Visual disability, visual function, and myopia among rural chinese secondary school children: the Xichang Pediatric Refractive Error Study (X-PRES)--report 1.

PURPOSE: To evaluate visual acuity, visual function, and prevalence of refractive error among Chinese secondary-school children in a cross-sectional school-based study. METHODS: Uncorrected, presenting, and best corrected visual acuity, cycloplegic autorefraction with refinement, and self-reported visual function were assessed in a random, cluster sample of rural secondary school students in Xichang, China. RESULTS: Among the 1892 subjects (97.3% of the consenting children, 84.7% of the total sample), mean age was 14.7 +/- 0.8 years, 51.2% were female, and 26.4% were wearing glasses. The proportion of children with uncorrected, presenting, and corrected visual disability (< or = 6/12 in the better eye) was 41.2%, 19.3%, and 0.5%, respectively. Myopia < -0.5, < -2.0, and < -6.0 D in both eyes was present in 62.3%, 31.1%, and 1.9% of the subjects, respectively. Among the children with visual disability when tested without correction, 98.7% was due to refractive error, while only 53.8% (414/770) of these children had appropriate correction. The girls had significantly (P < 0.001) more presenting visual disability and myopia < -2.0 D than did the boys. More myopic refractive error was associated with worse self-reported visual function (ANOVA trend test, P < 0.001). CONCLUSIONS: Visual disability in this population was common, highly correctable, and frequently uncorrected. The impact of refractive error on self-reported visual function was significant. Strategies and studies to understand and remove barriers to spectacle wear are needed.

Impact of posterior subcapsular opacification on vision and visual function among subjects undergoing cataract surgery in rural China: Study of Cataract Outcomes and Up-Take of Services (SCOUTS) in the Caring is Hip Project, report 5.

AIM: To study the effect of posterior capsular opacification (PCO) on vision and visual function in patients undergoing cataract surgery in rural China, and to compare this with the effect of refractive error. METHODS: Patients undergoing cataract surgery in at least one eye by local surgeons in a rural setting between 8 August and 31 December 2005 were examined with slit lamp grading of PCO 10-14 months after surgery. Subjects with any PCO associated with best-corrected visual acuity of 6/7.5 or worse, or with grade 2+ or worse PCO without visual decrement, were offered YAG laser capsulotomy. Vision and self-reported visual function were assessed, and various demographic and clinical factors potentially associated with PCO were recorded. RESULTS: Of 313 patients operated on within the study window, 239 (76%) could be contacted by telephone; study examinations were performed on 176 (74%). Examined subjects had a mean (SD) age of 69.4 (10.5) years, 116 (67%) were female, and 149 (86%) had been blind (presenting visual acuity < or = 6/60) in the operated eye before surgery. PCO of grade 1 or above was present in 34 of 204 operated eyes (16.7%). Those with PCO had significantly worse presenting vision (p = 0.007) but not visual function (p>0.3) than those without PCO. Women had a significantly higher prevalence of PCO (20.9%) than did men (8.6%, p<0.05). Of 19 eyes undergoing capsulotomy with best-corrected visual acuity measured the next day, 13 (68%) improved by one or more lines, and seven (37%) improved by two or more lines. Despite a higher uptake of capsulotomy (95%) as opposed to refraction (35%) in this cohort, the yield in terms of eyes with poor presenting visual acuity (< 6/18) that could be improved was higher for refraction (26% = 9/35) than for capsulotomy (9% = 3/35). CONCLUSION: The prevalence of PCO and impact on vision and visual function in this cohort was modest 1 year after surgery. However, PCO prevalence increases with time. Follow-up of this cohort is underway to determine the effectiveness of this early intervention in identifying and treating subjects who will eventually experience clinically significant PCO.

Visual morbidity due to inaccurate spectacles among school children in rural China: the See Well to Learn Well Project, report 1.

PURPOSE: Inadequately corrected refractive error is the leading cause of visual disability among children in China; inaccurate spectacles are a potential cause. The prevalence and visual impact of spectacle inaccuracy were studied among rural, secondary-school children, to determine the optimal timing for updating of refraction. METHODS: A random sample of children from years 1 and 2 in all junior and senior high schools in Fuyang Township, Guangdong Province, underwent ocular examination. All children who reported wearing glasses received cycloplegic refraction, vision assessment, and measurement of current spectacles. RESULTS: Among 3226 examined children, 733 (22.7%) reported owning spectacles. Refractive error and spectacle power were assessed for 588 (80.2%) children. They had a mean age of 15.0 +/- 1.6 years; 70.2% were girls, 83.3% had more than -1.5 D of myopia, and 17.9% had presenting vision < or = 6/12 in the better eye. The glasses of 48.8% of children were inaccurate by > or = 1 D; inaccuracy was > or = 2 D in 17.7%. Children with inaccurate glasses (> or = 1 D) had presenting vision in the better eye significantly (P < 0.001) worse than that of children with accurate glasses, and 30.3% had presenting acuity < or = 6/12. In multivariate models, younger age (P = 0.004), more myopic refractive error (P < 0.001), and having glasses > or = 1 year old (P = 0.04) were associated with inaccurate spectacles. DISCUSSION: Inaccurate spectacles are common and are associated with significant visual impairment among children in rural China. Reducing outdated glasses could lessen the visual burden, although refractive services may have to be offered on an annual basis for optimal benefit.

Reducing the visual burden of glaucoma in Asia: what we know and what we need to know.

Despite great progress in elucidating risk factors and effective treatments for eye disease in the last decades, blindness prevalence in the developing and developed world is either static or rising. A research agenda is needed to develop and test specific strategies to reduce the burden of blindness from glaucoma and other common eye diseases. Current knowledge about open and closed-angle glaucoma is reviewed and a strategy to reduce glaucoma blindness in Asia is suggested. A critical component of this strategy is enhanced training in the detection of narrow angles and optic nerve damage by direct examination. Specific research topics that could inform such a strategy are outlined.

A population-based study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children.

PURPOSE: To evaluate the prevalence and causes of visual impairment among Chinese children aged 3 to 6 years in Beijing. DESIGN: Population-based prevalence survey. METHODS: Presenting and pinhole visual acuity were tested using picture optotypes or, in children with pinhole vision < 6/18, a Snellen tumbling E chart. Comprehensive eye examinations and cycloplegic refraction were carried out for children with pinhole vision < 6/18 in the better-seeing eye. RESULTS: All examinations were completed on 17,699 children aged 3 to 6 years (95.3% of sample). Subjects with bilateral correctable low vision (presenting vision < 6/18 correctable to >or= 6/18) numbered 57 (0.322%; 95% confidence interval [CI], 0.237% to 0.403%), while 14 (0.079%; 95% CI, 0.038% to 0.120%) had bilateral uncorrectable low vision (best-corrected vision of < 6/18 and >or= 3/60), and 5 subjects (0.028%; 95% CI, 0.004% to 0.054%) were bilaterally blind (best-corrected acuity < 3/60). The etiology of 76 cases of visual impairment included: refractive error in 57 children (75%), hereditary factors (microphthalmos, congenital cataract, congenital motor nystagmus, albinism, and optic nerve disease) in 13 children (17.1 %), amblyopia in 3 children (3.95%), and cortical blindness in 1 child (1.3%). The cause of visual impairment could not be established in 2 (2.63%) children. The prevalence of visual impairment did not differ by gender, but correctable low vision was significantly (P < .0001) more common among urban as compared with rural children. CONCLUSION: The leading causes of visual impairment among Chinese preschool-aged children are refractive error and hereditary eye diseases. A higher prevalence of refractive error is already present among urban as compared with rural children in this preschool population.

Cataract surgical outcomes, visual function and quality of life in four rural districts in Vietnam.

BACKGROUND: To evaluate cataract surgical outcomes in four rural districts of Ha Tinh Province, Vietnam. DESIGN: Cross-sectional study. PARTICIPANTS: Post-cataract surgery patients sampled randomly from facilities in four rural districts of Ha Tinh Province >3 months after surgery. MAIN OUTCOME MEASURES: Postoperative visual acuity (VA), visual function and quality of life. RESULTS: Among 412 patients, the mean age was 74.5 ± 9.4 years, 67% (276) were female, and 377 (91.5%) received intraocular lenses (IOL). Nearly two-thirds of patients had no postoperative visits after discharge. Postoperatively, more than 40% of eyes had presenting VA <6/18, while 20% remained <6/60. The mean self-reported visual function and quality of life for all patients were 68.7 ± 23.8 and 73.8 ± 21.6, respectively. Most patients (89.5%) were satisfied with surgery and the majority (94.4%) would recommend surgery to others. One-third of patients paid ≥$US50 for surgery. In multiple regression modelling, older age (P < 0.01), intraoperative complications (P < 0.01) and failure to receive an IOL (P < 0.01) were associated with postoperative VA <6/60. CONCLUSION: Satisfaction with surgery was high, and many patients were willing to pay for their operations. Poor visual outcomes were common; however, and better surgical training is needed to reduce complications and their impact on visual outcomes. More intensive postoperative follow-up may also be beneficial. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Early assessment of visual acuity after cataract surgery in rural Indonesia.

BACKGROUND: The accuracy and impact on service uptake of early examination after cataract surgery is not known. DESIGN:   Prospective cohort study. PARTICIPANTS: Cataract patients in rural Indonesia. METHODS: Visual acuity was measured preoperatively, 1day, 1-3, 4-6 and >12weeks after surgery, and 6-8months postoperatively at an outreach examination. Acceptance of second-eye surgery and spectacles was evaluated. MAIN OUTCOME MEASURE: Presenting visual acuity in the operated eye. RESULTS: Among 241 subjects (extracapsular surgery 84%), examinations at 1day, 1-3, 4-6 and >12weeks and 6-8months were completed for 100% (241), 90.9% (219), 67.6% (163), 22.0% (53) and 80.0% (193), respectively. Among subjects at the final examination (mean age 65.8±10.6years, 51.8% male), 73.6% had bilateral preoperative presenting visual acuity≤6/60. By 4-6weeks, the proportion with good (≥6/18) or poor (≤6/60) visual acuity did not differ significantly from the final examination. Among 49 persons accepting free second-eye surgery, 69.4% (34) and 16.3% (8) returned to clinic at 4-6 and >12weeks, respectively. Among 131 patients (67.9%) paying US$7 for glasses, 94 (71.8%) and 30 (22.9%) attended 4- to 6- and >12-week examinations, respectively. CONCLUSION: Even with large-incision surgery, early assessment of postoperative vision is representative of final vision, and may help deliver postoperative services to more of those needing them. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy

PURPOSE: Glaucoma patients are still at risk of becoming blind. It is of clinical significance to determine the risk of blindness and its causes to prevent its occurrence. This systematic review estimates the number of treated glaucoma patients with end-of-life visual impairment (VI) and blindness and the factors that are associated with this.

METHODS: A systematic literature search in relevant databases was conducted in August 2014 on end-of-life VI. A total of 2574 articles were identified, of which 5 on end-of-life VI. Several data items were extracted from the reports and presented in tables.

RESULTS: All studies had a retrospective design. A considerable number of glaucoma patients were found to be blind at the end of their life; with up to 24% unilateral and 10% bilateral blindness. The following factors were associated with blindness: (1) baseline severity of visual field loss: advanced stage of glaucoma or substantial visual field loss at the initial visit; (2) factors influencing progression: fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP; (3) longer time period: longer duration of disease and older age at death because of a longer life expectancy; and (4) coexistence of other ocular pathology.

CONCLUSIONS: Further prevention of blindness in glaucoma patients is needed. To reach this goal, it is important to address the risk factors for blindness identified in this review, especially those that can be modified, such as advanced disease at diagnosis, high and fluctuating IOP, and poor compliance.

Reflexões Estratégicas de Desenvolvimento Local no Contexto da Preservação da Identidade de Penedos (Mértola)

Resumo O trabalho de investigação que está a decorrer, tem como objeto de estudo as questões da identidade e da memória de uma aldeia alentejana, enquanto território de partilha de uma comunidade rural, tendo em conta a participação estratégica dos atores locais. Estudaremos a partir daí, a sua relação com a terra, o quotidiano, a mudança, a organização social, a ruralidade, os fatores portadores de futuro e novas propostas de desenvolvimento local, para territórios de baixa densidade. Pretende-se encontrar formas contributivas para preservar a identidade da aldeia e concomitantemente encontrar conjuntamente com os atores locais territorializados, alternativas de desenvolvimento local, capazes de contrariar a tendência de despovoamento e empobrecimento territorial. Com este trabalho de investigação, que se insere no âmbito da Sociologia da Ação, será utilizada metodologicamente o MACTOR e a sua aplicabilidade na determinação da estratégia de atores e respetivas relações de forças com o território e o que a ele diz respeito e ainda a observação participante/método de pesquisa de terreno e consequentemente o inquérito por entrevista. Pretendendo-se aprofundar e conhecer os problemas da interioridade e abandono populacional, designadamente na aldeia de Penedos que se situa na margem direita do rio Guadiana, freguesia de S. Miguel do Pinheiro e concelho de Mértola, no Baixo Alentejo. Abstract The research that is taking place, has as its object of study the issues of identity and memory of an Alentejo village, while sharing the territory of a rural community, taking into account the strategic participation of local actors. We'll look from there, his relationship with the earth, the everyday, change, social organization, rurality, the factors bearing on the future and new proposals for local development to areas of low density. The aim is to find ways contributory to preserve the identity of the village and found concomitantly in conjunction with local stakeholders territorialized, alternative local development, able to counteract the trend of depopulation and impoverishment territorial. With this research work, which falls within the Sociology of Action, will be used to methodologically MACTOR and its applicability in determining the strategy of respective actors and power relations with the territory and that he has concerns and participant observation / method of field research and thus the survey interview. Intending to go deeper and understand the problems of interiority and abandoned population, particularly in the village of Penedos which lies on the right bank of the Guadiana River, parish of S. Miguel do Pinheiro, county of Mértola, in the Baixo Alentejo.

Comunicação organizacional e identidade colectiva num agrupamento de escolas

O reforço e a diversificação do investimento na comunicação por parte das instituições educativas são discutidos neste estudo como uma das consequências da nova gestão pública. Tendo em vista a ‘qualidade’ e a ‘eficácia’ das suas prestações, as escolas têm procurado tornar-se mais dialogantes, assumindo a aposta na comunicação organizacional como parte integrante de uma estratégia empreendedora, que lhes tem vindo a conferir uma nova identidade colectiva unificada em torno dos valores neoliberais. Não obstante, os sistemas de comunicação criados são mais complexos do que se poderia supor. Revelando a influência de pressões híbridas, estes sistemas transformaram-se num contexto mediador da mudança embutido em novas concepções de escola e dos novos mandatos para a educação (assim legitimados interna e externamente), surgindo, ao mesmo tempo, como o locus de produção de novas identidades. Tal acontece porque a comunicação constitui o ponto de convergência entre as diferentes políticas educativas e as práticas localmente adoptadas na sequência de um processo de interpretação criativa das diferentes pressões. É este o sentido com que afirmamos que a comunicação se constitui numa meta-ideia ao serviço da ‘qualidade’, ainda que esta possa ser perspectivada a partir do ideal burocrático da organização (como sinónimo de eficiência administrativa), do ideal profissional (centrada no processo de ensino-aprendizagem) ou do ideal empreendedor (valorizando a capacidade de resposta às solicitações do mercado). Os dados empíricos, que sustentaram o nosso estudo, resultaram da observação do quotidiano de um agrupamento de escolas do ensinobásico e dos testemunhos recolhidos, ao longo de três anos, nesta comunidade educativa. Recorrendo ao estudo de caso como estratégia de investigação enveredámos inicialmente, num contexto de descoberta, pela realização de observações ‘desarmadas e naturais’. Usámos, posteriormente, a análise documental, a entrevista e o questionário na recolha de informação complementar, o que, mediante o cruzamento de métodos de análise qualitativa e quantitativa, nos permitiu tirar partido da triangulação dos dados. Os resultados obtidos apontam para a centralidade dos processos de comunicação na transformação induzida pela nova gestão pública e para o desenvolvimento de uma matriz discursiva bilinguista, que procura harmonizar os imperativos de ‘mercado’ com o discurso pedagógico e com modelos burocrático-profissionais de organização.

A construção da identidade em ambientes digitais: estudo de caso sobre a construção da identidade online no Sapo Campus e em ambientes informais

O reconhecimento da dimensão criativa, participativa e social da rede trouxe profundas alterações à forma como se percebem e compreendem as questões relacionadas com a identidade, a educação, a prática e o conhecimento. Num cenário caraterizado pela conectividade e pela facilidade de acesso a pessoas e conteúdos, a rede oferece aos indivíduos um espaço onde podem interagir, trabalhar na sua aprendizagem, trocar experiências e construir uma identidade e reputação acessíveis a toda a comunidade. Quando se torna praticamente impossível permanecer fora do mundo digital e, consequentemente, da produção de uma identidade online (Costa e Torres, 2011; Warburton, 2009), a presença construída pelo indivíduo na rede surge como um currículo vitae ativo e dinâmico, revelador não apenas das competências adquiridas e certificadas em contextos de aprendizagem formais como daquelas desenvolvidas pela interação com os pares, pela partilha e pela comunicação. Partindo da análise da utilização de uma plataforma suportada institucionalmente (i.e. SAPO Campus), o presente trabalho de investigação tem como principal objetivo a análise e caraterização da construção da identidade online de um grupo de alunos do Mestrado em Comunicação Multimédia da Universidade de Aveiro num espaço providenciado pela instituição de ensino que frequentam. Com recurso a inquéritos por questionário, entrevistas em profundidade (realizadas aos participantes no estudo e a profissionais da área da comunicação e gestão de carreiras) e observação direta (análise quantitativa e qualitativa dos conteúdos publicados pelos participantes no SAPO Campus e em duas redes informais), procurou-se ainda caraterizar e analisar a identidade construída em espaços formais e informais, e aferir a importância – para alunos, instituição e mercado – da identidade online enquanto espaço de manifestação e divulgação de competências. Ainda que circunscrita ao contexto específico do Mestrado em Comunicação Multimédia e mais especificamente aos alunos cuja identidade online foi objeto de estudo, análise dos dados permite avançar que, de facto, os alunos estão conscientes da sua própria identidade online bem como da relevância de construir uma identidade e reputação sólidas e autênticas, que reflitam as suas competências e capacidades enquanto aprendentes e profissionais. Assim, poder-se-á avançar que no SAPO Campus os alunos estão a construir uma identidade online mais formal e cuidada, editando e selecionando os conteúdos de acordo com o contexto. Neste espaço, a maioria das publicações está diretamente relacionada com os trabalhos de investigação dos participantes, que recorrem à sua partilha nas redes informais para aumentar a visibilidade e exposição dos conteúdos publicados. Os participantes no estudo revelaram ainda valorizar o sentimento de segurança providenciado pelas tecnologias institucionais, bem como a possibilidade de construir uma identidade numa plataforma associada à sua instituição de ensino. Do estudo efetuado resultou ainda uma proposta de um modelo para a análise da identidade online, que poderá ser utilizado na análise da presença dos indivíduos em ambientes online formais e informais. Apresentando a identidade online como uma realidade assente na representação digital, na gestão da privacidade e na reputação construída na rede, o modelo foi aplicado aos dados recolhidos pelo estudo, conduzindo ao desenho de duas grandes formas de estar na rede: identidade orientada pelo contexto, e identidade orientada pelo utilizador. Quando as caraterísticas dos mundos digitais alteram a forma de produção da identidade e num cenário onde a contextualização de dados e informação assume uma importância crescente, este estudo de caso poderá contribuir para o conhecimento dos processos de construção da identidade em espaços formais e informais, da forma como os indivíduos gerem e constroem a sua identidade online, e ainda sobre a importância e o impacto da construção de uma identidade online consciente e credível para a reputação dos indivíduos e das Instituições de Ensino Superior.

As escolas de saxofone clássico como narrativas da identidade

A presente tese tem como objectivo propor uma nova abordagem à problemática das escolas de interpretação musical. Centrando essa abordagem no universo do saxofone clássico e tendo em conta as especificidades históricas deste instrumento, é levantada uma série de questões que parecem ausentes da investigação previamente existente nesta área. Trata-se de saber em que medida as escolas de interpretação correspondem a uma realidade histórica, discursiva e performativa efectivamente observável no universo do saxofone clássico. Partindo do enquadramento histórico do percurso do saxofone, são realizadas análises ao discurso de saxofonistas significativos naquele universo e a gravações seleccionadas de obras e de saxofonistas representativos. O ponto de partida teórico é o de que as escolas de interpretação fazem parte dos processos de construção das narrativas identitárias dos intérpretes e definem-se através de narrativas identitárias assentes nas realidades histórica, discursiva e performativa.