scholarly journals Diabetic retinopathy service delivery and integration into the health system in Pakistan—Findings from a multicentre qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260936
Author(s):  
Stevens Bechange ◽  
Anne Roca ◽  
Elena Schmidt ◽  
Munazza Gillani ◽  
Leena Ahmed ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Health Workers ◽  
Tracking System ◽  
Integrated Approach ◽  
Community Services ◽  
Great Promise ◽  
Diabetic Patients ◽  
Local Health ◽  
Integration Of Services ◽  
The Impact

This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments’ priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.

scholarly journals The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Miao Liu ◽  
Jianhua Wang ◽  
Yao He
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Risk Model ◽  
Continuous Variable ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Lower Baseline ◽  
The Impact ◽  
Chinese Male

Aims. This study aimed at assessing the impact of baseline bilirubin (TBiL) on the incidence of diabetic retinopathy (DR) based on a five-year cohort study which consisted of 5323 Chinese male diabetic patients.Methods. A cohort study based on 5323 male diabetic patients was conducted in Beijing, from 2009 to 2013. Both baseline TBiL and follow-up changes were measured. Cox proportional risk model was used to calculate the hazard ratio (HR) of TBiL for DR risk.Results. During the follow-up period, there were 269 new DR cases. The incidence of five-year follow-up was 5.1% (95% CI: 4.5%~5.6%). The TBiL level of those who had diabetic retinopathy was lower than that of those without (12.51+ 1.20 mol/L and 13.11+ 1.32μmol/L,P=0.033). And more interestingly, along with the quintiles of baseline TBiL, there showed a U-shaped curve with DR incidence. And the RRs were 0.928 (95% CI: 0.646–1.331), 0.544 (95% CI: 0.365–0.811), 0.913 (95% CI: 0.629–1.324), and 1.035 (95% CI: 0.725–1.479) for the second, third, fourth, and fifth quintiles of baseline TBiL levels, respectively, compared with the first quintile. For follow-up TBiL changes, after being adjusted for related covariables and baseline TBiL levels (as continuous variable) in the model, the RRs for DR were 1.411 (95% CI: 1.081–1.842) for those who had decreased TBiL level and 0.858 (95% CI: 0.770–0.947) for those who had increased TBiL level during follow-up. And this association was more prominent among those with lower baseline TBiL level.Conclusions. Serum TBiL had a U-shaped relationship with DR incidence, which was independent of control status of diabetes and other related covariates.

scholarly journals The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Giuseppe Scarpa ◽  
Francesca Urban ◽  
Stela Vujosevic ◽  
Michele Tessarin ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Early Detection ◽  
Large Scale ◽  
Screening Programme ◽  
Cost Effective ◽  
Diabetic Patients ◽  
Local Health Authority ◽  
Local Health ◽  
Fundus Camera ◽  
Diabetic Retinopathy Screening

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

scholarly journals Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Lao PDR

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Monnaphat Jongdeepaisal ◽  
Soulixay Inthasone ◽  
Panarasri Khonputsa ◽  
Vilayvone Malaphone ◽  
Kulchada Pongsoipetch ◽  
...  
Keyword(s):  
Health Workers ◽  
Lao Pdr ◽  
Integrated Approach ◽  
Careful Consideration ◽  
Control Measures ◽  
Indigenous Populations ◽  
Local Health ◽  
Prophylactic Regimen ◽  
Incidence And Mortality ◽  
Depth Interviews

Abstract Background Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge in the region; transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited exposure periods, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of anti-malarial chemoprophylaxis for forest goers in Lao PDR. Methods In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis. Results In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit sub-optimally using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Lao PDR. Among policymakers, choice and cost of anti-malarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.

scholarly journals Correlation between types of diabetic retinopathy and its psychosocial impact

2015 ◽  
Author(s):  
Chinmay T Jani ◽  
Tejas Desai ◽  
Sonal Parikh ◽  
Aashka A Shah ◽  
Sonali Katara
Keyword(s):  
Diabetic Retinopathy ◽  
General Health Questionnaire ◽  
Proliferative Retinopathy ◽  
P Value ◽  
Diabetic Patients ◽  
Psychosocial Impairment ◽  
Language Version ◽  
Gujarati Language ◽  
The Impact

INTRODUCTION: Diabetic retinopathy affects majority (70% to 90%) of diabetic patients, causes visual impairment which leads to severe psycho-social disruption in life. Our objective was to study the patients of diabetic retinopathy, co-relate between the types of diabetic retinopathy and the extent of psychosocial impairment in these patients. MATERIALS AND METHODS: Data of the diabetic patients attending the Retina Clinic of C.H. Nagri Eye Hospital, Ahmedabad was collected using a pretested questionnaire. It included ocular history, history related to diabetes, data of ocular examination and type of retinopathy (if present). For psycho-social assessment, the patients were made to fill the validated Gujarati language version of “General Health Questionnaire -28 (GHQ 28).” Self-scoring was done ranging from 0-1-2-3 (lower to higher disability respectively). Analysis of significance was carried out by Mann-Whitney Test using statistical software. RESULTS: Total 308 patients were studied. The subjects were divided into 3 groups: (A) Diabetes Mellitus Type-2 (DM-2) patients without retinopathy. (B) DM-2 patients having Non-Proliferative Retinopathy (C) DM-2 patients having Proliferative Retinopathy. According to the accepted scoring pattern of GHQ-28 (cut of point 25), it was observed that 80.26% of patients having non proliferative retinopathy in both eyes and 93.75% patients having proliferative retinopathy in both eyes were psychosocially impaired. The impairment was found to be more severe in proliferative retinopathy patients as compared to non-proliferative retinopathy patients. (p value <0.005) (Mean GHQ score in PDR=41.88 > NPDR = 35.74). It was also found that in DM-2 patients without retinopathy the average mean score was 25.22 which showed less impairment (p value <0.005). Detailed analysis showed that there was more impairment in the field of social dysfunction. CONCLUSION: Patients of Diabetic Retinopathy had more psychosocial impairment which shows its significant impact on quality of life and overall health. Psychiatric counselling must be given to the impaired patients to decrease the impact of the disease on the psychosocial aspect of health. It is necessary to decrease the psychosocial suffering along with the control of disease.

scholarly journals Acceptability of Information Technology Systems Developed for Distant Philippine Communities among Local Health Providers

2021 ◽  
Author(s):  
Alvin B. Caballes
Keyword(s):  
Information Technology ◽  
Health Workers ◽  
Tracking System ◽  
Relevant Information ◽  
Local Health ◽  
Health Providers ◽  
Diagnostic Device ◽  
Health Records ◽  
It Systems ◽  
Device Component

Introduction. The National Telehealth Service Program (NTSP) has developed Information Technology (IT) systems aimed at improving health services primarily in isolated Philippine communities. These included two electronic health records modalities (Community Health Information Tracking System, or CHITS, and Real-time Regular Routine Reporting for Health, or R4Health), a referral system (Telemedicine), and a remote diagnostic device (RxBox).Objectives. This study was undertaken to describe the utilization and cost patterns as well as the perceptions of the local health personnel regarding the use of the various NTSP systems. The implications of the end-user perceptions on the acceptability and expanded use of the IT interventions were inferred, from which corresponding policy recommendations were made.Methods. Twelve NTSP sites, including far-flung and economically depressed communities, where the systems were concurrently available over a defined six month period, were selected. The frequency of respective system transactions for these sites was collected from NTSP files. Interviews and focus group discussions were conducted at the communities, involving physicians, nurses, midwives, and other health workers. Associated costs, and perceptions related to the adoption, operation, and sustained use of the IT systems were elucidated.Results. Telemedicine, though the least costly modality, was the least utilized of the systems. While both R4Health and CHITS facilitated health data management, CHITS provided more locally-relevant information. The RxBox system, due to its clinical diagnostic device component, was widely accepted and also increased health center consultations, especially among pregnant patients. Technical malfunctions, as well as system failures following natural calamities, were recurrent problems.Conclusions. The RxBox system, with its bundled health records and specialist consultation functions, is highly accepted by health providers and other community stakeholders. The technology can be expected to be similarly well-regarded in other settings. The stand-alone IT modalities that do not directly or significantly benefit the actual implementers are not as sustainable.

scholarly journals To study the impact of diabetic retinopathy on quality of life in Indian diabetic patients

2020 ◽  
Vol 68 (5) ◽  
pp. 848
Author(s):  
Subina Narang ◽  
Jyoti Deswal ◽  
Nitin Gupta ◽  
Jitender Jinagal ◽  
Meenakshi Sindhu
Keyword(s):  
Quality Of Life ◽  
Diabetic Retinopathy ◽  
Diabetic Patients ◽  
The Impact

scholarly journals Correlation of types of diabetic retinopathy and its psychosocial impact

2018 ◽  
Vol 6 (10) ◽  
pp. 3220
Author(s):  
Chinmay T. Jani ◽  
Tejas R. Desai ◽  
Sonal Parikh ◽  
Ashka S. Shah
Keyword(s):  
Diabetic Retinopathy ◽  
General Health Questionnaire ◽  
Proliferative Retinopathy ◽  
P Value ◽  
Diabetic Patients ◽  
Psychosocial Impairment ◽  
Language Version ◽  
Gujarati Language ◽  
The Impact

Background: Diabetic retinopathy affects majority (70% to 90%) of diabetic patients, causes visual impairment which leads to severe psycho-social disruption in life. Our objective was to study the patients of diabetic retinopathy, co-relate between the types of diabetic retinopathy and the extent of psychosocial impairment in these patients.Methods: Data of the diabetic patients attending the Retina Clinic of C.H. Nagri Eye Hospital, Ahmedabad was collected using a pretested questionnaire. It included ocular history, history related to diabetes, data of ocular examination and type of retinopathy (if present). For psycho-social assessment, the patients were asked to fill the validated Gujarati language version of “General Health Questionnaire -28 (GHQ 28).” Selfscoring was done ranging from 0-1-2-3 (lower to higher disability respectively). Analysis of significance was carried out by Mann-Whitney Test using statistical software.Results: Total 308 patients were studied. The subjects were divided into 3 groups: (A) Diabetes mellitus type-2 (DM-2) patients without retinopathy. (B) DM-2 patients having non-proliferative retinopathy (C) DM-2 patients having proliferative retinopathy. According to the accepted scoring pattern of GHQ-28 (cut of point 25), it was observed that 80.26% of patients having non-proliferative retinopathy in both eyes and 93.75% patients having proliferative retinopathy in both eyes were psychosocially impaired. The impairment was found to be more severe in proliferative retinopathy patients as compared to non-proliferative retinopathy patients. (p value <0.005) (mean GHQ score in PDR=41.88 >NPDR = 35.74). It was also found that in DM-2 patients without retinopathy the average mean score was 25.22 which showed less impairment (p value <0.005).Conclusions: Patients of Diabetic Retinopathy had more psychosocial impairment which shows its significant impact on quality of life and overall health. Psychiatric counselling must be given to the impaired patients to decrease the impact of the disease on the psychosocial aspect of health. It is necessary to decrease the psychosocial suffering along with the control of disease.

scholarly journals Correlation between types of diabetic retinopathy and its psychosocial impact

2015 ◽  
Author(s):  
Chinmay T Jani ◽  
Tejas Desai ◽  
Sonal Parikh ◽  
Aashka A Shah ◽  
Sonali Katara
Keyword(s):  
Diabetic Retinopathy ◽  
General Health Questionnaire ◽  
Proliferative Retinopathy ◽  
P Value ◽  
Diabetic Patients ◽  
Psychosocial Impairment ◽  
Language Version ◽  
Gujarati Language ◽  
The Impact

INTRODUCTION: Diabetic retinopathy affects majority (70% to 90%) of diabetic patients, causes visual impairment which leads to severe psycho-social disruption in life. Our objective was to study the patients of diabetic retinopathy, co-relate between the types of diabetic retinopathy and the extent of psychosocial impairment in these patients. MATERIALS AND METHODS: Data of the diabetic patients attending the Retina Clinic of C.H. Nagri Eye Hospital, Ahmedabad was collected using a pretested questionnaire. It included ocular history, history related to diabetes, data of ocular examination and type of retinopathy (if present). For psycho-social assessment, the patients were made to fill the validated Gujarati language version of “General Health Questionnaire -28 (GHQ 28).” Self-scoring was done ranging from 0-1-2-3 (lower to higher disability respectively). Analysis of significance was carried out by Mann-Whitney Test using statistical software. RESULTS: Total 308 patients were studied. The subjects were divided into 3 groups: (A) Diabetes Mellitus Type-2 (DM-2) patients without retinopathy. (B) DM-2 patients having Non-Proliferative Retinopathy (C) DM-2 patients having Proliferative Retinopathy. According to the accepted scoring pattern of GHQ-28 (cut of point 25), it was observed that 80.26% of patients having non proliferative retinopathy in both eyes and 93.75% patients having proliferative retinopathy in both eyes were psychosocially impaired. The impairment was found to be more severe in proliferative retinopathy patients as compared to non-proliferative retinopathy patients. (p value <0.005) (Mean GHQ score in PDR=41.88 > NPDR = 35.74). It was also found that in DM-2 patients without retinopathy the average mean score was 25.22 which showed less impairment (p value <0.005). Detailed analysis showed that there was more impairment in the field of social dysfunction. CONCLUSION: Patients of Diabetic Retinopathy had more psychosocial impairment which shows its significant impact on quality of life and overall health. Psychiatric counselling must be given to the impaired patients to decrease the impact of the disease on the psychosocial aspect of health. It is necessary to decrease the psychosocial suffering along with the control of disease.

The Impact of Associated Diabetic Retinopathy on Stroke and Severe Bleeding Risk in Diabetic Patients With Atrial Fibrillation

CHEST Journal ◽  
2015 ◽  
Vol 147 (4) ◽  
pp. 1103-1110 ◽  
Author(s):  
Gregory Y.H. Lip ◽  
Nicolas Clementy ◽  
Bertrand Pierre ◽  
Mathieu Boyer ◽  
Laurent Fauchier
Keyword(s):  
Atrial Fibrillation ◽  
Diabetic Retinopathy ◽  
Bleeding Risk ◽  
Diabetic Patients ◽  
Severe Bleeding ◽  
The Impact

scholarly journals Forest Malaria and Prospects for Antimalarial Chemoprophylaxis Among Forest Goers: Findings From a Qualitative Study in Lao PDR

2021 ◽  
Author(s):  
Monnaphat Jongdeepaisal ◽  
Soulixay Inthasone ◽  
Panarasri Khonputsa ◽  
Vilayvone Malaphone ◽  
Kulchada Pongsoipetch ◽  
...  
Keyword(s):  
Health Workers ◽  
Lao Pdr ◽  
Integrated Approach ◽  
Careful Consideration ◽  
Control Measures ◽  
Indigenous Populations ◽  
Local Health ◽  
Prophylactic Regimen ◽  
Incidence And Mortality ◽  
Depth Interviews

Abstract Background Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge. Transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited periods of exposure, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of antimalarial chemoprophylaxis for forest goers in Lao PDR.Methods In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis.Results In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit suboptimality using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Laos. Among policymakers, choice and cost of antimalarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.

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