Outreach Centers Research Articles

Video based educational intervention in waiting area to improve awareness about health screening among patients visiting family medicine clinics

BackgroundMultiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians’ waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics.MethodsIt was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar’s Chi-square test.ResultsTotal 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25–36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p < 0.001). Following the study intervention, there was significant increase in proportion of participants who had adequate knowledge related to diabetes (p = 0.045), hypertension (p < 0.001), cholesterol (p < 0.001), cervical cancer (p < 0.001), colon cancer (p < 0.001) and hepatitis B & C (p < 0.001). No significant improvement in breast cancer related knowledge was observed (p = 0.074). Highest post-intervention increase in knowledge from baseline was observed for hypertension (13.3% versus 63.3%) followed by colon cancer (24.3% versus 59.3%), cholesterol (67 versus 96.7%), hepatitis b & C (56.7% versus 77.3%), diabetes (29.7% versus 48%), cervical cancer (1.7% versus 19%), and breast cancer (7.7% versus 18.3%).ConclusionThis study highlighted a pivotal role of an educational video intervention in clinic waiting area to improve awareness regarding health screening among patients and their families. Further interventional community based or multicenter studies are warranted to assess the long-term impact of these educational videos on knowledge and utilization of health screening among adult population.

Pattern of Eye Disease in Nenwe Rural Eye Clinic, Nigeria: A Seven Year Review

Background: The establishment of eye clinics in the form of rural outreach centers as a means of educating and providing eye care to rural residents was made necessary by the lack of eye care services in rural areas within Nigeria and the need to increase the cataract surgical rate among ophthalmologists in training. Understanding patterns of eye diseases in rural areas and eye health-seeking behaviors is crucial to achieving the goals of Vision 2020 especially for aspiring ophthalmologists. Aim and objectives: To examine the types of eye conditions observed at Nenwe, a rural outreach post of a tertiary hospital, and to evaluate their distribution. Methodology: A retrospective analysis of all patients who were seen at the community eye clinic during seven years was carried out. Records of patients at the Nenwe outreach eye clinic dating from November 2016 to August 2023 were examined, yielding information on patients examined during the period of study. Results: Glaucoma was the most common eye condition to be diagnosed. Cataracts were the second most common eye condition accounting for 20.8%. Other common eye illnesses were refractive error (9%), pterygium (7%), and allergic eye disease (6%) with 129, 101, and 95 cases, respectively. Retinal detachment (51 cases), prebyopia (47 cases), corneal lesion (58 cases), and dry eye condition (47 cases) were less common. Conclusion: The results show the burden of eye disorders in the Nenwe rural community and the importance of community-based eye care services.

Diabetes Self-Efficacy on Glycemic Control and Well-Being of Patients With Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study.

Diabetes mellitus is a major, chronic, and progressive lifestyle disease. It adversely affects patients' quality of life, effectiveness, and well-being. Self-care practices are universally recognized as imperative to keep the illness under control and prevent complications. Self-efficacy is one of the factors involved in the successful self-care of diabetic patients. The primary objective of the study was to estimate the proportion of diabetes self-efficacy and to assess the correlation ofdiabetes self-efficacy with glycemic control, and the well-being of patients with type 2 diabetes mellitus (T2DM). The secondary objective was to assess the factors associated with diabetes self-efficacy. An analytical cross-sectional study was conducted among T2DM patients attending the non-communicable disease clinic in the outreach centers of Government Medical College, Thiruvananthapuram, Kerala, India. Four hundred patients with T2DM were included in the study.Diabetes self-efficacy was assessed by the Stanford Diabetes Self-Efficacy Scaleand the WHO-5 index scale was used to assess wellbeing. Glycemic control was determinedby HbA1C estimation, with ≤7% as good control. Among 400 patients with T2DM, 51.25 % (95% CI: 46.2-56.2) had high diabetes self-efficacy. A significantly negative correlation was found between HbA1C and self-efficacy (r =- 0.208, p = 0.01), and a positive correlation was shown between well-being and self-efficacy (r = 0.418, p = 0.01). Logistic regression analysis found that factors associated with diabetes self-efficacy were upper socioeconomic status (OR = 8.53, 95% CI: 3.06-13.82), family support (OR = 1.97, 95% CI: 1.10-3.54), participation in diabetes education classes (OR = 1.95, 95% CI: 1.10-3.54), diet compliance (OR = 4.74, 95% CI: 2.80-8.01), glycemic control (OR = 1.69, 95% CI: 1.01-2.84), and overall wellbeing (OR = 6.7, 95% CI: 3.84-11.64). The proportion of high diabetes self-efficacy was 51.25% (95% CI: 46.2-56.2). The factors associated with diabetes self-efficacy were family support, participation in diabetes education classes, high socioeconomic status, absence of complications, good glycemic control, and well-being. The study findings depicted that high self-efficacy was significantly correlated with good glycemic control and well-being of patients with T2DM.

Establishing a protocol to increase racial/ethnic minority enrollment on an active radiation oncology randomized clinical trial.

TPS1638 Background: In the United States (US), underrepresented racial/ethnic groups lack ample enrollment in clinical trials, yielding ungeneralizable trial results. Barriers to increasing minority enrollment include decreased awareness of clinical trials, lack of access, financial burden and toxicity, medical system mistrust, and discordant physician-patient demographics. The ongoing Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN) clinical trial (NCT05617716) has a study design to actively accrue minority patients. We present our protocol addressing key targets to increase minority enrollment on this randomized, phase II clinical trial. Methods: Adults with evidence of symptomatic spine metastases are eligible. Baseline demographics (including race/ethnicity) are reported for statistical analysis. Our protocol seeks to minimize barriers to minority enrollment and targets four key areas. Access to care: SPORTSMEN involves institutions located in zip codes with diverse ethnic populations, presently located in regions 46% and 70% African American. Clinical trial design: SPORTSMEN has a prespecified goal of accruing patients to mirror US census representation. The rate of minority enrollment will be reviewed periodically at the discretion of the Data Safety and Monitoring Board. Community outreach and engagement: The trial team will engage with local health care systems to create an alliance within different oncology specialties to provide the basis and benefit for SPORTSMEN and patient-centered education on eligibility criteria, rationale, and intended outcomes. Our principal focus will be providers in prostate, breast, and lung cancers as minorities with these primary site malignancies have a higher propensity to be trial-eligible. Furthermore, we understand the historical mistrust of minorities for the medical community. Therefore, we will engage local grassroot organizations such as churches, community outreach centers, and social clubs to increase awareness of clinical trials and to help foster trust. Financial burden and toxicity: SPORTSMEN does not have direct enrollment costs. A short-course treatment regimen is used to minimize the number of treatment visits required allowing for decreased resources for travel, time lost at work, and additional childcare or eldercare needs. Financial toxicity will be objectively quantified using the validated COST-Functional Assessment of Chronic Illness Therapy survey. Increasing clinical trial diversity is a challenge that must be addressed with meaningful intent to present robust Level 1 data that broadens the understanding of treatment response in all demographics. Our protocol takes a patient-centered approach to achieve the objective of concordant racial/ethnic representation in a randomized clinical trial. Clinical trial information: NCT05617716 .

Altered Passive Eruption among Patients Visiting Dental Outpatient Department in a Tertiary Care Center: A Descriptive Cross-sectional Study.

The eruption of teeth is considered to be a continuous phenomenon. Two types of eruption are possible namely, active and passive eruption. Failure in passive eruption (by the apical movement of gingiva from the enamel surface) generally results in a clinical condition known as altered passive eruption. It can result in the shortened crown height of a tooth and an esthetically unpleasant situation i.e., excessive gingival display or gummy smile. The main motto of this study was to find out the prevalence of altered passive eruption and associated gingival biotypes in adult patients visiting for dental treatment in tertiary centers along with strategically placed outreach centers. A descriptive cross-sectional study was done in the Department of Dentistry, Dhulikhel Hospital, and four outreach centers of the same hospital. The study was conducted from October 2022 to April 2023 after obtaining the ethical approval. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 165 patients, the prevalence of altered passive eruption was 21 (12.72%) (7.62-17.78 at 95% Confidence Interval). Furthermore, among 21 patients, the altered passive eruption was seen in the thick biotype patients in 16 (76.19%) and thin biotype patients in 5 (23.81%). The prevalence of altered passive eruption appeared to be equivalent when compared with the previous studies.

Utilizing Community Health Ambassadors to improve COVID-19 vaccine uptake in equity priority neighborhoods in Toronto, Canada

East Toronto Health Partners (ETHP) is comprised of 100+ health and social organizations, with a leadership council consisting of patient/caregivers and six anchor organizations representing the continuum of care. During the pandemic ETHP implemented a Community Health Ambassador (CHA) Model to increase access to COVID19 vaccinations in underserved neighborhoods through health promotion activities and referral to COVID19 outreach Centers (CoCs).&#x0D; The intervention focuses on equity priority neighborhoods with significant concentrations of underserved populations including but not limited to newcomers and households with low incomes.&#x0D; Early in the COVID-19 pandemic it became apparent that the impact was disproportionally high in equity priority neighbourhoods. Once COVID19 vaccine became available to the public, it became evident that the wealth of knowledge residing within the community was essential to improve vaccine uptake, particularly in priority neighbourhoods. ETHP partnered with the community to co-design outreach strategies. A particularly meaningful partnership was the collaboration with community members who assisted us in designing our CHA model. The CHAs program was administered through one of the community ETHP health service providers.&#x0D; CHAs were localized to the neigbourhood where they lived and utilized their knowledge of the community to identify and address misinformation and barriers to vaccination. CHAs were able to engage in individualized educational interventions locally and escalate systemic barriers to the ETHP. These issues were addressed through rapid cycle change quality improvement methodology by the members of the ETHP.&#x0D; From December, 2021 to March, 2022, we engaged and deployed 197 CHAs to conduct outreach activities. They reached out to over 25,000 individuals in our priority neighbourhoods. Their work bridged the equity gap in vaccination. In September 2021, there was a 20% point difference in 1st dose coverage between the most vaccinated and least vaccinated neighborhoods in East Toronto; in March 2022, this difference decreased to 16% partly as the result of CHA outreach in priority neighborhoods.&#x0D; Barriers to vaccine uptake could best be identified by hyper-local strategies implemented by CHA with a deep understanding of the local neighborhood. The barriers identified by CHAs could be addressed with the help of an integrated health system to improve equitable delivery of COVID-19 vaccine.&#x0D; Based on the success of the CHA model were are co-designing a strategy to utilize CHAs to assist with health care recovery focusing on other preventive interventions that not equitably delivered such as cancer screening.

Inorganic Nitrite to Amplify the Benefits and Tolerability of Exercise Training in Heart Failure With Preserved Ejection Fraction: The INABLE-Training Trial

ObjectiveTo determine whether nitrite can enhance exercise training (ET) effects in heart failure with preserved ejection fraction (HFpEF). MethodsIn this multicenter, double-blind, placebo-controlled, randomized trial conducted at 1 urban and 9 rural outreach centers between November 22, 2016, and December 9, 2021, patients with HFpEF underwent ET along with inorganic nitrite 40 mg or placebo 3 times daily. The primary end point was peak oxygen consumption (VO2). Secondary end points included Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS, range 0 to 100; higher scores reflect better health status), 6-minute walk distance, and actigraphy. ResultsOf 92 patients randomized, 73 completed the trial because of protocol modifications necessitated by loss of drug availability. Most patients were older than 65 years (80%), were obese (75%), and lived in rural settings (63%). At baseline, median peak VO2 (14.1 mL·kg−1·min−1) and KCCQ-OSS (63.7) were severely reduced. Exercise training improved peak VO2 (+0.8 mL·kg−1·min−1; 95% CI, 0.3 to 1.2; P<.001) and KCCQ-OSS (+5.5; 95% CI, 2.5 to 8.6; P<.001). Nitrite was well tolerated, but treatment with nitrite did not affect the change in peak VO2 with ET (nitrite effect, −0.13; 95% CI, −1.03 to 0.76; P=.77) or KCCQ-OSS (−1.2; 95% CI, −7.2 to 4.9; P=.71). This pattern was consistent across other secondary outcomes. ConclusionFor patients with HFpEF, ET administered for 12 weeks in a predominantly rural setting improved exercise capacity and health status, but compared with placebo, treatment with inorganic nitrite did not enhance the benefit from ET. Trial RegistrationClinicalTrials.gov identifier: NCT02713126.

Cost-efficient child vaccination project results from hard-to-reach rural communities in Kenya

Abstract Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children &amp;lt; 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities. Key messages • Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities. • Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.

Self-Medication Among the Elderly and Factors Associated with It

Objective: Our study aims to assess the frequency of self-medication in elderly people of Karachi, identify its reasons and associated risk factors. Study Design &amp; Setting: This cross-sectional study was conducted in waiting areas of OPDs at Liaquat National hospital and its outreach centers. Methodology: Study duration was June-December, 2021. We approached all patients and aged 60 years and above. After taking written informed consent, targeted population was interviewed to find out self-medication performed within last three months and its reason and causes. Participants’ demographics, symptoms for which self-medication was performed, different type of medications used, reasons of opting self-medication and different approaches for dose adjustment were also investigated. Data was recorded by a pre-designed questionnaire. Data was analyzed using SPSS version 21. Result: Out of 200 elderly included in the study, 87% of them reported self-medication in a 3-month recall period. Pain (63.8%), fever (56.9%), headache (50%), cough, and cold (37.4%) were the most common symptoms. Pain killers (81.6%), fever-reducing drugs (58%) and cough syrup (39.1%) were the top three medicines used for self-medication. One-fifth of the respondents reported self-medication of antibiotics. Top three frequent reasons for self-medication were convenience (99.4%), disease of mild nature (85.1%) and for quick relief of symptoms (78.7%). None of the patient’s demographic factors were found to be associated with self-medication practice. Conclusion: Self-medication is a highly prevalent practice in elderly people of Karachi including non-prescribed usage of antibiotics. Major reforms in primary health care are needed to address this growing problem

Frequency and predictors of depression among the elderly population of Karachi.

Depression among the elderly is falsely considered as a normal part of aging and hence remains un-diagnosed in the majority. Elderly people are at a high risk of depression, which may produce a negative impact on their quality of life. Depression is a potentially treatable condition; hence, it is worthwhile to explore its burden in order to ensure its timely evaluation and management. To determine the frequency and predictors of depression among the elderly population of Karachi. The current study was a cross-sectional study, conducted in out-patient clinics of a tertiary care hospital and its out-reach centers located in different areas of Karachi. Patients aged 60 years and above were enrolled in the study. Demographic profiles and physical health conditions were investigated. Depression was assessed using Geriatric Depression Scale-15. Data were entered in SPSS version 21 for statistical analysis. A total of 232 participants were enrolled into the study with a median age of 65.8 [inter-quartile range = 61-69] years. Out of 232 participants, 186 (80.2%) were found to be depressed. In the multi-variable model, employment status, financial issues, and peer groups were left as independent predictors of depression. The current study found a significant burden of depression among elderly people in Karachi. Employment status, financial problems, and relationship with peers have been identified as risk factors of depression. There might be over-reporting of depression as the data collection was conducted during the coronavirus disease 2019 first wave. Hence, further community-based research is warranted to confirm the findings.

Online Speech Therapy for Cleft Palate Patients in Rural Nepal: Innovations in Providing Essential Care during COVID-19 Pandemic.

Speech therapy is important for ideal functional outcome after cleft palate surgery. Nationwide lockdown due to outbreak of COVID-19 in Nepal restricted the ability of patients to travel to nearby outreach centers for regular speech therapy. The objectives were to assess the feasibility and challenges of conducting online speech therapy with postpalatoplasty children during COVID-19 pandemic; and evaluate the ways to overcome them. Patients with cleft palate surgery done at least 3 months prior were given online speech therapy. Feasibility, advantages and challenges of online speech therapy were evaluated through interviewing the guardians and speech therapy providers. A total of 89 patients were included in the study. Only 11.2% had secondary palatine procedures. Almost all the children (97.8%) had face to face speech therapy prior to study period. Best use of time, use of audiovisual aid, no need to travel and rapid progress were the most commonly perceived strengths of online speech therapy. The most frequent challenges were internet connectivity, unclear voice, lack of direct interaction and unstable power supply. Recommended ways to improve online speech therapy were cited as better internet connectivity, having a fixed schedule and availing free or affordable Wifi. Despite the challenges, online speech therapy provided us with a way to reach out to the cleft palate children when face-to-face therapy was not possible due to COVID-19 pandemic. We see its role even during non-pandemic situations for the children who are unable to visit the speech therapy centers.

Legume Cover Crop Contributions to Ecological Nutrient Management in Upper Midwest Vegetable Systems

Cover cropping, especially with legumes, is a critical approach to ecological soil nutrient management as a means to meet Sustainable Development Goal (SDG) 2, addressing food security issues via sustainable agriculture approaches. However, cover cropping in some of the most intensified food production regions of the northern U.S. is challenged by short growing seasons and harsh winters with variable temperatures and increasingly erratic snowfall. In this study, we explore the potential of winter annual legume cover crops to augment soil organic carbon (C) and nitrogen (N) stocks within a horticultural cropping system under climate conditions that allow only modest cover crop biomass production. We compared hairy vetch, cereal rye, red clover, and a hairy vetch/rye biculture in a randomized complete block design at two sites (North Central and Southwest Research and Outreach Centers in Minnesota) over 2 years. Cover crops were established in fall and terminated in spring prior to sweet corn planting, and soils sampled both at pre-cover crop termination and 2 weeks post-termination. We determined several indicators of C and N dynamics, including microbial biomass C (MBC), permanganate-oxidizable C (POXC), particulate organic matter C and N (POMC and POMN, respectively), extractable soil N (EXTN), and potentially mineralizable N (PMN). Out of all treatments evaluated, vetch production increased soil EXTN the greatest after 2 weeks, contributing two to 11 times more EXTN to soils compared to non-vetch treatments, meeting N requirements for sweet corn in three out of four site-years. Overall, time of sampling, either pre-or post-termination, consistently impacted soil measurements, with p &amp;lt; 0.05 in 20 out of 24 soil parameter × site-year combinations. Study results suggest that cover crops planted in colder northern climates during winter fallow periods can supply valuable N following spring termination, but termination effects on labile C and N pools are mixed. Our findings advance understanding of how cover cropping can support SDG 2 outcomes by assessing cover crop legume systems under biophysical conditions that challenge cover crop integration in agroecosystems.

Epidemiology of dermatologic disease in Palau: a cross-sectional study in the national public and community health service.

Dermatologic disease is a neglected public health challenge that disproportionately affects resource-poor settings. Globally, dermatologic disease contributes the fourth highest burden of nonfatal disability with the most acute impact in the Oceanic region, including the Republic of Palau. Efforts to address the dermatologic health inequality are hindered without the necessary epidemiologic evidence to guide health policy in the resource-poor setting of Palau. We conducted a 4-year cross-sectional study of all Dermatology Service patients in the Belau National Hospital and outreach community health centers from 2015 to 2018. No other specialized dermatology service was available. Skin disease was classified by both diagnosis and Global Burden of Disease criteria and analyzed by age, gender, region, and surrounding Oceanic nations. The study enrolled 494 patients comprising 179 males and 315 females between 2015 and 2018. The most prevalent diseases were eczema (48.8%), superficial fungal infection (24.5%), and pruritus (22.7%). The neglected tropical disease of scabies was detected in four patients. Males were significantly more likely to present with cellulitis, keratinocyte carcinoma, stasis dermatitis, wounds, marine-related dermatitis, viral skin disease, tinea faciei, verruca, and xerosis and females with melasma and hyperpigmentation. This study presents the first primary epidemiologic data describing the prevalence of dermatologic disease in the Palauan adult population. The significant burden of disease in Palau compared with other Oceanic nations validates ongoing dermatology services and informs public health implications for resource allocation and disease management to achieve health equality in the resource-poor nation.

My Sister's Keeper: Survivors Disclosing Sexual Violence to a Sibling.

Siblings are often cited as a source of support throughout life, but they have not been included in studies of sexual violence disclosure. Survivors of sexual violence often delay or do not disclose their sexual violence. The current study investigated if and why survivors of sexual violence decided to disclose to their sibling. This qualitative investigation included 10 female participants, of which six had disclosed their abuse to their sibling. The participants ranged in age from 20 to 58, five identified as Hispanic, one as Hispanic and White three identified as White, and one identified as Middle Eastern. Thematic analysis was used to examine the data. Three major themes were identified that affected sibling disclosure decisions: sibling dynamics, perceived and real reactions to disclosure, and words of advice. The findings from this study demonstrate the continued need to investigate siblings and their role in disclosure of sexual violence. Practitioners may also want to examine the sibling relationship as a source of support for survivors of sexual violence. Finally, as policies continue to develop around support of survivors of sexual violence, inclusion of siblings in family policies, outreach centers, and counseling services may be beneficial.

Feasibility and Outcomes of Corneal Transplantation Performed at Rural Centers: An Extension of the Pyramidal Model of Enhanced Eye Care at Rural Outreach.

The aim of this study was to report on the feasibility of setting up a system of corneal transplants at rural outreach centers and report the outcomes of the first 111 cases. Retrospective analysis of the outcomes of corneal transplantation performed on patients with optical indications between March 2016 and September 2019 at 4 secondary (rural) centers. The centers are a part of a network in the pyramidal model developed by L V Prasad Eye Institute. The graft clarity and best-corrected visual acuity (BCVA) at 1-year follow-up were analyzed. Of the 111 patients, 34.23% underwent penetrating keratoplasty and 65.77% endothelial keratoplasty. The mean age was 59.4 ± 15.0 (range-17-86 years); 47.75% were men and 52.25% were women. The indications for surgery were bullous keratopathy (54.05%), corneal scar/adherent leukoma (23.42%), and repeat grafts (13.51%). At the end of 1 year, 69.37% grafts remained clear. Factors associated with graft failure included poor socioeconomic status and graft infiltrate in both univariate and multivariate analyses. Surgical technique of endothelial keratoplasty was associated with failure on multivariate analysis only. Of the 77 eyes with clear corneal grafts at 1 year, the preoperative mean logMAR BCVA was 1.91 ± 0.06, which improved to 0.90 ± 0.08 postoperatively. Overall, 84.4% had preoperative BCVA of <3/60. Postoperatively, 40% had BCVA of 6/18 or better. Our study showed that close to 70% grafts remained clear at 1 year. Graft failure was associated with poor socioeconomic status and graft infiltrates. This study established a viable model for delivery of corneal transplant surgery and care in a rural setup.

Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage.

Although the approved COVID-19 vaccine has been shown to be safe and effective, mass vaccination in Bangladeshi people remains a challenge. As a vaccination effort, the study provided an empirical evidence on willingness to vaccinate by sociodemographic, clinical and regional differences in Bangladeshi adults. This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on hesitancy and reluctance of vaccination for COVID-19. Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a fee, while 8.5% were reluctant to vaccinate. With a minimum fee, 46.5% of the respondents showed intent to vaccinate. Among the respondents, 16.8% reported adequate adherence to health safety regulations, and 35.5% reported high confidence in the country's healthcare system. The COVID-19 vaccine refusal was significantly high in elderly, rural, semi-urban, and slum communities, farmers, day-laborers, homemakers, low-educated group, and those who had low confidence in the country's healthcare system. Also, the prevalence of vaccine hesitancy was high in the elderly population, low-educated group, day-laborers, people with chronic diseases, and people with low confidence in the country's healthcare system. A high prevalence of vaccine refusal and hesitancy was observed in rural people and slum dwellers in Bangladesh. The rural community and slum dwellers had a low literacy level, low adherence to health safety regulations and low confidence in healthcare system. The ongoing app-based registration for vaccination increased hesitancy and reluctancy in low-educated group. For rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, vaccination should be continued without a fee and thus Bangladesh's COVID vaccination program can become a model for other low and middle-income countries.

Association between Lifestyle Factors and Oral Potentially Malignant Disorders among People of Bangalore: A Case-control Study

Introduction: The increase in prevalence of oral premalignant lesions and oral cancer in India is due to cultural, ethnic, geographic factors and varying lifestyle factors like consumption of tobacco, alcohol and standard of living. Some of the risk factors are modifiable and emphasises the need for detailed assessment of these modifiable risk factors and increasing awareness among general public and policy makers. Aim: The present study was conducted to assess the association between lifestyle factors and Oral Potentially Malignant Disorders (OPMDs). Materials and Methods: A case-control study was conducted where 154 cases and controls were selected from MS Ramaiah Dental College and Hospital, Bangalore and peripheral outreach centers of MS Ramaiah Dental College and Hospital, Bangalore. Cases diagnosed as oral leukoplakia, erythroplakia and Oral Submucous Fibrosis (OSMF) based on the World Health Organisation (WHO) criteria (1980) were included in the study group. Age and sex (1:1) matched controls without OPMDs were included in control group. The data was collected regarding socio-demographic factors, blood group and lifestyle factors using specially designed proforma. Chi-square test and odds ratio were utilised to association and strength of association between various lifestyle factors and development of OPMDs. Univariate logistic regression test was done followed by multiple logistic regression for identifying the risk factors. The p-value &lt;0.05 was considered as statistically significant. SPSS version 11.0 was used for data analysis. Results: Out of 154 cases, 84 (54.5%) cases were leukoplakia, 2 (1.3%), cases were erythroplakia, 53 (34.4%) cases were OSMF and 15 (9.7%) cases were with multiple potentially malignant disorders (leukoplakia+OSMF). In univariate analysis, OR for tobacco smoking in individuals who smoked more than 20 times a day was 2.56 (95% CL 1.19-5.5) compared to non-smokers, tobacco chewing who chewed more than 10 times a day was 43.03 (95% CL-17.2-107) in comparison to non-chewers and alcohol consumption who consumed alcohol daily was 3.2 (95% CL 0.6-16.3) in comparison to non-alcoholics. Following multiple logistic regression analysis occupation, smoking, chewing tobacco and vegetable intake was found to be statistically significant as independent risk factors p&lt;0.05. Conclusion: Occupation, smoking, chewing tobacco and vegetable consumption were identified as independent risk factors for the development of OPMDs. Identifying the risk factors and OPMD at an early stage is important for prevention of oral cancer.

National Trends in the Public's Likelihood of Getting a COVID-19 Vaccine in Bangladesh: Understanding the&amp;nbsp;Strategies to Optimize Vaccination Coverage

Background: Although the COVID-19 vaccine has been proved to be safe and effective, mass vaccination in Bangladeshi people remains a challenge even without a cost. A high percentage of reluctance to vaccine could result in poor control of the disease. We aim to identify the prevalence of vaccine acceptance in Bangladeshi adults and analyze the associated sociodemographic, clinical, and healthcare-related factors on the likelihood of getting a COVID-19 vaccine.Methods: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on uncertainty and reluctance to be vaccinated for COVID-19.Findings: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a cost, while 8.5% were reluctant to vaccinate. The prevalence of vaccine acceptance will decline to 46.5% if the government introduces a minimum vaccine fee. Moreover, 612 (16.8%) of the 3643 respondents reported adequate adherence to health safety regulations for COVID-19, and 1294 (35.5%) of the respondents reported high confidence in the country's healthcare system. However, the COVID-19 vaccine refusal was significantly increased in elderly, rural, semi-urban, and slum communities, farmers, day laborers, homemakers, low-educated populations, and those who had low confidence in the country's healthcare system. Moreover, the prevalence of vaccine uncertainty is high in the elderly population, low-educated group, day-laborers, presence of chronic diseases, and people with low confidence in the country's healthcare system.Interpretation: A high prevalence of vaccine refusal and uncertainty is observed in rural people and slum dwellers in Bangladesh. This community of people also has a low literacy level, and we found a decreasing trend of prevalence in vaccine acceptance with decreasing education level. It is expected that an app-based registration system would not be appropriate for low-educated groups, and a feasible alternative strategy such as local spot-registration could be devised. Furthermore, for rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, free vaccination should be continued until the end of the vaccination program. Thus Bangladesh's Covid vaccination program can become a model for other low and middle-income countries.Funding Statement: None. Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The Institutional Review Board approved the study at North South University, Bangladesh (2020/OR-NSU/IRB/1003).

Slit-lamp measurement of anterior chamber depth and its agreement with anterior segment optical coherence tomography and Lenstar LS 900 in pseudoexfoliation and normal eyes.

Purpose:There is a considerable lack of awareness of slit-lamp measurement of anterior chamber depth (ACD) by the Redmond Smith method (SACD) in present day-to-day clinical practice, which may provide rapid assessment in pseudoexfoliation (PXF) when assessing for angle closure and planning for cataract surgery. This assumes importance not only in outreach clinics but also in the ongoing pandemic caused by the highly contagious novel coronavirus, where social distancing is advocated to contain the spread. We aimed to compare the axial ACD in PXF and normal patients by SACD, and its agreement with the anterior segment optical coherence tomography (ASOCT) and LenstarLS-900.Methods:A prospective comparative observational study was done at a tertiary eye care hospital. A PXF group and a normal group of controls were recruited. All eyes were phakic with normal cornea. Any eye with previous intraocular/refractive surgery and cause of other secondary or uncontrolled glaucoma was excluded. SACD was measured clinically via slit-lamp method and also via ASOCT and Lenstar; agreement between the methodologies was plotted.Results:Fifty patients were recruited in each group. Mean age was 66.82 ± 4.88 years in PXF patients and 65 ± 5.46 years in controls (P = 0.2). ACD was found to be greater in controls compared with the PXF patients; this difference was statistically significant (P < 0.001) across all methodologies. A good agreement with narrow 95% limits of agreement was found between these methodologies.Conclusion:Redmond Smith slit-lamp methodology of estimating the axial ACD is recommended as a rapid, quantifiable, noncontact screening technique during routine examination, especially in primary outreach centers, and is also advantageous during the ongoing pandemic by reducing expendable investigations.

Barriers to Computerized Career Interventions in Community Outreach Centers

This study used a survey design to investigate if computer experience and computer attitudes influence whether economically marginalized individuals desire access to computerized career services in community outreach centers. The majority (84%) of the sample reported a desire for access to computerized career services at community outreach centers. A multiple regression analysis indicated computer attitudes as most predictive of intention to use computerized career services (β = .29, p &lt; .01). Results support extending access to computerized career services in community outreach centers to meet the needs of economically marginalized individuals.