Marked increases in costs have been identified when complications of these chronic diseases occur, underlining the importance of secondary prevention approaches in disease management in South Asia. Higher quality studies, especially those that include longitudinal costs, are required to establish more robust cost estimates.
BackgroundThere were an estimated 7 million people living with diabetes in Pakistan in 2014, and this is predicted to reach 11.4 million by 2030.AimTo assess if an integrated care package can achieve better control of diabetes.Design & settingThe pragmatic cluster randomised controlled trial (cRCT) was conducted from December 2014–June 2016 at 14 primary healthcare facilities in Sargodha district. Opportunistic screening, diagnostic testing, and patient recording processes were introduced in both the control 'testing, treating, and recording' (TTR) arm, and the intervention 'additional case management' (ACM) arm, which also included a clinical care guide and pictorial flipbook for lifestyle education, associated clinician training, and mobile phone follow-up.MethodClinics were randomised on a 1:1 basis (sealed envelope lottery method) and 250 patients recruited in the ACM arm and 245 in the TTR-only arm (age ≥25 years and HbA1c >7%). The primary outcome was mean change in HbA1c (%) from baseline to 9-month follow-up. Patients and staff were not blinded.ResultsThe primary outcome was available for n = 238/250 (95.2%) participants in the ACM arm and n = 219/245 (89.4%) participants in the TTR-only arm (all clusters). Cluster level mean outcome was -2.26 pp (95% confidence intervals [CI] = -2.99 to -1.53) for the ACM arm, and -1.44 pp (95% CI = -2.34 to -0.54) for the TTR-only arm. Cluster level mean ACM–TTR difference (covariate-unadjusted) was -0.82 pp (95% CI = -1.86 to 0.21; P = 0.11).ConclusionThe ACM intervention in public healthcare facilities did not show a statistically significant effect on HbA1c reduction compared to the control (TTR-only) arm. Future evaluation should assess changes after a longer follow-up period, and minimal care enhancement in the comparator (control) arm.
To determine the prevalence of asthenopia and to identify modifiable risk factors in medical students. Therefore, as to provide with necessory instruction and precaution to reduce the occurrence of the ocular morbidity. METHODSA cross sectional observational study was conducted amongst 200 medical students who are using smart phone, laptop and computer to determine the relationship between asthenopia and related risk factors. Data were based on demographic features, type and duration of electronic items used and asthenopic symptoms was collected by self-administered questionnaire. The data was compiled and entered into excel sheet and analyzed by using appropriate statistical test. Statistical analysis was done using SPSS Version 20. RESULTSWe found out of96% students, 51.56% had moderate asthenopic symptoms. Most of the students had more than one asthenopic symptoms, in which headache (56.77%) was found to be the most common symptom followed by eye strain (50.52%), blurring of vision (40.62%) and redness (23.95%). Those who were using electronic devices for4-10 hours, had more moderate to severe asthenopic symptoms about 85%. The ocular morbidity was found to be more among the smartphone users followed by laptops. There was association between ocular symptoms and type of electronic devices (χ2= 14.6, p < 0.006) and duration (χ2= 25.6, p<0.001) of its use. CONCLUSIONWith this study we can identify the modifiable risk factors and excess use of electronic devices, therefore we can guide the students to limit the risk factors so that we can reduce the ocular morbidity.
BackgroundIn Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.ResultsUtilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.ConclusionThe integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.
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