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Background: The American Academy of Pediatrics recommends pediatric vision screening to detect and refer vision disorders during the critical early years when intervention yields the greatest benefits. We determined the rate of vision screening for US children 3-5 years of age with commercial insurance and compared rates among those living in rural versus urban areas. Children in rural compared with urban areas were expected to have lower rates of vision screening., Methods: A cross-sectional study using commercial claims for 3- to 5-year-olds derived from the Merative MarketScan Database (IBM, Armonk, NY), 2011-2020, was conducted. Primary outcome was the proportion of children with a claim for vision screening. Adjusted incident rate ratios (aIRR) of vision screening with 95% confidence intervals were computed for children living in rural compared with urban areas of the United States., Results: Claims for 2,299,631 children were included. Most children (1,724,923 [75.0%]) were enrolled in preferred provider organization plans and lived in urban areas (2,031,473 [88.3%]). A total of 662,619 (28.8%) had a claim for a vision screening. Children living in rural versus urban areas had a lower adjusted incident rate of vision screening (15.1 vs 30.6%, aIRR 0.57; 95% CI, 0.53- 0.61) after adjusting for sex, age, region, and insurance type., Conclusions: For preschool age children with commercial insurance, vision screening is low, especially in rural compared with urban areas., (Copyright © 2024. Published by Elsevier Inc.)

Background: Vision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor's office ('primary care')., Method: Population-based data for US children aged 3 to 6 years was derived from the National Survey of Children's Health (2018-2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH ('PCMH care'), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care., Results: Among 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care., Conclusions: Caregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications., Competing Interests: Declarations Ethical approval and consent to participate This study was exempt from institutional review because it was a secondary analysis of a publicly available deidentified data set. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

Purpose: To investigate whether immigrant generation is associated with caregiver-reported receipt of vision testing., Methods: Nationally representative data from the 2018-2019 National Survey of Children's Health was used. The primary exposure was immigrant generation, with first generation defined as child and all reported parents born outside the United States; second generation, as child born in the United States but at least one parent born outside the United States; and third generation, as all parents in the household born in the United States. The main outcome was caregiver-reported vision testing during the previous 12 months. Odds ratios adjusted for sociodemographic characteristics and 95% confidence intervals were computed based on immigrant generation., Results: The sample included 49,442 US children 3-17 years of age. The proportion of children who had vision testing in any setting was lower for first- (60.3%) than third-generation children (74.6%; aOR = 0.54; 95% CI, 0.41-0.71). This association remained after excluding children without health coverage. For Hispanic children, both first- (aOR = 0.58; 95% CI, 0.36-0.94) and second-generation children (aOR = 0.73; 95% CI, 0.55-0.96) had lower odds of a vision test in any setting compared with third-generation Hispanic children., Conclusions: First-generation children had lower odds of vision testing than third-generation children, even when adjusting for sociodemographic characteristics, especially in Hispanic households., (Copyright © 2024. Published by Elsevier Inc.)

The aim of this study was to determine whether immigrant generation is associated with caregiver-reported vision loss in children adjusting for sociodemographic characteristics. Nationally representative data from the National Survey of Children's Health (2018-2020) was used. The primary exposure was immigrant generation defined as: first (child and all reported parents were born outside the United States); second (child was born in the United States and at least one parent was born outside the United States); third or higher (all parents in the household were born in the United States). The main outcome was caregiver-reported vision loss in child. Adjusted odds ratios (aOR) and 95% confidence intervals were computed based on immigration generation. The study sample included 84,860 US children aged 3-17 years. First generation children had higher adjusted odds of caregiver-reported vision loss (aOR 2.30; 95% CI 1.21, 4.35) than third or higher generation children after adjusting for demographic characteristics and social determinants of health. For Hispanic families, first generation (aOR 2.99; 95% CI 1.34, 6.66), and second-generation children (aOR 1.70; 95% CI 1.06, 2.74) had a higher adjusted odds of vision loss compared with third or higher generation children. Even when adjusting for sociodemographic characteristics, first generation children had greater odds of vision loss, especially in Hispanic households, than third generation children. Immigration generation should be treated as an independent risk factor for vision loss for children and is a social determinant of eye health., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 years and younger in the United States., Design: This cross-sectional study used data from the National Survey of Children's Health (NSCH), a nationally representative and population-based survey of randomly sampled households., Participants: Participants were children aged 0 to 17 years, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online., Methods: Weighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables., Main Outcome Measures: Caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses., Results: Caregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education high school or less, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English., Conclusions: Children from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objectives:  To document our initial experience using whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) and bi-parametric magnetic resonance imaging (bpMRI) as a single exam in the staging of biopsy-proven prostate cancers., Methods: This retrospective study involved 120 African men with biopsy-confirmed prostate cancer (PCa). All the participants had a single exam that included both a bpMRI and a WB-DWI/MRI. The results were analyzed based on the American Urological Association's risk stratification system and evaluated using descriptive statistics., Results: The combined imaging approach confirmed PCa in all cases, identifying pelvic lymph node metastases in 21 (17.5%) patients. Among 72 high-risk patients, bpMRI+WB-DWI/MRI detected pelvic lymph node metastases in 18 (25.0%), bone metastases in 15 (20.8%), retroperitoneal lymph node metastases in six (8.3%), and extraprostatic extension in 18 (25%), with no solid organ metastases observed., Conclusion: The combination of WB-DWI/MRI and bpMRI in a single-step approach demonstrates diagnostic potential in primary prostate cancer staging for high-risk groups, with the added advantage of shorter examination times, lower patients' costs, and elimination of the risks of adverse events associated with the use of contrast agents and exposure to radiation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Asafu Adjaye Frimpong et al.)

Importance: Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown., Objective: To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective., Design, Setting, and Participants: An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors., Main Outcomes and Measures: For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained., Results: School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively., Conclusions and Relevance: In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

This study investigates public sentiments and the essential topics of discussion on Africa's innovation amidst COVID-19. Web scraping techniques were used to collect and parse data from Twitter platform using the keywords "Africa Innovation COVID-19". A total of 54,318 cleaned English tweets were gathered and analysed using Twint Python Libraries. Our sentiment analysis findings revealed that 28,084 tweets (52 per cent) were positive, 21,037 (39 per cent), and 5197 (9 per cent) of tweets were neutral and negative, respectively, for Polarity sentiments. Notably, Healthcare, Imagination, Support, Webinar, Learning, Future, Rwanda, and Challenge were the most discussed topics on Africa's innovation during COVID-19. The topic labelling sentiments on the themes identified were positive, neutral, and negative, respectively. The study also revealed a cluster relationship between all identified topics. The relationship among these themes divulged how COVID-19 is positively shaping social and technological innovation in Africa. The study further presented practical implications to better position African leaders and policymakers to capitalise on the current innovation ecosystems and institutional capacities to transform the continent into a digital and innovation hub. The research concludes with theoretical recommendations and study limitations that will guide researchers and academicians in conducting future research in the subject area., Competing Interests: The authors declare no conflicts of interest., (© 2022 John Wiley & Sons Ltd.)

Objective: To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children., Methods: Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ)., Results: Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality., Conclusion: Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening., (© 2021. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objective: To test the association of material deprivation and the utilization of vision care services for young children., Study Design: We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician., Results: Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas., Conclusions: Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The current educational disruption caused by the COVID-19 pandemic has fuelled a plethora of investments and the use of educational technologies for Emergency Remote Learning (ERL). Despite the significance of online learning for ERL across most educational institutions, there are wide mixed perceptions about online learning during this pandemic. This study, therefore, aims at examining public perception about online learning for ERL during COVID-19. The study sample included 31,009 English language Tweets extracted and cleaned using Twitter API, Python libraries and NVivo, from 10 March 2020 to 25 July 2020, using keywords: COVID-19, Corona, e-learning, online learning, distance learning. Collected tweets were analysed using word frequencies of unigrams and bigrams, sentiment analysis, topic modelling, and sentiment labeling, cluster, and trend analysis. The results identified more positive and negative sentiments within the dataset and identified topics. Further, the identified topics which are learning support, COVID-19, online learning, schools, distance learning, e-learning, students, and education were clustered among each other. The number of daily COVID-19 related cases had a weak linear relationship with the number of online learning tweets due to the low number of tweets during the vacation period from April to June 2020. The number of tweets increased during the early weeks of July 2020 as a result of the increasing number of mixed reactions to the reopening of schools. The study findings and recommendations underscore the need for educational systems, government agencies, and other stakeholders to practically implement online learning measures and strategies for ERL in the quest of reopening of schools., Competing Interests: The authors declare there is no conflict of interest., (© 2021 John Wiley & Sons Ltd.)

This study examined the effect of socio-economic features of low-income communities and COVID-19 related cases in New York City. The study developed hypotheses and conceptual framework of low-income communities and COVID-19 associated cases based on literature and theoretical review. The proposed framework was then tested using Structural Equation Model (SEM) with secondary data collected from New York Health and Mental Hygiene Department, US Census Bureau, and the Centers for Disease Control and Prevention. The findings revealed that unfavourable working conditions, underlying health conditions, and poor living conditions significantly and positively affects the number of COVID-19 confirmed cases. The study further revealed a positive and significant relationship between confirmed COVID-19 cases and COVID-19 related deaths. Theoretically, this study provides empirical results and a conceptual framework that could be used by other researchers to investigate low-income communities and COVID-19 related topics. Practically, this study called on the federal and state governments to effectively apply the health justice approach to eliminate healthcare discrimination for people living in low-income and marginalised communities as well as providing accessible, safe housing for the more vulnerable who need a place to self-quarantine due to COVID-19 exposure. Further practical and theoretical implications policies are discussed.

Vision impairment has a significant impact on quality of life. Seventy percent of existing vision impairment in Canada is estimated to be correctable with prescription glasses. The sizeable proportion of correctable vision impairment appears related to the barriers to access to vision care in Canada. The objective of this scoping review is to determine gaps in the understanding of barriers to accessing vision care for vulnerable populations in Canada. The Arksey and O'Malley methodological framework was adopted. Studies published in English between 2005 and September 2017 on access to primary vision care by vulnerable populations in Canada were reviewed. Electronic databases used included Ovid MEDLINE, Ovid EMBASE, SCOPUS, ProQuest, and CINAHL. The Behavioural Model of Health Services Use was used to elucidate gaps in the literature. To develop relevant policies around vision care, efforts should be made to assess all dimensions of access for vulnerable populations across Canada.

Objective: Amblyopia is the leading cause of monocular vision impairment in children. Early intervention is critical to prevent permanent vision impairment. Preschool vision screening programs in Canada are limited. This study reports the initial results of a community-wide vision screening program for preschoolers using the Plusoptix S12C Photoscreener (Plusoptix Inc, Nuremburg, Germany)., Design: Cross-sectional., Participants: For this study, 1443 children aged 18-59 months were recruited and screened in various community settings in London, Ontario., Methods: Participants were screened with the Plusoptix S12C device from September 2015 to May 2016. Data were analyzed for percentage of children referred for amblyogenic risk factors using the Arnold 2012 referral criteria. Referral, inconclusive results, follow-up rate, and positive predictive value were reported., Results: Data from 1321 children were analyzed. Mean age of children meeting the inclusion criteria was 34.1 ± 9.6 (18-58) months. One hundred and nineteen children were referred to an optometrist for a comprehensive eye exam; 39 (3.0%) were inconclusive screens. The referral rate for children detected with amblyogenic risk factors was 6.1%. Forty (50.0%) children were documented as complying with the follow-up examination. The positive predictive value was 81.8%., Conclusions: Our community-wide vision screening program identified in a timely, manner, 80 preschoolers with amblyogenic risk factors previously unknown to be present. Results identified children with amblyogenic risk factors that may have gone undetected. This program could serve as a model for consideration by policy makers., (Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)