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A baseline audit of the population groups accessing optometry training clinics in Aotearoa New Zealand: looking towards equity in eye care.
Get PDFCLINICAL RELEVANCE: To improve equity in eye care, optometry training clinics should be accessible to all population groups so that future optometrists develop skills working with different population groups. BACKGROUND: In the 2019 World Report on Vision, the World Health Organization highlighted a need to improve access to eye care globally. In Aotearoa New Zealand, a renewed focus on equity followed the 2022 health system reform. The School of Optometry and Vision Science (SOVS) at The University of Auckland has an important role in promoting equity within the eye health sector. The aim of this study was to assess whether the SOVS teaching clinics are accessible to a range of population groups. METHODS: The demographics and travel distances of patients accessing the SOVS teaching clinics within the five-year period immediately prior to the New Zealand health system reform (2017-2021) were assessed. The representativeness of patients accessing the main teaching clinic was compared to the wider New Zealand population. RESULTS: Information describing patient ethnicity was not available for 82% of the 18,981 patients. Compared to the New Zealand population, people who accessed the main teaching clinic were more likely to live in areas with low levels of deprivation, and those who lived in areas of high deprivation travelled the furthest (all p < 0.01). Compared to patients accessing the main teaching clinic, a person accessing care at a fully subsidised community-based clinic was 27 times more likely to live in an area with the highest level of deprivation. CONCLUSIONS: Due to its location, the teaching clinic where New Zealand optometrists are trained is less accessible to people who live in areas with high levels of deprivation, and greater focus on collecting patient ethnicity information is required. Funding for routine, community outreach services would address inequities and embed a culture of equity into optometry education
Prevalence and Correlates of Fearing a Partner During the COVID-19 Pandemic in Britain: Findings from Natsal-COVID.
Get PDFPURPOSE: The COVID-19 pandemic and lockdown restrictions introduced personal and relationship stressors that potentially increased the risk of intimate partner violence (IPV) for some. We estimated the population prevalence and correlates of fearing a partner in the first year of the pandemic in Britain.
METHOD: We used data from Natsal-COVID Wave 2-a web-panel survey undertaken one year after the initial British lockdown from 23 March 2020. Quotas and weighting were used to achieve a quasi-representative sample of the general population. Participants were asked about fearing a partner, which is a simple and valid screening tool to identify IPV experiences.
RESULTS: In our sample (unweighted n = 6302, aged 18-59), 9.0% of women and 8.7% of men reported fearing a partner in the first year of the pandemic. Women (73.3%) were more likely than men (49.9%) to indicate that fearing a partner made them feel anxious or depressed; men were more likely to report increased substance use (30.8% vs. 18.4%) and affected work/studies (30.0% vs. 20.0%). For both women and men, fearing a partner during the first year of the pandemic was associated with established health and wellbeing outcomes like anxiety/depression, alcohol use, accessing sexual/reproductive health services, and relationship dissolution as well as feeling that the "pandemic made things worse" across various life domains.
CONCLUSIONS: Population-level estimates of IPV during the COVID-19 pandemic highlight harmful experiences that occurred alongside other wide-ranging hardships, and the associations presented identify key populations with potential ongoing need. We make recommendations for primary, secondary, and tertiary prevention of IPV
Visually assessed ischemia on cardiac magnetic resonance, but not quantitative perfusion metrics, predicts symptomatic improvement in coronary artery bypass.
Get PDFBackground: Serial perfusion cardiovascular magnetic resonance (CMR) in symptomatic patients undergoing coronary artery bypass grafting (CABG) may provide mechanistic insight into dynamic abnormalities of the myocardium.
Objectives: To assess how changes in cardiac reperfusion and remodeling associate with symptom improvement in patients undergoing CABG METHODS: Patients awaiting elective CABG completed serial quality of life questionnaires and detailed CMR at baseline and at 6-12 months post-CABG as per protocol. Automated fully quantitative stress and rest myocardial blood flow was calculated, alongside assessment of the visual ischemic burden. Findings were correlated with changes in symptomatology.
Results: Of 40 patients who underwent serial evaluation with CMR (mean age 62.1±9.3, median LVEF 68% [IQR: 62-73%]), there was improvement in the median visual ischemic burden (42% [IQR: 27-51] vs 18% [IQR: 11-21], P<0.001), mean global stress myocardial blood flow (1.34±0.5 mL/min/g vs 1.59±0.5 mL/min/g, P=0.002) and median global myocardial perfusion reserve (1.85±0.6 vs 2.4±0.9, P<0.001) following CABG. Greater improvement in the SAQ-7 summary score was associated with a greater decrease in the visual ischemic burden following CABG (ρ=-0.38, P=0.02). Quantitative MBF metrics did not associate with baseline or change in SAQ-7 summary score.
Conclusion: Serial perfusion CMR identifies dynamic changes in markers of myocardial perfusion in patients following CABG. Greater reduction of visually assessed ischemia associated with improvement in SAQ-7 score. Quantitative perfusion indices were not associated with symptom improvement in this study. The results also suggest residual inducible ischemia post-CABG, requiring further studies to elucidate its clinical relevance
Does war moderate the association between mental wellbeing and its predictors among children? A multi-country cross-sectional study.
Get PDFBACKGROUND: This study explores how war or conflict influences the established predictors of mental well-being among children, addressing a significant gap in current research. METHODS: Utilizing data from Multiple Indicator Cluster Surveys (MICS6) collected between 2016 and 2021, we examined children aged 5-17 years in four low or middle-low-income countries experiencing war or conflict and compared them to 20 control countries. We employed logistic models to analyze the data, focusing on mental well-being as the outcome. Primary independent variable was exposure to war, with an emphasis on the interaction between this exposure and potential predictors, including age, sex, having a physical disability, enrolled in education, having siblings, living with at least one parent, residence place, and family wealth status. RESULTS: The analysis revealed significant modifications in the association between factors like age, disability, education, economic status, and place of residence and mental well-being due to war (p values < 0.05). Specifically, the impact of war was more pronounced in older children (OR = 1.48, 95%CI = 1.18-1.85) compared to younger ones. Education was found to mitigate anxiety in conflict-affected areas (OR = 0.75, 95%CI = 0.60-0.95), whereas children with disabilities were more vulnerable to mental health challenges (OR = 2.05, 95%CI = 1.65-2.55) in these settings. LIMITATIONS: The mental well-being measure was based on caregiver reports, which may not fully capture the children's experiences. CONCLUSION: Our findings provide crucial insights into the differential impact of war on children's mental well-being. They underscore the need for tailored, context-specific mental health interventions for children in conflict-affected areas and encourage further research into the nuanced effects of war on child and adolescent mental health
The triple impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy: a focus on people living with HIV/AIDS in Maiduguri, Nigeria
Get PDFBackground: The multifaceted impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy (ART) among people living with HIV/AIDS (PLHIV) in Maiduguri, Nigeria is highlighted by this article. While ART has transformed HIV from a fatal condition to a manageable chronic illness, achieving consistent access in regions facing socioeconomic and environmental challenges such as Maiduguri remains a critical issue. Factors such as inflation, poverty, and high transportation costs hinder PLHIV’s ability to obtain treatment and related medical services. Although antiretroviral drugs are subsidised in Nigeria, associated costs, including transport-fare and laboratory fees, place a significant burden on patients. This financial strain disrupts adherence to treatment, risking clinical failures and drug resistance. Insecurity due to the Boko Haram insurgency exacerbates these challenges. Methods: A comprehensive literature search was conducted using keywords such as ART, economic hardship, Maiduguri, flooding, and insecurity to identify relevant articles from Scopus, PubMed, and Google Scholar. Boolean operators "AND" and "OR" were applied to construct precise search strings, ensuring broad yet targeted retrieval of relevant studies. A total of 27 articles were included based on their relevance, methodological quality, and contribution to the study's aim. Eligible publications encompassed original research, systematic and narrative reviews, meta-analyses, perspectives, and grey literature, with priority given to studies published in English within the last ten years. A snowballing bibliometric approach was also employed to identify additional relevant literature. Full-text articles were critically analyzed and narratively synthesized under appropriate subheadings. Conclusion: There is an urgent need for comprehensive strategies that address these interlinked issues. Bolstering healthcare infrastructure, developing climate-resilient HIV prevention strategies, and enhancing policy frameworks for emergency health response, strengthening government coordination and securing both local and international support are vital for sustaining ART access. These could assist to improving health outcomes for vulnerable populations such as PLHIV in conflict and disaster-affected areas like Maiduguri
Ending nuclear weapons, before they end us.
Get PDFThis May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war. Health professionals and their associations should urge their governments to support such a mandate and support the new UN comprehensive study on the effects of nuclear war
Water, Sanitation, and Hygiene for Everyone Intervention Study: Protocol for a Controlled Before-and-After Trial.
Get PDFBACKGROUND: Community-based behavior change interventions are a common approach to Water, Sanitation, and Hygiene (WASH). Yet, published evaluations of how these interventions work in district-wide approaches are rare. OBJECTIVE: This study reports the baseline characteristics and study design for a trial assessing the effectiveness of a district-level Community-led Total Sanitation (CLTS) intervention compared to the additional integration of local care groups (CG) on sanitation coverage and use and hygiene behaviors in Chiradzulu District, Malawi. METHODS: This study is a controlled before-and-after trial with 2 treatment arms and a control group. Clusters are rural villages in 3 traditional authorities (TAs). One arm will receive CLTS and the CG model (CLTS+CG group), one arm CLTS only (CLTS group), and one group will serve as the control. The trial is part of the wider WASH for Everyone (W4E) project, led by World Vision Malawi that aims to expand access to WASH services across the entire district by 2025. Study participants were selected from the 3 TAs. Systematic sampling procedures were used to select 20 households per cluster with a total of 1400 households at both baseline and end line. The primary outcome is sanitation coverage. Secondary outcome measures include sanitation use, safe disposal of child feces, observed handwashing facility, and Sanitation-related Quality of Life Index (SanQoL-5). RESULTS: The baseline observations indicate a balanced distribution of potential demographic confounders in the trial arms with a slight variation on some WASH proxy measures. We noted the low coverage of handwashing facilities with soap and water in all 3 arms: 8% in the CLTS group, 4% in the CLTS+CG group, and 4% in the control group. There was a marginal variation in handwashing practices among the study arms with 3% of individuals handwashing with soap and water in the CLTS group, 5% in the CLTS+CG group, and 2% in the control group. Sanitation coverage also varied among the study arms at baseline as 83% of households had access to unimproved sanitation in the CLTS group, 70% in the CLTS+CG group, and 81% in the control group. CONCLUSIONS: Results from this trial will provide evidence on whether the CLTS+CG approach is effective at improving sanitation and hygiene practices in the W4E program area compared to CLTS alone and no intervention, as well as inform implementing partners on future interventions in Chiradzulu District, Malawi. The results are expected to be published in 2025. TRIAL REGISTRATION: ClinicalTrials.gov NCT05808218; https://clinicaltrials.gov/study/NCT05808218. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/68280
COVID-19 and older people’s wellbeing in northern KwaZulu-Natal – the importance of relationships [version 5; peer review: 1 approved, 1 approved with reservations, 1 not approved]
Get PDFBackground: The COVID-19 pandemic and the non-pharmacological prevention methods have affected the wellbeing of older people. In this paper we focus on the wellbeing, and vulnerability, of older people in rural northern KwaZulu-Natal, South Africa during the first year of the pandemic.
Methods: We conducted monthly in-depth interviews for up to four months with 26 people aged 57 years and older. A total of 86 interviews were conducted by telephone, because of restrictions on face-to-face contact, and digitally recorded. After transcription and translation, the data were coded thematically, with analysis guided by a wellbeing theoretical framework.
Results: Having access to food, to healthcare and to somewhere they felt safe to stay, was essential for everyone. For many managing expenses became more of a struggle as adult children who had lost their source of employment came home to stay. However, despite the shortages of money, the importance of relationships, whether they are familial or the close community of neighbours, was highlighted in the accounts of many participants. Older people not only got help with day-to-day life from others, but also found solace in the company of others. The sense of community, from family and neighbours, helped to ease some of the stress experienced because of the lockdowns.
Conclusions: The COVID-19 pandemic and the restrictions imposed to limit the spread of the virus impacted the wellbeing of older adults in rural KwaZulu-Natal. Our findings show how the importance of relationships with family and friends contributed to nurturing wellbeing for older people
Analysis of the Projected Climate Impacts on the Interlinkages of Water, Energy, and Food Nexus Resources in Narok County, Kenya, and Vhembe District Municipality, South Africa
Get PDFThe current changing climate requires the development of water–energy–food (WEF) nexus-oriented systems capable of mainstreaming climate-smart innovations into resource management. This study demonstrates the cross-sectoral impacts of climate change on interlinked sectors of water, energy, and food in Narok County, Kenya, and Vhembe District, South Africa. This study used projected hydroclimatic extremes across past, present, and future scenarios to examine potential effects on the availability and accessibility of these essential resources. The projected temperature and rainfall are based on nine dynamically downscaled Coupled Model Intercomparison Project Phase 5 (CMIP 5) of the Global Climate Models (GCMs). The model outputs were derived from two IPCC “Representative Concentration Pathways (RCPs)’’, the RCP 4.5 “moderate scenario”, and RCP 8.5 “business as usual scenario”, also defined as the addition of 4.5 W/m2 and 8.5 W/m2 radiative forcing in the atmosphere, respectively, by the year 2100. For the climate change projections, outputs from the historical period (1976–2005) and projected time intervals spanning the near future, defined as the period starting from 2036 to 2065, and the far future, spanning from 2066 to 2095, were considered. An ensemble model to increase the skill, reliability, and consistency of output was formulated from the nine models. The statistical bias correction based on quantile mapping using seven ground-based observation data from the South African Weather Services (SAWS) for Limpopo province and nine ground-based observation data acquired from the Trans-African Hydro-Meteorological Observatory (TAHMO) for Narok were used to correct the systematic biases. Results indicate downscaled climate change scenarios and integrate a modelling framework designed to depict the perceptions of future climate change impacts on communities based on questionnaires and first-hand accounts. Furthermore, the analysis points to concerted efforts of multi-stakeholder engagement, the access and use of technology, understanding the changing business environment, integrated government and private sector partnerships, and the co-development of community resilience options, including climate change adaptation and mitigation in the changing climate. The conceptual climate and WEF resource modelling framework confirmed that future climate change will have noticeable interlinked impacts on WEF resources that will impact the livelihoods of vulnerable communities. Building the resilience of communities can be achieved through transformative WEF nexus solutions that are inclusive, sustainable, equitable, and balance adaptation and mitigation goals to ensure a just and sustainable future for all