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Effectiveness of health education and monetary incentive on uptake of diabetic retinopathy screening at a community health center in South Gujarat, India.
Chariwala, RA, Shukla, R, Gajiwala, UR, Gilbert, C, Pant, H, Lewis, MG, Murthy, GVS
Indian journal of ophthalmology. 2020;(Suppl 1):S52-S55
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Abstract
PURPOSE The effectiveness of Accredited Social Health Activists (ASHAs) with and without monetary incentive in uptake of diabetic retinopathy (DR) screening at community health center (CHC) was compared in South Gujarat, India. METHODS In this non-randomized controlled trial, ASHAs were incentivized to refer people with diabetes mellitus (PwDM) from their respective villages for DR screening after people were sensitized to DM and DR. The minimum sample size was 63 people in each arm. RESULTS Of 162, 50.6% were females, 80.2% were literate, 56.2% were >50 years, 54.3% had increased random blood sugar (RBS), and 59.9% had diabetes for 5 years. The percentage of screening was significantly higher [relative risk (RR) = 4.37, 95% confidence interval (CI) 2.79, 6.84] in ASHA incentive group and health education (HE) group (RR = 3.67, 95% CI 2.35, 5.75) compared with baseline. Providing incentive to ASHAs was not found to be of extra advantage (RR = 1.19, 95% CI 0.89, 1.57). The likelihood of uptake of screening was higher among uncontrolled PwDM, poor literacy, and higher duration of diabetes in incentive phase (P < 0.001) compared with HE. The results show that age (P = 0.017), education (P = 0.015) and level of RBS (P = 0.001) of those referred were significantly associated with incentives to ASHAs. CONCLUSION ASHAs can be used effectively to refer known PwDM for DR screening especially when DR screening program is introduced in population with low awareness and poor accessibility. When incentives are planned, additional burden on resources should be kept in mind before adapting this model of care.
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Diabetic Retinopathy Screening and Monitoring of Early Stage Disease in Australian General Practice: Tackling Preventable Blindness within a Chronic Care Model.
Crossland, L, Askew, D, Ware, R, Cranstoun, P, Mitchell, P, Bryett, A, Jackson, C
Journal of diabetes research. 2016;:8405395
Abstract
INTRODUCTION Diabetic retinopathy (DR) is the leading cause of preventable blindness in Australia. Up to 50% of people with proliferative DR who do not receive timely treatment will become legally blind within five years. Innovative and accessible screening, involving a variety of primary care providers, will become increasingly important if patients with diabetes are to receive optimal eye care. METHOD An open controlled trial design was used. Five intervention practices in urban, regional, and rural Australia partnered with ophthalmologists via telehealth undertook DR screening and monitoring of type 2 diabetes patients and were compared with control practices undertaking usual care 2011-2014. RESULTS Recorded screening rates were 100% across intervention practices, compared with 22-53% in control practices. 31/577 (5%) of patients in the control practices were diagnosed with mild-moderate DR, of whom 9 (29%) had appropriate follow-up recorded. This was compared with 39/447 (9%) of patients in the intervention group, of whom 37 (95%) had appropriate follow-up recorded. DISCUSSION AND CONCLUSION General practice-based DR screening via Annual Cycle of Care arrangements is effective across differing practice locations. It offers improved recording of screening outcomes for Australians with type 2 diabetes and better follow-up of those with screen abnormalities.
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Vibration perception threshold for sight-threatening retinopathy screening in type 2 diabetic outpatients.
Shen, J, Hu, Y, Liu, F, Zeng, H, Li, L, Zhao, J, Zhao, J, Zheng, T, Lu, H, Lu, F, et al
Diabetes/metabolism research and reviews. 2013;(7):525-31
Abstract
OBJECTIVE We investigated the relationship between vibration perception threshold and diabetic retinopathy and verified the screening value of vibration perception threshold for severe diabetic retinopathy. METHODS A total of 955 patients with type 2 diabetes were recruited and divided into three groups according to their fundus oculi photography results: no diabetic retinopathy (n = 654, 68.48%), non-sight-threatening diabetic retinopathy (n = 189, 19.79%) and sight-threatening diabetic retinopathy (n = 112, 11.73%). Their clinical and biochemical characteristics, vibration perception threshold and the diabetic retinopathy grades were detected and compared. RESULTS There were significant differences in diabetes duration and blood glucose levels among three groups (all p < 0.05). The values of vibration perception threshold increased with the rising severity of retinopathy, and the vibration perception threshold level of sight-threatening diabetic retinopathy group was significantly higher than both non-sight-threatening diabetic retinopathy and no diabetic retinopathy groups (both p < 0.01). The prevalence of sight-threatening diabetic retinopathy in vibration perception threshold >25 V group was significantly higher than those in 16-24 V group (p < 0.01). The severity of diabetic retinopathy was positively associated with diabetes duration, blood glucose indexes and vibration perception threshold (all p < 0.01). Multiple stepwise regression analysis proved that glycosylated haemoglobin (β = 0.385, p = 0.000), diabetes duration (β = 0.275, p = 0.000) and vibration perception threshold (β = 0.180, p = 0.015) were independent risk factors for diabetic retinopathy. Receiver operating characteristic analysis further revealed that vibration perception threshold higher than 18 V was the optimal cut point for reflecting high risk of sight-threatening diabetic retinopathy (odds ratio = 4.20, 95% confidence interval = 2.67-6.59). CONCLUSION There was a close association between vibration perception threshold and the severity of diabetic retinopathy. vibration perception threshold was a potential screening method for diabetic retinopathy, and its optimal cut-off for prompting high risk of sight-threatening retinopathy was 18 V.
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Urinary di-(2-ethylhexyl)phthalate metabolites in athletes as screening measure for illicit blood doping: a comparison study with patients receiving blood transfusion.
Monfort, N, Ventura, R, Latorre, A, Belalcazar, V, López, M, Segura, J
Transfusion. 2010;(1):145-9
Abstract
BACKGROUND Subjects submitted to intravenous (IV) blood transfusions for medical reasons or blood doping to increase athletic performance are potentially exposed to the plasticizer di-(2-ethylhexyl)phthalate (DEHP) found in IV bags. Exposure to DEHP has been evaluated by measuring DEHP metabolites in selected groups of subjects. STUDY DESIGN AND METHODS Urinary DEHP metabolites, mono-(2-ethylhexyl)phthalate, mono-(2-ethyl-5-hydroxyhexyl)phthalate (MEHHP), and mono-(2-ethyl-5-oxohexyl)phthalate (MEOHP) were measured in a control group with no explicit known exposure to DEHP (n = 30), hospitalized patients receiving blood transfusions (n = 25), nontransfused hospitalized patients receiving other medical care involving plastic materials (n = 39), and athletes (n = 127). Patients were tested in the periods 0 to 24 and 24 to 48 hours after exposition. RESULTS Urinary concentrations of all three DEHP metabolites were significantly higher in patients receiving blood transfusion than in nontransfused patients and the control group, except for MEHHP and MEOHP in the period 24 to 48 hours. Samples from four athletes showed increased concentrations of DEHP metabolites comparable to urinary concentrations of patients receiving blood transfusion. CONCLUSION Elevated concentrations of urinary DEHP metabolites represent increased exposure to DEHP. High concentrations of DEHP metabolites present in urine collected from athletes may suggest illegal blood transfusion and can be used as a qualitative screening measure for blood doping.
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The 3-ounce (90-cc) water swallow challenge: a screening test for children with suspected oropharyngeal dysphagia.
Suiter, DM, Leder, SB, Karas, DE
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2009;(2):187-90
Abstract
OBJECTIVES To investigate the clinical utility of the 3-ounce (90-cc) water swallow challenge alone to determine both aspiration status and oral feeding recommendations in children. DESIGN Cross-sectional evaluation of a diagnostic test with a consecutive, referral-based sample. SETTING Urban, tertiary care, teaching hospital. PARTICIPANTS Fifty-six children (age range 2-18 years; mean 13 years) referred for swallowing evaluations. OUTCOME MEASURES Aspiration status during fiberoptic endoscopic evaluation of swallowing (FEES) was the objective criterion standard with which results from the 3-ounce water swallow challenge were compared. RESULTS Twenty-two (39.3%) participants passed and 34 (60.7%) failed the 3-ounce challenge. Sensitivity for predicting aspiration status during FEES = 100.0 percent, specificity = 51.2 percent, and false-positive rate = 48.4 percent. Sensitivity for identifying individuals who were deemed safe for oral intake based on FEES results = 100.0 percent, specificity = 44.0 percent, and false-positive rate = 56.0 percent. CONCLUSIONS If the 3-ounce water swallow challenge is passed, not only thin liquids but diet recommendations with puree and solid food consistencies can be made without the need for further instrumental dysphagia assessment. SIGNIFICANCE The 3-ounce water swallow challenge has been shown to be a clinically useful screening test for oropharyngeal dysphagia in children.
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Cardiovascular health status and health risk assessment method of preference among worksite employees.
Marschke, LM, Allen, GJ, Coble, DA, Zellner, SR, Klein, R, Aiudi, B, Murphy, D, Pescatello, LS
The journal of primary prevention. 2006;(1):67-79
Abstract
We investigated whether employees (n = 62) selecting a self-report Health Risk Assessment (HRA) would be at increased CVD risk compared to employees (n = 114) choosing an HRA with measurement of cardiovascular (CVD) health indicators. Participants were mostly middle-aged (44.1 +/- 0.8 yr) men (71.6%) displaying borderline features of the cardiometabolic syndrome. Although there were no significant differences between the groups regarding their measured CVD health status or self-reported lifestyle habits, employees in both groups consistently over-stated their level of cardiovascular health. Contrary to reports in the literature, cardiovascular health status did not appear to influence employee HRA method of preference.Editors' Strategic Implications: These findings await replication in other samples, both more diverse and less self-selected. Nonetheless, the authors' methods and their conclusions about workers' over-estimation of their health and the lack of differences across assessment methods will be useful to employers, health professionals, and all practitioners with an interest in health risk assessments.
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Evaluation of a screening program for diabetic retinopathy in a primary care setting Dodia (Dépistage ophtalmologique du diabète) study.
Massin, P, Aubert, JP, Eschwege, E, Erginay, A, Bourovitch, JC, BenMehidi, A, Nougarède, M, Bouée, S, Fagnani, F, Tcherny, MS, et al
Diabetes & metabolism. 2005;(2):153-62
Abstract
OBJECTIVES The aim of this observational study was to evaluate the screening for diabetic retinopathy (DR) using eye fundus photography taken by a nonmydriatic camera and transmitted trough the Internet to an ophthalmological reading centre, as compared to a dilated eye examination performed by an ophthalmologist. METHODS A total of 456 and 426 diabetic patients were included by two different groups of primary care physicians (PCPs), 358 being screened with the non-mydriatic camera (experimental group) and 320 with dilated eye fundus exam (control group). RESULTS The proportion of screened patients for whom PCPs received a screening report within the 6-month follow-up period was 74,1% for the experimental group and 71,5% for the control group. Screening for DR was negative in 77,6% of patients with eye fundus photographs vs 89,6% with dilated eye examination. DR was diagnosed in 62 patients (17,3%) with eye fundus photographs versus 31 with dilated eye examination (10,4%). Referral to an ophthalmologist was required in 59 reports of patients with photographs (16.5%), 23 of them due to high grade DR. Finally, the non-mydriatic camera was found of little inconvenience by patients. CONCLUSION The telemedical approach to DR screening proved to be effective in providing primary care practitioners with information about their patient's eye status. This screening method allowed to identify patients requiring prompt referral to the ophthalmologist for further complete eye examination. In conclusion, this study provided successful results of DR screening using fundus photography in primary care patients, and strongly supports the need to further extend this screening program in a larger number of French sites.
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Screening for diabetic retinopathy using digital colour photography and oral fluorescein angiography.
Newsom, R, Moate, B, Casswell, T
Eye (London, England). 2000;:579-82
Abstract
PURPOSE To evaluate digital colour photography and oral fluorescein angiography (OFA) for diabetic retinopathy screening. METHODS Thirty-seven patients were selected from either a diabetic retinopathy screening or a medical retina clinic. Three 45 degrees colour digital images and a single macula 45 degrees OFA image were taken from each eye. Standard seven-field stereo photography with ETDRS grading was used as a gold standard for data comparison. The images were assessed by two graders and the results of each method compared using the McNemar test. RESULTS Five eyes had no diabetic retinopathy, 50 had background diabetic retinopathy, 3 had pre-proliferative diabetic retinopathy, 11 had proliferative disease and 3 had quiescent posttreatment disease. Clinically significant macular oedema was present in 25 eyes and absent in 48. For grading diabetic retinopathy digital colour photography produced a sensitivity of 0.87 (specificity 0.83); OFA produced a sensitivity of 0.87 (specificity 0.80) (p = 0.1). For the detection of diabetic maculopathy, the sensitivity of digital colour photography was 0.48 (specificity of 0.95) and for OFA was 0.87 (specificity 0.87) (p < 0.01). CONCLUSION This pilot study has shown that both digital colour photography and OFA compare well with conventional methods for diabetic retinopathy screening. The results encourage the further evaluation of OFA in the screening for diabetic maculopathy.