Accuracy of diagnosis of pterygium by optometrists and general practitioners in Australia

Background: It was the author's (LWH) observation that pterygium was frequently misdiagnosed by general practitioners that led to this study. The aim was to identify the rate of misdiagnosis of pterygium by optometrists and general practitioners based upon assessing referral accuracy to a single ophthalmologist (LWH). Methods: This study involved a prospective case series from 25 March 2015 to 18 December 2018 in a tertiary referral practice specialising in pterygium. The accuracy of diagnosis of pterygium, based upon the content of the clinical referral, was undertaken for optometrists and general practitioners. The benchmark for diagnostic accuracy was the diagnosis made by the author (LWH) during a consultation in person by the author (LWH) using a hand-light examination and confirmed by slitlamp examination. Results: A total of 1,511 consecutive patients were included in the study with 90/549 incorrectly diagnosed (16 per cent) by general practitioners and 14/962 (1.4 per cent) by optometrists. General practitioners were 13.28 times more likely to incorrectly diagnose a pterygium than optometrists (95% CI 7.48–23.57). Almost exclusively, the incorrect diagnosis made by general practitioners was naming a pinguecula, a pterygium. The same misdiagnosis was made by optometrists but far less frequently. Conclusion: General practitioners misdiagnosed pterygium far more often than optometrists which may reflect a reduction in training in eye health

Understanding the physiological and biological response to ambient heat exposure in pregnancy: protocol for a systematic review and meta-analysis

Introduction: Climate change increases not only the frequency, intensity and duration of extreme heat events but also annual temperatures globally, resulting in many negative health effects, including harmful effects on pregnancy and pregnancy outcomes. As temperatures continue to increase precipitously, there is a growing need to understand the underlying biological pathways of this association. This systematic review will focus on maternal, placental and fetal changes that occur in pregnancy due to environmental heat stress exposure, in order to identify the evidence-based pathways that play a role in this association. Methods and analysis: We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search PubMed and Ovid Embase databases from inception using tested and validated search algorithms. Inclusion of any studies that involve pregnant women and have measured environmental heat stress exposure and either maternal, placental or fetal physiological or biochemical changes and are available in English. Modelling studies or those with only animals will be excluded. The risk of bias will be assessed using the Office of Health Assessment and Translation tool. Abstract screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Environmental parameters will be reported for each study and where possible these will be combined to calculate a heat stress indicator to allow comparison of exposure between studies. A narrative synthesis will be presented following standard guidelines. Where outcome measures have at least two levels of exposure, we will conduct a dose–response meta-analysis should there be at least three studies with the same outcome. A random effects meta-analysis will be conducted where at least three studies give the same outcome. Ethics and dissemination: This systematic review and meta-analysis does not require ethical approval. Dissemination will be through peer-reviewed journal publication and presentation at international conferences/interest groups. PROSPERO registration number: CRD42024511153

The Controversies and Difficulties of Diagnosing Primary Ciliary Dyskinesia

We welcome the correspondence from Lavie and Amirav (1), highlighting the difficulties diagnosing primary ciliary dyskinesia (PCD) and the role of high-speed video analysis (HSVA). As members of the European Respiratory Society (ERS) PCD Diagnostic Task Force (2) and/or large PCD Centres, we agree that HSVA has an important role that is not recognized by the American Thoracic Society (ATS) PCD Diagnostic Guideline (3). This risks a large proportion of false-negative “missed” diagnoses and a sizable number of false-positive cases; we make additional important observations.</div

Models of Alternative Dispute Resolution (ADR): A report for the Legal Ombudsman

The aim of this research was to investigate what the Legal Ombudsman can learn from other Alternative Dispute Resolution (ADR) providers. The research was commissioned by the Legal Ombudsman to help it review and develop its dispute resolution model and ensure it remains fit-for-purpose. The research involved a case study design and fieldwork was conducted with ten organisations: four in the UK, one in Ireland, two in New Zealand, one in Australia, one in Canada and one in the USA. The research highlighted a range of dispute resolution practices and illustrated some of the key design choices that ADR providers need to make when designing or reviewing a dispute resolution scheme. These fell within four areas: the use of online dispute resolution; the early stages of dispute resolution processes; mediation approaches; and the later stages of dispute resolution and building influence.div_BaMpub3584pu

Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings.

Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings

Dysfunctional accountability in complaint systems: The effects of complaints on public service employees

Item previously deposited in University of Glasgow repository on 14 Jun 2019: http://eprints.gla.ac.uk/188357/This article examines the effect that being complained about has on public service employees. The volume of complaints about public bodies is significant: an estimated 543,000 complaints a year are made about central government, while the English NHS was subject to 208,415 complaints in 2016-2017. Despite the significant expansion of complaint procedures following the Citizen’s Charter reforms in the 1990s, there has been no empirical research into the way in which complaints affect employees outwith the healthcare sector. Most scholarly debate has focused on whether complaints procedures within government have improved customer service or been useful for service improvement. Little attention has been paid to the experience of being subject to a complaint and the influence this has on work practice. In this respect, the public accountability literature suggests that significant dysfunctional effects may result from accountability regimes, including: defensive practices, tick-box compliance, excessive formality, and reduced innovation. In the healthcare setting, negative effects arising from being complained about include defensive medical practice, avoidance behaviours, wariness towards service users, and reduced wellbeing. While some positive effects have been reported, the thrust of healthcare studies is that complaints have harmful effects on professionals. To date, however, the effects of complaint systems outwith the healthcare context remain uncharted: we do not know whether other public services are affected in similar ways.https://www.sweetandmaxwell.co.uk/Catalogue/ProductDetails.aspx?recordid=469&productid=7106pubpu

Mobile health (mHealth) interventions for health promotion during the perinatal period in India: a scoping review

Introduction: Perinatal and maternal mortality rates remain high in India compared to global levels, and there is significant heterogeneity in outcomes across Indian states. Many mobile health (mHealth) interventions have been developed to improve maternal and infant health outcomes in India, however it is unclear how mHealth can best support women in this culturally and resource diverse setting. Therefore, we aimed to identify mHealth interventions targeting women and their families in the perinatal period in India, identify barriers and facilitators to their uptake, and future research directions. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews was used for study selection and screening and the mHealth evidence reporting and assessment checklist was used for evaluating mHealth interventions. PubMed, CINAHL, Global Health, and ACM digital library were searched for records up to 2 April 2023. Studies were included where women who were pregnant, planning for a child, or in the 12 months after delivery, and their families, living in India received health advice via a technological medium. Results: 1,783 records were screened, 29 met the inclusion criteria, describing 22 different mHealth interventions. Most frequent behavioural targets for interventions were breastfeeding, antenatal nutrition, and infant healthcare. Most interventions communicated to women through one-way communication methods, most frequently SMS. Participants reported positive views of mHealth, reported facilitators included group communication, use of non-maternal informative content, and a pictorial information format. Reported barriers included household responsibilities, technical difficulties, difficulty accessing a phone and difficulty understanding, or misinterpreting messages. Discussion: We conclude that mHealth interventions are acceptable to women in India during the perinatal period. However, current interventions lack evidence of long term behavioural change and fail to report on features important in sustainability and scalability, namely network infrastructure, data security and interoperability. We propose the need for a framework to understand existing cultural beliefs and support structures to avoid early intervention failure. Future research should investigate multimodal mHealth interventions for behavioural change, identify the appropriate frequency and format of mHealth messages, and address access limitations such as shared mobile phone ownership, and illiteracy rates

Mobile health (mHealth) interventions for health promotion during the perinatal period in India: a scoping review

IntroductionPerinatal and maternal mortality rates remain high in India compared to global levels, and there is significant heterogeneity in outcomes across Indian states. Many mobile health (mHealth) interventions have been developed to improve maternal and infant health outcomes in India, however it is unclear how mHealth can best support women in this culturally and resource diverse setting. Therefore, we aimed to identify mHealth interventions targeting women and their families in the perinatal period in India, identify barriers and facilitators to their uptake, and future research directions.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews was used for study selection and screening and the mHealth evidence reporting and assessment checklist was used for evaluating mHealth interventions. PubMed, CINAHL, Global Health, and ACM digital library were searched for records up to 2 April 2023. Studies were included where women who were pregnant, planning for a child, or in the 12 months after delivery, and their families, living in India received health advice via a technological medium.Results1,783 records were screened, 29 met the inclusion criteria, describing 22 different mHealth interventions. Most frequent behavioural targets for interventions were breastfeeding, antenatal nutrition, and infant healthcare. Most interventions communicated to women through one-way communication methods, most frequently SMS. Participants reported positive views of mHealth, reported facilitators included group communication, use of non-maternal informative content, and a pictorial information format. Reported barriers included household responsibilities, technical difficulties, difficulty accessing a phone and difficulty understanding, or misinterpreting messages.DiscussionWe conclude that mHealth interventions are acceptable to women in India during the perinatal period. However, current interventions lack evidence of long term behavioural change and fail to report on features important in sustainability and scalability, namely network infrastructure, data security and interoperability. We propose the need for a framework to understand existing cultural beliefs and support structures to avoid early intervention failure. Future research should investigate multimodal mHealth interventions for behavioural change, identify the appropriate frequency and format of mHealth messages, and address access limitations such as shared mobile phone ownership, and illiteracy rates

Fire risk reduction on the margins of an urbanizing world

Globally, over 95% of fire related deaths and injuries occur in low- and middle-income countries. Within informal settlements, the risk of fire resulting in injury or death is particularly high. This paper examines fire risks in informal settlements in New Delhi and Cape Town, and tented informal settlements in Lebanon. Our analysis draws on primary sources, secondary literature, statistical data and qualitative interviews. The distribution of fire risk across urban societies is a fundamentally political issue. Residential fire risk can be tackled by accessible, affordable, safety-compliant housing. That said, important interim measures can be taken to mitigate fire risk. Some of the risks requiring attention are similar across our case studies, driven by high population densities; flammable housing materials; unreliable or inaccessible access to safe power sources; and - in the case of Cape Town and New Delhi particularly - the inability of fire services to reach sites of fire. However, these common risks are embedded in distinct social, economic and political contexts that must be placed at the centre of any intervention. Interventions must also be aware that the risk of fire is not spread evenly within informal settlements, intersecting as it does with factors like gender, age, health and disability. Informal settlement fires have been under-studied to date. The studies that do exist tend to operate within disciplinary silos. This paper represents an important interdisciplinary approach to fire within informal settlements, which grounds technical data, modelling and experiments in political, social and economic realities