{"id":"https://openalex.org/W7128315661","doi":"https://doi.org/10.1080/17450128.2026.2621047","title":"Visual acuity problems, access to care, and related academic performance among primary school students in Tanzania: a mixed methods study","display_name":"Visual acuity problems, access to care, and related academic performance among primary school students in Tanzania: a mixed methods study","publication_year":2026,"publication_date":"2026-02-07","ids":{"openalex":"https://openalex.org/W7128315661","doi":"https://doi.org/10.1080/17450128.2026.2621047","pmid":"https://pubmed.ncbi.nlm.nih.gov/41788225"},"language":"en","primary_location":{"id":"doi:10.1080/17450128.2026.2621047","doi":"https://doi.org/10.1080/17450128.2026.2621047","is_oa":false,"landing_page_url":"https://doi.org/10.1080/17450128.2026.2621047","pdf_url":null,"source":{"id":"https://openalex.org/S138054872","display_name":"Vulnerable Children and Youth Studies","issn_l":"1745-0128","issn":["1745-0128","1745-0136"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","jufo-1","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319847","host_organization_name":"Routledge","host_organization_lineage":["https://openalex.org/P4310319847","https://openalex.org/P4310320547"],"host_organization_lineage_names":["Routledge","Taylor & Francis"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Vulnerable Children and Youth Studies","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12959907/","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5122112802","display_name":"Michael Maizel","orcid":"https://orcid.org/0009-0001-0297-5755","observed_orcids":["https://orcid.org/0009-0001-0297-5755"]},"institutions":[{"id":"https://openalex.org/I114027177","display_name":"University of North Carolina at Chapel Hill","ror":"https://ror.org/0130frc33","country_code":"US","type":"education","lineage":["https://openalex.org/I114027177"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Michael Maizel","raw_affiliation_strings":["University of North Carolina at Chapel Hill"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of North Carolina at Chapel Hill","institution_ids":["https://openalex.org/I114027177"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5005159567","display_name":"Arisa Shichijo","orcid":"https://orcid.org/0009-0004-5517-6211","observed_orcids":["https://orcid.org/0009-0004-5517-6211"]},"institutions":[{"id":"https://openalex.org/I114027177","display_name":"University of North Carolina at Chapel Hill","ror":"https://ror.org/0130frc33","country_code":"US","type":"education","lineage":["https://openalex.org/I114027177"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Arisa Shichijo","raw_affiliation_strings":["University of North Carolina at Chapel Hill"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of North Carolina at Chapel Hill","institution_ids":["https://openalex.org/I114027177"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093941165","display_name":"David Gitagno","orcid":"https://orcid.org/0009-0005-1047-6197","observed_orcids":["https://orcid.org/0009-0005-1047-6197"]},"institutions":[{"id":"https://openalex.org/I154840374","display_name":"Muhimbili University of Health and Allied Sciences","ror":"https://ror.org/027pr6c67","country_code":"TZ","type":"education","lineage":["https://openalex.org/I154840374"]}],"countries":["TZ"],"is_corresponding":false,"raw_author_name":"David Gitagno","raw_affiliation_strings":["Muhimbili University of Health & Allied Sciences"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Muhimbili University of Health & Allied Sciences","institution_ids":["https://openalex.org/I154840374"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5087423999","display_name":"Rachel Jared Mtei","orcid":"https://orcid.org/0009-0006-2839-5536","observed_orcids":["https://orcid.org/0009-0006-2839-5536"]},"institutions":[{"id":"https://openalex.org/I154840374","display_name":"Muhimbili University of Health and Allied Sciences","ror":"https://ror.org/027pr6c67","country_code":"TZ","type":"education","lineage":["https://openalex.org/I154840374"]}],"countries":["TZ"],"is_corresponding":false,"raw_author_name":"Rachel Jared Mtei","raw_affiliation_strings":["Muhimbili University of Health & Allied Sciences"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Muhimbili University of Health & Allied Sciences","institution_ids":["https://openalex.org/I154840374"]}]},{"author_position":"middle","author":{"id":null,"display_name":"Katalia Alexander","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I114027177","display_name":"University of North Carolina at Chapel Hill","ror":"https://ror.org/0130frc33","country_code":"US","type":"education","lineage":["https://openalex.org/I114027177"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Katalia Alexander","raw_affiliation_strings":["University of North Carolina at Chapel Hill"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of North Carolina at Chapel Hill","institution_ids":["https://openalex.org/I114027177"]}]},{"author_position":"middle","author":{"id":null,"display_name":"Joseph R. Egger","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I170897317","display_name":"Duke University","ror":"https://ror.org/00py81415","country_code":"US","type":"education","lineage":["https://openalex.org/I170897317"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Joseph R. Egger","raw_affiliation_strings":["Duke University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Duke University","institution_ids":["https://openalex.org/I170897317"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5006606494","display_name":"Anna Minja","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I154840374","display_name":"Muhimbili University of Health and Allied Sciences","ror":"https://ror.org/027pr6c67","country_code":"TZ","type":"education","lineage":["https://openalex.org/I154840374"]}],"countries":["TZ"],"is_corresponding":false,"raw_author_name":"Anna Minja","raw_affiliation_strings":["Muhimbili University of Health & Allied Sciences"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Muhimbili University of Health & Allied Sciences","institution_ids":["https://openalex.org/I154840374"]}]},{"author_position":"middle","author":{"id":null,"display_name":"Emily W. Gower","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I114027177","display_name":"University of North Carolina at Chapel Hill","ror":"https://ror.org/0130frc33","country_code":"US","type":"education","lineage":["https://openalex.org/I114027177"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Emily W. Gower","raw_affiliation_strings":["University of North Carolina at Chapel Hill"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of North Carolina at Chapel Hill","institution_ids":["https://openalex.org/I114027177"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5026091946","display_name":"Eric van Praag","orcid":"https://orcid.org/0000-0003-3889-783X","observed_orcids":["https://orcid.org/0000-0003-3889-783X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Eric van Praag","raw_affiliation_strings":["Independent Consultant"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Independent Consultant","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031473274","display_name":"Isaac Lema","orcid":"https://orcid.org/0009-0002-3480-865X","observed_orcids":["https://orcid.org/0009-0002-3480-865X"]},"institutions":[{"id":"https://openalex.org/I154840374","display_name":"Muhimbili University of Health and Allied Sciences","ror":"https://ror.org/027pr6c67","country_code":"TZ","type":"education","lineage":["https://openalex.org/I154840374"]}],"countries":["TZ"],"is_corresponding":false,"raw_author_name":"Isaac Lema","raw_affiliation_strings":["Muhimbili University of Health & Allied Sciences"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Muhimbili University of Health & Allied Sciences","institution_ids":["https://openalex.org/I154840374"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5074890349","display_name":"Sylvia Kaaya","orcid":"https://orcid.org/0000-0001-6732-3590","observed_orcids":["https://orcid.org/0000-0001-6732-3590"]},"institutions":[{"id":"https://openalex.org/I154840374","display_name":"Muhimbili University of Health and Allied Sciences","ror":"https://ror.org/027pr6c67","country_code":"TZ","type":"education","lineage":["https://openalex.org/I154840374"]}],"countries":["TZ"],"is_corresponding":false,"raw_author_name":"Sylvia Kaaya","raw_affiliation_strings":["Muhimbili University of Health & Allied Sciences"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Muhimbili University of Health & Allied Sciences","institution_ids":["https://openalex.org/I154840374"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5043041584","display_name":"Joy Noel Baumgartner","orcid":"https://orcid.org/0000-0002-1783-8972","observed_orcids":["https://orcid.org/0000-0002-1783-8972"]},"institutions":[{"id":"https://openalex.org/I114027177","display_name":"University of North Carolina at Chapel Hill","ror":"https://ror.org/0130frc33","country_code":"US","type":"education","lineage":["https://openalex.org/I114027177"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Joy Noel Baumgartner","raw_affiliation_strings":["University of North Carolina at Chapel Hill"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of North Carolina at Chapel Hill","institution_ids":["https://openalex.org/I114027177"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5043041584"],"corresponding_institution_ids":["https://openalex.org/I114027177"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.07658581,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":"1","last_page":"22"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10381","display_name":"Ophthalmology and Visual Impairment Studies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10381","display_name":"Ophthalmology and Visual Impairment Studies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12831","display_name":"School Health and Nursing Education","score":0.0,"subfield":{"id":"https://openalex.org/subfields/3616","display_name":"Speech and Hearing"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10596","display_name":"Child Nutrition and Water Access","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/school-vision-screening","display_name":"school vision screening","score":0.8429999947547913},{"id":"https://openalex.org/keywords/access-to-eye-care","display_name":"access to eye care","score":0.8130000233650208},{"id":"https://openalex.org/keywords/academic-achievement","display_name":"academic performance","score":0.9200000166893005},{"id":"https://openalex.org/keywords/elementary-school-students","display_name":"elementary school students","score":0.9430000185966492},{"id":"https://openalex.org/keywords/financial-barriers-to-care","display_name":"financial barriers to care","score":0.6439999938011169}],"concepts":[{"id":"https://openalex.org/C2778257484","wikidata":"https://www.wikidata.org/wiki/Q555066","display_name":"Visual acuity","level":2,"score":0.5530999898910522},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5232999920845032},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.47200000286102295},{"id":"https://openalex.org/C119767625","wikidata":"https://www.wikidata.org/wiki/Q618211","display_name":"Optometry","level":1,"score":0.4641999900341034},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.37310001254081726},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.322299987077713},{"id":"https://openalex.org/C99508421","wikidata":"https://www.wikidata.org/wiki/Q2678675","display_name":"Physical medicine and rehabilitation","level":1,"score":0.2703999876976013},{"id":"https://openalex.org/C75630572","wikidata":"https://www.wikidata.org/wiki/Q538904","display_name":"Applied psychology","level":1,"score":0.24330000579357147},{"id":"https://openalex.org/C2986587452","wikidata":"https://www.wikidata.org/wiki/Q938438","display_name":"Statistical analysis","level":2,"score":0.24330000579357147},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.23849999904632568}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1080/17450128.2026.2621047","doi":"https://doi.org/10.1080/17450128.2026.2621047","is_oa":false,"landing_page_url":"https://doi.org/10.1080/17450128.2026.2621047","pdf_url":null,"source":{"id":"https://openalex.org/S138054872","display_name":"Vulnerable Children and Youth Studies","issn_l":"1745-0128","issn":["1745-0128","1745-0136"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","jufo-1","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319847","host_organization_name":"Routledge","host_organization_lineage":["https://openalex.org/P4310319847","https://openalex.org/P4310320547"],"host_organization_lineage_names":["Routledge","Taylor & Francis"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Vulnerable Children and Youth Studies","raw_type":"journal-article"},{"id":"pmid:41788225","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41788225","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Vulnerable children and youth studies","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:12959907","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12959907/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Vulnerable Child Youth Stud","raw_type":"Text"}],"best_oa_location":{"id":"pmh:oai:pubmedcentral.nih.gov:12959907","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12959907/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Vulnerable Child Youth Stud","raw_type":"Text"},"sustainable_development_goals":[{"score":0.98580002784729,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"},{"score":0.9235000014305115,"id":"https://metadata.un.org/sdg/4","display_name":"Quality education"},{"score":0.5676000118255615,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"}],"sustainable_development_goals_aurora":[{"score":0.7575249075889587,"id":"https://metadata.un.org/sdg/4","display_name":"Quality education"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G7670702667","display_name":"Adolescent Wellness Visits in Tanzania","funder_award_id":"R01HD102279","funder_id":"https://openalex.org/F4320337611","funder_display_name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development"}],"funders":[{"id":"https://openalex.org/F4320332161","display_name":"National Institutes of Health","ror":"https://ror.org/01cwqze88"},{"id":"https://openalex.org/F4320337364","display_name":"National Institute of Child Health and Human Development","ror":"https://ror.org/04byxyr05"},{"id":"https://openalex.org/F4320337611","display_name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","ror":"https://ror.org/04byxyr05"}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":34,"referenced_works":["https://openalex.org/W1549672311","https://openalex.org/W1891849751","https://openalex.org/W1992611204","https://openalex.org/W1996523216","https://openalex.org/W1997548489","https://openalex.org/W2020155291","https://openalex.org/W2051848389","https://openalex.org/W2093277759","https://openalex.org/W2150206563","https://openalex.org/W2152304019","https://openalex.org/W2168396441","https://openalex.org/W2764218365","https://openalex.org/W2765989435","https://openalex.org/W2773100328","https://openalex.org/W2892906463","https://openalex.org/W2954850454","https://openalex.org/W3014019297","https://openalex.org/W3103716639","https://openalex.org/W3130938027","https://openalex.org/W3158790149","https://openalex.org/W3198699313","https://openalex.org/W3204539510","https://openalex.org/W4200030353","https://openalex.org/W4206958291","https://openalex.org/W4220790233","https://openalex.org/W4220842178","https://openalex.org/W4229002036","https://openalex.org/W4234523333","https://openalex.org/W4281787639","https://openalex.org/W4306911632","https://openalex.org/W4322775548","https://openalex.org/W4388168464","https://openalex.org/W4388672762","https://openalex.org/W4393045320"],"related_works":[],"abstract_inverted_index":{"Adolescents":[0],"in":[1,14,56,59],"lower-resource":[2],"countries":[3],"face":[4],"a":[5,153],"high":[6],"burden":[7],"of":[8,22,63,130,144,169,210,218],"eye":[9,50,213],"health":[10,79],"problems.":[11],"This":[12],"study":[13],"Tanzania":[15],"aimed":[16],"to":[17,44,161,191,200,225],"1)":[18],"estimate":[19],"the":[20,60,64,158,208,216],"prevalence":[21,217],"distance":[23,34,83,233],"vision":[24,46,84,135,140,151,176,201,234],"impairment":[25,220],"among":[26],"young":[27],"adolescents,":[28],"2)":[29],"describe":[30],"academic":[31,226],"performance":[32],"by":[33,182],"visual":[35,219],"acuity":[36],"status,":[37],"and":[38,42,48,95,105,110,119,136,184,203,221,242],"3)":[39],"examine":[40],"facilitators":[41],"barriers":[43,199],"school-facilitated":[45],"screenings":[47,177],"receiving":[49],"care.":[51,174,214],"Participants":[52],"(primary":[53],"school":[54,109],"students":[55,131,145,170],"Standard":[57],"7)":[58],"intervention":[61],"arm":[62],"Vijana":[65],"Tambua":[66],"Afya,":[67],"translated":[68],"as":[69],"\"Youth":[70],"Health":[71],"Check,\"":[72],"clinical":[73],"trial":[74],"(n=509)":[75],"attended":[76],"school-facilitated,":[77],"clinic-based":[78],"check-ups":[80],"that":[81],"included":[82,89,116],"screening":[85,239],"(presenting":[86],"acuity).":[87],"Data":[88],"adolescent":[90],"surveys,":[91],"medical":[92],"record":[93],"extraction,":[94],"Primary":[96],"School":[97],"Leaving":[98],"Examination":[99],"scores.":[100],"Semi-structured":[101],"interviews":[102],"with":[103,108,146,163],"parents":[104],"focus":[106],"groups":[107],"clinic":[111],"staff":[112],"were":[113,178,188],"conducted.":[114],"Analyses":[115],"descriptive":[117],"statistics":[118],"qualitative":[120],"thematic":[121],"analysis.":[122],"Overall,":[123],"based":[124],"on":[125,141,157,207,238],"their":[126],"worse":[127],"eye,":[128],"6.9%":[129],"had":[132,138],"mildly-":[133],"reduced":[134,148],"4.3%":[137],"impaired":[139,150],"screening.":[142],"71.9%":[143],"mildly":[147],"or":[149,155],"scored":[152],"C":[154],"lower":[156],"PSLE":[159],"compared":[160],"59.9%":[162],"normal":[164],"vision.":[165],"Less":[166],"than":[167],"10%":[168],"referred":[171],"received":[172],"follow-up":[173,192,244],"School-based":[175],"deemed":[179],"largely":[180],"successful":[181],"clinicians":[183],"teachers,":[185],"but":[186],"there":[187],"challenges":[189],"related":[190],"care":[193,245],"including":[194],"referral":[195],"linkages,":[196],"households'":[197],"financial":[198],"care,":[202],"insufficient":[204],"parental":[205],"knowledge":[206],"importance":[209],"timely":[211],"pediatric":[212],"Given":[215],"its":[222],"potential":[223],"link":[224],"performance,":[227],"governments":[228],"should":[229],"consider":[230],"requiring":[231],"school-based":[232],"screenings.":[235],"Further":[236],"research":[237],"implementation":[240],"strategies":[241],"strengthening":[243],"is":[246],"needed.":[247]},"counts_by_year":[],"updated_date":"2026-10-15T10:00:46.086208","created_date":"2026-02-09T00:00:00"}