Reducing visual deficits caused by refractive errors in school and preschool children: results of a pilot school program in the Andean region of Apurimac, Peru

Background: Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment. Objective: To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design: A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was<6/9 [20/30] (Group I) and≤6/9 (Group II) in one or both eyes, measured with the Snellen Tumbling E chart at 6 m, were referred for a comprehensive eye exam. Specificity and positive predictive value to detect refractive error were calculated against clinical examination. Program assessment with participants was conducted to evaluate outcomes and procedures. Results: A total sample of 364 children aged 3–11 were screened; 45 children were examined at Centro Oftalmológico Monseñor Enrique Pelach (COMEP) Eye Hospital. Prevalence of refractive error was 6.2% (Group I) and 6.9% (Group II); specificity of teacher vision screening was 95.8% and 93.0%, while positive predictive value was 59.1% and 47.8% for each group, respectively. Aspects highlighted to improve the program included extending training, increasing parental involvement, and helping referred children to attend the hospital. Conclusion: Prevalence of refractive error in children is significant in the region. Vision screening performed by trained teachers is a valid intervention for early detection of refractive error, including screening of preschool children. Program sustainability and improvements in education and quality of life resulting from childhood vision screening require further research.

Invited commentary: Gender regimes in health systems

In short, what Elisa Chilet has found in her recent thesis dissertation entitled 'Gender bias in clinical research, pharmaceutical marketing and the prescription of drugs', a review of which is published in this issue of the journal, is a significant amount of gender bias.

Gender and health inequalities: intersections with other relevant axes of oppression

The risk of disease, disability, and mortality as well as access to health services are unfairly distributed among the population, with certain groups bearing an unequally larger burden of ill health and poorer access to care due to gender, sexual identity/orientation, ethnic background, or class. According to the WHO Commission on Social Determinants of Health (CSDH), these health inequalities emanate from socioeconomic and political factors (governance, cultural values, macroeconomic policies), which generate a set of socioeconomic positions in society according to which populations are stratified based on gender, ethnicity, education, income, or other factors. These societal inequalities influence people’s material and psychosocial circumstances as well as behavioral and biological factors, which in turn impact on health inequalities. Tackling gender, race/ethnic, and socioeconomic inequalities in society is thus recognized as the most powerful action to cope with unequal health risks distribution, and social innovations focusing on these ‘root causes’ are needed in order to prevent and stop endemic social inequalities and social exclusion in health within low-income as well as high-income countries. Increasing existing knowledge and making visible the health status of the most vulnerable and invisible groups are critical in order to contribute to this imperative challenge.

El contrato de alimentos a favor de tercero: particularidades de su configuración a la luz del Derecho Europeo de Contratos

La sociedad actual se enfrenta con problemas hasta ahora desconocidos que necesitan una rápida y efectiva solución. El progresivo aumento de la esperanza de vida ha dado lugar a que hoy en día nos encontremos con sociedades envejecidas y necesitadas de protección. Se habla incluso de la «cuarta edad» y de la aparición de un nuevo fenómeno demográfico denominado «envejecimiento del envejecimiento», esto es, el aumento de la población con edad superior a ochenta años. A demás, aunque la vejez no implica necesariamente enfermedad, la tasa de discapacidad crece con la edad. A lo que se debe añadir que muchas de estas personas tienen hijos discapacitados que, con toda probabilidad y debido a los avances médicos, sobrevivirán a sus ancianos padres y necesitarán medios materiales y/o personales para continuar con sus vidas. Para paliar estos problemas existe, entre otras medidas, el denominado contrato de alimentos; y especialmente útil para alcanzar este cometido resulta su configuración a favor de terceras personas. Pero su régimen jurídico cuando se celebra para beneficiar a una persona que no es parte contractual presenta importantes peculiaridades derivadas de la especial relación generada entre alimentista y alimentante. Estas particularidades serán objeto de análisis en este trabajo.