Psychological distress and its association with socio-demographic factors in a rural district in Bangladesh: A cross-sectional study.

BackgroundPsychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.MethodsA total of 2425 adults (1249 women) aged 18-90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants' socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.ResultsThe overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, pConclusionsIn this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh

Concordance between Different Criteria for Self-Reported Physical Activity Levels and Risk Factors in People with High Blood Pressure in a Rural District in Bangladesh

Self-reported assessment of physical activity (PA) is commonly used in public health research. The present study investigated the concordance of self-reported PA assessed using the global physical activity questionnaire (GPAQ) and two different measurement approaches. Participants (n = 307, aged 30–75 years with hypertension) were recruited from a rural area in Bangladesh. We analyzed the difference between the World Health Organization (WHO) recommendations of more than 600 metabolic-equivalent time-minutes (MET-min) and the self-reported active hours, at least 2.5 h per week. Tests of sensitivity and specificity were conducted to determine concordance between the two measures. According to the WHO criteria, 255 (83%) participants were active more than 600 MET-min per week and 172 (56%) people were physically active 2.5 h or more per week, indicating a 27% difference in self-reported PA. The sensitivity, specificity, positive and negative predictive values and concordance between the two measures were 64%, 92%, 98%, 34% and 70%, respectively. Considering the WHO MET-min as the appropriate measure, 89 (35%) were false negative (FN). Older age, professionals and businesspersons were associated with a higher proportion of FN. There is a gap between self-reported PA, thus a better estimate of PA may result from combining two criteria to measure PA levels

Factors Associated with Physical Activity among People with Hypertension in a Rural Area in Bangladesh: Baseline Data from a Cluster Randomized Control Trial

The health benefits of physical activity (PA) are well recognized, and PA levels vary in different populations. The study aimed to investigate PA levels and associated sociodemographic factors among people with hypertension in a rural area in Bangladesh. Baseline data were part of a cluster randomized controlled trial of 307 adults aged 30–75 years to study the effectiveness of PA and lifestyle changes in lowering blood pressure. The outcome variables were PA at work, commuter, recreation, metabolic equivalent task (MET)-minute per week and sitting time. Total 68 (22.1%) people participated in vigorous-intensity activity, 23 (7.5%) participated in moderate-intensity sports. Overall, 83% of people were physically active more than 600 MET-min. Women (OR 2.95, 95% CI, 1.36–6.39) compared to men, and people with no education (OR 4.47, 95% CI, 1.62–12.33) compared to people with secondary school certificates or above were less physically active. Of total PA, 63% were work-related, and 1% were recreation-related for women, and these figures were 55% and 3% for men. The study reports that vigorous-intensity PA is low, and recreation time is minimal. Routine PA, especially for women and people with low education levels, should be encouraged to increase PA to manage hypertension

Comparison of diabetic retinopathy graded by the CERA grader and the local graders after learning from a test set of 32 eyes graded by the CERA grader.

<p>Comparison of diabetic retinopathy graded by the CERA grader and the local graders after learning from a test set of 32 eyes graded by the CERA grader.</p

Age and sex of patients with diabetes included and those who were not included in the diabetic retinopathy study.

<p>Age and sex of patients with diabetes included and those who were not included in the diabetic retinopathy study.</p

Accuracy and reliability of retinal photo grading for diabetic retinopathy: Remote graders from a developing country and standard retinal photo grader in Australia

<div><p>Background</p><p>To evaluate the accuracy and reliability of fundus retinal photos graded by local graders in Bangladesh with those graded by an expert at the Centre for Eye Research Australia (CERA) in the context of mass scale diabetic retinopathy (DR) screening in Bangladesh.</p><p>Methods</p><p>A population-based cross-sectional study of 3,104 adults identified 213 (7.2%) eligible patients with diabetes of age ≥ 40 years in 2012–2013. Retinal photographs were collected using a non-mydriatic digital fundus retinal camera and a two-field imaging protocol. The photos were graded by two remote graders (G1 and G2) who were trained by a retinal specialist (RS) in Bangladesh, by the RS himself, and by a Centre for Eye Research Australia (CERA) grader. The local graders up skilled their grading ability by comparing 30% of the photos graded by the CERA grader with their own grades. Learning from that exercise was applied to the remaining 70% of photos, which were re-graded. Reliability and accuracy of grading amongst the graders were reported using cross tabulation, inter- and intra-grader reliability, and with sensitivity and specificity.</p><p>Results</p><p>Of 122 eyes from 61 patients, the mild (R1) DR was estimated to be 14 to 25%, pre-proliferative (R2) DR 4–8%, and proliferative (R3) DR 0.8 to 1.6%, whereas 25%, 8%, 18%, and 15% were found to be ungradable by CERA, RS, G1, and G2, respectively. Of 8 (6.6%) eyes identified as R2 by the CERA grader, 5 (63%), 3 (38%) and 3 (38%) were correctly classified as R2, whereas the rest were classified either as R1 or R3 but none were classified as no DR (R0) or ungradable by the RS, G1 and G2, respectively. After getting experience reviewing the 30% test set graded by the CERA grader, the local graders graded moderate and severe DR with 100% accuracy. After excluding ungradable photos, the sensitivity (specificity) relative to the CERA grader was 82% (88%) before and 80% (93%) after training for G1 and 56% (87%) before and 77% (90%) after training for G2. In case of maculopathy, the CERA grader reported 11.2% eyes with maculopathy, which included 100% of the 4.9% by RS, 6.6% by G1, and 7.4% by G2.</p><p>Conclusions</p><p>Local graders in Bangladesh are able to grade retinal photos with high accuracy if the DR is at least of a moderate level. With appropriate training and experience, local graders have the ability to contribute significantly to the grading of millions of retinal photos, which required grading in resource- poor countries.</p></div

Comparison of maculopathy graded by the CERA grader, retinal specialist and the local graders before training through the test set.

<p>Comparison of maculopathy graded by the CERA grader, retinal specialist and the local graders before training through the test set.</p

Correctly classified retinal photos with and without DR by CERA grader and the local graders in grading DR after learning from a test set of 32 eyes graded by the CERA grader.

<p>Correctly classified retinal photos with and without DR by CERA grader and the local graders in grading DR after learning from a test set of 32 eyes graded by the CERA grader.</p

Correctly classified retinal photos with and without DR, and with and without maculopathy by CERA grader, retinal specialist and the local graders before training through the test set.

<p>Correctly classified retinal photos with and without DR, and with and without maculopathy by CERA grader, retinal specialist and the local graders before training through the test set.</p

DR (%) graded by CERA grader, retinal specialist (R. Specialist) and the local graders (Grader 1 and Grader 1).

<p>DR (%) graded by CERA grader, retinal specialist (R. Specialist) and the local graders (Grader 1 and Grader 1).</p