SUMMARY An analysis of blind registration forms was made to determine the commonest causes of blindness in the west of Scotland. It was found that the leading causes of blindness in order of frequency of incidence were senile macular degeneration, glaucoma, cataract, diabetic retinopathy, and myopic degeneration. Diabetic retinopathy was the leading cause of blindness among persons of working age.

Sunlight-exposure recommendations are inappropriate for individuals of South Asian ethnicity who live at the UK latitude. More guidance is required to meet the vitamin D requirements of this sector of the population. This study was registered at www.isrctn.org as ISRCTN 07565297.

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Targeted guidance on sunlight exposure could usefully enhance vitamin D status to avoid deficiency [25(OH)D concentration >10 ng/mL] in South Asians living at latitudes distant from the equator. This trial was registered at the ISRCTN Register (www.isrctn.org) as 07565297.

Objective: When providing care for a loved one with a terminal illness, family members often look to health care providers for guidance and expertise. The objective of this study is to explore family caregiver accounts of their experiences within the health care system and with individual providers.Methods: A thematic analysis of secondary qualitative data was performed. Data are from a subsample of bereaved and current family caregivers (N ¼ 31) in a prior study of coping in end-of-life cancer situations. Data from these participants referring to experiences with health care providers was thematically coded and the concept of "security" was used as an analytic lens to facilitate conceptual development and exploration.Results: Considered together, the findings can be viewed as manifestations of a need and desire for security in palliative family caregiving. Specifically, family caregivers' accounts illustrate the importance of feeling secure that health care services will be provided by competent professionals; feeling secure in their timely access to needed care, services, and information; and feeling secure in their own identity and self-worth as a caregiver and individual. In addition, the findings suggest a conceptualization of security that extends beyond trust in individuals to include a generalized sense of institutional trust in the health care system.Significance of results: The concept of security moves beyond description of individual satisfaction or dissatisfaction with health care to identify a common, foundational need underlying such evaluations. Further empirical research is needed that explicitly focuses on caregivers' experiences of security and insecurity in the domains identified in this article. This will contribute to theory building as well as assist in identifying the causes and consequences of security.

SUMMARY Histological examination of 99 human lacrimal glands showed a relationship between atrophy of the secretory acini and secretory duct obstruction, ascending periductal fibrosis, and obliteration of the adjacent blood vessels caused by lymphocytic and polymorphonuclear inflammation. Investigation of the subgroups of the B lymphocytic series by immunohistochemistry did not show any statistical change with age, sex, fibrosis, or lymphocytic inflammation. The concept of senile atrophy occurring as a result of senescent involution of the lacrimal gland is challenged on the basis of the histological findings.Keratoconjunctivitis sicca in the elderly population is widely considered to be due to senescent involution of the lacrimal gland. '`This degeneration has been termed 'senile atrophy" to distinguish the condition from atrophy secondary to Sjogren's syndrome, infection, and malignancy. Although arteriosclerosis45 and inflammation"7 were formerly considered to be important causative factors, various clinical reports8" have recently stressed the need for further contemporary histological studies of age related changes in the lacrimal gland.This study of the human lacrimal gland was carried out in order to define the nature and prevalence of fibrosis, acinar atrophy, and duct pathology. The original hypothesis was that, if a low intensity inflammatory process had caused these changes, there might be alterations in the relative frequency and distribution of the subgroups ofthe B lymphocytic series.Accordingly this component of the immune system was investigated by means of immunohistochemistry. Materials and methodsLacrimal gland tissue was obtained from two exenteration specimens and 97 post-mortem examinations of patients in a general hospital. Two-thirds of these specimens were used in a previous study.3 The patients were randomly selected, and cases were excluded from the study only if the quality or quantity of the material did not permit histological grading of the degree of fibrosis.The lacrimal gland was removed from one or both sides within 24 hours post mortem either via the orbit or by the conjunctival route. The tissue was fixed in cacodylate gluteraldehyde 2-5% or buffered formalin and embedded in paraffin. Sections were stained with haematoxylin and eosin, and Unna-Pappenheim technique, and the immunoperoxidase technique for immunoglobulins and macrophages "' (Dakopatts A/S). Without prior knowledge of the age, sex, and cause of death the pathological material was categorised according to the degree of fibrosis, duct pathology, and acinar atrophy. When both glands had been removed, quantitative assessment was carried out on only one specimen, which was chosen at random. This was because prior examination had revealed no significant differences between the two sides.The

Previous studies involving palliative patients suggest a preference for dying at home. The purpose of this paper is to examine, prospectively, patient and family caregiver preferences for, and congruence with, location of death for hospitalized patients with cancer and end-stage medical conditions. Questionnaires were administered to 440 eligible in-patients and 160 family caregivers in five hospitals across Canada. This paper reports results of 138 patient/family caregiver dyads who answered a question about preference for location of death. The results suggest that only half of all patients and family caregivers report a preference for a home death. Furthermore, half of the patient/family caregiver dyads disagree on preferred location of death. If one of the primary goals of end of life care is to enhance the quality of life of dying patients and their family caregivers, policies directed towards ensuring that patients die in their location of choice ought to be a priority and resources should be allocated to promote the development of excellent care, not only in the home, but also within our institutional settings.

SUMMARY The clinical usefulness of the Arden grating test in assessing early abnormalities in retinal function of diabetics has been explored. Although the test revealed significant differences in constrast sensitivities between diabetics and normal persons, the large variances in the test scores of diabetics limit its use as a clinical tool for the screening of diabetic patients.