Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg

Comunicação e mentira em "Casos de família": uma abordagem psicanalítica e complexa de um programa de tv

Este trabalho discorre sobre aspectos da Comunicação e da Mentira, através do estudo de um programa de televisão do SBT, “Casos de Família”. Destaca, como categorias a serem observadas a priori, os conceitos de “talk show”, Âncora e autoajuda. Aborda, também, aspectos do comportamento do público e convidados, que comparecem ao programa. Para alicerçar este estudo, recorremos à Teoria Psicanalítica, com categorias a priori, como a Negação, a Onipotência, o Narcisismo, a Influência da âncora, o Talk Show, a Idealização, a Mentira e a Transgeracionalidade. Como categorias examinadas, surgidas a posteriori, focalizamos a situação Edípica, o Alcoolismo e a Relações de Mães e Filhos. Usamos, como Metodologia desta pesquisa de caráter Qualitativo, o Paradigma da Complexidade de Edgar Morin. Através dele, transita-se pelas categorias da complexidade e assume-se o conhecimento como algo não restrito ou reduzido a uma disciplina, mas como um corpo transdiciplinar, que se expande, contamina e utiliza–se de todo e qualquer aspecto que colabore e enriqueça a busca do saber científico.Obtivemos, como resposta a essa trajetória, inúmeras questões, algumas a serem pensadas e ainda mais pesquisadas e outras elucidativas, como a presença da Mentira em todos os aspectos da subjetividade humana; a confirmação da necessidade de mentir, como um ato de sobrevivência física e emocional dos indivíduos, principalmente em sociedades organizadas; a função catártica e pouco verdadeira dos métodos chamados de auto-ajuda; e a dissimulação nas intenções de algumas ações deste gênero que, quase certamente, buscam outros fins. Concluímos, finalmente, que este é um estudo que contempla inúmeros olhares de pesquisa, pois envolve a complexidade do comportamento humano, sua subjetividade, seu desejo de atenção e auto conhecimento, mas também aspectos pouco assumidos e discutidos, como a arte de enganar em proveito próprio e a mentira para si mesmo, com conseqüências, por vezes, bastante danosas e sofridas para os indivíduos e a sociedade onde convivem.This project concerns aspects of Communication and the Lie, through the study of an SBT television program called “Casos da Família”. Categories to be observed a priori are singled out as being the concepts of the talk show, Anchor and self-help. It also deals with aspects of the behavior of the public and the guests appearing on the program. The foundation of the work makes use of Psychoanalytic Theory, with a priori categories such as Denial, Omnipotence, Narcissism, Anchorwoman’s influence, Talk Show, Idealization, Lie and Transgenerationality. As categories to be examined that emerged a posteriori, we focus on the Oedipus situation, Alcoholism, Mother and Child relationships. We use Edgar Morin’s Paradigm of Complexity as the Qualitative Methodology for this research. This goes through categories of complexity and considers knowledge as something not restricted or reduced to a discipline, but as a transdisciplinary body, which expands, infects and makes uses of each and every aspect that aids and enriches the search for scientific knowledge.The results of this line of investigation raised numerous question, some to be considered and further researched and others revealing, such as the presence of the lie in all aspects of human subjectivity; confirmation of the need for lying as an act for the physical and emotional survival of the individual, principally in organized societies; the cathartic and hardly real function of so called self-help methods; and the falsity in the intentions of some of these types of actions, which almost certainly seek other ends. Finally, we conclude that this is a study that considers numerous approaches to research, since it involves the complexity of human behavior, its subjectivity, its desire for attention and self knowledge, but also aspects that are little considered and discussed, such as the art of deceit for one’s own benefit and lying for its own sake, with consequences which are often harmful and undergone by individuals and the society in which they live

Translation and cross-cultural adaptation of the Rating Scale for Countertransference (RSCT) to American English

Abstract Introduction: The Rating Scale for Countertransference (RSCT) - originally, Escala para Avaliação de Contratransferência (EACT) - is a self-administered instrument comprising questions that assess 23 feelings (divided into three blocs, closeness, distance, and indifference) that access conscious countertransferential emotions and sentiments. This paper describes the process of translation and cross-cultural adaptation of the RSCT into American English. Methods: This study employed the guidelines proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force for Translation and Cultural Adaptation which define 10 steps for translation and cross-cultural adaptation of self-report instruments. Additionally, semantic equivalence tools were employed to select the final versions of terms used. The author of the RSCT gave permission for translation and took part in the process. The instrument is available for use free of charge. Results: Analysis of the back-translation showed that just seven of the 23 terms needed to be adjusted to arrive at the final version in American English. Conclusions: This study applied rigorous standards to construct a version of the RSCT in American English. This version of the RSCT translated and adapted into American English should be of great use for accessing and researching countertransferential feelings that are part of psychodynamic treatment

Prevalência de sintomas depressivos em uma amostra de prostitutas de Porto Alegre Prevalencia de síntomas depresivos en una muestra de prostitutas de Porto Alegre Prevalence of depressive symptoms in a sample of prostitutes in Porto Alegre

INTRODUÇÃO: a prevalência de transtornos depressivos na população feminina de Porto Alegre é estimada em 14,5%. Não existem relatos sobre a prevalência de sintomas ou transtornos depressivos entre as prostitutas, população de risco para transtornos mentais. OBJETIVOS: quantificar a prevalência de sintomas depressivos em amostra de prostitutas de Porto Alegre e fatores associados. MATERIAL E MÉTODOS: uma amostra consecutiva e não aleatória de 97 mulheres entre 18 e 60 anos, cadastradas na Organização Não Governamental Núcleo de Estudos da Prostituição (NEP), de Porto Alegre, foi estudada. Após consentimento informado, as entrevistadas foram investigadas através do Inventário para depressão de Beck (BDI). O ponto de corte igual ou maior que 13 foi utilizado para detecção de sintomas depressivos. RESULTADOS: na amostra estudada, a idade média foi de 29,6 anos (dp 8,5 anos); 67% apresentaram sintomas depressivos (ponto de corte³ 13) com escore médio no BDI de 19,1 (dp 10,9); 24,7% da amostra apresentava sintomas leves; 40,2% sintomas moderados e 7,2% sintomas graves. Houve associação estatisticamente significativa entre a presença de sintomas depressivos e uso de álcool, história de doenças sexualmente transmissíveis e ausência de prática religiosa (p<0,05). CONCLUSÃO: além de alta taxa de prevalência de sintomas depressivos (67%), 47,4% das mulheres avaliadas apresentaram níveis moderado e grave de sintomatologia. O uso de álcool, história de doenças sexualmente transmissíveis e ausência de prática religiosa surgiram como fatores associados à presença de sintomas depressivos na amostra estudada.<br>INTRODUCCIÓN: la prevalencia de trastornos depresivos en la población femenina de Porto Alegre es estimada en 14,5 %. No existen relatos sobre la prevalencia de síntomas o trastornos depresivos entre las prostitutas, población de riesgo para trastornos mentales. OBJETIVOS: cuantificar la prevalencia de síntomas depresivos en muestra de prostitutas de Porto Alegre y factores asociados. MATERIAL Y MÉTODOS: fue estudiada una muestra consecutiva y no aleatoria de 97 mujeres entre 18 y 60 años, cadastradas en la Organización No Governamental Nucleo de Estudios de la Prostitución (NEP), de Porto Alegre. Después de informado el consentimiento, las entrevistadas fueron investigadas a través del Inventario para Depresión de Beck (BDI). El punto de corte igual o mayor que 13 fue utilizado para detección de síntomas depresivos. RESULTADOS: en la muestra estudiada la edad media fue de 29,6 años (dp 8,5 años), 67% presentaron síntomas depresivos (punto de corte³ 13) con escore medio en el BDI de 19,1 (dp 10,9); 24,7 % de la muestra presentaba síntomas leves, 40,2 % síntomas moderados y 7,2 % síntomas graves. Hubo asociación estatísticamente significativa entre la presencia de síntomas depresivos y el uso de alcohol, histórico de enfermedades sexualmente transmisibles y la ausencia de práctica religiosa, (p<0,05). CONCLUSIÓN: además de la alta tasa de prevalencia de síntomas depresivos (67%) 47,4% de las mujeres evaluadas presentaron niveles moderado y grave de sintomatología. El uso de alcohol, histórico de enfermedades sexualmente transmisibles y la ausencia de práctica religiosa surgieron como factores asociados a la presencia de síntomas depresivos en la muestra estudiada.<br>INTRODUCTION: the prevalence of depressive disorders in the female population in Porto Alegre was estimated to be 14.5%. There are no reports on the prevalence of depressive symptoms or depressive disorders among prostitutes that are a group at risk for mental disorders. OBJECTIVES: the main purpose of this study was to evaluate the prevalence of depressive symptoms and to identify associated factors in a sample of Porto Alegre prostitutes. MATERIAL AND METHODS: a consecutive and non-randomized sample of 97 women between 18 and 60 years, registered at a non-governmental organization in Porto Alegre was studied using the Beck Depression Inventory (BDI) after informed consent. A cut off point equal or higher then 13 was used to detect depressive symptoms RESULTS: the mean age (&plusmn;SD) was 29.6 (8,5), depressive symptoms (cut off³ 13) were noted in 67% of the sample, the mean score (&plusmn;SD) of BDI was 19.1 (10.9). The depressive symptoms were found to be mild in 24.7%, moderate in 40.2% and severe in 7.2% of the sample. A statistically significant association was found between depressive symptoms and use of alcohol, and sexually-transmitted diseases, and lack of religious practices (p<0,05). CONCLUSION: besides the high prevalence of depressive symptoms (67%) 47.4% of the women studied presented moderate or severe levels of depression. Use of alcohol, and sexually-transmitted diseases and lack of religious practices were associated with depressive symptoms in the studied sample

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used