Purpose: Quality improvement project to improve diabetic retinopathy education and screening in a rural primary care clinic to meet the standard of care. Aims: To improve the delinquency rate of diabetic retinopathy screening. Processes: Participants included those with type 1 and type 2 diabetes ages 18 and up in the rural health clinic. Diabetic retinopathy screening importance education was displayed in the clinic and provided to each applicable patient in the form of a handout. A diabetic eye camera was brought to the rural health primary care clinic to offer more convenient access and free eye exams to clinic patients with diabetes. The project was deemed quality improvement by the IRB. Results: (To be determined after project implementation – results anticipated to be excellent based on the number of patients who are signed up to participate in this day.) There are 486 patients with a diagnosis of diabetes in the clinic. ___ were delinquent in eye exam prior to implementation and ___ were delinquent after. Limitations: Project performed in only one clinic; project leader is employed at the clinic in this study. Conclusions: Implementation of the eye exam day improved the delinquency rate of diabetic retinopathy screening in the clinic and proved to be a valuable means of enhancing patient compliance and satisfaction of routine eye health monitoring in patients with diabetes.

Yes / Inequities in access to diabetic retinopathy (DR) services particularly in rural and remote Fiji is concerning. This is because DR when left undiagnosed and untreated for long, can lead to vision loss and permanent blindness. Appropriate channels must be explored to strengthen services and ensure equitable access to healthcare for everyone. This study describes the development and implementation of DR awareness training for community health workers (CHWs) and their subsequent engagement to raise awareness and scale-up DR screening for communities throughout Fiji. As part of a programme to reduce the incidence of avoidable blindness due to diabetes amongst people living in the Pacific, DR training for primary level nurses was developed and implemented. As these primary level nurses were already inundated by clinical duties and competing health priorities, a shifting of the task was proposed to engage the CHWs who would instead educate communities on diabetes and DR and make referrals for DR screening. A one-day DR awareness training was developed and implemented by the Pacific Eye Institute with funding from the Fred Hollows Foundation New Zealand. At the end of the DR programme in 2019, the team had achieved their target and trained a total of 823 CHWs giving an 81.32% coverage of the total 1012 registered CHW in the MHMS register. Anecdotal evidence showed a spike in DR referrals and screenings recorded at health facilities. Three key themes emerged related to the involvement of CHWs which include engagement of CHWs, benefits of the engagement, and health system-related challenges. The use of CHWs who are already integrated into the health system was considered a sustainable intervention to strengthen diabetes and DR services at the primary level of care, particularly if it involves community awareness, health education, and health services facilitation The future of the CHWs will depend on their being integrated more systematically into local health services with strengthened management and supervision. / We acknowledge Fred Hollows Foundation New Zealand for granting this project.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Introduction: Diabetic retinopathy (a diabetes complication that affects eyes) is one of the leading causes of blindness and low vision in the US. More than 90% of vision loss caused by diabetes can be prevented by a routine annual eye examination and early treatment. However, data shows that about half of people with diabetes in the US do not receive the recommended annual eye screening exams, and there is a scarcity of literature assessing the specific role of health insurance. This study aimed to assess if having health insurance had an impact on eye screening. Methods: The nationally representative 2021 Behavioral Risk Factor Surveillance System (BRFSS) was used to examine having an eye exam within the past year among individuals 18 years of age and older who self-reported living with diabetes. Those who reported having some form of health insurance were considered as having access to health insurance and those who reported no, or don’t know or refused or missing responses were considered as having no access to insurance. Meeting the national recommendations of having a dilated eye exam within the past year was the primary outcome of interest. Those who reported having an eye exam within the past year were considered as meeting the recommendations and who reported no, or don’t know or more than one year ago were considered as not having the recommended service. Other independent variables were defined according to the Andersen Model of Healthcare Services Utilization (predisposing factors, enabling factors, need factors, environment, and health behavior. Chi-square analysis and multivariable logistic regression with OR and 95% CI were used to determine the association between eye screening and health insurance adjusting for other covariates. Results and conclusions: Ninety-one percent (91.3%, 53,919) of the adults reported having some form of health insurance, as compared to 8.7%(3,697) who reported having no form of insurance coverage. Approximately 66.2% of the study population had an eye exam at least once within the past year. A higher proportion of adults who had health insurance reported having an eye exam compared to those with no health insurance (68.6 vs. 44.8%; p=0.000). Among those older than 65 years, 73.9% had eye exam as compared to 42.7% among those younger than 35 years (p=$50,000, 71% had eye exam as compared to 59.9% in those earning

No description available.

published_or_final_version / abstract / Anatomy / Doctoral / Doctor of Philosophy

A retinopatia diabética (RD) é uma das complicações crônicas do diabetes mellitus e constitui a principal causa de cegueira no mundo. Este estudo tem como objetivo compreender a percepção visual de pacientes diabéticos acometidos pela RD. Foram entrevistados 11 sujeitos diabéticos em um Centro de Pesquisa e Extensão Universitária do interior paulista, em 2007. Utilizou-se o referencial teórico-metodológico da fenomenologia e da percepção do corpo, à luz de Merleau-Ponty. A organização dos dados possibilitou a elaboração de quatro categorias de análise: a percepção visual de pacientes com RD como \"algo\" não refletido, a percepção visual de pacientes com retinopatia diabética como \"algo\" em movimento, a percepção da retinopatia diabética e a experiência existencial do conviver com a retinopatia diabética. A diminuição da acuidade visual ou a cegueira conduz o homem a uma nova existência traduzida por um redimensionar do corpo habitual para um novo corpo atual, encontrando maneiras próprias de habitar o mundo. Compreender o paciente em sua experiência vivida, buscando entender as mudanças existenciais decorrentes da RD, é importante para o estabelecimento de estratégias educacionais com vista à atenção integral à saúde. Os resultados reafirmam a necessidade de se repensar o cuidado para além da dimensão biológica e do enfoque fragmentado do corpo centrado na doença, em direção a uma dimensão humana em todas as suas vertentes / Diabetic retinopathy (DR) is one of the chronic complications of diabetes mellitus and constitutes the main cause of blindness around the world. This study aims to understand the visual perception of diabetic patients affected by DR. Eleven diabetic patients were interviewed at a University Research and Community Service Centre in the interior of São Paulo State, Brazil, in 2007. The theoretical-methodological framework consisted of phenomenology and the perception of the body, in the light of Merleau-Ponty. Data organization permitted the elaboration of four analysis categories: the visual perception of DR patients as \"something\" that is not reflected, the visual perception of patients with diabetic retinopathy as \"something\" moving, the perception of diabetic retinopathy and the existential experience of living with diabetic retinopathy. Decreased visual acuity or blindness lead man to a new existence, translated by a redimensioning of the habitual body to a current body, finding one\'s own ways of living in the world. Understanding patients in their experience, attempting to understand the existential changes deriving from DR, is important to establish educational strategies with a view to integral health care. The results confirm the need to rethink care beyond the biological dimension and disease-centered fragmented focus on the body, towards a human dimension in all of its aspects

Diabete Melito (DM) é uma endocrinopatia frequentemente diagnosticada na clínica de pequenos animais e desenvolve-se pela deficiência relativa ou absoluta de insulina, sendo caracterizada pela hiperglicemia crônica. Complicações associadas ao DM são frequentes, dentre elas podemos citar catarata e retinopatia. A catarata, que é a oftalmopatia mais frequente nos cães, impossibilita à fundoscopia e nestes casos a avaliação da função retiniana pode ser feita com o auxílio do eletrorretinograma de campo total. O objetivo deste estudo foi avaliar a progressão da retinopatia diabética por meio de eletrorretinograma (ERG) de campo total pré e pós-operatória (180 dias) em cães portadores de catarata madura e hipermadura submetidos à facoemulsificação. Vinte e quatro cães (Grupo Diabético (DM) = 12 cães; Grupo Não Diabético (NDM) = 12 cães) de raças diversas foram avaliados. Previamente ao ERG, todos os cães foram submetidos ao exame oftalmológico completo e ultrassom ocular. Todos os cães foram sedados seguindo o mesmo protocolo. ERG de campo total foi realizado com sistema eletrodiagnóstico Veris 2000 e cúpula de estimulação (Ganzfeld), segundo o protocolo da ISCEV contendo 5 respostas. Para obtenção dos registros utilizou-se eletrodo bipolar Burian Allen. Avaliou-se a amplitude pico a pico das 5 respostas e o tempo de culminação da onda-b na resposta de bastonetes, máxima resposta, cones e flicker para cada registro em condições escotópicas e fotópicas. As respostas obtidas em cada olho no momento basal e após 6 meses foram comparadas por meio do teste de Wilcoxon. O teste de Mann-Whitney foi utilizado para comparação de respostas dos olhos operados (OP) com os olhos contralaterais (OC), assim como para comparação entre os grupos DM e NDM. O efeito da cirurgia e do tempo de DM foi ainda avaliado por meio do cálculo das diferenças entre as respostas no momento pré e pós 6 meses de cada olho (delta OP e delta OC). Observou-se diferenças entre OP e OC, no momento pré, nas respostas dos bastonetes e da máxima resposta (amplitude e tempo de culminação onda-b). No momento pós, foram observados diferenças entre OP e OC no tempo de culminação dos bastonetes e flicker, e nas amplitudes do potencial oscilatório, cones e flicker. No grupo NDM, não foram observados diferenças entre os momentos pré e pós assim como entre OP e OC. Quando comparadas as respostas dos grupos DM e NDM, observou-se valores significativamente maiores no grupo DM, no tempo de culminação da onda-b na máxima resposta do OP no momento pós, no tempo de culminação da onda-b na máxima resposta OC no momento pós e no tempo de culminação da onda-b da resposta de cones no momento pré cirurgia. Não foram observados diferenças entre delta OP e delta OC dentro de cada grupo e entre os grupos. Todos os pacientes que participaram do estudo recuperaram a visão após a cirurgia, sugerindo que a inflamação pós cirúrgica foi controlada com a medicação prescrita nos 2 grupos estudados. Conclui-se que a facoemulsificação representa mínimo impacto na evolução da retinopatia diabética em cães. A remoção cirúrgica da catarata não deve ser contraindicada nesta espécie, independentemente se o animal é ou não portador de DM, por resultar em melhoria da visão. / Diabetes mellitus (DM) is a common endocrinopathy in the small animals practice and it develops as a relative or absolute insulin deficiency characterized by a chronic hyperglycemia. There are frequent complications, such as cataracts, retinopathy, resulting in visual impairment. Cataracts are dogs most frequent ophthalmic affection and, since it prevents fundoscopic examination, full-field electroretinography is used for retinal functional evaluation. Therefore, to provide a better understanding of diabetic retinopathy (DR) progression in dogs with mature and hypermature cataracts undergoing phacoemulsification surgery, this study aims to analyze the full-field electroretinogram prior and 180 days post cataracts removal. Twenty four dogs (diabetic group (DM) = 12 dogs and non-diabetic group (NDM) = 12 dogs), from different breeds were evaluated. Before the ERG, all animals were submitted to a complete ophthalmic examination and ocular ultrasonography. All dogs were sedated following the same anesthetic protocol. The full-field ERG was recorded using 2000 VERIS system and a dome stimulator (ganzfeld) according to ISCEV five response standard. The recordings were obtained using bipolar Burian Allen electrodes. Peak to peak amplitude five response and b-wave culmination time in rod responses, maximum response, cone and flicker were evaluated in scotopic and photopic conditions. The responses obtained in each eye at baseline and after 6 months were compared using the Wilcoxon test. The Mann-Whitney test was used to compare the responses of the operated eyes (OP) and the contralateral eyes (OC) as well as for comparison between groups DM and NDMAs. The effect of surgery and duration of DM was assessed by calculating the differences between the responses prior and six months after surgery, of each eye (delta delta OP and OC). There were differences between OP and OC, in the baseline values, in rod responses and maximum response (amplitude values and b-wave implicit time). After phacoemulsification, differences were observed between OP and OC in b-wave implicit time of rods and flicker, and the amplitudes of the oscillatory potentials, cone and flicker. In the NDM group, no differences were observed between pre and post evaluations between OP and OC. Comparing the responses of DM and NDM groups, there were significantly higher values in the DM group, in b-wave implicit time and in maximum response of OP after caratact removal, and also, of the b-wave implicit time in the maximum response in OC after surgery and, finally, in the b-wave implicit time of cone response prior to the surgery. No differences were observed between delta OP and delta OC within each group and between groups. All patients recovered vision after surgery, suggesting that post-surgery inflammation was controlled by the prescribed medication in both groups. The phacoemulsification surgery did not appear to have a great impact on diabetic retinopathy evolution in dogs. Cataract surgery should not be contraindicated in this species, regardless of the presence of DM, as it can result in sight improvement.

Bakgrund Diabetes är en av de sjukdomar som ökar mest i hela världen, detta medför att även följdsjukdomar förknippade med diabetes ökar. Diabetesretinopati [DRP] är en av dessa följdsjukdomar. Regelbunden ögonbottenfotografering gör att förändringar upptäcks i tid. Följsamheten till ögonbottenfotografering bland patienter med diabetes är dock inte optimal.   Syfte Syftet med studien var att identifiera faktorer som bidrar till att patienter med diabetes har låg följsamhet till ögonbottenfotografering.   Metod Studien utfördes som en systematisk litteraturstudie, med kvalitativa och kvantitativa artiklar för att sammanställa tidigare forskning.    Resultat Studien resulterade i tre huvudkategorier Faktorer relaterade till interaktionen med sjukvården, faktorer relaterade till patientens livssituation och personlighet och faktorer relaterade till det omgivande samhället samt åtta underkategorier. De huvudsakliga faktorer som framkom var brist på information, ekonomiska aspekter samt känslor relaterade till undersökningarna.   Slutsats Genom att identifiera försvårande faktorer kan denna studies resultat användas som utgångspunkt för att utveckla hälsofrämjande åtgärder för en ökad följsamhet. Även annan vårdpersonal, till exempel diabetessjuksköterskan kan få nytta av kunskapen som framkommer. Vidare forskning behövs som behandlar nordiska förhållanden. / Background Diabetes is an increasing health problem all around the world. This means that health problems associated with diabetes are also increasing. Diabetic retinopathy [DRP] is one of these problems. To detect DRP at an early stage, regular fundus examinations are recommended. However, compliance among diabetic patients is not optimal. Purpose The purpose of the study was to identify factors that contribute to patients' with diabetes low compliance to fundus examinations. Method The study was a systematic literature review, including both qualitative and quantitative research in order for a comprehensive compilation of previous studies. Results The result showed three main categories. Factors related to the interaction with the healthcare system, factors related to the patient's life situation and personality and factors related to the surrounding society. There were also eight subcategories. The main factors that emerged were lack on information, economic aspects and emotions related to the examinations. Conclusions By identifying aggravating factors, the result in this study may be useful as a starting point to develop health-promoting actions to increase compliance. Other healthcare professionals, such as the diabetic nurse, may also benefit from the knowledge that emerges. Further research about the conditions in Scandinavia is required.

O presente estudo avaliou diferentes aspectos funcionais da visão de diabéticos do tipo 2 com e sem retinopatia diabética. A visão desses pacientes foi avaliada em diferentes níveis do sistema visual por meio da aplicação de uma bateria de testes psicofísicos e eletrofisiológicos de grande sensibilidade. O objetivo foi caracterizar as alterações visuais provocadas pela doença antes do aparecimento de retinopatia, e avaliar o efeito da presença da retinopatia sobre as alterações funcionais precoces. Materiais e métodos: 31 pacientes diabéticos com retinopatia não proliferativa leve (15 , 16 ; idade = 59 ± 09; tempo de diabetes = 10 ± 06 anos); 36 pacientes diabéticos sem retinopatia (16 , 20 idade = 56 ± 11; tempo de diabetes = 06 ± 04 anos) e 30 sujeitos controle (13 , 17 ; idade = 44 ± 10 anos) foram submetidos a exames de (1) eletrorretinograma multifocal - mfERG; (2) sensibilidade ao contraste acromático segregada em componentes magno (MC) e parvocelulares (PC) Teste do pedestal; (3) perimetria visual computadorizada branco/branco e azul/amarelo e (4) teste quantitativo de visão de cores Teste de cores de Cambridge. A comparação dos dados de pacientes e controles foi feita com ANOVA e a comparação da capacidade de detecção do dano funcional entre os testes foi feita por meio da análise de curvas ROC. Resultados: ambos os grupos de pacientes manifestaram perdas significantes no mfERG, sensibilidade ao contraste e visão de cores. Em ambos os protocolos de perimetria apenas os pacientes com retinopatia tiveram perdas significativas. As respostas de pacientes com e sem retinopatia não foram significantemente diferentes na maior parte das medidas. Diferenças significativas foram encontradas entre os dois grupos em parte das latências do mfERG e na visão de cores, nos limiares do eixo tritan,. Na análise entre testes, o mfERG teve os maiores índices de sensibilidade e especificidade, seguido por visão de cores, sensibilidade ao contraste e perimetria, nesta ordem. Na comparação das áreas sob as curvas ROC não houve diferença significativa apenas entre os testes 1, 2 e 4. Conclusões: foram encontradas perdas funcionais estatisticamente significativas na avaliação psicofísica e eletrofisiológica da visão de pacientes diabéticos do tipo 2 sem e com retinopatia diabética. O presente trabalho confirma e amplia o crescente corpo de evidencias de perdas funcionais observadas precocemente no curso da diabetes, na ausência de alterações morfológicas (vasculares) detectáveis na retina. A interpretação dessas perdas precoces é de que tenham origem neural. Nossos achados indicam que a presença de retinopatia leve não teve efeito significativo sobre a maior parte dos aspectos funcionais analisados, corroborando a noção de origem neural das perdas. O efeito da diabetes sobre a função neural não parece ser específico a nenhuma das vias de processamento visual, como indicado pelos testes de sensibilidade ao contraste e de visão de cores. Os achados deste trabalho confirmam a hipótese de que, para o sistema visual, a diabetes seja uma doença neurodegenerativa da retina que pode estabelecer- se mesmo na ausência de retinopatia. Assim, a avaliação dos aspectos funcionais da visão deve ser melhor que a avaliação morfológica da retina para a identificação de pacientes diabéticos sob risco de perda visual. / The present study evaluated different aspects of visual function in type 2 diabetics both with and without retinopathy. The approach was to evaluate vision at several levels of the visual system by means of application of a battery of modern, sensitive psychophysical and electrophysiological tests. The goals were to characterize the changes in visual function underlying the disease prior to the onset of retinopathy, and to verify how the early losses are affected once retinopathy has occurred. Materials and methods: 31 diabetic patients with non-proliferative retinopathy (15 , 16 ; age = 59 ± 09 years; duration of diabetes = 10 ± 06 years); 36 diabetic patients without retinopathy (16 , 20 ; age = 56 ± 11 years; duration of diabetes = 06 ± 04 years) and 30 controls (13 , 17 ; age = 44 ± 10 years) were evaluated with: (1) multifocal electroretinogram - mfERG; (2) achromatic contrast sensitivity segregated into magno- (MC) and parvocellular (PC) pathways Pedestal test; (3) white-onwhite and blue-on-yellow computerized visual perimetry and (4) quantitative computerized color vision test Cambridge Colour Test (CCT). An ANOVA was performed for the statistical comparison among groups and ROC curve analysis was used to compare the diagnostic power of the different tests. Results: both diabetic patient groups manifested significant functional losses compared to controls in the mfERG, the Pedestal test and the CCT. In the mfERG, both patient groups had significantly smaller amplitudes and longer latencies than controls in one or more of the signature mfERG waveform components. For the Pedestal Test, both patient groups manifested losses in both the M-targeting and P-targeting paradigms. The CCT chromatic discrimination test found significant losses along all three color confusion axes (protan, deutan, tritan) in both patient groups. In the visual fields, only the patients with retinopathy exhibited significant losses compared to controls. In the comparison between patients with and without retinopathy, no statistical differences between results were found, except for some of the mfERG latencies and the color discrimination in the tritan axis. The ROC analysis showed that the mfERG had the higher combined sensitivity and specificity indexes, followed by the CCT, pedestal test and perimetry with decreasing indexes in this order. Conclusions: statistically significant losses were found in psychophysical and electrophysiological assessment of visual function of type 2 diabetic patients with and without diabetic retinopathy. The present work strongly confirms the growing body of evidence that functional losses with neural etiology occur in type 2 diabetes before any vascular changes are clinically detectable in the retina. In the majority of the measures, the presence of retinopathy increased the functional losses, but did not determine significant differences in relation to the losses observed in the diabetics with normal fundus. According to our results from the Pedestal Test and the Cambridge Colour Test, the neural damage is not selective to either of the visual processing pathways. The results are consistent with the hypothesis that diabetes is a neurodegenerative disease of the retina whose establishment may occur even in the presence of retinopathy. Thus, the assessment of functional status rather than morphological examination seems a better approach to identify diabetic patients under vision threat.