Raul Sousa

Background: Injury remains a major concern to public health in the European region, particularly among adults younger than 49 years. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods: We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the hi...

Background: The Vision Loss Expert Group and Global Burden of Disease Study have extensively updated estimates of global vision loss burden in 2020, temporal changeover 3 decades and forecasts for 2050. Methods: A systematic review and meta-analysis was conducted of population-based datasets relevant to vision impairment (VI) from January 1980 to October 2018. Hierarchical models were fitted to estimate 2020 prevalence (with 95% uncertainty intervals, UI) of (1) mild VI (presenting visual acuity [PVA] 6/12). Findings: In 2020, an estimated 43.2 million (95% UI: 37.5-48.2 million; 55% female) people were blind, 295.3 (95% UI 267.0-325.5) million had MSVI, 257.3 (95% UI 232.2-284.7) million had mild VI, and 507.4 million (95% UI 369.3–663.8) were VI from uncorrected presbyopia. Globally among adults aged ≥50 years, age-standardised prevalence of blindness reduced by 29% between 1990 and 2020, while MSVI increased slightly (+2.4%). The number of blind people increased by 50.2% and MSVI by 91.6%. By 2050, we predict 895.5 million people blind/VI. Interpretation: It is encouraging that age-adjusted prevalence of blindness has reduced over the past 3 decades, yet due to population growth progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages. Funding Statement: Brien Holden Vision Institute. Fondation Thea. Fred Hollows Foundation. Gates Foundation. Sightsavers International. University of Heidelberg. Declaration of Interests: A.M. Bron, Allergan (C) Baush and Lomb (C), Santen (C), Thea (C) - (C) stands for consultant. J Kempen: Consultant (DSMC Chair) for Gilead. Grants and contracts from National Institutes of Health/National Eye Institute; Sight for Souls; and Christoffel Blindenmission. No other authors had conflicts to declare.

Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

This article presents a alternative and simple proof to the Dirichlet's Theorem and a proof for the Goldbach's Strong Conjecture, using the Complex Wave Model and its properties. The Complex Wave Model allows the definition of an α function based on a sines product. As a consequence of the properties of trigonometric functions, with emphasis to its periodicity and symmetry, some of the questions regarding the prime numbers distribution, k-tuples and prime numbers arithmetic progressions, including the Dirichlet's Theorem and Goldbach's Conjecture, can be solved.

O MECA (Medição da Espessura da Córnea por Alberto) calcula a espessura da córnea através da determinação da relação entre a posição da primeira e segunda imagem de Purkinje produzidas por uma lâmpada de fenda orientada verticalmente. Os parâmetros necessários para realizar os cálculos são: índice de refracção corneal (1,376 para o olho de Gullstrand), espessura da lâmpada de fenda e ângulo formado pelo braço de iluminação e braço de observação de um biomicroscópio. O MECA pode ser aplicado à medição da espessura de lentes de contacto ou outro meio transparente sem anestesia ou equipamento adicional para além de um biomicroscópio normal. Utilizamos o MECA para medir a espessura central de nove lentes de contacto RPG (nLC=1.436) e comparamos essas medidas com a espessura central medida por um método mecânico. A espessura central das lentes de contacto variou entre os 0,109 mm até 0,135 mm. A diferença média entre a MECA e o método mecânico foi de 0,004 mm com um desvio padrão de ±0.0...

Resumo Este relatório de atividades revê um período de 20 anos da minha vida profissional, desde a conclusão da licenciatura de Física Aplicada – Ramo Óptica Especialização em Optometria na Universidade do Minho até ao Mestrado em Optometria Avançada. Está elaborado de acordo com o despacho reitoral RT 38/2011. Serão revistas estudos em forma de publicações científicas com arbitragem científica, que realizei sobre os temas de medição da espessura da córnea, tonometria de aplanação sem anestésico,... This activity report reviews a period of 20 years of my professional life, since the completion of Applied Physics degree-Branch Optics Expertise in Optometry at the University of Minho to the Master in Advanced Optometry. This report is elaborated according to the order rectorial RT 38/2011. It is reviewed studies in the form of scientific publications with peer review, which I presented on the topics of measurement of corneal thickness, applanation tonometry without anesthetic, portugu...

Introduction: The potential of photostress recovery time (PSRT) test as a clinical tool was firstly reported by Bailliart in 1954 and received much attention in the eighties. PSRT test evaluates the capacity of the photoreceptors to regenerate visual pigment when exposed to a bright light. This is a simple, cheap and quick macular function test that can differentiate whether there is a retinal or pos-retinal disorder. Purpose: The purpose of this work was to study the effect of illuminance and exposure time variations on PSRT. Methods: Seventy nine subjects, divided in three age groups, participated in this study in the first experiment. The age range was: young-adults group 18-24 years (43), adults group 25-44 years (24) and older-adults 45-59 years (12). A total of 60 subjects, divided using the same age range criteria, participated in the second experiment (41 young-adults, 12 adults and 7 olderadults). In the first experiment PSRT was determined for exposure times of 25, 30, and...

Purpose. The photostress recovery time test ({PSRT}) has been widely reported as a helpful screening clinical tool. However, the poor standardization of its measurement technique remains to be a limitation among clinicians. The purpose of this study is to apply a recommended clinical technique to measure the {PSRT} in some of the most commons eye diseases to ascertain whether these

The aim of this study is to ascertain whether the quantity and quality of tear and eye subjective comfort are influenced by the temperature, humidity and oral Contraceptives Taking or Non-taking ({CTNT}). Forty-one students, females, from the University of Minho, Braga, Portugal, aged (mean±1standard deviation) of 21.51±1.85 years, ranging from 20 to 30 years, participated in this study. The {McMonnies}

This work aims to define contemporary scores for the Developmental Eye Movement Test (DEM) for native Portuguese-speaking children (PT) and to compare these scores with three other published scores: the original norms, published in 1987 for American English-speaking children (U.S.) and two other scores published in 1995 (SP1) and 2003 (SP2) for Spanish-speaking children. A standard DEM test was administered to 695 young students ranging in age from 6 to 13 years from the region of Braga, Portugal. The mean PT scores for vertical time and adjusted horizontal time as well as the corresponding errors and ratio were calculated according to age and grade, and these results were compared with those from other studies. In addition, the clinical response types (age and grade) were obtained based on mean PT scores. For several ages/grades, the scores obtained in this study were significantly different from the scores reported in other studies. A global qualitative analysis showed that PT made fewer errors and had similar ratios when compared with U.S. and SP2. However, PT were generally slower in vertical time and adjusted horizontal time in the younger age groups. When comparing PT and SP1, a higher ratio for SP1 was determined in all ages. The clinical response types signified below-normal performance scores for ages 6 to 9 and grades 1 to 5. The unusually large number of oculomotor and/or automaticity problems found in this normal PT population using a test based on U.S. norms highlights the need for PT-specific guidelines. It appears that DEM scores may be affected by differences in language, educational systems, and/or cultural systems. Therefore, clinicians should be aware of these findings when using the DEM test on children in countries with differing languages and cultures.

Goldmann applanation tonometry (GAT) is considered the gold standard technique for tonometry. It is a procedure involving administration of topical anaesthetic (a drug which could have several side effects). This prevents a large number of vision care practitioners from using GAT, due to legal restrictions regarding the use of these ophthalmic drugs. The purpose of this study was to establish whether the discomfort experienced during non-anaesthetic Goldmann Applanation Tonometry (NAGAT) would be acceptable to subjects. The intensity of pain inflicted by GAT, NAGAT, Non-Contact Tonometry (NCT) and Schirmer test was assessed on thirty-one subjects enrolled in the study using the Numerical Rating Scale (NRS) to assess pain. The GAT was performed on one eye and the other three procedures were carried out in random order on the fellow eye. Initially, each subject was asked to score their Maximum Pain Without Complaint (MPWC). The MPWC and the Schirmer test were used as references to grade the pain levels. The scores for the five procedures were registered using the NRS (0-10) and compared using a non-parametric statistical analysis (Friedman test and a post-hoc analysis). In addition, IOP results for GAT and NAGAT were also compared using the t-test. The scores obtained on the NRS ranged from 0-4, 0-5, 0-8, 0-7 and 3-8 with a median of 1, 1, 2, 2, and 5, respectively for NCT, GAT, NAGAT, Schirmer and MPWC. A statistically significant difference (p = 0.01) was found between the MPWC and the four clinical tests but no difference was found between the clinical tests. There was no statistically significant difference (p = 0.71) between the IOP results for GAT and NAGAT, 14.0 ± 2.0 mmHg and 13.8 ± 2.0 mmHg (mean ± 1S.D.) respectively. The Goldmann Applanation Tonometry without anaesthetic (NAGAT) can be performed with an acceptable level of discomfort for the majority of subjects and should be performed identically to a traditional GAT, informing the subjects about the possibility of feeling a small discomfort.

The topic of ophthalmic use of cocaine in clinical practice has a long history; nevertheless, the possible influence and pathways of action of inhaled cocaine in the human eye remain unknown. This study evaluates the effect of snorted cocaine in the eye tear of 22 occasional cocaine users using the Schirmer Test I (ST1). The tear amount without the subjects being under the effect of cocaine was (mean +/- standard deviation) 22.50 +/- 12.85 mm ranging from 5-55 mm. Under the effect of cocaine, 17 in 22 eyes had a decrease in the tear amount, averaging 16.52 +/- 10.13 mm ranging from 1-38 mm, representing a statistical significant decrease (paired t-test, one-tailed p = 0.0024) of about 27% between the previous conditions. The large majority of the subjects under the effect of cocaine present a decrease in ST1 determining a global statistical significant decrease in ST1. That suggests a relationship between snorted cocaine and a reduction in tear amount. The identification of the tear cocaine effect and the pathway of action cannot be overlooked in the research for a comprehensive characterization of inhaled cocaine action in the central and peripheral nervous system.

Euler’s formula establishes the relationship between the trigonometric function and the exponential function. In doing so unifies two waves, a real and an imaginary one, that propagate through the Complex number set, establishing relation between integer numbers. A complex wave, if anchored by zero and by a defined integer number N, only can assume certain oscillation modes. The first mode of oscillation corresponds always to a N prime number and the other modes to its multiples.
ψ(x) = xei(nπ N x)
Under the above described conditions, these waves and their admissible oscillation modes allows for primality testing of integer numbers, the deduction of a new formula π(x) for counting prime numbers and the identification of patterns in the prime numbers distribution with computing time gains in the calculations. In this article, four theorems and one rule of factorizing are put forward with consequences for prime number signaling, counting and distribution. Furthermore, it is establish the relationship between this complex wave with a time independent semi-classical harmonic oscillator, in which the spectrum of the allowed energy levels are always only prime numbers. Thus, it is affirmative the reply to the question if the prime numbers distribution is related to the energy levels of a physical system.

This activity report reviews a period of 20 years of my professional life, since the completion of Applied Physics degree - Branch Optics Expertise in Optometry at the University of Minho to the Master in Advanced Optometry. This report is elaborated according to the order rectorial RT 38/2011. It is reviewed studies in the form of scientific publications with peer review, which I presented on the topics of measurement of corneal thickness, applanation tonometry without anesthetic, portuguese standard of develomental eye movement, new fixation disparity test, photostress assessment conducted with ophthalmoscope , influence of oral contraceptive in the tear, tear the influence of cocaine. Also it will be presented work on publications in book form, as the anuário de lentes de contacto 2000, and nonscientific publications by invitation in an optical specialty magazine on the anisometropia and refraction and dispersion indices themes. Also conference contents, university lectures by invitation and workshops presented and taught by me, in academic and professional context. This report also presents the development process and capabilities of a computer program Utilitário de Cálculo da HydronTM, of my own authorship and development, as well as work in the recovery of the optical function of the Bom Jesus Telescope on my technical direction. Followed be the presentation of four selected clinical cases from my clinical practice as Optometrist, which are of interest to understand my application of Optometry science to clinical practice as Optometrist. Finally, this report addresses my contribution to the development of Optometry as a professional class, both in the educational aspect as the legislative.

The establishment and development of optometry in Portugal resulted from the committed work of many individuals and institutions. These efforts have had good results in terms of raising the public's awareness of the major role played by optometrists in primary eye care. Back in the late 80's higher education in optometry was started. Ten years ago the results of scientific research on the topic first became available and are now also contributing to the success of optometry in Portugal. In regard to the optometry profession, specific regulations are to be discussed in the national parliament. The Associação de Profissionais Licenciados de Optometria (APLO), as the professional organization representing optometrists in Portugal, has been critically important in this process. This article will present an overview of the history of optometry in Portugal, of change in the foreseeable future and of the APLO's experience and activities.

The aim of this method is to determine the thickness of a transparent medium, close to the corneal thickness, using the angle at the first and second Purkinje images are aligned for a specific optical slit width. An optical slit is projected in an oblique angle relatively to the transparent medium, producing two different reflections in each medium surface (first and second Purkinje images). The slit is then moved until the first and second Purkinje images of the slit are aligned in such a way, that look as if they were a continuous slit. The slit width, the angle between the illumination and observation, and the medium index are used, then, to calculate the medium thickness. This method was implemented in a slit lamp and the central thicknesses (CT) of nine gas-permeable contact lenses (CL) were measured, with this method and a mechanical gauge and the results were compared. The mean CT difference +/- standard deviation, between the two methods was 0.004 +/- 0.008 mm with minimum and maximum absolute values of 0.002 and 0.019 mm. This technique showed good precision to measure the CT of CL and should be tried in human corneas.

A new experimental setup for any standard Video Display Unit (VDUET) with dichromatic glasses was developed for fixation disparity (FD) accessing. A computer software produce a dark field with white targets for central and peripheral fusion and two lines colors red and green for dissociated vision with the use of red and green filters. These lines can be moved right or left by the subject, until are seen apparently aligned. The real displacement between the lines is then recorded. The fixation curve (FC) is obtained by the interposition of prisms before one or both eyes, as in a regular commercial FD test. A comparison for FD and measurement time between this experimental setup and two commercially available methods, Wesson and Saladin cards, was performed in thirty-two university students. The means slope, x-intercept and y-intercept were 0.13, -0.22 and -5.63 for Saladin; 0.01, -2.29 and -1.88 for Wesson; and 0.61, -1.33 and -2.46 for VDUET. The mean measurement test time was 582.3 s, 501.3 s and 444.8 s for Saladin, Wesson and VDUET. The FC measured by these three methods was different but not statically significant (ANOVA one-way, Tukey post-hoc test) with the exception of the slope between Wesson test and VDUET (p<0.05). The average time measurement for the VDUET was the faster by about one minute, although statically significant differences (ANOVA one-way, Tukey posthoc test) were only found between Saladin and VDUET (p<0.01). The VDUET has some features that represent some improvement over the current commercial methods for DF measurement.

1 Abstract This article presents a alternative and simple proof to the Dirichlet's Theorem and a proof for the Goldbach's Strong Conjecture, using the Complex Wave Model and its properties. The Complex Wave Model allows the definition of an α function based on a sines product. As a consequence of the properties of trigonometric functions, with emphasis to its periodicity and symmetry, some of the questions regarding the prime numbers distribution, k-tuples and prime numbers arithmetic progressions, including the Dirichlet's Theorem and Goldbach's Conjecture, can be solved.