Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?

Purpose: To determine the scientific evidence about the prevalence of accommodative and nonstrabismic binocular anomalies. Methods: We carried out a systematic review of studies published between 1986 and 2009, analysing the MEDLINE, CINAHL, FRANCIS and PsycINFO databases. We considered admitting those papers related to prevalence in paediatric and adult populations. We identified 660 articles and 10 papers met the inclusion criteria. Results: There is a wide range of prevalence, particularly for accommodative insufficiency (2 %-61.7 %) and convergence insufficiency (2.25 %-33 %). More studies are available for children (7) compared with adults (3). Most of studies examine clinical population (5 studies) with 3 assessed at schools and 1 at University with samples that vary from 65 to 2048 patients. There is great variability regarding the number of diagnostic signs ranging from 1 to 5 clinical signs. We found a relation between the number of clinical signs used and prevalence values for convergence insufficiency although this relationship cannot be confirmed for other conditions. Conclusion: There is a lack of proper epidemiological studies about the prevalence of accommodative and nonstrabismic binocular anomalies. Studies reviewed examine consecutive or selected patients in clinical settings and schools but in any case they are randomized and representative of their populations with no data for general population. The wide discrepancies in prevalence figures are due to both sample population and the lack of uniformity in diagnostic criteria so that it makes difficult to compile results. Biases and limitations of reports determine that prevalence rates offered are only estimations from selected populations.

Modulación del receptor nicotínico por moléculas de relevancia clínica

El receptor nicotínico de acetilcolina (nAChR) es el miembro mejor caracterizado de la superfamilia de canales iónicos activados por ligando (LGICs). Las disfunciones del nAChR se han relacionado con graves alteraciones fisiopatológicas del sistema nervioso, así como con alteraciones inflamatorias e inmunológicas y con el desarrollo de ciertos tipos de cáncer. Por ello, el conocimiento de las moléculas que modulan la función de este receptor, el estudio de sus mecanismos de acción y la dilucidación de sus lugares de unión son de gran interés científico, ya que son pasos fundamentales para avanzar en el desarrollo de nuevas moléculas de aplicación terapéutica, dirigidas al tratamiento de las patologías mencionadas. Esta revisión pretende describir los principales mecanismos de modulación del nAChR y exponer los efectos que diversas moléculas de interés clínico ejercen sobre el nAChR, algunas inhibiendo su actividad y otras potenciándola.

Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

Purpose: To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. Methods: We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. Results: The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients’ symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

El urbanismo expansivo y la movilidad infantil en Cataluña

Los modelos de movilidad son una de las expresiones de las distintas formas urbanas. El urbanismo expansivo, como una de estas formas urbanas, está asociado a ciertos tipos de desplazamientos, relacionados a altos niveles de disfunciones sociales, económicas y medioambientales. La comunicación explora las tipologías de desplazamientos en un grupo ciudadano muy específico: los menores de 16 años. La población infantil tiene sus propias pautas de movilidad y estas están relacionadas, también, a las distintas formas urbanas. El análisis se basa en los datos que ofrece la Encuesta de Movilidad Cotidiana de Cataluña 2006 y de ella se analizan las grandes cifras para la comunidad catalana en conjunto. También se comparan los distintos subámbitos territoriales en relación a las características urbanas que estos presentan.