Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener.

INTRODUCTION: With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. METHODS: Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. RESULTS: In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < - 0.06D or SE < - 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p < 0.001 versus p = 0.628) and in 10-18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of - 0.10D in Plusoptix_A09 predicted a myopia progression of - 0.04D and - 0.05D, respectively. CONCLUSION/RELEVANCE: This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of - 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.

Myopia control: short-term effect of 0.01% atropine vs. defocus incorporated multiple segment lenses-a retrospective study in European children.

PURPOSE: To compare 0.01% atropine with DIMS spectacle lenses in the prevention of myopia progression in European children. METHODS: This was a retrospective study including data from pediatric European patients with myopia. From November 2021 to March 2022, only 0.01% atropine was prescribed because DIMS lenses were still not available in Portugal. From March to October 2022, only DIMS spectacle lenses were prescribed due to patients' parents' preference. Myopia progression endpoints were axial length (AL) and spherical equivalent (SE) differences between before and 6 months after treatment. AL and SE evolution were compared using a general linear model with repeated measures. RESULTS: The study included 98 eyes from 50 patients: 47 in the atropine group and 51 in the DIMS group. There were no statistically significant differences between groups in terms of initial AL, initial SE, sex or age. The mean AL elongation at 6 months was 0.057 mm in the atropine group (SD = 0.118) and 0.002 mm (SD = 0.077) in the DIMS group. SE progression was - 0.098 (SD = 0.232) D in the atropine group and - 0.039 (SD = 0.105) D in the DIMS group. AL elongation was significantly lower in the DIMS lens group (p = 0.038, partial Eta2 = 0.045). There was no difference in SE progression between groups (p = 0.302, partial Eta2 = 0.011). CONCLUSION: Comparison between 0.01% atropine eyedrops and DIMS spectacle lenses for slowing the progression of myopia favored DIMS lenses in terms of AL elongation in a short-term follow-up. There was no difference in terms of SE between groups.

Ophthalmologic Manifestations of Wolfram Syndrome: Report of 14 Cases.

PURPOSE: The aim of this study was to describe ophthalmological abnormalities in 14 cases of Wolfram syndrome belonging to 9 different families. METHODS: Patients were submitted to a complete ophthalmological, neurological, otorhinolaryngological, urological, and genetic evaluation. RESULTS: Our sample comprised 14 Caucasian patients belonging to 9 different families. Their ages ranged from 10 to 38 years. The mean duration of known disease was 11.3 ± 8.7 years. Genetic confirmation was obtained in 7 families. There was a parental consanguinity history in 2 families. Five families were homozygous for a mutation of exon 8 of the WFS1 gene (Chr. 4), and 2 patients were heterozygous. Diabetes mellitus was the first manifestation in all except 1 patient. The mean age at diagnosis was 8.7 years (range 3-22). None had diabetic retinopathy. The mean age at diagnosis of optic atrophy was 11.1 years (range 8-35). The best-corrected visual acuity ranged from counting fingers to 20/50. CONCLUSIONS: Association of optic atrophy with insulin-dependent diabetes mellitus should raise the suspicion of Wolfram syndrome.

Retinal vein and artery occlusion as the first manifestation of primary antiphospholipid syndrome in a pediatric patient.

Antiphospholipid syndrome is an acquired autoimmune disease characterized by hypercoagulability associated with recurrent venous and arterial thromboembolism in the presence of antiphospholipid antibodies. Herein, we report a case of rapid sequential retinal vein and artery occlusion as the first manifestation of a primary antiphospholipid syndrome triggered by an acute Mycoplasma infection in a previously healthy 11-year-old patient. On day 1, ophthalmoscopy revealed a central retinal vein occlusion. The patient developed temporal branch retinal artery occlusion the next day. On day 3, a central retinal artery occlusion was observed. Serum lupus anticoagulant, immunoglobulin (Ig) G anticardiolipin, IgG anti-ß2-glycoprotein 1 antibody, and Mycoplasma pneumoniae IgM antibody levels were increased. Thus, retinal vascular occlusions can be the first manifestation of primary antiphospholipid syndrome. Although it may not improve visual prognosis, prompt diagnosis and treatment are essential to avoid further significant morbidity.

Prediction and cost-effectiveness comparison of amblyopia screening methods at ages 3-4 years.

PURPOSE: Compare the performance of different amblyopia screening tests. METHODS: Based on exploratory factor analyses (EFA) of different screening tests performed in 3295 children, we created models of screening strategies in a matrix with: uncorrected visual acuity (UCVA), Plusoptix measurements (PO), Randot Stereo-test (SR), and Cover-Test (CT). Receiver Operating Characteristic (ROC) curves and confusion matrix were used to compare performance of different model's algorithm to predict new diagnosis of amblyopia. Estimated screening costs per screened and treated child were compared. RESULTS: Regression analyses revealed that, although all models predicted amblyopia (all p < 0.001), only models including PO or UCVA had higher prediction capacity (R2 > 0.4) and better discriminating ROC curves (AUC > 0.95; p < 0.001). For 96% sensitivity, UCVA + PO was the most cost-effective model, since the estimated average screening costs per treated child, almost doubled and tripled if using PO or UCVA alone, respectively, versus using both exams. When UCVA + PO is not possible to implement, adding SR to either UCVA or PO resulted in cost-savings of 28% and 18%, respectively. CONCLUSIONS: In a previous unscreened population, aged 3-4 years, screening programs using either UCVA or PO alone, should reconsider doing both tests simultaneously, since, for a high level of sensitivity, using simultaneously UCVA + PO is more cost-effective, per screened, and treated amblyopia. Concerns relating higher time-consuming exams for the combination of UCVA + PO should be surpassed, since costs per treated child drop considerably. When children benefit from good primary-care routine examinations since birth, no benefit was found for using CT in a screening setting. SR showed little benefit.

Amblyopia screening effectiveness at 3-4 years old: a cohort study.

OBJECTIVE: To study the effectiveness of amblyopia screening at ages 3-4. METHODS AND ANALYSIS: From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated. RESULTS: Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia. CONCLUSIONS: Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.

Bilateral papilledema and abducens nerve palsy following cerebral venous sinus thrombosis due to Gradenigo's syndrome in a pediatric patient.

PURPOSE: To report a case of bilateral papilledema and abducens nerve palsy following cerebral venous sinus thrombosis in a 9-year-old female with undiagnosed Gradenigo's Syndrome. OBSERVATIONS: The patient presented to our Emergency Room with a unilateral left 6th nerve palsy, left eye relative afferent pupillary defect, and bilateral papilledema. She underwent cranial magnetic resonance imaging with gadolinium contrast and magnetic resonance venography, which diagnosed a left mastoiditis, left sigmoid sinus and jugular vein thrombosis. The patient underwent urgent mastoidectomy and myringotomy with tube placement and was admitted for adequate treatment with intravenous antibiotics and anticoagulants. CONCLUSIONS AND IMPORTANCE: Gradenigo's syndrome is a rare complication of otitis media, and even rarer is cerebral venous thrombosis. This potentially life-threatening situation requires immediate surgical and antibiotic therapy. Ocular symptoms can be the initial signs of this illness.

How Many Plusoptix S04 Measures Yield the Most Sensitive Amblyopia Screening?

PURPOSE: To analyze how the Plusoptix S04 (Plusoptix, Atlanta, GA), a widely used technology for amblyopia screening, predicts amblyopia. METHODS: A total of 1,547 children aged 3 to 4 years underwent a non-invasive eye examination in a whole population screening. The Plusoptix was measured binocularly three consecutive times. Seven models were developed: the first (P1), second (P2), and third (P3) measure of Plusoptix, the mean of P1, P2, and P3 (Pmean123), the maximal value of P1, P2, and P3 (Pmax123), the mean of P1 and P2 (Pmean12), and the maximal value of P1 and P2 (Pmax12). RESULTS: Internal consistency was excellent for sphere, cylinder (alpha = 0.92 vs 0.97), aniso-sphere, and aniso-cylinder (alpha = 0.87 vs 0.86). All models predicted amblyopia (P < .001); there was 2.3% new diagnosis and 5.1 events per variable. A bootstrap analysis with 1,000 samples confirmed the stability of the model. Astigmatism (P < .001; odds ratio [OR] = 2.1 to 3.6) and aniso-sphere (P < .001; OR = 3.6 to 9.0) predicted amblyopia. Although sphere, when measurable, did not predict amblyopia (P > .19; OR = 1.2 to 1.3), the likelihood of amblyopia presence was 100 times higher when the Plusoptix displayed "hyper." All receiver operating characteristic (ROC) curves were significant (P < .001), with no differences between them (all P > .16). Adjusting the cut-off from ROC curves for the highest sensitivity, Pmax12 referred 31.9% and 16.1% fewer patients than P1 and Pmean12, respectively. A third measure revealed accommodation-related false-negative results; therefore, adding measurements showed no benefit. CONCLUSIONS: This was the first study to assess the Plusoptix's prediction of amblyopia. When aiming for maximal sensitivity, the Plusoptix refers many children (> 20% children in all models). The first measure refers more children than two measures. Non-measurable results must be considered abnormal because the chance of amblyopia presence was high. [J Pediatr Ophthalmol Strabismus. 2019;56(5):305-312.].

Late Ophthalmologic Referral of Anisometropic Amblyopia: A Retrospective Study of Different Amblyopia Subtypes.

INTRODUCTION: Amblyopia requires a timely diagnosis and treatment to attain maximum vision recovery. Specialty literature is lacking on how early amblyopia is referred. We aimed to understand if there are mean age differences at first referral for ophthalmologic tertiary center consultation among non-amblyopic and different types of amblyopia, in a context of lack of population screening. MATERIAL AND METHODS: In this retrospective model, the sample corresponded to all children born in Braga Hospital during 1997 - 2012 (3 - 18 years-old), with an ophthalmologic consultation in 2014. Data was collected from the clinical records and children were divided in a non-amblyopic versus amblyopic group. The amblyopic group was subdivided in strabismic versus refractive (anisometropic/bilateral). RESULTS: The sample had a total of 1665 participants, 1369 (82.2%) without amblyopia and 296 (17.8%) with amblyopia. Among amblyopia: 67.9% (n = 201) refractive, 32.1% (n = 95) strabismic. Within refractive amblyopia: 63.7% (n = 128) anisometropic and 36.3% (n = 73) bilateral. The mean age at first consultation was 6.24 ± 3.90 years-old: 6.39 ± 3.98 for non-amblyopic and 5.76 ± 3.58 for amblyopic. Among amblyopia subgroups, there were significant differences in mean age at first consultation (F3,1250 = 8.45; p < 0.001; Î·2 = 0.020). Strabismic and bilateral refractive amblyopia were referred earlier, when compared to non-amblyopia or anisometropic amblyopia (p < 0.05). Anisometropic amblyopia had the highest first consultation mean age: 6.92 ± 3.57 years-old. DISCUSSION: Without specific pre-school screening, children with amblyopia were referred to their first ophthalmologic evaluation significantly later than desired, especially anisometropic amblyopia, with a postschool mean age for first consultation. CONCLUSION: Recognizing high-risk children is essential for earlier referral and helps minimize future visual handicap.

Introdução: A ambliopia requer uma abordagem atempada para uma máxima recuperação visual. Não existe informação sobre a idade de referenciação da ambliopia. O presente artigo pretende perceber se há diferenças na idade média de referenciação para consulta terciária de Oftalmologia, entre não-amblíopes e amblíopes, num contexto sem rastreio implementado. Material e Métodos: A amostra correspondeu a todas as crianças nascidas no Hospital de Braga entre 1997 - 2012 (3 - 18 anos de idade), com consulta de Oftalmologia em 2014. A informação foi recolhida pelos registos clínicos, tendo sido criado o grupo nãoamblíope e amblíope, dividido em estrábico e refrativo (anisometrópico/bilateral). Resultados: A amostra contemplou 1665 participantes, 1369 (82,2%) não-amblíopes e 296 (17,8%) amblíopes. Dentro das ambliopias: 67,9% (n = 201) refrativas e 32,1% (n = 95) estrábicas. Nas ambliopias refrativas: 63,7% (n = 128) anisometrópicas e 36,3% (n = 73) bilaterais. A média de idades na primeira consulta foi de 6,24 ± 3,90 anos, 6,39 ± 3,98 nos não-amblíopes e 5,76 ± 3,58 nos amblíopes. Dentro dos subgrupos de ambliopia, existiram diferenças significativas na idade na primeira consulta (F3,1250 = 8,45; p < 0,001; η2 = 0,020). As ambliopias estrábicas e as refrativas bilaterais foram referenciadas mais cedo, quando comparadas com não-amblíopes ou ambliopias anisometrópicas (p < 0,05). A ambliopia anisometrópica teve a maior média de idade na primeira consulta: 6,92 ± 3,57 anos de idade. Discussão: Sem um rastreio pré-escolar específico, os amblíopes foram referenciados para a primeira observação oftalmológica significativamente mais tarde do que o desejado, especialmente a ambliopia anisometrópica, com uma idade pós-escolar de média para a primeira avaliação oftalmológica. Conclusão: Identificar crianças de alto risco é essencial para uma referenciação precoce, ajudando a minimizar consequências visuais.

Retinal vein and artery occlusion as the first manifestation of primary antiphospholipid syndrome in a pediatric patient / Oclusão arterial e venosa como primeira manifestação da síndrome antifosfolipide primária em criança

ABSTRACT Antiphospholipid syndrome is an acquired autoimmune disease characterized by hypercoagulability associated with recurrent venous and arterial thromboembolism in the presence of antiphospholipid antibodies. Herein, we report a case of rapid sequential retinal vein and artery occlusion as the first manifestation of a primary antiphospholipid syndrome triggered by an acute Mycoplasma infection in a previously healthy 11-year-old patient. On day 1, ophthalmoscopy revealed a central retinal vein occlusion. The patient developed temporal branch retinal artery occlusion the next day. On day 3, a central retinal artery occlusion was observed. Serum lupus anticoagulant, immunoglobulin (Ig) G anticardiolipin, IgG anti-β2-glycoprotein 1 antibody, and Mycoplasma pneumoniae IgM antibody levels were increased. Thus, retinal vascular occlusions can be the first manifestation of primary antiphospholipid syndrome. Although it may not improve visual prognosis, prompt diagnosis and treatment are essential to avoid further significant morbidity.

RESUMO A síndrome antifosfolipide é uma doença autoimune adquirida caracterizada por hipercoagulabilidade associada a tromboembolismo venoso e arterial recorrente na presença de anticorpos antifosfolipídicos. Aqui, relatamos um caso clínico de oclusão sequencial de veia e artéria da retina como primeira manifestação de uma síndrome antifosfolipíde primária desen­cadeada por uma infeção aguda por Mycoplasma num paciente de 11 anos previamente saudável. No primeiro dia, a oftalmoscopia revelou uma oclusão da veia central da retina. No dia seguinte, o paciente desenvolveu uma oclusão do ramo temporal da artéria central da retina. No terceiro dia, uma oclusão da artéria central da retina foi diagnosticada. Os níveis de anticoagulante lúpico sérico, anticorpos IgG anticardiolipina e IgG anti-β2-glicoproteína 1 e anticorpos IgM para Mycoplasma pneumoniae estavam aumentados. As oclusões vasculares retinianas podem ser a primeira manifestação da síndrome antifosfolipíde primária. Apesar do prognóstico visual ser reservado, o seu diagnóstico e o tratamento imediatos são essenciais para evitar outras morbilidades associadas.

Quality of life and mental health in amblyopic children treated with and without occlusion therapy.

PURPOSE: To assess the long-term (≥1 year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers. METHODS: Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1 year earlier. RESULTS: A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses + occlusion group. Median age of subjects was 12 years (IQR = 3.0). Mean age of the 79 caregivers was 41.9 ± 5.0 years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs ≥6 years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P = 0.036; effect size = 0.23). CONCLUSIONS: In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

Should tumbling E go out of date in amblyopia screening? Evidence from a population-based sample normative in children aged 3-4 years.

AIMS: To determine a normative of tumbling E optotype and its feasibility for visual acuity (VA) assessment in children aged 3-4 years. METHODS: A cross-sectional study of 1756 children who were invited to participate in a comprehensive non-invasive eye exam. Uncorrected monocular VA with crowded tumbling E with a comprehensive ophthalmological examination were assessed. Testability rates of the whole population and VA of the healthy children for different age subgroups, gender, school type and the order of testing in which the ophthalmological examination was performed were evaluated. RESULTS: The overall testability rate was 95% (92% and 98% for children aged 3 and 4 years, respectively). The mean VA of the first-day assessment (first-VA) and best-VA over 2 days' assessments was 0.14 logMAR (95% CI 0.14 to 0.15) (decimal=0.72, 95% CI 0.71 to 0.73) and 0.13 logMAR (95% CI 0.13 to 0.14) (decimal=0.74, 95% CI 0.73 to 0.74). Analysis with age showed differences between groups in first-VA (F(3,1146)=10.0; p<0.001; η2=0.026) and best-VA (F(3,1155)=8.8; p<0.001; η2=0.022). Our normative was very highly correlated with previous reported HOTV-Amblyopia-Treatment-Study (HOTV-ATS) (first-VA, r=0.97; best-VA, r=0.99), with 0.8 to 0.7 lines consistent overestimation for HOTV-ATS as described in literature. Overall false-positive referral was 1.3%, being specially low regarding anisometropias of ≥2 logMAR lines (0.17%). Interocular difference ≥1 line VA logMAR was not associated with age (p=0.195). CONCLUSIONS: This is the first normative for European Caucasian children with single crowded tumbling E in healthy eyes and the largest study comparing 3 and 4 years old testability. Testability rates are higher than found in literature with other optotypes, especially in children aged 3 years, where we found 5%-11% better testability rates.

New pediatric risk factors for amblyopia: strabismic versus refractive.

PURPOSE: To assess the role of risk factors for amblyopia, such as family history and neonatal background, for the prediction of either strabismic amblyopia or refractive amblyopia. METHODS: In this retrospective case-control model, the study population included all children born at the Hospital de Braga during 1997-2012 (3 to 18 years old) with ophthalmologic consultation in 2014. Data collection was performed from the clinical database and through telephone questionnaire surveys. RESULTS: A total of 298 (50%) controls and 298 (50%) cases (120 [40.3%] strabismic amblyopia and 178 [59.7%] refractive amblyopia) were analyzed. A significantly lower birthweight was detected in patients with strabismic amblyopia (mean 2,961 g [95% confidence interval (CI) 2,827-3,096]) compared to controls (mean 3,198 g [95% CI 3,125-3,271]) (p = 0.002). Five-minute Apgar was significantly lower in patients with strabismic amblyopia (mean 9.57 [95% CI 9.37-9.77]) than in controls (mean 9.83 [95% CI 9.77-9.90]) (p = 0.004) or patients with refractive amblyopia (mean 9.79 [95% CI 9.69-9.89]) (p = 0.031). Family history of either amblyopia or strabismus was associated with amblyopia (χ2 [2, n = 562] = 12.66; p = 0.002; Cramer V = 0.150; χ2 [2, n = 561] = 11.0; p = 0.004; Cramer V = 0.140), but was significantly more associated with strabismic amblyopia (p = 0.0023 and p = 0.0032) than with refractive amblyopia (p = 0.48 and p = 0.015, respectively). Multinomial logistic regression model explained 50.8% of the variance in amblyopia development. Low 5-minute Apgar had a relevant odds ratio (OR) for either strabismic amblyopia (OR 3.44; p = 0.066) or refractive amblyopia (OR 3.30; p = 0.077). CONCLUSIONS: This division in amblyopia subtypes gives a new perspective of the risk factors for amblyopia, with family history and some obstetrician/neonatal outcomes appearing to be more relevant in strabismic amblyopia. Educating health care providers to recognize these risk factors can result in an early ophthalmologic referral.

Contaminação pelo SARS-COV-2 entre profissionais de saúde do Oeste Baiano

Este estudo tem como objetivo descrever a ocorrência e caracterizar o perfil da contaminação pelo SARS-CoV-2 em profissionais de saúde na macrorregião Oeste da Bahia. Trata-se de um estudo transversal com abordagem quantitativa e descritiva, realizado através da estratégia Web Survey, no período de fevereiro a maio de 2021, com profissionais de saúde atuantes na região. Participaram do estudo 186 profissionais, de 22 categorias profissionais distintas e provenientes de 23 municípios da região. Do total de entrevistados, 63 participantes (33,9%) testaram positivo para o SARS-CoV-2, com predominância do sexo feminino (70,0%), idade média de 36 anos (DP ± 8,7), de enfermeiros contaminados (25,4%) e da forma leve da doença (76,2%), entretanto, 15,9% (n=10) desenvolveram sequelas e 11,1% (n=07) necessitaram de readaptações das atividades de trabalho. 40,9% dos entrevistados (n=76) relataram que após o início da pandemia desenvolveram algum problema de ordem mental ou tiveram piora de condição já existente e 58,1% (n=108) informaram indisponibilidade de cuidado em saúde mental no local de trabalho. Pelo exposto, torna-se cada vez mais importante a adoção/atualização de estratégias de proteção, promoção e recuperação da saúde direcionadas para estes profissionais, considerando as suas diferentes realidades e necessidades.

Relações entre leitura e empatia: uma revisão integrativa da literatura / The relationship between reading and empathy: an integrative literature review / La relación entre lectura y empatía: una revisión integradora de la literatura

This study seeks to know the main investigations on the relationship between reading fiction texts and empathy in children and adolescents. Through an integrative review of the scientific literature from the Scientific Electronic Library Online (Scielo), Education Resources Information Center (Eric), and PsycInfo databases between 2009 and 2020, 21 articles were analyzed in detail, showing a predominance of intervention studies, followed by case and correlational studies. The research samples are predominantly made up of students, although some also include the perception of teachers, parents, and guardians. Different aspects of the relationship between reading and empathy were identified, both studies that emphasize the contribution of reading to the development of empathy and studies that show the contribution of empathy to initial learning and the development of reading comprehension were observed. Most of the research was conducted in the North American context, pointing out a gap in the Brazilian scenario.

O objetivo deste estudo foi conhecer as principais investigações sobre as relações entre a leitura de textos ficcionais e a empatia em crianças e adolescentes. Por meio de uma revisão integrativa da literatura científica nas bases SciELO, ERIC e PsycInfo, de 2009 a 2020, foram analisados, na íntegra, 21 artigos. A análise realizada mostrou uma predominância de estudos de intervenção, seguidos por estudos de caso e estudos correlacionais. A amostra das investigações se constitui, predominantemente, de estudantes, apesar de algumas incluírem também a percepção do professor e dos pais e responsáveis. Foram verificadas diferentes facetas da relação entre leitura e empatia, sendo identificados tanto estudos que enfatizam a contribuição da leitura para o desenvolvimento da empatia como estudos que mostram a contribuição da empatia para a aprendizagem inicial e o desenvolvimento da compreensão leitora. Grande parte das pesquisas foi realizada no contexto norte-americano, apontando uma lacuna no cenário brasileiro.

Este estudio busca conocer las principales investigaciones entre la relación de la lectura de textos de ficción y la empatía en niños y adolescentes. Mediante una revisión integradora de la literatura científica en las bases de datos SciELO, ERIC y PsycInfo (2009-2020), se analizaron detalladamente 21 artículos que demostró un predominio de estudios de intervención, seguido de estudios de casos y correlacionales. La muestra de investigaciones está constituida predominantemente por estudiantes, aunque algunas también incluyen la percepción de los maestro, padres y tutores. Se identificaron diferentes facetas de la relación entre lectura y empatía, se observaron tanto estudios que enfatizan la contribución de la lectura al desarrollo de la empatía como estudios que muestran la contribución de la empatía al aprendizaje inicial y el desarrollo de la comprensión lectora. La mayor parte de la investigación se realizó en el contexto norteamericano, señalando una brecha en el escenario brasileño.

Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty.

INTRODUCTION:: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. METHOD:: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. RESULTS:: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. CONCLUSION:: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.

Vertical muscle transposition with silicone band belting in VI nerve palsy.

A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary.

Reading in developmental dyslexia: the role of phonemic awareness and executive functions / Leitura na dislexia do desenvolvimento: o papel da consciência fonêmica e das funções executivas

This study investigated the correlations and the possible deficits in reading, phonemic awareness, and executive functions among students with developmental dyslexia. A total of 28 students participated in the study, between 9 and 11 years old, 14 with developmental dyslexia and 14 without reading difficulties. Specific instruments were used to assess reading, phonemic awareness, and executive functions. The Spearman test indicated moderate and very significant correlations between performance in tasks of phonemic awareness and reading (recognition and comprehension) and tasks that assessed cognitive functioning involving the following executive functions: cognitive flexibility, working memory, inhibitory control, and orthographic verbal fluency. No correlation was found between the reading and phonemic awareness assessments and the results of the planning done with the Tower of London instrument. The results allowed the researchers to hypothesize that an intervention planned for the development of phonemic awareness and executive functions may have an effect in improving the reading performance of dyslexics.

Este estudo investigou as correlações e os possíveis déficits em leitura, consciência fonêmica e funções executivas entre estudantes com dislexia do desenvolvimento. Participaram do estudo 28 estudantes, com idade entre 9 e 11 anos, sendo 14 com dislexia do desenvolvimento e 14 sem dificuldade de leitura. Foram utilizados instrumentos específicos para avaliação da leitura, consciência fonêmica e funções executivas. O teste Spearman indicou correlações moderadas e muito significativas entre o desempenho nas tarefas de consciência fonêmica e leitura (reconhecimento e compreensão) e as tarefas que avaliaram o funcionamento cognitivo envolvendo as seguintes funções executivas: flexibilidade cognitiva, memória de trabalho, controle inibitório e fluência verbal ortográfica. Não foi encontrada correlação entre as avaliações de leitura e consciência fonêmica e planejamento com o instrumento Torre de Londres. Os resultados possibilitam hipotetizar que uma intervenção para o desenvolvimento da consciência fonêmica e das funções executivas pode melhorar o desempenho em leitura dos disléxicos.

Compreensão Leitora: Efeitos do Ensino Explícito no 3º ano do Ensino Fundamental / Reading Comprehension: Effects of Explicit Teaching among 3rd Grade Students / Comprensión Lectora: Efectos de la Enseñanza Explícita en 3º año de la Enseñanza Primaria

Muito mais do que reconhecer palavras, ler significa extrair sentido do que é lido. Neste artigo, é apresentada e analisada uma intervenção pedagógica que focalizou o ensino explícito da compreensão leitora entre estudantes de 3º ano do ensino fundamental em uma escola pública municipal de Curitiba-PR. A pesquisa teve um desenho quase-experimental com pré e pós-teste, cuja amostra constituiu-se por 48 estudantes, sendo 24 do grupo experimental e 24 do grupo controle. No Pré-teste foi aplicada uma Prova de Compreensão de Texto, a qual foi repetida no Pós-teste (1) juntamente com uma segunda Prova de Compreensão (Pós-teste 2), utilizada para avaliar a compreensão dos participantes excluindo-se a possibilidade de as respostas terem sido aprendidas. Os resultados indicaram que, após a intervenção, os grupos apresentaram diferenças de desempenho na compreensão de textos estatisticamente significativas. Contudo, os grupos não apresentaram diferenças significativas em compreensão inferencial, sugerindo que a compreensão literal possa ser um nível basilar na trajetória do desenvolvimento de uma compreensão leitora mais abrangente. Aponta-se como linha de investigação futura a inclusão de mais um módulo de intervenção, focalizando níveis mais complexos de compreensão, para que se possa ter uma avaliação mais acurada da eficácia do programa. (AU)

Reading is more than merely recognizing words. It means extracting meaning from what is read. This article presented and analyzed a pedagogical intervention focused on the explicit teaching of reading comprehension among 3rd grade students attending a state municipal school located in Curitiba, PR, Brazil. This research was a quasi-experimental study with pre and post-test, with a sample composed of 48 students: 24 from the experimental group and 24 from the control group. In the Pre-test, a Text Comprehension Test was applied, which was repeated in the Post-test (1) together with a second Comprehension Test (Post-test 2), used to assess the comprehension of the participants, excluding the possibility that the answers have been learned. The results showed significant differences in the groups' reading comprehension levels, though no significant differences were found in terms of inferential comprehension, suggesting that literal comprehension is basic when developing deeper reading comprehension. Future research should include more than one intervention module, focusing on more complex comprehension levels to assess the program's effectiveness more accurately. (AU)

Mucho más que reconocer palabras, leer significa extraer sentido de lo que se lee. En este artículo se presenta y analiza una intervención pedagógica centrada en la enseñanza explícita de la comprensión lectora entre los estudiantes de tercer año de la educación primaria pública municipal de Curitiba-PR. La investigación tuvo un diseño casi experimental con pre y post-test, participaron 48 estudiantes, 24 del grupo experimental y 24 del grupo control. En la prueba preliminar se aplicó una Prueba de Comprensión de Textos, el cual se repitió en la posprueba (1) junto con una segunda Prueba de Comprensión (posprueba 2), utilizado para evaluar la comprensión de los participantes, excluyendo la posibilidad de que las respuestas se han aprendido. Los resultados indicaron que, después de la intervención, los grupos presentaron diferencias de desempeño en la comprensión de textos estadísticamente significativas. Los grupos no presentaron diferencias significativas en comprensión inferencial, sugiriendo que la comprensión literal pueda ser un nivel básico en la trayectoria del desarrollo de una comprensión lectora más amplia. Se apunta como línea de investigación futura la inclusión de otro módulo de intervención, focalizando niveles más complejos de comprensión, para tener una evaluación más precisa de la eficacia del programa. (AU)

Empatia Afetiva e Cognitiva no Transtorno do Espectro Autista (TEA): uma Revisão Integrativa da Literatura / Affective and Cognitive Empathy on the Autism Spectrum Disorder (ASD): An Integrative Literature Review

RESUMO A literatura vem apontando um crescente interesse pelos estudos sobre como a empatia, em seus componentes cognitivo e afetivo, desenvolve-se em pessoas com Transtorno do Espectro Autista (TEA). Assim, esta revisão integrativa da literatura teve o objetivo de investigar a empatia, em seus componentes cognitivo e afetivo, em indivíduos com TEA e fatores associados. Para isso, efetuou-se uma busca por artigos científicos nas bases de dados PubMed, ERIC e PsycINFO. Adotaram-se as palavras-chave e marcadores booleanos Autism [or] ASD (Autism Spectrum Disorder) [and] Empathy. Como resultado, foram recuperadas 180 publicações, das quais 26 foram analisadas. Os critérios de inclusão foram estudos empíricos - correlacionais e de intervenção - que abordassem as relações entre empatia e TEA, indexados nas bases de dados aqui mencionadas entre os anos de 2005 e 2020. As categorias resultantes da análise foram: empatia afetiva e cognitiva, diferenças associadas ao gênero na empatia e diferenças associadas à idade e ao Quociente de inteligência(QI) em pessoas com TEA. Verificou-se que a empatia cognitiva, que envolve a inferência de emoção do estado mental de outra pessoa, pode ser reduzida em pessoas com TEA, enquanto a empatia afetiva, que se refere à capacidade de compartilhar a emoção dos outros, não apresenta déficit. Além disso, alguns estudos apontaram para a importância do ensino de responsividade empática em crianças com TEA. Contudo, não foram encontrados artigos em bases brasileiras sobre o tema, assinalando uma importante lacuna de pesquisas sobre a empatia em pessoas com autismo no cenário nacional.

ABSTRACT Literature has shown a growing interest in studies on how empathy, regarding its cognitive and affective components, can be developed in people with Autism Spectrum Disorder (ASD). Thus, this integrative literature review aimed to investigate empathy, in its cognitive and affective components, in individuals with TEA and associated factors. For this, a search for scientific papers was carried out in the PubMed, ERIC, and PsycINFO electronic databases. The keywords and Boolean operators Autism [or] ASD (Autism Spectrum Disorder) [and] Empathy were adopted. As a result, 180 publications were found, and 26 were analyzed. The inclusion criteria were empirical pieces of research - correlational and intervention - that addressed the relationship between empathy and ASD, indexed in the databases already mentioned between 2005 and 2020. The categories resulting from the investigation were: affective and cognitive empathy, gender differences in empathy, and differences related to age and Intelligence Quotient (IQ) in individuals with ASD. The studies showed that cognitive empathy, which involves the inference of emotion from another person's mental state, can be reduced in people with ASD, while affective empathy, which refers to the ability to share the emotions of others, does not suffer the same deficit. In addition, some studies have pointed to the importance of teaching empathic responsiveness in children with ASD. No studies were found in Brazilian databases on the topic, signaling an important research gap on empathy in people with autism on the national scene.