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1.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320996

RESUMEN

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Asunto(s)
Bases de Datos Factuales , Oftalmología/educación , Estudiantes de Medicina , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
2.
Eur J Ophthalmol ; 30(1): 196-200, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30474398

RESUMEN

INTRODUCTION: Ergonomics in ophthalmology is neither taught during professional training nor does it readily receive consideration or priority in clinical practice. Owing to a high prevalence of musculoskeletal disorders among ophthalmologists, ergonomic awareness, and practices are vital in averting this modern epidemic. OBJECTIVE: To assess the ergonomic practices and prevalence of self-reported musculoskeletal disorders among ophthalmologists in India. METHOD: An online survey was conducted among ophthalmologists who were registered with the All India Ophthalmological Society of India using a pre-tested and validated questionnaire. RESULTS: The prevalence of self-reported musculoskeletal disorder in the 377 participants was 75.3% (284; 95% confidence interval: 70.6-79.5). Low back pain (149, 52.9%) was the most commonly reported symptom. Musculoskeletal disorder-attributed productivity loss was reported by 58.45% (166) of the respondents. Musculoskeletal disorder was most frequently associated with less than 10 years of work experience (odds ratio: 1.2; 95% confidence interval: 1.1-1.3, p = 0.01) and lack of good clinic (odds ratio: 1.7; 95% confidence interval: 1.1-2.7, p = 0.03) and operation room ergonomic practices (odds ratio: 1.8; 95% confidence interval: 1.1-2.9, p = 0.03). Only 27.9% (105) of the respondents had accessed information related to ergonomics in ophthalmic practice. CONCLUSION: The self-reported musculoskeletal disorder among ophthalmologists in India is quite high and significant enough to cause some degree of productivity loss. It is thus imperative to emphasize the implementation of good ergonomic practices, especially among relatively young ophthalmologists.


Asunto(s)
Ergonomía/estadística & datos numéricos , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Profesionales/epidemiología , Oftalmólogos/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Prevalencia , Autorrevelación , Encuestas y Cuestionarios
3.
Eur J Ophthalmol ; 30(2): 321-349, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30832499

RESUMEN

OBJECTIVES: Regulatory approval of new medicines requires a thorough assessment of the potential clinical benefits and risks. Study end-points are expected to demonstrate a clinically relevant treatment effect that will translate into direct patient benefits. This study sought to review the ophthalmic medicines with European Union-wide approval granted via the Centralised Procedure and characterise the key efficacy end-points underpinning the demonstration of clinical benefit. METHODS: This study was a retrospective review of published data pertaining to the European regulatory authorisation of centrally approved ophthalmic products between 1999 and 2017, inclusive. All sources and data consulted are in the public domain. European Public Assessment Reports published by the European Medicines Agency were consulted for data concerning the pivotal clinical efficacy studies supporting the applications. Data analyses were descriptive. RESULTS: The European Medicines Agency have authorised 30 products via the Centralised Procedure between 1999 and 2017. For these products, a total of 24 additional approvals for line extensions or additional therapeutic indications were granted. Four products have been approved for orphan indications, including one approval 'under exceptional circumstances' and one 'Conditional Marketing Authorisation'. Approvals for products in retina (36%) and glaucoma (28%) indications together accounted for the majority of authorisations, with trial end-points predominantly based on visual acuity and intraocular pressure parameters, respectively. Products were also approved for indications in ocular surface disease, inflammation, optic neuropathy and surgical adjuncts, with a range of functional and anatomical end-points. CONCLUSION: Approvals for ophthalmic medicines have been granted for a range of clinical indications, representing a considerable portion of available major therapeutics for practitioners. Benefit-risk assessments rely on clinical trial data demonstrating a clearly relevant patient benefit.


Asunto(s)
Aprobación de Drogas/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Unión Europea , Humanos , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento
4.
Am J Ophthalmol ; 211: 132-141, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31730839

RESUMEN

PURPOSE: To perform a comprehensive analysis of characteristics of ophthalmology trials registered in ClinicalTrials.gov. DESIGN: Cross-sectional study. METHODS: All 4,203 ophthalmologic clinical trials registered on ClinicalTrials.gov between October 1, 2007, and April 30, 2018, were identified by using medical subject headings (MeSH). Disease condition terms were verified by manual review. Trial characteristics were assessed through frequency calculations. Hazard ratios and 95% confidence intervals were determined for characteristics associated with early discontinuation. RESULTS: The majority of trials were multiarmed (73.6%), single-site (69.4%), randomized (64.8%), and had <100 enrollees (66.3%). A total of 33% used a data-monitoring committee (DMC), and 50.6% incorporated blinding. Other groups (51.6%) were funded by industry, whereas 2.6% were funded by the US National Institutes of Health (NIH). NIH trials were significantly more likely to address oncologic (NIH = 15.5%, Other = 3%, Industry = 1.5%; P < 0.001) or pediatric disease (NIH = 20.9%, Other = 5.9%, Industry = 1.4%; P < 0.001). Industry-sponsored trials (69.6% of phase 3 trials) were significantly more likely to be randomized (Industry = 68.7%, NIH = 58.9%, Other = 60.8%; P < 0.001) and blinded (Industry = 57.2%, NIH = 42.7%, Other = 43.5%; P < 0.001). A total of 359 trials (8.5%) were discontinued early, and 530 trials (12.6%) had unknown status. Trials were less likely to be discontinued if funded by sources other than industry (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.55-0.95; P = 0.021) and/or had a DMC (HR, 0.71; 95% CI, 0.55-0.92; P = 0.010). CONCLUSIONS: Ophthalmology trials in the past decade reveal heterogeneity across study funding sources. NIH trials were more likely to support historically underfunded subspecialties, whereas Industry trials were more likely to face early discontinuation. These trends emphasize the importance of carefully monitored and methodologically sound trials with deliberate funding allocation.


Asunto(s)
Ensayos Clínicos como Asunto/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Proyectos de Investigación , Ensayos Clínicos como Asunto/economía , Estudios Transversales , Financiación Gubernamental/economía , Organización de la Financiación/economía , Investigación sobre Servicios de Salud , Humanos , National Institutes of Health (U.S.)/estadística & datos numéricos , National Library of Medicine (U.S.)/estadística & datos numéricos , Oftalmología/economía , Apoyo a la Investigación como Asunto/economía , Estados Unidos
5.
Am J Ophthalmol ; 209: 71-76, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31525356

RESUMEN

PURPOSE: To analyze the academic background, scholarly achievements, and demographic characteristics of all US ophthalmology residency program directors (PDs). DESIGN: Cross-sectional study. METHODS: Online search of publicly available resources conducted from February 16, 2019, to February 26, 2019. STUDY POPULATION: 116 ophthalmology residency PDs. Main outcome measurements were demographic and academic data. RESULTS: A total of 116 program directors were analyzed. Eighty-four of 116 (72%) PDs were male. The average age was 50.0 years old. The mean age at appointment was 42.9 years old. Ninety-three percent graduated from an American medical school, and 97% received an MD degree. Twenty percent of PDs completed an additional graduate degree, most commonly a master's degree (7 of 23) and doctor of philosophy (7 of 23). Seventy-eight percent completed a fellowship, with the most frequent in glaucoma (24%), cornea and external diseases (22%), and neuroophthalmology (21%). The mean number of publications according to PubMed was 17.6 (range, 0-92). There were no significant differences between the average number of publications by male PDs and those by female PDs (19.2 ± 20.5 vs. 13.5 ± 23.1, respectively; P = 0.21). On average, the H-index was 8.7 (range, 0-35) and was higher in male than in female PDs (9.8 ± 8.3 vs. 5.4 ± 4.0, respectively; P = 0.01). CONCLUSIONS: Ophthalmology PDs are predominantly male with fellowship training in glaucoma, cornea, or neuro-ophthalmology. Women remain underrepresented, and future efforts should be aimed at addressing this disparity.


Asunto(s)
Éxito Académico , Internado y Residencia , Oftalmología/educación , Oftalmología/estadística & datos numéricos , Ejecutivos Médicos/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Educación de Postgrado en Medicina , Docentes Médicos , Becas , Femenino , Encuestas de Atención de la Salud , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Revisión de la Investigación por Pares , Médicos Mujeres , Encuestas y Cuestionarios , Estados Unidos/epidemiología
6.
Acta Med Port ; 32(12): 767-775, 2019 Dec 02.
Artículo en Portugués | MEDLINE | ID: mdl-31851886

RESUMEN

INTRODUCTION: Congenital deafness or early acquired deafness affects 1 to 3 out of 1000 newborns without risk factors and 20 to 40 out of 1000 newborns with risk factors. The universal newborn hearing screening enables its early identification. Children with congenital deafness/early acquired deafness have a higher prevalence of other conditions, especially ophthalmologic and neurodevelopmental ones, and at least 30% to 40% have at least one associated comorbidity. MATERIAL AND METHODS: We carried out a cross-sectional, multicenter study in which 83% (n = 30) of the hospitals/maternity hospitals of the National Health Service participated. RESULTS: All surveyed hospitals/maternity hospitals routinely performed universal newborn hearing screening to all newborns before discharge; 63% referred children with risk factors for hearing loss to Otorhinolaryngology. All children with congenital deafness/early acquired deafness are referred to: Pediatrics in 23% hospitals/maternity hospitals. In 23 hospitals/maternity hospitals, all children with congenital deafness/early acquired deafness are referred to: Speech Therapy in 44% hospitals/ maternity hospitals; Ophthalmology in 17% hospitals/maternity hospitals; National System of Early Intervention in Childhood in 30% hospitals/maternity hospitals; 22% of hospitals/maternity hospitals refer all children with congenital deafness/early acquired deafness, with no identified cause, to Clinical Genetics clinics. The number of diagnoses of deafness in the years 2014 and 2015 was 2.5 and 1.5 per 1000 newborns, respectively, in 15 hospitals/maternity hospitals. DISCUSSION: Awareness of universal newborn hearing screening seems to be widely spread in the National Health Service. The number of children with SC / SPA, as well as the percentage of different types of deafness diagnosed, were identical to those found in other studies and shows its importance. The assessment / follow-up of these children by specialties other than the otolaryngology was heterogeneous in different health entities and revealed that not all children with risk factors for deafness follow up advised by existing standards. CONCLUSION: Results show that Portugal made an important path in the screening and follow-up of children with SC / SPA. It is important, with the ultimate aim of continually improving the care of these children, to reflect on the involvement of specialties other than otolaryngology, such as the National Early Childhood Intervention System in the follow-up of these children.


Asunto(s)
Sordera/diagnóstico , Pérdida Auditiva/congénito , Pérdida Auditiva/diagnóstico , Estudios Transversales , Sordera/epidemiología , Sordera/etiología , Intervención Médica Temprana , Estudios de Seguimiento , Servicios Genéticos/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Pérdida Auditiva/epidemiología , Maternidades/estadística & datos numéricos , Humanos , Recién Nacido , Tamizaje Neonatal , Oftalmología/estadística & datos numéricos , Otolaringología/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Portugal/epidemiología , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo
7.
Clinics (Sao Paulo) ; 74: e1101, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31508716

RESUMEN

OBJECTIVES: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. METHODS: Responses to self-administered online questionnaires were analyzed. RESULTS: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). CONCLUSION: The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.


Asunto(s)
Selección de Profesión , Motivación , Oftalmología/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción Personal , Calidad de Vida , Autoinforme
8.
J Environ Public Health ; 2019: 3813298, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31428165

RESUMEN

Purpose: The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets. Methods: This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020. Results: The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level. Conclusion: The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Visión Ocular , Ceguera/epidemiología , Extracción de Catarata/estadística & datos numéricos , Estudios Transversales , Prestación de Atención de Salud/organización & administración , Ghana/epidemiología , Encuestas de Atención de la Salud , Fuerza Laboral en Salud/estadística & datos numéricos , Humanos , Oftalmología/estadística & datos numéricos , Optometría/estadística & datos numéricos
9.
BMC Health Serv Res ; 19(1): 609, 2019 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-31464616

RESUMEN

BACKGROUND: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. METHOD: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. RESULTS: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. CONCLUSIONS: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.


Asunto(s)
Oftalmopatías/diagnóstico , Oftalmopatías/terapia , Evaluación de Necesidades , Análisis Costo-Beneficio , Urgencias Médicas/economía , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/economía , Tratamiento de Urgencia/estadística & datos numéricos , Inglaterra , Oftalmopatías/economía , Médicos Generales/economía , Médicos Generales/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Oftalmología/estadística & datos numéricos , Optometría/estadística & datos numéricos , Satisfacción del Paciente , Atención Primaria de Salud/economía , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/economía , Derivación y Consulta/estadística & datos numéricos
10.
Ophthalmologe ; 116(12): 1171-1176, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31338590

RESUMEN

PURPOSE: Every year around New Year's Eve severe eye injuries are caused by fireworks. There is a large variety ranging from slight superficial injuries to very severe trauma necessitating extensive and sometimes repeated surgical treatment. As a consequence the patients not only suffer from functional or cosmetic impairments but also from socioeconomic problems, such as reduced capacity to work and inability to work. All firework-related eye injuries treated at the University Hospital Halle from 2008 to 2018 were retrospectively and systematically analyzed. MATERIAL AND METHODS: The patients were analyzed with respect to age, gender, injury distribution, type of injury, circumstances, form of treatment, consequences and duration of inability to work. RESULTS: From the turn of the year 2008/2009 to the turn of the year 2018/2019 a total of 144 eyes from 116 patients were treated at the ophthalmology department of the University Hospital Halle. The injuries involved 80 male patients (69%) and 36 female patients (31%), among them 44 children (38%) aged under 18 years, 81 right and 63 left eyes. In 28 patients both eyes were affected. Of the patients 44% handled the fireworks themselves and 56% were bystanders. Injuries were mostly caused by bangers (37%) and rockets (24%). Of the patients 37 had to be hospitalized, 14 eyes needed immediate surgical treatment, 2 eyes needed surgery later on in irritation-free intervals and 12 eyes needed repeated surgery. The duration of inability to work was on average 21.6 days, 2 eyes went blind because of the fireworks-related injury and 29% of the patients had visual impairments of which 43% were classified as severe impairments. CONCLUSION: Fireworks-related injuries are preventable injuries. As in most cases children, young adults and bystanders are affected by fireworks injuries, prophylactic and educational programs are urgently needed and legal regulations are necessary.


Asunto(s)
Traumatismos por Explosión , Lesiones Oculares , Adolescente , Traumatismos por Explosión/epidemiología , Traumatismos por Explosión/terapia , Niño , Lesiones Oculares/epidemiología , Lesiones Oculares/terapia , Femenino , Hospitales Universitarios , Humanos , Masculino , Oftalmología/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
11.
Ocul Immunol Inflamm ; 27(6): 905-911, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31314623

RESUMEN

Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.


Asunto(s)
Enfermedades Autoinmunes/epidemiología , Oftalmopatías/epidemiología , Hospitales Privados/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Reumatología/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/tratamiento farmacológico , Oftalmopatías/diagnóstico , Oftalmopatías/tratamiento farmacológico , Femenino , Angiografía con Fluoresceína , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Especialización/estadística & datos numéricos , Adulto Joven
12.
Am J Ophthalmol ; 205: 184-196, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31004590

RESUMEN

PURPOSE: To compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada. DESIGN: Retrospective cohort study. METHODS: Physician and patient data from 1992-2013 were used to calculate the yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty, and year of birth. Age-period-cohort models were used for analysis. RESULTS: There was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There were a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had a significantly greater number of visits and patients. Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians, and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians. CONCLUSION: Younger cohorts of Ontario physicians have greater yearly payments compared with older cohorts at the same age despite similar or a slightly lower number of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians but remained significant for all physicians and ophthalmologists.


Asunto(s)
Oftalmólogos/economía , Oftalmología/estadística & datos numéricos , Pautas de la Práctica en Medicina , Salarios y Beneficios/estadística & datos numéricos , Adulto , Factores de Edad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ontario , Oftalmólogos/normas , Estudios Retrospectivos , Factores Sexuales
13.
J Fr Ophtalmol ; 42(5): 492-498, 2019 May.
Artículo en Francés | MEDLINE | ID: mdl-30987760

RESUMEN

INTRODUCTION: Visual impairment is a handicap defined as any alteration of visual function responsible for a partial or total limitation of the activities of daily living (OMS, 2004). The objective of this study is to assess quality of life in patients before and after management of low vision. PATIENTS AND METHODS: This was a mono-centric, transverse, analytical study over a period of 6 months. Our study population included all adult patients seen in ophthalmologic consultation and followed in the low vision unit with visual acuity less than 3/10 and greater than or equal to 1/20 in the best eye with best optical correction. The National Eye Institute's quality of life questionnaire, the NEF VFQ 25, was administered to patients on site prior to management and then a month later. RESULTS: Low-vision management improved overall the dimensions of the quality of life questionnaire. Following the end-of-care assessment, the score for ocular pain was lowest (38.20), followed by the overall vision score (44.95) and near vision difficulty score (45.33). DISCUSSION: Our sample population was distinguished by a cultural mix, with diversity of beliefs and lifestyles, and also by the relatively advanced age of the subjects constituting it. This can influence the individual's perception of him- or herself within his or her environment, modifying the patient's estimation of his or her condition and therefore his or her behavior. CONCLUSION: Low-vision rehabilitation can improve the quality of life of visually impaired patients, particularly for near vision, activities of daily living and psychological health.


Asunto(s)
Calidad de Vida , Baja Visión/terapia , Actividades Cotidianas/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Personas con Discapacidad/psicología , Personas con Discapacidad/rehabilitación , Personas con Discapacidad/estadística & datos numéricos , Dolor Ocular/terapia , Femenino , Estado de Salud , Hospitales Universitarios , Humanos , Masculino , Malí/epidemiología , Persona de Mediana Edad , Oftalmología/normas , Oftalmología/estadística & datos numéricos , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Baja Visión/epidemiología , Baja Visión/fisiopatología , Baja Visión/psicología , Agudeza Visual/fisiología , Adulto Joven
14.
Ophthalmology ; 126(9): 1219-1229, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-30981915

RESUMEN

PURPOSE: Epidemic and seasonal infectious conjunctivitis outbreaks can impact education, workforce, and economy adversely. Yet conjunctivitis typically is not a reportable disease, potentially delaying mitigating intervention. Our study objective was to determine if conjunctivitis epidemics could be identified using Google Trends search data. DESIGN: Search data for conjunctivitis-related and control search terms from 5 years and countries worldwide were obtained. Country and term were masked. Temporal scan statistics were applied to identify candidate epidemics. Candidates then were assessed for geotemporal concordance with an a priori defined collection of known reported conjunctivitis outbreaks, as a measure of sensitivity. PARTICIPANTS: Populations by country that searched Google's search engine using our study terms. MAIN OUTCOME MEASURES: Percent of known conjunctivitis outbreaks also found in the same country and period by our candidate epidemics, identified from conjunctivitis-related searches. RESULTS: We identified 135 candidate conjunctivitis epidemic periods from 77 countries. Compared with our a priori defined collection of known reported outbreaks, candidate conjunctivitis epidemics identified 18 of 26 (69% sensitivity) of the reported country-wide or island nationwide outbreaks, or both; 9 of 20 (45% sensitivity) of the reported region or district-wide outbreaks, or both; but far fewer nosocomial and reported smaller outbreaks. Similar overall and individual sensitivity, as well as specificity, were found on a country-level basis. We also found that 83% of our candidate epidemics had start dates before (of those, 20% were more than 12 weeks before) their concurrent reported outbreak's report issuance date. Permutation tests provided evidence that on average, conjunctivitis candidate epidemics occurred geotemporally closer to outbreak reports than chance alone suggests (P < 0.001) unlike control term candidates (P = 0.40). CONCLUSIONS: Conjunctivitis outbreaks can be detected using temporal scan analysis of Google search data alone, with more than 80% detected before an outbreak report's issuance date, some as early as the reported outbreak's start date. Future approaches using data from smaller regions, social media, and more search terms may improve sensitivity further and cross-validate detected candidates, allowing identification of candidate conjunctivitis epidemics from Internet search data potentially to complementarily benefit traditional reporting and detection systems to improve epidemic awareness.


Asunto(s)
Conjuntivitis/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Internet/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Vigilancia de la Población/métodos , Motor de Búsqueda/estadística & datos numéricos , Monitoreo Epidemiológico , Reacciones Falso Positivas , Salud Global , Humanos , Morbilidad/tendencias , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Medios de Comunicación Sociales
15.
Ocul Immunol Inflamm ; 27(6): 897-904, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31020877

RESUMEN

Purpose: To describe the clinical experience with retinal vasculitis at 4 Egyptian tertiary eye centers. Methods: A multicenter retrospective chart review of all patients with retinal vasculitis encountered at 4 ocular inflammation referral clinics in Egypt between February 2013 and February 2018. Results: The study included 618 patients (327 males and 291 females). Of these, 284 patients had isolated retinal vasculitis, whereas 233 patients had an associated systemic inflammatory disease, the most frequent being Behçet's disease, followed by sarcoidosis. In 101 patients, retinal vasculitis could be attributed to an infectious etiology, and among this category, the most common was tuberculosis, followed by toxoplasmosis. Conclusion: In our Egyptian cohort, more than half the patients had their retinal vasculitis as part of a serious systemic disease, or as part of an infectious process, as tuberculosis. And in view of the significant potential morbidity of these conditions, the local ophthalmologists need to be aware of these entities when faced with patients presenting with retinal vasculitis.


Asunto(s)
Hospitales Especializados/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Vasculitis Retiniana/epidemiología , Atención Terciaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Síndrome de Behçet/epidemiología , Niño , Preescolar , Estudios de Cohortes , Egipto/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vasculitis Retiniana/diagnóstico , Estudios Retrospectivos , Sarcoidosis/epidemiología , Toxoplasmosis Ocular/epidemiología , Tuberculosis Ocular/epidemiología
16.
Artículo en Inglés | MEDLINE | ID: mdl-30974863

RESUMEN

Latin American immigrants make up 49% of the total immigrant population in Spain, yet little is known about their eye health. The aim of this study is to determine if there are differences in self-perceived eye health, access to eye care specialists, and use of lenses between a sample of Latin American immigrant workers from Colombia and Ecuador, and native-born workers in Spain. We used data from the PELFI cohort (Project for Longitudinal Studies of Immigrant Families). The sample consisted of 179 immigrant workers born in Colombia or Ecuador, and 83 Spanish-born workers. The outcome variables were self-perceived eye health, access to eye specialists, and use of lenses. A descriptive analysis of the sample was carried out, and the prevalence of the three outcome variables in immigrants and natives was calculated and adjusted for explanatory variables. Random effects logistic regression models examined eye health outcomes by workers' country of birth. Immigrants are less likely to report poor self-perceived eye health than native-born (ORc 0.46; CI 95%, 0.22-0.96). Furthermore, they have less access to specialists (ORc 2.61; CI 95%, 1.32-5.15) and a higher probability of needing lenses but not having them (ORc 14.14; CI 95%, 1.77-112.69). This latter variable remained statistically significant after adjusting for covariates (ORa 34.05; CI 95%, 1.59-729.04). Latin American immigrants may not value the use of lenses, despite eye care specialists indicating that they need them. Eye health education is required to recognize the importance of using lenses according to their visual needs.


Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Lentes/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Grupos de Población/estadística & datos numéricos , Especialización/estadística & datos numéricos , Adolescente , Adulto , Colombia , Estudios Transversales , Ecuador , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , España , Adulto Joven
17.
Am J Ophthalmol ; 206: 161-167, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30910517

RESUMEN

PURPOSE: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. DESIGN: Time-and-motion study with a structured survey. METHODS: This study was conducted in a single academic ophthalmology department. A convenience sample consisted of 7 attending ophthalmologists from 6 subspecialties observed during 414 patient encounters for the time-motion analysis and 12 attending ophthalmologists for the survey. Outcome measurements consisted of total time spent by attending ophthalmologists per patient and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours. RESULTS: Among the 7 attending ophthalmologists observed (6 men and 1 woman), mean ± SD age 43.9 ± 7.1 years, during encounters with 414 patients (57.8 ± 24.6 years of age), total time spent per patient was 8.1 ± 4.8 minutes, with 2.8 ± 1.4 minutes (38%) for documentation, 1.2 ± 0.9 minutes (17%) for examination, and 3.3 ± 3.1 minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends. CONCLUSIONS: Paper-based documentation takes up a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.


Asunto(s)
Centros Médicos Académicos , Documentación/estadística & datos numéricos , Registros Electrónicos de Salud/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Flujo de Trabajo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Estudios de Tiempo y Movimiento , Adulto Joven
18.
Arch Soc Esp Oftalmol ; 94(5): 211-217, 2019 May.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30837174

RESUMEN

OBJECTIVES: To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015. METHODS: All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorised using codes from ICD-9, CM. RESULTS: A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit. CONCLUSIONS: Given that the great majority of Ophthalmological Emergency visits are categorised as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Distribución por Edad , Urgencias Médicas/epidemiología , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Distribución por Sexo , Factores de Tiempo
19.
Ophthalmic Epidemiol ; 26(3): 189-199, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30767630

RESUMEN

PURPOSE: Women bear an inequitable burden of blinding conditions compared to men primarily because they have more limited access to eye care services. This systematic review sought evidence regarding interventions to increase gender equity in eye care. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and EBSCO CINAHL, and contacted experts to identify studies in low- and middle-income countries of health services interventions for age-related cataract, childhood cataract, and trachoma. Eligible studies could be clinical trials or observational studies, but had to present sufficient data for intervention effects to be estimated separately for women and men. RESULTS: We included four cluster RCTs and nine observational studies. All were judged to have serious risk of bias. Six studies examined interventions involving training rural community volunteers to identify, educate and assist individuals with unmet eye care needs. Interventions were associated with reduced gender inequities in all-cause blindness, clinic attendance, cataract surgery coverage and trachoma treatment coverage (low-to-very low quality evidence). Studies in Nepal and Tanzania examining a multicomponent intervention to improve follow-up after pediatric cataract surgery found reduced gender inequities in follow-up rates at 10 weeks (low quality evidence). CONCLUSION: Limited evidence exists to inform health service planners regarding interventions to reduce gender inequity in visual impairment and blindness. Training community volunteers to identify and counsel affected individuals, and empower them to circumvent or challenge socioeconomic barriers to accessing care holds promise. Future interventions ought to explicitly consider gender in their design and implementation, and incorporate high-quality evaluation efforts.


Asunto(s)
Países en Desarrollo , Equidad en Salud/normas , Accesibilidad a los Servicios de Salud/normas , Oftalmología/estadística & datos numéricos , Femenino , Humanos , Masculino , Factores Sexuales
20.
Int Ophthalmol ; 39(10): 2385-2390, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30710253

RESUMEN

PURPOSE: To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. METHODS: This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20. RESULTS: The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 ± 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 ± 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care. CONCLUSION: Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.


Asunto(s)
Glaucoma/terapia , Oftalmología/normas , Pautas de la Práctica en Medicina , Adulto , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Oftalmología/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Trabeculectomía/estadística & datos numéricos
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