-selected exemplary quotations are provided. IMPLICATIONS: Native Hawaiian drug prevention will be place-based in culturally significant community locations, experiential, and guided by multigenerational teaching and learning.

Parental weight status and offspring cardiovascular disease risks: a cross-sectional study of Chinese children.

INTRODUCTION: Prevalence of childhood obesity in China is increasing, and parental weight is a risk factor for the development of obesity in children. We examined the relationship of parental body weight status with risk of offspring cardiovascular disease (CVD) in Chinese children. METHOD: We conducted a cross-sectional study in Wuhan, China, during May and June 2010. Parental body mass index (BMI) was calculated according to self-reported height and weight. Offspring CVD risk factors, including BMI, waist circumference, blood pressure, fasting glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, cardiorespiratory fitness (CRF), and metabolic risk score (MRS), were assessed through anthropometric measures, blood samples, and a CRF test. Multiple linear regression and analysis of covariance were used to examine the effects of maternal and paternal weight status on offspring CVD risks. RESULTS: A total of 580 Chinese children (339 boys and 241 girls, mean [standard deviation] age, 9.6 [0.7] years) participated in the study. Maternal BMI was significantly associated with offspring elevated BMI (ß = 0.134, P = .002), waist circumference (ß = 0.253, P = .04), and decreased CRF (ß = -0.134, P = .01). Paternal BMI was significantly associated with elevated offspring BMI (ß = 0.161, P < .001), waist circumference (ß = 0.404, P < .001), triglycerides (ß = 0.017, P = .03), MRS (ß = 0.084, P = .03), and decreased CRF (ß = -0.174, P < .001). BMI (P < .001), waist circumference (P < .001), and MRS (P < .05) were positively associated with additional overweight/obese parents, whereas CRF was negatively associated (P < .001). CONCLUSION: Parental weight status was significantly associated with increased risk of CVD in their children, and the association was stronger for paternal weight status.