Aims: To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. Methods: A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients. Results: The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years. Conclusions: Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.
Objectives This study aimed to determine whether personal protective equipment (PPE) results in deterioration in chest compression (CC) quality and greater fatigue for administering health care providers (HCPs). Methods In this multicenter study, HCPs completed 2 sessions. In session 1 (baseline), HCPs wore normal attire; in session 2, HCPs donned full PPE. During each session, they performed 5 minutes of uninterrupted CCs on a child manikin. Chest compression rate, depth, and release velocity were reported in ten 30-second epochs. Change in CC parameters and self-reported fatigue were measured between the start and 2- and 5-minute epochs. Results We enrolled 108 HCPs (prehospital and in-hospital providers). The median CC rate did not change significantly between epochs 1 and 10 during baseline sessions. Median CC depth and release velocity decreased for 5 minutes with PPE. There were no significant differences in CC parameters between baseline and PPE sessions in any provider group. Median fatigue scores during baseline sessions were 2 (at start), 4 (at 2 minutes), and 6 (at 5 minutes). There was a significantly higher median fatigue score between 0 and 5 minutes in both study sessions and in all groups. Fatigue scores were significantly higher for providers wearing PPE compared with baseline specifically among prehospital providers. Conclusions During a clinically appropriate 2-minute period, neither CC quality nor self-reported fatigue worsened to a significant degree in providers wearing PPE. Our data suggest that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use.
BACKGROUND AND OBJECTIVES:The Best Pharmaceuticals for Children Act (BPCA) incentivizes the study of on-patent medicines in children and mandates that the National Institutes of Health sponsor research on off-patent drugs important to pediatric therapeutics. Failing to enroll cohorts that reflect the pediatric population at large restricts the generalizability of such studies. In this investigation, we evaluate racial and ethnic minority representation among participants enrolled in BPCA-sponsored studies.METHODS: Data were obtained for all participants enrolled in 33 federally funded studies of drugs and devices conducted from 2008 through June 2020. Observed racial and ethnic distributions were compared with expected distributions by sampling Census data at the same geographic frequency as in the studies. Racial and ethnic enrollment was examined by demography, geography, study type, study burden, and expected bias. Standard descriptive statistics, x 2 , generalized linear models, and linear regression were applied.RESULTS: A total of 10 918 participants (51% male, 6.6 6 8.2 years) were enrolled across 46 US states and 4 countries. Studies ranged from treatment outcome reviews to randomized, placebo-controlled trials. Minority enrollment was comparable to, or higher than, expected (10.1% to 12.6%) for all groups except Asian Americans (23.7%, P , .001). American Indian and Alaskan Native and multiracial enrollment significantly increased over the evaluation period (P , .01). There were no significant differences in racial distribution as a function of age or sex, although differences were observed on the basis of geography, study type, and study burden. CONCLUSIONS AND RELEVANCE:This study revealed no evidence of racial and ethnic bias in enrollment for pediatric studies conducted with funding from BPCA, fulfilling the legislation's expectation to ensure adequate representation of all children. WHAT'S KNOWN ON THIS SUBJECT:The federal government has purposefully investigated the impact of legislation on the inclusion of children in studies of on-patent drugs and reported on racial and ethnic inclusion. However, representation in legislatively mandated, federally funded studies of off-patent medications is yet undescribed.WHAT THIS STUDY ADDS: In this study, we highlight the extent to which pediatric investigators, overseeing drug and device trials, ensure balanced ethnic and racial representation among study participants. To our knowledge, similar findings have not been reported for other large Government-sponsored pediatric trial programs.
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