Low Socioeconomic Regions Research Articles

Fertility patterns in Pakistan: a comparative analysis of family planning trends across different geographic regions.

Family planning includes a wide range of services, such as counseling, contraception, and support to couples. Evidence shows that developing countries have a high degree of inequality in contraception use and prevalence. Reasons for these inequalities include cultural barriers such as traditional preferences and a desire for larger families and lineage, especially in rural areas. The primary objective of this research was to examine the updated contraceptive method preferences of couples in rural and urban regions of Pakistan and how these translate to family planning practices among the different provinces. A secondary survey analysis using the Pakistan Demographic and Health Survey 2019 survey data was conducted. The dataset included 15 143 women sampled proportionally from the provinces, including Gilgit Baltistan and Azad Jammu and Kashmir. The unit of analysis was 'women' from the individual survey dataset. Age, type of residence (rural, urban), division, education level, and language were used to evaluate access to family planning and contraception services. The c2 test assessed the relationship between dependent and independent variables. Multivariate logistic regression analysis was then performed to see the likelihood of contraceptive use among women. Of the women in the sample, 55% were from rural areas and 50% were without formal education; 51.7% of these women were using or practicing any form of contraception method. The most common method used was condoms (9.2%), followed by injectables (6.2%). Regression analysis showed that women aged 15-19 years were less likely (odds ratio (OR)=0.71, 95% confidence interval (CI)=0.51-1.01) to use contraception when compared to the reference group. The likelihood of contraceptive use was higher in urban areas (OR=1.53, 95%Cl=1.39-1.69). Noticeably, contraceptive use was less likely in uneducated women (OR=0.62, 95%Cl=0.56-070). Punjab province had the highest contraceptive prevalence (34.3%), whereas Baluchistan had the lowest (6.9%). The use of contraception in urban and rural populations was similar in all provinces except Sindh and Gilgit Baltistan. In urban and rural areas, women in the age group 30-35 years who use contraception show a prevalence of 21% and 22% respectively. The study highlights suboptimal use of contraceptives and the existence of high levels of inequalities among the regions. There is a need for the implementation of focused educational initiatives and counseling interventions along with prioritization of accessibility and affordability of contraceptive methods among women in lower socioeconomic regions.

Unveiling Malaria's Silent Threat: From Socioeconomic Divides to Religious Influences, A Path to Effective Prevention in India.

Malaria remains a formidable public health challenge in India, particularly in low-socioeconomic regions, where it exacts a heavy toll on lives every year. This pressing issue gains prominence in light of a recent study conducted by Ronald et al. in Uganda, which illuminates the factors contributing to the elevated prevalence of malaria in economically disadvantaged areas. The study underscores the efficacy of interventions such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS) in curtailing malaria incidence. Additionally, the World Health Organization's endorsement of the RTS, S/AS01 (RTS, S) malaria vaccine presents a promising development in the battle against this devastating disease. This letter underscores the imperative nature of implementing comprehensive strategies in India, which encompass widespread ITN distribution, the expansion of IRS programs, and the integration of the RTS, S/AS01 vaccine into the national immunization regimen. These concerted efforts are pivotal in furnishing cost-effective preventive measures to counter the mounting wave of malaria cases in India. Confronting malaria through a multifaceted approach stands as an essential approach to mitigate the disease's burden and ultimately safeguard the lives of India's vulnerable populations.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study.

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe. Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires. Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age. These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Efficacy of a digital media platform to combat inequities in global oncology education.

132 Background: Social media has emerged as a powerful vehicle for the dissemination of medical information, especially in resource-limited regions, due to its mass global reach. However, 1/3 of social media posts contain misinformation with 76.9% of them containing harmful information leading to adverse outcomes that are a detriment to global public health. To address this, MedNews Week (MNW), a free, digital medical education platform dedicated to combating healthcare misinformation, was developed to contribute to global oncology education through biweekly programming. Its main show, Keynote Conference, features live virtual presentations from oncology’s premier global leaders discussing the latest developments in cancer before a mainstream global audience. The aim of this study was to assess the worldwide reach and impact of this cost-free, virtual oncology education platform. Methods: From January 2022 to 2023, MNW hosted 25 global oncology leaders as Keynote Speakers (Mean H-index=50.09). Viewership, impressions, and outreach data were collected from MNW’s social media accounts and TweepMaps. Data was analyzed to assess MNW’s global reach and engagement and stratified based on engagement sentiment, gender, age group, and occupation. Results: During this period, MNW generated a Healthcare Social Graph Score of 92.77% (top 7.33 percentile of global healthcare influencers) with over 109,128 Twitter impressions and 4,731 engagements reaching 1.9 million accounts globally over 12 months (Table). Most of the followers were from non-healthcare fields with slightly more males than females. Those who engaged conveyed positive sentiments (59.9% likes and 26.2% mentions) contributing to a viewership increase from 72,136 (6 months) to 157,559 (1 year). The platform reached 100 cities and 57 countries of which 16 were of low-to-middle socioeconomic (SE) status. Conclusions: MNW has demonstrated an ability to attract and sustain a diverse, global, growing audience. Given MNW’s continued growth, it provides an innovative model to engage and disseminate medical information to mainstream audiences. The platform’s ability to showcase global leaders to mainstream audiences gratuitously, especially in lower SE regions that have been historically underserved, offers a practical approach to combat educational inequity. Thus, MNW represents a novel approach with promising potential to positively impact global oncology education.[Table: see text]

Automated Segmentation of Levator Ani Muscle from 3D Endovaginal Ultrasound Images.

Levator ani muscle (LAM) avulsion is a common complication of vaginal childbirth and is linked to several pelvic floor disorders. Diagnosing and treating these conditions require imaging of the pelvic floor and examination of the obtained images, which is a time-consuming process subjected to operator variability. In our study, we proposed using deep learning (DL) to automate the segmentation of the LAM from 3D endovaginal ultrasound images (EVUS) to improve diagnostic accuracy and efficiency. Over one thousand images extracted from the 3D EVUS data of healthy subjects and patients with pelvic floor disorders were utilized for the automated LAM segmentation. A U-Net model was implemented, with Intersection over Union (IoU) and Dice metrics being used for model performance evaluation. The model achieved a mean Dice score of 0.86, demonstrating a better performance than existing works. The mean IoU was 0.76, indicative of a high degree of overlap between the automated and manual segmentation of the LAM. Three other models including Attention UNet, FD-UNet and Dense-UNet were also applied on the same images which showed comparable results. Our study demonstrated the feasibility and accuracy of using DL segmentation with U-Net architecture to automate LAM segmentation to reduce the time and resources required for manual segmentation of 3D EVUS images. The proposed method could become an important component in AI-based diagnostic tools, particularly in low socioeconomic regions where access to healthcare resources is limited. By improving the management of pelvic floor disorders, our approach may contribute to better patient outcomes in these underserved areas.

Development of a Virtual Platform to Combat Global Inequity in Oncological Education

At the onset of the pandemic, conventional medical education was disrupted, forcing an unprecedented exploration of virtual learning. Social media and online lectures continue to provide promising platforms that enhance learning, address inequities, and reach a wider global audience. MedNews Week is an online medical platform aimed at combating medical misinformation, especially within oncology, by sharing the latest developments in the field from primary sources through its programming. This platform features weekly keynote conferences featuring internationally renowned oncologists before a diverse mainstream global audience who provide the latest updates in hematology oncology, including malignant hematology, rare hematological malignancies and the impact of COVID-19 on patients with blood cancers. This platform is unique because it utilizes social media to bring these prominent global luminaries to worldwide audiences. Here we report the uptake and impact of this new virtual emerging platform. During the past 6 months, MedNews Week invited over 22 distinguished oncologists as Keynote Speakers. They all possessed high academic achievements in oncology research (as evidenced by their citation history and h-index), and thus are considered global leaders in the field. All members of MedNews Week promoted each Keynote lecture for a week across Twitter, Instagram, and LinkedIn social media platforms. All events were streamed online across these social media platforms, Clubhouse and YouTube. For this study, lecture topics were divided into 5 groups: Biomarkers & immuno-oncology, rare heme malignancies, cancer & COVID-19, myeloproliferative disease, and microbiome & immunotherapies. To assess the sustainability of this platform, the number of attendees was assessed based on this classification and between topics of rare-hematological and non-rare hematological malignancies. From January to June 2022, the total number of attendees was 72,136, and the overall number of attendees per lecture has been steadily increasing. All of the keynote speakers had achieved outstanding academic achievements in oncology. The mean (SD) of the number of citations of all speakers was 22351.86 (26723.39). MedNews Week Twitter promotions generated over 95,375 impressions with a mean (SD) of 4335.409 (3006.866). It was also observed that the number of tweet impressions per speaker had increased over the past 6 months. The number of attendees has consistently been between 2,000 to 4,000 across all Keynote Lecture topics. The most attendees were present for myeloproliferative disease lectures (Figure 1a). However, there has not been a decline in the number of attendees for Keynote lectures when comparing rare with non-rare hematological malignancies (Figure 1b). In conclusion, results show that MedNews Week has developed a baseline audience and this platform has maintained steady and continued growth. Although the pandemic has further widened inequities, including in education, MedNews Week's platform has strived to narrow this gap, especially in developing and lower socioeconomic regions, by connecting global leaders in the field to mainstream audiences consisting of patients and patient advocates. Thus, this platform represents a promising approach to impact global education in hematology oncology. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Infant-Feeding Patterns and the Effects of Early Introduction to Formula and Solid Foods on Childhood Overweight or Obesity among 10-Years-Olds in a Low Socioeconomic Area of Lebanon: An Exploratory Analysis.

In Lebanon, there has been an alarming increase in childhood overweight and obesity. In addition, most mothers do not meet the WHO recommendation that infants should be introduced to formula or solids only during the second half of their first year. Because the study population, Burj Hammoud, which is a low socioeconomic district, is small, we performed an exploratory analysis of infant feeding patterns and the effects of introducing formula and solids within six months, respectively, on childhood overweight/obesity among 10-year-old children. A total of 101 mothers were recruited from seven intercommunity dispensaries located across the district. Descriptive, univariate and multivariate logistic regression analyses were performed. There were 86.1% infants initiating breastfeeding, 18% exclusively breastfeeding at 6 months of age, 67.1% and 52.6% starting formula and solids by 6 months, respectively, and 53.5% becoming overweight/obese by the age of 10 years. Working mothers were significantly less likely to introduce formula but not solids within the first six months of infancy. Based on two case-control studies, after controlling for maternal employment, there were 2.278- and 1.511-fold significantly higher odds of introducing solids and formula before the age of 6 months compared with after the age of 6 months, respectively, for the overweight/obese individuals among 10-year-olds. Future research should focus on conducting a larger study by incorporating other low socioeconomic regions to confirm these relationships.

SARS-CoV-2 saliva testing using RT-PCR: a systematic review

ObjectivesThere remain challenges in using SARS-CoV-2 RNA diagnostic assays in the respiratory tract in a pandemic. More so certain countries such as Hong Kong have already included saliva as part of their mass-testing protocol. The aim of this study was to conduct a systematic review on the alternate use of saliva as a SARS-CoV-2 RNA testing specimen in the context of mass screening with reverse transcription polymerase chain reaction.MethodsOur search methodology was modeled after the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, and the risk of bias of the selected studies was qualitatively assessed. The percentage individual positive and percentage agreement of both index (saliva) and reference (nasopharyngeal swab), in preference to specificity and sensitivity, were estimated using Kappa statistics.ResultsA total of 44 studies met the inclusion criteria. The average percentage positive saliva cases was 72.7% (95% confidence interval), which was lower but not substantially different from the percentage positive NPS of 78.7% (95% confidence interval), and there was an average overall agreement of 89.7% (95% confidence interval).ConclusionAlthough the literature supports nasopharyngeal swab as a superior testing specimen, an alternative clinical specimen in saliva may offer potential benefits such that a potentially reduced accuracy may be tolerated, especially in low socioeconomic regions.

OKUL ÖNCESİ ÖĞRETMENLERİNİN ÇOCUKLARDA MOTOR BECERİLERİ GELİŞTİRMEK İÇİN UYGULADIĞI ETKİNLİKLERİN İNCELENMESİ

In this study, it is aimed to examine the activities applied by preschool teachers in order to develop fine and gross motor skills within the scope of motor skills in terms of various variables. The study group of the research consists of 30 preschool teachers working in independent kindergartens affiliated to the Ministry of National Education in Yeşilyurt district of Malatya province. Research data were collected by interview technique, which is frequently used in qualitative research. During the interview, the answers given by the teachers were collected by voice recording and then transferred to the computer environment and a qualitative data list was created. Descriptive content analysis method was used in the analysis of the data. The types of activities, frequency and frequency and percentage distributions of the codes obtained in the definition of the problems encountered by preschool teachers in order to develop fine and gross motor skills are given in tables by calculating. As a result of the research, it was found that while there were no significant differences in the diversity of fine and gross motor skill activities originating from socioeconomic regions, teachers working in low socioeconomic regions had problems in developing fine motor skills due to environment, opportunity and readiness, and family differences. It was determined that the teachers working in all three regions had similar problems in the development of gross motor skills. The frequency of activities applied is shaped according to the regions and the interests and needs of the children. Keywords: Preschool education, preschool teachers, early childhood, motor skills, gross motor skills, fine motor skills.

Cardiovascular disease prevention: Risk factor modification at the heart of the matter

Cardiovascular disease prevention: Risk factor modification at the heart of the matter

Synthetic Fuels in a Transport Transition: Fuels to Prevent a Transport Underclass

The Paris Agreement set policy scenarios to address mitigating against the climate emergency, by reducing greenhouse gas emissions to limit the temperature increase to 1.5°C. There has been a drive toward electrifying transport, with battery electric vehicles (BEVs) at the forefront. Reliance on single-technology policy development can lead to consequential impacts, often not considered, or dismissed. Energy cannot be created or destroyed but can be transformed. While BEVs may represent zero tailpipe emissions, the battery energy must be sourced elsewhere. An ideal policy scenario will come from “renewable” sources; however, current global energy mixes require the electricity to come from carbon-burning point source emitters. Therefore, the emissions are deferred to low socioeconomic regions. The move to ban new internal combustion engine (ICE) vehicle sales has been accelerated. High BEV costs will preclude low-income groups from making purchases. Such groups typically rely on used cars for mobility. Without considered consequential policy analysis, transport underclasses may result, where private transport is only accessible by the wealthy. Synthetic fuels derived from CO2represent a social bridge in the energy transition, also helping to accelerate toward net zero. The Covid-19 lockdown provided a unique opportunity to experience an environment with reduced transport-related emissions. Global studies allowed the consequential effects of pollution reduction to be studied. These are surprising and offer the opportunity for policies, driven by science, to be developed. Here, we consider the consequential effects of clean air policies, and how these can be used to propose dynamic responses to policy recommendations.

Racial and socioeconomic disparities in the use of stereotactic body radiotherapy for treating non-small cell lung cancer: a narrative review.

In the past two decades, there has been a steady increase in the use of stereotactic body radiotherapy (SBRT) as an alternative to surgical intervention for early-stage non-small cell lung cancer (NSCLC) patients; however, not much is known about the impact of race and socioeconomic status (SES) on the delivery of SBRT. Here, we conduct a narrative review to examine potential disparities in the use of SBRT. Keyword searches of MEDLINE/PubMed, Web of Science, Embase, and Google Scholar databases were performed for studies focused on race, SES, and the use of SBRT published between 2000 and 2020. Six studies were identified, and showed that minority patients, especially Blacks, were less likely to receive SBRT and had a significantly longer median time between diagnosis to SBRT treatment. Patients with lower income or lower education, as well as those from lower socioeconomic regions were less likely to receive SBRT; they were more likely to receive conventionally fractionated external beam radiation (CFRT) or no treatment. These racial and socioeconomic factors were associated with worse survival in other general early-stage NSCLC studies. In conclusion, the limited number of published studies suggest significant disparities in the treatment of early-stage NSCLC with SBRT. These factors potentially lead to worse survival outcomes among vulnerable patient populations. Equal access to SBRT should be a focus of healthcare delivery systems, to ensure optimal clinical outcomes for patients with early-stage NSCLC.

Utilization of Artificial Intelligence for Diagnosis and Management of Urinary Incontinence in Women Residing in Areas with Low Resources: An Overview

Urinary incontinence (UI) is a distressing condition involving involuntary loss of urine from the body. Urinary incontinence can negatively impact a person’s overall quality of life and lead them into stages of embarrassment and depression. It is an underrepresented and undertreated condition prevalent in women, especially in low socioeconomic regions where women may not be able to express their concerns due to unawareness of diagnosis and treatment/management options. There are different diagnostic and management protocols for UI; however, utilizing artificially intelligent systems is not standard care. This paper overviews the use of artificial intelligence in women’s health and as a means of cost-effectively diagnosing patients, and as an avenue for providing low-cost treatments to women that suffer from urinary incontinence in low-resource communities. Studies found that these systems, mainly utilizing artificial neural networks (ANNs) and convolutional neural networks (CNNs), served to be an effective method in diagnosing patients and providing an avenue for personalized treatment for improved patient outcomes. A simple artificial intelligence (AI) model utilizing Multilayer Perceptron (MLP) Networks was proposed to diagnose and manage urinary incontinence.

Seroprevalence of Hepatitis A among Medical Students of a Tertiary Care Centre in Kerala, Southern India

Introduction: Hepatitis A Virus (HAV) is a major cause of acute viral hepatitis caused by a Ribonucleic Acid (RNA) virus. The mode of transmission is fecal-oral route and the risk factors include unsafe water, poor personal hygiene and sanitation. Even though seroprevalence rate is high in low socio-economic regions, it is low in urban areas and the need of vaccination is looked for. Aim: To estimate the seroprevalence of hepatitis A in medical students of Southern India. Materials and Methods: The present study was a cross-sectional study conducted in the medical students of Government Medical College, Manjeri, Kerala, India. Blood samples of 377 students during the year 2015-2018 were taken. These students were in their 1st, 2nd, 3rd and 4th year MBBS course who admitted in the years 2018, 2017, 2016 and 2015, respectively. Commercially available Enzyme-Linked Immunoassay (ELISA) kits for anti HAV IgG antibodies were used. Chi-square test was used for statistical analysis. Results: Out of 377 participants 238 (63.2%) were females and 139 (36.8%) were males. A total of 51 (13.5%) were positive for IgG antibodies. A total of 43 were in 21-22 age group with a p-value >0.05. An association of seropositivity and seronegativity with frequency of dining out pattern was there with a p-value <0.05. Conclusion: The seroprevalence of hepatitis A was found in a declining stage hence, vaccination against hepatitis A should be included in the National Immunisation Schedule.

Knowledge, Attitude, and Practices Regarding Scabies Among Health Care Workers in Sarhad Psychiatric Hospital Peshawar, Khyber Pakhtunkhwa

Scabies is endemic in tropical and subtropical regions of the world. It is a disease of developing and low socioeconomic regions Objective: The aim of my study is to assess the knowledge attitude and practices level of health care workers of Sarhad Hospital for Psychiatric diseases Peshawar regarding scabies. Method: Study was conducted at Sarhad Hospital, Peshawar. A total of 120 health care workers (HCWs) were enrolled and asked questions related to their knowledge, attitude and practices towards scabies. Data was analyzed through SPSS latest version Results: The respondents were doctors, Nurses, and junior clinical technicians of both sexes. Regarding knowledge, it is assessed that more than 90% health care workers (HCWs) know about scabies, more than 70% knows the sign and symptoms of scabies, more than 60 know the causes. One of the most important things is that less than 30% HCWs know the causative agent of scabies i.e. mite Conclusion: The knowledge level of HCWs was satisfactory but the practices were not good enough. It is due to lack of facilities like isolation rooms, trained HCWs about infection control measures and lack of infection control team to implement these practices.

Dietary patterns and food insecurity of students participating in a food aid programme: the Mediterranean perspective.

To explore the effect of household food insecurity on dietary patterns of children and adolescents participating in a school food-aid programme in regions of Greece with low socioeconomic status. A cross-sectional study was conducted during the school year 2013-14, among 406 schools in low socioeconomic status regions of Greece. Dietary habits and sociodemographic characteristics of students and their families were recorded. Factor analysis was used in order to derive children's and adolescents' dietary patterns and analysis of covariance was performed to examine the effect of households' food insecurity level on those patterns. A total of 31399 students participated in the study; 16652 children (5-11 years) and 14747 adolescents (12-18 years). Factor analysis identified five dietary patterns in both age groups, explaining the 49.1% (children) and 53.0% (adolescents) of the total variation in intake. After adjusting for various factors, the household's food insecurity was significantly associated with the majority of the derived patterns in both age groups, with most pronounced differences being observed for the consumption of red meat, poultry and fish, fruits, as well as red processed meat, cereals and dairy products, which was lower among children and adolescents with food insecurity. Children with food insecurity consumed significantly more unhealthy food, such as chips, fast food, sugared drinks, sweets, French fries and mayonnaise sauce. Promotion of healthy eating to households facing food insecurity is of crucial importance, giving emphasis in the design of low cost, yet highly nutritious programmes.

The roles of social economic status and undernutrition in regional disparities of the under‐five mortality rate in Vietnam

From 2005 to 2017, the prevalence of mortality in Vietnamese children under five years old showed large regional disparities. In 2017, mortality in the wealthiest region was 12.6‰, whereas the most disadvantaged region it was three times as high, at 36‰. This study aims to identify factors affecting regional disparities of the under-five mortality rate (U5MR) in Vietnam. We applied Structural Equation Modelling to estimate the degree and the pathway through which undernutrition and socio-economic status (SES) contributed to the under-five mortality disparities. SES is estimated as a common latent factor of three socio-economic measures, that is, education, poverty and income. The direct effect of SES on U5MR is at 2.16 through the underweight pathway, which is 5 times higher than the effect of underweight on U5MR. Through the stunting channel, this direct impact is 1.43, nearly twice as high as the impact of the stunting rate. SES also has an indirect effect on U5MR through these undernutrition pathways. In total, we estimate that an increase in SES index will make the U5MR increase by 2.73‰. Among the three indicators of SES, poverty conveys the strongest signal of a considerable change in SES, thus to a subsequent change in U5MR. Among two types of undernutrition, the effect of stunting on U5MR is dominant, more than 3 times as high as that of underweight. These findings have important implications for socio-economic and health interventions: those that strongly focus on the reduction of regional poverty and stunting rates would be effective in bridging the regional gap in the U5MR in Vietnam.

Cost-effectiveness and diagnostic accuracy of telemedicine in macular disease and diabetic retinopathy: A systematic review and meta-analysis.

To determine cost-effectiveness and the diagnostic accuracy of teleophthalmology (TO) in the detection of macular edema (ME) and various grades of diabetic retinopathy (DR). MEDLINE, EMBASE, and Cochrane databases were searched for TO, ME, and DR on May 25, 2016. The search was updated on April 2, 2019. Pooled sensitivity and specificity for ME and various grades of DR were determined using Meta-Disc software. A systematic review of the articles discussing the cost-effectiveness of TO screening was also performed. Thirty-three articles on the diagnostic accuracy and 28 articles on the cost-effectiveness were selected. Telescreening is moderately sensitive but very specific for the diagnosis of diabetic retinopathy. Non-mydriatic Teleretinal screening services are cost-effective, decrease clinics workload, and increase patient compliance if provided free of cost in remote low socioeconomic regions.

Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data.

Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001–2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.

Two-year supervised tooth brushing program evaluation in preschools in Southern Israel

Abstract Background Dental care for children was included into National Health Insurance Law in 2010 and eligibility age went up gradually to 18 in 2019, providing universal dental care. As a part of dental care reform, community based preventive School Dental Services were extended to preschool children. School dental service (SDS), funded entirely by the State, was extended to younger ages providing supervised tooth brushing module. The national supervised teeth brushing program (STBP) was first implemented in 2015-2016 amongst 3-4 year old children attending 600 nurseries in Israel. Due to the program’s success, it was gradually extended to more nurseries in low socio economic regions across the country, reaching 2200 settings in 2019. The objective of this study was to assess dental health among preschool children participating in the program during the last two years, comparing to those who did not. Methods Participant and non-participant kindergartens were randomly selected in Jewish and Bedouin Arab towns in the Southern district matched according to SES level. DMFT index measuring mean number of decayed, missing and filled teeth was recorded among preschool 5 years-old children. Results 283 children were examined, 157of them Jewish (86 participants in STBP, 71 non-participants) and 126 Bedouins (59 vs 67 respectively). Mean untreated carious teeth (d) was 1.15 vs 1.8 for Jews and 3.22 vs 3.9 for Bedouins. Percent of treated teeth within total caries experience index (f/dmf) was higher in tooth brushing group: 37% vs. 29% for Jews and 23% vs. 8% for Bedouins. Key messages Supervised tooth brushing shows favorable effect. Less carious teeth and more treated caries were recorded in STBP group.