Defining measures of emergency care access in low-income and middle-income countries: a scoping review.

BACKGROUND: Over 50% of annual deaths in low-income and middle-income countries (LMICs) could be averted through access to high-quality emergency care. OBJECTIVES: We performed a scoping review of the literature that described at least one measure of emergency care access in LMICs in order to understand relevant barriers to emergency care systems. ELIGIBILITY CRITERIA: English language studies published between 1 January 1990 and 30 December 2020, with one or more discrete measure(s) of access to emergency health services in LMICs described. SOURCE OF EVIDENCE: PubMed, Embase, Web of Science, CINAHL and the grey literature. CHARTING METHODS: A structured data extraction tool was used to identify and classify the number of 'unique' measures, and the number of times each unique measure was studied in the literature ('total' measures). Measures of access were categorised by access type, defined by Thomas and Penchansky, with further categorisation according to the 'Three Delay' model of seeking, reaching and receiving care, and the WHO's Emergency Care Systems Framework (ECSF). RESULTS: A total of 3103 articles were screened. 75 met full study inclusion. Articles were uniformly descriptive (n=75, 100%). 137 discrete measures of access were reported. Unique measures of accommodation (n=42, 30.7%) and availability (n=40, 29.2%) were most common. Measures of seeking, reaching and receiving care were 22 (16.0%), 46 (33.6%) and 69 (50.4%), respectively. According to the ECSF slightly more measures focused on prehospital care-inclusive of care at the scene and through transport to a facility (n=76, 55.4%) as compared with facility-based care (n=57, 41.6%). CONCLUSIONS: Numerous measures of emergency care access are described in the literature, but many measures are overaddressed. Development of a core set of access measures with associated minimum standards are necessary to aid in ensuring universal access to high-quality emergency care in all settings.

Community exposures among Colorado adults who tested positive for SARS-CoV-2 -A case-control study, March-December 2021.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), is spread primarily through exposure to respiratory droplets from close contact with an infected person. To inform prevention measures, we conducted a case-control study among Colorado adults to assess the risk of SARS-CoV-2 infection from community exposures. METHODS: Cases were symptomatic Colorado adults (aged ≥18 years) with a positive SARS-CoV-2 test by reverse transcription-polymerase chain reaction (RT-PCR) reported to Colorado's COVID-19 surveillance system. From March 16 to December 23, 2021, cases were randomly selected from surveillance data ≤12 days after their specimen collection date. Cases were matched on age, zip code (urban areas) or region (rural/frontier areas), and specimen collection date with controls randomly selected among persons with a reported negative SARS-CoV-2 test result. Data on close contact and community exposures were obtained from surveillance and a survey administered online. RESULTS: The most common exposure locations among all cases and controls were place of employment, social events, or gatherings and the most frequently reported exposure relationship was co-worker or friend. Cases were more likely than controls to work outside the home (adjusted odds ratio (aOR) 1.18, 95% confidence interval (CI): 1.09-1.28) in industries and occupations related to accommodation and food services, retail sales, and construction. Cases were also more likely than controls to report contact with a non-household member with confirmed or suspected COVID-19 (aOR 1.16, 95% CI: 1.06-1.27). CONCLUSIONS: Understanding the settings and activities associated with a higher risk of SARS-CoV-2 infection is essential for informing prevention measures aimed at reducing the transmission of SARS-CoV-2 and other respiratory diseases. These findings emphasize the risk of community exposure to infected persons and the need for workplace precautions in preventing ongoing transmission.

Variability of Accommodative Microfluctuations in Myopic and Emmetropic Juveniles during Sustained near Work.

Near work has been considered to be a potential risk factor for the onset of myopia, but with inadequate evidence. Chinese adolescents use digital devices for near work, such as study and entertainment purposes, especially during the COVID-19 pandemic. In this study, we investigated the influence of prolonged periods of near work on accommodative response, accommodative microfluctuations (AMFs), and pupil diameter between juvenile subjects of myopia and emmetropia. Sixty juveniles (30 myopes and 30 emmetropes) were recruited for the study. Participants were instructed to play a video game on a tablet PC at a distance of 33.3 cm for 40 min. Accommodative response and pupil diameter were measured with an open-field infrared refractometer in High-speed mode. Parameters of the subjects were measured once every 10 min, and analyzed by one-way repeated measure ANOVA for variation tendency. There were no significant differences between emmetropia and myopia groups with respect to age and sex (p > 0.05). The low-frequency component (LFC) of myopia gradually increased with time, reached a peak at 30 min, and then declined (p = 0.043). The high-frequency component (HFC) of myopia also reached a peak at 30 min (p = 0.036). Nevertheless, there was no significant difference in the LFC (p = 0.171) or HFC (p = 0.278) of the emmetropia group at each time point. There was no significant difference in the mean and standard deviation of the accommodative response and pupil diameter both in emmetropic and myopic juveniles. Compared with juvenile emmetropes, myopes exhibit an unstable tendency in their accommodation system for prolonged near work at a certain time point. Accommodative microfluctuations may be a sensitive, objective indicator of fatigue under sustained near work in juvenile myopes.

The visual consequences of virtual school: acute eye symptoms in healthy children.

PURPOSE: To investigate acute eye symptoms in healthy children after a typical day of virtual school during the COVID-19 pandemic. METHODS: The study population included 110 healthy children 10-17 years of age who were enrolled in full-time or hybrid virtual school. Children with a history of central nervous system or ocular pathology, recent concussions, reported poor vision, convergence insufficiency, history of orthoptic therapy, strabismus, amblyopia, or learning disorders were excluded. Background information was collected, including demographics, family and personal ocular history, and virtual school specifications. Eligible children completed a modified convergence insufficiency symptom survey (CISS) and an asthenopia survey before and after a virtual school session. CISS and asthenopia survey symptoms were scored, and the differences in symptomatology before and after school were calculated. RESULTS: The average sum of the CISS scores increased from 5.17 before school to 9.82 after (P < 0.001), with 61% of children recording an increase in convergence insufficiency symptoms and 17% experiencing severe convergence insufficiency symptoms after school. Average asthenopia symptom scores increased from 1.58 to 2.74 (P < 0.001), with 53% of children recording an increase in asthenopia symptoms. Significant increases were seen in 12 of 15 CISS questions and in 4 of 5 asthenopia questions. CONCLUSIONS: In this study cohort, otherwise healthy children experienced acute ocular symptoms following virtual school.

Binocular Accommodation and Vergence Dysfunction in Children Attending Online Classes During the COVID-19 Pandemic: Digital Eye Strain in Kids (DESK) Study-2.

PURPOSE: To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. METHODS: Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. RESULTS: A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more (P = .019). Mean near exophoria (P = .03), negative fusional vergence (P = .02), negative relative accommodation (P = .057), and accommodation amplitude (P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient rs = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor (P = .07) for the symptomatic CISS score. CONCLUSIONS: Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [J Pediatr Ophthalmol Strabismus. 2021;58(4):224-231.].