A clinically informative screening for perinatal depression: bringing psychopathology and positive mental health together

Universal screening for perinatal depression (PND) has been widely debated, and several trustworthy guidelines have been published worldwide on how to effectively conduct it. Nevertheless, a narrow view of perinatal mental health and the strict adherence to condition-specific assessment protocols limit the clinical utility of such screenings. In this paper, traditional approaches to screening for PND are revisited to simultaneously consider two main and highly correlated psychopathological dimensions (i.e., anxiety and depression), as well as the complementary aspects of flourishing mental health. For that purpose, straightforward methodological guidelines are discussed on the grounds of current empirical research to maximize the cost-effectiveness of clinically informative PND screenings

Factos urbanos : os mercados na cidade do Porto

Dissertação de Mestrado Integrado em Arquitectura, apresentada ao Departamento de Arquitectura da Faculdade de Ciências e Tecnologia da UC

Efficacy and safety of bimatoprost in glaucoma and ocular hypertension in non-responder patients

AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT) patients with inadequate intraocular pressure (IOP)on current therapy. METHODS: Pre- and post-switch IOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in IOP post-pre switch was analyzed using a 2-sided Student's paired t-test at the 5% significance level. RESULTS: There was a statistically significant mean reduction in IOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment (P<0.001). Subgroup analysis also demonstrated a statistically significant mean reduction in IOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy (P<0.001). CONCLUSION: This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy

Soft Contact Lenses to Optimize Vision in Adults with Idiopathic Infantile Nystagmus: A Pilot Parallel Randomized Controlled Trial

<p><i>Purpose</i>: The optimal management of infantile nystagmus syndrome (INS) is still unclear. Contact lenses (CL) may be superior to glasses in improving visual function in INS but it is not known whether their beneficial effects are due to optical correction alone, or to an additional proprioceptive effect, and whether soft CLs would be as effective as rigid CLs. There is little data on feasibility and and the present study aimed to provide this information.</p> <p><i>Methods</i>: We completed a pilot Randomized Control Trial (RCT) at a single tertiary referral centre in London, UK. We enrolled 38 adults with idiopathic INS and randomised them to either plano CL (with corrective spectacles if required) or to corrective CL. CL wear was required for a minimum of 2 weeks. Primary outcome measures were feasibility and safety of CL wear in INS; secondary outcome measures were visual acuity and nystagmus waveform parameters.</p> <p><i>Results</i>: 27 completed the study (27/38,71%). 4 partcipants withdrew due to difficulty with CL insertion/removal and 7 were lost to follow up. CL tolerability was high (24/27,89%) - 2 found the CLs irritant, and 1 had an exacerbation of allergic eye disease. At two weeks, mean improvement in binocular visual acuity from baseline with plano CLs was 0.07 logMAR (95% confidence interval (CI: 0.03-0.11) and 0.06 logMAR with fully corrective CLs (95% CI:0.02-0.1). Mean improvement in the eXpanded Nystagmus Acuity Function (NAFX, a nystagmus acuity function based on eye movement recording) with plano CLs was -0.04(95% CI: -0.08-0.005) and -0.05 with fully corrective CLs(95% CI: -0.09–0.003).</p> <p><i>Conclusions</i>: CLs are well tolerated, with a low risk profile. Whilst our study was not powered to detect significant changes in BCVA and waveform parameters between treatment arms, we observed a trend towards an improvement in visual function at two weeks from baseline with CLs.</p

Ophthalmic statistics note 8: missing data-exploring the unknown

Medical research is conducted to answer uncertainties and to identify effective treatments for patients. Different questions are best addressed by different types of study design—but the randomised, controlled clinical trial is typically viewed as the gold standard, providing a very high level of evidence, when examining efficacy.1 While clinical trial methodology has advanced considerably with clear guidance provided as to how to avoid sources of bias, even the most robustly designed study can succumb to missing data.2 ,3 In this statistics note, we discuss strategies for dealing with missing data but what we hope emerges is a very clear message that there is no ideal solution to missing data and prevention is the best strategy