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Developing and Evaluating an Online Educational Program for Falls Prevention Care in Community Optometric Primary Care Settings: A Pilot Study

Introduction Globally, falls are the leading cause of injury hospitalisation, with vision being a significant falls risk factor. Community optometrists, as primary eye care professionals, are well positioned to contribute to falls prevention care. However, scant studies have evaluated if education could enable optometrists to incorporate falls prevention care into practice. This two-phase pilot study aimed to design and develop an online education program for community optometrists to deliver primary falls prevention care and to evaluate optometrists reaction to, and learning from, the education. Methods In phase one, an education program was designed by optometrists and falls experts and published online. In phase two, community optometrists were recruited through convenience sampling to undertake the education. Guided by the New World Kirkpatrick model(R) of training evaluation, reaction and learning were evaluated using pre/post surveys. Quantitative data were analysed using Wilcoxon sign-rank tests and McNemar Exact Tests and qualitative responses using inductive content analysis. Results Participants (n=13) reported high levels of satisfaction and engagement with the online education and unanimously endorsed its relevance to clinical practice. Participants demonstrated significantly improved knowledge and awareness of falls prevention post-education, compared to pre-education and were significantly more confident to enact falls prevention care. Perceived enablers to providing falls prevention care included having access to practical resources and ongoing education. Time constraints during consultation and cost to patients for further care if subsequent referrals were made were identified as possible barriers to providing falls prevention care. Conclusion Online education improved community optometrists knowledge and confidence to provide falls prevention care. Further research that evaluates the effectiveness of continuing education for optometrists to enact falls prevention care into practice is required.

Effect of tenofovir on the outcomes of COVID-19 in persons with chronic hepatitis B: a nationwide cohort study in Sweden.

Background: Patients with chronic hepatitis B (CHB) may have an increased risk of severe COVID-19. Tenofovir has been hypothesized to confer protection against severe disease, but evidence is inconclusive. We evaluated the risk of severe COVID-19 among CHB patients treated with tenofovir compared with other nucleos(t)ide analogues (NAs). Methods and findings: In this nationwide, registry-based cohort study, we included all adults with CHB and laboratory-confirmed COVID-19 in Sweden between February 2020 and July 2022. Data from national health and socioeconomic registers were linked using unique personal identification numbers (PINs). Patients with HIV, hepatitis C, or hepatitis D coinfection were excluded. Exposure was defined as tenofovir versus other NA therapy. The primary outcome was severe COVID-19, defined as hospitalization >2 days or death within 30 days of diagnosis. Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), controlling for age, sex, comorbidities, vaccination, socioeconomic status, and region of birth. Among 5,877 CHB patients with COVID-19, 672 were receiving NA therapy (437 tenofovir, 235 other NAs). Severe COVID-19 occurred in 8.0% of tenofovir-treated patients and 14.5% of those receiving other NAs (unadjusted OR 0.52; 95% CI, 0.31-0.85). After adjustment, the association was attenuated and no longer significant (aOR 0.72; 95% CI, 0.39-1.31). Older age, comorbidities, and unvaccinated status were strongly associated with severe disease. Conclusions: The apparent protective effect of tenofovir against severe COVID-19 in unadjusted analyses was largely explained by confounding factors. The risk of severe disease was primarily driven by age, comorbidities, and vaccination status. Prevention of severe COVID-19 in patients with CHB should instead focus on vaccination and management of comorbidities.