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1.
Br J Ophthalmol ; 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31676594

RESUMO

BACKGROUND/AIMS: During the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified. METHODS: In Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008-2017. RESULTS: Of 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed. CONCLUSION: Modification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26-29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.

2.
JAMA Netw Open ; 2(1): e186801, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30646195

RESUMO

Importance: Retinopathy of prematurity (ROP) can cause severe visual disability even in high-resource settings. A better understanding of the prevalence and processes leading to ROP-induced severe visual impairment may help health care professionals design preventive measures. Objectives: To determine the prevalence of severe visual disability among children born preterm in Sweden, evaluate adherence to best practice, and determine the health system's structural capacity. Design, Setting, and Participants: Population-based, nationwide cohort study of 1 310 227 children born between January 1, 2004, and December 31, 2015, in Sweden, of whom 17 588 (1.3%) were born very preterm (<32 weeks of gestation). Children born preterm with a verified diagnosis of severe visual disability had their medical records reviewed for evaluation of ROP screening, diagnosis, and treatment. In addition, a questionnaire on structural capacity was sent to all ophthalmology departments. Exposures: Stages 4 and 5 ROP. Main Outcomes and Measures: The primary outcome was prevalence of severe visual disability (visual acuity ≤20/200 for both eyes) associated with ROP stages 4 and 5. Secondary outcomes included adherence to national ROP guidelines using a predefined protocol with 15 key performance indicators for screening, diagnosis, and treatment; assessment of whether visual disability was deemed avoidable; and examination of structural capacity, including information on equipment and facilities, staffing, and patients. Results: Seventeen children (10 boys; mean [range] birth weight, 756 [454-1900] g; mean [range] gestational age, 25 [22-33] weeks) became severely visually disabled because of ROP, corresponding to a prevalence of 1 in 1000 very preterm infants (<32 weeks of gestational age) and 1 in 77 000 for all live births. Severe visual impairment was considered potentially avoidable in 11 of 17 affected children (65%) owing to untimely or no screening, missed diagnosis, or untimely and suboptimal treatment. Large variations in infrastructure (facilities, guidelines, staffing, and annual patient numbers) were also identified as potential contributors to these findings. Conclusions and Relevance: Retinopathy of prematurity still causes severe visual disability in Sweden, resulting in 1 affected infant per 1000 very preterm births. In most of these infants, noncompliance with best practice was identified, indicating that a significant proportion could have been avoided.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Retinopatia da Prematuridade , Transtornos da Visão , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Recém-Nascido , Masculino , Registros Médicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/terapia , Índice de Gravidade de Doença , Suécia/epidemiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Transtornos da Visão/prevenção & controle
3.
Acta Ophthalmol ; 96(2): 142-148, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29068172

RESUMO

PURPOSE: Retinopathy of prematurity (ROP) causes childhood blindness globally in prematurely born infants. Although increased levels of oxygen supply lead to increased survival and reduced frequency of cerebral palsy, increased incidence of ROP is reported. METHODS: With the help of a Swedish register for ROP, SWEDROP, national and regional incidences of ROP and frequencies of treatment were evaluated from 2008 to 2015 (n = 5734), as well as before and after targets of provided oxygen changed from 85-89% to 91-95% in 2014. RESULTS: Retinopathy of prematurity (ROP) was found in 31.9% (1829/5734) of all infants with a gestational age (GA) of <31 weeks at birth and 5.7% of the infants (329/5734) had been treated for ROP. Analyses of the national data revealed an increased incidence of ROP during the 8-year study period (p = 0.003), but there was no significant increase in the frequency of treatment. There were significant differences between the seven health regions of Sweden, regarding both incidence of ROP and frequency of treatment (p < 0.001). Comparison of regional data before and after the new oxygen targets revealed a significant increase in treated ROP in one region [OR: 2.24 (CI: 1.11-4.49), p = 0.024] and a borderline increase in one other [OR: 3.08 (CI: 0.99-9.60), p = 0.052]. CONCLUSION: The Swedish national ROP register revealed an increased incidence of ROP during an 8-year period and significant regional differences regarding the incidence of ROP and frequency of treatment.


Assuntos
Retinopatia da Prematuridade/epidemiologia , Peso ao Nascer , Feminino , Geografia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Triagem Neonatal , Oxigênio/administração & dosagem , Sistema de Registros , Retinopatia da Prematuridade/diagnóstico , Fatores de Risco , Suécia/epidemiologia , Seleção Visual
4.
Acta Ophthalmol ; 96(1): 51-55, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28612950

RESUMO

AIM: To report basic epidemiological data concerning surgically treated childhood cataract in Sweden and Denmark. METHODS: Data were derived from the Paediatric Cataract Register (PECARE), a binational, web-based surgical register representing Sweden and Denmark. All children operated before 8 years of age between 1 January 2007 and 31 December 2013 were included. Age-specific prevalence per 100 000 population was calculated. RESULTS: A total 574 operations in 213 boys (51.7%) and 199 girls (48.3%), altogether 412 children, were registered, the vast majority (n = 395/412; 95.9%) being individuals with congenital/infantile cataract. Of these 412, a total of 294 (147 boys and 147 girls) were Swedish and 118 (66 boys and 52 girls) were Danish. The age-specific prevalence of operated cataract in Sweden was 31/100 000 and in Denmark 28/100 000. In 454 of 574 eyes (79.1%), the cataract was dense. Altogether, 266 of 574 (46.3%) were operated during the first year of life, 193 during the first 12 weeks representing 33.6% of all operations. A primary intraocular lens (IOL) implantation was done in altogether 411 of 574 eyes (71,6%). In total, 210 unilateral cataract operations (210/574; 36.6%) were performed. Persistent fetal vasculature (PFV) was present in 64 of 193 (33.1%) of those with a congenital unilateral cataract. In 84 individuals (84/395; 21.3%) with congenital or infantile cataract, a coexisting disorder was found. CONCLUSION: The age-specific binational prevalence of operated congenital/infantile cataract in Sweden and Denmark is 30/100 000. About half of the operations are performed within the first year of life, one-third within the first 3 months. In our study population, a primary IOL was implanted in the majority of cases.


Assuntos
Extração de Catarata/estatística & dados numéricos , Catarata/epidemiologia , Implante de Lente Intraocular/estatística & dados numéricos , Sistema de Registros , Acuidade Visual , Catarata/etiologia , Catarata/fisiopatologia , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Masculino , Morbidade/tendências , Estudos Retrospectivos , Suécia/epidemiologia
5.
Acta Paediatr ; 107(5): 811-821, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29281748

RESUMO

AIM: This study evaluated the contributions of various prenatal and postnatal predictive factors to a documented high prevalence of ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm. METHODS: We carried out a prospective population-based study of all children born in Sweden at a gestational age of 22 + 0 to 26 + 6 weeks based on the Extremely Preterm Infants in Sweden Study. The main outcome measures were a combined score of visual impairment, refractive errors and strabismus at 6.5 years of age. Models of univariate and multivariable regression were used to analyse potential prenatal and postnatal predictive factors at different clinically relevant time-points from one minute after birth to 30 months. RESULTS: We focused on 399 known extremely preterm survivors and compared them to 300 full-term controls. Significant antecedents for ophthalmological abnormalities included prematurity per se, retinopathy of prematurity that required treatment, severe bronchopulmonary dysplasia and cerebral palsy. Severe intraventricular haemorrhage was no longer a significant risk factor when we adjusted it for the 30-month cognitive and neuromotor development outcomes. CONCLUSION: This time-course risk analysis model showed a changing panorama of significant risk factors for ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.


Assuntos
Displasia Broncopulmonar/patologia , Paralisia Cerebral/patologia , Olho/patologia , Retinopatia da Prematuridade/patologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Risco
6.
J Am Assoc Lab Anim Sci ; 56(1): 95-97, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28905722

RESUMO

Glucose tolerance tests are used frequently in nonclinical research with laboratory animals, for example during characterization of obese phenotypes. Despite published standard operating procedures for glucose tolerance tests in rodents, how glucose doses should be calculated when obese and lean animals are compared is not well documented. Typically the glucose dose is calculated as 2 g/kg body weight, regardless of body composition. With this approach, obese mice receive larger glucose doses than do lean animals, potentially leading to overestimation of glucose intolerance in obese animals. In this study, we performed intraperitoneal glucose tolerance tests in mice with diet-induced obesity and their lean controls, with glucose doses based on either the total body weight or the lean body mass of the animals. To determine glucose tolerance, we determined the blood glucose AUC during the glucose tolerance test. We found that the blood glucose AUC was increased significantly in obese mice compared with lean mice by 75% on average when glucose was dosed according to the lean body mass and by 87% when the glucose dose was calculated according to total body weight. Therefore, mice with diet-induced obesity were approximately equally glucose intolerant between the 2 dose-calculation protocols. However, we recommend calculating the glucose dose according to the lean body mass of the mice, because doing so eliminates the concern regarding overdosing of obese animals.


Assuntos
Glicemia/análise , Teste de Tolerância a Glucose/veterinária , Glucose/administração & dosagem , Animais , Composição Corporal , Peso Corporal , Dieta , Teste de Tolerância a Glucose/métodos , Insulina/sangue , Masculino , Camundongos , Camundongos Obesos , Obesidade
7.
JAMA Ophthalmol ; 134(5): 555-562, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27010699

RESUMO

Importance: This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP). Objectives: To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP. Design, Setting, and Participants: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study. Main Outcomes and Measures: Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP. Results: The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment). Conclusions and Relevance: In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.

8.
Br J Ophthalmol ; 100(12): 1656-1661, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26969711

RESUMO

BACKGROUND/AIMS: Retinopathy of prematurity (ROP) is a sight-threatening disease, requiring efficient screening and treatment. The present study aims to describe various aspects on treatment for ROP in Sweden. METHODS: Data on treatment for ROP in infants born in 2008-2012 were extracted from Swedish national register for retinopathy of prematurity, a web-based national register. RESULTS: During 2008-2012, 3488 infants with a gestational age (GA) at birth of <31 weeks had been screened for ROP in Sweden. Altogether, 30.3% (1057/3488) of the infants developed ROP and 5.2% (181/3488) were treated. Type 1 ROP was found in at least one eye in 83.2% (149/179) of the treated infants. One third of the eyes (32.2% right, 29.9% left eyes) were treated more than once. Laser was the only treatment in 90% of the eyes. Mean number of laser spots at first laser session was 1177 and 1386 in right and left eyes, respectively. Number of laser spots correlated negatively with GA at birth (p=0.01). There was no change in frequency of treatment or number of laser spots during the 5-year period. Anti-vascular endothelial growth factor injections were performed in 28 eyes, encircling band was used in five eyes and vitrectomies were performed in seven eyes. Twenty-six retinal surgeons performed 9.4 (range 1-37) treatment sessions in the 181 infants. CONCLUSIONS: The present study reveals similar incidences of ROP and frequencies of treatment during the 5-year study period. Many surgeons were involved in treatment of a rather limited number of infants. The results call for national discussions on organisation of ROP treatment.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Recém-Nascido Prematuro , Fotocoagulação a Laser/métodos , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Retinopatia da Prematuridade/terapia , Vitrectomia/métodos , Peso ao Nascer , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Injeções Intravítreas , Vigilância da População/métodos , Prognóstico , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Suécia/epidemiologia , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
9.
Acta Ophthalmol ; 93(1): 24-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25613125

RESUMO

PURPOSE: To analyse and discuss screening for the detection of congenital cataract in two Nordic countries, Denmark and Sweden. METHODS: Until 2011, in Denmark, no guideline concerning screening for congenital cataract existed. Since 2011, Danish guidelines regarding eye examination include examination with a pencil light at age 5 weeks, whereas newborn red reflex examination using a handheld ophthalmoscope is routine protocol in Swedish maternity wards. Data regarding age of referral were derived from the Pediatric Cataract Register (PECARE). All children operated on before 1 year of age between January 2008 and December 2012 were included. Statistical comparison of the different screening strategies was made. RESULTS: The number of children undergoing surgery for congenital cataract before 1 year of age was 31 (17 bilateral cases) in Denmark and 92 (38 bilateral cases) in Sweden. The proportion was 14 per 100.000 children in Denmark and 16 in Sweden (p < 0.05). There was a statistically significant difference between Denmark and Sweden in the percentage of children referred within 42 days of birth (p < 0.0001) and within 100 days (p < 0.001). CONCLUSION: Due to the screening procedure with red reflex examination, congenital cataract in Swedish children is detected significantly earlier than in Danish children.


Assuntos
Catarata/congênito , Catarata/diagnóstico , Triagem Neonatal , Sistema de Registros/estatística & dados numéricos , Seleção Visual , Distribuição por Idade , Extração de Catarata/estatística & dados numéricos , Dinamarca , Diagnóstico Precoce , Humanos , Lactente , Recém-Nascido , Exame Físico , Estudos Prospectivos , Encaminhamento e Consulta , Suécia
10.
Acta Ophthalmol ; 93(3): 265-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25044161

RESUMO

PURPOSE: To investigate whether recent Swedish guidelines for Retinopathy of Prematurity (ROP) screening, that is, a gestational age (GA) at birth of <31 weeks (w), are applicable in a new national cohort of prematurely born infants. METHODS: SWEDROP is a national register for ROP, initiated in 2006. The present paper reports on data from the register on various aspects of screening for ROP in infants born between 2010 and 2011 and compares the results with those for a previously published cohort born between 2008 and 2009. RESULTS: During the study period, 1744 infants were screened for ROP. Mean GA was 28.4 w (22-31), and mean birth weight was 1239 g (382-2615). Screening started at postnatal age (PNA) 5.4 w (0.4-13.3) and postmenstrual age (PMA) 33.8 w (24.9-50.1) Mean number of examinations was 5.4 per infant (1-38). Mild (stages 1-2) and severe (≥ stage 3) ROP was found in 15.4% and 8.7%, respectively. Treatment was performed in 4.2% (73/1744) of the infants, but in none with a GA of 30 weeks or more. The first treatment was performed at a mean PNA and PMA of 12.7 w (7.7-25.4) and 37.4 w (32.1-51.4), respectively. CONCLUSIONS: Recently introduced new guidelines for ROP screening in Sweden remain applicable. Reassuringly, in infants born between 2010 and 2011, incidence of ROP, frequency and timing of treatment, frequency and timing of examinations and national coverage of ROP screening remained almost identical to those for a previous cohort from 2008 to 2009. The two SWEDROP cohorts provide a basis for discussion among Swedish ophthalmologists and neonatologists on the question of further lowering the upper screening limit with 1 week.


Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Fidelidade a Diretrizes/normas , Triagem Neonatal/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde/normas , Sistema de Registros , Retinopatia da Prematuridade/diagnóstico , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Retinopatia da Prematuridade/classificação , Suécia
11.
Acta Ophthalmol ; 92(4): 311-5, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23782559

RESUMO

PURPOSE: The primary aim was to analyse regional incidences of retinopathy of prematurity (ROP) and frequencies of treatment and their relation to perinatal risk factors during a 3-year period. A secondary aim was to study adherence to the study screening protocol in the different regions. METHODS: A population-based study of neonatal morbidity in extremely preterm infants in Sweden (EXPRESS) was performed during 2004-2007. Screening for ROP was to start at postnatal age 5 weeks and to continue weekly until the retina was completely vascularized or until regression of ROP. Logistic regression analyses were used for evaluation of differences in incidence of Any ROP, ROP 3 or more and ROP Type 1 between the seven regions of the country. RESULTS: The regional incidence of ROP varied between 54% and 92% for Any ROP, between 25% and 43% for ROP stage 3 or more and between 8% and 23% of infants with ROP Type 1, all of whom were treated. There was no significant difference between the regions regarding ROP Type 1, even when adjusting for known risk factors for ROP. CONCLUSION: The heterogeneity between the regions regarding the incidence of ROP was reduced with increasing severity of ROP, and there was no heterogeneity regarding frequency of treatment for ROP, which is the most important issue for the children. We cannot exclude observer bias regarding mild ROP and ROP stage 3 in this study.


Assuntos
Idade Gestacional , Lactente Extremamente Prematuro , Triagem Neonatal , Retinopatia da Prematuridade/epidemiologia , Seleção Visual , Peso ao Nascer , Humanos , Incidência , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Razão de Chances , Retinopatia da Prematuridade/diagnóstico , Fatores de Risco , Suécia/epidemiologia
12.
JAMA Ophthalmol ; 132(2): 182-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24310059

RESUMO

IMPORTANCE: Follow-up at 30 months' corrected age reveals eye and visual problems in one-third of children born extremely prematurely (<27 weeks' gestation). OBJECTIVE: To investigate the ophthalmologic outcome of extremely preterm children at 30 months' corrected age. DESIGN, SETTING, AND PARTICIPANTS A prospective, population-based follow-up study (Extremely Preterm Infants in Sweden Study [EXPRESS]) was conducted in Sweden. The population included extremely preterm infants (<27 weeks' gestation) born in Sweden between 2004 and 2007, of whom 491 survived until age 2.5 years. Screening for retinopathy of prematurity (ROP) was performed in the neonatal period. At 30 months' corrected age, an ophthalmologic assessment was performed in 411 of 491 children (83.7%). MAIN OUTCOMES AND MEASURES: Visual acuity, manifest strabismus, and refractive errors were evaluated. RESULTS: Visual impairment was identified in 3.1% of the children, and 1.0% were blind. Refractive errors, defined as myopia less than -3 diopters (D), hypermetropia greater than +3 D, astigmatism 2 D or more, and/or anisometropia 2 D or more, were found in 25.6% of the children, and 14.1% had manifest strabismus. There were significant associations between visual impairment and treated ROP (P = .02), cognitive disability (P < .001), and birth weight (P = .02). Multiple regression analyses revealed significant associations between strabismus and treated ROP (P < .001), cognitive disability (P < .01), and cerebral palsy (P = .02). Refractive errors were significantly correlated with severity of ROP (right eye, P < .001; left eye, P < .01). Children who had been treated for ROP had the highest frequency (69.0%) of eye and visual abnormalities. CONCLUSIONS AND RELEVANCE: One-third of the extremely prematurely born children in this study had some kind of eye or visual problems, such as visual impairment, strabismus, or major refractive error. Despite being born extremely preterm, the present cohort has a similar prevalence of blindness and visual impairment as in previous Swedish cohorts of children born less prematurely.


Assuntos
Cegueira/epidemiologia , Lactente Extremamente Prematuro , Erros de Refração/epidemiologia , Retinopatia da Prematuridade/epidemiologia , Estrabismo/epidemiologia , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Masculino , Estudos Prospectivos , Suécia/epidemiologia , Acuidade Visual
13.
Acta Paediatr ; 102(3): 263-7, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23205674

RESUMO

AIM: To study which eye-screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study and compare results with earlier Swedish retrospective results. METHODS: Surveys were sent in 2006 to maternity/neonatal and women's health departments regarding screening policy. Response frequency was 96% (122/127). Data were derived from the Paediatric Cataract Register (PECARE), Sweden. All Swedish children diagnosed with congenital cataract and operated on before 1 year of age between January 2007 and December 2009 were included. Statistical comparison with earlier retrospective results was performed. RESULTS: Eye screening is a routine protocol at a rate of 90% of Swedish maternity wards. Sixty-one children were included in the study. An increase was shown in case referrals from maternity wards compared to 10 years ago (64% vs. 50%). Detection was performed within 6 weeks of age in 75% of the cases. A significant difference between the probabilities of early referral (0.38; p < 0.001, < 6 weeks of age) and early surgery (0.36; p < 0.001) (PECARE) was found in comparison with the historical data of no maternity-ward screening. Well-baby clinics were instrumental in early detection, as well. CONCLUSION: Eye screening in maternity wards is effective. Clear Swedish directives are to be preferred.


Assuntos
Catarata/congênito , Catarata/diagnóstico , Centros de Saúde Materno-Infantil , Unidade Hospitalar de Ginecologia e Obstetrícia , Sistema de Registros , Fatores Etários , Catarata/epidemiologia , Protocolos Clínicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Estudos Prospectivos , Estudos Retrospectivos , Suécia/epidemiologia
14.
Arch Ophthalmol ; 130(11): 1418-24, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23143441

RESUMO

OBJECTIVES: To evaluate screening for retinopathy of prematurity (ROP) in Sweden and to investigate possible modifications of the present screening guidelines. METHODS: Infants in Sweden with a gestational age (GA) of 31 weeks + 6 days or less are screened for ROP. Data from the Swedish national register for ROP (SWEDROP) during 2008 and 2009 were extracted and compared with a national perinatal quality register. RESULTS: In SWEDROP, there were 1791 infants born before a GA of 32 weeks from January 1, 2008, through December 31, 2009. Another 70 infants were registered in the perinatal quality register but not in SWEDROP (dropout rate, 3.8% [70 of 1861 infants]). Seven infants died before termination of screening. In the final study cohort (1784 infants), 15.6% had mild ROP and 8.5% had severe ROP. Treatment was performed in 4.4% of the infants, none of whom had a GA at birth of more than 28 weeks. Nine infants with a GA of more than 28 weeks at birth developed stage 3 ROP, which regressed spontaneously. The total number of examinations was 9286 (964 in infants with a GA of 31 weeks), and the mean (range) number of examinations of each infant was 5.2 (1-30). CONCLUSIONS: The SWEDROP, a quality register for ROP, has a national coverage (ie, participation) of 96%. Data from 2008 to 2009 show that it seems possible to reduce the upper limit for screening in Sweden by 1 week, including only infants with a GA of 30 weeks + 6 days or less. However, such a change should be combined with a strong recommendation to neonatologists to refer also severely ill and more "mature" infants.


Assuntos
Triagem Neonatal/métodos , Sistema de Registros , Retinopatia da Prematuridade/diagnóstico , Seleção Visual/métodos , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Suécia/epidemiologia
16.
Arch Ophthalmol ; 129(2): 167-72, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21320961

RESUMO

OBJECTIVE: To analyze screening for retinopathy of prematurity (ROP) during a 3-year period in a national cohort of infants born before 27 weeks' gestation. METHODS: A national prospective study of neonatal morbidity in extremely preterm infants was performed in Sweden between April 1, 2004, and March 31, 2007. Screening for ROP was to start in the fifth postnatal week and to continue weekly until complete vascularization of the retina or until regression of ROP. RESULTS: The first eye examination was performed no later than the sixth postnatal week in 84.8% of 506 infants, and the last examination was performed at postmenstrual age (PMA) of 38 weeks or later in 96.2% of infants. The mean and median numbers of days between examinations in the total cohort were 8.6 and 7.9 days, respectively (range, 1-27.8 days), and the mean and median numbers of examinations were 12 and 10, respectively. Most infants were treated during a limited period (eg, at PMA of 39 weeks, 75.0% of infants had been treated). CONCLUSIONS: The objective of screening for ROP is timely detection of ROP before reaching treatment of criteria, ie, type 1 ROP, according to the Early Treatment for ROP recommendations. In our population of infants born before 27 weeks' gestation, the first examination could safely be postponed until PMA of 31 weeks because the onset of ROP stage 3 did not occur before then and criteria for treatment were not reached before PMA of 32 weeks. Gestational age at birth and PMA at the time of examination should be considered when deciding when and where the next examination should be performed.


Assuntos
Idade Gestacional , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Retinopatia da Prematuridade/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Prospectivos , Retinopatia da Prematuridade/fisiopatologia , Suécia
17.
Health Expect ; 14(4): 361-73, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21199199

RESUMO

BACKGROUND: Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. OBJECTIVE: To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. METHODS: Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. SETTING AND PARTICIPANTS: Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. RESULTS: Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. DISCUSSION AND CONCLUSIONS: The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends.


Assuntos
Satisfação do Paciente , Farmácias/estatística & dados numéricos , Q-Sort , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
18.
Arch Ophthalmol ; 128(10): 1289-94, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20937998

RESUMO

OBJECTIVE: To investigate the natural history of retinopathy of prematurity (ROP) in 506 extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. METHODS: A national population-based study was performed in Sweden from April 1, 2004, to March 31, 2007. According to the study protocol, initial eye examinations were to be performed at postnatal week 5, and examinations were repeated until the retina was completely vascularized or until criteria for treatment were met. The examinations were to be performed weekly, enabling study of the course and severity of ROP. In infants without ROP or with mild ROP without progression during the latest examinations, further examinations were performed weekly or every other week from postmenstrual age 35 weeks. RESULTS: During the study, 368 infants (72.7%) developed ROP. Postmenstrual age at onset of ROP was significantly related to severity of ROP, even when controlling for gestational age (ie, the earlier the onset of ROP, the higher the risk of developing severe ROP). Site of onset of ROP was significantly related to gestational age at birth. The risk of nasal onset was almost doubled for every week of decrease in gestational age at birth. Nasal onset was associated with severe ROP, even after adjusting for gestational age at birth. CONCLUSION: This population-based study confirms results of the Cryotherapy for Retinopathy of Prematurity study and shows new correlations regarding time and site of onset of ROP, both of which are associated with disease severity.


Assuntos
Idade Gestacional , Retinopatia da Prematuridade/epidemiologia , Idade de Início , Progressão da Doença , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Nascimento Prematuro , Estudos Prospectivos , Retinopatia da Prematuridade/diagnóstico , Suécia/epidemiologia , Fatores de Tempo
19.
Cornea ; 29(10): 1096-102, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20567200

RESUMO

PURPOSE: The purpose of this research is 2-fold. First of all, the level of keratopathy development in patients with congenital aniridia is studied. In addition, a correlation between the effects of ocular surgery on the severity of keratopathy is made. METHODS: A thorough search for the total number of patients with aniridia in Sweden and Norway was performed. One hundred eighty-one patients were identified and 124 (69%) of these were examined. Three artificial eyes, 16 eyes with corneal transplants, and 1 eye with a corneal limbal allograft were excluded from the study. All participating patients underwent clinical ophthalmologic examinations, including photographs, and their medical history was recorded. A slit lamp was used to examine the presence of keratopathy. RESULTS: Visible keratopathy was found in 80% of the eyes. Keratopathy that caused impaired visual acuity was found in 26% of the eyes. The study displayed a significant correlation between the level of keratopathy and the patient's age. A significant correlation between the level of keratopathy and intraocular surgery exists. This is irrespective of the patient's age. The study also found that irrespective of the patient's age, a significant correlation between the level of keratopathy and impaired corneal sensitivity exists. CONCLUSIONS: This research identified the presence of visible keratopathy in 80% of eyes. In addition, 26% of eyes had a keratopathy level that caused visual disturbances. The study showed that the prevalence and severity of keratopathy increased with the patient's age. Further conclusions are that intraocular surgery increases the severity of keratopathy and that the severity of keratopathy is correlated to reduced corneal sensitivity. Finally, extreme care should be taken when selecting patients for intraocular surgery because this procedure can trigger the development of keratopathy.


Assuntos
Aniridia/complicações , Doenças da Córnea/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Aniridia/epidemiologia , Criança , Pré-Escolar , Doenças da Córnea/epidemiologia , Doenças da Córnea/cirurgia , Humanos , Lactente , Pressão Intraocular , Pessoa de Meia-Idade , Noruega/epidemiologia , Suécia/epidemiologia , Acuidade Visual
20.
Am J Ophthalmol ; 150(1): 23-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20447615

RESUMO

PURPOSE: To follow up children born after in vitro fertilization (IVF) with respect to eye malformations and poor visual acuity. DESIGN: Observational cohort study based on Swedish health registers. METHODS: Congenital eye malformations were studied in 32 091 children born from 1982 through 2007 and severe visual impairment was studied in 24 628 children born from 1985 through 2005 after IVF in Sweden. Comparisons were made with all children born in Sweden during corresponding periods with adjustment for various confounders. The main outcome measure was the presence of a congenital eye malformation and poor visual acuity. RESULTS: Thirty-six (1.1 per 1000) IVF infants with ocular malformations were identified, and the risk, compared with non-IVF children, was not increased when adjusted for maternal age, parity, smoking, and body mass index (odds ratio, 1.05; 95% confidence interval, 0.75 to 1.47). Severe visual impairment was identified in 25 cases (1.0 per 1000), and the risk increase was statistically significant (odds ratio, 1.65; 95% confidence interval, 1.12 to 2.45) and was only slightly reduced when adjustment as above was made (odds ratio, 1.55; 95% confidence interval, 1.04 to 2.32). When adjustment was made for known length of unwanted childlessness, the OR decreased to 1.15 (95% confidence interval, 0.61 to 2.16). Only 3 of the 25 children with visual impairment had ocular malformations. CONCLUSIONS: Although there is an increased risk for visual impairment among children born after IVF, the individual risk is small and may be secondary to parental characteristics. No increased risk for eye malformations was found.


Assuntos
Anormalidades do Olho/epidemiologia , Fertilização In Vitro , Transtornos da Visão/epidemiologia , Acuidade Visual , Criança , Pré-Escolar , Estudos de Coortes , Anormalidades do Olho/etiologia , Humanos , Lactente , Recém-Nascido , Razão de Chances , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Transtornos da Visão/etiologia
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