Showing papers by "Alfred Sommer published in 1989"
TL;DR: The winners and nominees for this year's Pulitzer Prize for public service announcements are:.
328 citations
TL;DR: A computer simulation model predicts that proliferative diabetic retinopathy (PDR) requiring panretinal photocoagulation (PRP) will eventually develop in 72% of type I diabetics and macular edema will develop in 42%.
179 citations
TL;DR: Investigation of the role of exposure to ultraviolet light in the B range (UV-B) and other potential risk factors for the development of PSC cataracts suggested that UV-B exposure may be an important risk factor for PSCCataracts.
Abstract: • Posterior subcapsular (PSC) cataracts are a visually disabling form of cataract and account for 40% of surgical cases. Although PSC opacities may occur following intraocular inflammation, trauma, or use of steroids, the cause is often unknown. A case-control study was undertaken to investigate the role of exposure to ultraviolet light in the B range (UV-B) and other potential risk factors for the development of PSC cataracts. Surgical PSC cataract cases from a large rural ophthalmic practice on the lower eastern shore of Maryland were matched with phakic controls without PSC cataract changes from the same geographic area by age, sex, and referral pattern. All patients with PSC opacities who underwent cataract surgery in a 12-month period were chosen. One hundred sixty-eight cases and 168 controls were interviewed regarding sunlight exposure, drug use, occupational history, history of diabetes, hypertension, and other diseases. Matched-pairs analyses indicated that a history of relatively high exposure to UV-B was associated with increased risk of PSC cataracts. The association of PSC cataracts with steroid use and diabetes was reconfirmed. Subjects with blue eyes and less than high school education were also at increased risk for PSC cataracts. Smoking and hypertension were not found to be PSC cataract risk factors. These data suggest that UV-B exposure may be an important risk factor for PSC cataracts.
178 citations
134 citations
TL;DR: Regulators view cataract surgery as a growing threat to the health care budget and increasing attention is being given to the indications for surgery and ways to reduce what appears to be the inexorable growth in the number ofCataract operations.
Abstract: Congress and the Health Care Finance Administration have recently targeted cataract extraction procedures for particular scrutiny and cost containment. The reasons have been amply stated: cataract surgery now accounts for 12% of the entire Medicare budget and is presently the most frequently performed surgical procedure reimbursed by Medicare. 1 Given the apparent threefold or greater increase in the annual number of cataract operations in the past decade and the prediction by some that the number of intraocular lens (IOL) implantations will approach 2 million per year, 2 regulators view cataract surgery as a growing threat to the health care budget. The Health Care Finance Administration has tried, largely in vain, to contain costs by reducing reimbursement. Increasing attention is therefore being given to the indications for surgery and ways to reduce what appears to be the inexorable growth in the number of cataract operations. Continued collection and analysis of
103 citations
TL;DR: Book of epidemiology of eye disease, as an amazing reference becomes what you need to get, as a source that may involve the facts, opinion, literature, religion, and many others are the great friends to join with.
Abstract: New updated! The latest book from a very famous author finally comes out. Book of epidemiology of eye disease, as an amazing reference becomes what you need to get. What's for is this book? Are you still thinking for what the book is? Well, this is what you probably will get. You should have made proper choices for your better life. Book, as a source that may involve the facts, opinion, literature, religion, and many others are the great friends to join with.
94 citations
TL;DR: Observational studies indicate that vitamin A--deficient children grow poorly, are more anemic, have more infections and are more likely to die than their peers, and that the magnitude of many of these consequences is directly related to the severity of the deficiency, even after adjusting for other variables.
Abstract: This year marks the 75th anniversary of the discovery of vitamin A by E.V. McCollum. Interest over the past 40 years has focused almost exclusively on the ocular complications of deficiency. Recent data from Indonesia, India, Thailand, Tanzania, Guatemala and elsewhere are reorienting concerns. Observational studies indicate that vitamin A--deficient children grow poorly, are more anemic, have more infections and are more likely to die than their peers, and that the magnitude of many of these consequences is directly related to the severity of the deficiency, even after adjusting for other variables. The few supplementation trials completed to date support these conclusions. Even after excluding children with frank deficiency at baseline, vitamin A-supplemented children have grown faster, developed higher hemoglobin values, and died less frequently (by 30-60%) than their nonsupplemented peers. The great surprise is not the central role vitamin A plays in each of these areas (McCollum and others recognized this long ago), but that this single nutrient can so profoundly affect children who are subject to multiple adverse influences.
74 citations
TL;DR: It is suggested that stunting, rather than wasting, puts younger children at greater risk of death, but among older children, wasting carries a greater relative mortality risk over an 18-month period.
Abstract: Weights and heights were obtained on approximately 4000 preschool-aged children in six rural villages of West Java [Indonesia] between 1977 and 1978. Deaths occurring in the ensuing 18 months were ascertained at three-month intervals. The abilities of relative weight for height and height for age to discriminate children at greatest risk of dying were compared....[The] results suggest that stunting rather than wasting puts younger children at greater risk of death but among older children wasting carries a greater relative mortality risk over an 18-month period. (EXCERPT)
37 citations
17 citations
Journal Article•
TL;DR: Vitamin A is a fat-soluble vitamin stored in the liver, so that a large dose of 200,000 IU every 6 months reduces mortality, stimulates growth, and prevents xerophthalmia and nutritional blindness.
Abstract: Vitamin A deficiency is a serious problem throughout the developing world. An estimated 25-50 million children may well suffer the physiologic consequences of vitamin A deficiency; 5 million develop xerophthalmia, of whom 250,000 to 500,000 go blind every year; and untold numbers are at increased risk of diarrhea, respiratory disease, and death. Even mild vitamin A deficiency has been associated with a 14- to 10-fold increase in mortality, and controlled field trials have demonstrated vitamin A supplementation can reduce childhood death rates by 30%-70%. Three general intervention strategies exist for improving vitamin A status of high-risk, rural, economically deprived populations. These include nutrition education leading to increased dietary intake; vitamin A fortification of centrally processed, widely consumed dietary items; and periodic administration of large doses of vitamin A. At present, the latter is far and away the most widely employed intervention activity, because of its immediate impact, and because it can be implemented through the existing (and specialized) health care infrastructure. Vitamin A is a fat-soluble vitamin stored in the liver, so that a large dose of 200,000 IU (100,000 IU for children under 1 year of age) every 6 months reduces mortality, stimulates growth, and prevents xerophthalmia and nutritional blindness. Recent data suggest more frequent administration, every 3 to 4 months, may be desirable. Side effects have been minimal, with mild nausea, vomiting, and headaches in less than 1% to 4% of recipients. Care should be taken, however, that doses above 10,000 IU not be administered to women during the first trimester of pregnancy because of potential teratogenic effects.(ABSTRACT TRUNCATED AT 250 WORDS)
12 citations
TL;DR: The authors defined glaucoma as a variable combination of elevated intraocular pressure (IOP), optic disc abnormalities, and visual field defects, and suggested that there is a stage at which effective intervention can curb the disease.
TL;DR: The significance of even marginal, 'subclinical' deficiency has important implications for the management of cystic fibrosis and related disorders, while one should be observant for signs and symptoms of frank deficiency.
Abstract: Vitamin A deficiency is commonly considered a Third World problem. The article by Vernon et al. (this issue, p 46) reminds us that the condition occurs, albeit infrequently, in affluent western societies. Recognition requires a high level of suspicion, particularly when confronting patients on 'fad' diets', patients with malabsorption states, and especially alcoholics with recalcitrant corneal ulcers2. The problem that vitamin A deficiency poses to the West is only a tiny reflection of the 5 million new cases of xerophthalmia and the quarter million instances of associated corneal destruction and blindness suffered by Third World children each year3. Vernon et al. cite the high risk of subsequent ocular damage to their already deficient subjects. Indeed, sudden decompensation ofborderline vitamin A status can result in rapid corneal necrosis, even before conjunctival xerosis or Bitot's spots appear4. Measles is one of several potent precipitating factors, particularly in Africa5. Recent data suggest that even mild, 'subclinical' deficiency may have important implications for growth, health and survival6. Mortality and infectious morbidity among Indonesian children are more closely correlated with vitamin A status than with general anthropometric measurements7'8. Periodic supplementation with large doses ofvitamin A twice a year9 or daily small-dose supplementation through fortification of a dietary staple'0 both appear to reduce preschool mortality by at least one-third\". Vitamin A treatment reduced case-fatality rates among Tanzanian children hospitalized with severe measles by 50%12. In Indonesia, supplementation increased linear'0 and ponderal'3 growth; while in Indonesia'0 and Latin America'4 it increased serum haemoglobin values. Small daily doses given to otherwise well nourished, healthy Australian children reduced the incidence of recurrent lower respiratory infection by a quarter'5. The mechanism(s) by which vitamin A affects morbidity, mortality, growth and haematopoesis remain uncertain. Vitamin A is necessary for maintenance of mucous-secreting epithelial linings of a wide variety of organs. Deranged metaplasia no doubt interferes with their normal barrier function. Animal experiments in particular suggest roles for vitamin A in the regulation ofboth cell-mediated and humoral immunity'6. Whether the role of vitamin A on growth and haematopoesis is direct, or secondary to its effect on infection, is uncertain. The significance of even marginal, 'subclinical' deficiency has important implications for the management of cystic fibrosis and related disorders. While one should be observant for signs and symptoms of frank deficiency, proper care will ensure these never occur in the first place; by the time they do, the individual may already have suffered potentially lethal consequences. Daily supplementation with 5000-10 000 i.u. is often inadequate for maintaining normal vitamin A stores in patients with cystic fibrosis. The average daily intake ofAmericans lies within this range. Daily oral supplements of 25 000 to 50 000 i.u. vitamin A are often required. The optimal daily supplement needs to be titrated through periodic assessment. Serum retinol, as reliably determined by high performance liquid chromatography (HPLC), provides a useful index. As long as levels run well within the normal range (40-70 #g/dl [ 1.4-2.5 ismol/I] ) the absence of even subclinical deficiency is reasonably assured. In some instances of severe lipid malabsorption, periodic intramuscular injections ofwatermiscible vitamin A may be necessary. Oil miscible vitamin A, as was used in Vernon's first case, is poorly absorbed from the injection site and should therefore be avoided. Chronic, severe malabsorption of vitamin A, as sometimes encountered in cystic fibrosis, is one ofthe very few instances in which injectable vitamin A is required. The vast majority of vitamin A deficient children, including Third World children with severe malnutrition, diarrhoea and keratomalacia, respond as rapidly and successfully to oral as to injectable preparations'7. Oral therapy is obviously far cheaper and safer.
TL;DR: Sebagai suatu wilayah dengan prevalensi xeroftalmia paling tinggi di Indonesia, banyak faktor risiko yang diidentifikasi bagi daerah ini, termasuk kejadian kecacingan, kekurangan frekuensi pemberian ASI pada anak yang masih menyusu anda variasi diet yang terbatas.
Abstract: Berdasarkan data "Survei Prevalensi Kebutaan Gizi" tahun 1977, Lombok, Nusa Tenggara Barat, dinyatakan sebagai wilayah tinggi prevalensi xeroftalmia. Sebagai suatu wilayah dengan prevalensi xeroftalmia paling tinggi di Indonesia, banyak faktor risiko yang diidentifikasi bagi daerah ini, termasuk kejadian kecacingan, kekurangan frekuensi pemberian ASI pada anak yang masih menyusu; kekurangan "kamar cuci" di dalam rumah; variasi diet yang terbatas, tidak ada variasi konsumsi bahan pokok selain beras; dan kecilnya konsumsi sumber-sumber protein. Faktor risiko khusus xeroftalmi-korneal berkaitan dengan riwayat penyakit yang baru diderita si anak (campak dan infestasi berat kecacingan) dan kurang kalori protein berat. Sejak tahun 1978, Pemerintah Indonesia telah mengembangkan berbagai macam pendekatan untuk mengawasi (kontrol) xeroftalmia; sampai tahun 1982 telah mencapai 80% sasaran (anak Balita) dan telah menghasilkan penurunan prevalensi xeroftalmia di wilayah ini. Penurunan prevalensi ini dicapai tanpa penurunan secara proporsional faktor-faktor risiko terkait.