The impact of COVID-19 on a cohort of patients treated with clozapine.

OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic and its associated restrictions on a cohort of patients with severe and enduring mental illness treated with clozapine. METHODS: Semi-structured interviews were conducted with 63 individuals attending a clozapine clinic within the Galway-Roscommon Mental Health Services to determine the impact of COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life, by utilising Likert scale data. The Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A) were additionally utilised to measure anxiety symptoms cross-sectionally. RESULTS: Anxiety symptoms were low with a median BAI score of 4.0 and HAM-A score of 4.0. Likert scale measurements recorded only a modest adverse impact of COVID-19 restrictions on anxiety and depressive symptoms, quality of life and occupational and social functioning. Free-text comments from patients (n = 55), were grouped into five themes: neutral impact (n = 22), negative psychological impact (n = 13), negative social impact (n = 11), positive psychological impact (n = 5) and media coverage inducing anxiety (n = 4). CONCLUSIONS: Three months into the COVID-19 pandemic and its restrictions, the impact on individuals with treatment-resistant psychotic disorders attending a clozapine clinic has been modest, with preliminary evidence demonstrating minimal increases in subjective symptoms of anxiety and reduced social functioning. Reduced social engagements and supports attainable both within the community and from mental health services were noted by some participants.

Traveller health: prevalence of diabetes, pre diabetes and the metabolic syndrome.

Irish Travellers are an ethnic minority group exposed to a myriad of social and health inequalities. Their current life expectancy equals that of the background population in the 1940s and one of the main causes of death is cardiovascular disease (CVD). There is a paucity of information on CVD risk factor assessment in the research literature in this population. This study assesses the prevalence of Diabetes, Pre-Diabetes and the Metabolic Syndrome (MetS) in a sample population from this community. Working with the Galway Traveller Movement, and following an overnight fast we measured fasting plasma glucose, HDL-cholesterol and Triglycerides. In addition weight, height, waist circumference (WC) and blood pressure (BP) were recorded. Of the 47 subjects, there were 4 (8.5%) participants identified as having diabetes, 5 (10.6%) pre-diabetes and 25 (53.2%) with the metabolic syndrome. The point prevalence of diabetes was calculated as 8.5%, pre-diabetes 10.6% and the metabolic syndrome 53.2%. In addition abdominal obesity was present in 70% and hypertension in 43%. Targeted screening for glucose abnormalities and traditional CVD risk factors is needed. Based on current literature, appropriate interventions might reasonably be expected to lower mortality and increase life expectancy.

Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey.

OBJECTIVE: To determine the causes of blindness and visual impairment in adults (> or =30 years old) in Pakistan, and to explore socio-demographic variations in cause. METHODS: A multi-stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling. RESULTS: A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to > or =6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention. CONCLUSIONS: This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.

Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

AIM: To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS: Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS: 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION: Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.

Prevalence of asthma in Galway school children 2004.

We aimed to ascertain the prevalence of asthma amongst Galway schoolchildren aged 9-10, and to compare the results to a similar study carried out in 1992. A questionnaire was distributed to parents of all children attending 4th class in Galway city schools. 652 of 750(87%) questionnaires were returned. Prevalence of "wheeze ever" was 27.6%, and "current wheeze" 16.3%. The prevalence of asthma was 18.5%. Of those with asthma there was a 2 to 1 male preponderance, 80% had mild asthma, 14% moderate, and 6% severe asthma. 80% were taking anti-asthma therapy, with 48% taking regular inhaled steroids. 84% had a diagnosis of asthma made by a doctor. Comparison with the study of 1992 shows little change in the prevalence of current wheeze, or asthma. There has however been a significant decline in the severity of asthma, and an increase in the use of prophylactic anti-asthma medication. Asthma prevalence appears to be stable in the age group studied. There is a much greater willingness to diagnose, and treat asthma in the community. The severity of asthma, as measured by attack frequency, has declined.

The prevalence of Down syndrome in County Galway.

This is a retrospective survey of all cases of Down syndrome recorded between 1981 and 2000 to mothers resident in Co. Galway. The study compares the incidence of Down syndrome in both decades and examines the effects of changing demographics on incidence rates. The overall prevalence rate was 26.8/10,000 live births for the full period. Although there were 5119 fewer births in the 1991-2000 period, the prevalence was 29.8/10,000 compared to 24.1/10,000 in the previous decade. Despite the falling birth rates and fertility rates observed in our study between the two decades we found that the higher prevalence of Down syndrome in the second decade was directly related to the significant increase in the proportion of women in the 30 plus age group. Our study also found the place of the child with Down syndrome in the family changed, with 25.3% being the 5th or more child in the first decade compared with 9.5% in the second decade.

Prevalence and causes of blindness and visual impairment in Muyuka: a rural health district in South West Province, Cameroon.

AIM: To estimate the prevalence and causes of blindness and visual impairment in the population aged 40 years and over in Muyuka, a rural district in the South West Province of Cameroon. METHODS: A multistage cluster random sampling methodology was used to select 20 clusters of 100 people each. In each cluster households were randomly selected and all eligible people had their visual acuity (VA) measured by an ophthalmic nurse. Those with VA <6/18 were examined by an ophthalmologist. RESULTS: 1787 people were examined (response rate 89.3%). The prevalence of binocular blindness was 1.6% (95% CI: 0.8% to 2.4%), 2.2% (1.% to 3.1%) for binocular severe visual impairment, and 6.4% (5.0% to 7.8%) for binocular visual impairment. Cataract was the main cause of blindness (62.1%), severe visual impairment (65.0%), and visual impairment (40.0%). Refractive error was an important cause of severe visual impairment (15.0%) and visual impairment (22.5%). The cataract surgical coverage for people was 55% at the <3/60 level and 33% at the <6/60 level. 64.3% of eyes operated for cataract had poor visual outcome (presenting VA<6/60). CONCLUSIONS: Strategies should be developed to make cataract services affordable and accessible to the population in the rural areas. There is an urgent need to improve the outcome of cataract surgery. Refractive error services should be provided at the community level.

Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.

AIMS: To determine the coverage, outcome, and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria. METHODS: People 30 years and above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had received an operation for cataract were examined to determine the outcome and, where applicable, the causes of poor outcome. RESULTS: 480 people were examined. Cataract was the commonest cause of blindness. The cataract surgical coverage (people) was 39.2% for orthodox surgery and 29.7% for couching. After surgery, visual acuity > or =3/60 had been restored to 82.1% of eyes that had had orthodox surgery, but only 58.6% of eyes that had been couched. Cost was the commonest reason given for not seeking treatment for cataract. CONCLUSIONS: Cataract is the major cause of blindness in this population but cataract surgical needs are currently not being met. There is a need for better collaboration between leprosy control and ophthalmic services, improved education of people affected by leprosy, a commitment to improving orthodox cataract surgery outcomes, and consideration of a possible role for traditional healers as sources of referral for orthodox surgical services.

The prevalence of glaucoma in Bangladesh: a population based survey in Dhaka division.

BACKGROUND/AIM: Few studies have reported on the epidemiology and clinical characteristics of glaucoma in south Asia. This project aimed to determine the prevalence of glaucoma of Dhaka, Bangladesh. METHOD: A multistage, stratified, clustered sample was drawn from Dhaka Division, Bangladesh, using systematic sampling to identify individual subjects aged 35 years and older. Examination of all subjects included Snellen visual acuity, slit lamp examination (including gonioscopy and applanation tonometry) and a stereoscopic assessment of the vertical cup:disc ratio (CDR). In selected subjects, a threshold visual field examination was performed. Glaucoma was diagnosed on the basis of statistical abnormality of the vertical CDR combined with an abnormal visual field test, or in subjects with advanced glaucoma who could not complete field testing, a grossly abnormal CDR. If it was not possible to examine the optic discs and the subject was blind, glaucoma was diagnosed on the basis of a raised intraocular pressure. RESULTS: Of 3562 eligible subjects, 2347 were examined (66%). Among people aged 40 years and older, the prevalence of definite glaucoma was 2.1% (95% confidence interval: 1.5 to 2.9; 39 people). The prevalence of definite and probable glaucoma was 3.1% (95% CI: 2.4 to 4.0; 58 people) in subjects of the same age. Primary open angle glaucoma was the most common form of glaucoma, accounting for 75% of the total. Among cases of blindness not attributable to refractive error, 5% were caused by glaucoma. Glaucoma prevalence was higher in men than women, but did not show the typical increase with age. CONCLUSION: Glaucoma prevalence is relatively high in Bangladesh, although it accounts for only a small proportion of blindness in the community. It is estimated that there are approximately 586 000 people 40 years and older with definite or probable glaucoma in Bangladesh.

Outcomes of cataract surgery in Bangladesh: results from a population based nationwide survey.

AIM: To evaluate the outcome of cataract surgery in the population of Bangladesh. METHODS: Data were collected by the National Blindness and Low Vision Prevalence Survey of Bangladesh, a cross sectional, nationally representative sample (12 782 subjects) of the population aged >or=30 years. An interview recorded socioeconomic data. Each subject was tested for logMAR visual acuity (VA) of each eye, autorefracted, and then underwent optic disc examination. Those with <6/12 VA on presentation in either eye were retested with their refractive correction, dilated, and examined for anterior and posterior segment disease. In aphakic and pseudophakic subjects the date, location and operating conditions (eye camp/hospital), and type of operation(s) were recorded. RESULTS: 11 624 eligible subjects were examined (90.9% response rate) in the survey. 162 subjects, 77 men and 85 women, had undergone cataract surgery in one or both eyes. 199 (88%) eyes had undergone intracapsular cataract extraction (ICCE), and 22 (10%) extracapsular surgery with intraocular lens (ECCE+IOL); surgical technique(s) in four cases were not identified. Presenting VA for the 226 operated eyes were: 68 eyes (30.1%) were 6/12 or better, 31 (13.7%) <6/12 >or=6/18, 63 (27.9%) 6/18 to 6/60, 8 (3.5%) <6/60 >or=3/60, and 56 (24.8%) <3/60. With "best" refractive correction these values were 114 (50.4%), 31 (13.7%), 51 (22.6%), 5 (2.2%), and 25 (11.1%), respectively. Of the 158 eyes with VA of 6/12 or worse on presentation, 44 (28%) were the result of coincident disease (principally age related macular degeneration), 95 (60%) refractive error (44 of these had uncorrected aphakia), and 19 (12%) operative complications. ICCE was more likely to result in a VA of <6/18 (OR: 4.26, p = 0.01) than ECCE+IOL. Likewise, eye camp surgery was more likely to result in a VA of <6/60 (OR: 1.98, p = 0.04). No significant association was found between time since surgery and VA outcome, nor was there a sex difference for postoperative vision. Literate subjects were significantly less likely to have an outcome of <6/18 (OR: 2.38, p <0.01) or <6/60 (OR: 2.87, p <0.01). Following ICCE (199 eyes), 56 (37%) of the 151 eyes with an aphakic spectacle correction achieved 6/12 or better. Females, eye camp surgeries, illiterate subjects, and rural dwellers were less likely to wear their aphakic correction. The ratio of ICCE:ECCE+IOL has reduced in the past 3 years (3.8:1) compared to >or=4 years before the survey (25:1). Hospital based ECCE+IOL surgeries were associated with a better outcome, yet 36% of these eyes were <6/12 postoperatively, after excluding coincident disease. CONCLUSION: This evaluative research study into cataract surgery outcomes in Bangladesh highlights the need for an improvement in quality and increased quantity of surgery with a more balanced distribution of services.

Prevalence and causes of blindness and visual impairment in Bangladeshi adults: results of the National Blindness and Low Vision Survey of Bangladesh.

AIM: To determine the age, sex, and cause specific prevalences of blindness and visual impairment in adults 30 years of age and older in Bangladesh. METHODS: A nationally representative sample of 12 782 adults 30 years of age and older was selected based on multistage, cluster random sampling with probability proportional to size procedures. The breakdown of the cluster sites was proportional to the rural/urban distribution of the national population. The examination protocol consisted of an interview, visual acuity (VA) testing, autorefraction, and optic disc examination on all subjects. Corrected VA retesting, cataract grading, and a dilated fundal examination were performed on all visually impaired subjects. The definitions of blindness (<3/60) and low vision (<6/12 to >or=3/60) were based on the presenting visual acuity in the better eye. The World Health Organization/Prevention of Blindness proforma and its classification system for identifying the main cause of low vision and blindness for each examined subject was used. RESULTS: In total, 11 624 eligible subjects were examined (90.9% response rate) across the 154 cluster sites. A total of 162 people were bilaterally blind (1.53% age standardised prevalence) while a further 1608 subjects (13.8%) had low vision (<6/12 VA) binocularly. Visual acuity was >6/12 in the "better eye" in the remaining 9854 subjects (84.8%); however, 748 of these people had low vision in the fellow eye. The main causes of low vision were cataract (74.2%), refractive error (18.7%), and macular degeneration (1.9%). Cataract was the predominant cause (79.6%) of bilateral blindness followed by uncorrected aphakia (6.2%) and macular degeneration (3.1%). CONCLUSIONS: There are an estimated 650 000 blind adults (95% CI 552 175 to 740 736) aged 30 and over in Bangladesh, the large majority of whom are suffering from operable cataract. This survey indicates the need for the development and implementation of a national plan for the delivery of effective eye care services, aimed principally at resolving the large cataract backlog and the inordinate burden of refractive error.

Prevalence and associations of the metabolic syndrome among patients prescribed clozapine.

BACKGROUND: There is increasing concern that the use of second-generation antipsychotic medications in schizophrenia is associated with the development of metabolic syndrome. AIMS: This study assessed the prevalence and clinical associations of metabolic syndrome among patients receiving clozapine within the catchment area of a mental health service in the west of Ireland. METHOD: A total of 84 patients (96% response rate) taking clozapine were interviewed and thoroughly investigated using physical assessments, comprehensive laboratory testing and review of medical records. RESULTS: Of the patients, 46.4% taking clozapine fulfilled the criteria for metabolic syndrome. Male gender, high body mass index, high insulin level and receiving a concomitant antipsychotic medication were significantly associated with the presence of metabolic syndrome. CONCLUSION: Almost half of the patients receiving clozapine have metabolic syndrome and are consequently at risk of cardiovascular morbidity and mortality. Such patients should be closely monitored in order to facilitate interventions, which could alleviate the adverse health consequences of this syndrome.

Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey.

OBJECTIVE: To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. DESIGN: Cross sectional population based survey. SETTING: 221 rural and urban clusters selected randomly throughout Pakistan. PARTICIPANTS: Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). MAIN OUTCOME MEASURES: Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. RESULTS: 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). CONCLUSION: Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.

Transcriptional regulation in response to exercise.

Much progress has been made in recent years into understanding molecular mechanisms by which transcription is regulated following changes in physiological stimuli. This review has tried to focus on what is known about four specific physiological challenges--mechanical load, intracellular calcium, hypoxia, and redox state. Because of our biased interest in exercise, it was our goal to review these relatively well-studied systems so that we might provide insight into potential mechanisms that govern exercise-induced transcriptional changes. What becomes obvious, when reaching the end of this review, is that there are many common themes among the different physiological responses described. Some examples include the activation of IEGs, such as c-jun and c-fos, the phosphorylation of the transcription factor CREB, and the importance of the serum response element and the serum response factor. These commonalities across the different physiological systems suggest a certain redundancy or shared mechanism(s) for regulating transcription in response to physiological stimuli. While very little is known at this time about how exercise regulates transcription, it is an exciting time in this field of research. The recent growth in the molecular biological research literature of more physiologically-based studies provides exciting new molecular and cellular tools for those researchers willing to take on the challenge of understanding the complex mechanisms of exercise-induced adaptations.

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland.

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.

Evaluating a new logMAR chart designed to improve visual acuity assessment in population-based surveys.

AIMS: This study aimed to evaluate a new chart designed to improve the collection of visual acuity data in population-based surveys. The Reduced logMAR E chart (RLME) employs three letters per line, 'tumbling E' optotypes, and conforms to accepted contemporary design principles. METHODS: The performance of the chart was assessed within a population-based glaucoma survey in Thailand. Performance indices were test-retest variability (TRV) and agreement with acuity data measured using the ETDRS logMAR chart which acted as the 'gold standard'. RESULTS: The 95% confidence limits for TRV of RLME acuity data were +/-0.15 logMAR. This figure is consistent with published data on the TRV of acuities measured using five-letter-per-line logMAR charts. The mean difference between RLME and ETDRS acuity data was 0.00 logMAR (95% confidence intervals of +/-0.05 logMAR) indicating that RLME acuities agreed well with those of the ETDRS chart. The chart and its method of use was readily accepted by the local ancillary staff who required only minimal training before acuity measurement could be delegated to them. CONCLUSIONS: The study demonstrated that the RLME chart is capable of accurate and repeatable acuity measurements. Certain aspects of the design of the RLME chart may be particularly pertinent to the measurement of vision in population-based surveys.