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Purpose To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren's syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. Design Multi-center cross-sectional study. Methods The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3,514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear break-up time (TBUT), and staining of the cornea (0 to 6 points) and conjunctiva (0 to 6 points). Multivariate logistic regression analysis was performed to identify predictive factors for: 1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4mm2) and 2) positive anti-SSA/B serology. Results The adjusted odds of having a positive LSG biopsy was significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05 to 1.51, P=0.014), positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39 to 1.53, P < 0.001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08 to 1.21, P < 0.001). The odds of having a positive serology was significantly higher among those with an abnormal Schirmer I test (adjusted OR=1.3; 95% CI 1.09 to 1.54 P=0.004), and conjunctival staining (adjusted OR=1.51; 95% CI 1.43 to 1.58, P < 0.001). Conclusions In addition to corneal staining which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS as they were associated with a higher likelihood of having a positive LSG biopsy and serology.

While nearly three-quarters of cancer mortalities occur in low- and middle-income countries, we know little about the factors contributing to patient delays in seeking care for cancer. Our study employs a multifactorial approach by examining three key areas: patient socio-demographic factors, structural factors of health-care access and cancer patients' beliefs about their illness and cancer in general as potential determinants of their delay in seeking care in Thailand. We conducted a cross-sectional study using a systematic sample of 264 patients with cancer treated during 2006-2007 at Prince Maha Vajiralongkorn Cancer Centre, a hospital of the National Cancer Institute of Thailand. We defined patient delay as when a patient waited more than 3 months after symptom onset to seek medical care. We used bivariate analysis and multivariate logistic regression to examine unadjusted and adjusted associations of patient delays in seeking care with: patient socio-demographic factors, structural factors of health-care access and patients' beliefs about their illness in particular and about cancer in general. We also obtained patient self-reports about their reasons for delaying care. In multivariate analysis, only patient-belief factors were significantly associated with delay. Patients who believed that the primary causes of cancer were non-medical (vs. medical) were more likely to delay seeking care (adjusted odds ratio (OR)=4.37, 95% confidence interval (CI)=2.27-8.67). Patients who believed that cancer was probably curable or was curable (vs. incurable) were significantly less likely to delay seeking care (adjusted OR=0.2, 95% CI=0.08-0.56; adjusted OR=0.18, 95% CI=0.07-0.49, respectively). Patient socio-demographic factors and structural factors of health-care access were not significantly associated (p>0.05). Our findings suggest that interventions to reduce delays in care seeking should address patient beliefs regarding cancer in order to effectively mitigate barriers to access.

Purpose of review To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma. Recent Findings Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. Immunologic studies suggest that chronic inflammation can lead to progressive scarring, even in the absence of chlamydia. Confocal microscopy can obtain accurate grading of scarring progression. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections. Summary Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. While studies continue to demonstrate reduction in infection in hyperendemic areas, more work will need to be done to achieve elimination of this blinding disease.