Biomedical subjects

Wayne Smith

Publications and source records attributed to Wayne Smith.

At least 37 records · Page 2Linked to original sources

PubMed2005

Chronic arsenic exposure and adverse pregnancy outcomes in bangladesh.

BACKGROUND: Chronic exposure to arsenic through drinking water has the potential to cause adverse pregnancy outcomes, although the association has not been demonstrated conclusively. This cross-sectional study assessed the association between arsenic in drinking water and spontaneous abortion, stillbirth, and neonatal death. METHODS: In this cross-sectional study, 533 women were interviewed. Information on sociodemographic characteristics, drinking water use, and adverse pregnancy outcomes was obtained through a structured pretested interviewer-administered questionnaire. The respondents reported use of a total of 223 tube wells; for 208 wells, water samples were measured using an ultraviolet/visible spectrophotometry method, whereas 15 were measured by flow-injection hydride generation atomic absorption spectrometry (FIHG-AAS). RESULTS: Excess risks for spontaneous abortion and stillbirth were observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for participant's height, history of hypertension and diabetes, and (for neonatal death only) age at first pregnancy. Comparing exposure to arsenic concentration of greater than 50 microg/L with 50 microg/L or less, the odds ratios were 2.5 (95% confidence interval=1.5-4.3) for spontaneous abortion, 2.5 (1.3-4.9) for stillbirth, and 1.8 (0.9-3.6) for neonatal death. CONCLUSIONS: These study findings suggest that chronic arsenic exposure may increase the risk of fetal and infant death.

Abortion, Induced↗

PubMed2005

Distribution of ocular biometric parameters and refraction in a population-based study of Australian children.

PURPOSE: To study the distribution of spherical equivalent refraction and ocular biometric parameters in a young Australian population. METHODS: Noncontact methods were used to examine ocular dimensions and cycloplegic autorefraction in a stratified random cluster sample of year 1 Sydney school students (n = 1765), mean age 6.7 years (range, 5.5-8.4 years). Repeated measures of axial length, anterior chamber depth, and greatest and least corneal radius of curvature (CR1, CR2, respectively) were taken in each eye. Refraction was measured as the spherical equivalent. RESULTS: Mean spherical equivalent refraction in right eyes was +1.26 +/- 0.03 D (SEM; range, -4.88 to +8.58). The distribution was peaked (kurtosis 14.4) and slightly skewed to the right (skewness, 1.7). Prevalence of myopia, defined as spherical equivalent refraction < or = -0.5 D, was 1.43% (95% CI, 0.94-2.18) in the overall population. Axial length, anterior chamber depth, and corneal radii of curvature were normally distributed. The mean axial length in right eyes was 22.61 +/- 0.02 mm (SEM; range, 19.64-25.35). The mean anterior chamber depth was 3.34 +/- 0.01 mm (SEM; range, 2.14-4.06). Mean CR1 was 7.85 +/- 0.01 mm (SEM) and mean CR2 was 7.71 +/- 0.01 mm (SEM). The distribution of axial length/mean corneal radius ratio was peaked (leptokurtic) with a mean of 2.906. Mean axial length was longer, anterior chambers were deeper, and corneas were flatter in the boys. CONCLUSIONS: A peaked (leptokurtic) distribution of spherical equivalent refraction was present in this predominantly hyperopic 6-year-old population. The results also showed that ocular biometric measures were normally distributed, with statistically significant gender differences found in measurements.

Adolescent↗

PubMed2005

Effect of stature and other anthropometric parameters on eye size and refraction in a population-based study of Australian children.

PURPOSE: To determine the effect of anthropometric parameters on refraction and ocular biometry. METHODS: Noncontact methods were used to examine ocular dimensions and cycloplegic refraction in a stratified random cluster sample of year-1 Sydney school students (mean age, 6 years; n = 1765). Height, body weight, and waist circumference were measured according to a standardized protocol. Body mass index (BMI) was subsequently calculated. The percentage of body fat was measured with leg-leg bioelectrical impedance analysis. Associations between parameters were analyzed by multiple linear regression. RESULTS: After adjustment for age in weeks, height was found to be strongly associated with axial length and corneal radius. Children in the 1st quintile for height had axial length of 22.39 +/- 0.04 mm compared with 22.76 +/- 0.04 mm in children in the 5th quintile. Other anthropometric parameters were not associated with axial length or corneal radius. Height was not associated with anterior chamber depth after adjustment for weight. Increases in weight, BMI, and waist circumference were associated with a deeper anterior chamber after adjustment for height. No associations were found between the measured anthropometric parameters and refraction or axial length-corneal radius ratio. CONCLUSIONS: This study found a strong association between height and axial length and corneal radius, but not spherical equivalent refraction. The findings may demonstrate the effectiveness of emmetropization in the presence of normal physiological influences.

Anterior Chamber↗

PubMed2005

Isotretinoin, depression and suicide: a review of the evidence.

There is currently considerable controversy regarding a proposed causal relationship between the use of isotretinoin and depression and suicide. A search was made of the MEDLINE, EMBASE and PsychINFO databases using the search terms 'isotretinoin', 'depression' and 'suicide'. Despite numerous case reports linking isotretinoin to depression, suicidal ideation and suicide, there is, as yet, no clear proof of an association. While isotretinoin, used to treat acne vulgaris, has not been demonstrated to be associated with depression or suicide, the possibility of a relatively rare idiosyncratic adverse effect remains. GPs have a role in the clinical application of these findings.

Acne Vulgaris↗

PubMed2005

Patients' perceptions of isotretinoin, depression and suicide--a qualitative study.

BACKGROUND: Isotretinoin is an effective acne medication. The evidence for it causing depression and suicide, although widely publicised, remains uncertain. METHODS: Twenty-six semi-structured interviews with patients with acne were coded and subjected to thematic analysis. RESULTS: Isotretinoin was perceived to be effective but dangerous. The most well known adverse effects were depression and suicide. DISCUSSION: The overemphasis of serious psychological adverse events in patients might discourage the use of isotretinoin by those who might benefit from it.

Abnormalities, Drug-Induced↗

PubMed2004

Retinal arteriolar narrowing is associated with 5-year incident severe hypertension: the Blue Mountains Eye Study.

We assessed whether retinal arteriolar narrowing and structural abnormalities independently predicted 5-year incident severe (grade 2 or 3) hypertension in an older population-based cohort. The Blue Mountains Eye Study baseline (1992 to 1994) examined 3654 residents aged 49 and older in 2 postal code areas, west of Sydney. Of the 2335 participants (75.1% of survivors) who returned at the 5-year examinations, 1319 were normotensive or had mild (grade 1) hypertension at baseline. Baseline retinal photographs were graded for focal retinal vessel wall signs and vessel diameters were measured. Participants were classified as having normal, high-normal blood pressure [BP] (systolic BP 121 to 139 mm Hg and/or diastolic BP 81 to 89 mm Hg), mild hypertension (systolic BP 140 to 159 mm Hg and/or diastolic BP 90 to 99 mm Hg), or severe hypertension if they had a previous diagnosis of hypertension and were receiving antihypertensive medications or had systolic BP > or =160 mm Hg and/or diastolic BP > or =100 mm Hg at examination. Incident severe hypertension was defined in persons who were free of severe hypertension at baseline but classified as having severe hypertension at the 5-year examinations. Of the 1319 baseline subjects at risk, 390 (29.6%) developed severe hypertension. After adjusting for age, sex, body mass index, smoking, glucose, and total cholesterol, generalized retinal arteriolar narrowing at baseline was associated with increased risk of incident severe hypertension (odds ratio 2.6; 95% confidence interval, 1.7 to 3.9) when comparing the narrowest versus widest quintile. This association remained significant after further adjustment for baseline mean arterial BP or BP status. Our findings support the hypothesis that small vessel structural changes may precede the development of severe hypertension.

Aged↗

PubMed2004

Risk factors for incident age-related macular degeneration: pooled findings from 3 continents.

OBJECTIVE: To examine risk factors for incident age-related macular degeneration (AMD) after combining data from 3 population-based cohort studies. DESIGN: Population-based cohort study. POPULATION: A population of 9523 adults (age range, 43-95 years at baseline) living in Australia, The Netherlands, and the United States who participated in a baseline examination and a follow-up examination on average 5 or 6 years later. METHODS: Similar procedures were used at all study sites. Examinations included a standardized questionnaire, pupillary dilation, and stereoscopic color fundus photography. Fundus photographs were graded for lesions associated with AMD using the Wisconsin and International Age-Related Maculopathy Grading Systems. Senior investigators from each site adjudicated all photos graded as late AMD. MAIN OUTCOMES MEASURE: Incidence of late AMD. RESULTS: Among studies, distributions for most risk factors differed, and overall incidence rates were similar. In the Beaver Dam Eye Study, total serum cholesterol was inversely associated with incident neovascular AMD. In the Blue Mountains Eye Study, current smoking (defined as smoking at the time of the baseline examination) was associated with an increased risk of incident geographic atrophy and late AMD; increased total serum cholesterol, having diabetes, and older age at menopause were positively associated with incident geographic atrophy; and an increase in high-density lipoprotein serum cholesterol was inversely related to incident geographic atrophy. In the Rotterdam Study, current smoking was associated with an increased risk of incident geographic atrophy, neovascular AMD, and late AMD; past smoking was associated with an increased risk of incident neovascular AMD and late AMD; and an increased number of years between menarche and menopause was directly related to incident geographic atrophy. After pooling data, the only statistically significant relationships found were between smoking and total serum cholesterol and incident AMD. Current smoking was associated with an increased incidence of geographic atrophy and late AMD (odds ratios [ORs] relative to nonsmokers: 2.83 and 2.35, respectively; ORs relative to past smokers: 2.80 and 1.82, respectively), and total serum cholesterol was associated directly with incident geographic atrophy (OR: 1.08 per 10 mg/dl) and inversely with incident neovascular AMD (OR: 0.94 per 10 mg/dl). CONCLUSIONS: Pooled data support a growing body of evidence indicating that smoking is related to an increased risk of incident AMD. Current smokers were at higher risk of incident AMD than both past smokers and those who never smoked. The relationships found in this study between total serum cholesterol and incident geographic atrophy and neovascular AMD are not readily explained.

Adult↗

PubMed2004

Association between nutritional status and arsenicosis due to chronic arsenic exposure in Bangladesh.

The role of nutritional factors in arsenic metabolism and toxicity is not clear. Provision of certain low protein diets resulted in decreased excretion of DMA and increased tissue retention of arsenic in experimental studies. This paper reports a prevalence comparison study conducted in Bangladesh to assess the nutritional status among the chronic arsenic exposed and unexposed population. 138 exposed individuals diagnosed as arsenicosis patients were selected from three known arsenic endemic villages of Bangladesh and age, sex matched 144 unexposed subjects were randomly selected from three arsenic free villages. The mean arsenic concentration in drinking water for the exposed and unexposed population was 641.15 and 13.5 microg L(-1) respectively. Body Mass Index was found to be lower than 18.5, the cut off point for malnutrition, in 57 (41.31%) out of 138 exposed arsenicosis cases and 31 (21.53%) out of 144 unexposed individuals. The crude prevalence ratio (or risk) was 1.92 (95% CI = 1.33-2.78) for poor nutritional status among the arsenicosis cases compared to the unexposed population. The findings of this study add to the evidence that poor nutritional status may increase an individual's susceptibility to chronic arsenic toxicity, or alternatively that arsenicosis may contribute to poor nutritional status.

Adult↗

PubMed2004

Overcoming RNA inhibition in the fluorescent polymerase chain reaction assay to enhance detection of bovine DNA in cattle feeds.

The practice of incorporating mammalian protein in ruminant feeds was banned in the United States in 1997 as a measure to avoid transmission of bovine spongiform encephalopathy (BSE). A sensitive means of identifying the banned additives in feeds would be by detection of species-specific DNA using the polymerase chain reaction (PCR). However, problems may arise in the PCR due to the presence of inhibitory substances. Using human DNA as an internal PCR control, inhibitory substances were evident in the DNA extraction products of cattle feeds. The results of heating experiments excluded enzymes as a cause of inhibition, and spectrophotometric calculations suggested the possibility of RNA contamination. Co-electrophoresis of untreated and RNAse digested extracts confirmed the presence of RNA in the undigested product. Seven cattle feeds were spiked with predetermined amounts of bovine meat and bone meal (BMBM). The DNA extracted products were treated with RNAse and the bovine specific mitochondrial DNA (B-mtDNA) was amplified by PCR. The minimum level of detection of B-mtDNA was influenced by RNAse treatment and feed composition. RNAse treatment decreased false-negative results overall by 75%. False-negative results were decreased 100% in the higher BMBM concentrations and 50% in the lower BMBM concentrations. Also, each cattle feed was spiked to attain a 2% wt/wt concentration with each swine, fish, sheep, or poultry product, or cattle dried blood. Amplification of B-mtDNA occurred only with the cattle dried blood and only in three feeds in which B-mtDNA was detected at the only level tested (2%). A commercial immunochromotographic assay (Neogen) detected the spiked BMBM in only one of the seven feeds and only at the upper concentration (1%).

Animal Feed↗

PubMed2004

Refractive status and the 5-year incidence of age-related maculopathy: the Blue Mountains Eye Study.

This study aimed to assess the longitudinal association between refraction and 5-year incident age-related maculopathy (ARM) in the Blue Mountains Eye Study population. The dataset included 3654 participants aged 49+ (82.4% of eligible) examined at baseline (1992-1994), and 2335 (75.1% of survivors) examined after 5 years. Retinal photograph grading followed the International ARM Classification. Incident ARM was assessed using a side-by-side comparison. Refraction was performed using autorefraction with subjective refinement. Spherical equivalent was calculated from spherical plus half the cylindrical power. After adjusting for age, sex and smoking, no association was found between baseline spherical equivalent and 5-year incident late or early ARM. Hyperopic right eyes had slightly higher incident rates for late (0.8%) and early (6.3%) ARM, compared with myopic (0.4% and 4.1%, respectively) or emmetropic (0.5% and 5.0%, respectively) right eyes. After multivariable adjustment, this study found no significant association between hyperopia and the 5-year incidence of late or early ARM. Left eyes or the combined data from both eyes had similar findings.

Female↗

PubMed2004

Impact of bilateral visual impairment on health-related quality of life: the Blue Mountains Eye Study.

PURPOSE: To assess the impact of visual impairment on health-related quality of life (HRQOL) in an older population and compare it with the impact of major medical conditions. METHODS: Participants of the second cross-sectional Blue Mountains Eye Study (BMES; n = 3509; mean age, 66.7 years; 57% female) were asked to complete the self-administered 36-item Short-Form health survey (SF-36), a comprehensive interview, and an eye examination. Visual impairment was defined as visual acuity less than 20/40 (better eye). RESULTS: Of 3154 (89.9%) participants with complete data, 172 (5.5%) had visual impairment due to refractive errors (correctable visual impairment) and 66 (2.1%) due to eye conditions (noncorrectable visual impairment; 49 mild, 9 moderate, 8 severe). After adjustment for demographic and medical confounders, there was a trend toward lower SF-36 scores in participants with noncorrectable impairment than in those with correctable impairment (physical component score [PCS] Ptrend = 0.01 and mental component score [MCS] Ptrend = 0.02). Increasingly severe noncorrectable visual impairment was associated with significantly poorer SF-36 scores in all but two dimensions. The impact of noncorrectable visual impairment was comparable to that from major medical conditions (e.g., stroke) and had a greater impact on mental than physical domains (mean MCS = 46.2, PCS = 41). No significant differences in HRQOL were demonstrated between visual impairment cases caused by age-related maculopathy and cataract, after adjusting for severity of visual impairment. CONCLUSIONS: Noncorrectable visual impairment was associated with reduced functional status and well-being, with a magnitude comparable to major medical conditions. These data have implications for disability weights such as those developed by the Global Burden of Disease study.

Aged↗

PubMed2004

The effect of arsenic mitigation interventions on disease burden in Bangladesh.

Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs; undiscounted) lost per year in those exposed to arsenic concentrations > 50 microg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 microg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections. Key words: arsenic/adverse effects, Bangladesh, burden of disease, diarrhea, risk assessment, water pollutants, water supply.

Adolescent↗

PubMed2003

Risk of age-related macular degeneration in eyes with macular drusen or hyperpigmentation: the Blue Mountains Eye Study cohort.

OBJECTIVE: To quantify the 5-year risk of age-related macular degeneration (AMD) in eyes with different macular drusen characteristics (ie, size, type, location, and total area) or hyperpigmentation in a population-based cohort. METHODS: The Blue Mountains Eye Study examined 3654 residents during 1992-1994; 2335 (75.1% of survivors) were reexamined during 1997-1999. Retinal photographs were graded using the Wisconsin Age-Related Maculopathy Grading System. Incident AMD lesions were defined by development of neovascular AMD or geographic atrophy in eyes without these lesions at baseline (eyes at risk). Age-adjusted relative risks (RRs) were determined. Generalized estimating equation models were used to estimate odds ratios, adjusting for the correlation between eyes and other AMD risk factors. Main Outcome Measure Incidence of AMD. RESULTS: Of the 4634 eyes at risk, 52 (1.1%) developed neovascular or atrophic AMD lesions over 5 years. In right eyes, presence vs absence of the following macular signs predicted AMD: drusen that were 125 micro m or larger (13.9 vs 0.6%; age-adjusted RR, 5.7; 95% confidence interval [CI], 3.6-9.0), indistinct soft or reticular drusen (23.2% vs 0.4%; RR, 9.9; 95% CI, 6.4-15.4), total drusen area of half the disc area or more (31.4% vs 0.6%; RR, 13.5; 95% CI, 8.0-22.8), and hyperpigmentation (14.4% vs 0.5%; RR, 8.0; 95% CI, 5.4-11.9). After adjusting for age, sex, and smoking status, eyes with these signs at baseline had a high likelihood of developing AMD. Eyes with Age-Related Eye Disease Study categories 3 and 4 were 5 times more likely to develop AMD compared with eyes in categories 1 and 2. CONCLUSION: This study quantifies the 5-year risk of AMD in eyes with macular drusen and hyperpigmentation.

Aged↗

PubMed2003

Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains eye studies.

PURPOSE: To assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM). DESIGN: Combined analysis of longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study. PARTICIPANTS: The Beaver Dam Eye Study examined 4926 persons aged 43 years or older at baseline and re-examined 3684 after 5 years. The Blue Mountains Eye Study examined 3654 persons aged 49 years or older at baseline and re-examined 2335 after 5 years. METHODS: The two studies used similar protocols for retinal photography and photographic grading. We defined incident late-stage ARM as the development of neovascular ARM or geographic atrophy in eyes without either lesion type at baseline that was confirmed by consensus between the study investigators. Nonphakic eyes included eyes that were aphakic or pseudophakic at baseline. Eye-specific data were analyzed. Age- and study site-adjusted relative risks were calculated using the Cochran-Mantel-Haenszel method. Multivariate-adjusted odds ratios (ORs) were also estimated using generalized estimating equation models. RESULTS: Of the 6019 participants examined after 5 years, 11,391 eyes were considered at risk for developing late-stage ARM, including 315 nonphakic and 11,076 phakic eyes. Late-state ARM (either neovascular ARM or geographic atrophy) developed in 6.0% to 7.5% of nonphakic eyes (10 of 168 right and 11 of 147 left eyes), compared with 0.7% of phakic eyes (40 of 5504 right and 37 of 5572 left eyes) during the 5-year period. Age- and study site-adjusted 5-year relative risks were 2.8 (95% confidence interval [CI], 1.6-5.1) for right and 3.7 (95% CI, 2.1-6.4) for left eyes. After further adjustment for gender, smoking, and the presence of indistinct or reticular drusen or pigmentary abnormalities at baseline, nonphakic eyes had a substantially higher risk for developing either late-stage ARM lesion compared with phakic eyes, OR = 5.7 (95% CI, 2.4-13.6). CONCLUSIONS: Pooled findings from these two large population-based cohorts support the hypothesis that cataract surgery in older persons may be associated with an increased subsequent risk for developing late-stage ARM, particularly neovascular ARM.

Adult↗

PubMed2003

Searching for an optimum solution to the Bangladesh arsenic crisis.

Searching for an optimum solution to the Bangladesh arsenic crisis: Thirty years ago Bangladesh experienced very high levels of infant and child mortality, much of it due to water-borne disease in deltaic conditions where surface water was highly polluted. In what appeared to be one of the great public health achievements, 95% of the population were converted to drinking bacteria-free tubewell water from underground aquifers. Recently, it has been shown that perhaps 20% of this water is arsenic contaminated and alternatives to tubewell water have been sought. This paper reports on two national surveys collaboratively carried out in 2000 by the Health Transition Centre, Australian National University and Mitra and Associates, Dhaka: A census of tubewells and a household survey of tubewell use and arseniosis. The study found that the tubewell revolution has been promoted not only by health considerations but also by the demand for a household water facility and the desire by women to reduce workloads associated with using surface water. Because of this, and because the population had absorbed the message about safe tubewell water, it is argued that the movement away from the use of tubewell water should be as limited as possible, even if this means using safe tubewells which are often found in the neighbourhood. To enable such a move the most urgent need is not changing the source of water but comprehensive national water testing providing essential information to households about which wells are safe and which are not.

Arsenic↗

PubMed2003

Five-year incidence of age-related maculopathy in relation to iris, skin or hair colour, and skin sun sensitivity: the Blue Mountains Eye Study.

This study aimed to assess longitudinal associations between iris,hair and skin colour, plus skin sensitivity to sun and the 5-year incidence of age-related maculopathy (ARM). Of 3654 baseline Blue Mountains Eye Study participants (aged 49+ years), 2335 survivors (75.1%) were re-examined after 5 years. Retinal photographs were graded using the Wisconsin ARM Grading System and incident ARM lesions confirmed using side-by-side grading.Iris/skin/hair colour was assessed and skin sensitivity questions were asked at baseline. After adjusting for age, sex and smoking, no significant associations were found between iris or hair colour and incident late or early ARM. Compared to persons with fair skin, those with very fair skin had an increased risk of developing geographical atrophy (odds ratio [OR] 3.5,95% confidence interval [CI] 1.2-10.4).However, persons with sun-related skin damage were less likely than those without to develop indistinct soft drusen (OR 0.6, 95% CI 0.4-0.9). Longitudinal data provide no support for the previously reported cross-sectional association between iris colour and ARM.

Eye Color↗

PubMed2003

Visual impairment and nursing home placement in older Australians: the Blue Mountains Eye Study.

PURPOSE: To assess whether visual impairment at baseline is an independent contributor to subsequent nursing home placement during a 6-year follow-up. METHODS: 3654 non-institutionalised people aged 49+ years (82.4% of those eligible) who participated in baseline examinations of the Blue Mountains Eye Study (1992-94) were followed during 1997-99. Presenting visual acuity was measured with current glasses and a standardised refraction performed. We defined visual impairment as visual acuity reduced to <or=20/40. Permanent nursing home admissions during follow-up were confirmed by the regional Aged Care Assessment Team and government subsidy payment records. RESULTS: At baseline, 511 participants had presenting visual impairment. After refraction, vision improved to 20/30 or better in 346 persons (68%, "correctable"), while 165 (32%) remained visually impaired. During follow-up, 162 study participants (5.0%) were admitted permanently to a nursing home. The age-adjusted 6-year incidence was 3.6% for participants with normal vision, 16.2% for those with visual impairment after best correction and 8.1% for those with "correctable" visual impairment. After adjusting for non-cognitive factors that predicted nursing home placement, the relative risk (RR) for nursing home admission among persons with visual impairment after best correction was 1.8 (95% CI 1.1-2.9). A similar magnitude of association was found among persons with "correctable" visual impairment (RR 2.1, 95% CI 1.4-3.1). For each line of reduction in presenting visual acuity at baseline, there was a 7% increased risk of subsequent nursing home placement. CONCLUSIONS: This study suggests that decreased vision may be a marker or contributing factor to subsequent nursing home placement in general older populations.

Aged↗

PubMed2003

Systemic use of anti-inflammatory medications and age-related maculopathy: the Blue Mountains Eye Study.

PURPOSE: To assess whether an association exists between systemic use of anti-inflammatory medications at baseline and the prevalence or incidence of either late or early age-related maculopathy (ARM) in a population-based cohort. METHODS: 3654 participants of the Blue Mountains Eye Study baseline examination (1992-94) were followed during 1997-99. Use of anti-inflammatory medication was recorded during the baseline interview. After excluding 543 persons who died since baseline, 2334 (75% of the surviving participants) attended 5-year follow-up examinations. Retinal photographs taken during both examinations were graded using the Wisconsin Age-Related Maculopathy Grading System. Prevalence refers to the proportion of participants having ARM at baseline. Incidence refers to the proportion of participants without ARM at baseline who developed it over the 5-year period. Known ARM risk factors were adjusted for when assessing the relationship between use of anti-inflammatory medications and ARM. RESULTS: At baseline, 1010 (27.6%) of 3654 participants were current users of non-steroidal anti-inflammatory drugs (NSAIDs), 514 (14.1%) were past users and 1282 (35.1%) were ever users. The corresponding numbers of subjects reporting current, past or ever use of corticosteroids (including inhaled steroids) were 225 (6.2%), 519 (14.2) and 564 (15.4), respectively. Late ARM was present in 72 participants (2.0%) and early ARM was present in 171 participants (4.9%) at the baseline examination. During the follow-up period, 25 participants (1.1%) developed incident late ARM and 192 (8.7%) developed incident early ARM. After adjusting for age, sex, family history of ARM and smoking, no significant associations were evident for the use of NSAIDs or corticosteroids and the prevalence of either late or early ARM. There were also no associations found between use of these medications at baseline and the 5-year incidence of either late or early ARM. CONCLUSIONS: No association was found between use of systemic anti-inflammatory medications and either the cross-sectional prevalence or longitudinal incidence of ARM in this population.

Aged↗