Biomedical subjects

Beatriz Munoz

Publications and source records attributed to Beatriz Munoz.

26 records · Page 2Linked to original sources

PubMed2004

Nuclear cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors.

PURPOSE: To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. METHODS: All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. RESULTS: Among 307 probands (mean age, 77.6 +/- 4.5 years) and 434 full siblings (mean age, 72.4 +/- 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30-3.30) among individuals with a sibling with nuclear cataract (nuclear grade > or = 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%-50.3%) after adjustment for the covariates. CONCLUSIONS: Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity.

Aged↗

PubMed2003

Household willingness to pay for azithromycin treatment for trachoma control in the United Republic of Tanzania.

OBJECTIVE: Household willingness to pay for treatment provides important information for programme planning. We tested for relationships between socioeconomic status, risk of trachoma, perceptions of the effects of azithromycin, and the household willingness to pay for future mass treatment with azithromycin. METHODS: We surveyed 394 households in 6 villages located in central United Republic of Tanzania regarding their willingness to pay for future azithromycin treatment. A random sample of households with children under 8 years of age was selected and interviewed following an initial treatment programme in each village. Data were gathered on risk factors for trachoma, socioeconomic status, and the perceived effect of the initial azithromycin treatment. Ordered probit regression analysis was used to test for statistically significant relationships. FINDINGS: 38% of responding households stated that they would not be willing to pay anything for future azithromycin treatment, although they would be willing to participate in the treatment. A proxy for cash availability was positively associated with household willingness to pay for future antibiotic treatment. Cattle ownership (a risk factor) and being a household headed by a female not in a polygamous marriage (lower socioeconomic status) were associated with a lower willingness to pay for future treatment. A perceived benefit from the initial treatment was marginally associated with a willingness to pay a higher amount. CONCLUSIONS: As those at greatest risk of active trachoma indicated the lowest willingness to pay, imposing a cost recovery fee for azithromycin treatment would likely reduce coverage and could prevent control of the disease at the community level.

Adult↗

PubMed2003

Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.

PURPOSE: To determine whether cataract surgery is associated with an increased prevalence of age-related macular degeneration (AMD) in three independent population-based data sets. DESIGN: Cross-sectional study. METHOD: Data were used from the Salisbury Eye Evaluation (2,520 subjects from Salisbury, Maryland, aged 65 to 84 years), the Proyecto VER (4,774 Hispanic subjects from Arizona aged 40 years and older), and the Baltimore Eye Survey (4,396 subjects from Baltimore, Maryland, aged 40 and older). The main outcome measure was AMD as determined by retinal photographs or clinical examination. RESULTS: A history of cataract surgery was associated with an increased prevalence of late AMD in all three data sets after adjusting for age, race, sex, and smoking, but odds ratios (OR) were not individually statistically significant. The OR for the combined analysis was 1.7 (95% confidence interval: 1.1-2.6). Having a severe cataract in the eye was also associated with a slightly higher prevalence of late AMD, although the combined OR was not statistically significant (OR = 1.4; 95% confidence interval, 0.8%-2.4). Overall, increasing time since cataract surgery was not associated with late AMD. CONCLUSIONS: A history of cataract surgery may be associated with an increased prevalence of late AMD. However, having a severe cataract in the eye may also be associated with a higher prevalence of late AMD. Additional research is needed to investigate whether a causal relationship exists between cataract surgery and AMD or whether this relationship is due to residual confounding or bias.

Adult↗

PubMed2002

Risk factors for Type II diabetes and diabetic retinopathy in a mexican-american population: Proyecto VER.

PURPOSE: Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. DESIGN: Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. METHODS: Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. RESULTS: 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). CONCLUSIONS: Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.

Adult↗

PubMed2002

Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics.

OBJECTIVE: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics. DESIGN: A cross-sectional study. PARTICIPANTS: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research). TESTING: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes. MAIN OUTCOME MEASURES: Causes of visual loss (best-corrected acuity worse than 20/40). RESULTS: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant. CONCLUSIONS: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.

Adult↗

PubMed2002

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.

Accidental Falls↗

PubMed2002

Grating visual acuity using the preferential-looking method in elderly nursing home residents.

PURPOSE: To assess the performance of two approaches to visual acuity testing in a group of nursing home residents with cognitive impairment. The study was a cross-sectional comparison of the effectiveness of two tests of visual acuity. METHODS: Nursing home residents participating in a clinical trial were tested with both recognition acuity charts and grating acuity cards (Teller) by masked observers. RESULTS: Of the nursing home residents (n = 656) who participated in the study, 86% could respond to visual acuity testing in at least one eye. Eighty-four percent were testable using Teller cards versus 73% who were testable by Early-Treatment Diabetic Retinopathy Study (ETDRS) charts or Lea symbol charts. Forty-one percent of individuals with MiniMental Status Examination (MMSE) scores lower than 10 were testable by recognition acuity, whereas 61% were testable with grating acuity cards. Grating acuity correlated well with recognition acuity (R = 0.79; 95% CI, 0.75-0.98, intraclass correlation coefficient [ICC]). The correlation was slightly lower in individuals with decreased MMSE scores. Although grating acuity was one line better than recognition acuity on average and median acuities were the same, 24% of individuals had results that differed by three or more lines. CONCLUSIONS: Teller acuity cards can effectively test the vision in cognitively impaired individuals who are not testable by conventional means. Grating acuity results correlated well with those of recognition acuity, although differences of three or more lines were not uncommon. Wider use of grating acuity testing allows a more complete assessment of visual function in the cognitively impaired elderly.

Aged↗

PubMed2002

The impact of visual impairment and eye disease on vision-related quality of life in a Mexican-American population: proyecto VER.

PURPOSE: To describe the relationship of visual acuity impairment and eye disease on vision-related quality of life, as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), in a cross-sectional, population-based study of older Hispanic persons living in Arizona. METHODS: A random sample of block groups with Hispanic residents in Nogales and Tucson, Arizona, were selected for study. Participants were interviewed at home with a questionnaire that included the NEI-VFQ-25, an instrument measuring vision-related quality of life. Acuity was obtained with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and standard protocol. Cataract was determined by clinical examination, diabetic retinopathy was diagnosed on stereo fundus photographs, and glaucoma was diagnosed on the basis of clinical examination and visual field results. Analyses were done to determine the degree of association between subscale scores and acuity in the better-seeing eye, monocular visual impairment, and specific eye diseases, with adjustment for acuity. RESULTS: Of the 4774 participants in the study, 99.7% had completed questionnaires that were not completed by proxy. Participants with visual impairment had associated decrements in scores on all subscales, with a decrease in presenting acuity associated with a worse score (P < 0.05), after adjustment for demographic variables. Monocular impairment was also associated with lower scores in several subscales. In those with cataract, low acuity explained most of the low scores, but those with glaucoma or diabetic retinopathy had low scores independent of acuity. CONCLUSIONS: In this study of Mexican-American persons aged 40 or more, monocular impairment and better-eye acuity was associated with a decrease in most domains representing quality of life. Subjects with uncorrected refractive error, cataract, diabetic retinopathy, and glaucoma had associated decrements in quality of life, many not explained by loss of acuity. Further work on the specific measures of vision associated with reported decreases in quality of life, such as visual field or contrast sensitivity, is warranted.

Adult↗