ContextDiabetes is a serious and costly disease that is becoming increasingly
common in many countries. The role of diabetes as a cancer risk factor remains
unclear.ObjectiveTo examine the relationship between fasting serum glucose and diabetes
and risk of all cancers and specific cancers in men and women in Korea.Design, Setting, and ParticipantsTen-year prospective cohort study of 1 298 385 Koreans (829 770
men and 468 615 women) aged 30 to 95 years who received health insurance
from the National Health Insurance Corp and had a biennial medical evaluation
in 1992-1995 (with follow-up for up to 10 years).Main Outcome MeasuresDeath from cancer and registry-documented incident cancer or hospital
admission for cancer.ResultsDuring the 10 years of follow-up, there were 20 566 cancer deaths
in men and 5907 cancer deaths in women. Using Cox proportional hazards models
and controlling for smoking and alcohol use, the stratum with the highest
fasting serum glucose (≥140 mg/dL [≥7.8 mmol/L]) had higher death rates
from all cancers combined (hazard ratio [HR], 1.29; 95% confidence interval
[CI], 1.22-1.37 in men and HR, 1.23; 95% CI, 1.09-1.39 in women) compared
with the stratum with the lowest level (<90 mg/dL [<5.0 mmol/L]). By
cancer site, the association was strongest for pancreatic cancer, comparing
the highest and lowest strata in men (HR, 1.91; 95% CI, 1.52-2.41) and in
women (HR, 2.05; 95% CI, 1.43-2.93). Significant associations were also found
for cancers of the esophagus, liver, and colon/rectum in men and of the liver
and cervix in women, and there were significant trends with glucose level
for cancers of the esophagus, colon/rectum, liver, pancreas, and bile duct
in men and of the liver and pancreas in women. Of the 26 473 total cancer
deaths in men and women, 848 were estimated as attributable to having a fasting
serum glucose level of less than 90 mg/dL. For cancer incidence, the general
patterns reflected those found for mortality. For persons with a diagnosis
of diabetes or a fasting serum glucose level greater than 125 mg/dL (6.9 mmol/L),
risks for cancer incidence and mortality were generally elevated compared
with those without diabetes.ConclusionIn Korea, elevated fasting serum glucose levels and a diagnosis of diabetes
are independent risk factors for several major cancers, and the risk tends
to increase with an increased level of fasting serum glucose.

https://jamanetwork.com/journals/jama/articlepdf/200151/JOC41853.pdf

Fasting serum glucose level and cancer risk in korean men and women

The Internet increasingly serves as a platform for the delivery of public health interventions. The efficacy of Internet interventions has been demonstrated across a wide range of conditions. Much more work remains, however, to enhance the potential for broad population dissemination of Internet interventions. In this article, we examine the effectiveness of Internet interventions, with particular attention to their dissemination potential. We discuss several considerations (characterizing reach rates, minimizing attrition, promoting Web site utilization, use of tailored messaging and social networking) that may improve the implementation of Internet interventions and their associated outcomes. We review factors that may influence the adoption of Internet interventions in a range of potential dissemination settings. Finally, we present several recommendations for future research that highlight the potential importance of better understanding intervention reach, developing consensus regarding Web site usage metrics, and more broadly integrating Web 2.0 functionality.

The Delivery of Public Health Interventions via the Internet: Actualizing Their Potential

Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care.To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation).We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies.We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions.For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes.We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups.The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.

/pdf/interactive-telemedicine-effects-on-professional-practice-1xxbw8tg81.pdf

Interactive telemedicine: effects on professional practice and health care outcomes

Background
Long-term illnesses affect a significant proportion of the population in developed and developing countries Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-effective ways of supporting self-management and improving patients' self-efficacy skills through, for instance, medication reminders, therapy adjustments or supportive messages

Objectives
To assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition Secondary objectives include assessment of: user evaluation of the intervention; health service utilisation and costs; and possible risks and harms associated with the intervention

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009)

We also reviewed grey literature (including trial registers) and reference lists of articles

Selection criteria
We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention We selected only studies where it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions

Data collection and analysis
Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third Primary outcomes of interest were health outcomes as a result of the intervention and capacity to self-manage long-term conditions We also considered patients' and providers' evaluation of the intervention, perceptions of safety, health service utilisation and costs, and potential harms or adverse effects The included studies were heterogeneous in type of condition addressed, intervention characteristics and outcome measures Therefore, a meta-analysis to derive an overall effect size for the main outcome categories was not considered justified and findings are presented narratively

Main results
We included four randomised controlled trials involving 182 participants

For the primary outcome of health outcomes, including physiological measures, there is moderate quality evidence from two studies involving people with diabetes showing no statistical difference from text messaging interventions compared with usual care or email reminders for glycaemic control (HbA1c), the frequency of diabetic complications, or body weight There is moderate quality evidence from one study of hypertensive patients that the mean blood pressure and the proportion of patients who achieved blood pressure control were not significantly different in the intervention and control groups, and that there was no statistically significant difference in mean body weight between the groups There is moderate quality evidence from one study that asthma patients receiving a text messaging intervention experienced greater improvements on peak expiratory flow variability (mean difference (MD) -1112, 95% confidence interval (CI) -1956 to -268) and the pooled symptom score comprising four items (cough, night symptoms, sleep quality, and maximum tolerated activity) (MD -036, 95% CI -056 to -017) compared with the control group However, the study found no significant differences between the groups in impact on forced vital capacity or forced expiratory flow in 1 second

For the primary outcome of capacity to self-manage the condition, there is moderate quality evidence from one study that diabetes patients receiving the text messaging intervention demonstrated improved scores on measures of self-management capacity (Self-Efficacy for Diabetes score (MD 610, 95% CI 045 to 1175), Diabetes Social Support Interview pooled score (MD 439, 95% CI 285 to 592)), but did not show improved knowledge of diabetes There is moderate quality evidence from three studies of the effects on treatment compliance One study showed an increase in hypertensive patients' rates of medication compliance in the intervention group (MD 890, 95% CI 018 to 1762) compared with the control group, but in another study there was no statistically significant effect on rates of compliance with peak expiratory flow measurement in asthma patients Text message prompts for diabetic patients initially also resulted in a higher number of blood glucose results sent back (460) than email prompts did (235)

For the secondary outcome of participants' evaluation of the intervention, there is very low quality evidence from two studies that patients receiving mobile phone messaging support reported perceived improvement in diabetes self-management, wanted to continue receiving messages, and preferred mobile phone messaging to email as a method to access a computerised reminder system

For the secondary outcome of health service utilisation, there is very low quality evidence from two studies Diabetes patients receiving text messaging support made a comparable number of clinic visits and calls to an emergency hotline as patients without the support For asthma patients the total number of office visits was higher in the text messaging group, whereas the number of hospital admissions was higher for the control group

Because of the small number of trials included, and the low overall number of participants, for any of the reviewed outcomes the quality of the evidence can at best be considered moderate

Authors' conclusions
We found some, albeit very limited, indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self-management of long-term illnesses However, there are significant information gaps regarding the long-term effects, acceptability, costs, and risks of such interventions Given the enthusiasm with which so-called mHealth interventions are currently being implemented, further research into these issues is needed

/pdf/mobile-phone-messaging-for-facilitating-self-management-of-k0dvgh9kn1.pdf

Mobile phone messaging for facilitating self-management of long-term illnesses.

Aim: This study was performed to determine the levels of depression and anxiety, and coping strategies, and the effects of the levels of depression and anxiety on strategies for coping with stress in cancer patients. Method: The study was designed as a definitive and correlation search ing investigation and has been performed at the Medical Oncology Clinic of Ataturk University Research Hospital between the dates July-August 2005. The study was carried out on 96 cancer patients. The question form prepared with the purpose of determining demographic and disease-related features (type of treatment, duration of disease and treatment) of the patients, and the Hospital Anxiety and Depression Scale (HAD), Strategies for Coping with Stress Scale in collecting the data. Result: It was determined that the type of treatment of 84.4% of the patients was chemotherapy only and mean duration of disease was 15.02±14.05 months, mean duration of treatment was 14.05±14.16 months. Anxiety was determined in 61.5% and depression in 81.3% of the patients. It has been found that patient benefited most from social support seeking strategy. This has been followed by problem solving strategy and avoidance strategy. A positive, statistically significant relationship was found between the avoidance strategy, and anxiety and depression levels of the patients. Conclusion: Patients experience moderate anxiety and depression. It was concluded that patients recruited active coping strategies mostly. Patients are observed to avoid stressful events with the increasing levels of anxiety and depression.

/pdf/coping-anxiety-and-depression-in-turkish-patients-with-49cr21pft2.pdf

Coping, anxiety and depression in turkish patients with cancer

PURPOSE The purpose of this study was to evaluate the effect of web-based diabetic education on plasma glucose and serum lipids in obese people with diabetes. METHOD A random allocation design with control and experimental groups being assessed pre- and post-intervention was used. Eighteen patients were randomly allocated to an intervention group and 16 to a control group. Participants were requested to input their blood glucose levels weekly for 3 months at http://www.biodang.com by cellular phone or wire Internet. The researcher sentoptimal recommendations to each patient weekly for 3 months using a short message service (SMS) of the cellular phone and wire Internet. RESULTS Patients in the intervention group had a mean decrease of 1.2% in glycosylated haemoglobin (HbA1c) levels and those in the control group had no difference in HbA1c levels. There was a significant mean change in 2-hour post prandial blood glucose (2HPPG) for the intervention group, with a mean change of -120.1 mg/dl. The mean change in the control group, however, was not significant. CONCLUSION These findings indicate that this web-based intervention using SMS of the cellular phone for 3 months improved HbA1c and 2HPPG, but did not affect total cholesterol, triglyceride, and high density lipoprotein cholesterol in obese type 2 diabetic patient.

/pdf/effects-of-web-based-diabetic-education-in-obese-diabetic-57z1bg6fj3.pdf

[Effects of Web-based diabetic education in obese diabetic patients].

PURPOSE The purpose of this study was to compare metabolic syndrome (MS) risk factor prevalence by obesity and age in middle-aged women. METHOD Two hundred and fifty-one subjects were recruited from the health promotion center of a tertiary care hospital in an urban city. MS was defined by the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(Adult Treatment Panel III)(ATPIII), and obesity was determined by body mass index(BMI)>/= 25kg/m(2). RESULTS The mean blood pressure, fasting glucose, total cholesterol, and triglyceride were significantly higher in the obese group than in the non-obese group. The prevalence of MS, hypertension, and impaired fasting glucose were significantly higher in the obese group than in the non-obese group. In the forties, blood pressure was significantly higher in the obese group than in the non-obese group. In the fifties, body fat, systolic blood pressure, fasting glucose, total cholesterol, and triglyceride were significantly higher in the obese group than in the non-obese group. CONCLUSIONS These results show that the nurse should focus on the obese fifty year old female patients for improvement of the MS risk factors.

https://jkan.or.kr/Synapse/Data/PDFData/1006JKAN/jkan-37-453.pdf

Comparison of the metabolic syndrome risk factor prevalence forty and fifty something women

PURPOSE The purpose of this study was to identify the stress and the coping methods in the cancer patients and their caregivers. METHOD The stress method was measured by VAS(Visual Analogue Scale). The coping methods was measured using the modified Ways of Coping Questionnaire. The phases of patient illness consisted of 1st(initial) stage, and 2nd(recurred) stage and 3rd(terminal) stage based on Lewandowski & Jones(1988) method. The data were collected by a survey of convenience sampling of 257 cancer patients and 196 of their caregivers from two hospitals in Seoul. The data were analyzed using paired t-test, unpaired t-test. RESULT The stress level of cancer patients was lower than their caregivers. The cancer patients used emotion-focused coping mode than problem-focused coping mode. The caregivers problem-focused coping mode over emotion-focused coping mode. In the problem-focused coping mode, the caregivers significantly used two coping strategies that were 'positive cope', 'information seeking' more than patients. In emotion-focused coping mode, the caregivers significantly used one coping strategies that was 'wish' more than patients. The patients tended to used two coping strategies that were 'blame' and 'emotion expression' more than the caregivers. CONCLUSION Further study needs to be done to positively identify these coping methods and develop interventions to assist patients and their caregivers.

/pdf/the-comparison-of-the-stress-and-coping-methods-of-cancer-48kbw1ff8v.pdf

The comparison of the stress and coping methods of cancer patients and their caregivers

/pdf/prevalence-and-risk-factors-for-diabetes-mellitus-and-492q54zi48.pdf

Prevalence and Risk Factors for Diabetes Mellitus and Impaired Fasting Glucose of Adults

/pdf/effects-of-cardiac-rehabilitation-teaching-program-on-1pjqhlnbvl.pdf

Effects of Cardiac Rehabilitation Teaching Program on Knowledge Level and Compliance of Health Behavior for Patients with Myocardial Infarction

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