A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality.

OBJECTIVE: To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. METHODS: Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. RESULTS: Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. CONCLUSIONS: Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality / Una evaluación comparativa de la ceguera y la deficiencia visual evitables en siete países latinoamericanos: prevalencia, cobertura y desigualdades

Objective. To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Methods. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Results. Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. Conclusions. Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

Objetivo. Realizar un análisis comparativo de las desigualdades sociales en materia de salud ocular y atención oftálmica, y generar datos probatorios de referencia de siete países latinoamericanos como un ejercicio de evaluación comparativa para vigilar el progreso hacia tres metas del Plan de Acción para la Prevención de la Ceguera y la Deficiencia Visual Evitables: el aumento de la cobertura de los servicios de salud ocular, la reducción al mínimo de las barreras y la disminución de la carga de morbilidad relacionada con la salud ocular. Métodos. Se analizaron los resultados de las encuestas transversales de salud ocular realizadas en seis países latinoamericanos (Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay) desde el 2011 al 2013, y las encuestas nacionales del Paraguay recientemente publicadas. Mediante el empleo de técnicas ordinarias de análisis exploratorio de datos, se investigó la magnitud de las desigualdades absolutas y relativas entre países en cinco dimensiones de la salud ocular a través del gradiente poblacional definido por tres variables de estratificación de equidad (logro educativo, alfabetización y riqueza). Resultados. La prevalencia general de la ceguera en personas de 50 años de edad o mayores varió de 0,7% (intervalo de confianza (IC) de 95%: 0,4-1,0) en Argentina a 3,0% (IC95%: 2,3-3,6) en Panamá. La prevalencia general de la deficiencia visual (grave y moderada) varió de 8,0% (IC95%: 6,5-11,0) en Uruguay a 14,3% (IC95%: 13,9-14,7) en El Salvador. La principal causa notificada de ceguera fue la catarata no operada, mientras que la mayor parte de los casos de deficiencia visual fueron causados por un error de refracción no corregido. Tres países tenían una cobertura quirúrgica de la catarata de más de 90% para las personas ciegas, mientras que dos terceras partes de los pacientes operados de cataratas mostraban una buena agudeza visual. Conclusiones. Las prevalencias de la ceguera y la deficiencia visual moderada se concentraban en las personas más desfavorecidas socialmente, mientras que la cobertura quirúrgica de la catarata así como los resultados óptimos de esta intervención se concentraban en los más adinerados. Son necesarias acciones políticas para aumentar la cobertura y la calidad de los servicios con objeto de alcanzar la universalidad.

WISECARE+: Results of a European study of a nursing intervention for the management of chemotherapy-related symptoms.

While the use of chemotherapy has significantly improved survival rates, the symptoms associated with chemotherapy remain a major burden for patients. Preventing or appropriately managing side effects significantly improves patients' functional status and quality of life, ultimately leading to greater patient acceptance of chemotherapy. However, symptom assessment and management are fraught with difficulties such as poor patient recall, retrospective assessment conducted by clinicians and lack of appropriate, clinically relevant and patient friendly symptom assessment and management tools. Furthermore the differences between clinician and patient perceptions of stresses and distress during chemotherapy are well recognised. This study aimed to evaluate the impact of a nursing intervention incorporating structured symptom assessment and management, facilitated by information technology, on chemotherapy-related symptoms, nausea, vomiting, fatigue and mucositis. This pan-European study, involved 8 clinical sites from Belgium, Denmark, England, Ireland and Scotland. Adults (n=249) receiving first line chemotherapy for breast, lung, ovarian or colorectal cancer, osteosarcoma, acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL) or lymphoma were recruited to the study. Patients completed daily symptom assessment questionnaires for 14 days following consecutive cycles of chemotherapy. Symptom outcomes were compared before and after the introduction of the intervention with positive impact on patients' experiences of nausea, vomiting and oral problems. Fatigue was not significantly improved.

Nutritional status in Jamaica, St. James, 1985

A cross-sectional study of 373 household with 509 children aged 0-59 months was conducted in St. James to be part of a national survey and to be compared with data collected in previous years. The main objectives were to examine nutritional status in ecological areas, and compare factors related to nutritional status in 1982 and 1985 and identify areas and households at risk of malnutrition. The study underscores the need and necessity of a disaggregated database, and careful data collection procedures. The necessity for ongoing assessment is also highlighted by the study, as various factors may intervene over different periods

Nutritional status in Jamaica, St. James, 1985

A cross-sectional study of 373 household with 509 children aged 0-59 months was conducted in St. James to be part of a national survey and to be compared with data collected in previous years. The main objectives were to examine nutritional status in ecological areas, and compare factors related to nutritional status in 1982 and 1985 and identify areas and households at risk of malnutrition. The study underscores the need and necessity of a disaggregated database, and careful data collection procedures. The necessity for ongoing assessment is also highlighted by the study, as various factors may intervene over different periods

A study of undernutrition, poverty and national development in Jamaica

A socio-economic survey of 301 households was conducted in the parish of St. James, during 1982. Households were chosen from enumeration districts, randomly selected from within three ecologically defined strata. Urban households from wealthy districts and rural households farming over 10 acres of land were excluded. The data suggest that the prevalence of urban undernutrition has increased over the past 7-9 years. Of the observed variation in nutritional status, 28 percent was explained by 10 socio-economic variables. Of 7 categories of households identified, least at risk were those supported by professional and technical persons or farmers operating over 2.5 acres, while those most at risk were dependent on the urban unskilled and the skilled self-employed. Casual analysis revealed that although child health and food consumption were the direct precursors of child malnutrition, these were in turn due to poor household and community socio-economic conditions. The households' inability to provide adequate diets and child care appeared related to inadequate and unstable income and employment opportunities. Two public policies were evaluated. The data suggest that while the Food Assistance Plan will save some of the most at-risk from nutritional disaster, the benefits are too little to be generally effective. Better targeting and commodity choice would improve the plan. Additionally, an income supplement might be a better alternative to food stamps. The First Rural Development Project was found to have improved the incomes of beneficiaries. However, insufficient selection bias, inadvertent displacement of squatters, the number of beneficiaries and the real size of income increases make its impact small in relation to need. The study confirms the necessity to approach nutrition improvements through socio-economic development, and underscores the importance of far reaching social restructuring to prevent the continuous occurrence of malnutrition in Jamaica (AU)

Food consumption patterns in St. James - abstract

A household survey was conducted in March 1982 using a stratified random sample the population in 3 ecological zones: urban (U), Rural Lowland (RL, <1000 feet), and Rural Upland (RU, >1000 feet). Households with 10 acres of land and children over 3 years were excluded. This paper examines the patterns of food consumption and assesses the adequacy of the household's consumption by use of 24-hour recall conducted by trained Community Health Aides. One hundred and three different items were reported from the 301 households in the U (N = 82), RL (N = 118), RU (N = 101) zones. Fifteen items used by at least 15 percent of the sample contributed 80.8 percent and 68.7 percent to total calories and protein respectively, in the parish, Cereals contributed 32.3 percent, 36.5 percent and 30.5 percent to total calories while root crops contributed 12.7 percent, 15.0 percent and 33.2 percent in U, RL and RU respectively. The average househeld calorie satisfaction was not significantly different for the 3 zones (106 percent), 104 percent, 110 percent) nor the proportion of households with < 80 percent calorie satisfaction. The mean protein energy per cent was 13.7 ñ 2.3 for urban, 11.7 ñ 2.8 and 10.8 ñ 2.8 for the RL and RU zones respectively (p<.001). Households spending > J$3.00/2000Kcal were 63.4 percent in urban, 55.9 percent and 56.4 percent in RL and RU zones. The average weekly food expenditure per person was J$17.2 ñ 9.1, J$13.4 ñ 7.5 and J$14.6 ñ 7.2 (p<0.5): expressed as percentage of total expenditure: 52.7 percent, 66.2 percent, and 75.3 percent, in the U, RL and RU zones (p<.01). Elasticity of demand for calories consumption was negative in the urban area (r bar to second power = 0.360; p<.001) and positive in the combined rural zones (r bar to second power = 0.502, p<.001). Certain implications are suggested byu the data: 1. Very few food items can be used to construct a food basket which could be monitored once or twice yearly. 1. The urban dwellers consumed more "luxury" items hence more expensive calories than the rural dwellers. 3. Increased income has different effects on calorie consumption depending on income class and geographical location (AU)

Baseline information on related factors in the Canaan mountain area Westmoreland 1979

Survey of the food consumption of a poor rural population consisting of landless households, deficit and subsistence farm households suggests that the group cannot be considered functionally homogenous as the energy intake differed according to income and food distribution. The nutritional status of pre-school age children in landless households was less than that of the others. Concludes that the undernutrtion in these areas was partly due to inadequacy of household food resources. Suggests that development efforts to relieve poverty in this area should address the need for employment opportunities among the functionally landless, supplements to current farm lands or wage work opportunities for some households and extensive services to help farmers to increase their productivity and income. (AU)

Body composition studies in children admitted to hospital with protein-energy malnutrition

Thirteen children who were suffering from protein energy malnutrition were studied in an effort to determine their body composition on admission to hospital, while they were rapidly growing and when they had fully recovered. A review of the available methods for measuring body composition, the methods which are applicable to malnourished children, those used in this project, the results obtained and the difficulties encountered from the body of this report. The main aims of this study were (i) to validate the use of simple anthropometric measurements in body composition studies, and (ii) to see whether the children who recovered from malnutrition were depositing tissue in normal proportions when fed on the high calorie dietary regime. The results are encouraging and have opened up new areas for future reseach. The main findings can be summerised as follows:- (1) the values for total body fat calculated from anthropometric measurements are not significantly different from those calculated from total body water measurement. In the malnourished phase total body fat (TBF) was found to be 14.3 percent and 10.2 percent of body weight from TBW and skinfold measurements respectively. While values for the rapidly growing stage were 16.7 percent and 15.9 percent and in the recovered stage these values were 22.8 percent and 22.5 percent. (2) The measurement of 24 hour urinary creatinine excretions is not a reliable indicator of muscle mass in malnourished children. (3) The serial measurements of TWB should carried out at carefully timed intervals which relate to the energy intake on admission, during rapid growth and at recovery. (4) The faecal energy losses of the 5 children studied on nitrogen balance were variable. In the malnourished stage these values were 5.1 percent, 37.4 percent and 45.3 percent of the energy intake. In the rapidly growing phase the values ranged from 8.1 percent - 58.9 percent of the intake. In the recovered stage there was less variation but the values were higher than those reported in the literature(39.1 percent - 43.1 percent of the intake). (5) Simple anthropometric measurements (arm circumference, triceps skinfold) can be used to estimate the nutritional status of children, and as a measure of recovery from malnutrition (Summary)