Visual impairment and associated factors in adults from three suburban communities in Nampula, Mozambique.

CLINICAL RELEVANCE: Scientific evidence on the burden of visual impairment, its causes, and associated factors are essential to monitor progress in eye health, identify priorities and develop strategies and policies that meet the needs of the population, towards the eradication of preventable blindness. BACKGROUND: The aim of this study was to determine the prevalence of visual impairment, its causes and associated factors in adults living in suburban communities in Nampula. METHODS: This is a cross-sectional study conducted from November 2019 to February 2020. Eye examinations were performed on adults aged ≥18 years covered by the Lúrio University program, 'one student, one family'. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated to study the association between the dependent variable (presenting visual impairment) and independent variables (gender, age, school level, residence, family income and systemic diseases), with a 95% confidence interval. RESULTS: Distance and near presenting visual impairment had a prevalence of 16.3% and 21.1%, respectively, and were statistically associated with the age groups between 45-65 (OR:4.9) and >65 years (OR: 29.1), illiterate (OR:13.8), primary (OR:4.8) and secondary (aOR:37.5) school level, farmer (OR:32.8) and retired (OR:14.3) occupation, and presence of systemic diseases (OR :3.3). The main causes of presenting visual impairment were uncorrected refractive error and cataract. CONCLUSION: The prevalence of presenting visual impairment is relatively high, given the enormous effort undertaken within the framework of VISION 2020: The Right to Sight global initiative. There is a need to develop intervention plans targeted at the highest risk groups, with a view to achieving the 'one student, one family' program goals with respect to eye health.

Efficient Single Nucleotide Polymorphism Marker-Assisted Selection to Fusarium Wilt in Chickpea.

Fusarium wilt is one of the most destructive chickpea diseases worldwide. Race 5 (Foc5) is the most harmful in the Mediterranean basin. The primary objective of this study is to validate a block of six SNP markers previously mapped in Ca2 in a diverse panel of cultivars, advanced and inbred lines phenotyped for resistance to fusarium wilt. Additionally, we aim to assess the effectiveness of using these markers in the selection of resistant Foc5 lines in an ongoing breeding program. The results showed a 100% coincidence between phenotype and expected haplotype in plant material evaluated for Foc5. We also analyzed 67 inbred lines previously phenotyped by different authors for fusarium wilt reaction, though the specific race was not specified. In these accessions, 65.8% of the analyzed lines exhibited complete correspondence between the phenotype and haplotype. Our results suggest that in early generations it is possible to select resistant materials with reliability, leading to the removal of a significant number of lines, thereby reducing costs and facilitating the handling of materials for additional trait evaluations. Functional annotation of genes delimited by the SNP block revealed several genes in the "response to stimulus" category with potential roles in the resistance reaction.

Computer vision syndrome and associated factors in university students and teachers in Nampula, Mozambique.

BACKGROUND: Computer Vision Syndrome (CVS) is a complex of eye and visual problems that arise while using a computer or other Video Display Terminal (DVT). With the advent of the COVID-19 pandemic, the use of these DVTs has become indispensable in the lives of students and teachers. This study aims to identify the prevalence of CVS and associated factors in students and teachers at Lúrio University, in Nampula, during the pandemic period. METHODS: This is a cross-sectional study, carried out between November 2020 and March 2021. The validated CVS questionnaire (CVS-Q) and another semi-structured questionnaire on ergonomic risk factors were applied. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated to measure the association between CVS and computer use conditions. RESULTS: The prevalence of CVS was 76.6%, and the female gender, age ≤ 20 years, levels I, II, III of course, lack of knowledge about ergonomics, use the computer to study, use more than 6 hours daily, absence of anti-reflex treatment, use of other devices and sitting in an inappropriate chair were risk factors for the occurrence of CVS, while being a teacher was a protective factor. CONCLUSION: The prevalence of CVS found in this study was high, due to several factors, especially not using ergonomic principles when using computers and other DVTs. There is a need to adopt intervention strategies focused on the most vulnerable groups such as women, age group ≤20 years and students, especially at the first year level, right after entering the University.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique.

BACKGROUND: The unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province. METHODS: A mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated. RESULTS: Nampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope. CONCLUSIONS: There is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.

Assessment of cataract surgery outcomes in Nampula (Mozambique): visual acuity, visual function and quality of life.

BACKGROUND: Despite advances in surgical techniques, cataract remains the leading cause of preventable blindness, and massive surgeries have been adopted as a strategy to change this situation. Monitoring the results of cataract surgeries has become imperative to ensure their quality. Therefore, this study aims to assess the cataract surgery outcomes performed at the Central Hospital of Nampula Mozambique. METHODS: This is a prospective and longitudinal study in which translation, cultural adaptation and validation of the visual function (VF) and quality of life (QoL) questionnaire were performed. The appearance, content, construct, criterion, internal consistency and responsiveness were validated using the most common methods and indicators. Visual acuity (VA), VF and QoL were evaluated on 447 patients before and after surgery by t-test and effect sizes. RESULTS: VF and QoL questionnaires showed one-dimension, good values of TLI (0.973, 0.951) and SRMR (0.057, 0.054), and for each item, weights > 0.7, H2 > 0.5, ranges > 5.8 and the RMSEA < 0.08. Correlations for criterion validity were high and for responsiveness were high for QoL and moderate for VF one and the ordinal Cronbach's alpha coefficients were greater than 0.97. Difference between VA, VF and QoL before and after surgery was statistically significant (p < 0.001). After surgery, 74.3% of patients had good, 23.5% had borderline and 2.2% had poor VA. CONCLUSIONS: The cataract surgery outcomes are outside the WHO recommendations regarding VA, but they have had a great impact on improving VF and QoL. The questionnaires showed excellent psychometric properties and should be used in daily clinical practice to evaluate the results of cataract surgeries.

Contrast Sensitivity Assessment in Early Diagnosis of Diabetic Retinopathy: A Systematic Review.

INTRODUCTION: The purpose of this systematic review was to study whether contrast sensitivity assessment in people with diabetes could be a reliable test in early detection of diabetic retinopathy. A systematic search based on population, intervention, comparison, and outcome strategy was performed. METHODS: PubMed, Scopus, and Web of Science were searched for English articles of human patients with type 1 and type 2 diabetes and contrast sensitivity measurements as domain studied. RESULTS: Twentyone comparative cross-sectional studies were included. All of them showed significant loss of contrast sensitivity in people with diabetes and diabetic retinopathy regarding control patients of the same age, regardless of the method used. However, those without diabetic retinopathy, involve a loss of contrast sensitivity, although not always significant. CONCLUSION: Changes in contrast sensitivity suggest that there is damage to the retina prior to the vascular ones and that they could be detected by this test.

Effect of macular pigment carotenoids on cognitive functions: A systematic review.

Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of these carotenoids have been positively related to cognitive performance. Therefore, this systematic review analyses the relationship between macular pigment density and cognitive functions. Most relevant databases were scoured for studies on healthy people relating cognitive functions to macular pigment optical density (MPOD). There were no age, sex, or race limitations. PROSPERO registration: CRD42021254833. Nineteen studies were included, seven randomized controlled trials (RCT) and eleven observational studies. The general aim of the studies was to examine the association between carotenoids (lutein, meso­zeaxanthin and zeaxanthin) and cognitive function. Most observational studies correlates MPOD levels with cognitive function or brain activity. Besides, RCTs compared the cognitive function and/or brain activity after increasing lutein and zeaxanthin intake though dietary supplementation or avocado consumption. Dietary lutein and zeaxanthin intake increased MPOD in six of the seven clinical trials and significantly improved most of the cognitive functions studied. A wide variety of test and methodologies for measuring cognitive functions were observed. Memory, processing speed, attention and reasoning were the cognitive function significantly related to MPOD levels in adults. Brain activity also was related to MPOD, but the results were inconsistent. Only four of the eleven observational studies were based on young people and all studies showed a significant relationship between MPOD and cognitive functions. This systematic review showed a direct relationship among cognitive functions, macular pigment and the intake of lutein and zeaxanthin.

Barriers to Accessing Eye Health Services in Suburban Communities in Nampula, Mozambique.

Globally, an estimated 2.2 billion people are visually impaired (VI) or blind, and a large proportion (90%) of those affected live in low- and middle-income countries (LMICs), where access to eye health services is limited. This study aimed to identify barriers to accessing eye health services and associated factors in suburban communities of Nampula. A cross-sectional community-based study was carried out on adults ≥18 years old. A total of 338 adults were randomly selected from three communities (Muthita, Piloto, and Nthotta). Individual interviews were carried out and socio-demographic data, eye symptoms, date of last eye examination, and barriers to access to eye health services were extracted. Among participants, 49.4% had eye symptoms and 41.7% did not have their eye examinations up to date. The most cited barriers were crowding in hospitals (40.7%), financial difficulties (30.0%), self-medication (20.5%), traditional treatment (17.8%), and buying eyeglasses on the street (11.6%). Barriers limited the service target to 33%. Lower levels of schooling and monthly family income and farmer occupation were statistically associated with the most barriers as risk factors. The use of eye health services was lower due to barriers to accessing eye services. More specific intervention plans and greater cooperation between sectors are needed to improve these indicators.

The Prevalence of Visual Impairment and Refractive Errors among a Youth Population in Mozambique: Evidence of the Need for Intervention.

Visual impairment (VI) can significantly interfere in the child's daily activities and quality of life, having a negative effect on their development and learning. The aim of the study was to determine the prevalence of VI and associated demographic factors in students examined during the program "Moçambique te vejo melhor". This study was cross-sectional and retrospective, based on the 2018/19 edition of the program. Eye examinations were performed in secondary school students, aged between 12 and 20 years, of five districts in Nampula province. The examination included visual acuity, non-cycloplegic refraction and assessment of the anterior and posterior segment and ocular adnexa. The prevalence of uncorrected, presenting and best-corrected VI found was 18.3%, 10.8%, and 5.0%, respectively. Refractive error (RE) had a prevalence of 24.7%, and the age groups between 15-17 years and 18-20 years were significantly associated with myopia (with OR: 4.9 and OR: 8.8, respectively), as well as the 11th and 12th grade (OR: 8.1 and OR: 10.7, respectively), and Malema district had association with myopia (ORa: 0.4) and hyperopia (ORa: 0.4 and OR: 0.3) as a protective factor. The prevalence of RE and VI was relatively high, showing the need for greater intervention at the school level.

Complications and Explantation Reasons in Intracorneal Ring Segments (ICRS) Implantation: A Systematic Review.

PURPOSE: To review the intraoperative and postoperative complications after intracorneal ring segment implantation and to report the explantation rate among the available scientific literature. METHODS: Three different databases (PubMed, Web of Science, and Scopus) were assessed from January 1995 to June 2019. The keywords used were: ring, rings, ICRS (intracorneal ring segments), segment, segments or Intacs, complication, explantation, explanted, retired, and removal. RESULTS: The selection process of this systematic review study is described in a flow diagram. A total of 39 studies published between 1995 and 2019 were included. Sixteen studies were case reports, 21 were case series studies, and 2 were chart analysis works. This study enrolled 1,946 participants, and 2,590 eyes were included. The postoperative complications described in most studies included migration, ring extrusion, corneal thinning, corneal melting, and some type of infective keratitis. These complications together with glare, halos, fluctuating vision, neovascularization, foreign body sensation, or pain represented most of the causes. The percentage rate of explantation ranged from 0.5% up to 83.3%. If we analyze those articles with a high number of implantations (2,124 eyes), an explantation rate between 0% and 1.4% was obtained. CONCLUSIONS: The complication rate and explantation ratio in segments of the intracorneal ring segments analyzed in the available scientific literature are minimal. Therefore, patient selection, surgery planning, and postoperative follow-up are critical to the success of surgery. [J Refract Surg. 2019;35(11):740-747.].

Bandage contact lens use after photorefractive keratectomy.

The use of a bandage contact lens (BCL) immediately after photorefractive keratectomy (PRK) results in less pain. This review analyzed which BCL is most effective in decreasing pain immediately after PRK and evaluated the reepithelialization process in the treated zone. Two databases, PubMed and Medline, were checked for articles published from January 2005 to May 2018. The keywords were photorefractive keratectomy, PRK, contact lens, and bandage contact lens. The review comprised 13 studies; these studies enrolled 842 patients who had PRK. All studies compared the early postoperative results for two types of BCL material (senofilcon A and lotrafilcon A). Of the materials, the pain scores were lowest with a senofilcon A. The size of the defect in the epithelialized area 1 day after surgery decreased fastest with lotrafilcon A.

Is it possible to relate accommodative visual dysfunctions to neck pain?

The aim of this study was to establish whether there is a relationship between conditions of accommodative visual dysfunctions and cervical complaints. Fifty-two participants were included. Variables were accommodative amplitude, positive and negative relative accommodation (NRA), accommodative response, and accommodative facility. Subjects were classified as accommodative insufficiency, accommodative excess, or normal. Neck complaints were measured with the Neck Disability Index, the Visual Analogue Scale, and by cervical range of motion, deep flexor muscle activation score, and performance index. We found the following significant relationships: between NRA and both performance index and left-side bending; accommodative amplitude right-eye with right-side bending and with left-side bending; accommodative amplitude left-eye with right-side bending; and accommodative facility left-eye with both performance index and left-side bending. In accommodative amplitude right-eye, aIl participants showed significant values and greater than those with accommodative excess. In both groups, performance index values were decreased. Greater pain and lower right-rotation were found in participants with accommodative excess than in those with accommodative insufficiency. We conclude that accommodative dysfunctions are related to low performance index, decreased range of motion, as well as greater neck pain.

Automedicación previa a la indicación farmacéutica en gripe o resfriado / Self-medication before pharmaceutical prescribing in flu or cold

Antecedentes: La auto-medicación es una práctica cada vez más extendida en nuestra sociedad. Sin embargo, conlleva un riesgo que puede ser importante para la salud. El farmacéutico, por servicio de indicación farmacéutica, puede desempeñar un papel clave como consejero en la automedicación. Objetivo: describir el comportamiento de los pacientes con respecto a la automedicación, antes y después de recibir asesoramiento farmacéutico para el resfriado o la gripe. Método: Estudio descriptivo, a través de una encuesta en una farmacia comunitaria, incluidos los pacientes que solicitan medicamentos para la gripe, el resfriado o síntomas aislados relacionados durante el período de estudio. Todos los pacientes siguieron un protocolo de prescripción farmacéutica para la gripe y el resfriado. El servicio consistió en dispensar un medicamento y dar suficiente información sobre el mismo, o derivarlo al médico. Una semana después, el mismo farmacéutico realizó una segunda entrevista telefónica para evaluar las acciones tomadas por el paciente y su satisfacción en el servicio recibido. Resultados: las personas que ingresaron a la farmacia y solicitaron asesoramiento farmacéutico fueron en su mayoría pacientes (72,5%). Los problemas de salud consultados se dividieron casi por igual entre la gripe y el resfriado (50,2%) y los síntomas relacionados aislados (49,8%). Casi el 90% de los pacientes tenía uno o dos síntomas. Se encontró que el 40% de los pacientes había tomado previamente medicamentos por problemas de salud consultados antes de acudir a la farmacia. Además, el 67% de ellos tomó medicación durante uno (44.1%) y dos días (22.9%). El origen de esto fue la automedicación (85,6%) y fue ineficaz en el 64,4% de los casos. La causa de la ineficacia fue la "medicación inapropiada" (56.5%). Una semana después de brindar asesoramiento farmacéutico, la mayoría de los pacientes (90,8%) respondieron una encuesta posterior a la intervención. Reveló que solo el 2,6% se automedicaba y el 7,7% de los pacientes, que habían recibido asesoramiento farmacéutico, finalmente se derivaron del médico. Los pacientes, que tomaron la medicina recomendada por el farmacéutico, lo hicieron durante 3 o 4 días (43.9%). La satisfacción con el servicio de asesoramiento farmacéutico fue de 8, 9 o 10 de cada 10 puntos para el 89,5% de los pacientes, y la mayoría de ellos (97,7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. Reveló que solo el 2,6% se automedicaba y el 7,7% de los pacientes, que habían recibido asesoramiento farmacéutico, finalmente se derivaron del médico. Los pacientes, que tomaron la medicina recomendada por el farmacéutico, lo hicieron durante 3 o 4 días (43.9%). La satisfacción con el servicio de asesoramiento farmacéutico fue de 8, 9 o 10 de cada 10 puntos para el 89,5% de los pacientes, y la mayoría de ellos (97,7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. Reveló que solo el 2,6% se automedicaba y el 7,7% de los pacientes, que habían recibido asesoramiento farmacéutico, finalmente se derivaron del médico. Los pacientes, que tomaron la medicina recomendada por el farmacéutico, lo hicieron durante 3 o 4 días (43.9%). La satisfacción con el servicio de asesoramiento farmacéutico fue de 8, 9 o 10 de cada 10 puntos para el 89,5% de los pacientes, y la mayoría de ellos (97,7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. Finalmente auto-derivado al médico. Los pacientes, que tomaron la medicina recomendada por el farmacéutico, lo hicieron durante 3 o 4 días (43.9%). La satisfacción con el servicio de asesoramiento farmacéutico fue de 8, 9 o 10 de cada 10 puntos para el 89,5% de los pacientes, y la mayoría de ellos (97,7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. Finalmente auto-derivado al médico. Los pacientes, que tomaron la medicina recomendada por el farmacéutico, lo hicieron durante 3 o 4 días (43.9%). La satisfacción con el servicio de asesoramiento farmacéutico fue de 8, 9 o 10 de cada 10 puntos para el 89,5% de los pacientes, y la mayoría de ellos (97,7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. y la mayoría de ellos (97.7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico. y la mayoría de ellos (97.7%) dijeron que volverían a la farmacia para solicitar un nuevo asesoramiento farmacéutico. Conclusión: la automedicación con medicamentos para la gripe o el resfriado fue bastante común entre la población y fue inapropiada en más de la mitad de los casos. Los pacientes que siguieron las recomendaciones del farmacéutico se mostraron muy satisfechos con el servicio de asesoramiento farmacéutico.