Recruitment and Selection Strategies in Optometric Education Towards Addressing Human Resource Disparities in Sub-Saharan Africa

The dire need for eye care services and a dearth of human resources (HR) in sub-Saharan Africa motivated the setting up of new optometry programmes. However, to make a meaningful impact, geographical, gender, economic and educational disparities must additionally be addressed. A qualitative study utilizing purposive sampling to select academic leadership and students from optometry programmes in sub-Saharan Africa was conducted. Individual and focus group interviews produced data that were coded and analysed using a deductive thematic analysis approach. The themes that emerged as contributing to disparities in access through recruitment and selection were institutional barriers (student intake numbers, programme marketing, minimum entry requirements, absence of pre-medical programme) and socio-economic barriers (finance, poor secondary school education, lack of knowledge of optometry, geographic location of institutions, gender). To address equity, institutions should engage with communities, market via community radio stations, offer pre-medical and bridging programmes, partner with governments and private funders to offer loans and bursaries and affirm females and rural applicants in recruitment and selection. In conclusion, universities must be socially accountable in all facets of education including recruitment and selection

Towards a culture of quality assurance in optometric education in sub-Saharan Africa

Background: New optometry education programmes in sub-Saharan Africa share a responsibility for blindness prevention by virtue of producing the countries first practitioners. Programmes need to be relevant and of a high quality to ensure sustainability. A quality culture is not a single event involving an accreditation audit but an integrated continuous system across core academic areas and accepted by all concerned in the programme. Aim: The aim was to determine the extent to which quality assurance is integrated into the 11 participating optometry education programmes in sub-Saharan Africa. Setting: The study was conducted in sub-Saharan Africa. Methods: A qualitative approach, employing a phenomenological design was used in the study. Key academics in leadership were purposively selected and then consented to participate in interviews covering the core academic areas, namely, governance, recruitment and selection, teaching and learning, curriculum design, staff development, research, community-based training and student support. Transcribed data was iteratively analysed. Results: Only one sub-Saharan country undergoes the three levels of quality audits within a regulated optometric environment. Despite a few pockets of best practices in some core areas, there was a reported general lack of quality assurance initiatives, national guidelines and adequate leadership capacity. Conclusion: This study highlighted the absence of regulatory authorities and mandatory quality audits, which contribute to the general lack of a quality culture in optometry programmes. Schools should aim to embed a culture of quality that produces competent, socially relevant graduates and impactful research. It is recommended that schools at national, regional and global levels collaborate towards the development of a quality assurance culture across optometry education programmes in sub-Saharan Africa

Addressing vision impairment in Mozambique and the Africa region

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for low income settings

Addressing Avoidable Vision Impairment in Mozambique and the Africa Region

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for lowincome settings

TB/HIV pleurisy reduces Th17 lymphocyte proportion independent of the cytokine microenvironment

T-helper (Th) 17 cells are a pro-inflammatory subset of CD4+ effector T-cells critical in mucosal immunity. Imbalances in Th17 cell proportion have been implicated in the pathogenesis of several diseases; however, this has not been adequately explored in tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. Since Th17 cells are predominantly mucosally associated, we assessed Th17 proportion and associated microenvironment in pleural effusions from patients co-infected with TB/HIV. Our results show that TB+HIV+ pleurisy results in significantly reduced frequency of CD4+IL-17+RORC+STAT3+ Th17 cells compared to TB−HIV−ex vivo (p = 0.0054) and was confirmed in conditioned media studies in vitro (p = 0.0001). This was not associated with alterations in Th17 polarising cytokines IL-6, IL-21 and IL-23 or changes in Th17 signature cytokines IL-17A and F. However, the mRNA expression of Th17 signalling molecules, IL-6 (p = 0.0022), IL-6R (p = 0.0247), IL-1β (p = 0.0022) and signal transducer and activator (STAT) 3 (p = 0.0022) were significantly upregulated. Notably, TB+HIV+ pleural fluid contained significantly higher concentrations of IL-1β (p = 0.0008), IL-22 (p = 0.0115), IL-31 (p = 0.0210), TNF-α (p = 0.0251) and IFN-γ (p = 0.0026) than TB−HIV− pleural fluid ex vivo. Taken together, this suggests a reduced portion of Th17 lymphocytes in TB/HIV pleurisy is independent of locally mediated cytokine polarisation.The National Research Foundation, KwaZulu-Natal Research Institute for Tuberculosis and HIV and College of Health Sciences, University of KwaZulu-Natal.http://intl.elsevierhealth.com/journals/tube2017-07-31hb2016Physiolog

A frequency analysis of cone characteristics for the different stages of keratoconus

Background: The stages of keratoconus can be classified according to the degree of corneal conicity as either early or advanced, or morphologically by the shape of the cone. Knowledge of the different cone characteristics for the different stages of keratoconus may assist practitioners in diagnosing and managing these patients. Aim: To describe the cone characteristics for the different stages of keratoconus. Methods: In this retrospective study, a sample of 190 eyes from 106 cases of previously diagnosed keratoconic patients was analysed. The stage of keratoconus and cone characteristics, namely: cone location, cone decentration, morphology, and topographical patterns were analysed using an Oculus 3M corneal topographer. Results: Our study revealed that for all stages of keratoconus centrally located cones were the most frequent, with corneal apical decentration between 0 mm and 2 mm. Frequency analysis revealed that nipple cones were most frequent in all stages. Topographical pattern frequencies revealed a wide distribution amongst the different corneal patterns in all stages of keratoconus. Conclusion: Cone analysis should be of consideration to the contact lens practitioner when deciding on management of the condition. It additionally serves to compliment the clinical signs such as nerve visibility, Fleischer’s ring, Vogt’s striae and corneal scarring

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication