Diseño y validación de material didáctico para una intervención educativa de enfermería en cuidadores primarios / Design and validation of didactic materials for a nursing educational intervention to primary caregivers / Desenho e validação de material didático para uma intervenção educativa de enfermagem em cuidadores primários

Resumen Introducción: El cuidador es una persona que en sí misma requiere cuidado, existe poca evidencia sobre la validación de material dirigido a cuidadores primarios de adultos en el domicilio. Objetivo: Diseñar y validar el material didáctico de apoyo en una propuesta de intervención educativa de enfermería para mejorar el autocuidado de cuidadores primarios de personas con enfermedades crónicas no transmisibles. Material y Métodos: Investigación metodológica para validación de diez carteles. Evaluación por cuatro expertos y diez cuidadores primarios. La investigación se desarrolló en cuatro fases: a) valoración de las necesidades en salud y determinación de los contenidos, b) elaboración de material didáctico, c) jueceo y validación técnica, d) validación con población. Se evaluaron los aspectos de atracción, comprensión, involucramiento y aceptación con un cuestionario dicotómico de ocho preguntas por cartel. Se calculó el coeficiente V de Aiken como indicador de aprobación. Se tomó el valor de 0.7 y superior como punto para la validación. Resultados: En la primera ronda de evaluación por los expertos se modificaron tres carteles por su bajo coeficiente de comprensión-atracción y se reelaboró un cartel. En la segunda versión de los carteles se alcanzaron coeficientes superiores a 0.81. Sin embargo, los cuidadores puntuaron dos carteles con valores inferiores al estándar, por lo que luego de tomar su opinión al respecto se modificaron aspectos de diseño. Discusión: Las recomendaciones de los expertos en el área y particularmente los intereses de los cuidadores primarios fueron la base para mejorar el diseño del material didáctico. Conclusiones: Tras ajustar elementos de la atracción y comprensión de los carteles se concluyó que el Material Didáctico (MD) es adecuado para su implementación en una Intervención Educativa (IE) dirigida a mejorar el autocuidado de cuidadores primarios.

Abstract Introduction: Caregivers are persons who themselves also need care, and there is few evidence regarding the validation of educational materials for caregivers of adult home care. Objective: To design and validate supporting didactic materials for a nursing educational intervention proposal in order to improve self-care among primary caregivers attending patients with non-transmissible chronic illnesses. Materials and Methods: This is a validating research study using 10 educational materials which were assessed by 4 field experts and 10 primary caregivers. The research study was developed in four stages: a) assessment of the health needs and determination of the contents for the education materials, b) elaboration of the education materials, c) technical validation, d) assessment on the use in a population. Features of attractiveness, comprehension, involvement, and acceptance were estimated using a dichotomous questionnaire of 8 questions for each educational material. The Aiken V coefficient of approval was calculated. Values greater than 0.7 were considered as valid results. Results: In the first round of assessment by the experts, three educational materials were modified due to their low coefficient of comprehension-attractiveness and one education material was redesigned. The subsequent version of the education materials showed coefficients higher than 0.81, however, caregivers gave two materials scores below the standard, and these materials were further redesigned. Discussion: The recommendations from the experts in the field, along with the interests of the primary caregivers, were the base to improve the design of the didactic materials. Conclusions: After adjusting elements related to the attractiveness and comprehension of the didactic materials, it was concluded that the redesigned materials were adequate for an educational intervention aimed at improving self-care among primary caregivers.

Resumo Introdução: O cuidador é uma pessoa que em si mesmo requer de cuidado, há pouca evidência sobre a validação de material dirigido aos cuidadores primários de adultos no domicílio. Objetivo: Desenhar e validar o material didático de apoio em uma proposta de intervenção educativa de enfermagem para melhorar o autocuidado de cuidadores primários de pessoas com doenças crônicas não transmissíveis. Material e Métodos: Pesquisa metodológica para validação de dez pôsteres. Avaliação por quatro especialistas e dez cuidadores primários. A pesquisa desenvolveu-se em quatro fases: a) avaliação das necessidades de saúde e determinação dos conteúdos, b) elaboração do material didático, c) julgamento e validação técnica, d) validação com população. Avaliaram-se os aspectos de atração, compreensão, envolvimento e aceitação com um questionário dicotômico de oito perguntas por pôster. Foi calculado o coeficiente V de Aiken como indicador de aprovação. Tomou-se o valor de 0.7 e superior como ponto para a validação. Resultados: Na primeira rodada de avaliação dos especialistas modificaram-se três pôsteres por seu baixo coeficiente de compreensão-atração e foi reelaborado um pôster. Na segunda versão dos pôsteres foram alcançados coeficientes superiores a 0.81. Porém, os cuidadores pontuaram dois pôsteres com valores inferiores ao padrão, portanto, após se manifestarem sobre o assunto modificaram-se aspectos de desenho. Discussão: As recomendações dos especialistas da área e particularmente, os interesses dos cuidadores primários foram a base para melhorar o desenho do material didático. Conclusões: Após ajustar elementos da atração e compreensão dos pôsteres foi concluído que o MD é adequado para sua implementação em uma IE dirigida a melhorar o autocuidado de cuidadores primários.

Visual impairment and refractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019).

PURPOSE: To estimate the nationwide prevalence of visual impairment and associated refractive error in school children in Bhutan. METHODS: The sample of this prospective cross-sectional national survey comprised of randomly selected classes in levels IV-IX (age 10 to 15 years) from schools throughout Bhutan. The examination included measurement of visual acuity (VA), evaluation of ocular motility, refraction under cycloplegia, examination of the external eye, media and fundus. The principal cause of impairment was determined for eyes with uncorrected VA ≤6/12. The main outcome measures were distance VA and cycloplegic refractive error. RESULTS: With a sampling frame of 1967 class-based clusters from 190 schools, 160 classes in 103 schools were randomly selected; 4985 (98.5%) of 5060 enumerated children were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (VA≤6/12) in the better eye was 14.5%, 12.8%, and 0.34%, respectively. Refractive error was the principal cause (94.2%) of impaired vision and 88% of children who could achieve VA ≥6/9 with best correction were without necessary spectacles. The prevalence of myopia (≤ -0.5 D) was 6.64% and was associated with female gender (P = 0.004), urban schooling (P = 0.002), and greater parental education (P<0.001). The prevalence of hyperopia (≥ +2.0 D) was 2.17% and was significantly associated with lower class-level (P = 0.033), and female gender (P = 0.025). The overall prevalence of astigmatism (≥ 0.75 D) was 9.75%. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a public health problem among school-age children in Bhutan. Effective school eye health strategies are needed to eliminate this easily treatable cause of visual impairment.

Impact of pre-radiation therapy quality of life in lung cancer survival: a prospective, intention-to-treat, multicenter study.

PURPOSE: Lung cancer (LC) has a significant impact on patients' health-related quality of life (HRQoL). We investigate the correlations between pre-radiation therapy HRQoL and survival. MATERIALS AND METHODS: A prospective, intention-to-treat, multicentre study of 437 patients with LC recruited at the radiation oncology departments of three different institutions was conducted between 2012 and 2016. QoL was assessed using the EORTC-QLQ-C30 (v3.0) and EORTC-QLQ-LC13 questionnaires. Global health status (GHS), physical (PF), role functioning (RF), emotional (EF), cognitive (CF), and social functioning (SF) as well as symptoms scores were evaluated in univariate and multivariate analyses. RESULTS: The cohort consisted of 376 men (86%) and 61 women, with a median age of 66 years (range 31-88). Histology was: 72% (n = 315) non-small cell lung cancer and 28% small cell lung cancer. The most common stage was III (80%) and the median follow-up for alive patients was 30 months (range 7-76). Multivariate analysis showed that RF was associated with a lower risk of mortality (HR: 0.693; p = 0.008) and recurrence (HR: 0.737; p = 0.040). Additionally, lower scores on EF and PF were associated with higher mortality (HR: 0.696; p = 0.003 and HR: 0.765; p = 0.044, respectively). Appetite loss, constipation, and dysphagia were associated with a higher risk of mortality (HR: 1.985; p < 0.001, HR: 1.373; p = 0.036, and HR: 1.659; p = 0.002, respectively), while appetite loss was the only symptom associated with a higher risk of recurrence (HR: 1.525; p = 0.014). CONCLUSIONS: Pre-radiation therapy scores on RF, EF, and PF and symptoms like appetite loss, dysphagia, and constipation were associated with the risk of mortality. This information could be added to other prognostic factors to guide our treatment decisions.

[Cavernous hemangioma of the nasal bones: a case report]. / Hemangioma cavernoso de huesos propios de la nariz: a propósito de un caso.

Cavernous hemangiomas represent less than 1% of all bone tumours, with the vertebrae and the skull being the most common locations. These tumours are extremely rare in the bones of the nose, with very few cases published in the medical literature, where they have been reported in turbinates, vomer, nasal bones or perpendicular lamina of the ethmoid. They usually present as a tumour lesion that grows over time, involving the bone and even the soft tissues, which can cause complications such as nasal obstruction, bleeding, ulcerations and infection. We present the case of a 37 year-old patient with a cavernous hemangioma located in the bones of the nose, reviewing the most notable aspects of this rare tumour. Keywords. Cavernous Hemangioma. Bone hemangioma. Nasal tumor. Nasal bones. Surgical treatment.

Cataract Surgical Coverage and Visual Acuity Outcomes in Rural China in 2014 and Comparisons With the 2006 China Nine-Province Survey.

PURPOSE: To estimate surgical coverage of cataract-related vision impairment and blindness and visual acuity outcomes in operated eyes in rural China in 2014 with comparisons with the 2006 Nine-Province Survey. DESIGN: Population-based, cross-sectional study. METHODS: Geographical cluster sampling was used in randomly selecting residents from a rural county or semi-rural district within 9 provinces: Beijing, Jiangsu, Guangdong, Heilongjiang, Jiangxi, Hebei, Ningxia, Chongqing, and Yunnan. Persons 50 years of age or older were enumerated through household visits and invited to examination sites for visual acuity testing and ocular examination. Surgical coverage and visual acuity outcomes in 2014 were compared with data from the 2006 survey. RESULTS: Among 51 310 examined persons, surgical coverage among those presenting with cataract-related severe visual impairment or blindness (<20/200) was 62.7% overall, ranging from 43.4% to 83.6% across the 9 study sites. Unoperated cataract was significantly associated with older age, female sex, and lack of education. Presenting visual acuity outcomes ≥ 20/63 in cataract-operated eyes was 62.2% overall, ranging from 51.6% to 78.6%, and 75.2%, ranging from 67.1% to 81.5%, with best-corrected visual acuity. As a proportional percentage of cataract surgical coverage in 2006, overall surgical coverage increased by 81.4% during the 2006-2014 interval, and by 110% when adjusted for visual acuity outcomes ≥ 20/63. CONCLUSIONS: Cataract blindness control is well underway in rural China, as evidenced by significant increases in cataract surgical coverage and improvement in visual acuity outcomes during the 2006-2014 interval. Further efforts are needed to provide greater access to affordable cataract surgery for the elderly, female persons, and those with little or no education.

Metabolic response 4 years after gastric bypass in a complete cohort with type 2 diabetes mellitus.

AIMS: To evaluate the long-term remission rates of type 2 diabetes mellitus and associated comorbidities after gastric bypass surgery in a complete cohort, in a real-life clinic setting. METHODS: A retrospective study of all consecutive patients with type 2 diabetes mellitus who underwent gastric bypass at a Veterans Affairs Medical Center from 2003 to 2010. The main outcome was remission of type 2 diabetes mellitus defined as HbA1c <6.5% (49 mmol/mol) without diabetic medication usage. Secondary outcomes were remission of hypertension and hyperlipidemia, weight loss, and long-term complications four years post-gastric bypass. RESULTS: Eighty-four patients with type 2 diabetes mellitus underwent gastric bypass. Four-year follow-up data were available for 92% (77/84) of patients. The patients (73% male; mean age 54 years) had a mean body mass index of 49 kg/m2 ±â€¯8.3. Hypertension and hyperlipidemia prevalence were 92% and 85%, respectively. The mean total body weight decrease over four years was 35 kg ±â€¯21. Remission of type 2 diabetes mellitus occurred in 15% at 6 months and 49% four years after surgery. Diabetes remission was more likely (OR 3.2; 95% confidence interval 1.2-9.7) in patients not using insulin at baseline. Remission rates were 12% (9/74) for hypertension and 16% (11/68) for hyperlipidemia. Long-term surgical complications included reoperation (11%), incisional hernia (10%) and anastomotic ulcer (10%). Forty-four percent of patients had one or more nutritional complications. CONCLUSIONS: The metabolic effects of gastric bypass are significant and durable for at least four years, even in a predominantly male cohort and real-life clinical setting.

Comparison of Methods for Analyzing Human Adipose Tissue Macrophage Content.

OBJECTIVE: The relationship between inflammation, obesity, and adverse metabolic conditions is associated with adipose tissue macrophages (ATM). This study compared the measurements of human ATM using flow cytometry, immunohistochemistry (IHC), and real-time polymerase chain reaction (RT-PCR) of ATM markers. METHODS: A new software program (AMCounter) was evaluated to help measure ATM using IHC, and this was compared to flow cytometry and RT-PCR. RESULTS: IHC had good intraindividual reproducibility for total (CD68), proinflammatory (CD14), and anti-inflammatory (CD206) ATM. The AMCounter improved interreader agreement and was more time efficient. Flow cytometry had acceptable intraindividual reproducibility for the percentage of CD68+ cells that were CD14+ or CD206+ , but not for ATMs per gram of tissue. ATMs per gram of tissue was much greater using IHC than flow cytometry. The flow cytometry and IHC measures of ATM from the same biopsies were not correlated. There were statistically significant correlations between RT-PCR CD68 and IHC CD68, CD14, and CD206 ATMs per 100 adipocytes. Also of interest were statistically significant correlations between RT-PCR CD68 and IHC CD68, CD14, and adipose flow cytometry measures of CD68+ , CD68+ /CD14+ , and CD68+ /CD206+ ATMs per gram of tissue. CONCLUSIONS: The AMCounter software helps provide reproducible and efficient measures of IHC ATMs. Flow cytometry, IHC, and RT-PCR measures of adipose inflammation provide somewhat different information.

Key Issues in Hymenoptera Venom Allergy: An Update.

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.

Thyroglobulin (Tg) Testing Revisited: Tg Assays, TgAb Assays, and Correlation of Results With Clinical Outcomes.

CONTEXT: Measurement of thyroglobulin (Tg) by mass spectrometry (Tg-MS) is emerging as a tool for accurate Tg quantification in patients with anti-Tg autoantibodies (TgAbs). OBJECTIVE: The objective of the study was to perform analytical and clinical evaluations of two Tg-MS assays in comparison with immunometric Tg assays (Tg-IAs) and Tg RIAs (Tg-RIAs) in a cohort of thyroid cancer patients. METHODS: A total of 589 samples from 495 patients, 243 TgAb-/252 TgAb+, were tested by Beckman, Roche, Siemens-Immulite, and Thermo-Brahms Tg and TgAb assays, two Tg-RIAs, and two Tg-MS assays. RESULTS: The frequency of TgAb+ was 58%, 41%, 27%, and 39% for Roche, Beckman, Siemens-Immulite, and Thermo-Brahms, respectively. In TgAb- samples, clinical sensitivities and specificities of 100% and 74%-100%, respectively, were observed across all assays. In TgAb+ samples, all Tg-IAs demonstrated assay-dependent Tg underestimation, ranging from 41% to 86%. In TgAb+ samples, the use of a common cutoff (0.5 ng/mL) for the Tg-MS, three Tg-IAs, and the USC-RIA improved the sensitivity for the Tg-MSs and Tg-RIAs when compared with the Tg-IAs. In up to 20% of TgAb+ cases, Tg-IAs failed to detect Tg that was detectable by Tg-MS. In Tg-RIAs false-high biases were observed in TgAb+ samples containing low Tg concentrations. CONCLUSIONS: Tg-IAs remain the method of choice for Tg quantitation in TgAb- patients. In TgAb+ patients with undetectable Tg by immunometric assay, the Tg-MS will detect Tg in up to 20% additional cases. The Tg-RIA will detect Tg in approximately 35% cases, but a significant proportion of these will be clinical false-positive results. The undetectable Tg-MS seen in approximately 40% of TgAb+ cases in patients with disease need further evaluation.

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study.

PURPOSE: To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). METHODS: SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. RESULTS: Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2-82.3%), PVA <20/63-20/200 in 11 (15.8%, 95% CI 8.9-22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3-17.9%). CONCLUSIONS: Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.

The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study.

BACKGROUND: Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. METHODS: A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. RESULTS: Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). CONCLUSION: The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully.

Randomized trial of nutrition education added to internet-based information and exercise at the work place for weight loss in a racially diverse population of overweight women.

OBJECTIVE: Obesity in the United States is highly prevalent, approaching 60% for black women. We investigated whether nutrition education sessions at the work place added to internet-based wellness information and exercise resources would facilitate weight and fat mass loss in a racially diverse population of overweight female employees. METHODS: A total of 199 (average body mass index 33.9±6.3 kg m(-2)) nondiabetic women (57% black) at our institution were randomized to a 6-month program of either internet-based wellness information (WI) combined with dietitian-led nutrition education group sessions (GS) weekly for 3 months and then monthly with shift in emphasis to weight loss maintenance (n=99) or to WI alone (n=100). All were given access to exercise rooms convenient to their work site. Fat mass was measured by dual-energy X-ray absorptiometry. RESULTS: WI+GS subjects lost more weight than WI subjects at 3 months (-2.2±2.8 vs -1.0±3.0 kg, P>0.001). Weight (-2.7±3.9 vs -2.0±3.9 kg) and fat mass (-2.2±3.1 vs -1.7±3.7 kg) loss at 6 months was significant for WI+GS and WI groups (both P<0.001), but without significant difference between groups (both P>0.10); 27% of the WI+GS group achieved 5% loss of initial weight as did 18% of the WI group (P=0.180). Blacks and whites similarly completed the study (67 vs 74%, P=0.303), lost weight (-1.8±3.4 vs -3.3±5.2 kg, P=0.255) and fat mass (-1.6±2.7 vs -2.5±4.3 kg, P=0.532), and achieved 5% loss of initial weight (21 vs 32%, P=0.189), irrespective of group assignment. CONCLUSION: Overweight women provided with internet-based wellness information and exercise resources at the work site lost weight and fat mass, with similar achievement by black and white women. Additional weight loss benefit of nutrition education sessions, apparent at 3 months, was lost by 6 months and may require special emphasis on subjects who fail to achieve weight loss goals to show continued value.

[Prevalence of blindness and low vision among adults aged 50 years or above in Ji'an county of Jiangxi province: the China nine-province survey].

OBJECTIVE: To estimate the prevalence of cataract, the outcomes of cataract surgery, cataract surgical coverage rate, cataract blindness social burden rate in Ji'an county of Jiangxi province, China. METHODS: Cluster sampling was used in randomly selected 5010 individuals aged ≥ 50 years in Ji'an county of Jiangxi province. All individuals were received visual acuity and eye examination, including the evaluation of lens status and cataract surgical status by slit lamp biomicroscopy. Data bank was established by Epi-info Software. Statistical analyses were performed using Stata/SE Statistical Software, release 9.0 (Stata Corp, College Station, TX). Confidence intervals and P values (considered significance at the P < 0.05 level) for prevalence of cataract, cataract surgical coverage rate, cataract blindness social burden rate and outcomes of surgery were calculated with adjustment for clustering effects and stratification associated with the sampling design. RESULTS: In 5010 individuals, 1158 cases of cataract were found, the prevalence of cataract was 23.11% among adults aged 50 or above. The prevalence of cataract was higher in the aged, female (P < 0.01). In 99 eyes with cataract surgery, 50.51% and 5.05% of eyes were performed by the modern extra-capsular surgery and phacoemulsification respectively. The rate of intraocular lens implantation was 55.56%. Post-operative presenting and best corrected visual acuity equal to or more than 0.7 was 10.1% and 45.5% of operated eyes respectively. The main causes of the post-operated eyes with worse visual acuity were post-capsular opacity and refractive error. The cataract surgical coverage rate was 32.29%, and the cataract blindness social burden rate was 3.83%. The cataract surgical rate was lower and cataract blindness social burden rate was higher in the aged persons (P < 0.01). CONCLUSIONS: Cataract is the most common eye disease that may lead into blindness and severe visual impairment among older adults aged equal or more than 50 years. The cataract surgical coverage rate is not high but the cataract blindness social burden rate is heavy in Ji'an county. The rate of intraocular lens implantation need increase and the visual outcomes of the surgery should be further improved in the future.

[Prevalence and surgery status of cataract among adults aged 50 years or above in the Shunyi district of Beijing: the China Nine-Province Survey].

OBJECTIVE: To assess the prevalence of cataract, the outcomes of cataract surgery, the rate of cataract surgical coverage, and the rate of cataract blindness social burden. METHODS: Cluster sampling was used in 5118 randomly selected individuals aged > or = 50 years in the Shunyi district of Beijing from April to August 2006. All individuals were received visual acuity and eye examination, including the evaluation of lens status and cataract surgical status by slit lamp biomicroscopy. Data bank was established by Epi-info Software. Statistical analyses were performed using Stata/SE Statistical Software, release 9.0 (Stata Corp, College Station,TX). Multiple logistic regression analysis was employed to analyzed the prevalence of cataract,cataract surgical coverage rate,cataract blindness social burden rate and outcomes of surgery among different ages, sex and educational background. RESULTS: In 5118 individuals, 797 cases of cataract were found, the prevalence of cataract was 15.57% among adults aged 50 or above. The prevalence of cataract was higher in the aged, female, illiterate persons (P < 0.01). In 189 eyes with cataract surgery, 65.08% and 23.28% of eyes were performed by the modern extra-capsular surgery and Phacoemulsification respectively. The rate of intraocular lens implantation was 89.42%. Post-operative presenting and best corrected visual acuity more than 0.7 was 30.16% and 61.38% of operated eyes respectively. The main causes of the post-operated eyes with worse visual acuity were post-capsular opacity and refractive error. The cataract surgical coverage rate was 62.22%, and the cataract blindness social burden rate was 2.64%. The cataract surgical rate was lower and cataract blindness social burden rate was higher in the aged persons (P < 0.01). CONCLUSIONS: Cataract is the most common eye disease that may lead into blindness and severe visual impairment among older adults aged equal or more than 50 years. The cataract surgical coverage rate is high in the Shunyi district, but still is lower in the aged persons. The visual outcomes of the surgery should be further improved in the future.

[Prevalence and surgery status of cataract among adults aged 50 years or above in Qidong City of Jiangsu Province: the China Nine-Province Survey].

OBJECTIVE: To estimate the prevalence of cataract, the rate of cataract surgical coverage rate,and the rate of cataract-blindness social burden among older adults aged 50 years or above in Qidong City of Jiangsu Province, China, in 2006. METHODS: Cluster sampling was used in randomly selected 5662 individuals aged 50 years or above in 16 clusters in Qidong City. 5141 individuals received visual acuity and eye examination from September to December 2006. Lens and cataract operation status were evaluated by slit lamp. Multiple logistic regression analysis was employed to analyzed the prevalence of cataract, cataract surgical coverage rate, cataract blindness social burden rate and outcomes of surgery among different ages, sex and educational background. RESULTS: In 5141 individuals, 1098 cases of cataract were found, the prevalence of cataract was 21.35% among adults aged 50 or above. The prevalence of cataract was higher in the aged, female, illiterate persons (P < 0.01). In 89 eyes with cataract surgery, 25.84% and 42.70% of eyes were performed by the modern extra-capsular surgery and Phacoemulsification respectively. The rate of intraocular lens implantation was 69. 66%. Post-operative presenting and best corrected visual acuity more than 0.7 was 24.70% and 48.31% of operated eyes respectively. The main causes of the post-operated eyes with worse visual acuity were retinal disorders post-capsular opacity and glaucoma. The cataract surgical coverage rate was 37.96%, and the cataract blindness social burden rate was 2.10%. The cataract blindness social burden rate was higher in the aged persons (P < 0.01). CONCLUSIONS: Cataract is the most common and important eye disease that may lead into blindness and severe visual impairment among older adults aged 50 years or above. The cataract surgical coverage rate is not so high in Qidong City, and even lower in the aged persons. The first important task in blindness prevention still is the elimination of cataract blindness. The visual outcomes of the cataract surgery should be further improved in the future.

[Sampling and measurement methods of the protocol design of the China Nine-Province Survey for blindness, visual impairment and cataract surgery].

OBJECTIVE: To design the protocol of the China nine-province survey for blindness, visual impairment and cataract surgery to evaluate the prevalence and main causes of blindness and visual impairment, and the prevalence and outcomes of the cataract surgery. METHODS: The protocol design was began after accepting the task for the national survey for blindness, visual impairment and cataract surgery from the Department of Medicine, Ministry of Health, China, in November, 2005. The protocol in Beijing Shunyi Eye Study in 1996 and Guangdong Doumen County Eye Study in 1997, both supported by World Health Organization, was taken as the basis for the protocol design. The relative experts were invited to discuss and prove the draft protocol. An international advisor committee was established to examine and approve the draft protocol. Finally, the survey protocol was checked and approved by the Department of Medicine, Ministry of Health, China and Prevention Program of Blindness and Deafness, WHO. RESULTS: The survey protocol was designed according to the characteristics and the scale of the survey. The contents of the protocol included determination of target population and survey sites, calculation of the sample size, design of the random sampling, composition and organization of the survey teams, determination of the examinee, the flowchart of the field work, survey items and methods, diagnostic criteria of blindness and moderate and sever visual impairment, the measures of the quality control, the methods of the data management. CONCLUSION: The designed protocol became the standard and practical protocol for the survey to evaluate the prevalence and main causes of blindness and visual impairment, and the prevalence and outcomes of the cataract surgery.

[The healthcare professional's perceptions on the implementation and usefulness of the surgical safety checklist]. / Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica.

OBJECTIVE: To find out the perception of the health care professionals on the level of implementation and the usefulness of the surgical safety checklist (LVQ) after its introduction in a tertiary care hospital. MATERIAL AND METHOD: A descriptive cross-sectional study was conducted using a specially designed self-completion questionnaire. This consisted of 5 questions on the usefulness, 5 questions on the use of the LVQ, one open question and 4 control questions. The target population was hospital surgeons, anaesthetists, ward nurses, and surgical nurses. RESULTS: The response rate was 73%, ranking from 51% to 88% depending on the respondent profile. Almost all (95.7%) of the respondents declared they always or almost always used the LVQ when performing a surgical operation. The health care professionals rated the usefulness of the LVQ with a mean of 6.6 (scale, 1-10); 11.6% mentioned that actual errors had been avoided through the use of the LVQ; 32.5% considered the LVQ as a tool that improves communication between professionals; and 68% of the respondents declared they would like the LVQ to be used if they were surgical patients. Those respondents who answered that the LVQ had prevented errors gave higher usefulness scores, 1.4 above the mean. In this same group, 100% of the respondents would like the LVQ to be used on themselves and 63.2% considered that communication had improved. There were no differences in usefulness scores as regards professional experience or gender. CONCLUSIONS: The health care professionals use the LVQ very frequently, and consider that it has a moderate usefulness. Those professionals with experience of the LVQ preventing errors considered it to be more useful than those who did not experience an error being prevented.

Bio-inspired porous SiC ceramics loaded with vancomycin for preventing MRSA infections.

Implant-related infections are a serious complication in orthopaedic and dental surgery resulting in prolonged hospitalization, high medical costs and patient mortality. The development of porous implants loaded with antibiotics may enable a local delivery for preventing surface colonization and biofilm formation. A new generation of bio-derived porous ceramic material that mimics hierarchical structures from Nature was evaluated. Silicon carbide ceramics derived from Sapelli wood (bioSiC) were obtained by pyrolysis of Entandrophragma cylindricum wood followed by infiltration with molten silicon. This process renders disks that keep the bimodal pore size distribution (3 and 85 µm) of the original material and are highly cytocompatible (BALB/3T3 cell line). The ability of the bio-ceramic to load the antimicrobial agent vancomycin was evaluated by immersion of disks in drug solutions covering a wide range of concentrations. The disks released at pH 7.4 an important amount of drug during the first 2 h (up to 11 mg/g bioSiC) followed by a slower release, which is related to the presence of macro- and mesopores. Finally, the anti-biofilm effect against methicillin resistant Staphylococcus aureus was assessed and a considerable reduction (92%) of the bacterial film was observed. Results highlight the bioSiC potential as component of medicated medical devices.

Aplicaciones de la toxina botulínica en glándulas salivales / Application of botulinum toxin in salivary glands

Botulinum toxin is a neuromodulator produced by Clostridium botulinum, a gram-negative, anaerobic bacterium responsible for botulism. The clinical utility of botulinum toxin initially became evident in the treatment of strabismus. Subsequently, botulinum toxin has been used for a variety of other medical conditions such as muscular hyperactivity, including blepharospasm, hemifacial spasm, and cervical dystonia. In addition to its well-known applications, within the properties of botulinum toxin are those that make possible the treatment of various diseases affecting salivary glands and oral cavity. Recently there has been an important development in research and finding new applications in otolaryngology. Recent studies have demonstrated the advantages of botulinum toxin injected into the salivary glands of patients who present drooling, reducing the salivary flow and improving their quality of life. In the same way it has proven to be effective as a treatment of sialocele in patients with parotid gland surgery. In parotid and pharyngocutaneous fistula it has proven effective in reducing the salivary flow, facilitating the closure of the defect. Moreover, in patients with Frey’s syndrome it has been effective reducing symptoms and improving quality of life. It has also been histologically demonstrated its protective effect on the glandular damage in patients undergoing radiotherapy.