emergency room at the University of São Paulo General Hospital: a tertiary hospital providing primary and secondary level care. Clinics. 2007;62(3):301-8. OBJECTIVE:To assess the need for emergency care in a tertiary hospital, in the Ophthalmology Emergency Room of the University of the São Paulo Medical School General Hospital. MATERIALS AND METHODS:A cross-sectional analytic study of the treatment complexity level was carried out in a readily available sample, n = 574, of patients seen at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital, during a typical week. RESULTS: Of the 574 treated patients, 69.0% of the cases were diagnosed as requiring a simple treatment for their problem. The most frequent diagnoses were related to ocular inflammation and infection (55.0%), mainly including conjunctivitis (29.4%) and eyelid inflammations (10.5%). Next in frequency were ocular trauma (19.2%), particularly foreign bodies on the cornea (7.5%) and blunt trauma (5.2%). Refractive errors (3.1%) was the most prevalent diagnosis in the "other ocular modifications" category. CONCLUSION: Most of the cases (69.0%) treated at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital could have been diagnosed and treated in primary or secondary care units. Also, the fact that return visits to check recovery are seen in the ER demonstrates the lack of referral services. The fact that patients come to a tertiary hospital with rather simple cases shows the poor structure of the Brazilian Public Healthcare System, which overloads the tertiary care facilities, where costs for human resources, materials, and other items are higher.

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According to this study, there is no lack of Ophthalmologists in the country, but a distribution imbalance which leads to professional shortage in particular places. A higher concentration of ophthalmologists/inhabitants was noticed in States which the economic growth is higher, expressed by the GDP per capita.

PURPOSETo evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country.METHODSA prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques.RESULTSOf the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated.CONCLUSIONUnder the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

The average saving with PHACO compared to ECCE technique was US$ 61.50 for employers, patients, caregivers and Social Security.

DedicatóriaAos meus pais Zenaide e Darnay, com muito amor e admiração, por sempre terem me incentivado a lutar e a não desanimar nunca, mesmo percorrendo trilhas difíceis. iv AgradecimentosAgradeço primeiro e acima de tudo, ao Prof. Dr Newton Kara José, pelo incentivo, pela orientação, compreensão, carinho e força constante, não só durante os anos em que foi meu orientador, mas em todos os momentos de minha vida profissional. "Chefe", eu serei eternamente grata. Muito obrigada! Ao Prof. Dr. Mário Luiz Monteiro, por acreditar nesse projeto desde o início.Aos meus filhos Gabriela e Cássio, pelo incentivo a todo o momento e pela compreensão das vezes que não pude estar presente.Às minhas irmãs, Denize, Renata e Gisele, pelo amor e carinho constantes.Aos meus padrinhos Luis e Lúcia, por sempre estarem me incentivando e apoiando.À professora e amiga Edméa Temporini, por me compreender e orientar de diversas formas.Ao Dr. Paulo Eduardo Mangeon Elias, pela solicitude e preciosidade das orientações.Aos amigos e companheiros de trabalho Regina Noma e Flávio Villela, por sempre estarem torcendo e me dando força quando mais precisava."Almôndegas" para vocês.Ao amigo e companheiro de trabalho José Valter Dário, pelo estímulo recebido durante a pesquisa. Ao Gustavo Vasconcelos pela ajuda na leitura da tese.Ao Newton Kara-Jr por sua amizade e recomendações.Ao Prof. Cintra pelos conselhos e por me ensinar a "sorrir para a tese".Às minhas grandes amigas enfermeiras da Oftalmologia pelo constante carinho recebido.A todos os amigos que torceram por mim e acreditaram no meu trabalho.Aos oftalmologistas que participaram com dedicação da pesquisa.Aos pacientes, pois sem eles, não haveria a pesquisa.A Fundação de Amparo e Apoio a Pesquisa (FAPESP) por acreditar no tema e apoiar financeiramente a pesquisa.A Deus e um de seus representantes na terra, meu querido Padre Anísio, por iluminar meu caminho para que eu conseguisse vencer todos os obstáculos encontrados.vii "Acredito na verdade tal qual ela se me apresenta hoje.

Abstract. The paper examines the prevalence of equine infectious anemia (EIA) in horse populations in the northern part (comprising 89 cities) of Minas Gerais State, Brazil, from January 2002 to December 2004. Data on 8,981 agar gel immunodiffusion test results from the region were used as input for a statistical and autoregressive analysis model to construct a city-level map of the distribution of EIA prevalence. The following EIA prevalence (P) levels were found: 49 cities with 0 , P # 0.5%, 26 with 0.5% , P # 1.5%, 10 with 1.5% , P # 5%, and 4 with 5% , P # 25%.

Purpose: To analyze the results of recall absent schoolchildren to eye health projects. Methods: Crosssectional study. Visual screening was performed in schoolchildren attending 1 st to 4 th grades at public schools, from 7 to 10 yearsold, to select and forward to complete ophthalmic evaluation. The projects were performed during weekends, at a public school, in the same municipality. Free transportation, food and eyeglasses were offered. A second opportunity of examination was offered to the students who were absent from the first call, with the same facilities. Results: 51,509 schoolchildren had their vision tested, 14,651 (28.4%) were referred for ophthalmic examination. Of these, 8,683 (59.3%) attended the first call, 2,228 (37.3%) attended the recall and 25.5% of parents did not take their children to oph thalmic examination. The need for eyeglasses for children who attended the examination was 23.8% and 32.0% in the first opportunity and recall, respectively. The recall increased the coverage in 15.2% (59.3% to 74.5%). Conclusion: An expressive number of parents (25.5%) did not bring their children to be examined, even at a second opportunity of exam. The facilities offered: access, free examination, transportation and glasses. Children who were absent in the first opportunity and appeared at recall had a greater need for eyeglasses. Recall increa sed the coverage in 15.2% (59.3% to 74.5%) and it is not recommended when financial resources are limited.