Economic impact of work disability due to chronic low back pain from the patient perspective.

OBJECTIVES: Low back pain (LBP) is one of the main expenditure items for health systems. Data on the economic impact of LBP are uncommon from the patient perspective. The aim of this study was to estimate the economic impact of work disability related to chronic LBP from the patient perspective. METHODS: We conducted a cross-sectional analysis from patients aged over 17 years suffering from non-specific LBP for at least 3 months. Systematic medical, social and economic assessments were collected: pain duration and intensity; functional disability with the Quebec Back Pain Disability Scale (0-100); quality of life with the Dallas Pain Questionnaire; job category; employment status; duration of work disability due to LBP, and income. Factors associated with loss of income were identified by multivariable logistic regression analysis. RESULTS: We included 244 workers (mean age 43 ± 9 years; 36% women); 199 patients had work disability, including 196 who were on sick leave, 106 due to job injury. Three were unemployed due to layoff for incapacity. The mean loss of income for patients with work disability was 14% [SD 24, range -100 to 70] and was significantly less for patients on sick leave due to job injury than on sick leave not related to job injury (p < 0.0001). On multivariable analysis, the probability of loss of income with LBP was about 50% less for overseers and senior managers than workers or employees (odds ratio 0.48 [95% confidence interval 0.23-0.99]). CONCLUSION: Work disability due to LBP resulted in loss of income in our study. The loss of income depended on the type of social protection and job category. It was reduced for patients on sick leave related to work injury and for overseers and senior managers.

Meaningful Activity, Psychosocial Wellbeing, and Poverty During COVID-19: A Longitudinal Study.

Background: Only a few studies have explored experiences of meaningful activity and associations with psychosocial wellbeing during COVID-19. None reflect a Canadian context or focus on persons living in poverty. Purpose: To identify experiences and associations between meaningful activity and psychosocial wellbeing for persons living in poverty during the first year of COVID-19. Method: We delivered a quantitative survey at three time points during the first year of the pandemic supplemented by qualitative interviews at Time(T) 1 and 1 year later at T3. Findings: One hundred and eight participants completed T1 surveys, and 27 participated in qualitative interviews. Several statistically significant correlations between indices of meaningful activity engagement and psychosocial wellbeing were identified across T1-T3. Meaningful activity decreased from T1-T3 [X2 (2, n = 49) = 9.110, p < .05], with a significant decline from T2-T3 (z = -3.375, p < .001). In T1 qualitative interviews, participants indicated that physical distancing exacerbated exclusion from meaningful activities early in the pandemic. At T3 (1 year later), they described how classist and ableist physical distancing policies layered additional burdens on daily life. Implications: Meaningful activity engagement and psychosocial wellbeing are closely associated and need to be accounted for in the development of pandemic policies that affect persons living in low income. Occupational therapists have a key role in pandemic recovery.

The Effect of Food is Medicine Interventions on Diabetes-related Health Outcomes Among Low-income and Food-insecure Individuals: A Systematic Review and Meta-analysis.

OBJECTIVE: In this study, we aim to review the current evidence of Food is Medicine interventions on diabetes outcomes among low-income or food-insecure individuals. METHODS: Seven databases were searched from January 1, 2000 to October 26, 2021 for full-text articles written in English. The studies included experimental studies of any duration and design which addressed the effect of Food is Medicine interventions on fruit and vegetable (F&V) intake and glycated hemoglobin (A1C) levels among low-income or food-insecure populations with prediabetes or diabetes of any age group. Only direction of effect of interventions on F&V intake were ascertained due to high variability in outcome measurement. A1C results were pooled using generic inverse variance with a fixed-effects model. Heterogeneity was assessed using Cochran's Q and quantified by I2. RESULTS: Sixteen studies were included. Five of the 8 studies reported a significant increase in F&V intake. Seven of the 14 studies reported a significant decrease in A1C levels. A meta-analysis of 5 randomized controlled trials (n=843) resulted in clinically meaningful reductions in A1C compared with control (mean difference, -0.47%; 95% confidence interval, -0.66 to -0.29, I2=88%, p<0.0001). Half (n=8) of the studies have a high risk of bias due to missing data, detection bias, and confounding. CONCLUSIONS: Food is Medicine interventions are effective in increasing F&V intake and reducing A1C levels of the target population. More randomized controlled studies are needed to validate the results.

Participatory Methods to Develop Health Education for PW-SCI: Perspectives on Occupational Justice.

Background. Many people with spinal cord injury (PW-SCI) in the Gaza Strip in Palestine are discharged from inpatient rehabilitation with limitations in their ability to meet basic needs, and reach their full potential. There is limited evidence of how clinicians can promote occupational justice for PW-SCI. Purpose. To describe participants' perspectives revealed during a participatory action research (PAR) process used to develop an education manual for PW-SCI in Gaza, using Participatory Occupational Justice as a lens. Methods. Following ethical approval, a four-step PAR design was utilized by eight researchers to co-construct the Spinal Cord Injury Activities of Daily Living-education Manual with 54 participants from SCI rehabilitation settings in Gaza. Qualitative data from eight focus groups were analyzed using inductive thematic analysis. Findings. Two main themes were evident in the participants' viewpoints: Enabling occupational justice and Removing barriers to occupational justice. Implications. Occupational justice is a central value that needs to be considered when developing occupational therapy educational interventions for this client group. PW-SCI health education may facilitate occupational justice in practical and culturally relevant ways when participatory methods are used to develop educational resources.

A retrospective analysis of pain changes and opioid use patterns temporally associated with a course of chiropractic care at a publicly funded inner-city facility.

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population.

Contexte: Conformément aux directives de pratique clinique, un traitement non pharmacologique, notamment des soins chiropratiques, à la place de prescriptions d'opioïdes est désormais recommandé dans le traitement initial de la douleur chronique à la colonne vertébrale. Les soins chiropratiques, qui comprennent habituellement la manipulation vertébrale, ont été liés de manière provisoire à une consommation réduite d'opioïdes sur ordonnance chez les vétérans souffrant de douleurs à la colonne vertébrale. Objectif: Déterminer si un traitement chiropratique, y compris la manipulation vertébrale, était lié à une diminution de la douleur ou de la consommation d'opioïdes chez les personnes défavorisées sur le plan financier utilisant des médicaments à base d'opioïdes et souffrant de problèmes musculosquelettiques. Méthodologie: Une analyse rétrospective des données sur l'assurance de la qualité provenant d'un établissement de soins de santé financé par l'État a été menée. Les mesures portaient sur des résultats numériques de la douleur à la colonne vertébrale et des extrémités des membres à trois moments différents, la consommation d'opioïdes, des données démographiques et les modes de soins. Résultats: La douleur et la consommation d'opioïdes ont sensiblement diminué dans le cadre de soins chiropratiques. Conclusions: Une diminution importante de la douleur et de la consommation d'opioïdes observée de façon statistique et clinique a coïncidé de manière provisoire avec des soins chiropratiques financés par l'État dans un groupe de personnes défavorisées sur le plan financier vivant au centre-ville.

Validation Study and Outcomes of the Diabetes Quality of Life in Youth Instrument in Haitian Youth With Type 1 Diabetes Residing in Haiti.

OBJECTIVES: Health-related quality of life (HRQL) in type 1 diabetes is a critical health outcome but has not been studied in many low-income countries. In this study we evaluated the validity of 2 HRQL instruments, measured the HRQL and explored the association between HRQL and glycemic control. METHODS: This was a cross-sectional study of Haitian youth with diabetes between 0 and 25 years of age and living in Haiti. We administered the 51-item Diabetes Quality of Life for Youth (DQOLY) questionnaire and the EuroQol Visual Analogue Scale (EQ-VAS). Psychometric analyses evaluated internal consistency and construct validity of the DQOLY and its 21-item short form, the DQOLY-SF. Linear regression was used to identify predictors of HRQL and glycated hemoglobin (A1C). RESULTS: In 85 youth (59% female; mean age, 17.5 years; mean diabetes duration, 3.7 years; mean A1C, 11.3%), DQOLY and DQOLY-SF had adequate internal consistency with Cronbach's alpha values of 0.86 and 0.84, respectively. Confirmatory factor analysis revealed adequate validity for the DQOLY-SF and DQOLY Satisfaction subscale. HRQL, as measured using the DQOLY-SF, was 62±16 (mean ± standard deviation) out of 100. Mean EQ-VAS score was 78±24 out of 100. Older age (p=0.004), female sex (p=0.02) and lower socioeconomic status (SES) (p=0.03) were risk factors for lower DQOLY score, and older age (p=0.02) and marginally female sex (p=0.06) for lower DQOLY-SF score. No predictors of EQ-VAS were identified. HRQL measures were not associated with glycemic control. CONCLUSIONS: The DQOLY-SF and DQOLY Satisfaction subscale are valid measures of HRQL in Haitian youth with diabetes. HRQL is low and was worse in older, female and low-SES youth, but was not associated with glycemic control.

Sustainable neurosurgical training around the globe. A review and outline.

Sharing an equal and quality neurosurgical training across the globe without exclusion may seem utopian. However, such training is possible through educational opportunities and the ongoing digital revolution. The aim is to present the current state of neurosurgery training and education methods indicating strengths, weaknesses and opportunities. The thoughts, comments and suggestions of the authors are based on their academic experiences, training missions around the world and particularly in low- and middle-income countries by pointing out the French experience. The learning must be interactive and programmed over time, integrating varied courses and activities. Virtual reality and neurosurgical simulation need to be developed. The content of the teaching including e-learning must be evidence-based and peer-reviewed. Pedagogical training of trainers is fundamental. It is critical to evaluate the training under real working conditions. The optimization of human resources should create economies of scale that would attenuate the financial burden. The commitment of the teams, tutoring are success factors.

Cross-Cultural Adaptation and Validation of the Quality of Life Questionnaire for Caregivers of Patients with Schizophrenia (S-CGQoL) in Latin America.

OBJECTIVES: The aim of this study was to adapt and validate the Schizophrenia Caregiver's Quality of Life Questionnaire (S-CGQoL) for use in the Hispanic-American population from the caregiver's perspective. METHODS: A cross-sectional instrumental model was used, with a sample of 253 caregivers of patients suffering of Schizophrenia in Bolivia, Peru and Chile. The psychometric properties of the S-CGQoL were tested through construct validity, reliability and some aspects of external validity. In addition, in order to assess the nature of the different items across the three countries, a Differential Performance Analysis (DPA) was conducted. RESULTS: A confirmatory factor analysis showed that the scale structure was well correlated to the initial structure of the QoL-MDS. The results confirmed the existence of adequate reliability indicators (α>.70 and ω>.80) and the absence of FIDs supporting the invariance of item calibrations among the three Latin American countries. CONCLUSIONS: The adaptation and validation of the S-CGQoL questionnaire demonstrate adequate psychometric properties to assess the quality of life of caregivers in samples of middle-income countries in Latin America.

Type 2 Diabetes Risk in Older Adults Living in Social Housing: A Cross-Sectional Study.

OBJECTIVES: This study aimed to describe the risk of developing diabetes and the probable prevalence of diabetes and prediabetes in residents of subsidized or social housing who were 55 years of age or older. METHODS: We conducted a cross-sectional study using data collected from an ongoing community health program in social housing buildings-the Community Paramedicine at Clinic (CP@clinic) program. Community paramedics staffing the CP@clinic program conducted lifestyle-related modifiable risk factor assessments of participating social housing residents who were 55 years of age or older. The Canadian Diabetes risk assessment (CANRISK) tool was administered to all participants, and those with moderate-to-high risk of developing diabetes were asked to return for a fasting capillary blood glucose (CBG) measurement. Data were collected from program participants who attended the sessions between December 2014 and May 2018. RESULTS: There were 728 participants. Most were women (80.5%), aged 65 to 84 (68.1%), white (85.4%) and educated to the high school level or less (69.2%). At baseline, 71.3% were identified as having overweight or obesity, and 12.5% were diagnosed with diabetes. Of participants not diagnosed with diabetes (N=632), 66.6% were at high risk of developing diabetes, and 30.1% were categorized as moderate risk. The CBG assessments showed that 37.7% (N=158) of those with high risk and 22.0% (N=42) of those with moderate risk had blood glucose readings indicating impaired fasting glucose or probable diabetes. CONCLUSIONS: This study shows that 96.7% of low-income older adults in social housing buildings had moderate-to-high risk of developing diabetes and that the probable prevalence of undiagnosed prediabetes and diabetes was 32.0%.

As mulheres na política de transferência de renda: uma revisão sistemática da literatura / Women in the income transfer policy: a systematic literature review / Mujeres en la política de transferencia de efectivo: una revisión sistemática de la literatura / Les femmes dans la politique de transfert monétaire: une revue systématique de la littérature

As mulheres, principais interlocutoras dos programas de transferência de renda, são convocadas à função de mediar a esfera pública e privada. Assim, realizou-se uma revisão sistemática acerca do papel atribuído às mulheres na política de transferência de renda. Para busca dos artigos, os descritores gênero e mulheres chefes de família foram cruzados com transferência de renda; feminização da pobreza; políticas públicas; pobreza; combate à pobreza, nas bases de dados: LILACS, IBECS, SCIELO, PepSIC, Paho, Psycinfo e Web of Science. Após a aplicação dos critérios de inclusão e exclusão, foram selecionados 22 trabalhos, sendo 15 teóricos e 7 empíricos. Nossos resultados indicam que a titularidade feminina é apresentada como um avanço político importante, mas sua participação torna-se contraditória pela natural forma com que a divisão sexual do trabalho ocupa nos programas de transferência de renda, o que remete ao debate sobre a feminização da pobreza e o trabalho de reprodução social.

Women are the main interlocutors of income transfer programs, being convoked to mediate the public and private sphere. Thus, a systematic review was made on the role attributed to women in income transfer policy. To search for articles, gender and female heads of household descriptors were crossed with income transfer; feminization of poverty; public policies; poverty; combating poverty, in the databases: LILACS, IBECS, SCIELO, PepSIC, Paho, Psycinfo and Web of Science. After applying the inclusion and exclusion criteria, 22 papers were selected, 15 of which were theoretical and 7 were empirical. Our results indicate that female ownership is presented as an important political advance, but its participation becomes contradictory due to the natural way in which the sexual division of labor occupies the income transfer programs. This leads to the debate about the feminization of poverty and social reproduction work.

Las mujeres, principales interlocutoras de los programas de transferencia de renta, son convocadas a la función de mediar la esfera pública y privada. Así, se realizó una revisión sistemática acerca del papel atribuido a las mujeres en la política de transferencia de ren-ta. Para la búsqueda de los artículos, los descriptores género y mujeres jefas de familia fueron cruzados con transferencia de renta; feminización de la pobreza; políticas públicas; la pobreza; en el marco de la lucha contra la pobreza, en las bases de datos: LILACS, IBECS, SCIELO, PepSIC, Paho, Psycinfo y Web of Science. Después de la aplicación de los criterios de inclusión y exclusión, se seleccionaron 22 trabajos, siendo 15 teóricos y 7 empíricos. Nuestros resultados indican que la titularidad femenina es presentada como un avance político importante, pero su participación se vuelve contradictoria por la natural forma con que la división sexual del trabajo ocupa en los programas de transferencia de renta, lo que remite al debate sobre la feminización de la pobreza y el trabajo de reproducción social.

Les femmes, principales interlocutrices des programmes de transferts de revenus, sont appelées à jouer un rôle de médiation dans les sphères publique et privée. Ainsi, un examen systématique a été effectué sur le rôle attribué aux femmes dans la politique de transfert de revenus. Pour rechercher les articles, les descripteurs genre et femme chefs de ménage ont été croisés avec transfert de revenus; féminisation de la pauvreté; politiques publiques; la pauvreté; lutte contre la pauvreté dans les bases de données: LILACS, IBECS, SCIELO, PepSIC, Paho, Psycinfo et Web of Science. Après application des critères d'inclusion et d'exclusion, 22 articles ont été sélectionnés, dont 15 théoriques et 7 empiriques. Nos résultats indiquent que la propriété féminine est présentée comme un progrès politique important, mais que sa participation est contredite par la manière naturelle dont la division sexuelle du travail occupe une place dans les programmes de transferts de revenus, ce qui conduit au débat sur la féminisation de la pauvreté. et le travail de reproduction sociale.

Suppurative otitis media in Angola: clinical and demographic features.

OBJECTIVE: To describe the demographics and clinical findings in patients with otorrhoea in Angola. METHODS: A total of 411 patients with otorrhoea presenting in the ear, nose and throat clinic in Luanda and healthcare centres in other Angolan provinces underwent interview and clinical examination. We describe the demographics and clinical characteristics of the patients. RESULTS: The majority (64%) of patients were children <15 years (age ranged from 1 month to 77 years; median age 10.9 years) while 31% were children <5 years. In 83% of the patients, otorrhoea had lasted >14 days at the time of the examination indicating chronic suppurative otitis media (CSOM), which was confirmed with otoscopy in 72% of patients. Acute otitis media occurred in 16% of patients and was more common in children than in adults (22% vs. 10%; P = 0.007). Median duration of otorrhoea was >12 months. Earache (67%), fever (20%), dizziness (17%), nausea and/or vomiting (6%) were the main symptoms. Adult patients reported noticing hearing impairment (HI) more often than the parents of child patients (72% vs. 50%; P < 0.0001). Reported HI correlated with otorrhoea duration (P < 0.0001), presence of earache, dizziness, and measles or meningitis in history. The level of education in the family did not correlate with symptom duration. CONCLUSIONS: Otorrhoea is mainly due to CSOM and affects patients long-term in Angola. Otorrhoea duration is the strongest predictor of HI. Education on OM and its treatment is needed to prevent HI.

OBJECTIF: Décrire les données démographiques et les résultats cliniques chez les patients atteints d'otorrhée en Angola. MÉTHODES: Au total, 411 patients atteints d'otorrhée visitant la clinique ORL à Luanda et dans les centres de soins de santé d'autres provinces angolaises ont subi un entretien et un examen clinique. Nous décrivons les caractéristiques démographiques et cliniques des patients. RÉSULTATS: La majorité (64%) des patients étaient des enfants <15 ans (tranche d'âge de 1 mois à 77 ans; âge médian de 10,9 ans) tandis que 31% étaient des enfants <5 ans. Chez 83% des patients, l'otorrhée avait duré >14 jours au moment de l'examen indiquant une otite moyenne suppurée chronique (OMSC), qui a été confirmée par otoscopie chez 72% des patients. Une otite moyenne aiguë est survenue chez 16% des patients et était plus fréquente chez les enfants que chez les adultes (22% vs 10%; P = 0,007). La durée médiane de l'otorrhée était >12 mois. Les maux d'oreille (67%), la fièvre (20%), les étourdissements (17%), les nausées et/ou les vomissements (6%) étaient les principaux symptômes. Les patients adultes ont rapporté avoir remarqué une déficience auditive (DA) plus souvent que les parents d'enfants patients (72% vs 50%; P < 0,0001). La DA rapportée était en corrélation avec la durée de l'otorrhée (P < 0,0001), la présence de maux d'oreille, d'étourdissements et de rougeole ou de méningite dans les antécédents. Le niveau d'éducation dans la famille n'était pas corrélé à la durée des symptômes. CONCLUSIONS: L'otorrhée est principalement due à l'OMSC et affecte les patients à long terme en Angola. La durée de l'otorrhée est le meilleur prédicteur de la DA. L'éducation sur l'OM et son traitement est nécessaire pour prévenir la DA.

Maternal mortality due to cardiac disease in low- and middle-income countries.

OBJECTIVES: To assess the frequency of maternal death (MD) due to cardiac disease in low- and middle-income countries (LMIC). METHODS: Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital-based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac-related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac-related MD/100 000 live births) and proportion of cardiac-related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country. RESULTS: Forty-seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac-related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac-related MD was higher in countries with a lower MMR. CONCLUSIONS: The burden of cardiac-related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called 'obstetric transition': pre-existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.

OBJECTIFS: Evaluer la fréquence des décès maternels (DM) dus à une maladie cardiaque dans les pays à revenu faible ou intermédiaire (PRFI). MÉTHODES: Revue systématique en recherchant sur Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED , WPRIM, IMSEAR jusqu'au 1er novembre 2017. Les reports de mortalité maternelle provenant des PRFI examinant tous les DM dans une zone géographique donnée ont été inclus. Les reports en milieu hospitalier ou ceux basés uniquement sur des autopsies verbales ont été exclus. Le nombre de DM et de décès liés à la maladie cardiaque a été extrait. Nous avons calculé le taux de mortalité maternelle par maladie cardiaque (TMMc, DM lié à un effet cardiaque/100.000 naissances vivantes) et la proportion de DM cardiaques parmi tous les DM. La fréquence des DM cardiaques a été comparée au TMM du pays. RÉSULTATS: 47 reports ont été inclus, faisant état de 38.486 décès maternels dans les PRFI. Le TMMc rapporté allait de 0/100.000 naissances vivantes (Moldavie, Ghana) à 31,9/100.000 (Zimbabwe). La proportion de DM d'origine cardiaque variait de 0% (Moldavie, Ghana) à 24,8% (Sri Lanka). Dans les pays avec un TMM plus élevé, le TMMc était également plus élevé. Cependant, la proportion de DM d'origine cardiaque était plus élevée dans les pays où le TMM était inférieur. CONCLUSIONS: La charge de la mortalité liée à une maladie cardiaque est difficile à évaluer en raison de la disponibilité limitée des rapports de mortalité. La proportion de décès cardiaques parmi tous les DM semble être plus élevée dans les pays où le TMM est plus faible. Cela correspond à ce que l'on a appelé la «transition obstétricale¼: les maladies médicales préexistantes, y compris les maladies cardiaques, deviennent relativement plus importantes là où le TMM chute.

The relationship between mental health conditions and hearing loss in low- and middle-income countries.

OBJECTIVE: Hearing loss can have far-reaching effects on social, emotional and cognitive development, but few studies have addressed the link with mental health conditions. We conducted a systematic review of the association between hearing loss and mental health conditions in low- and middle-income countries (LMICs). METHODS: We searched six electronic databases using predetermined criteria to retrieve original research reporting mental health in people with hearing loss. We considered quantitative studies measuring any type of mental health conditions according to the ICD10 classifications of 'Mental and behavioural disorders' in relation to any measure of hearing loss. We assessed risk of bias using a set of criteria according to the SIGN50 guidelines. RESULTS: We included 12 studies evaluating 35 604 people with hearing loss in 10 countries. Poorer mental health (measured as stress and anxiety, depression, and/or behavioural and emotional disorders) was more common among people with hearing loss compared to those without in 10 studies. One study found no difference in mental health outcomes between people with hearing, visual and no impairment. Another study reported that after hearing aids, those with severe hearing loss had significant improvement in psychosocial function, compared to no change among those without hearing loss. Overall, one study was judged to be high quality, seven medium quality and four low quality. CONCLUSIONS: Included studies showed a trend towards poorer mental health outcomes for people with hearing loss than for those without. However, our findings indicate that very few high-quality studies have been conducted in LMICs.

OBJECTIF: La perte auditive peut avoir des effets de grande envergure sur le développement social, émotionnel et cognitif, mais peu d'études ont abordé le lien avec les conditions de santé mentale . Nous avons effectué une revue systématique de l'association entre la perte auditive et les conditions de santé mentale dans les pays à revenu faible ou intermédiaire (PRFI). MÉTHODES: Nous avons effectué des recherches dans six bases de données électroniques en utilisant des critères prédéterminés pour récupérer des recherches originales faisant état de la santé mentale chez les personnes ayant une perte auditive. Nous avons considéré des études quantitatives mesurant tout type de conditions de santé mentale selon les classifications de la ICD10 des «troubles mentaux et comportementaux¼ par rapport à toute mesure de la perte auditive. Nous avons évalué le risque de biais en utilisant un ensemble de critères selon les directives SIGN50. RÉSULTATS: Nous avons inclus 12 études évaluant 35.604 personnes malentendantes dans 10 pays. Une mauvaise santé mentale (mesurée en termes de stress et d'anxiété, de dépression et/ou de troubles comportementaux et émotionnels) était plus fréquente chez les personnes malentendantes que chez les personnes non atteintes dans 10 études. Une étude n'a trouvé aucune différence dans les résultats de santé mentale entre les personnes ayant une déficience auditive, visuelle et celles sans déficience. Une autre étude a rapporté qu'après les prothèses auditives, les personnes souffrant de perte auditive sévère avaient une amélioration significative de la fonction psychosociale, par rapport à aucun changement chez celles sans perte auditive. Dans l'ensemble, une étude a été jugée de haute qualité, 7 de qualité moyenne et 4 de faible qualité. CONCLUSIONS: Les études incluses ont montré une tendance vers de moins bons résultats de santé mentale pour les personnes avec que pour celles sans perte auditive. Cependant, nos résultats indiquent que très peu d'études de haute qualité ont été menées dans les PRFI.

Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low- and middle-income countries: state of the evidence.

OBJECTIVES: To identify and assess the evidence for interventions to reduce stigma experienced by children with disabilities and their families in low- and middle-income settings. METHODS: Systematic review of seven databases (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) for studies of interventions that aimed to reduce stigma for children with disabilities published from January 2000 to April 2018. Data were extracted on study population, study design, intervention level(s) and target group, and type(s) of stigma addressed. A narrative approach was used to synthesise the results. RESULTS: Twenty studies were included. The majority (65%) of interventions targeted enacted stigma (negative attitudes) and the most common intervention approach was education/training (63%). Over half (54%) of interventions were delivered at the organisational/institutional level, and only four studies targeted more than one social level. The most common disability targeted was epilepsy (50%) followed by intellectual impairment (20%). The majority of studies (n = 18/20, 90%) found a reduction in a component of stigma; however, most (90%) studies had a high risk of bias. CONCLUSIONS: This review highlights the lack of quality evidence on effective stigma-reduction strategies for children with disabilities. Validation and consistent use of contextually relevant scales to measure stigma may advance this field of research. Studies that involve people with disabilities in the design and implementation of these strategies are needed.

OBJECTIFS: Identifier et évaluer les données des interventions visant à réduire la stigmatisation subie par les enfants avec des invalidités et leurs familles dans les milieux à revenu faible et intermédiaire. MÉTHODES: Revue systématique de sept bases de données (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) pour des études d'interventions visant à réduire la stigmatisation des enfants handicapés publiées de janvier 2000 à avril 2018. Les données ont été extraites sur la population étudiée, la conception de l'étude, le(s) niveau(x) d'intervention et le groupe cible, ainsi que le(s) type(s) de stigmatisation abordé(s). Une approche narrative a été utilisée pour synthétiser les résultats. RÉSULTATS: Vingt études ont été incluses. La majorité (65%) des interventions ciblaient la stigmatisation (attitudes négatives) et l'approche d'intervention la plus courante était l'éducation/la formation (63%). Plus de la moitié (54%) des interventions ont été réalisées au niveau organisationnel/institutionnel et seules quatre études ciblaient plus d'un niveau social. L'invalidité la plus fréquemment ciblée était l'épilepsie (50%) suivie de la déficience intellectuelle (20%). La majorité des études (n = 18/20, 90%) ont trouvé une réduction d'une composante de la stigmatisation, mais la plupart (90%) des études présentaient un risque élevé de biais. CONCLUSIONS: Cette revue met en évidence le manque de données probantes de qualité sur les stratégies efficaces de réduction de la stigmatisation pour les enfants handicapés. La validation et l'utilisation cohérente d'échelles contextuellement pertinentes pour mesurer la stigmatisation pourraient faire avancer ce domaine de recherche. Des études impliquant les personnes avec des invalidités dans la conception et la mise en œuvre de ces stratégies sont nécessaires.

Impact of mHealth on contraceptive use among women and men of reproductive age in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: Around the world, the use of modern contraceptives has risen significantly, but the quality and reach of sexual and reproductive health services remains weak in the poorest countries. To address the high unmet need, an opportunity arises for mobile health technology (mHealth) to empower both clients and providers. However, evidence that mHealth is effective in increasing modern contraceptive use is limited and mixed, and we set out to assess its impact. METHODS: A systematic literature search from seven electronic databases was conducted using key search terms. Individually randomised controlled trials that compared modern contraceptive use in women and men using phone message interventions and those without the intervention were included. Stata was used to calculate pooled estimates of effect under the random-effects model, as well as produce the risk of bias using the Egger's regression method. GRADEpro GDT was used to assess the quality of individual studies. RESULTS: A pooled estimate of all of the studies showed a positive association between phone messages and contraception use, but no clear evidence of benefit (OR 1.12; 95% CI 0.97-1.29). Notably, pooled results of studies that reported modern contraceptive use as the primary outcome showed that mobile phone messaging was associated with an increase in the use of modern contraception (OR 1.22; 95% CI 1.01-1.47). CONCLUSIONS: The finding of this systematic review suggests that mobile phone message interventions utilising a behavioural change technique are an effective method of increasing modern contraceptive use among men and women of reproductive age in low- and middle-income countries though the effect is small.

OBJECTIF: Partout dans le monde, l'utilisation de contraceptifs modernes a considérablement augmenté, mais la qualité et la portée des services de santé sexuelle et reproductive restent faibles dans les pays les plus pauvres. Pour répondre à cet important besoin non satisfait, une opportunité se présente avec la technologie de la santé mobile (mHealth) permettant d'autonomiser à la fois les patients et les prestataires. Cependant, les preuves que mHealth est efficace pour augmenter l'utilisation de la contraception moderne sont limitées et mitigées, et nous avons entrepris d'évaluer son impact. MÉTHODES: Une recherche systématique de la littérature dans 7 bases de données électroniques a été menée à l'aide de termes de recherche clés. Des essais contrôlés randomisés individuels comparant l'utilisation de la contraception moderne chez les femmes et les hommes utilisant des interventions via des messages téléphoniques et ceux sans intervention ont été inclus. Stata a été utilisé pour calculer des estimations d'effet poolées selon le modèle à effets aléatoires, ainsi que pour produire le risque de biais à l'aide de la méthode de régression d'Egger. GRADEpro GDT a été utilisé pour évaluer la qualité des études individuelles. RÉSULTATS: Une estimation poolée de toutes les études a montré une association positive entre les messages téléphoniques et l'utilisation de la contraception, mais aucune preuve claire de bénéfice (OR 1,12; IC95%: 0,97­1,29). Notamment, les résultats poolés des études qui rapportaient sur l'utilisation de la contraception moderne comme critère principal ont montré que la messagerie par téléphone mobile était associée à une augmentation de l'utilisation de la contraception moderne (OR 1,22; IC95%: 1,01­1,47). CONCLUSIONS: Les résultats de cette revue systématique suggèrent que les interventions de messagerie par téléphone mobile utilisant une technique de changement de comportement sont une méthode efficace pour augmenter l'utilisation de la contraception moderne chez les hommes et les femmes en âge de procréer dans les pays à revenu faible ou intermédiaire, bien que l'effet soit faible.

Ethnicity and Immigration Status as Risk Factors for Gestational Diabetes Mellitus, Anemia and Pregnancy Outcomes Among Food Insecure Women Attending the Montreal Diet Dispensary Program.

OBJECTIVE: The primary aim of this study was to characterize the rate of adverse pregnancy outcomes in a multicultural group of low-income women. METHODS: Data were extracted from the Montreal Diet Dispensary's database between June 2013 and December 2015. Risk was evaluated using logistic regression adjusted for covariates. RESULTS: Of the 1,387 pregnancies, the prevalence of gestational diabetes mellitus (GDM) was 17.2% (95% confidence interval [CI], 15.1% to 19.3%), maternal anemia 44.9% (95% CI, 41.9% to 47.9%) and hypertension 3.8% (95% CI, 2.8% to 4.8%). The prevalence of small-for-gestational-age infants was 5.5% (95% CI, 4.3% to 6.7%), preterm births 4.7% (95% CI, 3.6% to 5.9%), low birthweight 4.2% (95% CI, 3.1% to 5.2%) and large-for-gestational-age infants was 10.6% (95% CI, 9.0% to 12.2%). Asian women had an increased odds of gestational diabetes mellitus (adjusted odds ratio [aOR], 1.86; 95% CI, 1.17 to 2.98) and SGA infants (aOR, 2.35; 95% CI 1.21 to 4.57) compared with white women. Anemia was more likely for black women compared with white women (aOR, 1.74; 95% CI, 1.29 to 2.35). Black women were more at risk of preterm birth (aOR, 1.79; 95% CI, 1.01 to 3.19). Immigrants showed an increased risk of maternal anemia compared with Canadian-born women (aOR, 1.85; 95% CI, 1.06 to 3.21). CONCLUSIONS: As disparities in maternal and infant outcomes were present, nutritional intervention(s) need to be targeted toward prevention of adverse pregnancy outcomes, prioritization of higher-risk groups and adaptation of the program to a multiethnic low-income population.

[Treatment of congenital ptosis in a low-income country: polypropylene frontalis sling at the African Institute of Tropical Ophthalmology]. / Traitement du ptosis congénital dans un pays à faible revenu : suspension du releveur au muscle frontal par le polypropylène à l'Institut d'Ophtalmologie tropicale de l'Afrique (IOTA).

INTRODUCTION: Treatment of congenital ptosis is exclusively surgical; the frontalis sling method is most appropriate when the ptosis is severe, with no upper eyelid levator function. This surgery typically utilizes various materials (autologous fascia lata, silicone, nylon, or polypropylene bands, etc.). MATERIALS AND METHODS: This was a retrospective descriptive study of 22 children under 16 years of age, treated for congenital ptosis by frontalis suspension of the levator muscle of the upper eyelid using the polypropylene technique, between January 1, 2014 and June 30, 2017 at the African Institute of Tropical Ophthalmology teaching hospital. RESULTS: In our study, the surgical result (prior to correction of recurrences) was satisfactory in 81.82 % of cases, with a recurrence rate of 13.64 %. The mean follow-up was 14 months, ranging from 4 to 25 months. DISCUSSION: The use of polypropylene provides encouraging results in ptosis surgery, while also offering the advantage of being low cost and more available. Its use in developing countries deserves special attention.

Development of an emergency medical system model for resource-constrained settings.

OBJECTIVES: An emergency care system is an important aspect for healthcare organisations in low- and middle-income countries (LMICs) with a growing burden from emergency disease conditions. Evaluations of emergency care systems in LMICs in broader contexts are lacking. Thus, this study aimed to develop a comprehensive emergency medical system model appropriate for resource-constrained settings, based on expert opinions. METHODS: We used the Delphi method, in which questionnaire surveys were administered three times to an expert panel (both emergency medical care providers and healthcare service researchers), from which opinions on the model's components were compiled. The panel members were mostly from Asian countries. In the first round, the questionnaire drew a list of model components developed through a literature review; the panel members then proposed new components to create a more comprehensive list. In the second and third rounds, the panel members rated the listed components to achieve consensus, as well as to remove components with low ratings. Finally, we rearranged the list to improve its usability. RESULTS: In total, 32 experts from 12 countries participated. The final model totalled 177 components, categorised into 8 domains (leadership, community-based actions, emergency medical services, upward referral, definitive care, rehabilitation, downward referral, and evaluation and research). No components needed removal. CONCLUSIONS: We developed a comprehensive emergency care system model, which could provide a basis to evaluate emergency care systems in resource-constrained LMICs; however, field-testing and validation of this system model remain to be done.

OBJECTIFS: Un système de soins d'urgence est un aspect important pour les organisations de soins de santé dans les pays à revenu faible ou intermédiaire (PRFI), qui subissent une charge croissante d'affections de maladie d'urgence. Les évaluations des systèmes de soins d'urgence dans les PRFI dans des contextes plus larges font défaut. Cette étude visait donc à élaborer un modèle de système médical d'urgence complet, adapté aux contextes à ressources limitées, sur la base d'opinions d'experts. MÉTHODES: Nous avons utilisé la méthode Delphi, dans laquelle des enquêtes par questionnaire avaient été administrées à trois reprises à un groupe d'experts (prestataires de soins médicaux d'urgence et chercheurs en services de santé), à partir desquelles des avis sur les composants du modèle ont été compilés. Les membres du panel venaient principalement de pays asiatiques. Lors du premier tour, le questionnaire a dressé une liste des composants du modèle développés à travers une revue de la littérature; les membres du panel ont ensuite proposé de nouveaux composants pour créer une liste plus complète. Lors des deuxième et troisième tours, les membres du panel ont évalué les composants énumérés afin de parvenir à un consensus et d'éliminer les composants faiblement cotés. Enfin, nous avons réorganisé la liste pour en améliorer la convivialité. RÉSULTATS: Au total, 32 experts de 12 pays ont participé. Le modèle final comprenait 177 composants, classés en 8 domaines (leadership, actions communautaires, services médicaux d'urgence, référence ascendante, soins définitifs, suivi, référence postérieure, évaluation et recherche). Aucun composant ne nécessitait d'être exclus. CONCLUSIONS: Nous avons élaboré un modèle complet de système de soins d'urgence qui pourrait servir de base à l'évaluation des systèmes de soins d'urgence dans les PRFI aux ressources limitées. Cependant, les essais sur le terrain et la validation de ce modèle de système restent à faire.

Dialysis monitor and low-cost haemodialysis / Générateur de dialyse et hémodialyse à bas coût.

An experimental model of a hemodialysis monitor has been developed to perform ultrafiltration control, and urea and creatinine clearance tests. This model allowed us to develop an original device that separates the used dialysate from fresh dialysate and to define the characteristics of an industrial prototype which ultimate objective is to reduce the costs of haemodialysis treatment in low and middle-income countries.

Clinical performance among recent graduates in nine low- and middle-income countries.

OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low-income countries that are likely to limit health gains. This has focused attention on effectiveness of pre-service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low- or middle-income countries. METHODS: Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0-1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis. RESULTS: Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics. CONCLUSIONS: These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency-based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.

OBJECTIFS: Des études récentes ont identifié des déficits importants et systématiques dans les soins cliniques dans les pays à faible revenu, susceptibles de limiter les progrès en matière de santé. Cela a attiré l'attention sur l'efficacité de la formation initiale. Une des approches permettant cette évaluation a été l'observation de la performance clinique des diplômés récents dispensant des soins. Cependant, aucune étude n'a évalué la performance de manière standard dans tous les pays. Nous avons analysé les performances cliniques de prestataires récemment diplômés dans neuf pays à revenu faible ou intermédiaire. MÉTHODES: Des évaluations de la fourniture de services en Haïti, au Kenya, au Malawi, en Namibie, au Népal, au Rwanda, au Sénégal, en Tanzanie et en Ouganda ont été utilisées. Nous avons construit un indice de bonne pratique médicale qui évalue l'achèvement des actions cliniques essentielles à l'aide d'observations directes des soins (plage de 0 à 1), calculé les scores d'index par pays et par cadre clinique, et évalué le rôle de l'établissement et des caractéristiques cliniques à l'aide d'une analyse de régression. RÉSULTATS: Notre échantillon était constitué de 2.223 cliniciens avec au moins une observation des soins. Le score de bonne pratique médicale pour l'échantillon était de 0,50 (écart-type = 0,20). Les infirmières et les sages-femmes avaient le score le plus élevé de 0,57 (écart-type = 0,20), suivies des cliniciens associés avec 0,43 (écart-type = 0,18) et des médecins avec 0,42 (écart-type = 0,16). La performance moyenne nationale variait de 0,63 (écart-type = 0,18) en Ouganda à 0,39 (écart-type = 0,17) au Népal, persistant après ajustement en fonction des caractéristiques de l'établissement et du clinicien. CONCLUSIONS: Ces résultats montrent des écarts substantiels dans les performances cliniques des cliniciens récemment diplômés, ce qui soulève des inquiétudes concernant les modèles de formation clinique. Une éducation axée sur les compétences devrait être envisagée pour améliorer la qualité des soins dans les PRFM. Les observations des soins offrent des informations importantes sur la qualité de la formation clinique.