By LUO Jing & XIAO Chengfeng

Application of artificial intelligence to assist diabetic retinopathy screening and health education in Western Hunan

Diabetic retinopathy is the most familiar cause of blindness in adults. Early DR can be asymptomatic. Therefore, regular fundus screening for diabetic patients is very important. Timely diagnosis and treatment can effectively protect and restore the vision of DR patients.

However, due to the lack and unbalanced distribution of medical resources, the current screening of fundus lesions is not perfect; more than 60% of diabetes patients have never undergone fundus examination, and many have lost their vision due to the absence of timely treatment.

Background
Diabetes and hypertension are common chronic diseases that affect human health and quality of life. Diabetic retinopathy (DR), hypertensive ophthalmopathy and retinal vein occlusion are usual complications of diabetes and hypertension. Diabetic retinopathy is the most familiar cause of blindness in adults. Early DR can be asymptomatic. Therefore, regular fundus screening for diabetic patients is very important. Timely diagnosis and treatment can effectively protect and restore the vision of DR patients. However, due to the lack and unbalanced distribution of medical resources, the current screening of fundus lesions is not perfect; more than 60% of diabetes patients have never undergone fundus examination, and many have lost their vision due to the absence of timely treatment. Xiangxi Tujia and Miao Autonomous Prefecture is located in a remote and underdeveloped area of Hunan Province, thus lacking sufficient levels of care. Due to the influence of lifestyle, dietary habits and disease cognition, the incidence of diabetes and hypertension related complications such as diabetic retinopathy is high. In addition, there is a shortage of health institutions and medical personnel in the western Hunan area, and the health personnel allocation is lower than the provincial average. The screening work for chronic diseases such as diabetes and hypertension is progressing slowly and correlates with a rising mortality rate caused by chronic diseases. Thanks to the special anatomical structure of ophthalmology, the advancement of medical imaging diagnostic technology and the rapid development of image processing technology, artificial intelligence (AI) diagnosis in the field of clinical medicine has made breakthroughs in the diagnosis and treatment of ophthalmic diseases.

Aims
The aims of the project are to use the artificial intelligence assisted diabetic retinopathy

screening in western Hunan, to carry out relevant health education in Western Hunan, and to promote the development of ophthalmology telemedicine in western Hunan and solve the problem of insufficient ophthalmology medical resources.

Main activities (2020)
This project intends to use the diabetic retinopathy artificial intelligence assisted screening and diagnosis system to assist the screening of diabetic eye diseases in western Hunan, complete the clinical verification and demonstration application of the system, and build an APP on this basis for the health education of fundus diseases such as diabetes and hypertension related complications.

Outcomes
We will help West Xiangxi hospitals set up diabetic retinopathy screening systems, improve the local residents’ recognition of chronic disease complications such as DR, and train local doctors or nurses to conduct the screening.

Implications
This project can increase the screening rate of diabetic retinopathy in the western Hunan region and reduce the burden on patients, families and society caused by permanent vision loss.

Chia Fellows
LUO Jing, 2008 Xiangya Chia fellow; Professor, Department of Ophthalmology, the Second Xiangya Hospital, CSU
XIAO Chengfeng, 2013 Western Hunan Chia fellow; Endocrinologist, Huayuan County People's Hospital

By HUANG Ruixue & YANG Lifen

Magic Lotus Lantern
A randomized controlled trial for early childhood cognitive development

This 2020-2021 Chia Community Health Service project led by 2016 Chia Fellows HUANG Ruixue (associate professor, Xiangya School of Public Health) and YANG Lifen (supervisor nurse, Huayuan County People’s Hospital) suggests a strategy for addressing cognitive delay in children aged 0-3.

The first three years of a child’s life are critical. More than 80% of a child’s brain is formed during their first three years.

Due to a lack of early exposure to languages and other stimuli, a study conducted in rural Shaanxi found nearly half of toddlers tested are cognitively delayed.

Background
Early childhood, from birth to five years, is marked by one of the most critical and intensive period of brain development throughout the human lifespan. Healthy brain development during this period facilitates cognitive development and lays the foundation for future cognitive and academic accomplishments. Currently, nearly one-third of all children under 5-year-old in China are left behind in the rural area. As of 2010, there were approximately 61 million left-behind children in China. Half of rural toddlers aged 0-3 years in some China's rural region are cognitively delayed. Thus, an effective strategy for childhood cognitive development is to increase the early exposure to multi-stimuli, in particular, languages stimuli.

Aims
The aim of our project is to adapt and evaluate an evidence-based and culturally-tailored “The Magic Lotus Lantern” program to improve and facilitate early childhood development in rural Central South China. The ultimate goal is to disseminate the “The Magic Lotus Lantern” program to all rural primary care settings and improve rural left-behind child cognitive delayed in mainland China.

Main activities (2020)
The main activities are as follows, Phase I for a pilot study and Phase II for the randomized controlled trial (RCT). In the pilot study, we will first train village physicians with theories of best practice including resources and evidence about the benefits of early reading. After the pilot study, a RCT will be conducted to examine the efficacy of “The Magic Lotus Lantern” compared with usual health care at 6- and 12- month follow up in Hunan Province. In brief, in the “The Magic Lotus Lantern” program, during visiting the families are given free books selected based on the developmental age of child provided by trained village clinicians in primary local care settings and 6 monthly telephone-based follow-up consultations in rural China.

Outcomes
The analysis plan focuses on comparisons between the “The Magic Lotus Lantern” program and the control group with respect to primary outcomes and key intermediate variables. The comparisons take the form of 1) differences of average values of change from baseline to follow-up measures using the cognitive scales, and 2) an existing decision-tree model in Excel (GeDi ForCE, Gestational Diabetes Formulas for Cost-Effectiveness) to conduct the cost-effectiveness analysis.

Implications
Policy implications will be made to improve cognitive delayed in rural area child in China.  

Chia Fellows
HUANG Ruixue, 2016 Xiangya Chia fellow; Associate Professor, Xiangya School of Public Health, CSU
YANG Lifen, 2016 Western Hunan Chia fellow; Supervisor nurse, Huayuan County People's Hospital