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J Epidemiol Community Health. 2007 October; 61(10): 928.
PMCID: PMC2652979


Blindness and visual impairment in Pakistan

Data on blindness and visual impairment in Pakistan have been very limited, with an earlier survey by the National Committee for the Prevention of Blindness (NCPB) estimating the main cause of blindness to be cataract (66.7%). A second study carried out between 2002 and 2004 applied more rigorous survey methodologies to produce accurate data. In all, 16 507 adults (aged 30 years and older) were examined. Causes of visual impairment were classified by the accepted World Health Organization methodology. Cataract was still the most common cause of blindness (51.5%; defined as <3/60 in the better eye), 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 [gt-or-equal, slanted]6/60) refractive error was the most common cause (43%) followed by cataract (42%). Overall, 85.5% of cases of blindness were considered to be avoidable. An estimated 904 000 adults in Pakistan have cataract requiring surgical intervention. Services for refractive errors need to be further expanded and integrated into eye care services, particularly among the rural population of Pakistan. (Br J Ophthalmol published online 17 January 2007; doi: 10.1136/bjo.2006.108035)

Risk factors for stroke in India

Stroke is the leading cause of adult disability and is the second commonest cause of death worldwide. More than two‐thirds of the global burden of stroke is found in developing countries, where the average age of patients with stroke is 15 years younger than in developed countries. In a study, 214 south Indian patients, with a first ischaemic stroke between the age of 15 and 45 years, were compared with controls—99 age‐ and sex‐matched hospital controls and 96 community controls. A comparison of prevalence of the risk factors of smoking, elevated blood pressure, high fasting blood glucose and abnormal lipids was made. The stroke patients had a higher prevalence of smoking, higher systolic blood pressure and fasting blood glucose but lower high density lipoprotein (HDL) cholesterol than community controls, and a higher prevalence of smoking and lower HDL cholesterol than hospital controls. Tobacco smoking and diabetes are growing problems in developing countries; these findings suggest that smoking cessation, identification and treatment of elevated blood pressure, dyslipidaemia and diabetes are key to preventing ischaemic stroke in young adults from south India. (J Neurol Neurosurg Psychiatry published online 12 January 2007; doi: 10.1136/jnnp.2006.106831)

Link between cellular phones and brain tumours

Results from studies on long term mobile phone users showed a consistent pattern of increased risk for acoustic neuromas and gliomas, with ipsilateral exposure (same side as the tumour occurred) yielding the highest risk. This conclusion was drawn from a survey of two cohort studies and 16 case–control studies; no mortality studies were included. Three studies came from the United States, four from Denmark, one from Finland, five from Sweden, one from the United Kingdom, one from Germany, one from Japan and two from study groups overlapping these studies. Of the 16 case–control studies 11 gave results for 10 years or longer, but most of the results were based on low numbers of subjects. An association with acoustic neuroma was found in four studies. No risk was found in one study, but the tumour size was significantly larger among users. Six studies gave results for malignant brain tumours in that latency group. All gave increased odds ratio especially for ipsilateral exposure. (Occup Envir Med published online 4 April 2007; doi: 10.1136/oem.2006.029751)

Syphilis in STI patients in China

Syphilis infection has increased dramatically in China's sexually transmitted infections (STI) clinic population, suggesting a generalised spread of the disease through commercial sex, and bridging populations. A socioeconomic and geographic cross sectional study was conducted in eight cities across Guangxi Province in southern China. Serological testing for syphilis and HIV was conducted on 10 930 patients between December 2004 and February 2006. A total of 1297 (11.9%) patients were seropositive for syphilis. Fifty‐eight per cent (752) of seropositive subjects presented with a genital ulcer, palmar/plantar rash or inguinal lymphadenopathy. Higher syphilis prevalence was found in female patients (14.3%) than male (10.2%). Limited education and higher monthly income were associated with serologically positive status. Commercial sex use was noted in 52.4% of men while 17.1% of women were identified as commercial sex workers. Universal screening for syphilis is indicated in high risk populations as a decisive measure to control the growing disease in China. Public education should emphasise use of condoms as barriers against pregnancy, and simultaneously to protect against STIs and HIV. China also needs to scale up STI and HIV prevention programmes among commercial sex workers. (Sex Transm Infect published online 25 June 2007; doi: 10.1136/sti.2007.025015)

Worldwide trends in asthma prevalence

The International Study of Asthma and Allergies in Childhood (ISAAC) was designed to compare worldwide asthma symptom prevalence. Phase one of the study was carried out between 1993 and 1997. Phase three repeated the survey after 5–10 years in 56 countries in the 13–14 year age group (304 679 children) and in 37 countries in the 6–7 year age group (193 404 children) to assess changes in prevalence over time. The average symptom prevalence of current wheeze (in past 12 months) was only slightly raised in both age groups; and there was little change in average symptom prevalence of severe asthma. But there were regional differences in time trends of asthma: in western Europe current wheeze decreased by −0.07% per year in 13–14 year olds but increased by 0.20% per year in 6–7 year olds. The corresponding findings for other regions were: Oceania −0.39% per year in 13–14 year olds and 0.21% per year in 6–7 year olds; Latin America 0.32% and 0.07%; northern and eastern Europe 0.26%, 0.05%; Africa 0.16%, 0.10%; North America 0.12%, 0.32%; eastern Mediterranean −0.10%, 0.79%; Asia‐Pacific 0.07%, −0.06%; and Indian subcontinent 0.02%, 0.06%, respectively. The findings indicate that international differences in asthma symptom prevalence have reduced, particularly in 13–14 year olds. The increases in Africa, Latin America and parts of Asia indicate that the global burden of asthma is still rising, but global prevalence differences are lessening. (Thorax published online 15 May 2007; doi: 10.1136/thx.2006.070169)

Gleny Hughes

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