Big fall in prevalence of blindness
THE prevalence of blindness has fallen by 50% in the past two decades, and moderate and severe vision impairment (MSVI) prevalence is down by 38% in high-income countries such as Australia, according to research published in the British Journal of Ophthalmology. The researchers, including some from Australia, also found that macular degeneration, including age-related and myopic macular degeneration, had replaced cataract as the most important cause of blindness in these countries. The systematic review of cross-sectional population-based studies from 1980 to 2012 included 243 studies on the prevalence and causes of blindness and MSVI in high-income countries in the Asia Pacific, Australasia, Western Europe, North America, and Central and Eastern Europe. The researchers used statistical methods to calculate estimates of the prevalence and most common causes of blindness and MSIV between 1990 and 2010 for 190 countries. They found that over the 20-year period, the prevalence of blindness in high-income countries fell from 3.314 million people (0.2% of the population) to 2.736 million (0.1%), and of MSIV from 25.362 million (1.6%) to 22.176 million (1.0%). “The prevalence of age-related blindness and MSVI in older people (50 years and above) in the high-income regions was markedly lower than the figures for the global adult population. It shows the inverse association between the level of socioeconomic background and prevalence of visual impairment”, the researchers wrote. Uncorrected refractive error was found to be the most frequent cause of MSVI, and the third most common cause of blindness. The researchers warned of the impending impact of diabetes, saying many people with diabetes “are not only at risk of diabetic retinopathy but also cataract and glaucoma; thus, the impact of diabetes is multifold”.

Back pain a major global burden
TWO studies by Australian researchers, published in the Annals of Rheumatic Diseases, have highlighted the global burden of disability caused by low back pain (LBP). The first study used data from the Global Burden of Disease 2010 study to assess the prevalence, incidence, remission, duration and risk of death associated with LBP and the toll it takes in terms of years lived with a disability (YLDs) and disability-adjusted life-years (DALYs). Of the 291 Global Burden of Disease conditions, LBP ranked highest in YLDs and sixth in terms of DALYs. The researchers said LBP caused more YLDs than any other condition, and was the greatest contributor to overall burden in Western Europe and Australasia, with the prevalence and overall impact increasing with age. “Governments, health service and research providers and donors need to pay far greater attention to the burden that LBP causes than what they have done previously”, the researchers wrote. The second study examined global LBP exposure based on occupation. The researchers found that LBP at work caused an estimated 21.7 million DALYs in 2010, with developing countries particularly exposed. Males made up 62% of DALYs from LBP, with the largest number in those aged 35–55 years. The highest relative risk was in the agricultural sector. The researchers wrote that the study provided strong support for the need to identify, develop and implement effective interventions, “primarily by decreasing exposure to the causative ergonomic risk factors”.

Big benefits from smoke-free laws
LEGISLATING smoke-free environments has been associated with substantial reductions in preterm births and hospital attendances for asthma, according to research published in The Lancet. An analysis of 11 studies involving more than 2.5 million births and 247 168 asthma exacerbations which described smoking bans in work and/or public places in Europe and North America found a 10.4% reduction in the risk of preterm births and 10.1% reduction in hospital attendance for asthma. There was a small but not significant effect on low birthweight. “The association between smoke-free laws and reductions in preterm birth, birthweight for gestational age, and asthma events identified by our meta-analysis accord with recognised associations of these outcomes with second-hand smoke exposure and are biologically plausible”, the researchers wrote. “Smoke-free legislation is a cost-effective population intervention in view of the magnitude of its public health benefits and the established absence of adverse economic effects that have long been claimed by the tobacco industry.” An accompanying comment ADD LINK said laws to make workplaces and public places smoke free “stimulate people to make their homes smoke free voluntarily, which reduces second-hand smoke exposure and supports quitting. This effect is particularly crucial for infants and children who have no control over their environment”.

Online self-injury sites “poor quality”
A DAMNING assessment of the quality of online health information for young people about self-injury has been published in JAMA Pediatrics. The researchers used 92 non-suicidal self-injury (NSSI) related search terms over a year to yield 42 million global searches, with most in the US, UK, Canada, Australia and Ireland. Health information websites were the most common type of website found (21.5%) but of these, only 9.6% were endorsed by a health and/or academic institution. At least one NSSI myth was propagated per website, including statements that NSSI indicates a mental disorder (49.3%) or a history of abuse (40%), or the notion that primarily women self-injure (37%). The researchers said the study showed those searching online about NSSI could be exposed to potentially unreliable and inaccurate information. “Access to poor-quality information may impact decisions to seek help for those who self-injure”, they wrote. “In this study we found that minimal information about treatment effectiveness was available, and that some Internet users may be left with the belief that options to assist with recovery are scant.” They called for increased efforts to enhance NSSI literacy and access to credible online resources.

Doctors best at treating pulled elbow
A CANADIAN study has found nurses have a lower rate than doctors of successfully reducing radial head subluxation in children, but children who receive nurse-initiated care spend less time in the emergency department. The research, published in CMAJ, included 245 children aged 6 years and younger who presented to an emergency department with symptoms and signs consistent with radial head subluxation and who had sustained a known injury in the previous 12 hours. They were randomly assigned to either nurse- or doctor-initiated treatment. Of the children assigned to receive doctor-initiated care 96.7% (117/121) had a successful reduction, compared with 84.7% (105/124) of children assigned to receive nurse-treatment care. The researchers wrote that no safety concerns were identified in the study. They said it was not clear why nurses were not as successful as doctors at reducing radial head subluxation, but it likely related to experience with the procedure. “Task-shifting in health care involves trade-offs”, they wrote. “Given that the overall length of stay in the emergency department was shortened, reduction initiated by triage nurses has the potential to add important value to efficiency in the emergency department.”

Online alcohol intervention makes little difference
A NEW Zealand-based study has found that university students who took part in web-based alcohol screening and a brief intervention program had no significant reductions in the frequency or overall volume of drinking or academic problems. The randomised trial, published in JAMA, included 5135 students aged 17–24 years from seven New Zealand universities who took part in an Alcohol Use Disorders Identification Test-Consumption (AUDITC) screening test. Those who screened positive (AUDIT-C score ≥ 4) were randomised to have no further intervention or 10 minutes of assessment and feedback on alcohol expenditure, peak blood alcohol concentration, alcohol dependence and access to help and information. At a 5-month follow-up those who received the intervention consumed less alcohol during a typical drinking session (a median of four drinks compared with five for controls) but did not drink less often or less overall. Academic problem scores were not lower in the intervention group and effects on the risks of binge and heavy drinking were not significant. The researchers wrote that their findings indicated that web-based alcohol screening and brief intervention should not be relied upon alone to address unhealthy alcohol use among university students and should be used with other interventions such as restricting the availability and promotion of alcohol. An accompanying editorial said that an intervention involving electronic alcohol screening and brief counselling “does not appear to be the easy way out of alcohol-related problems that many, rightfully and reasonably, have wished for”.

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