RESUMO
To address multiple issues impacting the climate imbalance, insects, and in particular Tenebrio molitor, represent now a promising alternative for producing high-quality protein products with low environmental impact. As with any new species farmed on an industrial scale, insect breeding production must be improved through the accumulation of knowledge on rearing techniques and genetic management. Little information on the inheritance of agronomically interesting traits, dedicated to Tenebrio molitor, is available. This study aims to decipher the genetic parameters (heritability and genetic correlations) of reproduction, larval growth and survival, pupation rate and developmental time from a reference population made up of 1 931 sib-groups reared under pedigree, in controlled and stable environments and generated with single pair mating. Considering all sib-groups, 29 599 offspring have been generated and phenotyped over four generations to support this study and provide enough data to estimate, under linear animal models, the additive genetic and common environmental effects. Phenotypic analyses underlined an important variability among sib-groups and individuals, as for the total oviposition during 4 weeks counting (0-680 eggs, min - max, respectively) or larval body mass 63 days posteclosion (36.3-206.8 mg, min - max, respectively). Moderate to important heritability values have been obtained and ranged from 0.17 to 0.54 for reproduction phenotypes, 0.10-0.44 for growth parameters, 0.06-0.22 for developmental time and 0.10-0.17 for larval survival rates. The proportion of phenotypic variance explained by the environmental part varyies from 0.10 to 0.36 for reproductive traits, from 0.17 to 0.38 for growth parameters, from 0.06 to 0.36 for developmental time and 0.17-0.22 for survival rates. Genetic correlations underline relationships among phenotypes such as the trade-off between developmental time from egg to pupae and pupae weight (r2 = 0.48 ± 0.06). These important phenotypic variations coupled with promising heritability values pave the road for future breeding programs in Tenebrio molitor.
Assuntos
Cruzamento , Larva , Fenótipo , Reprodução , Tenebrio , Animais , Tenebrio/genética , Feminino , Masculino , Larva/crescimento & desenvolvimento , Larva/genética , Reprodução/genética , Oviposição/genéticaRESUMO
A QTL detection experiment was performed in French dairy cattle to search for QTL related to male fertility. Ten families, involving a total of 515 bulls, were phenotyped for ejaculated volume and sperm concentration, number of spermatozoa, motility, velocity, percentage of motile spermatozoa after thawing and abnormal spermatozoa. A set of 148 microsatellite markers were used to realize a genome scan. First, genetic parameters were estimated for all traits. Semen production traits were found to have moderate heritabilities (from 0.15 to 0.30) while some of the semen quality traits such as motility had high heritabilities (close to 0.60). Genetic correlations among traits showed negative relationships between volume and concentration and between volume and most quality traits such as motility or abnormal sperm while correlations between concentration and these traits were rather favourable. Percentages of abnormal sperm were negatively related to quality traits, especially with motility and velocity of spermatozoa. Three QTL related to abnormal sperm frequencies were significant at p < 0.01. In total, 11 QTL (p < 0.05) were detected. However, the number of QTL detected was within the range of expected false positives. Because of the lack of power to find QTL in this design further analyses are required to confirm these QTL.
Assuntos
Bovinos/genética , Genoma , Sêmen , Animais , Bovinos/classificação , Genômica , Heterozigoto , Masculino , Fenótipo , Locos de Características QuantitativasRESUMO
This study investigated the effects of the vaccination of rams with a serotype 2 bluetongue virus vaccine on the quality of their semen. One group of 23 rams was vaccinated on days 0 and 47, and 23 rams were left unvaccinated. Samples of blood, serum and semen were collected regularly in order to detect the virus genome, and to compare the quality of the semen from the vaccinated and unvaccinated rams. Segment 10 of the genome of the vaccine strain was detected in the blood of the vaccinated animals by reverse transcriptase-PCR (RT-PCR) on days 7, 13 and 19 after the first vaccination, but no virus was isolated from the RT-PCR-positive blood or from any of the semen samples from the vaccinated animals. There was a significant decrease in the concentration and motility of the spermatozoa and an increase in the proportion of abnormal and dead spermatozoa after the first vaccination; however, after the second vaccination only smaller, non-significant changes were observed. On day 69, the quality of the semen of the vaccinated animals was not significantly different from that of the controls.
Assuntos
Sêmen/fisiologia , Contagem de Espermatozoides/veterinária , Motilidade dos Espermatozoides/fisiologia , Vacinas Atenuadas/efeitos adversos , Vacinas Virais/efeitos adversos , Animais , Bluetongue/prevenção & controle , Genoma Viral , Masculino , Reação em Cadeia da Polimerase Via Transcriptase Reversa/veterinária , Sêmen/efeitos dos fármacos , Ovinos , Motilidade dos Espermatozoides/efeitos dos fármacos , Fatores de TempoRESUMO
Myelinated retinal nerve fibers observed rarely on ocular fundus examination, usually adjacent to the optic disc, are known to be stable throughout life. However, the possibility of rarefaction, and even disappearance, of these myelinated fibers has been pointed out in very rare cases of ocular or neuro-ophthalmological pathologies. We report such a regression, identified after a six-year period, in one case of primary open-angle glaucoma.
Assuntos
Glaucoma de Ângulo Aberto/patologia , Fibras Nervosas Mielinizadas/patologia , Degeneração Retiniana/patologia , Neurônios Retinianos/patologia , Idoso , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Disco Óptico/patologia , Degeneração Retiniana/complicações , Degeneração Retiniana/fisiopatologia , Acuidade VisualRESUMO
INTRODUCTION: Optic nerve head drusen are congenital calcium deposits located in the prelaminar section of the optic nerve head. Their association with visual field defects has been classically described, but the diagnosis of glaucoma is not easy in these cases of altered optic nerve head anatomy. CASE STUDY: We describe the case of a 67-year-old man with optic nerve head drusen complicated by glaucoma, which was confirmed by visual field and OCT examination of the peripapillary retinal nerve fiber layer (RNFL), but the measurement of the minimum distance between the Bruch membrane opening and the internal limiting membrane (minimum rim width, BMO-MRW) by OCT was normal. DISCUSSION: OCT of the BMO-MRW is a new diagnostic tool for glaucoma. Superficial optic nerve head drusen, which are found between the internal limiting membrane and the Bruch's membrane opening, overestimate the value of this parameter. CONCLUSION: BMO-MRW measurement is not adapted to cases of optic nerve head drusen and can cause false-negative results for this parameter, and the diagnosis of glaucoma in this case should be based on other parameters such as the presence of a fascicular defect in the retinal nerve fibers, RNFL or macular ganglion cell complex thinning, as well as visual field data.
Assuntos
Glaucoma/complicações , Glaucoma/diagnóstico , Drusas do Disco Óptico/complicações , Drusas do Disco Óptico/diagnóstico , Idoso , Glaucoma/patologia , Humanos , Masculino , Drusas do Disco Óptico/patologia , Tomografia de Coerência ÓpticaRESUMO
AIM: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification. METHODS: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. PRIMARY OUTCOME: IOP change; secondary outcomes: side effects and VA changes. RESULTS: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. EFFICACY: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kaplan-Meyer determined overall success rate (IOP < or = 21 mm Hg at the last visit with or without medications) as 76.9%. The number of antiglaucoma medications was reduced by 95% at year 1. Only six patients (23%) were taking IOP lowering treatment at their last visit, five with one medication and one with two medications. Side effects: early postoperative complications were clinically mild and included six cases of hypotony (IOP <5 mm Hg), three cases of hyphaema (<2 mm) with no clinically significant further effects. Long term complications were two cases (7.7%) of device rotation (one treated by reposition) and three cases (11.5%) of conjunctival erosion at 2 and 3 years. CONCLUSIONS: The Ex-PRESS implant, combined with phacoemulsification cataract extraction, is clinically safe and effective, maintaining in the long term a large reduction in IOP and in the number of antiglaucoma medications.
Assuntos
Catarata/complicações , Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Facoemulsificação , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Esquema de Medicação , Cirurgia Filtrante/efeitos adversos , Cirurgia Filtrante/métodos , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Aço Inoxidável , Acuidade VisualAssuntos
Glaucoma/terapia , Oftalmologia/normas , Complicações na Gravidez/terapia , Anestesia Local/métodos , Anestesia Local/normas , Animais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/classificação , Doença Crônica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Glaucoma/diagnóstico , Humanos , Lactação/efeitos dos fármacos , Lactação/fisiologia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos Cirúrgicos Oftalmológicos/normas , Oftalmologia/organização & administração , Parto/efeitos dos fármacos , Parto/fisiologia , Padrões de Prática Médica/normas , Gravidez , Complicações na Gravidez/diagnóstico , Medição de Risco/métodos , Medição de Risco/normas , Estados Unidos , United States Food and Drug AdministrationRESUMO
Predicting in vivo fertility of bull ejaculates using in vitro-assessed semen quality criteria remains challenging for the breeding industry. New technologies such as computer-assisted semen analysis (CASA) and flow cytometry may provide accurate and objective methods to improve semen quality control. The aim of this study was to evaluate the relationship between semen quality parameters and field fertility of bull ejaculates. A total of 153 ejaculates from 19 Holstein bulls have been analyzed using CASA (postthawing semen motility and morphology) and several flow cytometric tests, including sperm DNA integrity, viability (estimated by membrane integrity), acrosomal integrity, mitochondria aerobic functionality and oxidation. Samples were analyzed both immediately after thawing and after 4 hours at 37 °C. A fertility value (FV), based on nonreturn rate at 56 days after insemination and adjusted for environment factors, was calculated for each ejaculate. Simple and multiple regressions have been used to correlate FV with CASA and flow cytometric parameters. Significant simple correlations have been observed between some parameters and FV (e.g., straight line velocity [µm/s], r(2) = -0.12; polarized mitochondria sperm (%), r(2) = 0.07), but the relation between simple parameter and FV was too week to predict the fertility. Partial least square procedure identified several mathematical models combining flow cytometer and CASA variables and had better correlations with FV (adjusted r(2) ranging between 0.24 and 0.40 [P < 0.0001], depending on the number of included variables). In conclusion, this study suggests that quality assessment of thawed bull sperm using CASA and flow cytometry may provide a reasonable prediction of bovine semen fertility. Additional work will be required to increase the prediction reliability and promote this technology in routine artificial insemination laboratory practice.
Assuntos
Bovinos/fisiologia , Análise do Sêmen/veterinária , Animais , Membrana Celular , Fertilidade/fisiologia , Citometria de Fluxo , Processamento de Imagem Assistida por Computador , Masculino , Oxirredução , Valor Preditivo dos Testes , Controle de Qualidade , Análise do Sêmen/métodos , Análise do Sêmen/normasRESUMO
The early diagnostic of glaucoma (before the appearance of visual field defects) can be made in some cases with the help of certain objective tests and, to a lesser degree, with subjective or psychophysical tests. Retinal nerve fiber layer photography is certainly the most rewarding objective test, providing the technique has been mastered and there is a clear fundus view without chorio-retinal atrophy. The identification of nerve fiber defects is an almost sure sign of glaucomatous damage in the absence of other pathology. An abnormally small neuroretinal rim area can also be an indicator of glaucoma. However, no conclusion can be drawn if the value is within the wide range of normal limits. Electrophysiological tests in glaucoma patients at the present time give results that show too much variability and overlap with those of normals to be of practical value. The same can be said for subjective tests such as spatial and temporal contrast sensitivity (the flicker test, for example). The specificity and sensitivity of the tests are too weak to be useful for the diagnosis of glaucoma in 1992.
Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Nervo Óptico/fisiopatologia , Testes de Percepção de Cores , Sensibilidades de Contraste , Eletrorretinografia , Potenciais Evocados Visuais , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Nervo Óptico/patologia , Fatores de TempoRESUMO
Several clinical reasons induced Campbell to propose an iridotomy in cases of pigmentary dispersion: removing the inverse pupillary block, balancing pressures through the iris, and finally stopping the posterior erosion of the iris leading to pigmentary release. It is likely that certain failures in this method stem from an erroneous evaluation of the cases that could benefit from iridal perforation. Three conditions are required for this procedure to be successful: established ocular hypertension, an abnormally concave iris base, and absence of patent glaucoma.
Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Iridectomia , HumanosRESUMO
Trabeculoplasty was introduced in 1979 to decrease intra ocular pressure. Long-term results have been unsatisfactory compared to the first publications, because of the repeated relapse of initially successfully treated eyes. However, the technique may be particularly useful in numerous clinical conditions: pseudo exfoliation syndrome, pigmentary dispersion, slight cataract waiting for combined surgery, and in elderly patients. Developing new energy sources (i.e., selective laser trabeculoplasty) could extend the indications of this method, with longer-lasting results and/or completely harmless retreatments.
Assuntos
Glaucoma/cirurgia , Trabeculectomia , HumanosRESUMO
Glaucoma caused by primary closure of the iridocorneal angle accounts for half of the glaucoma cases in the world, 9 out of 10 in patients of Sino-Mongolian origin. The most frequent mechanism involved is anterior chamber angle blockage, but glaucoma can also be the result of a plateau iris structure, ciliary blockage, and exceptionally microphthalmos. Other than these forms, closure of the iridocorneal angle can be secondary to acquired iridopathies, or caused by crystallin anomalies or therapeutic interventions.
Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Complicações do Diabetes , Diagnóstico Diferencial , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/etiologia , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Recém-Nascido , Doenças da Íris/complicações , Cristalino/anormalidades , Masculino , Microftalmia/complicações , Pessoa de Meia-Idade , Fatores de Risco , Fatores SexuaisRESUMO
Between normal and glaucomatous subjects, a group with ocular hypertension exists which is not homogeneous as 10 p. cent of these will develop glaucoma. The problem is to select early eyes at risk. Three new methods of examination have been proposed: the response to the test of contrast sensitivity, the pupillary reaction test of Marcus Gunn, and photographic exploration of the nerve fiber layer of the retina.
Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Hipertensão Ocular/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Fibras Nervosas/patologia , Hipertensão Ocular/fisiopatologia , Atrofia Óptica/patologia , Disco Óptico/patologia , Reflexo Pupilar , Retina/patologia , Retina/fisiopatologia , Testes Visuais , Campos VisuaisRESUMO
With kinetic perimetry, the visual field chart had the appearance of a geographical map. Since the isopters were not geometric, their surfaces were barely measurable. However, with recent three dimensional computerised (or semi-computerised) perimetry quantitative evaluation of the print-out may easily be done. The visual acuity is expressed by a fraction or ratio. In a similar way our deficit ratio gives a percentage score of visual field volume defects. Using the Peritest, it is very easy to establish the field's deficit ratio. All the defects are classified and have a score. Scores are then added up to establish the deficit ratio. (The same procedure may be used with other perimeters like the Visual Field Analyser). Why express field loss as a deficit ratio? In the natural history of a Primary Open Angle Glaucoma (i.e. a disease of the visual field), the comparison between consecutive visual fields may be difficult. Instead of looking at a collection of print outs, it is easier to look at the numbers of the deficit ratio to appreciate if there is evolution of the disease. In discussions with the patient, it sounds better if the ophthalmologist speaks of a "percentage" of visual field loss: the patient may understand his own situation more easily. Each point is tested twice at each examination to give an idea of patient response fluctuation. Before finding progression of the disease, it is necessary to know the range of an individual's variation in answers. The principle of all sciences is to measure what is measurable, and to render measurable that which is not.
Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais , Computadores , Limiar Diferencial , Humanos , Macula Lutea/fisiopatologia , Pessoa de Meia-Idade , Escotoma/diagnóstico , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Testes de Campo Visual/instrumentaçãoRESUMO
Progress in the development of perimetry has been slow but certain since the first description of the perimeter by Goldmann in 1946. The creation of static perimetry, and of threshold detection with the multiple stimuli analyser of Friedmann, have been important stages in its development. Automatic perimetry (A.P.) is now available, our choice of apparatus being the Peritest, this instrument combining all the possibilities of A.P. with multiple or single manual perimetry in a very flexible manner. The apparatus allows 153 positions to be examined in the central 25 degrees and 55 in the periphery. The examination is conducted at a suprathreshold level (+ 0,6 log. U) after determination of the patient's eye threshold. Results are grouped in classes on a special chart to facilitate assessment. It is now possible, with the same instrument, to perform a detection A.P. (very useful in suspected glaucoma), a confirmative and limited manual study and, if necessary, a consecutive refined analysis.
Assuntos
Testes de Campo Visual/métodos , Campos Visuais , Glaucoma/fisiopatologia , Glaucoma de Ângulo Aberto/diagnóstico , História do Século XVII , História do Século XIX , História do Século XX , Humanos , Luz , Microcomputadores , Escotoma/diagnóstico , Limiar Sensorial , Testes de Campo Visual/história , Testes de Campo Visual/instrumentaçãoRESUMO
The possible applications of computer assisted static perimetry are examined after one and a half year of personal experience. The general advantage of a computer-assisted perimeter may be the elimination of the influence of the perimetrist on the results. We have employed the PERITEST perimeter because this system allows either full automatic perimetry or two types of manual perimetry with presentation of single or multiple stimuli. All perimetric examination is done after the determination of the individual visual retinal threshold. The examination is always performed at a supraliminal level relative to the individual threshold. The following conclusions can be drawn: 1 - Even after complete elimination of the perimetrist's influence fluctuations in results may be observed. Furthermore, the longer examination the more important patient cooperation becomes in automated perimetry as compared to the manual procedure. So we concluded that the best strategy should be related to the studies of the visual field defects. 2 - For perimetry of presupposed normal visual fields, the multiple stimulus procedure is quite adequate. If some problem appears, the flexibility of the PERITEST enables the use of the single manual stimulus mode. The full automatic examination is done only when there are mild field defects and in intelligent patients. 3 - These techniques enable the description of a new presentation of the classical perimetry's signs of early glaucoma: a loss of 0,5 Log. U.L. (which has the same significance as an isolated relative scotoma.
Assuntos
Testes de Campo Visual/métodos , Campos Visuais , Computadores , Limiar Diferencial , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Estimulação Luminosa/métodos , Escotoma/diagnóstico , Transtornos da Visão/diagnóstico , Testes de Campo Visual/instrumentaçãoRESUMO
Chronic glaucoma is a severe disease that can induce blindness.Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic(SF-36, SF-20 and SIP) and specific(VAQ, VF-14, NEI-VFQ) QOL questionnaires,one glaucoma-specific symptomatic scale (GSS),and one treatment preference scale (COMTol) have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to measure QOLin patients in the successive stages of the disease.
Assuntos
Glaucoma de Ângulo Aberto/psicologia , Glaucoma de Ângulo Aberto/terapia , Cooperação do Paciente , Qualidade de Vida , Atitude Frente a Saúde , Doença Crônica , Glaucoma de Ângulo Aberto/reabilitação , Humanos , Reprodutibilidade dos Testes , Ajustamento Social , Inquéritos e QuestionáriosRESUMO
Glaucoma is a serious ocular disorder potentially leading to blindness. Measuring the quality of life of patients with glaucoma is important because it makes it possible to evaluate the impact of the disease and its treatment on the patient's everyday life. Hitherto, this was done using generic scales, or those developed for other diseases; but no scale suitable for glaucoma was available. The recently developed GlauQOL scale is now available. We present the short version of this questionnaire adapted to individual use within an ophthalmology consultation setting.
Assuntos
Glaucoma , Qualidade de Vida , Inquéritos e Questionários , Glaucoma/diagnóstico , HumanosRESUMO
PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.
Assuntos
Glaucoma de Ângulo Aberto/economia , Hipertensão Ocular/economia , Idoso , Custos e Análise de Custo , Feminino , França , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/terapia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/cirurgia , Hipertensão Ocular/terapia , Análise de Regressão , Estudos Retrospectivos , Previdência Social , Análise de Sobrevida , Fatores de Tempo , Campos VisuaisRESUMO
The methods for developing Health-Related Quality-of-Life (HRQoL) measures and their application in medical research have demonstrated their utility in various chronic, progressive, or life-threatening diseases. The efforts made to allow the patient's perspective to be included in the methodological framework of evidence-based medicine have been successful. The assumption of a strong relationship between clinical status and daily life is certainly valid in ophthalmology. However, there is a lack of specific HRQoL measures dedicated to ophthalmic diseases. Our work aimed at creating the first Glaucoma-specific Quality of Life scale - the Glau-QoL questionnaire - to provide researchers and physicians with a comprehensive, practical, and validated tool. This article describes the first stage of the process, which consisted in generating items and formatting them in order to create a questionnaire that exhaustively covers the relevant concepts. The whole process was conducted by an expert committee including clinicians and methodologists. The standard recommendations in the development of a HRQoL questionnaire were followed: we first identified existing tools and performed a preliminary collection of concepts from the published literature; we then designed an interview guide with the help of clinicians; a trained psychologist interviewed 22 patients at various disease severity stages (from isolated hypertonic to severely impaired); the interviews were tape-recorded and scripted; general domains and related detailed concepts were identified from the script; they were then analyzed and organized; the format of the questionnaire was set up; and questions were derived from the patient's verbatim to capture the identified detailed concepts. The test questionnaire was applied to seven patients for cognitive debriefing. We finally amended the test questionnaire and designed the pilot questionnaire according to the patients' tests and the clinician's review. The test questionnaire was well accepted by the patients, despite a completion duration ranging from 14 to 35 minutes. The pilot questionnaire contained 151 items, grouped into 5 sections: (1) vision problems, physicians, and daily treatment (49 items); (2) activities of daily living (37 items); (3) self-expression (37 items); (4) vision problems and mood (14 items); and (5) other questions (14 items). The next step of our work will be the item reduction process and the psychometric validation of the Glau-QoL questionnaire.