Barriers to use of refractive services in Mozambique.

PURPOSE: Uncorrected refractive error remains a leading cause of visual impairment (VI) across the globe with Mozambique being no exception. The establishment of an optometry profession in Mozambique that is integrated into the public health system denotes significant progress with refractive services becoming available to the population. As the foundations of a comprehensive refractive service have now been established, this article seeks to understand what barriers may limit their uptake by the general population and inform decision making on improved service delivery. METHODS: A community-based cross-sectional study using two-stage cluster sampling was conducted. Participants with VI were asked to identify barriers that were reflective of their experiences and perceptions of accessing refractive services. A total of 4601 participants were enumerated from 76 clusters in Nampula, Mozambique. RESULTS: A total of 1087 visually impaired participants were identified (884 with near and 203 with distance impairment). Cost was the most frequently cited barrier, identified by more than one in every two participants (53%). Other barriers identified included lack of felt need (20%), distance to travel (15%), and lack of awareness (13%). In general, no significant influence of sex or type of VI on barrier selection was found. Location had a significant impact on the selection of several barriers. Pearson χ analysis indicated that participants from rural areas were found to feel disadvantaged regarding the distance to services (p ≤ 0.001) and adequacy of hospital services (p = 0.001). CONCLUSIONS: For a comprehensive public sector refractive service to be successful in Mozambique, those planning its implementation must consider cost and affordability. A clear strategy for overcoming lack of felt need will also be needed, possibly in the form of improved advocacy and health promotion. The delivery of refractive services in more remote rural areas merits careful and comprehensive consideration.

Target contrast affects reaching and grasping in the visually impaired subjects.

PURPOSE: The aim of this study is to investigate whether subjects with central visual impairment (VI) show different reaching and grasping behavior for targets of different contrasts compared with visually normal age-matched subjects. METHODS: Reaching and grasping performance was measured in 14 subjects with VI and 14 normal subjects. Subjects were asked to pick up a cylindrical target. Three different targets were used: black (low contrast), white (high contrast), and transparent, placed against a black background. A motion analysis system (Vicon 460) recorded and reconstructed the hand and finger movements. RESULTS: Significantly longer onset times, total movement duration, and time after maximum grip aperture were obtained for subjects with VI compared with normal subjects (p < 0.002). No significant differences existed in maximum velocity and grip aperture between the two groups for any of the targets. CONCLUSIONS: Subjects with VI took longer to initiate and to complete the movement. Maximum velocity and grip aperture were not different suggesting that once the target was "seen" by subjects with VI performance was similar to normal subjects. Time after maximum grip aperture was longer in subjects with VI indicating the need for "online" modifications in these subjects. Contrast sensitivity was significantly correlated to more indices than visual acuity.

How does the presence and duration of central visual impairment affect reaching and grasping movements?

PURPOSE: To examine how subjects with central visual impairment (CVI) due to macular degeneration conduct reaching and grasping movements compared to those with normal vision and to determine whether these are influenced by the duration of the impairment. METHODS: Eighteen subjects with CVI and 9 subjects of a similar age but with normal vision were recruited. Subjects were required to pick up a cylindrical object and a motion analysis system recorded and reconstructed the reaching and grasping movements in 3-D. Subjects were also divided into two groups based on the duration of their vision loss: subjects with CVI of less/greater than 10 years duration. RESULTS: Subjects with CVI showed significant differences in some transport and grasping indices compared to age matched normal subjects (p < 0.05) but not in all. More indices were correlated to contrast sensitivity (5) than to visual acuity results (2). CONCLUSIONS: Subjects with CVI required extra time prior to starting the movement (as shown by longer onset time) and this was probably needed to localise the object and to perceive its dimensions. They spent more time after maximum grip aperture, indicating a need for a longer time to grasp the object. A possible reason is that visually impaired patients need to use more tactile information than normal subjects in order to fully execute grasping of the object. CVI that was of <10 years in duration affected more indices compared to CVI that was of long standing and may suggest adaptation to the visual impairment for this task.

Bis{µ-2,2'-[(3-aza-pentane-1,5-di-yl)bis-(nitrilo-methyl-idyne)]diphenolato}dicopper(II) dimethyl sulfoxide disolvate.

The title compound, [Cu(2)(C(18)H(19)N(3)O(2))(2)]·2C(2)H(6)OS or [Cu(2)(SalenN(3)H)(2)]·2DMSO, where SalenN(3)H is the multidentate Schiff base 2,2'-[(3-aza-pentane-1,5-di-yl)bis-(nitrilo-methyl-idyne)]diphenolate dianion and DMSO is dimethyl sulfoxide, is a solvated dinuclear Cu(II) complex. The neutral complex is built from two Cu(SalenN(3)H) units related by an inversion center. All heteroatoms in the Schiff bases coordinate the Cu(II) ions, which display highly distorted trigonal bipyramidal geometries. The solvent mol-ecules are located in the structural voids of the complex and are disordered over two positions with occupancies of 0.642 (15) and 0.358 (15). The previously characterized acetone disolvate of the same complex presents identical mol-ecular and crystal structures, and crystallizes with cell parameters very close to those of the DMSO disolvate reported here.

[Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution]. / Hijo de madre con síndrome de HELLP: características y papel de la prematuridad, bajo peso y leucopenia en su evolución.

BACKGROUND: HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution. METHODS: A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place. RESULTS: Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed<1500g (four weighed <1000g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation. CONCLUSIONS: Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation.

How do flanking objects affect reaching and grasping behavior in participants with macular disorders?

PURPOSE: To investigate how objects (flankers) placed on either side of a target affect reaching and grasping behavior in visually impaired (VI) subjects due to macular disorders compared with age-matched normals. METHODS: Subjects reached out to grasp a cylindrical target placed on its own and when it had two identical objects (flankers) placed either half or one target diameter away on each side of the target. A motion analysis system (Vicon 460) recorded and reconstructed the 3-dimemsional (3D) hand and finger movements. Kinematic data for transport and grasping mechanisms were measured. RESULTS: In subjects with VI, crowding effected the overall movement duration, time after maximum velocity, and maximum grip aperture. Maximum effect was shown when the flankers were placed close to the target (high-level crowding) with a decreased effect shown for flankers placed farther away (medium-level crowding). Compared with normals, subjects with VI generally took longer to initiate the hand movement and to complete the movement. Time after maximum velocity and time after maximum grip aperture were also longer in subjects with VI. No interaction effects were found for any of the indices for the different levels of crowding in the two visual groups. CONCLUSIONS: Reaching and grasping behavior is compromised in subjects with VI due to macular disorders compared with normals, and crowding affected performance for both normal subjects and those with VI. Flankers placed half an object diameter away showed greater deterioration than those placed further away.

Hijo de madre con síndrome de HELLP: características y papel de la prematuridad, bajo peso y leucopenia en su evolución / Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution

ResumenIntroducción: El síndrome de HELLP es un grave trastorno hipertensivo del embarazo con importantes problemas neonatales en los hijos de las madres afectadas. El objetivo de este trabajo fue conocer las características de estos neonatos y su evolución.Métodos: Se llevó a cabo un estudio observacional descriptivo y retrospectivo de los neonatos hijos de madre con síndrome de HELLP, nacidos en un hospital universitario entre el 1° de enero de 2008 y el 31 de diciembre de 2013. Se estudiaron 33 neonatos procedentes de 28 gestaciones (cinco gemelares). Se realizó un análisis descriptivo y comparativo entre grupos, y posteriormente un análisis de multivarianza de factores asociados con la mortalidad dentro de la serie.Resultados: De 33 recién nacidos estudiados (2.2/1,000 recién nacidos totales), dos fueron mortinatos (6.1% del total) y cuatro fallecieron tras el nacimiento (12.9% de los neonatos vivos), con una mortalidad perinatal total del 18.2%; 28 neonatos terminaron la gestación antes de la semana 37 (84.8%) y 11 antes de la semana 32 (33.3%); siete neonatos pesaron menos de 1,500 g (cuatro de ellos menos de 1,000 g). De los 31 recién nacidos vivos, 13 neonatos tenían peso menor al percentil 10 para su edad gestacional (41.9%), 20 precisaron reanimación neonatal (64.5%) y 14 presentaban leucopenia neonatal (45.2%). En la regresión logística final, la mortalidad neonatal se asoció con la gran prematuridad, independientemente del bajo peso, leucopenia o necesidad de reanimación neonatal.Conclusiones: Los hijos de madre con síndrome de HELLP presentan elevada mortalidad asociada con la alta prematuridad, independientemente de la presencia de leucopenia, bajo peso para edad gestacional o necesidad de reanimación neonatal.

AbstractBackground: HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution.Methods: A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place.Results: Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed < 1500 g (four weighed <1000 g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation.Conclusions: Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation.

Reaching and grasping with restricted peripheral vision.

AIM: To investigate how prehensile movements, such as reaching and grasping, are affected by different fields of view when both haptic and visual information are available. METHODS: Ten volunteers with normal vision (mean age 24.5 years) participated. Subjects picked up an object with a full monocular field of view (FOV) and with two different sizes of pinholes which simulated a central FOV of 23 degrees and 11 degrees respectively. The Vicon motion analysis system was used to record and reconstruct the 3D-kinematic data. The kinematic parameters measured were total time of the movement, maximum velocity, time to maximum velocity, deceleration time, maximum grip aperture, time to maximum grip aperture and time taken after maximum grip aperture. RESULTS: Restricting the FOV affected both the transport and grasp components of the movement. The maximum velocity decreased (p = 0.008) and the maximum grip aperture increased (p = 0.003) with both restricted FOV when compared with the full field. The execution or on-line control of both reach and grasp components were also longer (p = 0.005 and p = 0.002 respectively) for the 11 degrees FOV only. CONCLUSIONS: Reducing the FOV to 11 degrees (an absence of peripheral vision) affects the planning and execution of the reach and the grasp component of the movement. Restricting the FOV to 23 degrees of central vision (with some peripheral cues present) affects only the planning of the reach and grasp component of the movement. Peripheral visual cues are therefore more important for the on-line control than for the planning of the movement. The findings of this study have important clinical implications in patients who suffer from ocular diseases in which peripheral vision gradually decreases.