ABSTRACT
OBJECTIVES: Uncorrected refractive errors are the leading cause of visual impairment in children. In this cross-sectional retrospective study, we analyzed a social visual screening program for school children in São Paulo, Brazil, evaluated its impact on the prevention and treatment of children's visual disabilities, and assessed its epidemiological outcomes to outline suggestions for its improvement. METHODS: First-grade children from public schools were submitted to prior visual screening by their teachers. Selected children were forwarded to the hospital's campaigns for a second screening by ophthalmologists and treatment if needed. Data were analyzed for age, sex, visual acuity, biomicroscopy, refractive errors, ocular movement disorders, amblyopia, number of donated spectacles, and number of children forwarded to specialized care. RESULTS: A total of 1080 children were included with mean age of 6.24±0.45 years. Children with normal ophthalmological exam, 591 (54.7%; 95% confidence interval [CI]: 51.7%-57.7%) were dismissed and considered false-positives. Myopia, hyperopia, and astigmatism components were found in 164 (15.2%; CI: 13.1%-17.4%), 190 (17.6%; CI: 15.3%-20.0%), and 330 (30.5%; CI: 27.8%-33.4%) children, respectively. Amblyopia was diagnosed in 54 (5%; CI: 3.5%-6.4%) children, and 117 (10.8%; CI: 9.8%-12.8%) presented ocular movement disorders. A total of 420 glasses were donated. CONCLUSION: Epidemiological findings for amblyopia and refractive errors are consistent with those of similar studies. The expressive number of diagnoses performed and number of glasses donated to underprivileged children depict the importance of such projects. New guidelines to improve their cost-effectiveness, such as professional training and community sensitization, are imperative.
Subject(s)
Humans , Child, Preschool , Child , Refractive Errors/diagnosis , Refractive Errors/therapy , Refractive Errors/epidemiology , Schools , Vision Disorders/diagnosis , Vision Disorders/prevention & control , Vision Disorders/epidemiology , Brazil , Prevalence , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Resumo Objetivo: Avaliar o perfil epidemiologico de disfuncao da acuidade visual (AV), possiveis disturbios oculares e a frequencia ao atendimento oftalmologico, de escolares do municipio de Itauna, Minas Gerais, Brasil. Posteriormente objetivou-se o encaminhamento ao especialista para correcao das anormalidades. Métodos: Estudo transversal, com populacao avaliada de 432 alunos da rede publica de ensino. Os individuos foram avaliados pelo metodo Snellen e a faixa etaria da amostra variou de 4 a 17 anos. Os dados foram colhidos e sistematizados. Foram encaminhados para o servico de Oftalmologia aqueles que possuiam AV ≤ 0,7 em pelo menos um dos olhos. Resultados: Dos 432 alunos avaliados neste estudo 14,5% apresentaram baixa AV, quando avaliados pelo teste de Snellen. Destes, 61,9 % pertenciam ao sexo feminino. A faixa etaria em que houve maior prevalencia de baixa visao foram escolares de 15 a 17 anos. A maioria apresentou alteracao em ambos os olhos e 60% dos alunos avaliados declararam nunca terem passado por uma consulta oftalmologica. Dos alunos que compareceram as consultas, a maioria foi diagnosticada com erros de refracao e necessitou de correcao otica. Conclusão: Os resultados encontrados demonstram que a parcela significativa dos individuos avaliados apresentou baixa visao e necessitou de encaminhamento oftalmologico. Alem disso, observou-se a inexistencia de consultas oftalmológicas anteriores em grande parte dos escolares. Esse fato reforca, diante dos orgaos publicos de saude, a necessidade de implantar sistemas de triagem visual nas escolas e oferecer assistencia a esses estudantes, objetivando melhorias em seu aprendizado e qualidade de vida.
ABSTRACT Objective: To evaluate the epidemiological profile of visual acuity (VA) dysfunction, the possible ocular disorders and the frequency of ophthalmologic care of school children from the city of Itaúna, Minas Gerais, Brazil. Methods: A cross-sectional study with a population of 432 students in the public schools. The individuals were evaluated by the Snellen method and the sample age ranged from 4 to 17 years. Data were collected and systematized. Those who had VA ≤ 0.7 in at least one eye were referred to the ophthalmology service. Results: Of the 432 students evaluated in this study, 14.5% presented low VA, when evaluated by the Snellen test. Of these, 61.9% were female. The age group with the highest prevalence of low vision were schoolchildren aged 15 to 17 years. The majority presented alteration in both eyes and 60% of the evaluated students stated that they had never had an ophthalmological consultation. Of the students who attended the consultations, most were diagnosed with refractive errors and needed optical correction. Conclusion: The results showed that a significant portion of the individuals evaluated had low vision and required ophthalmologic referral. In addition, there was no previous ophthalmological consultation in most of the schoolchildren. This fact reinforces to public health agencies, the need to implement visual screening systems in schools and offer assistance to these students, with the aim of improvements in their learning and quality of life
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Refractive Errors/diagnosis , Vision Disorders/diagnosis , Visual Acuity , Vision Screening , Schools , Students , Vision Tests , Prevalence , Cross-Sectional StudiesABSTRACT
Objetivos: determinar el grado de concordancia entre los resultados de la aplicación, por pediatras de Atención Primaria, del cribaje visual que establece una guía de práctica clínica, propuesta para cuidados visuales preventivos en edad pediátrica y el criterio de verdad dado por el examen de especialistas en Oftalmología. Métodos: se realizó un estudio descriptivo, prospectivo y transversal en una muestra de 481 pacientes de 6 a 35 meses de edad, en la consulta de Oftalmología del hospital pediátrico Marfán, de febrero del año 2014 a enero de 2015. Participaron dos especialistas en Pediatría, de Atención Primaria, dos especialistas en Oftalmología y un licenciado en Óptica y Optometría. El análisis de la concordancia entre los resultados del cribado visual realizado por pediatras y el criterio de verdad se realizó mediante el cálculo del índice Kappa a partir de cuatro variables, empleando el programa epitat 4. Resultados: la estimación de la fuerza de concordancia fue buena en el examen del comportamiento visual y del reflejo de fondo de ojo con K= 0,649 y 0,754; muy buena en el examen externo de anexos, globo ocular y alineación ocular, con K= 0,817 y 0,899. Conclusiones: el nivel de concordancia diagnóstica encontrado entre pediatras y oftalmólogos hace factible la aplicación de los procedimientos de examen que establece la Guía de Práctica Clínica propuesta(AU)
Objectives: to determine the level of agreement between the results of the application by primary health carepediatricians of the visual screening that sets a clinical practice guideline for preventive visual care at pediatric ages and the true criteria from the test performed by ophthalmologists. Methods: descriptive, prospective and cross-sectional study of a sample of 481 children aged 6 to 35 months old, who were seen at the ophthalmology service of Marfan pediatric hospital from February 2014 to January 2015. Two primary health care pediatricians, two ophthalmologists and a certified optometrist participated. The analysis of the level of agreement between the results of the visual screening by pediatricians and the truth criterion was made through the calculation of Kappa´s agreement index based on four variables by using Epidat 4 program. Results: the estimation of the force of agreement was good in the visual behavior and in the fundus reflection, with k= 0.649 and 0.754, respectively; it was very good in the external exam of the adnexa, the eyeball and the ocular alignment with k= 0.817 and 0.899, respectively. Conclusions: the level of diagnostic agreement found between ophthalmologists and pediatricians makes the application of the examination procedures established by the suggested clinical practice guideline possible(AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Diagnostic Techniques, Ophthalmological/adverse effects , Mass Screening/adverse effects , Practice Guidelines as Topic , Primary Health Care/methods , Visual Acuity , Cross-Sectional Studies , Epidemiology, Descriptive , Fundus Oculi , Prospective StudiesABSTRACT
Objetivo: validar los procedimientos de examen que establece la Guía de Práctica Clínica propuesta para el tamizaje de trastornos visuales en edad pediátrica a nivel de las consultas de cuidados de salud. Métodos: se realizó un estudio descriptivo, prospectivo y transversal en una muestra de 633 pacientes de 3 a 5 años de edad, en consulta de Oftalmología del Hospital Pediátrico Marfán, de febrero del año 2014 a enero de 2015. Participaron dos Especialistas en Pediatría de Atención Primaria y una Licenciada en Psicología, quienes realizaron el tamizaje establecido en la Guía de Práctica Clínica; dos especialistas en Oftalmología: uno como observador profesional, quien supervisó y controló que se cumpliera la aplicación del cribaje con el protocolo establecido, y el otro -junto con una Licenciada en Óptica y Optometría- realizó las pruebas seleccionadas como criterios de verdad. El estudio de la capacidad predictiva de los procedimientos de examen de la Guía de Práctica Clínica propuesta se realizó a partir de cuatro variables: agudeza visual, estereopsis, alineación ocular y examen del reflejo de fondo de ojo. Los datos se procesaron utilizando el software Statistic y Epidat 4. Resultados: se alcanzaron globalmente valores de sensibilidad de 88,15 por ciento; especificidad 97,21 por ciento, valor predictivo positivo 79,07 por ciento, valor predictivo negativo 98,57 por ciento y fuerza de concordancia muy buena, con K= 0,813. Conclusiones: los resultados obtenidos hacen fiable que la Guía de Práctica Clínica propuesta es un instrumento válido para ser recomendada en la pesquisa de trastornos visuales en las condiciones de la sociedad cubana en este grupo de edad(AU)
Objective: to validate the examination procedures established by the Clinical Practice Guideline suggested for the screening of visual disorders at pediatric ages in the primary health care. Methods: a descriptive, prospective and cross-sectional study of a sample of 633 patients aged 3-5 years was conducted at Marfan teaching pediatric hospital from February 2014 to January 2015. Two primary health care pediatricians and a psychologist performed the screening set by the clinical practice guideline; one ophthalmologist supervised and controlled the application of screening in line with the set protocol whereas the other, aided by an optometrist, made the selected tests as truth criteria. The study of the predictive capacity of the exam procedures in the suggested clinical practice guideline was based on four variables, i.e. visual acuity, stereopsis, eye alignment and fundus reflex examination. Data processing used Statistic software and Epidat 4. Results: the overall values for sensitivity was 88.15 percent, specificity 9.21 percent, positive and negative predictable values reached 79.07 percent and 98.57 percent, respectively. The agreement force was very good, with K= 0.813. Conclusions: the results confirm that the suggested Clinical Practice Guideline should be recommended as a valid tool to detect visual disorders at pediatric ages under the present conditions of the Cuban society(AU)
Subject(s)
Humans , Child, Preschool , Data Interpretation, Statistical , Practice Guideline , /statistics & numerical data , Vision Disorders/diagnosis , Cross-Sectional Studies , Epidemiology, Descriptive , Prospective Studies , Sensitivity and SpecificityABSTRACT
Introdução: A detecção e o tratamento precoces dos problemas visuais na infância são fatores cruciais para maximizar o potencial visual e impedir a instalação de sequelas sensório-motoras irreversíveis O objetivo deste estudo foi verificar a prevalência da baixa acuidade visual em escolares de uma escola pública de Campo Grande MS. Metodologia: Foram avaliados 141 escolares através do exame de triagem oftalmológico pela escala de Snellen. Alunos com acuidade visual ≤ 0,7 foram encaminhados ao serviço médico especializado para a realização de exame oftalmológico. Para análise estatística foi utilizado o teste qui-quadrado, considerando diferenças e associações significativas quando p menor que 0,05. Resultados: Dos 141 escolares, 50,4% eram do sexo masculino e 49,6% do sexo feminino. Em relação à idade, 33,3% tinham 6 anos, 66%, 7 anos e 0,7%, 9 anos. A prevalência de baixa acuidade visual foi de 14,2%. Deste total, 65% eram do sexo masculino e 35% eram do sexo feminino. Das 20 crianças detectadas com baixa acuidade visual, apenas 35% delas compareceram à consulta e destas, 42,9% crianças precisaram de correção, enquanto as demais, 57,1%, não precisaram de correção. Conclusões: A prevalência de baixa acuidade visual para crianças do sexo masculino e feminino foi estatisticamente igual, (p=0,227); também não houve uma associação significativa entre o sexo das crianças com baixa acuidade visual e a idade em que foram avaliadas (p=0,521). O estudo demonstra a necessidade da implementação de programas para detecção precoce da baixa acuidade visual a ser realizada por professores treinados ou outros profissionais orientados, assim como a conscientização dos pais sobre a importância da detecção e correção dos problemas oftalmológicos de seus filhos
Introduction: Early detection and treatment of eye problems in childhood are crucial factors to maximize the visual potential and prevent the installation of irreversible sensory-motor sequelae. The aim of this study was to assess the prevalence of low visual acuity among young children attending a public school in Campo Grande, MS. Methods: 141 first graders were submitted to ophthalmologic screening using the Snellen scale. Children with visual acuity ≤ 0.7 were referred to specialized medical service to be submitted to a thorough ophthalmologic examination. The chi-square test was used for the statistical analysis, in which differences and associations were considered as significant when p < 0.05. Results: Of 141 children, 50.4% were males and 49.6% were females. As for age, 33.3% were 6 years old, 66% were 7 y.o. and 0.7% 9 y.o. The prevalence of low visual acuity was 14.2%. Of these, 65% were males and 35% were females. Of the 20 children found to have low visual acuity, only 35% came to consult, and of these, 42.9% needed correction while the remaining 57.1% did not. Conclusions: The prevalence of low visual acuity in male and female children was statistically the same (p=0.227), and there was no significant association of childrens sex with low visual acuity and the age at which they were examined (p=0.521). The study shows the need to implement programs for early detection of low visual acuity to be performed by trained teachers or other guided professionals, as well as to raise parents awareness of the importance of early detection and correction of eye problems in their children
Subject(s)
Humans , Child , Visual Acuity , Students/statistics & numerical data , Child Care/statistics & numerical data , Cross-Sectional Studies , TriageABSTRACT
The incidence of cervical cancer is declining slowly necessitating concerted and organized control measures. Control through primary prevention has become a distinct reality though a prophylactic vaccine, which may take quite some time for its widespread use. Thus control of cervical cancer through secondary preventive measures is the only viable solution now. While high quality cytology screening may not be feasible for widescale implementation in developing countries because of lack of necessary infrastructure, quality control and poor sensitivity of cytology, alternative screening modalities such as visual screening techniques and HPV-DNA can be explored. Some technical and feasibility aspects of these three modalities are discussed.