An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.
Purpose
To estimate the incidence of age-related macular degeneration (AMD) and the association of smoking and alcohol in a population of older women.
Design
Prospective cohort study.
Methods
Subjects were women who attended the Study of Osteoporotic Fractures year 10 and year 15 follow-up clinic visits and had fundus photographs taken at both visits (n=1958; 245 Blacks and 1713 Whites. Mean age at year 10 visit=78.2 years). Forty-five degree stereoscopic fundus photographs were graded for AMD. Logistic regression was used to test whether risk factors were associated with incident AMD.
Results
The overall 5-year AMD inci dence was 24.1% (95% confidence interval [CI]: 21.7–26.6) for early and 5.7% (95% CI: 4.6–6.8) for late. Early AMD incidence in Whites ranged from 21.9% in those 74–79 years to 33.2% in those 80–84 years, but was observed at the slightly lower rate of 29.0% in subjects ≥85 years (trend p<0.0001). After confounder adjustment, alcohol consumption was significantly associated with an elevated risk of incident early AMD (odds ratio [OR] = 1.57; 95% CI: 1.18–2.11). There was an increased risk of early AMD among subjects aged 80 years or older who were smoking compared to those younger than 80 years who were not smoking (OR=5.49; 95% CI: 1.57–19.20; p for interaction=0.026).
Conclusions
The magnitude of the greater-than-additive effect of smoking on the age-adjusted risk of AMD reinforces recommendations to quit smoking even for older individuals.
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