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Madurai, India

Patel V.,London School of Hygiene and Tropical Medicine | Chatterji S.,Health Statistics and Informatics | Chisholm D.,WHO | Ebrahim S.,London School of Hygiene and Tropical Medicine | And 7 more authors.
The Lancet | Year: 2011

Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved. © 2011 Elsevier Ltd.

Das T.,L V Prasad Eye Institute | Raman R.,Sankara Nethralaya | Ramasamy K.,Aravind Eye Care System | Rani P.K.,L V Prasad Eye Institute
Middle East African Journal of Ophthalmology | Year: 2015

Telemedicine is exchange of medical data by electronic telecommunications technology that allows a patient's medical problems evaluated and monitored by a remotely located physician. Over the years, telemedicine and telescreening have become important components in health care, in both disease detection and treatment. Highly visual and image intensive ophthalmology is uniquely suited for telemedicine. Because of rising disease burden coupled with high opportunity cost in detection, diabetic retinopathy is an ideal ophthalmic disease for telescreening and decision-making. It fits to Wilson and Jungner's all 10 criteria of screening for chronic diseases and the American Telehealth Association's 4 screening categories.

Kumaragurupari R.,Library and Information Center | Sieving P.C.,U.S. National Institutes of Health | Lalitha P.,Aravind Eye Care System
Indian Journal of Ophthalmology | Year: 2010

Objective: The objective was to conduct a bibliometric analysis of Indian ophthalmic papers published from 2001 to 2006 in the peer-reviewed journals, to assess productivity, trends in journal choice, publication types, research funding, and collaborative research. Materials and Methods: We searched PubMed for articles indicating both vision-related content and author affiliation with an Indian research center. We identified research collaborations and funding from indexing for research support, and classified articles as reporting basic science, clinical science, or clinically descriptive research. Impact factors were determined from Journal Citation Reports for 2006. Results: The total number of published articles that were retrieved for the years 2001 to 2006 was 2163. During the six-year period studied, the annual output of research articles has nearly doubled, from 284 in 2001 to 460 in 2006. Two-thirds of these were published in international journals; 41% in vision-related journals with 2006 impact factors; and 3% in impact factor journals which were not vision-related. Fifty percent of the publications came from nine major eye hospitals. Clinical science articles were most frequently published whereas basic science the least. Publications resulting from international collaborations increased from 3% in 2001 to 8% in 2006. The focus of the journal with the highest number of publications corresponds to the most common cause of bilateral blindness in India, cataract. Conclusion: This bibliometric study of publications of research from India in the field of ophthalmic and vision research shows that research productivity, as measured in both the number of publications in peer-reviewed journals and qualitative measures of those journals, has increased during the period of this study.

Subburaman G.-B.B.,Aravind Eye Care System | Hariharan L.,University of Southern California | Ravilla T.D.,Aravind Eye Care System | Ravilla R.D.,Aravind Eye Care System | Kempen J.H.,University of Pennsylvania
American Journal of Ophthalmology | Year: 2015

Purpose To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere. Design Retrospective utilization analysis. Methods A historical review of the development of the Aravind Eye Care system was undertaken to evaluate the services provided by various tertiary services of the system. Demand for services is inferred based on the utilization statistics described below and distance traveled by patients to obtain services. Results Utilization of subspecialty services increased logarithmically for 17 years in all specialties. At all centers except one historically focused on glaucoma, retina services had the highest demand among subspecialty surgical services. The proportion of tertiary care patients among all new outpatients (39% in 2009 and 45% in 2013) and the proportion of specialty surgical and treatment procedures among all procedures (30% in 1997 and 49% 2013) increased over time. More patients traveled long distances (>100 kilometers) to receive specialty services than to receive cataract services (30% vs 23%). Conclusions These observations suggest that in regions where tertiary services are not widely available, (1) patients demand (travel further for) tertiary care more than general ophthalmology services; (2) demand for services can expand rapidly for many years; (3) tertiary care services tend to grow over time as a proportion of all services provided; and (4) retina services are the most highly demanded subspecialty surgical services. In such settings, it is likely that considerable latent demand exists; planned tertiary eye centers should anticipate sustained growth of tertiary services. © 2015 Elsevier Inc.

Srinivasan M.,Aravind Eye Care System | Mascarenhas J.,Aravind Eye Care System | Rajaraman R.,Aravind Eye Care System | Ravindran M.,Aravind Eye Care System | And 9 more authors.
Archives of Ophthalmology | Year: 2012

Objective: To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers. Methods: Randomized, placebo-controlled, doublemasked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization. Main Outcome Measures: The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/ scar size, reepithelialization, and corneal perforation. Results: Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P=.82), infiltrate/scar size (P=.40), time to reepithelialization (P=.44), or corneal perforation (P>.99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P=.03) and ulcer location (P=.04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P=.03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P=.02). Conclusions: We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers. Application to Clinical Practice: Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers. Trial Registration: clinicaltrials.gov Identifier: NCT00324168. ©2012 American Medical Association. All rights reserved.

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