Impact of persisting amblyopia on socio–economic, health and well–being outcomes in adult life: findings from the UK Biobank study

Objectives: This study aimed to investigate associations between persisting amblyopia into adulthood and its “real-life” impacts and inform the current debate about the value of childhood vision screening programs. Methods: Associations between persisting amblyopia and diverse socioeconomic, health, and well-being outcomes were investigated in multivariable-adjusted (sex, age, ethnicity, deprivation) regression models, with 126 400 participants (aged 40-70 years) of the UK Biobank with complete ophthalmic data. Analysis by age group (cohort 1, 60-70 years; cohort 2, 50-59 years; cohort 3, 40-49 years) assessed temporal trends. Results: Of 3395 (3%) participants with confirmed amblyopia, overall 77% (2627) had persisting amblyopia, declining from 78% in cohort 1 to 73% in cohort 3. The odds of persisting amblyopia were 5.91 (5.24-6.66) and 2.49 (2.21-2.81) times greater in cohort 1 and cohort 2, respectively, than cohort 3. The odds were also higher for more socioeconomically deprived groups and for white ethnicity. Reduced participation in sport, adverse general and mental health, and well-being were all independently associated with persisting amblyopia, with the strongest associations in the youngest cohorts. Associations with lower educational attainment and economic outcomes were only evident in the oldest cohort. Conclusions: There has been a decline in the overall frequency of persisting amblyopia since the introduction of universal child vision screening in the United Kingdom. Nevertheless, most adults treated for amblyopia in childhood have persisting vision deficits. There was no evidence that persisting amblyopia has vision-mediated effects on educational, employment-related, or economic outcomes. The observed adverse outcomes were largely those not directly mediated by vision. Patients undergoing treatment should be counseled about long-term outcomes

A comparison of the quality of image acquisition between two different sidestream dark field video-microscopes

Sidestream dark field (SDF) imaging enables direct visualisation of the microvasculature from which quantification of key variables is possible. The new MicroScan USB3 (MS-U) video-microscope is a hand-held SDF device that has undergone significant technical upgrades from its predecessor, the MicroScan Analogue (MS-A). The MS-U claims superior quality of sublingual microcirculatory image acquisition over the MS-A, however, this has yet to be robustly confirmed. In this manuscript, we therefore compare the quality of image acquisition between these two devices. The microcirculation of healthy volunteers was visualised to generate thirty video images for each device. Two independent raters, blinded to the device type, graded the quality of the images according to the six different traits in the Microcirculation Image Quality Score (MIQS) system. Chi-squared tests and Kappa statistics were used to compare not only the distribution of scores between the devices, but also agreement between raters. MS-U showed superior image quality over MS-A in three of out six MIQS traits; MS-U had significantly more optimal images by illumination (MS-U 95% optimal images, MS-A 70% optimal images (p-value 0.003)), by focus (MS-U 70% optimal images, MS-A 35% optimal images (p-value 0.002)) and by pressure (MS-U 72.5% optimal images, MS-A 47.5% optimal images (p-value 0.02)). For each trait, there was at least 85% agreement between the raters, and all the scores for each trait were independent of the rater (all p-values > 0.05). These results show that the new MS-U provides a superior quality of sublingual microcirculatory image acquisition when compared to old MS-

Timing of invasive strategy in non-ST-elevation acute coronary syndrome: risk and reward?

This commentary refers to ‘Timing of invasive strategy in elevation acute coronary syndrome: a meta-analysis of randomized controlled trials’, by T.A. Kite et al., https://doi.org/10.1093/eurheartj/ehac213 and the discussion piece ‘Timing of early invasive strategy in patients with non-ST-elevation acute coronary syndrome’, by A.I. Aladin et al., https://doi.org/10.1093/eurheartj/ehac466

Μελέτη της πολυνευροπάθειας σε ασθενεις με αμυλοείδωση

Σε αυτή τη διπλωματική εργασία έγινε αρχικά συστηματική ανασκόπηση της βιβλιογραφίας της περιφερικής νευροπάθειας, με έμφαση στη νευροπάθεια λεπτών ινών και κατ’επέκταση στην αμυλοειδική νευροπάθεια και ακολούθησε η μελέτη των δεδομένων 33 ασθενών με διάγνωση AL αμυλοείδωσης, που εξετάστηκαν το διάστημα 01/2015-12/2017 στο εργαστήριο Κλινικής Νευροφυσιολογίας, 1ο Νευρολογικό Τμήμα, Καποδιστριακού Πανεπιστημίου Αθηνών. Η περιφερικη νευροπάθεια αναφέρεται στη διαταραχή του Περιφερικού Νευρικού Συστήματος (ΠΝΣ) και αποτελεί μία από τις βασικές αιτίες άλγους και κινητικής αναπηρίας παγκοσμίως. Το ποσοστό των ασθενών με περιφερική νευροπάθεια ανέρχεται στο 2 με 8% και αυξάνεται με την ηλικία. Τα τελευταία χρόνια η νευροπάθεια λεπτών ινών αναγνωρίζεται ως ξεχωριστή νοσολογική οντότητα, η οποία υποδιαγιγνώσκεται, έχει ιδιαίτερα χαρακτηριστικά γνωρίσματα και για τη διάγνωση της, χρησιμοποιούνται νέες μη συμβατικές τεχνικές σε σχέση με τις υπόλοιπες νευροπάθειες, καθώς οι κλασικές νευροφυσιολογικές εξετάσεις όπως το ηλεκτρονευρογράφημα και το ηλεκτρομυογράφημα δεν αποτελούν διαγνωστικό εργαλείο αυτής. Χαρακτηρίζεται από εκλεκτική ή κυρίαρχη βλάβη των λεπτών εμμύελων Αδ ινών και των αμύελων C ινών, η κλινική της εικόνα αφορά την παρουσία θετικών ή αρνητικών αισθητικών συμπτωμάτων με η χωρίς δυσλειτουργία του Αυτόνομου Νευρικού Συστήματος (ΑΝΣ) και ταξινομείται σε βέβαιη, πιθανή και ενδεχόμενη νευροπάθεια . Η Συστηματική AL αμυλοείδωση αποτελεί νόσο στην οποία μεγάλο ποσοστό των ασθενών πάσχουν από νευροπάθεια λεπτών ινών. Μελετήσαμε τα δεδομένα από 33 ασθενείς με διάγνωση AL αμυλοείδωσης, που υποβλήθηκαν σε κλινική εξέταση, μελέτη ταχυτήτων αγωγιμότητας και εξέταση με QST. Στους ασθενείς μας η προσβολή του ΠΝΣ, αφορούσε μεγάλο ποοσοστό ασθενών, με συνηθέστερη μορφή την συμμετρική, μηκοεξαρτώμενη αξονική, αισθητικοκινητική πολυνευροπάθεια με συμμετοχή των λεπτών ινών. Ο μέσος όρος επιβίωσης τους ήταν περίπου 22.7 μήνες, με τη νευροπάθεια λεπτών ινών να αποτελεί αρνητικό, ποιοτικό, προγνωστικό δείκτη για την επιβίωση του ασθενούς. Δεν προέκυψε σαφής συσχέτιση της νευροπάθειας με την αμυλοειδική μυοκαρδιοπάθεια. Όσο αφορά τις κλίμακες NSS και NDS, υπήρξε θετική συσχέτιση μεταξύ του σκόρ στις κλίμακες και της βαρύτητας την νευροπάθειας. Στους ασθενείς με νευροπάθεια λεπτών ινών, πράγματι, δεν καταγράφηκε διαταραχή της παλλαισθησίας, η νευροπάθεια ήταν μηκοεξαρτώμενη και δεν υπήρξε σαφής επικράτηση της βλάβης ανάμεσα στις Αδ και C ίνες. Από τη μελέτη μας, φάνηκε η κατηργημένη παλλαισθησία να σχετίζεται με ιδιαίτερα χαμηλή τιμή του ύψους του γαστροκνημιαίου νεύρου από το ΗΝΓ (≤2) και σχετικά πιο υψηλό σκορ στην κλίμακα NSSs, ενώ η ήπια αισθητική νευροπάθεια, δεν επηρέασε την παλλαισθησία. Δυστυχώς η βιβλιογραφία για την νευροπάθεια στην AL αμυλοείδωση είναι περιορισμένη. Χρειάζονται περισσότερες μελέτες, σε μεγαλύτερο δείγμα ασθενών για την περαιτέρω κατανόηση της φύσης αλλά και της σημασίας της αμυλοειδικής νευροπάθειας.In this study, a systematic review of the literature on peripheral neuropathy was done, with focus on Small Fiber Neuropathy (SFN) and, subsequently on amyloid neuropathy, followed by the study of 33 patients with diagnosis of AL amyloidosis, examined during 01/2015- 12/2017 at the laboratory of Clinical Neurophysiology, 1st Neurologic Department, University of Athens. Peripheral neuropathy is a disorder of the peripheral nervous system (PNS) and is one of the leading causes of pain and motor disability worldwide. SFN has been lately recognized as a distinct disorder, that affects selectively or predominantly thinly myelinated Aδ-fibres and unmyelinated C-fibres and presents with positive or negative sensory symptoms with or without autonomic disfunction. SFN is classified as definite, probable or possible. Systemic AL amyloidosis is a disease in which peripheral neuropathy is a common complication with frequent small fiber involvement. We studied data of 33 patients with diagnosis of AL amyloidosis, who underwent clinical examination, Nerve Conduction Study (NCS), and QST test. In our study, the most common type of neuropathy was symmetrical, length-dependent, sensorimotor, axonal polyneuropathy with small fiber involvement. At the time of data analysis median survival was approximately 22.7 months, while SFN seemed to be poor prognostic factor in patient’s survival. No association between neuropathy and heart disease was found. Comparing NSS and NDS scales, there was positive correlation between higher score and severity of neuropathy. SFN in amyloidosis was lengthdependent, with no clear prevalence between Aδ and C fibers involvement. Patients with SFN had normal vibration perception. Αbnormal vibration perception was associated with low amplitude of sural nerve in conduction study (≤2) and with relatively higher score on the NSSs scale. Mild sensory neuropathy did not seem to affect vibration perception. Unfortunately literature on AL systemic amyloid neuropathy is limited. More studies, in larger samples of patients are needed, to further understand the nature and importance of AL Systemic Amyloidosis neuropathy

Trends in the long-term impact of childhood visual impairment on health and social outcomes in the UK: a cross-cohort study across three decades of disability-related legislation and policy implementation

BACKGROUND: Childhood vision impairment (VI) can adversely impact health and social outcomes and limit life chances. We investigated whether its adverse impacts into adult life changed during a period in which legislation, policy and services to address inequalities relating to disability were implemented. METHODS: Cross-cohort study comprising 14 247 participants from the 1946, 1958 and 1970 British birth cohorts (BC). Participants dichotomized as VI at age 15/16 (distance visual acuity was 6/12 or worse in the better-seeing eye) or normally sighted. Associations of childhood VI with health, well-being, socioeconomic and social participation outcomes in mid-adult life were investigated using regression models adjusted for participants' early life socioeconomic markers and sex. Change in adjusted odds ratios of >10% in the same direction in successive cohorts, or a > 20% difference between 1970BC and one older cohort were considered meaningful. RESULTS: Trends over time in impacts of childhood onset VI into mid-adult life were complex. This included worsening of odds of poorer physical health (odds ratio 1.47; 95% confidence interval 1.02-2.14), living in unsatisfactory (1.54; 1.03-2.29) or overcrowded (2.34; 1.26-4.06) households, being unemployed (2.19; 1.19-3.97) and not gaining additional educational qualifications during mid-adult life (1.61; 1.08-2.47). By contrast the odds of not participating in some social activities (e.g. seeing friends) improved over time. Associations with other outcomes were unchanged. CONCLUSIONS: Many adverse impacts of childhood VI do not appear ameliorated over time by legislation, policies and provision that would have been expected to reduce inequalities. Moreover, some were increased. Childhood VI continues to cast a life-long shadow

Development and validation of a semi-quantitative food frequency questionnaire for young school-aged children

The objective of the present study was to examine the validity for estimating energy and macronutrients intake of a newly developed picture aid, semi quantitative FFQ for Greek children and preadolescents. The two methods were found to agree in terms of mean energy intake according to the Bland and Altman method, although a trend in overestimating energy intake was found as the intake increased. Additionally, results of the Wilcoxon signed rank test revealed the similarity of the distribution in energy intake as estimated from the FFQ and the 3DD [median (IQR): 2038 (1264 - 2651) kcals for the FFQ vs. 1902 (1583 - 2324) kcals for the 3DD, p=0.33] (Table 1). Concerning macronutrients intake, according to the Bland and Altman method, although the mean difference was different than zero (all p’s <0.05), the agreement was considered adequate as the mean difference for each nutrient (with the exception of poly-unsaturated fatty acids) was < 1SD of the same nutrient intake as estimated from the reference method

A comparison of the quality of image acquisition between the incident dark field and sidestream dark field video-microscopes

BACKGROUND: The 'Cytocam' is a third generation video-microscope, which enables real time visualisation of the in vivo microcirculation. Based upon the principle of incident dark field (IDF) illumination, this hand held computer-controlled device was designed to address the technical limitations of its predecessors, orthogonal polarization spectroscopy and sidestream dark field (SDF) imaging. In this manuscript, we aimed to compare the quality of sublingual microcirculatory image acquisition between the IDF and SDF devices. METHODS: Using the microcirculatory image quality scoring (MIQS) system, (six categories scored as either 0 = optimal, 1 = acceptable, or 10 = unacceptable), two independent raters compared 30 films acquired using the Cytocam IDF video-microscope, to an equal number obtained with an SDF device. Blinded to the origin of the films, the raters were therefore able to score between 0 and 60 for each film analysed. The scores' distributions between the two techniques were compared. RESULTS: The median MIQS (95 % CI) given to the SDF camera was 7 (1.5-12), as compared to 1 (0.5-1.0) for the IDF device (p < 0.0001). Of the six categories assessed by the MIQS, nearly one fifth of the SDF videos were scored as unacceptable for pressure (20 %), content (20 %), and stability (17 %), with focus scoring deficiently 13 % of the time. High agreement between the two raters scoring values was evident, with an intra-class correlation coefficient (ICC) of 0.96 (95 % CI: 0.94, 0.98). CONCLUSIONS: These results demonstrate that the quality of sublingual microcirculatory image acquisition is superior in the Cytocam IDF video-microscope, as compared to the SDF video-microscope

Socio-economic and demographic determinants of childhood obesity prevalence in Greece: the GRECO (Greek Childhood Obesity) study

Objective: Given the rapid increase in the prevalence of childhood obesity, identifying the sociodemographic influences on obesity status is important for planning and implementing effective prevention initiatives. However, this type of data is limited for Greek children. Therefore the aim of the present study was to identify possible sociodemographic factors associated with childhood obesity at the national level. Design: Cross-sectional, population-based survey, carried out from October to May 2009. Setting: Under the context of the GRECO (Greek Childhood Obesity) study, a nationwide sample of 2315 primary-school children. Subjects: Children aged 10–12 years and their parents were voluntarily enrolled. Direct anthropometric measurements of the children were obtained and information on sociodemographic characteristics of the parents, as well as their self-reported values of body weight and height, were collected. Results: Overweight and obesity prevalence was 29?5 % and 13?1 %, respectively, among boys; 29?5 % and 9?0 %, respectively, among girls. Multiple logistic regression analysis revealed that the most important sociodemographic predictors of childhood obesity were mother’s age, parental BMI classification and father’s type of occupation. More specifically, increased mother’s age and normal BMI status of the parents seemed to have a protective effect on the likelihood of having an overweight/obese child. Additionally, the odds of a female child of being overweight/obese were reduced when the father’s type of occupation tended to be less manual. Conclusions: Anti-obesity health policy interventions have to address to the parents and promote their active involvement, to effectively confront the alarming magnitude of the paediatric obesity problem in Greece

Inverse Relationship between Adherence to the Mediterranean Diet and Serum Cystatin C Levels

OBJECTIVE: The aim of the present study was to examine serum cystatin C levels in association with the Mediterranean diet in a healthy Greek population. METHODS: Cystatin C together with basic clinical chemistry tests was measured in a total of 490 adults (46±16 years, 40% of males), who underwent an annual health check. Demographic, anthropometric and lifestyle characteristics were recorded, while adherence to the Mediterranean diet was evaluated through the MedDietScore (0-55). RESULTS: The mean level of serum cystatin C was 0.84 mg/L, while men had increased serum cystatin C levels compared to women (0.86 mg/L vs. 0.83 mg/L, respectively, 0.017). After adjusting for age, gender, body mass index, smoking status, hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate (eGFR), albumin and ferritin levels, each unit increase in MedDietScore led to 0.002 mg/dL drop off in cystatin C serum levels. CONCLUSIONS: We have demonstrated an inverse relationship between the MedDietScore and serum cystatin C levels. Our finding that increases in MedDietScore are associated with decreases in serum cystatin C levels could imply that adherence to the Mediterranean diet may reduce the cardiovascular risk, as assessed by cystatin C, a prognostic marker of the cardiometabolic risk. This notion could have a great impact on public health