Western Health Research Articles

Strategies of interfacing traditional health and western health in fight against Coronavirus

The study focused on strategies of interfacing traditional health and western in fight against Coronavirus. Experts contend that government agencies and health officials should collaborate with traditional healers rather than oppose them to successfully tackle COVID-19. Various stakeholders appear to be undermining South Africa's traditional health care system, which served as the indigenous people's major source of healthcare. The indigenous health care system and its methods are being demonized by youth and certain scientific institutions because they are linked to witchcraft and other wicked customs. The researcher noticed that, in the twenty-first century, there appeared to be an idea of interfacing Traditional Health Practices (THPs) with Western doctors. It appears that basic healthcare systems were provided by traditional medical professionals in civilizations prior to the arrival of colonialism. The objective of the study was as follows, to determine strategies of interfacing traditional health and western health in the fight against COVID-19, The study adopted an employ African healing theory and appreciative Inquiry. The study used a qualitative research design and was exploratory in nature. Data was generated using observation and semi-structured interviews as data collection instruments. The finding of the study showed that some people consult traditional healers during the night because they do not want to be seen, and some still believe that traditional healers consist of witchcraft. The study recommend that education could make our community conscious of the conventional health care system and work to make youth and scientific groups be able to know and understand the importance of traditional health care system, integration of traditional health and western healthcare system in the fight against coronavirus and Funding traditional health care system.

Creation of the Indigenous Support Line for health system navigation and culturally safe access to care: a quality improvement project

Indigenous Peoples face inequities in health and healthcare access due to colonial history and systems. To work towards the Truth and Reconciliation Commission of Canada’s Calls to Action and the...

Exploring perceptions and attitudes towards vaccines in a remote western DRC health zone

The Democratic Republic of the Congo (DRC) struggles with low full childhood vaccination coverage (around 50 %) and a high children-under-five mortality rate (79 deaths per 1000 live births). This situation is potentially exacerbated by vaccine hesitancy, which was identified by the World Health Organization (WHO) as one of the top 10 global health threats in 2019. To gain deeper insights into levels of vaccine confidence possibly influencing vaccination coverage, we explored perceptions and attitudes towards childhood and adult vaccines in Boende (Tshuapa province, western DRC), which experienced an Ebola outbreak in 2014 and hosted the EBL2007 Ebola vaccine trial (2019–2022). Using purposeful sampling, we conducted 29 individual interviews and 14 focus group discussions with diverse community members between July 2022 and March 2023. Our findings suggest the prevalence of a relatively low level of trust in COVID-19 vaccines compared to other vaccines. Additionally, the fear of Ebola disease seemed to lead to general acceptance of the EBL2007 trial vaccine, although some concerns were voiced about pre-testing and the decision to conduct the trial in the DRC. While trust in childhood vaccines and reported uptake appeared to be high, concerns existed regarding potential adverse effects and the possibility that vaccines targeted African children specifically. Our analysis further identified four recommendations to possibly enhance vaccine confidence in the region. This study highlights the multifaceted nature of vaccine confidence, influenced by the perceived risk of the targeted diseases, past experiences with medical interventions and staff, and sociopolitical contexts. However, we emphasise that increasing vaccine uptake requires a comprehensive approach, addressing not only vaccine confidence, but also crucial aspects like access to vaccines and robust disease surveillance activities. This would ultimately reduce the burden of vaccine-preventable diseases and lead to better public health outcomes in the region.

Artificial intelligence measured 3D lumbosacral body composition and clinical outcomes in rectal cancer patients.

Patient body composition (BC) has been shown to help predict clinical outcomes in rectal cancer patients. Artificial intelligence algorithms have allowed for easier acquisition of BC measurements, creating a comprehensive BC profile in patients using data from an entire three-dimensional (3D) region of the body. This study has utilized AI technology to measure BC from the entire lumbosacral (L1-S5) region and assessed the associations between BC and clinical outcomes in rectal cancer patients who have undergone neoadjuvant therapy followed by surgery. A retrospective, cross sectional analysis was performed on locally advanced rectal cancer (LARC) patients treated with neoadjuvant long-course chemoradiotherapy followed by curative resection with total mesorectal excision at a tertiary referral centre, Western Health, Melbourne, Australia. A pre-trained and validated in-house AI segmentation model was used to automatically segment and measure intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and skeletal muscle (SM) from CT slices across the entire L1-S5 level of each patient. Multivariate analysis between patient BC and clinical outcomes was performed. Two hundred and fourteen patients were included in the study. One hundred and fifty-one (70.6%) patients were male and 63 (29.4%) patients were female. The average age at diagnosis was 62.4 (±12.7) years. SM density, but not volume, was associated with better overall survival (OS) (HR 0.24, P = 0.029), recurrence-free survival (RFS) (HR 0.45, P = 0.048) and decreased length of stay (LoS) (HR 1.58, P = 0.036). Both IMAT volume (HR 0.13, P = 0.008) and density (HR 0.26, P = 0.006) were associated with better OS. This study measured 3D BC from the entire lumbosacral region of rectal cancer patients. SM density was the most significant BC parameter, and was associated with improved OS, RFS and LoS. This adds to growing evidence that SM is a key component of BC in cancer patients and should be optimized prior to treatment. IMAT was also a prognostic factor, giving rise to avenues of future research into the role of adiposity on nutrition and tumour immunology.

The role of a Macmillan senior pharmacy technician in a regional cancer centre in Northern Ireland: an evaluation

Abstract Introduction In the UK, up to two-thirds of all cancer patients have at least one comorbidity, with around half having multiple long-term conditions (LTCs).1 Older people with cancer often require multiple medications including cancer-specific treatments, supportive care medications, and medications for pre-existing LTCs. They are therefore at higher risk of the adverse effects of polypharmacy, inappropriate prescribing, drug-drug interactions, and drug-disease interactions. Complexity of medication regimens and treatment burden can cause confusion and medicines mismanagement, thereby influencing a patient's ability to adhere to treatment with the outcome being an increased chance of treatment failure. It is thus essential that medicines be optimised in these patients.2 The Oncology Pharmacy Team based in the North West Cancer Centre, located on the Altnagelvin acute hospital site in the Western Health and Social Care Trust, Northern Ireland, secured Macmillan funding to provide a specialist medicines optimisation service to older patients about to start cancer treatment (the Medicines Optimisation in Older People with Cancer [MOOC] Service). A pharmacy technician and pharmacist were recruited and the service implemented from October 2023. The roles are new and innovative and require extensive evaluation. Aim To evaluate the introduction of the Macmillan senior pharmacy technician into the oncology pharmacy team, analysing impact on medicines optimisation and patient safety. Methods A census approach was taken to include all patients with a new cancer diagnosis and medicines reconciliation (MedRec) completed by the pharmacy technician during the study period. The technician identified and rectified any issues prior to the patient’s first scheduled treatment. Patients with significant medicines-related concerns, or aged ≥65 years and taking ≥8 drugs, were referred to the Macmillan pharmacist for holistic medication review. Data collected included number of MedRecs completed by the pharmacy technician (relative to total completed by the team weekly), cancer diagnosis, medicines-related problems identified, interventions made, other activities completed, and time directed away from the pharmacist. Analysis of patient age and number of medications taken informed whether inclusion criteria for MOOC pharmacist referral were appropriate. Results The specialist medicines optimisation service started in October 2023, however, data collection for the purpose of this study commenced on 1st January and took place over a two-month period.101 patients (aged 69.0 ± 5.7 years, range 57 -74 years)) taking an average of 12.6 medicines (range = 8-18), and recently diagnosed with cancer were reviewed by the pharmacy technician. On average, the technician completed 76.4% of medicines reconciliations each week. 120 medicines-related problems were identified, and 178 interventions made. The service yielded net cost savings of £826.34 (pharmacist time saved). Nine patients were referred to the MOOC pharmacist service; a further five patients did not consent to referral. Discussion / Conclusion Although the evaluation of the MOOC service is ongoing, this interim analysis demonstrated that integration of the pharmacy technician into the oncology team yielded cost savings and reduced and improved provision of patient-centred healthcare and safety. Inclusion criteria for the MOOC pharmacist review were confirmed via analysis of patient age and number of medicines taken.

Why Is Hospice One of the Few Health Care Environments Structured for Peace?

Historically, Western medicine has recognized health care environments as vital to patient well-being and enhanced clinical outcomes. Yet most modern Western hospitals are primarily designed and regulated to promote safety and minimize risk rather than to enhance comfort or serve as therapeutic environments in and of themselves. Hospice stands out as one of the few places within the Western health care service delivery system in which the structures and spaces of caregiving are viewed as key to patient-centered practice. This commentary on a case suggests the importance of designing health care environments that center patient experiences of well-being throughout the lifespan, not just at the end of life.

Impact of low back pain and care-seeking behavior in an Indigenous community in Suriname: a qualitative approach.

Low back pain is a significant global public health issue affecting over half a billion people and contributing to disability worldwide. The impact of disability related to low back pain is growing, particularly in low- and middle-income countries. In contrast with previous research, current evidence shows Indigenous Peoples also experience low back pain's disabling effects. A clinical ethnographic can contribute by attempting to understand the data through the perspective of Indigenous Peoples. A clinical ethnographic study was conducted in Galibi, a Kalinya rural Indigenous village in Suriname, with support of the local traditional authority. The main objective was to explore the impact of low back pain and care-seeking behavior from the perspective of Indigenous Peoples with low back pain. The findings were that low back pain had a significant physical and emotional impact. Despite aggravating their low back pain, participants continued many of their activities of daily life since these were essential for their (economic) survival. Furthermore, participants expressed anxiousness, financial worries, and concerns about the cause and future of their low back pain. To address their low back pain, the Kalinya Indigenous Peoples used both western and traditional care. Visits to western healthcare practitioners were limited due to logistical challenges and travel costs, and the experience was often negative. The study highlights the experiences of Kalinya Indigenous Peoples dealing with low back pain. Low back pain is a burden within Indigenous Peoples of Galibi but accepted as an integral part of their life. When in pain, Indigenous Peoples face many barriers to access western health care and visits to healthcare practitioners were often unhelpful. This contributed to a long-lasting negative impact on the Indigenous people with low back pain. Further research is needed to develop strategies that improve health outcomes related to low back pain while reducing its associated disability in Indigenous Peoples.

Recognition of language barriers in comprehending non-communicable disease management among rural elderly people in the DIMAMO surveillance area: a case of AWI-Gen participants

BackgroundLanguage plays a critical role in health communication, particularly in the management and understanding of non-communicable diseases (NCDs) among elderly populations. This study aimed to explore the language barriers that affect elderly participants’ comprehension of NCDs, focusing on how these barriers impact their understanding of disease causes, symptoms, treatment, and self-management. The study also investigated how linguistic differences between healthcare workers and patients influence the effectiveness of health interventions in a rural South African context.MethodsThis qualitative phenomenological study was conducted with elderly participants aged 60 years and above, all of whom have chronic diseases. In-depth face-to-face interviews were conducted using an interview guide during the AWI-Gen 2 research feedback sessions in the Ga-Dikgale area. Data analysis was performed using QSR NVivo 10 to identify key themes.ResultsFive major themes emerged regarding participants’ understanding of NCDs and the perceived language barriers. These include Limited Knowledge and Awareness of NCDs, Misconceptions about NCDs, Mixed perceptions regarding NCD causes and treatment, Discrepancies in healthcare workers’ communication, and the Importance of interpreters in facilitating NCD-related communication.ConclusionThe study revealed significant misconceptions about diabetes and hypertension, as well as traditional practices like bloodletting, which were perceived to relieve hypertension symptoms. It also identified critical communication barriers, including limited time for health practitioners to explain diagnoses and treatments. The findings emphasize the need for interpreters and culturally sensitive communication strategies to improve health literacy and care. Collaborative efforts between traditional and western health practitioners are recommended to address these issues and enhance community health interventions.

Telehealth “Verzuz” Radical Telehealing: Reimagining Social Media as Virtual Healing Spaces for Black Communities

Evidence suggests that the conception of “mental health,” as well as Western health care models, needs to be reimagined to better reflect the unique care needs of Black people. Within these systems, Black people are more likely to experience secondary victimization and retraumatization. Despite these systemic failings, Black people often find ways to manage self-care, wellness, and healing. Within the context of dueling pandemics (COVID-19 and racial injustice), Black people turned to social media applications to develop community-led, culturally-congruent care models. This study aims to explore the ways Black people experienced virtual engagements on social media during the dueling pandemics. This exploratory study employed a six-phase thematic analysis approach, while utilizing publicly available textual data (Instagram comments) from two key social media engagements targeting Black audiences. Prominent themes gleaned from this analysis elucidate the healing and therapeutic value of these virtual gatherings. These include: (1) Expression of Gratitude and Appreciation, (2) Necessity, (3) Timeliness, (4) Accessibility, (5) Emotional and Spiritual Impact of the Virtual Space, (6) Ancestral and Culturally-Grounded Healing Practices, (7) Reprieve within the Virtual Space, and (8) Community and Collectivism. Our analysis reveals that when elaborating on their experience participating in two key social media engagements targeting Black audiences, attendees’ responses reflect key aspects of empirically-grounded, culturally-congruent care models for Black people (i.e., radical healing). We contend our findings demonstrate the unique ways social media applications might be more intentionally leveraged to create culturally-congruent care for Black people.

Incidence, aetiology and short term outcomes of extreme hyperbilirubinaemia, in term infants born in the Western health subdistrict of Cape Town, South Africa between 2019 and 2020.

Extreme levels of bilirubin in newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. To determine the incidence, aetiology and short-term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. This is a retrospective observational study looking at term neonates with a birth weight ≥2500 g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥430 μmol/L in the first week of life and received care in the public health system. Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 h old (SD 31 h). The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity.

The Double Folds of Racism and History

Abstract Aboriginal and Torres Strait Islander men have been overrepresented proportionately in specific sports—boxing, rugby league, and Australian rules football—that have been associated with concussion, but there is little written material, research, scholarship, commentary, or understanding about how they have been affected by traumatic brain injuries related to their participation. This article addresses this silence by examining two overlapping folds of history. The first fold explores the general silences about sport concussion that existed until recently. The second fold is centered on the traumatic consequences of colonization on the health and well-being of Australia's First Nations peoples. While the first silence is being addressed in a multitude of complex ways, the second silence remains a disturbing feature of contemporary sport. We argue that for the recognition, diagnoses, and treatment of concussion and brain injuries in Aboriginal and Torres Strait Islander peoples, there needs to be an appreciation of the continuing consequences of colonization and significant changes in the Western health system.

Confronting the Medical Leviathan: Reading a Report from the Front Lines.

This essay discusses how two physicians in Britain's National Health Service describe and analyze the conditions of their work: how algorithms and protocols structure the care they can provide and create the dilemmas they and their patients face. In these issues, the NHS is a canary in the mineshaft of contemporary Western health care. NHS practices are understood as how states and state-like entities, Leviathans, seek to render their subjects legible; in this instance, to make both physicians and patients transparently visible to surveillance and administration by standardizing medical work and patient need. Physicians respond by engaging in workarounds, finding ways to provide care despite systemic restrictions.

P.016 Re-norming medical education: centering patient experience and diverse bodies in Lumbar Puncture (LP) instruction

Background: Medical curricula are often created with limited patient and student input and underrepresent certain body types. Traditional medical education often prepares learners to perform procedures, such as lumbar punctures (LPs), on a young white able-bodied 70kg male. When approaching diverse patients, this educational gap can lead to medical learners’ lack of confidence, skill, and knowledge, resulting in poor patient experiences. Methods: This co-design project involves patient and student input. We interviewed five patients who underwent LPs and explored their experience through a trauma-informed approach. To visualize landmarking across body types, we recruited nine volunteers of diverse body sizes, ages, tattoos, and skin colour (Fitzpatrick Scale). Incorporating patient narratives, as well as videos and photographs showing landmarking on diverse bodies, we crafted an online LP instructional module. Focus groups of 6-10 students will be held to collect student perception of the effectiveness of the module. Results: Our learning module and related media will be built into Western University’s Undergraduate Medical Education curriculum, available under a Creative Commons license through the Western Health Education Media Library. Conclusions: Integrating patient experience and student feedback, we are developing a comprehensive educational tool to better equip medical learners to deliver patient-centered LPs across diverse body types.

Using a new artificial intelligence-aided method to assess body composition CT segmentation in colorectal cancer patients.

This study aimed to evaluate the accuracy of our own artificial intelligence (AI)-generated model to assess automated segmentation and quantification of body composition-derived computed tomography (CT) slices from the lumber (L3) region in colorectal cancer (CRC) patients. A total of 541 axial CT slices at the L3 vertebra were retrospectively collected from 319 patients with CRC diagnosed during 2012-2019 at a single Australian tertiary institution, Western Health in Melbourne. A two-dimensional U-Net convolutional network was trained on 338 slices to segment muscle, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Manual reading of these same slices of muscle, VAT and SAT was created to serve as ground truth data. The Dice similarity coefficient was used to assess the U-Net-based segmentation performance on both a validation dataset (68 slices) and a test dataset (203 slices). The measurement of cross-sectional area and Hounsfield unit (HU) density of muscle, VAT and SAT were compared between two methods. The segmentation for muscle, VAT and SAT demonstrated excellent performance for both the validation (Dice similarity coefficients >0.98, respectively) and test (Dice similarity coefficients >0.97, respectively) datasets. There was a strong positive correlation between manual and AI segmentation measurements of body composition for both datasets (Spearman's correlation coefficients: 0.944-0.999, P < 0.001). Compared to the gold standard, this fully automated segmentation system exhibited a high accuracy for assessing segmentation and quantification of abdominal muscle and adipose tissues of CT slices at the L3 in CRC patients.

Integrating Indigenous and Western Health Practices as Synergy for African Development in the Globalization Era: The Nigerian Example

The health policy of colonial rule precipitated structural and institutional changes in the healthcare system of the colonized Africans, as Western medicine was imposed across Africa as a better system of health management. This development fundamentally altered the professional and practical acceptability of indigenous medicine even beyond the colonial era. The much-acclaimed theoretical incompatibility of western and indigenous medical systems is one of the major causes of the strain in the levels of acceptance between indigenous medicine and western medicine in post-colonial Africa. In the case of Nigeria, a majority of the populace, especially in the rural areas, still consult the indigenous medical care providers. This consultation is arguably as a result of some factors, including the people’s thin financial resources,the mythical belief in the therapeutic efficacy of indigenous medicine, and closeness of the indigenous healthcare centres to the patients, among others. Given this, it becomes imperative to explore the historical development and value of Adepoju Adewale Toyin and Onagun Rasheed: Integrating Indigenous and… 415 indigenous healthcare practices in Nigeria and determine the possibility of its integration with western medicine. Towards accomplishing this, we explore historical-analytic method, using primary and secondary sources to examine the current state of indigenous traditional health practice in Nigeria, identify the factors that drive (mis)communication between patient and practitioner, and suggest solutions that can be implemented to address existing challenges. In addition, with illustrations drawn from successful examples of integration of indigenous and modern health practices in developing countries, the paper argues in the context of globalization that an advantageous synergy between indigenous and western health practices is feasible as a development strategy for Africa.

The treatment landscape of nonmetastatic castrate resistant prostate cancer: A contemporary perspective

ObjectivesThe incidence of nonmetastatic castrate resistant prostate cancer (nmCRPC) is not well defined in contemporary practice. The aim of this study is to describe the incidence and patterns of treatment of nmCRPC over the last 6 years at a single high-volume Australian health institution. Subjects and methodsAll men newly diagnosed with prostate cancer at Western Health, Melbourne from January 2016 to December 2021 were included in the study. Those diagnosed with nonmetastatic prostate cancer and treated with medical or surgical castration for biochemical failure post attempted curative therapy were retrospectively reviewed for signs of castration resistance using prostate specific antigen (PSA) and testosterone biochemical markers up until October 2022. ResultsFrom January 2016 to December 2021, 822 patients were diagnosed with prostate cancer, 590 had localized disease, 373 underwent definitive locoregional therapy, and 31 went on to have biochemical recurrence and were commenced on androgen deprivation therapy. Twenty-five patients had undetectable PSA levels and were classified as having nonmetastatic castrate sensitive prostate cancer (nmCSPC), whilst the remaining 6 patients experienced a rising PSA and were thus classified as nmCRPC. The incidence rate of nmCRPC was 228 cases per 100,000 person-years.The median age at the time of prostate biopsy was 74 years (interquartile range [IQR] 64–79) in the nmCRPC group and 62 years (IQR 57–69) in the nmCSPC group. The median prebiopsy PSA (ng/ml) in the nmCRPC and nmCSPC groups were 27.5 (IQR 19.9–50.4), and 16.5 (IQR 9.0–26.0), respectively. The median duration from prostate cancer diagnosis to onset of nmCRPC was 24 months (IQR 17–29) and the median PSA doubling time was 3.4 months (IQR 2.2–5.7). ConclusionsThus, nmCRPC is an uncommon disease. Further population-based studies are required to better understand the incidence of nmCRPC.

Regarding the implementation of foreign psychotherapeutic approaches in the mental health protection system of the population of Ukraine in conditions of war

Background. The work is devoted to the problem of preserving the mental health of the population of Ukraine. The emergence of stress-related mental disorders, including post-traumatic stress disorder, leads to a negative effect on families and communities, problems of mutual understanding, support and recovery. Against this background, there is no doubt about the need to implement the experience of Western colleagues in the mental health care system at all levels of care provision. The purpose of the work is to update the issue of the implementation of foreign psychotherapeutic approaches in the system of mental health care of the population of Ukraine in the conditions of war. Materials and methods. On the basis of the analysis of literary sources and information resources, a modern overview of the problem of introducing modern psychotherapeutic directions into the system of mental health protection of the population in wartime conditions was obtained. Discussion. An analytical review of pathogenetic prerequisites for the implementation of the experience of Western doctors in rehabilitation measures and psychological support measures was carried out. Implementation of strategies aimed at preventing mental illness through education, stress reduction, and development of psychosocial support can help reduce the prevalence of risk factors for the development of mental health problems. Justification of the implementation of Western experience is important for improving the provision of assistance in the mental health system in Ukraine, which will meet modern standards and take into account the peculiarities of Ukrainian culture and society.At the same time, ensuring effective rehabilitation for victims is an act of recognition of their dignity and rights to a full life. Conclusions. At the current stage, Western health care systems emphasize the prevention of mental illnesses through education, stress reduction, and the development of psychosocial support. Implementing these strategies can help reduce the prevalence of risk factors for developing mental health problems. The ability to integrate mental health care into the general medical context is a priority, as it can improve detection of mental illness, provide a comprehensive approach to treatment, and reduce stigmatisation in the society. Focusing on the scientific basis is a priority, because the proven base of Western approaches to the issue of maintaining mental health is based on scientific research and effective methods.

Estimating the burden of vitiligo: a systematic review and modelling study

Vitiligo is a chronic autoimmune disease characterised by depigmented skin patches, which can pose substantial psychosocial challenges particularly in individuals with dark skin tones. Despite its impact on quality of life, there is an absence of standardised global epidemiological data. We sought to address this gap with the present study. In this study we did a systematic review and modelling analysis to estimate the global, regional, and national prevalence and incidence of vitiligo. We did a comprehensive search of nine digital libraries (PubMed, Embase, Web of Science, Scientific Electronic Library Online, KCI Korean Journal Database, Russian Science Citation Index, Western Pacific Region Index Medicus, Informit, and Health Research and Development Information Network) from inception up to May 25, 2023. We included cross-sectional or cohort studies reporting the incidence rate or prevalence of vitiligo, or data from which incidence rate or prevalence could be calculated, in the general population of a country or area of a country. Summary estimate data were extracted. A main outcome was to estimate the worldwide, regional, and country-specific lifetime prevalence of vitiligo diagnosed by physicians or dermatologists among the general population and in adults and children (as per age groups defined in included studies). We used a Bayesian hierarchical linear mixed model to estimate prevalence, and calculated number of affected individuals using the UN population structure in 2022. In estimating lifetime prevalence, studies reporting point or period prevalence were excluded. Our other main outcome was to estimate incidence rates of vitiligo, but due to a small number of studies, the data on incidence were presented in a descriptive summary. This study was registered on PROSPERO, CRD42023390433. Our search identified 22 192 records, of which 90 studies met our inclusion criteria. Of these studies, six focused on the incidence of vitiligo, 79 reported on the prevalence of vitiligo, and five provided data on both incidence and prevalence. 71 studies reported on lifetime prevalence. In the most recent years studied, incidence rates in the general population ranged from 24·7 cases (95% CI 24·3-25·2) per 100 000 person-years in South Korea in 2019, to 61·0 cases (60·6-61·4) in the USA in 2017. In individual studies, incidence rates showed an increasing trend over the periods studied. The global lifetime prevalence of vitiligo diagnosed by a physician or dermatologist was estimated at 0·36% (95% credible interval [CrI] 0·24-0·54) in the general population (28·5 million people [95% CrI 18·9-42·6]), 0·67% (0·43-1·07) in the adult population (37·1 million adults [23·9-58·9]), and 0·24% (0·16-0·37) in the child population (5·8 million children [3·8-8·9]). Vitiligo prevalence was higher in adults than in children across all regions. Central Europe and south Asia reported the highest prevalence (0·52% [0·28-1·07] and 0·52% [0·33-0·82], respectively, in the general population). This study highlights the need for standardised epidemiological data collection globally to inform public health policies and improve vitiligo diagnosis and management. Emphasis on the impact on individuals with darker skin tones is crucial to reducing stigma and improving quality of life. Furthermore, our study highlights the need to conduct more research in regions and populations that have been historically under-represented, to effectively address the worldwide burden of vitiligo. None.

Health care use experiences of ethnoculturally diverse immigrant older adults: a meta-ethnography

PurposeCurrent and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices?Design/methodology/approachThe authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological s and s in Social Gerontology that yielded 17 papers eligible for review.Findings“There’s always something positive and something negative” is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults’ health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources.Originality/valueThe authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities.

Safety and solidarity: Using collective documents to share sex workers’ insider knowledges

Western culture and Western health care systems have created places of sexual health care that are highly individualised, privatised and professionalised. For people engaged in sex work, this reduces the possibilities for sharing skills and knowledges and instead leaves people with internalised feelings of shame, guilt and isolation. This paper describes collective therapeutic work that elicited insider knowledges, skills and sparkling moments from sex workers. These accounts sidestepped negative identity conclusions and fostered mutual support among the workers, even though the participants never met each other. The work was guided by narrative practice concepts including externalising, double listening, re-authoring, privileging insider knowledges and developing collective documents.