ABSTRACT
PURPOSE: To evaluate variables associated with failure to access free eye care after participating in glaucoma screening. DESIGN: Review of responses to a survey completed by participants during glaucoma screening. PARTICIPANTS: Two hundred seventy-three surveys completed by participants of African descent during screening. METHODS: African Americans 40 years or older participated in community glaucoma screening clinics, which included a survey with demographic and social variables. Each participant was given a preliminary diagnosis and encouraged to attend a free eye clinic for a complete examination. Survey results were correlated with attendance at the follow-up examination, using Student's t test, chi-square test, and logistic regression analysis. MAIN OUTCOME MEASURE: Noncompliance with follow-up after glaucoma screening. RESULTS: When adjusting for risk factors in logistic regression analysis, noncompliance was associated with living alone (P = 0.008), smoking (P = 0.0005), and lacking a car (P<0.01). Odds of noncompliance for participants living alone were 2.2 times higher than those for participants not living alone. Odds of noncompliance for participants who smoked were 3.0 times greater than those for participants who did not smoke. Odds of noncompliance for participants who did not have access to a car for their last eye examination were 2.1 times greater than those for participants who did. CONCLUSION: Socioeconomic factors such as smoking, lack of access to a car for eye examinations, and living alone are associated with noncompliance to follow-up after glaucoma screening clinics. Identifying persons with these variables may facilitate improved compliance.
Subject(s)
Black or African American , Diagnostic Techniques, Ophthalmological , Glaucoma/diagnosis , Glaucoma/ethnology , Mass Screening , Patient Compliance , Adult , Black or African American/statistics & numerical data , Aged , Diagnostic Techniques, Ophthalmological/statistics & numerical data , Follow-Up Studies , Humans , Middle Aged , Residence Characteristics , Retrospective Studies , Smoking , TransportationABSTRACT
Growth factors such as hepatocyte growth factor (HGF) are highly up-regulated during development and following renal injury and are known to induce marked morphogenic actions in cultured tubular epithelial cells, including scattering, migration, single cell branching morphogenesis, and multicellular branching tubulogenesis. In the present study, we demonstrate that HGF stimulates epithelial cells to express neutrophil gelatinase-associated lipocalin (Ngal), a member of the lipocalin family of secreted proteins that has recently been shown to participate in mesenchymal-epithelial transformation via its ability to augment cellular iron uptake. At concentrations below those found to mediate iron transport, purified Ngal can induce a promigratory and probranching effect that is dependent on ERK activation. The suppression of Ngal expression using short hairpin RNA results in increased cyst formation by tubular cells. However, the simultaneous addition of Ngal and HGF leads to direct association of the two proteins, and results in a partial inhibition of HGF-mediated activation of c-Met and the downstream MAPK and phosphatidylinositol 3-kinase signaling pathways. This inhibitory effect down-regulates HGF-stimulated single cell migration, and limits branching morphogenesis at both the single cell and multicellular level. These experiments demonstrate that the local expression of Ngal can play a regulatory role in epithelial morphogenesis by promoting the organization of cells into tubular structures while simultaneously negatively modulating the branching effects of HGF.
