Metabolic Syndrome among Female School Teachers: A Sedentary Occupational Sector.

Background: Dyslipidemia, insulin resistance, hypertension, and abdominal obesity are important determinants of metabolic syndrome (MetS). Ample studies provide statistical data on the prevalence of MetS among the general public. Conversely, there is a paucity of data on the risk of MetS among different sedentary occupational groups. Objective: To assess the risk of MetS among female school teachers and to identify factors contributing to MetS. Methodology: The study was conducted among 256 female school teachers residing in Chennai city. A questionnaire was used to elicit information on the socio-demographic profile, diet pattern, physical fitness, and genetic history of lifestyle diseases. Anthropometric, biochemical, and clinical parameters were measured using standard methods. MetS was diagnosed using the harmonizing definition. Data analysis was done using Statistical Package for Social Sciences software. Results: Results evince that 39.45% of female school teachers were diagnosed with MetS, of which 26.56% had three components, 9.77% had four components, and 3.12% had all components of MetS. Abdominal obesity (99%) and low levels of high-density lipoprotein cholesterol (HDL-C) (96.04%) were the most predominant components. The least common component was diastolic hypertension (32.67%). MetS components were high among school teachers aged 36-45 years and 46-55 years. Age, fasting hyperglycemia, paternal history of hypertension, physical inactivity, eating out, and consumption of refined cereals significantly contributed to MetS (P < 0.05). Conclusion: Results highlight the need to identify high-risk individuals and promote a healthy lifestyle through various intervention programs.

Determinants of Malnutrition among Elderly Women Living in Institutional Care.

Background: Healthy aging and well-being are largely influenced by nutrition. Objective: The objective of the study was to evaluate the risk of malnutrition in elderly women residing in institutional care and its contributing factors. Methodology: One hundred institutionalized women aged 60 years and above were screened for malnutrition using Mini Nutritional Assessment (MNA) tool. Details on sociodemographic profile, physical activity, medical conditions, and food habits were gathered through researcher administered survey method. Results: The study participants had an average height of 149.70 cm (±7.31), weight of 50.72 kg (±9.11), body mass index of 22.77 kg/m2 (±4.68), body fat percentage of 31.30% (±8.99), mid-arm circumference of 27.36 cm (±7.84), calf circumference of 30.11 cm (±7.51), MNA score of 10.42 (±4.06), and hand grip strength score of 18.69 kg/lbs (±3.80). Upon analyzing the MNA scores, it was found that 9% of elderly women were well nourished, 62% were at risk of malnutrition, and 29% were malnourished. A significant difference was observed in the mean MNA scores (P < 0.05). Age, education level, body fat percentage, appetite, and dental problems were significantly associated with malnutrition (P < 0.05). Conclusion: Geriatric residents in old-age homes require adequate nutrition to maintain health. This can be achieved by providing individualized meal planning, reducing barriers to eating, and incorporating nutrient-dense foods.

Efficacy of an Automated Algorithm for Screening Diabetic Retinopathy in Gradable and Ungradable Images in Real-Time Conditions.

Background: To examine the effectiveness of a computer-assisted device (CAD) for diabetic retinopathy (DR) screening from retinal photographs at a vitreoretinal outpatient department (VR OPD), telecamps, and diabetes outpatient clinic by an ophthalmologist. In particular, the effectiveness of CAD in gradable and ungradable retinal images was examined. Methods: A total of 848 eyes of 485 patients underwent 45° retinal photographs at the VR OPD of a tertiary care hospital in southern India. A total of 939 eyes of 472 patients with diabetes were examined in the telecamps conducted in remote villages in Tamil Nadu, a state in southern India. A total of 2,526 eyes of 1,263 patients were examined in a diabetes clinic using 45° field retinal photographs. The algorithm was validated under physiological dilatation (without pharmacological dilatation) in all three arms. Results: Seventy-one percent of 848 eyes in VR OPD, 13% of 939 eyes in telecamps, and 7% of 2,526 eyes in diabetes clinic were diagnosed to have DR. The algorithm showed 78.3% sensitivity and 55.1% specificity for all images and 78.9% sensitivity and 56.8% specificity for gradable images in the VR OPD; 80.1% sensitivity and 79.2% specificity for all images and 84.8% sensitivity and 80.0% sensitivity for gradable images in telecamps; 63.0% sensitivity and 79.6% specificity for all images and 63.2% sensitivity and 78.1% specificity for gradable images in the diabetes clinic. The algorithm had an overall accuracy of 76.4%. The ungradable rate was variable. Conclusion: The algorithm performs equally well in identifying DR from gradable and ungradable photographs and may be used for DR screening in a rural setting with limited or no access to eye care.

Telehealth as a Means of Enabling Health Equity.

OBJECTIVE: The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health. METHODS: The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system. RESULTS: Fifteen WG members from eight countries participated in the Delphi process to share their views. The experts agreed that while telehealth services before and during COVID-19 pandemic have enhanced the delivery of and access to healthcare services, they were also concerned that global telehealth delivery has not been equal for everyone. The group came to a consensus that health system concepts including technology, financing, access to medical supplies and equipment, and governance capacity can all impact the delivery of telehealth services. CONCLUSION: Telehealth played a significant role in delivering healthcare services during the pandemic. However, telehealth delivery has also led to unintended consequences (UICs) including inequity issues and an increase in the digital divide. Telehealth practitioners, professionals and system designers therefore need to purposely design for equity as part of achieving broader health system goals.

Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

OBJECTIVES: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. METHODS: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. RESULTS: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response. CONCLUSION: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.

Validation of a Customized Algorithm for the Detection of Diabetic Retinopathy from Single-Field Fundus Photographs in a Tertiary Eye Care Hospital.

The study was done to validate the real time efficacy of a customised algorithm in detecting diabetic retinopathy (DR) among diabetic patients being examined at the vitreo retinal outpatient department (VR OPD) of a tertiary care hospital, Diabetic Retinopathy algorithm showed sensitivity of 79% and specificity of 57% which is an acceptable methodology to diagnose diabetic retinopathy and avoid unnecessary referrals.

Developmental screening tool: Accuracy and feasibility of non-invasive anaemia estimation.

Anaemia is predicted as one of the serious communal health issue in the world. The deficiency exists most common among children and women. A substantial issue prevails in providing quality healthcare services to rural communities, which remains a challenge to health service providers throughout the world. Traditionally physician and health workers recognized anaemia from certain clinical findings, such as pallor of the conjunctivae, nail beds, lips, tongue, and oral mucosa. Confirmation of anaemic condition through physical examination of Dorsum of a tongue or lower bulbar conjunctiva is a subjective analysis. Invasive methods have a possibility to spread infection through the needle. The existing non-invasive techniques need costly equipment and qualified technicians. Growing developments in science and technologies play an important role in medicine. This proposal introduces a new non-invasive diagnostic tool correlating the hemoglobin with conjunctiva pallor colour scores and classification using neural networks. In this study, the eye images were obtained using a mobile camera were processed using the HSI model, which estimates different colour scores of the selected region. These scores were correlated with laboratory haemoglobin value. Feedforward neural network and Elman neural network were used for classifying anaemic and non-anaemic cases. This proposed tool will be useful for the health workers to identify the mass screening of anaemia in rural areas.

Customized nutrition intervention and personalized counseling helps achieve nutrition targets in perioperative liver transplant patients.

BACKGROUND AND AIM: Nutritional therapy is an integral part of care in all phases of liver transplantation (LTx). However, there are several factors that make it a challenge to manage malnutrition in these patients including, but not limited to, loss of appetite, dietary restrictions and dietary habits. Dietary habits are guided by personal choice, social, cultural and regional background with diversity ranging from veganism to vegetarianism with the latter predominant in Indian population. Therefore, it is difficult to improve nutritional intake of patients with standard dietary recommendations. We evaluated the effects of implementing personalized dietary counseling and a customized nutrition plan on its ability to enhance oral intake and, thereby improve nutritional status of patients with end stage liver disease (ESLD) being evaluated for LTx. We compared the outcomes with a matched group of patients who were prescribed standard dietary recommendations from a historic database. Primary outcome was measured by number of patients achieving ≥75% of recommended energy and protein requirements during hospitalization for LTx. Secondary outcomes included mean energy and protein intake, hours of ventilation, length of stay in Intensive Care Unit (ICU) and hospital, mortality and readmission rate in the acute phase (3months) after LTx. METHODS: This was a prospective observational study, performed at a single LTx centre. All patients >18years who enrolled for LTx and consented for the study were included. The study was conducted after obtaining institutional ethics committee approval. A protocol based nutrition planning was implemented from April'14. According to this protocol, all patients being evaluated for LTx underwent a detailed nutritional assessment by a qualified Clinical Dietitian (CD) and regularly followed up with until LTx. Nutritional intervention, including a customized nutrition care plan and personalized dietary counseling, was provided based on the severity of malnutrition. To evaluate the efficacy of this protocol, we compared the nutritional adequacy (calorie and protein intake) of 65 consecutive patients who underwent LTx between August'14-October'15 (group 1) with a historic database of 65 patients who underwent LTx between January'13 and April'14 (group 2). Patients' demographics, disease severity score, baseline markers of nutritional status (subjective global assessment (SGA), and body mass index (BMI)), were recorded. First, assessment of individual patient's oral energy and protein intake was determined by the daily calorie count during hospitalization. Then the nutritional intervention (oral nutrition supplement (ONS)/enteral nutrition (EN)/parenteral nutrition (PN)) plan was customized according to their spontaneous oral intake. As part of the protocol, health related quality of life was also assessed using short form 8 (SF-8) in group 1. Statistical analyses using Pearson's correlation, Chi-Square test were applied with SPSS version 20.0. RESULTS: The mean age of group 1 and 2 were 52.6 ± 9.8, 51.9 ± 10.5 (range 25-70years) with BMI of 26.8 ± 6.0, 26.5 ± 5.4 respectively. According to SGA, there was significant improvement in the nutritional status of group 1 patients compared to group 2 on admission for LTx. It was indicated that 88% of group 1 individuals in comparison to 98% in group 2 were malnourished. The calorie intake of group 1 (1740.2 ± 254.8) was significantly higher than group 2 (1568.5 ± 321.6) (p = 0.005). The marked improvement in protein intake in group 1 (63.1 ± 12.1) when compared with group 2 (53.1 ± 13.4) was statistically significant (p = 0.008). A subset analysis showed that non-vegetarians (consuming meat and dairy products) between the groups showed that group 1 had a significantly higher calorie (p = 0.004) and protein (p = 0.0001) intake compared to individuals in group 2. Following implementation of study's protocol, the goal of achieving ≥75% of the prescribed calories (p = 0.013) and protein (p = 0.0001) was significantly higher in group 1. CONCLUSION: When compared to the standard prescription, an individualized protocol to diagnose, stratify the severity of malnutrition early, and follow up by customized nutrition planning for patients helped to achieve nutritional targets more effectively. Inspite of patients' diversity in nutritional habits and reluctance to accept change, it is clear that a qualified and dedicated transplant nutrition team can successfully implement perioperative nutrition protocol to achieve better nutritional targets.

Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review.

Introduction: The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. Aims and Methods: A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Results: Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. Conclusions: This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. Implications: This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).

Assessment of Computer-Assisted Screening Technology for Diabetic Retinopathy Screening in India - Preliminary Results and Recommendations from a Pilot Study.

BACKGROUND: Diabetic retinopathy (DR) is regarded as a major cause of preventable blindness, which can be detected and treated if the cases are identified by screening. Screening for DR is therefore being practiced in developed countries, and tele screening has been a prominent model of delivery of eye care for screening DR. AIM: Our study has been designed to provide inputs on the suitability of a computer-assisted DR screening solution, for use in a larger prospective study. METHODS: Computer-assisted screening technology for grading diabetic retinopathy from fundus images by a set of machine learning algorithms. RESULTS: The preliminary recommendations from a pilot study of a system built using the public datasets and retrospective images, showed a good sensitivity and specificity. CONCLUSION: The machine learning algorithms has to be validated on a larger dataset of a population level study.

A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology.

OBJECTIVE: To inform about a very unique and first of its kind telehealth pilot study in India that has provided virtual telehealth consultation to eye care patients in low resource at remote villages. BACKGROUND: Provision of Access to eye care services in remote population is always challenging due to pragmatic reasons. Advances in Telehealth technologies have provided an opportunity to improve access to remote population. However, current Telehealth technologies are limited to face-to-face video consultation only. We inform about a pilot study that illustrates real-time imaging access to ophthalmologists. Our innovative software led technology solution allowed screening of patients with varying ocular conditions. METHODS: Eye camps were conducted in 2 districts in South India over a 12-month period in 2014. Total of 196 eye camps were conducted. Total of 19,634 patients attended the eye camps. Innovative software was used to conduct consultation with the ophthalmologist located in the city hospital. The software enabled virtual visit and allowed instant sharing of fundus camera images for assessment and diagnosis. RESULTS: About 71% of the patients were found to have Refractive Error problems, 15% of them were found to have cataract, 7% of the patients were diagnosed to have Retina problems and 7% of the patients were found to have other ocular diseases. The patients requiring cataract surgery were immediately transferred to city hospital for treatment. Software led assessment of fundus camera images assisted in identifying retinal eye diseases. CONCLUSION: Our real-time virtual visit software assisted in specialist care provision and illustrated a novel tele health solution for low resource population.

Governance and management of national telehealth programs in Asia.

UNLABELLED: Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency. OBJECTIVES: enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management. METHOD: Review of literature, review of official program websites and request for information from key informants. CONCLUSIONS: While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.

Are smartphones comparable to laptops for image diagnosis in teleophthalmology?

OBJECTIVE: To assess the reliability and accuracy of smartphones in diagnosing transmitted fundus images in comparison with a laptop. MATERIALS AND METHODS: Fundus images captured with a Topcon NW 200 camera were transferred onto a conventional laptop and a smartphone and given to ophthalmologists for diagnosis. The smartphone and the laptop diagnosis were compared with the actual face to face diagnosis statistically to assess their diagnostic accuracy. RESULTS: Fundus images of 228 eyes of 114 patients (mean age 47 years,73.6% males) were included in the study. 92.5% eyes were correctly diagnosed by both smartphones and laptop. Smartphone analysis revealed 98% sensitivity,57% specificity and kappa value of 0.62 in comparison to laptop, suggessting substantial interrater agreement. CONCLUSIONS: Smartphones are as effective as the laptop in diagnosing fundus pathologies and hold promise for teleophthalmology in future.

The Sankara Nethralaya mobile teleophthalmology model for comprehensive eye care delivery in rural India.

BACKGROUND: Teleophthalmology holds great potential to overcome barriers and improve quality, access, and affordability in eye care. We introduced mobile units for comprehensive eye care delivery and have successfully conducted eye camps over the past 1.5 years. METHODS: Here we describe the current process and review results of conducting comprehensive eye camps with the aid of teleophthalmology mobile units and determine major causes of avoidable blindness in central and south India. Retrospective chart reviews of all the camps were done as a part of the rural teleophthalmology project of Sankara Nethralaya during the period of April 2009-September 2010. Speciality consultation was achieved by means of teleophthalmology during which images were converted to Digital Imaging and Communications in Medicine standard and transferred to the base hospital by a satellite link using a very small aperture terminal at 256-384 kilobits per second with store-and-forward technology as well as real-time videoconferencing when possible. In addition to comprehensive examination, schoolteachers were trained to assess visual acuity, and various public awareness activities were undertaken. RESULTS: Over the 1.5-year study period, 54,751 patients underwent evaluation at 872 camps across four states in India. Among these, uncorrected refractive error was the commonest cause of avoidable blindness (59%), followed by cataract (30%). Retinal diseases, mainly diabetic retinopathy, contributed 3.3% of avoidable blindness, and corneal diseases accounted for another 1%. CONCLUSIONS: Comprehensive eye camps utilizing a mobile teleophthalmology unit appears to be a very useful tool to improve eye care delivery in the developing world.