Linda B. Bourque

Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study One Year After Surgery

The Prospective Evaluation of Radial Keratotomy (PERK) study is a nine-center, self-controlled clinical trial of a standardized technique of radial keratotomy in 435 patients who had physiologic myopia with a preoperative refraction between -2.00 and -8.00 diopters. The surgical technique consisted of eight incisions using a diamond micrometer knife with blade length determined by intraoperative ultrasonic pachymetry and the diameter of central clear zone determined by preoperative refraction. At one year after surgery, myopia was reduced in all eyes; 60% were within +/- 1.00 diopter of emmetropia; 30% were undercorrected and 10% were overcorrected by more than 1.00 diopter (range of refraction, -4.25 to +3.38 D). Uncorrected visual acuity was 20/40 or better in 78% of eyes. The operation was most effective in eyes with a refraction between -2.00 and -4.25 diopters. Thirteen percent of patients lost one or two Snellen lines of best corrected visual acuity. However, all but three eyes could be corrected to 20/20. Ten percent of patients increased astigmatism more than 1.00 diopter. Disabling glare was not detected with a clinical glare tester, but three patients reduced their driving at night because of glare. Between six months and one year, the refraction changed by greater than 0.50 diopters in 19% of eyes.

Weathering the Storm: The Impact of Hurricanes on Physical and Mental Health

The authors briefly review the deaths, injuries, and diseases attributed to hurricanes that made landfall in the United States prior to Hurricane Katrina; recent hurricane evacuation studies and their potential for reducing death, injury, and disease; information available to date about mortality, injury, and disease attributed to Hurricane Katrina; and psychological distress attributable to hurricanes. Drowning in salt water caused by storm surges has been reduced over the past thirty years, while deaths caused by fresh water (inland) flooding and wind have remained steady. Well-planned evacuations of coastal areas can reduce death and injury associated with hurricanes. Hurricane Katrina provides an example of what happens when evacuation is not handled appropriately. Preliminary data indicate that vulnerable elderly people were substantially overrepresented among the dead and that evacuees represent a population potentially predisposed to a high level of psychological distress, exacerbated by severe disaster exposure, lack of economic and social resources, and an inadequate government response.

Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles county

Background Geosocial networking applications (GSN apps) used for meeting sexual partners have become increasingly popular with men who have sex with men (MSM) since 2009. The current study aimed to determine if self-identified HIV-negative, MSM clinic attendees who used GSN apps have an increased incidence of sexually transmitted infections (STI) compared to self-identified HIV-negative, MSM attendees who met sexual partners via in-person venues, such as bars or clubs or through MSM-specific hook-up websites. Methods Data were collected between August 2011 and January 2013 on all self-identified HIV-negative, MSM clients visiting the L.A. Gay & Lesbian Center for STI screening. A total of 7184 individuals tested for STIs and self-reported behaviours on drug use and social networking methods to meet sexual partners. Multivariate logistic regression models were used to analyse the results. Results Individuals who used GSN apps for meeting sexual partners had greater odds of testing positive for gonorrhoea (OR: 1.25; 95% CI 1.06 to 1.48) and for chlamydia (OR: 1.37; 95% CI 1.13 to 1.65) compared to individuals who met partners through in-person methods only. There were no significant differences in syphilis and HIV incidence between those who met partners via in-person venues only, on the internet or through GSN apps. Conclusions The present study concludes that sexual health clinic MSM attendees who are meeting on GSN apps are at greater risk for gonorrhoea and chlamydia than MSM attendees who meet in-person or on the internet. Future interventions should explore the use of these novel technologies for testing promotion, prevention and education.

Pupil size and quality of vision after LASIK.

PURPOSE To evaluate factors related to the quality of vision after LASIK. DESIGN Survey study. PARTICIPANTS One hundred consecutive patients. INTERVENTION LASIK with a 6.0-mm elliptical ablation pattern without transition zone to treat mild to moderate myopia or astigmatism (preoperative manifest spherical equivalent [MSE], -4.79 +/- 1.33 diopters [D]; range, -2.88 to -9.25 D). The second eye was treated 1 month after the first. MAIN OUTCOME MEASURES Completed questionnaires assessing night vision problems (glare, haze, and halo symptoms) before surgery and at 1, 3, and 6 months after surgery in 97, 75, 81, and 66 subjects, respectively. Mesopic pupil size and preoperative and postoperative variables were analyzed with questionnaire data using an analysis of variance (ANOVA) and multivariate regression analysis. RESULTS Patients with large mesopic pupils had significantly more reports of glare, haze, and halo than did those with smaller pupils in the treated eye at 1 month after surgery (P=0.02, P=0.03, and P=0.02, respectively ANOVA) and of glare at 3 months (P=0.05). Significant predictors of symptoms at 6 months, identified through multivariate regression analysis, included preoperative MSE (for glare and haze), preoperative contrast acuity (glare), postoperative uncorrected visual acuity (UCVA; haze), and residual cylinder (haze). Together, these factors accounted for only 19% of the overall variability in glare and 37% of the variability in haze responses. No relationship between pupils and symptoms was noted at 6 months after surgery in either the ANOVA or regression analysis group. CONCLUSIONS Patients with large pupils had more quality of vision symptoms in the early postoperative period, but no correlation was observed 6 months after surgery. Factors related to long-term symptoms include the level of treatment (preoperative myopia), preoperative contrast acuity, postoperative UCVA, and residual cylinder. Most of the variability in visual quality could not be explained by preoperative or clinical outcome measures, including pupil size.

Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study Five Years after Surgery

In the Prospective Evaluation of Radial Keratotomy (PERK) Study, 793 eyes of 435 patients with 2 to 8 diopters (D) of myopia received a standardized surgery consisting of 8 incisions with a diamond-bladed knife set at 100% of the thinnest paracentral ultrasonic corneal thickness measurement and a diameter of the clear zone of 3.0 to 4.5 mm; 97 eyes (12%) received an additional 8 incisions. There were 757 eyes (95%) followed for 3 to 6.3 years. After surgery, uncorrected visual acuity was 20/40 or better in 88% of eyes. The refractive error was within 1 D of emmetropia for 64% of eyes; 19% were myopic and 17% were hyperopic by more than 1 D. Between 6 months and 5 years after surgery, 22% of the eyes had a refractive change of 1 D or more in the hyperopic direction. For 25 eyes (3%) there was a loss of 2 or more lines of best spectacle-corrected visual acuity.

The Changing South: National Incorporation of a Region

The South is herein viewed as a subsystem of a larger, American social system. The paper attempts to demonstrate, using a variety of socioeconomic and demographic indicators, the rapidity with which the South is becoming an integral part of American Society. The analysis is based upon a set of two-way comparisons: the South with itself over time; the non-South with itself over time; and the South with the non-South at specified points in time. The measures used are grouped into five areas: urbanization, industrialization, occupational redisTtribution, income, and education. The evidence indicates that in these sectors the South has been changing more rapidly than the rest of the nation for the past forty years and moreover is becoming increasingly indistinguishable from the rest of American society.

Exploring the causal relationship between exposure to the 1994 northridge earthquake and pre- and post- earthquake preparedness activities

Whether, when, and why individuals prepare for disasters are major concerns of disaster preparedness researchers. Using population-based survey data collected after the 1994 Northridge earthquake, multinomial logistic models are imposed to examine if preparedness activities were adopted after the quake because of quake-related financial loss, physical and emotional injury, and proximity to the earthquake epicenter and shaking. The extent to which people invest in sustained preparedness was also examined by comparing the preparedness activities occurring both before and after the earthquake. The results indicated that exposure to physical, financial, and emotional injuries, and to shaking increased post-quake preparedness. Engaging in certain types of pre-quake preparedness increased the likelihood of post-quake preparedness. Post-quake preparedness is not affected by socioeconomic status or demographic factors, except that married persons are more likely to prepare in all situations and immigrants are more likely to adopt post-quake preparedness activities.

Surviving Two Disasters: Does Reaction to the First Predict Response to the Second?

Respondents (N = 414) studied after a California earthquake were recontacted 4 years later to determine if their prior experience with a disaster impaired or enhanced their ability to deal with a second natural disaster—a slow-onset El Niño weather pattern. Analyses addressed whether being emotionally injured in one disaster influences the extent to which one prepares for a future disaster, whether emotional injuries experienced in one disaster predispose individuals to emotional injury in a subsequent disaster, and whether other disaster-related parameters (physical injury and property damage) are similarly associated across two disasters. Emotional injury both facilitated preparedness, in terms of number of hazard-mitigation activities performed, and predisposed to a subsequent emotional injury. An unexpected finding emerged showing that emotional injury increased the chance of reporting damage in a second disaster—a relationship that was maintained after controlling for emotional injury in the second disaster. The impact of self-reported emotional injury in two sequential disasters on what might be considered a more objective outcome—property damage in the second disaster—underscores the need for a comprehensive assessment of disaster reactions in postdisaster research and across disasters, when possible.

Psychological distress following urban Earthquakes in California

During and following a disaster caused by a natural event, human populations are thought to be at greater risk of psychological morbidity and mortality directly attributable to increased, disaster-induced stress. Drawing both on the research of others and that conducted at the Center for Public Health and Disaster Relief of the University of California-Los Angeles (UCLA) following California earthquakes, this paper examines the extent to which research evidence supports these assumptions. Following a brief history of disaster research in the United States, the response of persons at the time of an earthquake was examined with particular attention to psychological morbidity; the number of deaths that can be attributed to cardiovascular events and suicides; and the extent to which and by whom, health services are used following an earthquake. The implications of research findings for practitioners in the field are discussed.

Suicides in LOS Angeles County in relation to the Northridge earthquake.

INTRODUCTION Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population). HYPOTHESIS Suicide rates increased in the three calendar years (1994-1996) following the Northridge earthquake as compared to the three calendar years (1991-1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured. METHODS Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991-1993 vs. 1994 -1996) were analyzed using a z-statistic. RESULTS There is a statistically significant difference in the rates for the years prior to the earthquake (1991-1993) when pooled and compared to the suicide rates for the years after the earthquake (1994-1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z = -3.85, p < 0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84, z = -3.57, p < 0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide. CONCLUSION It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.