Background Contemporary incidence estimates of typhoid fever are needed to guide policy decisions and control measures and to improve future epidemiological studies. Methods We systematically reviewed 3 databases (Ovid Medline, PubMed, and Scopus) without restriction on age, country, language, or time for studies reporting the incidence of blood culture–confirmed typhoid fever. Outbreak, travel-associated, and passive government surveillance reports were excluded. We performed a meta-analysis using a random-effects model to calculate estimates of pooled incidence, stratifying by studies that reported the incidence of typhoid fever and those that estimated incidence by using multipliers. Results Thirty-three studies were included in the analysis. There were 26 study sites from 16 countries reporting typhoid cases from population-based incidence studies, and 17 sites in 9 countries used multipliers to account for underascertainment in sentinel surveillance data. We identified Africa and Asia as regions with studies showing high typhoid incidence while noting considerable variation of typhoid incidence in time and place, including in consecutive years at the same location. Overall, more recent studies reported lower typhoid incidence compared to years prior to 2000. We identified variation in the criteria for collecting a blood culture, and among multiplier studies we identified a lack of a standardization for the types of multipliers being used to estimate incidence. Conclusions Typhoid fever incidence remains high at many sites. Additional and more accurate typhoid incidence studies are needed to support country decisions about typhoid conjugate vaccine adoption. Standardization of multiplier types applied in multiplier studies is recommended.

Asthma is associated with abnormalities in IOS measures of peripheral airway dysfunction. This association is stronger in men and in those with asthma persisting since childhood. Tobacco and cannabis use are associated with different patterns of spirometry and IOS abnormalities and may affect the bronchial tree at different airway generations with differences in susceptibility between sexes.

The prevalence of myopia is increasing globally, putting individuals at risk of myopia-associated visual impairment. Lowdose atropine eye drops have been found to safely reduce the risk of progression from myopia to higher levels of myopia and pathological states. In New Zealand, school children have an eye check at age 11. In this study, we aimed to estimate the costeffectiveness of introducing photorefractive screening for myopia at age 11 in the New Zealand context, with atropine 0.01% eye drops treatment for those screening positive. Patients and Methods: A Markov cohort simulation was used to model the impact of screening plus atropine compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER), with utility measured in quality-adjusted life-years (QALYs). Multivariate sensitivity analyses were carried out to investigate factors influencing cost-effectiveness. Results:The ICER for screening plus atropine was NZ$1590 (95% CI 1390, 1791) per QALY gained, with 7 cases of lifetime blindness prevented per 100,000 children screened. Conclusion: Screening for myopia with photorefraction at age 11 and atropine 0.01% eye drop treatment of children screening positive is likely to be cost-effective. These results suggest that a real-world trial and cost-effectiveness analysis would be worth considering in New Zealand.

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Background Currently there is no universally agreed schema for predicting ocular morbidity in facial nerve palsy. The House Brackmann Scale has limitations in assessing ocular morbidity from facial nerve palsy. Our aim was to create a scoring system to help quantify ocular morbidity to aid in decision making regarding the need for corneal protective oculoplastic surgery. Methods We conducted a large cohort study observing 606 patients attending the specialist facial palsy clinic in Manchester UK between March 2002 and October 2017. Retrospective multivariate analysis identified clinical predictors for the 316 patients that required oculoplastic surgery. β coefficients generated in the multivariate analysis helped formulate a new facial nerve palsy scoring instrument to predict the need for corneal protective oculoplastic surgery. Results The House Brackmann Scale, corneal lagophthalmos and loss of corneal sensation proved clinically significant predictors for requiring corneal protective oculoplastic surgery. The scoring system derived from these factors provided an accurate and repeatable prediction tool demonstrated by validation studies on our patient population. The area under the ROC curve for the multivariate prediction model was 0.769 (0.726, 0.811). A score of 5 points out of a possible 8 was the best cut off score to recommend oculoplastic surgery, giving a sensitivity of 0.750 and a specificity of 0.671. Conclusion This study demonstrates that corneal lagophthalmos, corneal sensation and the House Brackmann Scale are important in predicting the need for corneal protective oculoplastic surgery. Our scoring tool is an important clinical decision tool for ophthalmic and ENT colleagues.