Prevalence of Amblyopia After Photoscreening.

PURPOSE: To assess the prevalence of amblyopia in a population of adolescents screened for amblyogenic risk factors at preschool age. METHODS: Data were retrospectively collected from the preschool screening for amblyogenic risk factors routinely performed in the authors' hospital. A stratified random sampling was used. A school from the region was randomly selected and then two grades were randomly selected. All classes from these grades were evaluated and only children who were previously screened for amblyogenic risk factors were included. Ophthalmological examination included best visual acuity (distance and near, Early Treatment of Diabetic Retinopathy Study scale and Jaeger eye chart) and stereopsis (Randot Stereo Test; Stereo Optical Company, Inc). Sample size was estimated as more than 283 participants. Pertinent data were extracted for analysis. RESULTS: A total of 520 children were recruited, and 299 met the inclusion criteria. Fifteen percent of children (n = 46) had results at the screening that prompted a further ophthalmological evaluation and 9% of children (n = 26) had meaningful refractive errors or strabismus. Overall amblyopia prevalence was 1.00%. One of the 3 children who developed amblyopia had microstrabismus, and the remaining 2 children had a previous positive screening result but missed the follow-up evaluations. At the follow-up evaluation, 79.3% (n = 237) of children were not wearing glasses. CONCLUSIONS: A structured screening may allow the early detection of amblyogenic factors and prevent further vision deterioration in children, thus improving their long-term quality of life. The prevalence of amblyopia in this study was lower than that recently stated for Europe. [J Pediatr Ophthalmol Strabismus. 2020;57(6):372-377.].

Photoscreening for amblyogenic risk factors in 1-year-olds: results from a single center in Portugal over a 9-year period.

PURPOSE: To report the experience of a single center in photoscreening 1-year-olds for amblyogenic risk factors over a 9-year period and to estimate amblyopia prevalence in this population. METHODS: The records of 11,029 children 11-18 months of age who were screened for amblyogenic risk factors at Centro Hospitalar de Entre o Douro e Vouga between 2004 and 2012 were reviewed. Measurements were performed with MTI (until 2008) and plusoptiX S04 (from 2009). The screening results were evaluated according to criteria adapted from Donahue and colleagues. RESULTS: The screening was negative in 8,985 children (82%), positive in 519 (5%), unreadable in 201 (2%), and borderline in 1,324 (12%). The overall positive predictive value (PPV) for the presence of at least one amblyogenic risk factor was 56.8%. The estimated prevalence of meaningful refractive errors in this population was 2.2%; of strabismus, 0.3%. CONCLUSIONS: The rate of unreadable screenings was low. The overall PPV was lower than other large studies, at older ages, but higher than those of the same-age children. Considering the potential benefits of early intervention in preventing the development of amblyopia, this study demonstrates the feasibility of screening 1-year-olds.

Development of adiposity, obesity and age at menarche: an 8-year follow-up study in Portuguese schoolgirls.

AIM: It has been suggested that the decline in menarcheal age is associated with the increase of obesity prevalence. OBJECTIVE: To examine the association between age at menarche and adiposity development from age 7 to 15 years. SUBJECTS: A cohort of 109 schoolgirls from Viana do Castelo (Northern Portugal). METHODS: Anthropometric measurements (height, weight, and triceps and subscapular skinfold thicknesses) were longitudinally obtained at 7, 8, 9, and 15 years. Waist circumference and self-reported age at menarche were obtained at age 15. Obesity was defined by the cut-off value of 30% body fat. Ages of <12 years, 12-13 years, and >13 years were classified as early menarche (EM), average menarche (AM) and late menarche (LM), respectively. RESULTS: Median menarcheal age was 12.0 years (range, 8-15 years), with 26.6% of girls classified as EM. Compared with their LM peers, EM girls were always fatter (p=0.001) and had higher waist circumference at age 15 (p=0.009). All variables showed significant negative associations with age at menarche, except subscapular to triceps skinfold ratio at all ages and height at age 15. At both ages 9 and 15 years, LM girls had the lowest prevalence of obesity (4.5% and 9.1%, respectively). The 8-year incidence of obesity in EM girls was 24.1%, while that in the AM plus LM group was 13.8% (p=0.005). CONCLUSION: EM seems to be a risk factor for the development of obesity during adolescence. However, this vulnerability may start to be programmed before menarche as girls with precocious menarche were already fatter than their late-maturing peers at age 7 years.

Physical fitness predicts adiposity longitudinal changes over childhood and adolescence.

OBJECTIVES: The purpose of this study was to examine the influence of physical fitness (PF) on the development of subcutaneous adipose tissue in children followed longitudinally over a 9 year period ranging from childhood to adolescence. DESIGN: This longitudinal study followed 518 healthy participants (262 boys, 256 girls) over a 9-year period ranging from childhood (age 6) to adolescence (age 15). Adiposity (triceps and subscapular skinfolds), and fitness (60s sit-ups, flexed arm hang, standing long jump, 50m dash, 10m shuttle run, sit-and-reach, and 20m pacer run) were assessed at four annual time points during primary school, and on a follow up, 6 years later, during secondary school. METHODS: Growth in subcutaneous fat was modeled within a HLM statistical framework, using fitness components as time changing predictors. RESULTS: Flexed arm hang (ß=-0.059; p=0.000), standing long jump (ß=-0.072; p=0.000), 60s sit-ups (ß=-0.041; p=0.040), 50m dash (ß=0.956; p=0.000), and 20m PACER (ß=-0.077; p=0.000) tests, were found to predict changes on body fat growth over the years, independently of sex. CONCLUSIONS: Improving PF individual levels can positively influence adiposity deposition over the time period covering childhood and adolescence. That occurs independently of the typical sex differentiated adiposity growth.

Changes in adiposity status from childhood to adolescence: a 6-year longitudinal study in Portuguese boys and girls.

BACKGROUND: Cross-sectional data show high prevalence of overweight in Portuguese children, but there are few longitudinal studies describing the patterns of obesity development in the young. AIM: To examine the trajectories of obesity from late childhood to adolescence. SUBJECTS AND METHODS: Triceps and subscapular skinfold thickness measurements were carried out in 288 children at age 9 (baseline) and later at age 15 (follow-up). Percentage body fat (%BF) was estimated according to Slaughter equations and the health-related definition of obesity ( ≥ 25%BF in boys and ≥ 30%BF in girls) was used. RESULTS: In boys, the prevalence of obesity decreased from 21.9% to 14.8% (p < 0.05) while in girls it increased from 14.3% to 19.5%. The incidence of obesity in the 6-year study period was 2.6% and 8.3% for boys and girls, respectively (p < 0.05). In comparison with girls, the percentage of boys that reversed obesity was more than 3-fold higher (3% vs 9.7%, p < 0.05). Obesity tracked moderately in both sexes (Kappa = 0.6, p < 0.001). CONCLUSION: The results indicate a marked sex difference in the incidence and reversal of obesity from late childhood to adolescence that is unfavourable to girls. Consideration of this difference might be important when designing programmes for the prevention and treatment of obesity focusing on this period.

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

OBJETIVO: Estimar o custo direto da esquizofrenia para o setor público. MÉTODOS: O estudo foi realizado no Estado de São Paulo, no ano de 1998. Utilizaram-se dados da literatura e de institutos governamentais de pesquisa para estimar o número total de pacientes com esquizofrenia no Estado sob cobertura do Sistema Unico de Saúde. Foi construída uma árvore de decisão mostrando a distribuição desses pacientes quanto ao nível de tratamento. Por meio de pesquisa em prontuários de alguns hospitais públicos e serviços ambulatoriais, documentou-se a utilização de recursos por esses pacientes no período de um ano. Foram atribuídos valores em Reais para esses recursos a fim de se calcular o custo direto total médico-hospitalar. RESULTADOS: Do total de pacientes, 81,5 por cento estão sob cobertura do SUS e encontram-se assim distribuídos: 6,0 por cento internados, 23,0 por cento em tratamento ambulatorial e 71,0 por cento sem tratamento regular. O custo direto total da esquizofrenia foi de R$222 milhões (US$191,781,327) (2,2 por cento do total de gastos em saúde do Estado), sendo 11 por cento destinados ao tratamento ambulatorial e 79,2 por cento às internações psiquiátricas. CONCLUSÕES: A maior parte dos pacientes com esquizofrenia no Estado está sem tratamento regular. Os achados apontam para a necessidade de se investir em pesquisas que possam orientar uma melhor alocação de recursos no tratamento dos transtornos mentais no País.

A epidemiologia da esquizofrenia

A epidemiologia estuda a ocorrencia e a distribuicao de uma doenca, ou condicao relacionada a saude, nos diversos grupos populacionais, procurando investigar os fatores determinantes em sua etiologia e prognostico. Para o calculo da frequencia de esquizofrenia na populacao, devem-se considerar o numerador (numero de doentes) e a populacao (numero de habitantes da area estudada) em determinada faixa etaria. Emuma dada populacao, todos os cados devem ser incluidos no numerador. Alguns aspectos epiudemiologicos identificam seus casos a partir do contato com os servicos de atendimento, enquanto outros sao desenvolvidos na comunidade, incluindo ou nao os pacientes eventualmente institucionalizados.