The economic impact of sight loss and blindness in the UK adult population

Background: To quantify the economic impact of sight loss and blindness in the United Kingdom (UK) population, including direct and indirect costs, and its burden on health. Methods: Prevalence data on sight loss and blindness by condition, Census demographic data, data on indirect costs, and healthcare cost databases were used. Blindness was defined as best corrected visual acuity (BCVA) of < 6/60, and sight loss as BCVA < 6/12 to 6/60, in the better-seeing eye. Results: Sight loss and blindness from age-related macular degeneration (AMD), cataract, diabetic retinopathy, glaucoma and under-corrected refractive error are estimated to affect 1.93 (1.58 to 2.31) million people in the UK. Direct health care system costs were £3.0 billion, with inpatient and day care costs comprising £735 million (24.6%) and outpatient costs comprising £771 million (25.8%). Indirect costs amounted to £5.65 (5.12 to 6.22) billion. The value of the loss of healthy life associated with sight loss and blindness was estimated to be £19.5 (15.9 to 23.3) billion or £7.2 (5.9 to 8.6) billion, depending on the set of disability weights used. For comparison with other published results using 2004 disability weights and the 2008 estimates, the total economic cost of sight loss and blindness was estimated to be £28.1 (24.0 to 32.5) billion in 2013. Using 2010 disability weights, the estimated economic cost of sight loss and blindness was estimated to be £15.8 (13.5 to 18.3) billion in 2013. Conclusions: The large prevalence of sight loss and blindness in the UK population imposes significant costs on public funds, private expenditure, and health. Prevalence estimates relied on dated epidemiological studies and may not capture recent advances in treatment, highlighting the need for population-based studies that track the prevalence of sight-impairing eye conditions and treatment effects over time

A redox switch in angiotensinogen modulates angiotensin release.

Blood pressure is critically controlled by angiotensins, which are vasopressor peptides specifically released by the enzyme renin from the tail of angiotensinogen-a non-inhibitory member of the serpin family of protease inhibitors. Although angiotensinogen has long been regarded as a passive substrate, the crystal structures solved here to 2.1 Å resolution show that the angiotensin cleavage site is inaccessibly buried in its amino-terminal tail. The conformational rearrangement that makes this site accessible for proteolysis is revealed in our 4.4 Å structure of the complex of human angiotensinogen with renin. The co-ordinated changes involved are seen to be critically linked by a conserved but labile disulphide bridge. Here we show that the reduced unbridged form of angiotensinogen is present in the circulation in a near 40:60 ratio with the oxidized sulphydryl-bridged form, which preferentially interacts with receptor-bound renin. We propose that this redox-responsive transition of angiotensinogen to a form that will more effectively release angiotensin at a cellular level contributes to the modulation of blood pressure. Specifically, we demonstrate the oxidative switch of angiotensinogen to its more active sulphydryl-bridged form in the maternal circulation in pre-eclampsia-the hypertensive crisis of pregnancy that threatens the health and survival of both mother and child

Decolonising drugs in Asia : the case of cocaine in colonial India

This article examines a drugs trade in Asia that has been largely forgotten by historians and policy-makers: cocaine. It will briefly trace some of the contours of this commerce and the efforts to control it. It will also assess how successful these efforts were. The article is designed to contribute fresh perspectives on recent controversies in the historiography of drugs in Asia to argue that the agendas and agency of consumers are central to understanding why markets have formed there for psychoactive substances in the modern period

Cocaine and the British Empire : the drug and the diplomats at the Hague Opium Conference, 1911–12

This article will consider the reasons for the inclusion of cocaine in the Hague Opium Convention of 1912. This was the first time that the emerging international drugs regulatory system considered substances other than opiates and it was British delegates who took the initiative to include cocaine in discussions and in the final version of the agreement. Historians have tended to keep brief their accounts of this episode, seeing the British agenda on cocaine as driven primarily by their wider interests in opium, or alluding briefly to colonial anxieties about manufactured drugs. This article returns to the events of 1911–12 and argues that Britain's position on cocaine deserves greater attention. It shows that British administrations in Asia had tried to control a growing market there for the drug since the turn of the century, and that their efforts had failed. In exploring the history of these efforts, and their impacts in the early days of the international narcotics-control regime, the article suggests that imperial policies are more complex than many historians have previously acknowledged, and that it may be time for fresh thinking on the relationship between empires and drugs in modern Asia