Edméa Rita Temporini

Quality of health care: patient satisfaction in a university hospital

OBJECTIVE To evaluate patient characteristics and satisfaction in an outpatient service at a university hospital, aiming at obtaining subsidies for standardization of a quality assessment program. METHOD Patient-representative sample was selected. It consisted of users of the Ophthalmology Outpatient Service at the Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP). A structured questionnaire was applied through interview, including the following variables: personal characteristics (gender, age, literacy, job), type of appointment (new patient, follow-up), waiting time for the first appointment, opinion regarding ease of access to the hospital, assistance at the front desk, time spent in the waiting room on the appointed day, quality of care, degree of satisfaction with the consultation and general evaluation of the assistance. RESULTS The sample was characterized by patients with low literacy and socioeconomic level; 21.7% had a steady income. The majority of them think that it is easy to obtain an appointment. According to patients, the mean waiting time for the appointment was 94.6 minutes and 45.3% of them received no orientation after the appointment. Final evaluation of the quality of assistance was positive and patients were satisfied with the provided assistance. CONCLUSION Although a high level of satisfaction regarding the provided service was observed, when the various factors that can affect patient satisfaction are considered, users reported limitations as concerns quality. Evaluation allowed a better knowledge about the provided service in a university hospital and pointed to the possibility of implantation of quality assessment routines.

Cataract surgery: expectations of patients assisted during a community project in São Paulo, state of São Paulo, Brazil

OBJECTIVE To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye) aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São Paulo, Brazil, in 1999. RESULTS The sample was composed of 331 subjects of low socioeconomic level ranging in age from 50 to 97 years (average = 71.8 years). Expectation of total recovery from the cataract condition by means of surgery was declared by 80.0% of the respondents, with no significant differences between male and female subjects (P < 0.1723). Hope to resume manual activities was expressed by 59.8%. CONCLUSION A predominance of expectations of resuming normal activity and achieving a better quality of life after cataract surgery were identified.

Emotional factors prior to cataract surgery

PURPOSE Identification of emotional factors related to daily difficulties and surgical treatment among patients with cataract at a university hospital. METHODS A cross-sectional study was carried out by means of a questionnaire, elaborated based on a previous study. The sample consisted of patients seen at the cataract unit of the ophthalmology clinic of a university hospital. RESULTS The sample consisted of 110 individuals of both sexes (34.5% men; 65.5% women) between the ages of 43 and 89 (average 69.0 +/- 10.3 years); 26.4% had never attended school, 59.1% had primary education, and 87.3% had no payed occupation. Most of the patients reported daily difficulties due to their ocular condition (82.7%), and 54.0% reported fear of visual loss. Doubt as to the outcome (32.7%), distress (26.4%), and sadness (25.5%) were reported. CONCLUSIONS Most of the patients reported difficulties in daily activities as a consequence of cataract. Fear was the predominant feeling related to undergoing surgery. The findings suggest the need for implementing intervention courses for emotional preparation for facing daily activities and cataract surgery.

Utilização de recursos ópticos e equipamentos por escolares com deficiência visual.

PURPOSE: To verify perceptions and conduct of students with visual impairment regarding devices and equipment utilized in schooling process. METHODS: A transversal descriptive study on a population of 12-year-old or older students in schooling process, affected by congenital or acquired visual impairment, inserted in the government teaching system of Campinas during the year 2000. An interview quiz, created based on an exploratory study was applied. RESULTS: A group of 26 students, 46% of them with low vision and 53.8% affected by blindness was obtained. Most of the students were from fundamental teaching courses (65.4%), studying in schools with classrooms provided with devices (73.1%). Among the resources used in reading and writing activities, 94.1% of the students reported they used the Braille system and 81.8% reported that the reading subject was dictated by a colleague. Most of the students with low vision wore glasses (91.7%), and 33.3% utilized a magnifying glass as optical devices. Among the non-optical devices, the most common were the environmental ones, getting closer to the blackboard (75.0%) and to the window (66.7%) for better lighting. CONCLUSIONS: It became evident that students with low vision eye-sight made use of devices meant for bearers of blindness, such as applying the Braille system. A reduced number of low vision students making use of optical and non-optical devices applicable to their problems were observed, indicating a probable unawareness of their visual potential and the appropriate devices to improve efficiency.

Evaluation of the criteria of the visual screening of elementary school first graders

Foram avaliados os resultados de triagem visual realizado por professores em alunos de primeira serie do primeiro grau de uma escola estadual, considerando os criterios de encaminhamento a exame especializado preconizados no Plano de Oftalmologia Sanitaria Escolar do Estado de Sao Paulo, Brasil. Entre 411 escolares examinados verificou-se a existencia de 48 casos de falsos positivos (encaminhamentos desnecessarios) e de 5 casos de falsos negativos (erroneamente nao encaminhados). Evidenciaram-se 36 casos (75%) de falsos positivos ocorridos em alunos com acuidade visual acima do limite considerado para encaminhamento, concluindo-se que se faz necessario um reforco periodico na orientacao desses aplicadores, visando a diminuicao desse numero. Foi analisado o criterio de encaminhar criancas com acuidade visual igual ou menor do que 0,7, concluindo-se que dentro das limitacoes de recursos assistenciais, este e um criterio conveniente, em se tratando de oftalmologia sanitaria.Foram avaliados os resultados de triagem visual realizado por professores em alunos de primeira serie do primeiro grau de uma escola estadual, considerando os criterios de encaminhamento a exame especializado preconizados no Plano de Oftalmologia Sanitaria Escolar do Estado de Sao Paulo, Brasil. Entre 411 escolares examinados verificou-se a existencia de 48 casos de falsos positivos (encaminhamentos desnecessarios) e de 5 casos de falsos negativos (erroneamente nao encaminhados). Evidenciaram-se 36 casos (75%) de falsos positivos ocorridos em alunos com acuidade visual acima do limite considerado para encaminhamento, concluindo-se que se faz necessario um reforco periodico na orientacao desses aplicadores, visando a diminuicao desse numero. Foi analisado o criterio de encaminhar criancas com acuidade visual igual ou menor do que 0,7, concluindo-se que dentro das limitacoes de recursos assistenciais, este e um criterio conveniente, em se tratando de oftalmologia sanitaria.

Ação preventiva em problemas visuais de escolares

Apresenta-se abordagem preventiva de problemas visuais de escolares, considerando os niveis de prevencao em Saude Publica (Leavell e Clark). E destacada a importância da atuacao em educacao para a saude na escola, dirigida a promocao da saude ocular e a prevencao de disturbios oftalmologicos, buscando a adocao de condutas acertadas do individuo, em termos pessoais e coletivos. A linha geral da programacao e descrita sucintamente, concluindo pela necessidade da manutencao dos seus propositos e bom nivel, embora ja implantada como rotina de servico.Apresenta-se abordagem preventiva de problemas visuais de escolares, considerando os niveis de prevencao em Saude Publica (Leavell e Clark). E destacada a importância da atuacao em educacao para a saude na escola, dirigida a promocao da saude ocular e a prevencao de disturbios oftalmologicos, buscando a adocao de condutas acertadas do individuo, em termos pessoais e coletivos. A linha geral da programacao e descrita sucintamente, concluindo pela necessidade da manutencao dos seus propositos e bom nivel, embora ja implantada como rotina de servico.

Validade da aferição da acuidade visual realizada pelo professor em escolares de 1ª à 4ª série de primeiro grau de uma escola pública do município de São Paulo, Brasil

Trata-se de avaliacao da medida da acuidade visual pelo professor, comparativamente aquela efetuada pelo medico-oftalmologista, utilizando-se ambos da tabela optometrica de Snellen. Este estudo foi realizado em decorrencia do Plano de Oftalmologia Sanitaria Escolar (POSE), em desenvolvimento no Estado de Sao Paulo, que atinge escolares de 1a serie, classe especial e pre-primario das escolas estaduais de 1o grau, onde a atuacao dos professores constitui fator basico da programacao, principalmente no seu aspecto educativo e na verificacao da acuidade visual. Foram testados 1.352 escolares de 1a a 4a serie de 1o grau de um estabelecimento de ensino do municipio de Sao Paulo (SP) em 1975. Encontrou-se uma concordância de resultados em 80,86% dos casos. Com a diferenca de 2 linhas entre os resultados do professor e do medico, constataram-se 122 casos (9,02%) e, com a diferenca de 3 linhas, 54 casos (3,99%). A medida em que se consideravam diferencas maiores, decrescia progressivamente o numero de casos discordantes encontrados. Observou-se que, a medida em que aumentava a desigualdade de afericao entre o professor e o oftalmologista, isto se verificava em ambos os olhos, o que evidencia uma dificuldade de interpretacao daquelas criancas para responder o teste. Considerou-se altamente valida a aplicacao do teste de acuidade visual pelo professor devidamente treinado, com a finalidade de triagem a nivel de escola, como um dos aspectos para identificar alunos necessitados de exame medico-oftalmologico.

Self-Medication: Initial Treatments Used by Patients Seen in an Ophthalmologic Emergency Room

OJECTIVE This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients’ use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS The sample included 561 subjects, 51.3% males and 48.7% females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5% reported self-medicating; 29.4% used a homemade preparation (13.9% referred to an industrialized product like boric acid as a homemade preparation), and 11.1% used a manufactured product. The most frequently used products included a boric acid solution (53.3%), a normal saline solution (35.7%), herbal infusions (6.1%) and breast milk (4.8%). Viral conjunctivitis was the most frequent diagnosis (24.4%), followed by the presence of a corneal foreign body (7.4%). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Ocular health beliefs among teachers in the public educational system, Brazil

OBJECTIVE With the purpose of collecting information for training programs targeted to teachers, ocular health beliefs were assessed concerning eyeglasses wear, visual problems and damages while reading in different settings. METHODS A survey was carried out among first-grade teachers of public elementary schools located in the Southern region of S. Paulo city, state of S. Paulo, Brazil. The study population included 545 subjects from 120 different schools. A self-administered structured questionnaire was developed based on a previous exploratory study. RESULTS Average age in this population was 37.8 years and they have been working as educators for an average of 13.2 years; most of them (67.4%) have not received orientation on ocular health for the last three years; almost all of them (99.4%) believed that eyeglasses should be wore constantly; 62. 3% considered the fact of a constant vision straining as an aggravating factor for eye disorders; 95% of the teachers admitted that there could be damaging consequences when someone watches television at a distance of less than 2 meters; 59.9% of them believed that watching TV with the lights off could damage ones vision; 45.6% considered reading in a moving vehicle a cause for visual problems. CONCLUSIONS Popular beliefs related to eye health reveal a need for orientation programs for teachers in order to implement preventive actions related to eye health within elementary schools.OBJETIVO: Verificar crencas em saude ocular relacionadas ao uso de oculos, esforco visual e danos a visao por leitura em diferentes situacoes, para subsidiar programas de treinamento de professores. METODOS: Levantamento de dados entre professores de primeira serie do ensino fundamental, das escolas publicas da regiao sul do Municipio de Sao Paulo, SP -- Brasil. Foi obtida uma populacao de 545 sujeitos, distribuidos em 120 escolas. Elaborou-se questionario auto-aplicavel, estruturado com base em estudo exploratorio. RESULTADOS: A populacao apresentou media de idade de 37,8 anos e media de tempo de magisterio de 13,2 anos. A maioria (67,4%) nao recebeu orientacao em saude ocular nos ultimos tres anos. Quase a totalidade (99,4%) acreditava na necessidade do uso constante de oculos; 62,3% consideraram ser o uso intensivo da visao fator agravante de disturbios oftalmologicos; consequencias danosas a visao por ver televisao a menos de 2 metros foram admitidas por 95% dos docentes e 59,9% deles acreditavam ser prejudicial a visao assistir a televisao com luzes apagadas; 45,6% acreditavam que a leitura em veiculos em movimento pode causar problemas de visao. CONCLUSOES: Foram evidenciadas crencas populares relacionadas a saude ocular, mostrando a necessidade de prover orientacao a professores para o desenvolvimento de acoes de oftalmologia sanitaria nas escolas de primeiro grau.OBJECTIVE: With the purpose of collecting information for training programs targeted to teachers, ocular health beliefs were assessed concerning eyeglasses wear, visual problems and damages while reading in different settings. METHODS: A survey was carried out among first-grade teachers of public elementary schools located in the Southern region of S. Paulo city, state of S. Paulo, Brazil. The study population included 545 subjects from 120 different schools. A self-administered structured questionnaire was developed based on a previous exploratory study. RESULTS: Average age in this population was 37.8 years and they have been working as educators for an average of 13.2 years; most of them (67.4%) have not received orientation on ocular health for the last three years; almost all of them (99.4%) believed that eyeglasses should be wore constantly; 62.3% considered the fact of a constant vision straining as an aggravating factor for eye disorders; 95% of the teachers admitted that there could be damaging consequences when someone watches television at a distance of less than 2 meters; 59.9% of them believed that watching TV with the lights off could damage ones vision; 45.6% considered reading in a moving vehicle a cause for visual problems. CONCLUSIONS: Popular beliefs related to eye health reveal a need for orientation programs for teachers in order to implement preventive actions related to eye health within elementary schools.

Aspectos do Plano de Oftalmologia Sanitária Escolar do Estado de São Paulo

No Estado de Sao Paulo, desenvolveu-se o Plano de Oftalmologia Sanitaria Escolar, no periodo de 1973 a 1976, junto as escolas da rede de ensino oficial estadual, que se propunha a detectar disturbios visuais de escolares, prover a devida assistencia, respaldado por atividades educativas e proceder a levantamento de dados sobre a problematica oftalmologica existente. Mediante mecanismo de descentralizacao da organizacao dos servicos de Saude e de Educacao, o trabalho atingiu todas as regioes administrativas do Estado, com participacao de grande contingente de pessoal da rede escolar, tecnicos e especialistas em saude, entidades governamentais, particulares e comunidade em geral. Considerando a metodologia empregada no Plano, o presente estudo aborda alguns aspectos referentes a: abrangencia do programa, pessoal administrativo e docente atingido, identificacao e assistencia a problemas visuais de escolares.