Sight Impairment registration in Trinidad: Trend in causes and populationcoverage in comparison to the National Eye Survey of Trinidad and Tobago

Background: Little was known about the population coverage and causes of sight impairment (SI) registration within the Caribbean, or the extent to which register studies offer insights into population eye health.Methods: We compared causes of SI registration in the Trinidad and Tobago Blind Welfare Association (TTBWA) register with findings from the 2014 National Eye Survey of Trinidad and Tobago (NESTT), and estimated registration coverage. Cross-sectional validation studies of registered clients included interviews, visual function and cause ascertainment in July 2013, and interviews and visual function in July 2016.Results: The TTBWA register included 863 people (all ages, 48.1%(n=415) male) registered between 1951 and 2015. The NESTT identified 1.1%(75/7158) people aged >5years eligible for partial or severe SI registration, of whom 49.3%(n=37) were male. Registration coverage was approximately 7% of the eligible population of Trinidad. Nevertheless, there was close agreement in the causes of SI comparing the register and population-representative survey. Glaucoma was the leading cause in both the register (26.1%,n=225) and population-based survey (26.1%, 18/69 adults), followed by cataract and diabetic retinopathy. In the validation studies combined, 62.6%(93/151) clients had severe SI, 28.5%(43/151) had partial SI and 9.9%(15/151) did not meet SI eligibility criteria. SI was potentially avoidable in at least 58%(n=36/62) adults and 50%(n=7/14) children.Conclusion: We report very low register coverage of the SI population, but close agreement in causes of SI to a contemporaneous national population-based eye survey, half of which resulted from preventable or treatable eye disease.</p

Co-developing a health literacy framework to integrate nutrition into standard care in sickle cell disease

Nutrition in Sickle Cell Disease (SCD) is a neglected part of standard care impacting patient outcomes, despite it being widely researched. Moreover, the clinical features of SCD, a marginalised genetically inherited blood disorder, are responsible for growth and nutritional deficiencies that require nutrition service provision. Thus, a need exists to identify the influencing factors affecting the lack of nutrition integration in SCD. Presently, a paucity of research exists on how to integrate nutrition into standard care in SCD using health literacy in a novel way to support policy and practice development.The study adopted a four phased sequential participatory Learning Alliance Methodology, involving sickle cell service users and carers (n=11) and service providers (n=7), between March to December, 2020, to co-develop a health literacy framework to support nutrition integration in SCD. Independent focus groups (phase one), network meetings (phase two, three and four) and an evaluation questionnaire, was used to collect the data.Thematic analysis of the focus groups outcomes revealed four common themes namely; (1) Invisibility of SCD, (2) Under-recognised importance of nutrition, (3) Lack of priority to nutrition and (4) Multi-level factors affecting nutrition and service provision that together reflect key influencing factors identified as knowledge and care gaps, essential to tailor policy and practice in nutrition in SCD. Following consensus development and validation through network meetings, the evaluation of the health literacy framework (phase four), found the framework to be a valuable educational, communication and policy tool.Overall the findings confirm the complexity, invisibility and neglect of nutrition service provision as part of standard care in SCD, a health inequality impacting patient experience, access and health outcomes, explained by the marginalisation of SCD. Hence, the influencing factors identified in the study require a whole systems policy and practice strategy to integrate nutrition into standard care in SCD.</p

Evaluation of determinants, acceptability and effectiveness of community-based management of multidrug-resistant tuberculosis (MDR-TB) in Nigeria

Background: Growing multidrug-resistant tuberculosis (MDR-TB) worldwide and new effective and affordable treatment modalities required exploration of options such as the community model of MDR-TB treatment (CM), as introduced in Nigeria. This study explores its acceptability implementation and follow-up for infection control, programme characteristics influencing the model outcomes, economic impact, and cost-effectiveness. The study also evaluates the Nigerian experience of the End TB Strategy target of impoverishment due to MDR-TB.Methods: Mixed methods were employed. Qualitative data were obtained from semi-structured interviews with 21 MDR-TB patients in Nigeria. An iterative interview process with adapted topic guides led to data saturation, and themes emerged inductively from thematic analysis. Effectiveness and cost-effectiveness analysis compares community (CM) and hospital-based MDR-TB care (HM). We assessed treatment outcomes data from the medical records of 423 MDR-TB patients to evaluate the effectiveness of HM and CM based on WHO treatment criteria. Treatment success” is defined as the sum of cure and treatment completion. “Cure” is the “treatment completion” with at least three negative cultures taken at least 30 days apart after the intensive phase in the absence of “treatment failure. Costs were assessed from a societal perspective and included health system costs and a cross-sectional survey of MDR-TB patients at different stages of treatment to obtain direct and indirect costs. Cost-effectiveness was calculated as the cost per patient successfully treated and incremental cost-effectiveness ratio (ICER) per patient cured or successful treatment. We also assessed the expected costs and health effects of HM vs CM using a decision-analytic model from the perspective of the Nigerian national healthcare system.Findings: Emergent themes indicate strong patient preference and acceptability of CM; mixed feelings about the risk and points of MDR-TB transmission; stigma influencing infection control and community support worker attitudes influencing the expansion of resistance. The median monthly cost incurred by patients was higher in HM than in CM, with US $55.38 (IQR: 27.90–65.69) versus US$28.72 (IQR: 13.68–38.40) (p Conclusion: Community-based-MDR-TB was seen as the patients' most preferred and acceptable model because of its convenience, which enhanced recovery, enabled social interaction, and promoted mental health. It also allowed economic productivity and earning potential. It improved the health system, patient affordability, and cost-effectiveness at ICER of US $-1190. However, CM was challenged by ineffective supervision and the need for more commitment among patients and community support workers to reducing community transmission. Despite social protection, patients experienced further impoverishment. The level of impoverishment experienced by MDR-TB patients in Nigeria suggests that it requires appropriate innovative patient-centred social protection for the Nigerian TB control programme to achieve the End TB Strategy targets and UHC. The findings also point to a need for continuous patient counselling and education to reduce stigma and improve coordination between patients and support workers to help patients comply with guidelines and impact the treatment outcome.</p

Guest Editorial: The IPS and ISCEV joint Guidelines for full-field stimulus testing

The first electrophysiology standard was published in 19891 as a collaboration between the International Society for Clinical Electrophysiology of Vision (ISCEV) and the National Retinitis Pigmentosa Foundation of the USA and is currently in its seventh version.2 These Standards are the keystone of clinical visual electrophysiology, embedding comparability and repeatability in the tests to an extent rarely achieved in clinical or laboratory measurement. We start 2024 with the publication of the Guideline for the Full-field Stimulus Test (FST).3 The Guideline is the result of a successful collaboration between ISCEV and the Imaging and Perimetry Society (IPS), bringing together both electrophysiology and psychophysics expertise as required for conduct and interpretation of the FST.</p

Improving the quality of quantitative polymerase chain reaction experiments: 15 years of MIQE

The quantitative polymerase chain reaction (qPCR) is fundamental to molecular biology. It is not just a laboratory technique, qPCR is a bridge between research and clinical practice. Its theoretical foundations guide the design of experiments, while its practical implications extend to diagnostics, treatment, and research advancements in the life sciences, human and veterinary medicine, agriculture, and forensics. However, the accuracy, reliability and reproducibility of qPCR data face challenges arising from various factors associated with experimental design, execution, data analysis and inadequate reporting details. Addressing these concerns, the Minimum Information for the Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines have emerged as a cohesive framework offering a standardised set of recommendations that describe the essential information required for assessing qPCR experiments. By emphasising the importance of methodological rigour, the MIQE guidelines have made a major contribution to improving the trustworthiness, consistency, and transparency of many published qPCR results. However, major challenges related to awareness, resources, and publication pressures continue to affect their consistent application. </p

Turn to the Wind

Feeling cut off and cast out from the communities they called home, two crews of veterans sail the coast of the British Isles and navigate the Thames to find peace in being at one with nature and a true sense of belonging and purpose again as part of a team.</p

The gamification of circular practices using the SDGs

Global society is becoming increasingly committed to the values of responsi-ble businesses and long-term value creation. There is also a strong under-standing of the need for more sustainable economic growth, which is demonstrated with the global sustainable development goals (SDGs). Gami-fication provides an opportunity to increase sustainable awareness and be-haviours by providing instantaneous rewards for completing desired pro-environmental tasks. These actions are based on circular economy practices, seeking to keep waste minimal, extending and closing the loop. A case study methodology was used to examine the gamified sustainability scheme launched by a higher education institution in the United Kingdom. The de-sign of this scheme was found to cover all four of the categorisations of sus-tainability games and apps, as well as optimising key gamification principles of realistic goals, clear progression and reward, as well as using strategy and novelty to engage users. The scheme also focused on the delivery of five of the seventeen SDGs and four of the Rs. Thus, although gamification princi-ples have been optimised to encourage circular practices in this case, further consideration should be given to the remaining SGDs and Rs to ensure a balanced approach to sustainable operations and growth. The case serves as an example of how gamification can be used to encourage stakeholders to-wards sustainable attitudes and behaviours.</p

Exploring spiritual capital in the social and economics context of Hong Kong: from case studies in social enterprise

This thesis investigates the recent growth of the role of spiritual capital in the social and economic context of Hong Kong. A gap in knowledge existed regarding how and why spiritual capital can have an impact on economic and social outcomes. The purpose of the research was to better understand the role of spiritual capital to shape economic and social behaviour in a profound way leading to redistribution of capital. The research also provided new insight into the practice of spiritual capital in the context of market-driven society and thus to contribute to knowledge, and practice.The research adopted the approach of case studies in social enterprise. It was designed as qualitative case studies of the emergence of spiritual capital in two social enterprises. Data were collected by interviews, observation and documentary analysis. The data provided descriptions and analysis on what was happening in the organizations. A cross-case analysis identified three main themes from the data (intrinsic motive; organizational culture, leadership and values; and habitus and virtues).The findings demonstrated that, unlike other capitals, which prioritise accumulation, spiritual capital is about giving and sharing as a response to the market-driven society that created the social issue of wealth gap. The findings also demonstrated the concept gap about what spiritual capital is. Spiritual capital is not limited to ethics, and spiritual wealth, it is spiritual knowledge that a person accumulated. The spiritual knowledge motived him/her to share and give for the redistribution of capital so as to alleviate the wealth gap.The research concludes that spiritual capital is spiritual knowledge, which can be drawn on to attain the redistribution of capital within a society. This can be practiced through social entrepreneurship that prioritizes social impact over financial profit. Spiritual capital responds to the drawback of capitalist market through redistribution of capital. By harnessing spiritual capital, individuals and communities can work towards creating a more just and equitable society.</p

Extending the job demands–resources model to understand the effect of the interactions between home and work domains on work engagement

Scholars have extensively used the job demands–resources model to explain the dynamics underlying work engagement and proposed several versions of the model. However, in theoretical terms, nonwork elements have not been incorporated into the model. This study investigated the roles of home demands and resources in the model by testing the boost/buffer hypotheses for work engagement from the perspective of the work–home interface. We demonstrated that (1) the demands of a domain boost the positive impact of resources drawn from another domain on work engagement, (2) the resources of a domain buffer the negative impact of demands derived from another domain on work engagement; and (3) the buffering and boosting effects of home demands and resources impact work engagement. We conducted a diary study on a group of coffee shop employees in Ireland. The results partially supported the proposed hypotheses but nevertheless indicated support for the cross‐domain boost/buffer hypotheses with regard to work engagement. The proposed model may serve as a theoretical foundation for research on issues related to the impact of work and nonwork domains on work engagement. </p

Prevalence of sarcopenia in Africa: a systematic review and meta-analysis of observational studies

Background: Existing literature suggests that sarcopenia is a highly prevalent condition in older people. However, most studies to date reporting data on its prevalence have been mainly carried out in Western countries, while data on sarcopenia in Africa is scarce. With this systematic review and meta‐analysis, we aimed to determine the prevalence of sarcopenia in African countries and to explore potential factors that could explain higher or lower prevalence of this condition in Africa. Methods: Major databases for studies reporting data on sarcopenia in African countries were searched from inception to June 2023. We conducted a meta-analysis of the prevalence [and 95% confdence intervals (95% CIs)] of sarcopenia in Africa, applying a random efect model. Several sensitivity and meta-regression analyses were run.Results: Among 147 articles initially screened, six articles (with seven cohorts) including a total of 10,656 participants were included. Mean age of participants was 66.9 years, and the majority were female (58.1%). The weighted prevalence of sarcopenia in the selected countries of Africa was 25.72% (95%CI: 18.90–32.55). This outcome was characterized by a high heterogeneity (I 2=99%) and by publication bias. Among the factors investigated, sarcopenia was lower when assessed using only one anthropometric measure, or in South Africa.Conclusion: Sarcopenia is a prevalent condition in Africa and thus research regarding this topic is a public health priority. Future studies that cover African countries for which data are not available and using standardized criteria are needed.</p