1
|
De-La-Borda-Prazak G, Mendez-Guerra C, Huertas-Campos F, Herrera-Añazco P, Benites-Zapata VA. Ethnicity and refractive errors in Peruvian children aged 7-11 years: A five-year analysis of the Demographic and Health Survey. JOURNAL OF OPTOMETRY 2024; 17:100486. [PMID: 38713932 PMCID: PMC11091506 DOI: 10.1016/j.optom.2023.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To assess the association between ethnicity and self-reported refractive errors (REs) among Peruvian children aged 7-11 years. MATERIALS AND METHODS We conducted a cross-sectional study incorporating a secondary data analysis of 2017-2021 data from the Peruvian Demographic and Health Survey (DHS). REs and ethnicity were obtained from focal child's mother's report. Four outcomes were assessed: hyperopia, myopia, astigmatism and any RE. We included potential confounders, such as age, sex, wealth index, area of residence, region of origin, frequency of watching TV and watching screens at less than 30 cm distance. Generalised linear models with the Poisson family and log link function were used to calculate crude prevalence ratio and adjusted prevalence ratio (aPR) with 95% confidence intervals (95% CI). RESULTS Data from a total of 52,753 children were included. The prevalence of RE in children aged 7-11 years was 10.90% (95% CI 10.49-11.33), of which 5.19% were hyperopia, 3.35% myopia and 2.36% astigmatism. Those of the Aymara ethnicity were less likely to suffer from any RE and astigmatism (aPR = 0.68, 95% CI 0.46-0.99, p = 0.046; aPR = 0.70, 95% CI 0.53-0.92, p = 0.012, respectively), Members of Amazon groups were more likely to have hyperopia (aPR = 1.95, 95% CI 1.14-3.36, p = 0.015) and Quechuas were more likely to have myopia (aPR =1.29, 95% CI 1.02-1.62, p = 0.028), where all were compared to Mestizos. CONCLUSION About 1 in 10 Peruvian children suffer from a RE. The most frequent RE in this study was hyperopia. Ethnic differences were seen in the frequency of RE.
Collapse
Affiliation(s)
| | | | | | | | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
| |
Collapse
|
2
|
Etty MC, Michaelsen S, Yelle B, Beaulieu K, Jacques P, Ettaleb S, Samaha D, Tousignant B, Druetz T. The sociodemographic characteristics and social determinants of visual impairment in a homeless population in the Montreal area. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:113-124. [PMID: 35969355 PMCID: PMC9377295 DOI: 10.17269/s41997-022-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/11/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Homelessness is a serious social and public health concern in Canada. Individuals experiencing homelessness face numerous health problems and barriers in accessing health services. Visual impairment can exacerbate the lower quality of life experienced by people who are homeless, but its incidence among this population has been poorly documented in the literature. Our study aimed to describe health and sociodemographic characteristics and determine their association with visual impairment, ocular pathology and uncorrected refractive errors in a homeless population in Montreal, Canada. METHODS This cross-sectional study was conducted between May 2019 and September 2020 in eight homeless shelters selected using a stratified random sampling approach on the island of Montreal. An eye examination was performed on all participants, who were also administered a survey on social determinants of health. Descriptive analysis was used to analyze survey data, and logistic regression was used for each of the three study outcomes. RESULTS A total of 124 individuals experiencing homelessness (93 men, 31 women) were recruited. Participants were mostly Caucasian (> 70%) with an average age of 48 years (standard deviation = 13 years). Our sample reported a high level of education (68% had a high school diploma or higher), a high level of health insurance coverage (77%), social assistance benefits (71%), and social support (over 50%). There was a high prevalence of chronic conditions including diabetes (14%), hypertension (25%), and HIV/AIDS (3%). Results from eye examinations showed a high prevalence of visual impairment (22%), ocular pathology (23%), and uncorrected refractive error (75%). Age was statistically significantly associated with each outcome variable. CONCLUSION Despite a high level of social and health support, individuals experiencing homelessness in Montreal, Canada, experience high levels of chronic conditions and visual impairment. Our study highlights the unmet need for eye healthcare among homeless populations, and that eye health can be a unique entry point for intervening with homeless populations.
Collapse
Affiliation(s)
- Marie-Christine Etty
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada
| | - Sonia Michaelsen
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada
| | - Brittany Yelle
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Kimberlie Beaulieu
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Patricia Jacques
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Sarah Ettaleb
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Dan Samaha
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Benoit Tousignant
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada ,School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada ,Public Health Research Centre (CReSP), University of Montreal, C.P. 6128 Succursale Centre-Ville, Montreal, QC H3C 3J7 Canada
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada. .,Public Health Research Centre (CReSP), University of Montreal, C.P. 6128 Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
| |
Collapse
|
3
|
Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
Collapse
Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| |
Collapse
|
4
|
Yelle B, Beaulieu K, Etty MC, Michaelsen S, Druetz T, Damaha D, Tousignant B. The prevalence and causes of visual impairment among the male homeless population of Montreal, Canada. Clin Exp Optom 2022; 106:431-435. [PMID: 35156540 DOI: 10.1080/08164622.2022.2036578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Homeless populations have lower health indicators, including in eye care. Few data exist on the levels and causes of visual impairment in Canadian homeless populations, and none in Montreal. BACKGROUND This study aims to characterise the causes and levels of visual impairment, as well as eye care services utilisation among the Montreal homeless. METHODS Using random sampling, five homeless shelters were selected. In each shelter, 20 participants were randomly selected. After obtaining informed consent, participants completed an ocular examination, which included: presenting visual acuity (pinhole as needed), intraocular pressure, confrontation visual field, dilated fundus examination, post-dilation autorefraction and questionnaire on social determinants of health. RESULTS A total of 95 participants were examined, of which 97.9% were male. The median age was 49 years old (interquartile range 38-56.5). The age-adjusted prevalence of visual impairment (presenting visual acuity <6/12) was 23.6% (95% CI 15.1-32.9) compared to 6.0% in the Canadian population (Z = 77.9, p < 0.0001). With pinhole correction, the prevalence of visual impairment dropped to 5.8% (95% CI 1.7-11.8). Prevalence was 8.2% (95% CI 3.7-15.9) for cataracts, 11.4% (95% CI 5.9-19.7) for glaucoma or suspects and 4.7% (95% CI 1.7-11.9) for diabetic retinopathy. Lastly, 18.9% of participants had an ocular examination within the last year compared to 41.4% in Canada (Z = -4.5, p < 0.0001) and 13.7% had never had a comprehensive eye examination. CONCLUSIONS This sample population shows a prevalence of visual impairment which is four times that of the general Canadian population, with highly prevalent uncorrected refractive error, while accessing primary eye care twice less often.
Collapse
Affiliation(s)
- Brittany Yelle
- School of Optometry, Université de Montréal, Montreal, QC, Canada
| | | | | | - Sonia Michaelsen
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Thomas Druetz
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Dan Damaha
- School of Optometry, Université de Montréal, Montreal, QC, Canada
| | | |
Collapse
|
5
|
Barrenechea-Pulache A, Portocarrero-Bonifaz A, Hernández-Vásquez A, Portocarrero-Ramos C, Moscoso-Carrasco J. Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey. Ophthalmic Epidemiol 2021; 29:339-348. [PMID: 34251970 DOI: 10.1080/09286586.2021.1948577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. METHODS A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. RESULTS Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33-2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28-1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67-2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74-3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. CONCLUSION The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.
Collapse
Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Universidad San Ignacio De Loyola, Vicerrectorado De Investigación, Centro De Excelencia En Investigaciones Económicas Y Sociales En Salud. Lima, Peru
| | | | - Jenny Moscoso-Carrasco
- Departamento de salud pública y administración, Unidad de epidemiolgia, ETS y VIH, Unidad De Informática Biomédica En Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|