Myopia and Regional Variations in Retinal Thickness in Healthy Eyes

Purpose: To investigate the effects of refraction on retinal thickness measurements at different locations and layers in healthy eyes of Saudi participants. Methods: Thirty-six randomly selected adults aged 27.0 ± 5.7 years who attended a Riyadh hospital from 2016 to 2017 were categorized into three groups: non-myopic (spherical equivalent refraction [SER], +1.00 to –0.50 diopters [D]), low myopic (SER, – 0.75 to –3.00D), and moderate to high myopic (SER ≤ –3.25D). Full, inner, and outer retinal thicknesses were measured at nine locations by spectral-domain stratus optical coherence tomography (Optovue Inc., Fremont, CA, USA) and were compared according to refractive group and sex. Results: The mean SERs for the non-myopia, low myopia, and moderate to high myopia groups were 0.2 ± 0.6, –1.5 ± 0.5, and –7.5 ± 1.9 D, respectively. Refractive error, but not sex, had significant effects on the retinal layer thickness measurements at different locations (P < 0.05). The parafoveal and outer retinal layers were significantly thicker than the perifoveal and inner retina layers in all groups (P < 0.05). The full foveal thickness was higher and the full parafoveal and perifoveal regions were thinner in moderate to high myopic eyes than in the non-myopic eyes (P < 0.05), but were similar to those in the low myopic eyes (P > 0.05). The foveal thicknesses measured in the inner and outer layers of the retina were higher but the thicknesses measured at the inner and outer layers of the parafoveal and perifoveal regions were lower in moderate to high myopic eyes. Conclusion: There were regional differences in the retinal layer thicknesses of healthy Saudi eyes, which was dependent on the central refractions. This is important when interpreting retinal nerve fiber layer thicknesses in myopia and disease management in Saudi participants

Evaluation of evidence-base practice among eye care practitioners in Saudi Arabia : a cross sectional survey study

Background: The importance of evidence-based optometry practice in the current era of expanding role of optometry cannot be overemphasized. With many optometrists being involved in the diagnosis, management and co-management of various eye diseases, there is need to assess the quality of evidence-based used in their clinical decision making. Methods: A self-administered survey that was made available via emails was administered to practicing optometrists in Saudi Arabia. Responses were analyzed descriptively and Chi squared test was performed to determine the level of association between practitioner characteristics and sources of evidence. Results: A hundred and fourteen optometrists (62% men, 38% females) aged 31.0 ± 7.1 years with an average of 7.2 years of experience completed the survey (response rate 53%). The four most important factors they identified which underpinned their clinical decision making in their order of ranking were; patients’ signs and symptoms (86%), knowledge and information gained during the postgraduate training/continuing education (64%), undergraduate optometry training (46%) and internet databases such as Pubmed and Medline (45%). About 45% indicated that they did not read scientific journals regularly, but depended on text books for information. For those who often read peer reviewed journals, Optometry and Vision Science (42%), Saudi Ophthalmology Journal (19%) and Clinical and Experimental Optometry (18%), journals were the most common. Approximately, 68% had made some modifications in their clinical decisions based on new evidence from literatures gleaned from test books, within the last two years especially in the nature of their soft contact lens practice and subjective refraction. Only 59% completed the minimum hours of continuous education required for license renewal and for about two-third of the respondents (68%), this was primarily sourced from local seminars offered by the Saudi Association of Optometry and Vision Scientist. Conclusion: Saudi optometrists appear to use evidence that is not “up to date” or ‘high level’ and that does not support evidence-based practice. The findings suggest the need to re-educate Saudi Optometrists on how and where to search for, and the importance of using current evidence rather than being dependent on information provided by their educators

Influence of parenting style on the visually impaired adolescents and their self-esteem : analysis based on a Saudi population

Purpose: To investigate the attitude of visually impaired adolescents, towards parents and examine the parents’ attitudes toward the visually impaired child. We also assessed the effects of the parenting styles on the self-esteem of the visually impaired adolescent. Methods: Buri’s parental authority questionnaire was completed by children and their parents and used to assess the perceived parental style of both groups. The short form of the Tennessee Self-Concept Scale (sort form) [TSCS-2] completed by 125 children and 250 parents of visually impaired school and public schools in Riyadh Central province of Saudi Arabia. Of the students who responded (39/125, 31.2%), 21 were males and 18 females and their age ranged from 13 to 18 years (mean age, 15 years). Of the parents who responded (119/250, 47.6%), 58 were males and 61 females and their age ranged from 19 to 36 years (mean = 27). Results: Parental Authority Questionnaire showed that more than one-half of the adolescents perceived parenting as authoritative (57%) and the remaining perceived parenting as either authoritarian (28%) or permissive (15%) but the differences was not significant (ANOVA: P0.05). The associations between the Tennessee Self Concept Score (TSCS) and the parenting styles was at borderline significance only for authoritative parenting style (P=0.08, r=0.28). The levels of self-esteem were higher in males than female (69%vs 31%) students. There was no difference in responses between students who attended public schools and those in the visually impaired school. Conclusion: The majority of visually impaired adolescents perceived parents as authoritative, had higher self-esteem than the fewer students with either authoritarians or permissive parents and had lower self-esteem. Further testing to elicit separate responses for mothers and fathers parenting styles could help reinforce these findings

Diabetes detection and communication among patients admitted through the emergency department of a public hospital

Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs)

Two-position measurement of intraocular pressure by PT100 noncontact tonometry in comparison with Goldmann tonometry

Kelechi C Ogbuehi, John C Chijuka, Uchechukwu L Osuagwu Department of Optometry & Vision Science, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi ArabiaBackground: The purpose of this study was to evaluate the precision of intraocular pressure measurements obtained by PT100 noncontact tonometry in a handheld and slit lamp-mounted position in comparison with that of Goldmann applanation tonometry in healthy young adults.Methods: Sixty eyes from 60 subjects (30 men and 30 women) aged 22 ± 1 (range 20–24) years participated in this study. Triplicate intraocular pressure measurement of a randomly selected eye was obtained by a noncontact tonometer in a handheld and slit lamp-mounted position in a randomized order, with the Goldmann applanation tonometer always performed last. A second measurement session was carried out after one week to assess repeatability.Results: The mean ± standard deviation of intraocular pressure readings in the first and second session, respectively, with the three techniques were: handheld position, 14.52 ± 3.28 mmHg and 15.26 ± 2.11 mmHg; slit lamp-mounted position, 14.01 ± 2.80 mmHg and 15.16 ± 2.34 mmHg; and Goldmann applanation tonometer, 14.86 ± 3.26 mmHg and 15.16 ± 2.42 mmHg. There were no significant differences (P > 0.05) between the techniques in the intraocular pressure measurements returned (Goldmann applanation tonometer vs handheld and Goldmann applanation tonometer vs slit lamp-mounted). The Goldmann applanation tonometer measured intraocular pressure 0.34 mmHg higher than handheld and 0.85 mmHg higher than slit lamp-mounted in session 1, and in session 2 Goldmann applanation tonometer intraocular pressure measurement was the same as with the slit lamp-mounted method but lower than with the handheld method by 0.11 mmHg. In PT100 handheld vs slit lamp-mounted comparisons, there were no significant differences (P > 0.05) between intraocular pressure measurements returned by both techniques in sessions 1 and 2. Intrasession and intersession repeatability coefficients for Goldmann applanation tonometer intraocular pressure and slit lamp-mounted intraocular pressure were similar, and better in comparison with those for handheld intraocular pressure.Conclusion: The Goldmann applanation tonometer and PT100 noncontact tonometer in both positions studied here are reliable, consistent techniques for measurement of intraocular pressure, and can be used interchangeably for obtaining intraocular pressure values in young normal subjects. Repositioning of the PT100 tonometer from hand-held to slit lamp-mounted improved its precision and reduced variation with respect to the Goldmann applanation tonometer.Keywords: intraocular pressure, Goldmann applanation tonometry, Reichert PT100 noncontact tonometer, handheld, slit lamp-mounted, repeatabilit

Eight-year retrospective study of young adults in a diabetes transition clinic

The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions

Factors associated with long intensive care unit (ICU) admission among inpatients with and without diabetes in South Western Sydney public hospitals using the New South Wales admission patient data collection (2014-2017)

Despite a campaign of effective educational interventions targeting knowledge, attitudes, and prevention, Human Immunodeficiency-Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to be a significant public health issue in India, with Mizoram reporting the highest HIV/AIDS cases in 2018–2019. In this study, we extracted Mizoram state from the National Family Health Survey Fourth Series (NFHS-4) 2015–2016 datasets and investigated factors associated with respondents’ knowledge, attitudes, and prevention towards HIV/AIDS. The sample included 3555 adults aged 15–49 years residing in Mizoram, North-east India. Respondents who reported having ever heard of HIV/AIDS was 98%. Multivariate analysis indicated that the probability of having inadequate knowledge of HIV/AIDS was higher among those with no schooling, who were illiterate, of non-Christian faiths, belonging to backward tribes or caste, from poor households, and those who lived in rural areas, not exposed to media. The odds of mother-to-child transmission (PMTCT) of HIV/AIDS transmission was high among females (AOR = 3.12, 95% CI 2.34–4.16), respondents aged 35–39 years (AOR = 1.74, 95% CI 1.05–2.87) and those belonging to other backward class. The HIV/AIDS knowledge of respondents was found to be encouraging as the majority (98%) were considered to have a good level of understanding of the condition. An educational intervention to reduce the number of adults 15–49 years infected with HIV/AIDS in Mizoram should target those from low socioeconomic groups, those from non-Christian religions, and those from other backward classes

Factors associated with non-utilization of postnatal care among newborns in the first 2 days after birth in Pakistan : a nationwide cross-sectional study

Background: Recent data indicated that approximately four in every ten newborns in Pakistan do not receive postnatal care (PNC) services in the first 48 hours after delivery. Objectives: This study aimed to identify factors associated with the non-utilization of PNC for newborns in Pakistan using the 2017–18 Pakistan Demographic and Health Survey (PDHS). Methods: This was a cross-sectional analytical study utilizing data from 3887 live-born newborns recorded in the 2017–18 PDHS. Non-utilization of PNC was assessed against a set of independent factors using multilevel logistic regression analysis, and the population attributable risk estimates of factors associated with non-utilization of PNC were also calculated. Results: There were 1443 newborns (37%) in Pakistan whose mothers did not utilize PNC check-ups in the first 2 days after delivery. The non-utilization of PNC was largely attributable to newborns delivered at non-health facilities 53% (47% to 59%) and those born to uneducated women 27% (13% to 38%). Adjusted analyses indicated that newborns with higher birth order and with a birth interval of more than 2 years, women who perceived their baby to be small at birth, women with no formal education and those living in regional areas of Khyber Pakhtunkhwa and Federally Administered Tribal Areas were significantly associated with non-utilization of PNC services. Conclusions: Tailored health messages by community health workers, including door-to-door visits on utilizing health facilities through pregnancy to the postnatal periods, are needed and should target places of low socioeconomic status, including educationally disadvantaged women from regional areas of Pakistan

Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014-2017)

Background: Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods: Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014–30 June 2015 to 1 July 2016–30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results: Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014–15 to 8.9% in 2016–17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49–35.02) but not in those with diabetes. Conclusions: In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed