Rahul Chakrabarti

Knowledge, Attitudes and Practice of Diabetes in Rural Bangladesh: The Bangladesh Population Based Diabetes and Eye Study (BPDES)

Background To assess the Knowledge, Attitudes and Practice (KAP) amongst the general community regarding type 2 diabetes mellitus (DM) in rural Bangladesh. Methods Data was collected using cluster random sampling from 3104 adults residing in a rural district in Bangladesh. Participants underwent a KAP questionnaire survey regarding assessing diabetes, socio-demographic and medical history. Descriptive, Chi-square and regression analyses were performed. Results Participants were aged between 30 and 89 years (M  = 51, SD  = 11.8) and 65.5% were female. The prevalence of diabetes was found to be 8.3%. The majority (93%) reported to have heard of diabetes, yet only 4% knew what a glucose tolerance test was. Only 50% reported that they knew physical inactivity was a risk factor. Age, gender, level of education and socio-economic status (SES) were significantly associated with KAP. A lower proportion (41%) of older participants (aged ≥65 years) reported that they knew that dietary modifications assist in diabetes control compared to those aged less than 35 years (69%), p<0.001. Males (β  = 0.393, 95% CI = 0.142–0.643), and any level of education compared to no schooling (β  = 0.726, 95% CI = 0.596, 0.857) reported significantly more knowledge, after multivariate adjustments for covariates. Participants aged under 35 years, (odds ratio (OR)  = 1.73, 95% CI  = 1.22–2.43) had significantly higher positive attitudes towards treatments of diabetes compared to those aged ≥65 years. Of the 99 people with known diabetes, more than 50% (n = 52) never had their blood sugar levels checked since diagnosis. Conclusions Knowledge of diabetes and its risk factors is very limited in rural Bangladesh, even in persons diagnosed with type 2 DM. The development of public health programmes to increase knowledge of diabetes and its complications is required to assist people living in rural Bangladesh to control and management of diabetes.

Diabetic retinopathy management guidelines

Diabetic retinopathy (DR) is an important cause of avoidable blindness worldwide. Seventy percent of diabetes occur in low and lower-middle income countries. Clinical practice guidelines for the management of DR have been implemented throughout the world, but mainly in developed nations. However, there is considerable variation between existing guidelines in the recommended frequency of referral, methods for examination and personnel involved in screening and review. This review compares the differences between current available guidelines in the context of the current medical evidence and also addresses the implications for management of DR in countries with limited resources.

Factors associated with awareness, attitudes and practices regarding common eye diseases in the general population in a rural district in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES)

Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30–35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks. Conclusions In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.

Prediabetes, diagnosed and undiagnosed diabetes, their risk factors and association with knowledge of diabetes in rural Bangladesh: The Bangladesh Population‐based Diabetes and Eye Study

The aim of the present study was to determine the prevalence and risk factors of prediabetes and diagnosed and undiagnosed diabetes mellitus (DM) in rural Bangladesh.

Undiagnosed hypertension in a rural district in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES)

Hypertension is mainly asymptomatic and remains undiagnosed until the disease progresses. The objective of the study was to determine the prevalence of and risk factors for hypertension in rural Bangladesh. Using a population-based cluster random sampling strategy, 3096 adults aged ⩾30 years were recruited from a rural district in Bangladesh. Data collected included two blood pressure (BP) measurements, fasting blood glucose, socio-demographic and anthropometric measurements. Hypertension was defined as systolic BP (SBP) ⩾140 mm Hg or diastolic BP (DBP) ⩾90 mm Hg or self-reported diagnosed hypertension. Logistic regression techniques were used for data analyses. The crude prevalence of hypertension was 40% (95% confidence interval (CI) 38–42%) of which 82% were previously undiagnosed. People from lower socio-economic status (SES) had a significantly higher percentage of undiagnosed hypertension compared with people with higher SES (P<0.001). There was no significant gender difference in severity of hypertension. Males with higher education level compared with no education had a higher prevalence of hypertension (odds ratio 2.34, 95% CI 1.49–3.69). Older age and waist circumference in both genders, and diabetes, lack of physical activity in females were found to be associated with higher prevalence of hypertension. Our research suggests the prevalence of undiagnosed hypertension was higher in the rural area in Bangladesh than that reported from the rural area in neighbouring India and China. Lower SES was associated with a higher risk of undiagnosed hypertension. Public health programs at the grass-roots level must emphasise the provision of primary care and preventive services in managing this non-communicable disease.

Attitudes and Perceptions of Eye Care Workers and Health Administrators Regarding Task Sharing in Screening and Detection for Management of Diabetic Retinopathy in Pakistan

ABSTRACT Purpose: The shortage of ophthalmologists in many countries is a major barrier to timely provision of eye care. A team work approach to screen, detect and manage diabetic retinopathy (DR) could achieve greater screening coverage of people with diabetes to prevent vision loss. This study aimed to assess the attitudes and perceptions of eye care workers and health administrators regarding task sharing for management of DR. Methods: Using purposive sampling, 121 eye and health care workers in five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey explored the possibility for involvement of optometrists and mid-level eye care workers to share tasks with ophthalmologists for DR management and the potential outcomes of task sharing, through multiple choice and open-ended questions. Results: Ninety-six (79%) participants–doctors (n = 56), optometrists (n = 29) and mid-level eye care workers (n = 11) responded to the survey. All participants supported task sharing in screening and detection for management of DR. There was no significant difference among the groups with respect to their positive attitude towards task sharing (p = 0.22). The majority in each group believed that the task sharing would not degrade the quality of care (p = 0.48). Two potential major outcomes of task sharing in the eye care system included the benefits for people with diabetes and potential DR and the strengthening of the health care system. Conclusion: Task sharing among various cadres of eye care workers has the potential to improve screening coverage of people with diabetes to prevent visual loss from DR.

A Review of m-Health in Medical Imaging

OBJECTIVE The increasing capabilities of camera-equipped mobile phones have led to a growing body of evidence regarding their use in medical imaging across a broad range of medical specialties. This article reviews the current evidence for the use of mobile health (m-health) in medical imaging. MATERIALS AND METHODS We performed a structured review of the published literature regarding m-health in medical imaging using the Medline, PubMed, and Web of Science databases (January 2002-August 2013). The two authors independently extracted data regarding type of specialty, purpose, and study design of publications. RESULTS In total, 235 articles were identified. The majority of studies were case reports or noncomparative product validation studies. The greatest volume of publications originated in the fields of radiology (21%), dermatology (15%), laboratory techniques (15%), and plastic surgery (12%). Among these studies, m-health was used as diagnostic aids, for patient monitoring, and to improve communication between health practitioners. With the growing use of mobile phones for medical imaging, considerations need to be given to informed consent, privacy, image storage and transfer, and guidelines for healthcare workers and patients. CONCLUSIONS There are several novel uses of mobile devices for medical imaging that show promise across a variety of areas and subspecialties of healthcare. Currently, studies are mostly exploratory in nature. To validate these devices, studies with higher methodological rigor are required.

Nonmydriatic digital ocular fundus photography with iPhone 3G.

utes, in which his right eye would quiver. During his initial evaluation, the patient was unable to reproduce the twitching movement. His symptoms were attributed to superior oblique myokymia based on his description of vertical jumping of his eye producing vertical oscillopsia. The patient was reassured that his condition was benign given the absence of other neurological features. He began treatment with gabapentin and was then lost to follow-up. The patient did not return until 2011, when the episodes started to become more frequent, occurring 5 out of every 7 days. During this visit, he was able to reproduce the eye movement disorder by supraduction, causing an excyclotorsion, lasting about 1 minute (video, http: //www.jamaophth.com). This is the opposite of what is expected for superior oblique myokymia, in which infraduction triggers incyclotorsion. The decision was made to perform 1.5-T magnetic resonance imaging of the brain and orbits given that this type of movement had not been described in the literature and the patient had a significant medical history, including human immunodeficiency virus and factor 11 deficiency. The patient contracted human immunodeficiency virus from a contaminated blood transfusion in the early 1980s and was being treated with 2 forms of antiretroviral therapy, emtricitabine/tenofovir and raltegravir. After normal findings on magnetic resonance imaging, he began treatment with timolol maleate, which provided no relief. The patient more recently tried oxcarbazepine, with no improvement initially.

The era of tailored mHealth

It is with great pleasure that we introduce the first issue of the fifth volume of the Journal with a diverse range of papers that illustrate the broad engagement of mobile health technologies to target the spectrum of socioeconomic groups in society. Currently the mHealth developers stand at the precipice of the greatest rate in growth of mHealth related apps. Results published in the mhealth App Developer Economics Survey in 2015 showed that the number of mHealth apps has now exceeded 165,000. However, with only 5 per cent of apps being developed from Africa and South America combined (compared to 72% from Europe and North America) there clearly remains a challenge in developing and implementing apps for low-resource settings.

The era of automated systems to facilitate health care

In this issue, Ludwig et al provide a brief overview of the existing technologies available to aid automated diagnostic and referral in the field of the ophthalmology. The authors provide a summary of a potential pathway for automated ophthalmic care through the use of mobile diagnostic devices that can facilitate image collection. The first step in the clinical algorithm is safe and accurate image capturing technologies. The authors highlight examples of mobile diagnostic adapters developed by the Peek Vision group (UK), D-eye system (Italy), and iExaminer (Welch Allyn) which convert the modern smartphone into an anterior and posterior segment image capturing device. These images can then be collated, filtered for quality, and interpreted by automated software and results can, in theory, be graded in real-time to provide risk stratification and triaging of patients.