Etiología de baja visión y ceguera en siete centros de referencia en Colombia entre los años 2012 a 2017 / Etiology of low vision and blindness in seven reference centers in Colombia between the years 2012 to 2017

Introducción: La baja visión y la ceguera tienen alta prevalencia mundial, siendo categorías de discapacidad frecuentes en Colombia. Se requieren estudios que caractericen la etiología de las deficiencias visuales permanentes. Objetivo: Identificar y caracterizar las diferentes causas de baja visión y ceguera en siete centros de referencia para la población con discapacidad visual en Colombia, atendida entre los años 2012 a 2017 en seis ciudades capitales. Materiales y métodos:Estudio retrospectivo, serie de casos, descriptivo y multicéntrico.Resultados: Se contó con una muestra de 879 registros de pacientes con discapacidad visual. El 70% (612/879) con baja visión y 30% (267/879) con ceguera. Para todos los grupos de edad es más prevalente la baja visión. La etiología más frecuente en pacientes con baja visión fue la degeneración macular asociada a la edad (DMAE) (24%, 144/612); en pacientes con ceguera fue el glaucoma (17%, 45/267). Discusión: Posiblemente en Colombia las causas de baja visión y ceguera van más allá de las cataratas, errores de refracción no corregidos y ceguera infecciosa. Discusión: Las etiologías más frecuentes encontradas son condiciones oculares crónicas y diversas, que requieren intervenciones específicas para disminuir su prevalencia y prevenir casos de baja visión y ceguera.

Introduction: Low vision and blindness have high global prevalence, with categories of disability common in Colombia. Studies that characterize the etiology of permanent visual impairments are required. Objective:To identify and characterize the different causes of low vision and blindness in seven reference centers for the visually impaired population in Colombia, attended between 2012 and 2017 in six capital cities. Materials and Methods:Retrospective, case series, descriptive and multicenter study. Results: A sample of 879 records of visually impaired patients was available. Low vision is more prevalent for all age groups. 70% (612/879) low vision and 30% (267/879) blindness. The most common etiology in patients with low vision was age-related macular degeneration (DMAE) (24%, 144/612); in patients with blindness it was glaucoma (17%, 45/267). Discussions: Possibly in Colombia the causes of low vision and blindness go beyond cataracts, un corrected refractive errors and infectious blindness. Conclusions: The most common etiologies found are chronic and diverse eye conditions, which require specific interventions to decrease their prevalence and prevent cases of low vision and blindness.

Introdução: Baixa visão e cegueira têm alta prevalência global, com categorias de incapacidade comuns na Colômbia. São necessários estudos que caracterizem a etiologia das deficiências visuais permanentes. Objetivo: Identificar e caracterizar as diferentes causas de baixa visão e cegueira em sete centros de referência para a população deficiente visual na Colômbia, atendidos entre 2012 e 2017 em seis capitais. Materiais e Métodos: Estudo retrospectivo, série de casos, descritivo e multicêntrico. Resultados: Uma amostra de 879 registros de pacientes com deficiência visual estava disponível. 54% (478/879) homens. A baixa visão é mais prevalente para todas as faixas etárias. 70% (612/879) baixa visão e 30% (267/879) cegueira. A etiologia mais comum em pacientes com baixa visão foi a degeneração macular relacionada à idade (DMAE) (24%, 144/612); em pacientes com cegueira foi glaucoma (17%, 45/267).Discussão: Possivelmente na Colômbia as causas da baixa visão e cegueira vão além da catarata, erros refrativos não corrigidos e cegueira infecciosa. Conclusões: As etiologias mais comuns encontradas são condições oculares crônicas e diversas, que requerem intervenções específicas para diminuir sua prevalência e prevenir casos de baixa visão e cegueira

Avaliação de um serviço hospitalar de emergência em oftalmologia na perspectiva da responsividade / Não disponível

The present study aimed to analyze the perceptions of users about a hospital emergency service in ophthalmology from the perspective of responsiveness. It is a qualitative research with descriptive-exploratory design. The data were collected through semi-structured interviews with 27 users of emergency service at the Eye Hospital (HBO) in Porto Alegre-RS between July and August 2016. A script with questions about the service based on responsiveness dimensions was used to carry out the interviews. Data analysis was performed according to the technique of thematic content analysis, with identification of the following thematic categories: dignity, autonomy, communication, confidentiality, dimensions of basic amenities’ quality (infrastructure), choice, social support (access to social support networks), and immediate attention (agility in service). In the interpersonal domain, ‘dignity’ was understood as being respected in one’s own individuality, well guided and followed in one’s own needs; ‘autonomy’ was highlighted as participation and understanding of the diagnosis and therapeutic indications to know how to deal with one’s own problem; ‘communication’ was described as empathy, accessible language and the possibility of clarifying questions; ‘confidentiality’ was underst bood as privacy, security and trust in relation to personal information provided during the service. (Continue)

(Continuação) Essa caracterização de profissionalismo determina em grande parte a percepção dos usuários. Diante desses resultados conclui-se que a acessibilidade e a qualidade do serviço especializado do HBO foram os dois aspectos mais destacados no atendimento. Esses aspectos identificam-se com duas dimensões centrais da responsividade, a agilidade e a dignidade, que foram percebidas pelos entrevistados e corresponderam às suas expectativas.

The present study aimed to analyze the perceptions of users about a hospital emergency service in ophthalmology from the perspective of responsiveness. It is a qualitative research with descriptive-exploratory design. The data were collected through semi-structured interviews with 27 users of emergency service at the Eye Hospital (HBO) in Porto Alegre-RS between July and August 2016. A script with questions about the service based on responsiveness dimensions was used to carry out the interviews. Data analysis was performed according to the technique of thematic content analysis, with identification of the following thematic categories: dignity, autonomy, communication, confidentiality, dimensions of basic amenities’ quality (infrastructure), choice, social support (access to social support networks), and immediate attention (agility in service). In the interpersonal domain, ‘dignity’ was understood as being respected in one’s own individuality, well guided and followed in one’s own needs; ‘autonomy’ was highlighted as participation and understanding of the diagnosis and therapeutic indications to know how to deal with one’s own problem; ‘communication’ was described as empathy, accessible language and the possibility of clarifying questions; ‘confidentiality’ was underst bood as privacy, security and trust in relation to personal information provided during the service. (Continue)

(Continuation) In the structural domain, in relation to ‘infrastructure’, it was highlighted the cleanliness of the rooms and the quality of the waiting room; in ‘choice’ the option for a specialized service in ophthalmology was mentioned; in ‘social support’ the possibility of a company in the doctor’s appointment and the welcoming of diversity of situations was pointed out; in ‘agility’, long waiting time and accessibility were evidenced as well as quality and specialized care efficaciousness, bearing in mind that it is a Unified Health Care System service. The fact of being a qualified public service was several times positively emphasized by the respondents. As for ‘agility’, the emergency service is characterized as a gateway to eye pathologies, causing, at certain moments, excessive demand and consequently long waiting time faced by the participants of the survey. What respondents most appreciated was the professionalism of the service, since it is a specialized service that goes straight to the problem, by having a well-organised risk rating system, by guiding the therapeutic care the user needs and, if necessary, forwarding him/her to another service. This characterization of professionalism largely determines users’ perception. Based on these results, it is concluded that the accessibility and the quality of the HBO specialized service were the two most prominent aspects in service offered. These aspects are identified with two core dimensions of responsiveness, agility and dignity, which were perceived by the interviewed ones and matched to their expectations.

Avaliação in vitro da citotoxicidade de instrumentos cirúrgicos enxaguados com diferentes qualidades de água / Assessment of in vitro cytotoxicity of surgical instruments rinsed with different qualities of water

Introdução: O Centro de Material e Esterilização (CME) deve garantir a remoção completa de resíduos orgânicos e inorgânicos, sobretudo detergentes e endotoxinas, dos produtos críticos para saúde por meio do enxágue suficiente com água de qualidade. Com base nos recentes relatos de síndromes tóxicas do segmento anterior ocular, que foram associadas às más práticas de processamento do instrumental de oftalmologia, especialmente, a qualidade da água utilizada em seu enxágue final, esta Tese teceu a hipótese de que quanto mais pura for a qualidade da água do último enxágue, menor será a citotoxicidade encontrada nos produtos para saúde. Objetivo: Avaliar a citotoxicidade de cânulas de hidrodissecção submetidas à contaminação desafio, limpeza automatizada com enxágue final em diferentes qualidades de água: de torneira, tratada por deionizador, por destilação, por osmose reversa e por ultrapurificação. Métodos: 130 cânulas de hidrodissecção foram usadas, 26 por grupo experimental, caracterizados, de acordo com a água utilizada no último enxágue. As amostras foram submetidas à contaminação desafio interna e externamente por uma solução contendo 20% sangue de carneiro desfibrinado e 80% de Cloreto de Sódio a 0,9%, para simular um cenário desafiador de sujidade no material cirúrgico oftalmológico, sendo em seguida processadas, de acordo com um procedimento operacional padrão validado para este tipo de cânula, variando-se apenas a qualidade de água no enxágue final.Como controle positivo, foram utilizadas três cânulas descartáveis, que foram submetidas ao mesmo procedimento de contaminação desafio, imersas em uma solução contendo água de torneira e detergente enzimático que, após a evaporação da solução, foram esterilizadas. Para o controle negativo, foram usadas três cânulas das mesmas utilizadas nos grupos experimentais, com o mínimo de manipulação e na forma como foram fornecidas pelo fabricante, tendo sido apenas esterilizadas. Adicionalmente, foi incluído um grupo comparativo, no qual três amostras foram processadas em condições idênticas às dos grupos experimentais, enxaguadas com água de torneira, porém, sem secagem. Sequencialmente, procedeu-se a realização do teste de citotoxicidade pela incorporação do corante vital vermelho neutro para a obtenção da média da viabilidade celular de cada grupo experimental. Resultados: Ausência de citotoxicidade nos extratos das amostras, independente da diluição considerada na análise, sendo 83% a porcentagem média de viabilidade celular mínima obtida no extrato das amostras enxaguadas com água tratada por destilação na diluição de 12,5%. Conclusão: As cânulas de hidrodissecção não demonstraram citotoxicidade, independentemente da qualidade de água utilizada no último enxágue. Os resultados apresentados puderam ser alcançados unicamente por meio do uso de um procedimento operacional padrão de limpeza validado, baseado em literatura científica, em recomendações oficiais e na legislação relacionada.

Introduction: The Central Sterile Supply Department (CSSD) must guarantee the complete removal of organic and inorganic waste, especially detergents and endotoxins, from critical medical devices through sufficient rinsing with good-quality water. Based on recent reports of toxic anterior segment syndromes, which were associated with poor processing practices of ophthalmology instruments, particularly the quality of water used in the final rinse, this thesis has raised the hypothesis that the better the quality of the water used in the last rinse, the lower the cytotoxicity found in medical devices. Objective: To evaluate the cytotoxicity of hydrodissection cannulas, that were submitted to contamination challenge and then automated cleaning with final rinse in different qualities of water: tap water, water treated by a deionizer device, by distillation, by reverse osmosis and by ultrapurification. Methods: 130 hydrodissection cannulas were used, 26 per experimental group, characterized according to the last rinse water used. The samples were submitted to internal and external contamination challenge using a solution containing 20% defibrinated sheep blood and 80% Sodium Chloride at 0.9%, to simulate a challenging scenario of soiled ophthalmic surgical material, which was then processed, according to a validated standard operating procedure for this type of cannula, changing only the quality of water at the final rinse. Three disposable cannulas were used as positive controls, being submitted to the same contamination challenge procedure, then immersed in a solution containing tap water and enzymatic detergent, and then sterilized after evaporation of the solution. Three cannulas, identical to those used in the experimental groups, were used as negative controls, after minimum handling and exactly as they were supplied by the manufacturer, having only been sterilized.Additionally, a comparison group was included, from which three samples were processed under conditions identical to the experimental groups, rinsed with tap water, but without drying. Sequentially, the cytotoxicity assay was performed by incorporating the neutral red vital dye to obtain mean cell viability from each experimental group. Results: We observed absence of cytotoxicity in the sample extracts, regardless of the dilution considered in the analysis, with 83% of minimal cell viability obtained in the sample extract rinsed with distilled water at 12.5% dilution. Conclusion: Hydrodissection cannulas showed no cytotoxicity, regardless of the quality of water used in the final rinse. The results shown here were achieved by using a validated cleaning standard operating procedure based on scientific literature, official recommendations and related legislation.

Estudo comparativo de figuras para optótipos entrecrianças do Brasil e Portugal / Comparative study of figures for optotypes with children from Brazil and Portugal / Estudio comparativo de figuras para optotipos entre niños de Brasil y Portugal

Para um resultado fiel no exame da acuidade visual o indivíduo deve conhecer o objeto demonstrado. Para préescolares,não existe um teste que atinja os objetivos esperados. Objetiva-se identificar figuras feitas porcrianças em Portugal e no Brasil e comparar características dos desenhos elaborados. De caráter comparativo equantitativo, este estudo foi realizado em 2003 no Brasil e em 2005 em Portugal, com 342 pré-escolares de 4 e 5anos. A coleta de dados foi feita com a elaboração de desenho livre e análise e seleção quantitativa. Asfrequências de desenho semelhantes entre as crianças do Brasil e as de Portugal foram: ser humano; sol; casa;árvore; flor; boneco; nuvem; e bola. As diferenças entre os desenhos das crianças dos países foramconsideradas significantes (p =0,026). Nas figuras que se repetiram existiram formatos diferentes para a casa, c2= 61,75; e para a árvore c2 = 18,31. Tais resultados reforçam a necessidade de escalas regionalizadas.

For reliable results on visual acuity tests, patients should know the object shown. No test exists that reaches theexpected goals for preschool children. This study aimed to identify figures made by children in Portugal and Braziland compare the characteristics of the elaborated drawings. A comparative and quantitative study was carried outin Brazil in 2003 and in Portugal in 2005, involving 342 preschool children aged 4 and 5. Data collection involvedthe elaboration of free drawings by the children and analysis and quantitative selection of the drawings. Thefollowing pictures frequencies were similar in Brazil and Portugal: a human being; sun; house; tree; flower; doll;cloud and ball. Differences between drawings in both countries were considered significant (p=0.026). In thefigures that were repeated, different formats existed for the house, c2 = 61.75; and for the tree c2 = 18.31. Theseresults strengthen the need to construct regionalized scales.

For reliable results on visual acuity tests, patients should know the object shown. No test exists that reaches theexpected goals for preschool children. This study aimed to identify figures made by children in Portugal and Braziland compare the characteristics of the elaborated drawings. A comparative and quantitative study was carried outin Brazil in 2003 and in Portugal in 2005, involving 342 preschool children aged 4 and 5. Data collection involvedthe elaboration of free drawings by the children and analysis and quantitative selection of the drawings. Thefollowing pictures frequencies were similar in Brazil and Portugal: a human being; sun; house; tree; flower; doll;cloud and ball. Differences between drawings in both countries were considered significant (p=0.026). In thefigures that were repeated, different formats existed for the house, c2 = 61.75; and for the tree c2 = 18.31. Theseresults strengthen the need to construct regionalized scales.

Percepções dos atores sociais sobre o atendimento prestado pelo laboratório óptico do programa de assistência primária de saúde escolar (PROASE) no município de Ribeirão Preto / Perceptions of social actors concerning the care delivered by the optical laboratory in the program of primary care of schoolchildren (PROASE) in the city of Ribeirão Preto

O presente estudo objetivou avaliar o atendimento prestado pelo Laboratório Optico do PROASE, segundo a percepção dos familiares e professores dos escolares que adquiriram óculos no período de 1991 a 1995, no município de Ribeirão Preto. Utilizamos para a análise dos dados a proposta indicada para análise de conteúdo e para atingirmos os significados manifestos no material qualitativo, utilizamos a técnica de análise temática. Concluímos que os atores sociais manifestam de forma positiva a importância do programa e deixam evidente que o PROASE não só na área de oftalmologia vem trazendo contribuições relevantes para saúde das crianças em idade escolar

Ensino da oftalmologia na graduação em Enfermagem: levantamento da situação no Brasil - 1987 / Oftalmology teaching in nursing schools: survey of the situation in Brazil - 1987

Este estudo tem como objetivo fazer um levantamento do ensino de oftalmologia que é oferecido aos alunos de graduação em enfermagem. Para sua efetivação foi enviado um questionário a todos os cursos de enfermagem do Brasil, no qual são abordadas questões relativas ao ensino que é administrado. Do total correspondente a 87 questionários foram obtidas 76 respostas (87,36%), restando assim, 11 (12,64%) correspondências sem terem sido respondidas. Os nossos achados apontam para um quadro, no qual verifica-se que 55,26% das escolas incluem em seus currículos assuntos de oftalmologia, sendo que em apenas 14,28% destas escolas são abordados aspectos ligados à prevenção da cegueira. Considerando que na literatura nacional e estrangeira pesquisadas não foi evidenciado qualquer relato sobre o preparo do enfermeiro em oftalmologia preventiva e analisando os dados obtidos no presente estudo, esperamos que os docentes em enfermagem reflitam sobre a importância deste ensino na formação do enfermeiro como educador e agente de saúde na comunidade.

This study aims to make a survey on the oftalmology nursing which is offered to the nursing university students. A questionnaire was sent to all the Brazilian nursing courses in which there are questions on the contents taught. Eighty-seven questionnaires were sent out and 76 (87, 36%) were received. The results show that 55, 26% of the schools include oftalmology subjects in their curriculum, but in only 14, 28% of these schools some topics related to blindness prevention were mentioned. In the Brazilian and foreign bibliography researched we have not found any study about the preparation of nurses in preventive oftalmology. Through the analysis of the data obtained in this study, we hope that the nursing professors will think about the relevance of including preventive oftalmology when preparing nurses to be educators and health care professionals.