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1.
Medicine (Baltimore) ; 100(14): e25366, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832118

RESUMO

ABSTRACT: To compare and analyze the postoperative 1-year outcomes of laser refractive surgery (LRS) alone vs LRS with laser asymmetric keratectomy (LAK), in patients with myopia, for preventing and resolving LRS complications.This retrospective study compared the preoperative and 1-year postoperative outcomes between the control and comparison groups using a sum of deviations in corneal thickness in 4 directions >80 µm. The control group included 41 patients with myopia (41 eyes) who underwent LRS. The comparison group included 33 patients (33 eyes) who received LAK-linked LRS. Age, spherical equivalent (SE), sphere, cylinder, uncorrected distance visual acuity (UDVA), pupil size, kappa angle, central corneal thickness, corneal irregularity in the 3.0 mm zone on Orbscan maps (SUM), distance between the maximum posterior elevation (best-fit-sphere) and the visual axis (DISTANCE), postoperative blurring scores, frequency of postoperative myopic regression, and efficiency index were compared.Preoperative age (P = .198), SE (P = .686), sphere (P = .562), cylinder (P = .883), UDVA (P = .139), pupil size (P = .162), kappa angle (P = .807), central corneal thickness (P = .738), corneal irregularity (P = .826), SUM (P = .774), and DISTANCE (P = .716) were similar between the 2 groups. The 1-year postoperative SE (P = .024), sphere (P = .022), corneal irregularity (P = .033), SUM (P = .000), DISTANCE (P = .04), blurring scores (P = .000), and frequency of postoperative myopic regression (P = .004) were significantly decreased in the comparison group compared to the control group. UDVA (P = .014) and the efficiency index (P = .035) were higher in the comparison group.LAK with LRS improved corneal symmetry by reducing the SUM and DISTANCE. UDVA and efficiency index were also improved and blurring and myopic regression were reduced postoperatively.


Assuntos
Córnea/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Miopia/cirurgia , Adulto , Estudos de Casos e Controles , Terapia Combinada , Córnea/fisiopatologia , Paquimetria Corneana/estatística & dados numéricos , Cirurgia da Córnea a Laser/métodos , Feminino , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Masculino , Miopia/diagnóstico , Miopia/fisiopatologia , Período Pós-Operatório , Refração Ocular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Acuidade Visual/fisiologia
2.
Medicine (Baltimore) ; 100(14): e25306, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832102

RESUMO

ABSTRACT: Pituitary tumors commonly cause visual impairment and the degree of impairment can depend on the size, location, and type of the tumor. However, no studies have been made regarding the differences caused by functioning pituitary adenoma (FPA) and non-functioning pituitary adenoma (NFPA). We aimed to investigate the relationship between clinical characteristics and visual impairment in patients with FPA and NFPA.This case series study included 73 pituitary adenoma patients. All patients underwent ophthalmic evaluations, and we retrospectively reviewed their medical records. Tumor types were confirmed by histological analysis, and the tumor volume was calculated. Magnetic resonance imaging was used to determine the tumor diameter. The observation indices of the two groups were compared. The correlation between the visual field and tumor volume was analysed using scatter plots.We enrolled 30 patients in the FPA group and 43 in the NFPA group. The first symptoms presented in the eyes in 23% of FPA patients and 41.9% of NFPA patients. The best-corrected visual acuity of the FPA group was better than that of the NFPA group, and 34 (56.7%) and 73 (84.9%) eyes in these groups had visual field defects, respectively. The visual field defects of the FPA patients were lighter than those of the NFPA patients. Except for the anteroposterior diameter, there were no differences in the other parameters of tumor diameter between the groups. The tumor volume of the FPA group was smaller than that of the NFPA group. The tumor size was positively correlated with the mean deviation and negatively correlated with the mean sensitivity in both groups.There was a longer delay between the onset of signs and symptoms and treatment in the FPA group than in the NFPA group. Future studies should focus on visual field defects caused by FPA and NFPA.


Assuntos
Adenoma/complicações , Adenoma/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Transtornos da Visão/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral/fisiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 100(16): e25618, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879731

RESUMO

ABSTRACT: To investigate the relationship between visual resolution and cone parameters in eyes with different levels of best corrected visual acuity (BCVA).Seventeen eyes of 10 volunteers with BCVA of 20/12.5 or better (group 1) and 16 eyes of 10 volunteers with BCVA of 20/16 (group 2) were investigated in the study. Images of the cone photoreceptors at 1.5° from the fovea were obtained using an adaptive optics (AO) retinal camera. The BCVA was obtained following a subjective refraction using a standardized logMAR visual acuity chart.The mean cone density (29,570.96 ±â€Š2489.94 cells/mm2) at 1.5° from the fovea in group 1 (BCVA ≥ 20/12.5, n = 17) was significantly greater (P < .001) than that (22,963.59 ±â€Š2987.92 cells/mm2) in group 2 (BCVA = 20/16, n = 16). The cone spacing at 1.5° from the fovea in group 1 was 6.45 ±â€Š0.28 µm (mean ±â€ŠSD), which was significantly smaller (P < .001) than 7.36 ±â€Š0.50 µm (mean ±â€ŠSD) in group 2. In the stepwise regression analysis, greater angular cone density (odds ratio [OR], 4.48; P = .005) and smaller angular cone spacing (OR, 0.60; P = .007) at 1.5° from the fovea were significantly associated with the better BCVA.The greater cone density and smaller cone spacing at the parafovea were found in eyes with BCVA of 20/12.5 or better, as compared to that in eyes with BCVA of 20/16. Knowledge of cone distribution for different BCVA levels may be beneficial for different clinical conditions.


Assuntos
Imagem Óptica/métodos , Células Fotorreceptoras Retinianas Cones , Transtornos da Visão/diagnóstico por imagem , Acuidade Visual , Adulto , Estudos Transversais , Feminino , Fóvea Central/diagnóstico por imagem , Humanos , Masculino , Retina/diagnóstico por imagem , Adulto Jovem
4.
Zhonghua Yan Ke Za Zhi ; 57(5): 321-325, 2021 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-33915632

RESUMO

Cerebral/central visual impairment (CVI) has a wide range of features owing to central visual pathway disorders. It is currently the most common type of visual impairment in children in developed countries and is increasing in the developing world. The major cause of CVI is hypoxic-ischemic encephalopathy in premature children. CVI occurs from the postgeniculate visual pathway to the occipital lobe and results in severe visual impairment and even blindness. CVI may also lead to visual cognitive disability, walk difficulty, delayed social interaction and autism spectrum. These children are less likely to live independently, and this will impose huge costs on families and society. Therefore, much more care and attention should be paid to CVI. (Chin J Ophthalmol, 2021, 57: 321-325).


Assuntos
Encefalopatias , Baixa Visão , Cegueira , Criança , Humanos , Transtornos da Visão , Vias Visuais
5.
Zhonghua Yan Ke Za Zhi ; 57(5): 391-395, 2021 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-33915645

RESUMO

Facial cosmetic injections refer to a medical cosmetology approach that applies percutaneous injection method to inject filler materials or drugs into the target position of the face to repair and remodel the face. Common facial cosmetic injections include facial filler injection and botulinum toxin injection. A number of iatrogenic eye complications following facial cosmetic injections have been reported, such as ptosis, ophthalmoplegia, vision loss. This article reviews the cosmetic iatrogenic eye complications of the two selected common facial cosmetic injections techniques, i.e. facial filler injection and botulinum toxin injection. (Chin J Ophthalmol, 2021, 57: 391-395).


Assuntos
Técnicas Cosméticas , Oftalmoplegia , Técnicas Cosméticas/efeitos adversos , Face , Humanos , Doença Iatrogênica , Transtornos da Visão
6.
Med Clin North Am ; 105(3): 397-407, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926637

RESUMO

Incidence of cataract, diabetic retinopathy, macular degeneration, and glaucoma will significantly increase by 2050. Visual impairment can increase morbidity and mortality in nonocular disease. There are different patterns of vision loss in cataract, diabetic retinopathy, age-related macular degeneration, and glaucoma. Internists and medical subspecialists play an important role in prevention, detection, and early treatment of eye disease. Awareness of screening guidelines for eye disease as well as a basic ocular history and simple penlight examination can decrease incidence of vision loss and its impact. Visual impairment places a significant financial burden on society.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Oftalmopatias/complicações , Oftalmopatias/prevenção & controle , Humanos , Medicina Interna , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/prevenção & controle , Transtornos da Visão/terapia
7.
Med Clin North Am ; 105(3): 409-423, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926638

RESUMO

Primary care physicians see nearly half of all clinical visits, and 2% to 3% of those are for eye complaints. Taking a good ocular history is essential to establishing the diagnosis. Patient complaints fall into several categories including visual change, redness, and pain. Primary care physicians can screen for patients at risk of vision loss from glaucoma, diabetes, and toxic medication and ensure that patients have appropriate eye evaluations. Examination techniques such as direct ophthalmoscopy, evaluation of the red reflex, eversion of the upper lid, checking pupillary response, and using fluorescein to stain the cornea are helpful in evaluating patients' ocular complaints.


Assuntos
Oftalmopatias/diagnóstico , Emergências , Oftalmopatias/etiologia , Oftalmopatias/terapia , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/etiologia , Traumatismos Oculares/terapia , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/terapia
8.
Praxis (Bern 1994) ; 110(6): 285-292, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33906446

RESUMO

CME: Giant Cell Arteritis Abstract. Giant cell arteritis (GCA) is the most common vasculitis among patients over the age of 50. Mainly large vessels are targeted. GCA can be differentiated into cranial and extra-cranial types; thus the symptoms can range from headache, blurred vision and jaw claudication to non-specific symptoms like fatigue, polymyalgia and fever. Complications such as an irreversible loss of vision are critical, which is why timeous diagnosis and treatment are essential. There are some recommendations for treatment, but no defined guidelines exist. Steroids have been the standard treatment for the past six decades and remain so, but side effects are common. Tocilizumab represents an alternative and more effective and safer treatment.


Assuntos
Arterite de Células Gigantes , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Cefaleia , Humanos , Mialgia , Transtornos da Visão
9.
Sensors (Basel) ; 21(7)2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33810546

RESUMO

Immersive video is changing the way we enjoy TV. It is no longer just about receiving sequential images with audio, but also playing with other human senses through smells, vibrations of movement, 3D audio, feeling water, wind, heat, and other emotions that can be experienced through all human senses. This work aims to validate the usefulness of an immersive and interactive solution for people with severe visual impairment by developing a haptic glove that allows receiving signals and generating vibrations in hand, informing about what happens in a scene. The study case presented here shows how the haptic device can take the information about the ball's location in the playing field, synchronized with the video reception, and deliver it to the user in the form of vibrations during the re-transmission of a soccer match. In this way, we take visually impaired people to live a new sensory experience, allowing digital and social inclusion and accessibility to audiovisual technologies that they could not enjoy before. This work shows the methodology used for the design, implementation, and results evaluation. Usability tests were carried out with fifteen visually impaired people who used the haptic device to attend a soccer match synchronized with the glove's vibrations.


Assuntos
Interface Usuário-Computador , Pessoas com Deficiência Visual , Mãos , Humanos , Movimento , Transtornos da Visão
10.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 133-136, 20210000.
Artigo em Espanhol | LILACS | ID: biblio-1178958

RESUMO

Los ojos son el foco principal de la cara y se les atribuye la expresión de la personalidad del individuo. La configuración anatómica de los párpados y de la región periorbitaria conforma una de las áreas más importantes de la expresión humana. Existen alteraciones aparentemente estéticas que llevan a trastornos visuales, como la dermatocalasis y blefarochalasis, que limitan el campo visual o provocar fatiga ocular por la presión de la piel redundante sobre los párpados, la laxitud de los tendones cantales origina un síndrome de exposición escleral y a la vez lagrimeo. La blefaroplastia produce resultados clínicos y estéticos favorables en los pacientes aquejados por esta patología.


The eyes are the main focus of the face and the expression of the individual's personality is attributed to them. The anatomical configuration of the eyelids and the periorbital region constitutes one of the most important areas of human expression. There are apparently aesthetic alterations that lead to visual disorders, such as dermatochalasis and blepharochalasis, which can limit the visual field or cause eye fatigue due to the redundant pressure of the skin on the eyelashes, the laxity of the canthal tendons causes a scleral exposure syndrome and at the same time tearing. Blepharoplasty produces favorable clinical and aesthetic results in patients suffering from dermatochalasis.


Assuntos
Astenopia , Blefaroplastia , Estresse Psicológico , Síndrome , Transtornos da Visão , Fadiga
11.
Invest Educ Enferm ; 39(1)2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33687813

RESUMO

OBJECTIVES: To understand changes in daily life emerging from the COVID-19 Pandemic in people with visual impairment from four cities of Colombia. METHODS: Exploratory-type, descriptive qualitative study. The study conducted 26 semi-structured interviews via telephone. The analysis process used the methodological design from the approach proposed by Taylor and Bogdan: following the discovery process, coding and relativizing of data. RESULTS: Three categories emerge: 1) Transformations in daily dynamics, 2) Barriers to mobility, and 3) Use of technology. CONCLUSIONS: People with visual impairment report barriers to mobility to take public transportation, which can affect maintenance of their autonomy and independence. Using technological tools is identified as facilitators for the continuity of educational and work activities; however, some did not have computer literacy or the basic inputs for connectivity. Difficulties were identified to continue work activities and maintain income.


Assuntos
Limitação da Mobilidade , Autonomia Pessoal , Transtornos da Visão/epidemiologia , Adulto , Idoso , Colômbia , Alfabetização Digital , Feminino , Humanos , Internet , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Medicine (Baltimore) ; 100(10): e24670, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725826

RESUMO

ABSTRACT: To report the rationale, design, and baseline demographic characteristics of TuYou-County Pediatric Eye study, which mainly aimed to determine the retinal microvascular changes with optical coherence tomography angiography (OCTA) and its association with eye abnormalities in school aged children and adolescents at suburban location in Northern China.TuYou-County Pediatric Eye study was a school-based survey conducted in TuYou-County. Multi-ethnic (Mongol, Han, and Hui) participants will be followed up for 5 years. Standardized ophthalmological examinations include visual acuity, ocular biometry, retinal photography, and OCTA. A questionnaire survey was conducted to collect variables regarding to eye disease such as parental history of eye diseases, near work, outdoor activities, living and eating habits, etc.After sampling, 687 participants were eligible for investigation, and 20 students did not attend the investigation, living 667 (response rate, 97.1%) students completed questionnaires and all ocular examinations. The average age of all participants was 14.9 ±â€Š5.11.TYPE study is the first large-scale school-based multi-ethnic survey in suburban site of Northern China. Continuous identification of retinal microvascular changes with eye diseases will provide new insights into the control related diseases in school-age children and adolescents.


Assuntos
Microvasos/diagnóstico por imagem , Projetos de Pesquisa , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Transtornos da Visão/diagnóstico , Adolescente , Angiografia , Criança , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , População Suburbana/estatística & dados numéricos , Tomografia de Coerência Óptica , Transtornos da Visão/epidemiologia , Acuidade Visual
13.
Lancet Digit Health ; 3(1): e29-e40, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33735066

RESUMO

BACKGROUND: In current approaches to vision screening in the community, a simple and efficient process is needed to identify individuals who should be referred to tertiary eye care centres for vision loss related to eye diseases. The emergence of deep learning technology offers new opportunities to revolutionise this clinical referral pathway. We aimed to assess the performance of a newly developed deep learning algorithm for detection of disease-related visual impairment. METHODS: In this proof-of-concept study, using retinal fundus images from 15 175 eyes with complete data related to best-corrected visual acuity or pinhole visual acuity from the Singapore Epidemiology of Eye Diseases Study, we first developed a single-modality deep learning algorithm based on retinal photographs alone for detection of any disease-related visual impairment (defined as eyes from patients with major eye diseases and best-corrected visual acuity of <20/40), and moderate or worse disease-related visual impairment (eyes with disease and best-corrected visual acuity of <20/60). After development of the algorithm, we tested it internally, using a new set of 3803 eyes from the Singapore Epidemiology of Eye Diseases Study. We then tested it externally using three population-based studies (the Beijing Eye study [6239 eyes], Central India Eye and Medical study [6526 eyes], and Blue Mountains Eye Study [2002 eyes]), and two clinical studies (the Chinese University of Hong Kong's Sight Threatening Diabetic Retinopathy study [971 eyes] and the Outram Polyclinic Study [1225 eyes]). The algorithm's performance in each dataset was assessed on the basis of the area under the receiver operating characteristic curve (AUC). FINDINGS: In the internal test dataset, the AUC for detection of any disease-related visual impairment was 94·2% (95% CI 93·0-95·3; sensitivity 90·7% [87·0-93·6]; specificity 86·8% [85·6-87·9]). The AUC for moderate or worse disease-related visual impairment was 93·9% (95% CI 92·2-95·6; sensitivity 94·6% [89·6-97·6]; specificity 81·3% [80·0-82·5]). Across the five external test datasets (16 993 eyes), the algorithm achieved AUCs ranging between 86·6% (83·4-89·7; sensitivity 87·5% [80·7-92·5]; specificity 70·0% [66·7-73·1]) and 93·6% (92·4-94·8; sensitivity 87·8% [84·1-90·9]; specificity 87·1% [86·2-88·0]) for any disease-related visual impairment, and the AUCs for moderate or worse disease-related visual impairment ranged between 85·9% (81·8-90·1; sensitivity 84·7% [73·0-92·8]; specificity 74·4% [71·4-77·2]) and 93·5% (91·7-95·3; sensitivity 90·3% [84·2-94·6]; specificity 84·2% [83·2-85·1]). INTERPRETATION: This proof-of-concept study shows the potential of a single-modality, function-focused tool in identifying visual impairment related to major eye diseases, providing more timely and pinpointed referral of patients with disease-related visual impairment from the community to tertiary eye hospitals. FUNDING: National Medical Research Council, Singapore.


Assuntos
Algoritmos , Aprendizado Profundo , Oftalmopatias/complicações , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Idoso , Área Sob a Curva , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação/métodos , Estudo de Prova de Conceito , Curva ROC , Sensibilidade e Especificidade , Singapura/epidemiologia
15.
Klin Monbl Augenheilkd ; 238(3): 249-259, 2021 Mar.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33784788

RESUMO

Inherited retinal diseases are a frequent cause of severe visual impairment or blindness in children and adults of working age. Across this group of diseases, there is great variability in the degree of visual impairment, the impact on everyday life, disease progression, and the suitability to therapeutic intervention. Therefore, an early and precise diagnosis is crucial for patients and their families. Characterizing inherited retinal diseases involves a detailed medical history, clinical examination with testing of visual function, multimodal retinal imaging as well as molecular genetic testing. This may facilitate a distinction between different inherited retinal diseases, as well as a differentiation from monogenic systemic diseases with retinal involvement, and from mimicking diseases.


Assuntos
Doenças Retinianas , Baixa Visão , Adulto , Cegueira , Criança , Humanos , Retina , Doenças Retinianas/diagnóstico , Doenças Retinianas/genética , Transtornos da Visão
16.
Lancet Glob Health ; 9(4): e418-e430, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33607015

RESUMO

BACKGROUND: The number of individuals with vision impairment worldwide is increasing because of an ageing population. We aimed to systematically identify studies describing the association between vision impairment and mortality, and to assess the association between vision impairment and all-cause mortality. METHODS: For this systematic review and meta-analysis, we searched MEDLINE (Ovid), Embase, and Global Health database on Feb 1, 2020, for studies published in English between database inception and Feb 1, 2020. We included prospective and retrospective cohort studies that measured the association between vision impairment and all-cause mortality in people aged 40 years or older who were followed up for 1 year or more. In a protocol amendment, we also included randomised controlled trials that met the same criteria as for cohort studies, in which the association between visual impairment and mortality was independent of the study intervention. Studies that did not report age-adjusted mortality data, or that focused only on populations with specific health conditions were excluded. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We graded the overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. We did a random-effects meta-analysis to calculate pooled maximally adjusted hazard ratios (HRs) for all-cause mortality for individuals with a visual acuity of <6/12 versus those with ≥6/12; <6/18 versus those with ≥6/18; <6/60 versus those with ≥6/18; and <6/60 versus those with ≥6/60. FINDINGS: Our searches identified 3845 articles, of which 28 studies, representing 30 cohorts (446 088 participants) from 12 countries, were included in the systematic review. The meta-analysis included 17 studies, representing 18 cohorts (47 998 participants). There was variability in the methods used to assess and report vision impairment. Pooled HRs for all-cause mortality were 1·29 (95% CI 1·20-1·39) for visual acuity <6/12 versus ≥6/12, with low heterogeneity between studies (n=15; τ2=0·01, I2=31·46%); 1·43 (1·22-1·68) for visual acuity <6/18 versus ≥6/18, with low heterogeneity between studies (n=2; τ2=0·0, I2=0·0%); 1·89 (1·45-2·47) for visual acuity <6/60 versus ≥6/18 (n=1); and 1·02 (0·79-1·32) for visual acuity <6/60 versus ≥6/60 (n=2; τ2=0·02, I2=25·04%). Three studies received an assessment of low risk of bias across all six domains, and six studies had a high risk of bias in one or more domains. Effect sizes were greater for studies that used best-corrected visual acuity compared with those that used presenting visual acuity as the vision assessment method (p=0·0055), but the effect sizes did not vary in terms of risk of bias, study design, or participant-level factors (ie, age). We judged the evidence to be of moderate certainty. INTERPRETATION: The hazard for all-cause mortality was higher in people with vision impairment compared with those that had normal vision or mild vision impairment, and the magnitude of this effect increased with more severe vision impairment. These findings have implications for promoting healthy longevity and achieving the Sustainable Development Goals. FUNDING: Wellcome Trust, Commonwealth Scholarship Commission, National Institutes of Health, Research to Prevent Blindness, the Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research, Moorfields Biomedical Research Centre, Sightsavers, the Fred Hollows Foundation, the Seva Foundation, the British Council for the Prevention of Blindness, and Christian Blind Mission.


Assuntos
Saúde Global/estatística & dados numéricos , Mortalidade , Transtornos da Visão/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Transtornos da Visão/diagnóstico
19.
JAMA Netw Open ; 4(2): e2034993, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555330

RESUMO

Importance: Severe maternal morbidity and mortality are important indicators of maternal health. Pregnancy rates are increasing in women with disabilities, but their risk of severe maternal morbidity and mortality is unknown, despite their significant social and health disparities. Objective: To determine the risk of severe maternal morbidity or mortality among women with a physical, sensory, or intellectual/developmental disability compared with women without disabilities. Design, Setting, and Participants: This population-based cohort study used linked health administrative data in Ontario, Canada, from 2003 to 2018. The cohort included all singleton births to women with preexisting physical, sensory, and intellectual/developmental disabilities as well as with 2 disabilities or more compared with women without a disability. Data analysis was conducted from September 2019 to September 2020. Exposures: Disabilities were identified with published algorithms applied to diagnoses in 2 physician visits or more or at least 1 emergency department visit or hospitalization. Main Outcomes and Measures: Severe maternal morbidity (a validated composite of 40 diagnostic and procedural indicators) or all-cause maternal mortality, arising between conception and 42 days post partum. Relative risks were adjusted for maternal age, parity, income quintile, rurality, chronic medical conditions, mental illness, and substance use disorders. Results: The cohort comprised women with physical disabilities (144 972 women; mean [SD] age, 29.8 [5.6] years), sensory disabilities (45 259 women; mean [SD] age, 29.1 [6.0] years), intellectual/developmental disabilities (2227 women; mean [SD] age, 26.1 [6.4] years), and 2 or more disabilities (8883 women; mean [SD] age, 29.1 [6.1] years), and those without disabilities (1 601 363 women; mean [SD] age, 29.6 [5.4] years). The rate of severe maternal morbidity or death was 1.7% (27 242 women) in women without a disability. Compared with these women, the risk of severe maternal morbidity or death was higher in women with a physical disability (adjusted relative risk [aRR], 1.29; 95% CI, 1.25-1.34), a sensory disability (aRR, 1.14; 95% CI, 1.06-1.21), an intellectual/developmental disability (aRR, 1.57; 95% CI, 1.23-2.01), and 2 or more disabilities (aRR, 1.74; 95% CI, 1.55-1.95). Similar aRRs were observed for severe maternal morbidity or death arising in pregnancy, from birth to 42 days post partum, and from 43 to 365 days post partum. Women with disabilities were more likely than those without disabilities to experience multiple severe maternal morbidity indicators. The most prevalent indicators in all groups were intensive care unit admission, severe postpartum hemorrhage, puerperal sepsis, and severe preeclampsia. Conclusions and Relevance: In this study, women with a preexisting disability were more likely to experience severe maternal morbidity or mortality. Preconception and perinatal care provisions should be considered among women with a disability to mitigate the risk of these rare but serious outcomes.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Anormalidades Congênitas/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Feminino , Perda Auditiva/epidemiologia , Humanos , Deficiência Intelectual/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Ontário/epidemiologia , Gravidez , Transtornos Puerperais/epidemiologia , Risco , Índice de Gravidade de Doença , Transtornos da Visão/epidemiologia , Adulto Jovem
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