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Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

Background Hypertension's role in dementia is regarded as modest, because it often overlooks stroke's role. We assessed the dementia risk attributed to hypertension, considering stroke as an intermediary factor, given that stroke is associated with an increased dementia risk and that over half of strokes are linked to hypertension. Method We recalculated hazard ratios and the dementia risk proportion attributable to hypertension using weighted population attributable fractions (accounting for overlapping risk factors), incorporating the dementia risk associated with stroke, the stroke risk linked to hypertension, and the prevalence of hypertension. Result Our analysis reveals that hypertension increases the risk of stroke fivefold and the risk of dementia eightfold. This corresponds to approximately 16.6% of dementia cases being preventable through hypertension control only (Figure 1). By addressing hypertension effectively, the overall potential for dementia prevention could exceed 59.6%. Conclusion Our recalculations of current evidence suggest that hypertension's role in dementia could be eight times higher than previous estimates when accounting for the role of stroke, underscoring the urgent need for enhanced global prevention strategies. Hypertension's high lifetime risk, widespread prevalence, frequent underdiagnosis, and inadequate management offer the single greatest opportunity for delaying, allaying, or preventing stroke, heart disease, and dementia.

The Institute of Medicine's To Err Is Human, published in 1999, represented a watershed moment for the US health care system. The report dramatically raised the profile of patient safety and stimulated dedicated research funding to this essential aspect of patient care. Highly effective interventions have since been developed and adopted for hospital-acquired infections and medication safety, although the impact of these interventions varies because of their inconsistent implementation and practice. Progress in addressing other hospital-acquired adverse events has been variable. In the past two decades additional areas of safety risk have been identified and targeted for intervention, such as outpatient care, diagnostic errors, and the use of health information technology. In sum, the frequency of preventable harm remains high, and new scientific and policy approaches to address both prior and emerging risk areas are imperative. With the increasing availability of electronic data, investments must now be made in developing and testing methods to routinely and continuously measure the frequency and types of patient harm and even predict risk of harm for specific patients. This progress could lead us from a Bronze Age of rudimentary tool development to a Golden Era of vast improvement in patient safety.

Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.

Potentially avoidable hospitalizations are associated with high and rising costs, and they have been widely considered as important performance indicators of the healthcare system, particularly in primary care. This study explored the relationship between spatial access to primary care and potentially avoidable hospitalizations of the elderly based on data from Chishui City, China, from 2014 to 2017. The enhanced two-step floating catchment area method was used to measure spatial access to care, while the relationship was estimated by a two-level logistic regression model with random effects, controlling for individual and household characteristics. We found a significantly negative association between potentially avoidable hospitalizations and spatial access to primary care, showing that the improvement of spatial access to primary care for the elderly would significantly reduce their potentially avoidable hospitalizations. Our results emphasized that the strategies to promote qualified, adequate and appropriate spatial distribution of primary care would substantially improve the healthcare system performance in China, also providing implications for other developing countries facing similar challenges.

Benchmarking and classification of avoidable errors in trauma care are difficult as most reports classify errors using variable locally derived schemes. We sought to classify errors in a large trauma population using standardized Joint Commission taxonomy. All preventable/potentially preventable deaths identified at an urban, level-1 trauma center (January 2002 to December 2010) were abstracted from the trauma registry. Errors deemed avoidable were classified within the 5-node (impact, type, domain, cause, and prevention) Joint Commission taxonomy. Of the 377 deaths in 11,100 trauma contacts, 106 (7.7%) were preventable/potentially preventable deaths related to 142 avoidable errors. Most common error types were in clinical performance (inaccurate diagnosis). Error domain involved primarily the emergency department (therapeutic interventions), caused mostly by knowledge deficits. Communication improvement was the most common mitigation strategy. Standardized classification of errors in preventable trauma deaths most often involve clinical performance in the early phases of care and can be mitigated with universal strategies.

Summary Background The role of morbidity and mortality conferences (M&MC) in surgical departments is to provide education and improve patient care. However, there is sparse evidence in the literature that M&MCs reduce preventable deaths. Therefore, this study aimed to assess the impact of routine M&MC on reducing the preventable death rate over 4 years at a tertiary hospital in Botswana. Methods This study used a quantitative research methodology. In this retrospective audit of the M&MC data, we collected all mortality data for the surgery department from the time the database started, July 2016, to December 2019. The department adopted and adapted the criteria and definitions of preventability based on the World Health Organization (WHO) guidelines for trauma quality improvement programs. We used the Pearson correlation statistic to evaluate the correlation between the time (years) since the start of routine M&MC and the preventable death rate. Ethical approval for the study was obtained. Results There were 4660 registered admissions from July 2016 to December 2019. Of these, 267 deaths were recorded, resulting in a crude mortality rate of 6%. Overall, the department considered 23% (61/267) of the deaths as preventable. A strong linear correlation ( R 2  = 0.982, p  = 0.009) was found between the preventable death rate and time (years) since the commencement of routine M&MC. Trauma was the leading cause of preventable deaths (24.6%, 15/61). Conclusion Our findings suggest that routine M&MCs have the desired effect of reducing preventable death rates. Further studies are required to investigate this observed effect.

One method of quantifying food wastage in households is a food waste diary. The goal of this study is to evaluate the reliability of food waste diaries as a methodology of waste-level measurements. This form of self-reporting is considered to underestimate the levels of food wastage because of three phenomena. The so-called self-selection bias is minimized by the chosen study set-up. The under-reporting and prevention effects were determined by measuring the food waste levels amongst 80 participating households. In week 1, the food waste amounts were determined by individual waste sorting analysis; in week 2, they used a food waste diary followed by a waste sorting analysis. The use of food waste diaries leads to a considerable prevention effect of 20%. Individual sorting analysis of uninformed households showed a generation of 59 kg∙inh−1∙yr−1 of avoidable food waste and 28 kg∙inh−1∙yr−1 of non-avoidable food waste. When using food waste diaries, these amounts dropped to 47 and 23 kg∙inh−1∙yr−1, respectively. In the study, instead of an under-reporting effect, the analyses showed an over-reporting of 7%. In medium-rise housing, the food wastage level is lower than in the overall population of the study, whereas both the prevention effect and the over-reporting is higher. Low-rise housing shows the highest initial food waste level. High-rise housing shows the smallest prevention effect. In the countryside, both the food wastage level and the prevention effect are significantly lower than elsewhere. In smaller towns, a slight under-reporting effect was observed; elsewhere there was an over-reporting effect. Further research might focus on if and how long the prevention effect of the food waste diaries lasts amongst Polish households.

Background The 2024 Lancet Commission Report analyzes 14 risk factors that account for 45 percent of global dementia cases. However, it overlooks four critical risk factors: poverty, wealth shocks, income inequality, and viral infections. This is particularly concerning given that 57 percent of the identified risk factors in the Lancet report are more prevalent in men, even though dementia predominantly affects women worldwide. Method In this policy paper, we used the recent global review studies and argue that it is essential to recalibrate and expand the 2024 Lancet Commission's list of risk factors to include poverty, wealth shocks, income inequality, and viral infections. Our analysis suggests that these overlooked risk factors could add an additional 20 percent to the risk of developing dementia, indicating that up to 65 percent of global dementia cases might be preventable. Result Furthermore, recognizing these additional risk factors allows for a more accurate representation of the global gender disparities in dementia progression. By incorporating these elements, we demonstrate that 55 percent of global dementia cases are more prevalent in women than in men, aligning with the true epidemiological patterns observed worldwide. Conclusion There is a necessity to calibrate the risk factors of the 2024 lancet commission to improve its global applicability.