Ametropia and ocular biometry in a UK university student population

Purpose. The prevalence of myopia is known to vary with age, ethnicity, level of education, and socioeconomic status, with a high prevalence reported in university students and in people from East Asian countries. This study determines the prevalence of ametropia in a mixed ethnicity U.K. university student population and compares associated ocular biometric measures. Methods. Refractive error and related ocular component data were collected on 373 first-year U.K. undergraduate students (mean age = 19.55 years ± 2.99, range = 17-30 years) at the start of the academic year at Aston University, Birmingham, and the University of Bradford, West Yorkshire. The ethnic variation of the students was as follows: white 38.9%, British Asian 58.2%, Chinese 2.1%, and black 0.8%. Noncycloplegic refractive error was measured with an infrared open-field autorefractor, the Shin-Nippon NVision-K 5001 (Shin Nippon, Ryusyo Industrial Co. Ltd, Osaka, Japan). Myopia was defined as a mean spherical equivalent (MSE) less than or equal to -0.50 D. Hyperopia was defined as an MSE greater than or equal to +0.50 D. Axial length, corneal curvature, and anterior chamber depth were measured using the Zeiss IOLMaster (Carl Zeiss, Jena, GmBH). Results. The analysis was carried out only for white and British Asian groups. The overall distribution of refractive error exhibited leptokurtosis, and prevalence levels were similar for white and British Asian (the predominant ethnic group) students across each ametropic group: myopia (50% vs. 53.4%), hyperopia (18.8% vs. 17.3%), and emmetropia (31.2% vs. 29.3%). There were no significant differences in the distribution of ametropia and biometric components between white and British Asian samples. Conclusion. The absence of a significant difference in refractive error and ocular components between white and British Asian students exposed to the same educational system is of interest. However, it is clear that a further study incorporating formal epidemiologic methods of analysis is required to address adequately the recent proposal that juvenile myopia develops principally from myopiagenic environments and is relatively independent of ethnicity.

White working-class neighbourhoods:common themes and policy suggestions

What does it mean to be white and working class in modern Britain? The Joseph Rowntree Foundation’s studies of traditionally white estates in Bradford, London, Coventry and Birmingham are part of a growing body of research into ‘white identities’. This paper: • identifies common findings from JRF research into traditionally white estates, in the context of other similar work; • suggests how issues of white identity can be better understood and makes recommendations for policy and practice. Key points: • Profound economic and social change has increased isolation and fear in traditionally white estates. Residents often claim that things were better in the past. • ‘Estatism’ refers to specific social dynamics associated with council estates and prejudice towards residents based on where they live. This can result in lowered self-esteem and reluctance to participate in community campaigns. • People on traditionally white estates often feel they are not listened to by outside agencies. Consultations can raise hopes but ultimately reinforce disengagement. Initiatives to ensure equality have become associated with political correctness (‘PC’). • White working-class people feel they are bound by values of hard work, reciprocity and support. They are frustrated by the closure and lack of access to community facilities. The social class system simultaneously disadvantages the working class while giving advantage to other classes. • There is a strong desire for allocation of resources to be fair, with a widespread perception that minorities are given preference. Blaming incomers for decline is common, with the target of blame differing between sites. Participants did not want to be considered racist and felt that labelling ideas as racist prevents discussion. Similarly, the term ‘PC’ can also be used to shut down debate. • Recommendations include community-twinning, new ways of accessing local authorities, involvement from the private sector in disadvantaged areas and local panels to define and develop the ‘Big Society’. Initiatives aimed solely at white working-class people are unlikely to be successful.

Is inflammation the cause of pre-eclampsia?

It has been proposed that either excessive inflammation or an imbalance in angiogenic factors cause pre-eclampsia. In the present review, the arguments for and against the role of inflammation and/or angiogenic imbalance as the cause of pre-eclampsia are discussed on the basis of the Bradford-Hill criteria for disease causation. Although both angiogenic imbalance and systemic inflammation are implicated in pre-eclampsia, the absence of temporality of inflammatory markers with pre-eclampsia challenges the concept that excessive inflammation is the cause of pre-eclampsia. In contrast, the elevation of anti-angiogenic factors that precede the clinical signs of pre-eclampsia fulfils the criterion of temporality. The second most important criterion is the dose-response relationship. Although such a relationship has not been proven between pro-inflammatory cytokines and pre-eclampsia, high levels of anti-angiogenic factors have been shown to correlate with increased incidence and disease severity, hence satisfying this condition. Finally, as the removal of circulating sFlt-1 (soluble Fms-like tyrosine kinase receptor-1) from pre-eclamptic patients significantly improves the clinical outcome, it fulfils the Hill's experiment principle, which states that removal of the cause by an appropriate experimental regimen should ameliorate the condition. In contrast, treatment with high doses of corticosteroid fails to improve maternal outcome in pre-eclampsia, despite suppressing inflammation. Inflammation may enhance the pathology induced by the imbalance in the angiogenic factors, but does not by itself cause pre-eclampsia. Development of therapies based on the angiogenic and cytoprotective mechanisms seems more promising.