Global estimates on the number of people blind or visually impaired by Uncorrected Refractive Error:a meta-analysis from 2000 to 2020

BackgroundUncorrected refractive error (URE) is a readily treatable cause of visual impairment (VI). This study provides updated estimates of global and regional vision loss due to URE, presenting temporal change for VISION 2020MethodsData from population-based eye disease surveys from 1980–2018 were collected. Hierarchical models estimated prevalence (95% uncertainty intervals [UI]) of blindness (presenting visual acuity (VA) < 3/60) and moderate-to-severe vision impairment (MSVI; 3/60 ≤ presenting VA < 6/18) caused by URE, stratified by age, sex, region, and year. Near VI prevalence from uncorrected presbyopia was defined as presenting near VA < N6/N8 at 40 cm when best-corrected distance (VA ≥ 6/12).ResultsIn 2020, 3.7 million people (95%UI 3.10–4.29) were blind and 157 million (140–176) had MSVI due to URE, a 21.8% increase in blindness and 72.0% increase in MSVI since 2000. Age-standardised prevalence of URE blindness and MSVI decreased by 30.5% (30.7–30.3) and 2.4% (2.6–2.2) respectively during this time. In 2020, South Asia GBD super-region had the highest 50+ years age-standardised URE blindness (0.33% (0.26–0.40%)) and MSVI (10.3% (8.82–12.10%)) rates. The age-standardized ratio of women to men for URE blindness was 1.05:1.00 in 2020 and 1.03:1.00 in 2000. An estimated 419 million (295–562) people 50+ had near VI from uncorrected presbyopia, a +75.3% (74.6–76.0) increase from 2000ConclusionsThe number of cases of VI from URE substantively grew, even as age-standardised prevalence fell, since 2000, with a continued disproportionate burden by region and sex. Global population ageing will increase this burden, highlighting urgent need for novel approaches to refractive service delivery

Self-reported questionnaires to assess indoor home environmental exposures in asthma patients:A scoping review

Background: The indoor home environment plays a crucial role in determining the outcome of respiratory diseases, including asthma. Researchers, clinicians, and patients would benefit from self-reported questionnaires to assess indoor home environmental exposures that may impact on respiratory health. Objective: To review self-reported instruments for assessing indoor home environmental exposures in asthma patients and to characterise their content, development, and psychometric properties.Design: A scoping review was conducted with content assessment.Methods: A literature search was conducted in Embase and PubMed using the key words housing quality, questionnaire and asthma and their index terms, covering articles published in English between January 2000 to July 2023. Articles in which questionnaires or single item questions were used to assess indoor home environmental exposures in asthma patients in middle- and high-income countries were included. We excluded articles in which the questionnaire required an interviewer or onsite observations and those conducted in low-income countries. Results: We screened 1584 articles to identify 44 studies containing self-reported questionnaires measuring indoor home environmental exposures. 36 studies (82%) were cross sectional, 35 (80%) had a sample size of greater than 1000 participants, and 29 (66%) were conducted in children. Most studies (86%, n=38) had binary (yes/no) or multiple-choice responses. 25 studies (57%) included a recall period of 12 months. 32 studies (73%) had a response rate of greater than 50%. Dampness, biological exposures (e.g. mould), and second-hand tobacco smoke were the most assessed indoor home environmental exposures. Childhood asthma (54%, n=24) and asthma symptoms (36%, n=16) were the most examined asthma related outcomes. The exposure most associated with adverse asthma outcomes was exposure to damp (79%, n=35). 13 studies (29%) had developed a self-reported instrument by adapting questions from previous studies and almost all instruments (n=42 studies, 95%) had not been validated.Conclusions: The scoping review did not identify a comprehensive, validated self-reported questionnaire for assessing indoor home environmental exposures in patients with asthma. There is need to develop and validate a robust but pragmatic self-reported instrument, incorporating the findings from this review. <br/

Consensus on Upper Gastrointestinal Endoscopy Key Performance Indicators to Reduce Post Endoscopy Upper Gastrointestinal Cancer

Background: Upper gastrointestinal (UGI) endoscopy lacks established key performance indicators. Up to three‐fold variation in post endoscopy upper gastrointestinal cancer rates has been observed among endoscopy providers in England, highlighting the need for standardisation of UGI endoscopy practices. Objective: We aimed to achieve consensus on evidence‐based key performance indicators to reduce post endoscopy upper gastrointestinal cancer. Methods: Modified nominal group technique was employed in two consensus workshops, with representation from clinicians, patients and relatives, moderated by James Lind Alliance facilitators. Potential indicators were identified from the umbrella systematic review, English provider post endoscopy upper gastrointestinal cancer rates, and differences in endoscopy practices from the National Endoscopy Database between providers with the highest (worst) and lowest (best) post endoscopy upper gastrointestinal cancer rates. KPIs were categorised as provider or endoscopist/procedure related and ranked as of major or minor importance. Minimum standards were proposed where possible. Results: Participants included 14 clinicians (gastroenterologists and UGI surgeons), 3 nurse endoscopists, 2 UGI cancer nurse specialists, 14 patients, their relatives and representatives from patient support groups and four observers. Endoscopy provider related major key performance indicators and proposed standards included monitoring post endoscopy upper gastrointestinal cancer rates (minimum standard ≤ 7%); less intense endoscopy lists (maximum 10 ‘points’ per list [one point is equivalent to 15 min]); endoscopy provider accreditation (all providers); and premalignant condition surveillance on dedicated lists by endoscopists with adequate training (> 90% surveillance endoscopies). Endoscopist/procedure related major key performance indicators included: examination time ≥ 7 min; training in early UGI neoplasia recognition (all endoscopists); mucosal view quality recorded and cleansing agents used if not excellent (> 90% endoscopies); intravenous sedation offered to all appropriate patients; recommended number of biopsies from cancer associated or premalignant lesions (> 90% endoscopy where such lesions identified); and endoscopists' annual UGI endoscopy volume > 100 (all endoscopists). Conclusion: This study offers a consensus on the key performance indicators and minimum standards that should be used to improve UGI endoscopy quality and reduce post endoscopy upper gastrointestinal cancer

The risk of immune-mediated inflammatory diseases following exposure to childhood maltreatment:a retrospective cohort study using UK primary care data

BackgroundAs a global public health issue, childhood maltreatment is associated with significant morbidity and mortality. We aimed to investigate the association between childhood maltreatment and immune-mediated inflammatory disorders (IMIDs).MethodsWe conducted a retrospective matched open cohort study using a UK primary care database between January 1, 1995 and January 31, 2021. Clinical codes were used to identify patients exposed to childhood maltreatment who were matched by general practice (GP), age, and sex to up to four unexposed patients. Cox regression analysis was used to evaluate the risk of developing IMIDs (inflammatory bowel disease, coeliac disease, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus) during follow-up in the exposed versus unexposed groups.Results256,130 exposed patients were matched to 712,478 unexposed patients. Those exposed to childhood maltreatment were 1) at an increased risk of developing Rheumatoid arthritis (aHR 1·39; 95 % CI 1·12-1·74) and Psoriasis (aHR 1·16; 95 % CI 1·10-1·23), 2) not statistically significantly at risk of developing inflammatory bowel disease (aHR 0·87; 95 % CI 0·75-1·00), multiple sclerosis (aHR 1·07; 95 % CI 0·77-1·49) and systemic lupus erythematosus (aHR 1·28; 95 % CI 0·89-1·85) and 3) at a reduced risk of coeliac disease (aHR 0·74; 95 % CI 0·62-0·88) compared to the unexposed group.InterpretationsChildhood maltreatment is estimated to affect one in three children globally; therefore, an increased risk of developing rheumatoid arthritis and psoriasis represents a substantial contribution to the burden of IMIDs. Implementation of broad public health approaches to prevent and detect childhood maltreatment and its negative downstream consequences, such as, IMID development, is essential

A decomposition of Fisher's information to inform sample size for developing fair and precise clinical prediction models -- Part 2:time-to-event outcomes

Background: When developing a clinical prediction model using time-to-event data, previous research focuses on the sample size to minimise overfitting and precisely estimate the overall risk. However, instability of individual-level risk estimates may still be large. Methods: We propose a decomposition of Fisher's information matrix to examine and calculate the sample size required for developing a model that aims for precise and fair risk estimates. We propose a six-step process which can be used before data collection or when an existing dataset is available. Steps (1) to (5) require researchers to specify the overall risk in the target population at a key time-point of interest; an assumed pragmatic 'core model' in the form of an exponential regression model; the (anticipated) joint distribution of core predictors included in that model; and the distribution of any censoring. Results: We derive closed-form solutions that decompose the variance of an individual's estimated event rate into Fisher's unit information matrix, predictor values and total sample size; this allows researchers to calculate and examine uncertainty distributions around individual risk estimates and misclassification probabilities for specified sample sizes. We provide an illustrative example in breast cancer and emphasise the importance of clinical context, including risk thresholds for decision making, and examine fairness concerns for pre- and post-menopausal women. Lastly, in two empirical evaluations, we provide reassurance that uncertainty interval widths based on our approach are close to using more flexible models. Conclusions: Our approach allows users to identify the (target) sample size required to develop a prediction model for time-to-event outcomes, via the pmstabilityss module. It aims to facilitate models with improved trust, reliability and fairness in individual-level predictions

A decomposition of Fisher's information to inform sample size for developing fair and precise clinical prediction models -- Part 2:time-to-event outcomes

Background: When developing a clinical prediction model using time-to-event data, previous research focuses on the sample size to minimise overfitting and precisely estimate the overall risk. However, instability of individual-level risk estimates may still be large. Methods: We propose a decomposition of Fisher's information matrix to examine and calculate the sample size required for developing a model that aims for precise and fair risk estimates. We propose a six-step process which can be used before data collection or when an existing dataset is available. Steps (1) to (5) require researchers to specify the overall risk in the target population at a key time-point of interest; an assumed pragmatic 'core model' in the form of an exponential regression model; the (anticipated) joint distribution of core predictors included in that model; and the distribution of any censoring. Results: We derive closed-form solutions that decompose the variance of an individual's estimated event rate into Fisher's unit information matrix, predictor values and total sample size; this allows researchers to calculate and examine uncertainty distributions around individual risk estimates and misclassification probabilities for specified sample sizes. We provide an illustrative example in breast cancer and emphasise the importance of clinical context, including risk thresholds for decision making, and examine fairness concerns for pre- and post-menopausal women. Lastly, in two empirical evaluations, we provide reassurance that uncertainty interval widths based on our approach are close to using more flexible models. Conclusions: Our approach allows users to identify the (target) sample size required to develop a prediction model for time-to-event outcomes, via the pmstabilityss module. It aims to facilitate models with improved trust, reliability and fairness in individual-level predictions

Association between sleep duration and obesity in patients with type 2 diabetes: A longitudinal study

Background: Obesity is prevalent in patients with type 2 diabetes (T2D) and negatively impacts diabetes outcomes. While studies in the general population have established a link between sleep duration and obesity, this relationship in T2D remains unclear. Objectives: To assess the association between sleep duration and adiposity in patients with T2D. Methods: This prospective study of adults enrolled in the SLEEP T2D study from 13 UK NHS Trusts. Sleep duration was self‐reported using the Pittsburgh Sleep Quality Index (PSQI) and categorized as short (≤ 6 h/ night), long (> 9 h/night) or (normal > 6‐9 h/night). Adiposity was assessed using body mass index (BMI) and waist circumference. Results: Among 229 patients (61% male, mean age 61.2 ( ± $$\pm$$ 11.7) years, 63.7% with BMI ≥ 30 kg/m2). At baseline, sleep duration negatively correlated with BMI (r = −0.27, p < 0.001) and waist circumference (r = −0.25, p = 0.001). After adjusting for potential confounders in different models, short sleep duration was associated with higher BMI (β = −1.01; p = 0.006) and waist circumference (β = −1.91; p = 0.01). Following a median follow‐up of 26.5 months, short sleep at baseline was associated with a 5% or more gain in BMI (adjusted OR 10.03; 95% CI 1.55–64.84; p = 0.01). Conclusion: Short sleep duration is associated with higher adiposity measures (BMI and waist circumference) and weight gain in patients with T2D. Addressing sleep duration may reduce the burden of obesity in T2D, and future studies in this area are warranted

Global estimates on the number of people blind or visually impaired by Uncorrected Refractive Error: a meta-analysis from 2000 to 2020

Background: Uncorrected refractive error (URE) is a readily treatable cause of visual impairment (VI). This study provides updated estimates of global and regional vision loss due to URE, presenting temporal change for VISION 2020 Methods: Data from population-based eye disease surveys from 1980–2018 were collected. Hierarchical models estimated prevalence (95% uncertainty intervals [UI]) of blindness (presenting visual acuity (VA) < 3/60) and moderate-to-severe vision impairment (MSVI; 3/60 ≤ presenting VA < 6/18) caused by URE, stratified by age, sex, region, and year. Near VI prevalence from uncorrected presbyopia was defined as presenting near VA < N6/N8 at 40 cm when best-corrected distance (VA ≥ 6/12). Results: In 2020, 3.7 million people (95%UI 3.10–4.29) were blind and 157 million (140–176) had MSVI due to URE, a 21.8% increase in blindness and 72.0% increase in MSVI since 2000. Age-standardised prevalence of URE blindness and MSVI decreased by 30.5% (30.7–30.3) and 2.4% (2.6–2.2) respectively during this time. In 2020, South Asia GBD super-region had the highest 50+ years age-standardised URE blindness (0.33% (0.26–0.40%)) and MSVI (10.3% (8.82–12.10%)) rates. The age-standardized ratio of women to men for URE blindness was 1.05:1.00 in 2020 and 1.03:1.00 in 2000. An estimated 419 million (295–562) people 50+ had near VI from uncorrected presbyopia, a +75.3% (74.6–76.0) increase from 2000 Conclusions: The number of cases of VI from URE substantively grew, even as age-standardised prevalence fell, since 2000, with a continued disproportionate burden by region and sex. Global population ageing will increase this burden, highlighting urgent need for novel approaches to refractive service delivery.publishedVersio