Why optometry must work from urban and regional Aboriginal Health Services

The gap in vision and ocular health between Aboriginal and Torres Strait Islander Australians and other Australians continues to be significant, yet three‐quarters of the identified Aboriginal and Torres Strait Islander population live in urban and regional areas of Australia where existing eye‐care services are available. In urban Australia, an improvement in the access and use of eye‐health services is required to provide equitable eye‐care outcomes for Australia's Indigenous peoples. Optometric services need to be available within Aboriginal Health Services in urban areas to effectively close the gap for vision.     

Is Gender a Risk Factor for Pesticide Intoxications Among Farmers in Bolivia? A Cross-Sectional Study

ABSTRACT

This study compares gender differences regarding knowledge, practice, and symptoms of intoxication when handling pesticides in farming. Data were gathered in La Paz County, Bolivia, in 2008 and 2009. Poor knowledge on safe handling, hazardous working practices, and use of very toxic pesticides were seen. Being a female and having a low educational level were risk factors for “poor knowledge on pesticides” and a “risky behavior when handling pesticides.” Females reported more symptoms of intoxication. The gender differences on knowledge and handling practices might explain why females report more symptoms. To minimize this gap, education and agricultural services should be made more accessible to female farmers in Bolivia.     

Occupational Exposure to Mercury Vapors and Biological Action

In workers exposed to an average atmospheric mercury vapor concentration below the current threshold limit value (TLV, 0.050 mg/cu m), the following biological changes were detected: increased blood and urine mercury concentrations, increased plasma galactosidase and plasma catalase activities, decreased red blood cell (RBC) cholinesterase activity. A significant correlation was found between airborne mercury level and urinary mercury concentration (r = 0.47), between mercury concentration in blood and in urine (r = 0.36), and between airborne mercury concentration and RBC cholinesterase inhibition (r = 0.33). Serum cholinesterase, RBC δ-aminolevulinic acid (ALA) dehydratase, and urine ALA levels were normal. No significant anomalies were found on the amino acid chromatographs and protein electrophoresis of serum and urine.     

A codesigned integrated kidney and diabetes model of care improves patient activation among patients from culturally and linguistically diverse backgrounds

Background

Little is known about the relationship between patients' cultural and linguistic backgrounds and patient activation, especially in people with diabetes and chronic kidney disease (CKD). We examined the association between culturally and linguistically diverse (CALD) background and patient activation and evaluated the impact of a codesigned integrated kidney and diabetes model of care on patient activation by CALD status in people with diabetes and CKD.

Methods

This longitudinal study recruited adults with diabetes and CKD (Stage 3a or worse) who attended a new diabetes and kidney disease service at a tertiary hospital. All completed the patient activation measure at baseline and after 12 months and had demographic and clinical data collected. Patients from CALD backgrounds included individuals who spoke a language other than English at home, while those from non-CALD backgrounds spoke English only as their primary language. Paired t-tests compared baseline and 12-month patient activation scores by CALD status.

Results

Patients from CALD backgrounds had lower activation scores (52.1 ± 17.6) compared to those from non-CALD backgrounds (58.5 ± 14.6) at baseline. Within-group comparisons showed that patient activation scores for patients from CALD backgrounds significantly improved by 7 points from baseline to 12 months follow-up (52.1 ± 17.6–59.4 ± 14.7), and no significant change was observed for those from non-CALD backgrounds (58.5 ± 14.6–58.8 ± 13.6).

Conclusions

Among patients with diabetes and CKD, those from CALD backgrounds report worse activation scores. Interventions that support people from CALD backgrounds with comorbid diabetes and CKD, such as the integrated kidney and diabetes model of care, may address racial and ethnic disparities that exist in patient activation and thus improve clinical outcomes.

Patient or Public Contribution

Patients, caregivers and national consumer advocacy organisations (Diabetes Australia and Kidney Health Australia) codesigned a new model of care in partnership with healthcare professionals and researchers. The development of the model of care was informed by focus groups of patients and healthcare professionals and semi-structured interviews of caregivers and healthcare professionals. Patients and caregivers also provided a rigorous evaluation of the new model of care, highlighting its strengths and weaknesses.