Lifestyle Changes for the Treatment of Nonalcoholic Fatty Liver Disease - A 2015-19 Update

Background: Lifestyle interventions aimed at weight loss have been associated with improved liver enzymes, reduced intrahepatic triglyceride content, and improved histology (including reduced fibrosis stage). Objective: To revise the evidence on the beneficial effects of lifestyle changes accumulated since 2015, following the publication of the pivotal Cuban experience with histologic outcome. Methods: A PubMed search covering the period 2015 to July 2019 was carried out. All retrieved references were analyzed and double-checked by authors. Results: 20 new studies were identified; in addition, two relevant studies provided new evidence. Thirteen studies were classified as randomized, controlled studies, three as proof-of-concept/pilot studies, four as cohort observational studies. In an attempt to maintain a closer contact between participants and the treatment center, a study implemented regular phone calls, another an e-mail service, a third was based on text messages, and finally, a study was totally web-based. Notably, the web-based treatment, accessed following intense motivational interviewing, was not less effective than a standard group-based behavior program. Conclusion: Lifestyle changes should form the basis of any NAFLD intervention. Information technology provides the opportunity to expand treatment, bypassing job and time constraints in younger patients, and to maintain long-term contact between patients and therapists in the NAFLD population.

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Challenges in Communication with Nursing and Midwifery Council of Nigeria (NMCN)

Volume 5 - 2020, Issue 9 - September - International Journal of Innovative Science and Research Technology ◽

10.38124/ijisrt20jun685 ◽

2020 ◽

Vol 5 (6) ◽

pp. 1100-1104

Author(s):

Princewill Aghedo ◽

Isaiah Dada Owoeye ◽

Moses Adeyemo ◽

Victor Bayem Nwachukwu ◽

Oluwatomisin Ogidan

Keyword(s):

Data Analysis ◽

Customer Service ◽

Text Messages ◽

Graduate Nurses ◽

Web Based ◽

The Public ◽

Phone Calls ◽

Online Availability

Communication is an important aspect of organisation’s relationship in service to the public. The study investigates nurses’ opinion on ‘Challenges in communicating with Nursing and Midwifery Council of Nigeria (NMCN)’. This is a descriptive web-based study with 896 participants. Data analysis was done using Google form. The result showed that 91.1% majority of the respondents were Registered/Graduate nurses. Majority 74.1% have tried to reach out to Nursing and Midwifery Council of Nigeria (NMCN) through email, phone calls, text messages, Letters etc. 39.2% of those who reached out by email never got any reply. The participants suggested a better customer service, embracement of online availability and prompt responses to the received messages by Nursing and Midwifery Council of Nigeria (NMCN). The study recommends that an active online availability by NMCN to improve communication.

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Feasibility and Acceptability of a Remotely Delivered, Web-Based Behavioral Intervention for Men With Prostate Cancer: Four-Arm Randomized Controlled Pilot Trial (Preprint)

10.2196/preprints.19238 ◽

2020 ◽

Author(s):

June M Chan ◽

Erin L Van Blarigan ◽

Crystal S Langlais ◽

Shoujun Zhao ◽

Justin W Ramsdill ◽

...

Keyword(s):

Prostate Cancer ◽

Behavioral Intervention ◽

Controlled Trial ◽

Pilot Trial ◽

Text Messages ◽

Web Based ◽

Randomized Controlled ◽

Phone Calls ◽

Diet And Exercise ◽

Level 1

BACKGROUND Diet and exercise may be associated with quality of life and survival in men with prostate cancer. OBJECTIVE This study aimed to determine the feasibility and acceptability of a remotely delivered web-based behavioral intervention among men with prostate cancer. METHODS We conducted a multi-site 4-arm pilot randomized controlled trial of a 3-month intervention (TrueNTH Community of Wellness). Eligibility included self-reported prostate cancer diagnosis, having a personal device that connected to the internet, age ≥18 years, and ability to read English and receive text messages and emails. Men receiving chemotherapy or radiation, or those who reported contraindications to exercise, could participate with physician clearance. Participants were randomized (1:1:1:1) to additive intervention levels: website; website and personalized diet and exercise prescription; website, personalized prescription, Fitbit, and text messages; and website, personalized prescription, Fitbit, text messages, and 2 30-minute phone calls—one with an exercise trainer and one with a registered dietician. Primary outcomes were feasibility (accrual and attrition) and acceptability (survey data and website use). We described self-reported diet and exercise behavior at the time of enrollment, 3 months, and 6 months as secondary outcomes. RESULTS In total, 202 men consented and were randomized between August 2017 and September 2018 (level 1: 49, level 2: 51, level 3: 50, level 4: 52). A total of 160 men completed the onboarding process and were exposed to their randomly assigned intervention (38, 38, 42, and 42 in levels 1, 2, 3, and 4, respectively). The follow-up rate was 82.7% (167/202) at 3 months and 77.2% (156/202) at 6 months. Participants had a median age of 70 years and were primarily White and college educated. Website visit frequency over the 3-month intervention period increased across levels (median: 2, 9, 11, and 16 visits for levels 1, 2, 3, and 4, respectively). Most were satisfied or very satisfied with the intervention (20/39, 51%; 27/42, 64%; 23/44, 52%; and 27/42, 64% for levels 1, 2, 3, and 4, respectively). The percentage of men who reported being very satisfied was highest among level 4 participants (10/42, 24% vs 4/39, 10%; 5/42, 12%; and 5/44, 11% for levels 1, 2, and 3, respectively). Dissatisfaction was highest in level 1 (5/39, 13% vs 1/42, 2%; 3/44, 7%; and 2/42, 5% for levels 2, 3, and 4, respectively). We observed small improvements in diet and physical activity at 3 months among men in level 4 versus those in level 1. CONCLUSIONS A web-based, remotely delivered, tailored behavioral intervention for men with prostate cancer is feasible. Future studies are warranted to increase the effect of the intervention on patient behavior while maintaining sustainability and scalability as well as to design and implement interventions for more diverse populations. CLINICALTRIAL ClinicalTrials.gov NCT03406013; http://clinicaltrials.gov/ct2/show/NCT03406013

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Feasibility and Acceptability of a Remotely Delivered, Web-Based Behavioral Intervention for Men With Prostate Cancer: Four-Arm Randomized Controlled Pilot Trial

Journal of Medical Internet Research ◽

10.2196/19238 ◽

2020 ◽

Vol 22 (12) ◽

pp. e19238

Author(s):

June M Chan ◽

Erin L Van Blarigan ◽

Crystal S Langlais ◽

Shoujun Zhao ◽

Justin W Ramsdill ◽

...

Keyword(s):

Prostate Cancer ◽

Behavioral Intervention ◽

Controlled Trial ◽

Pilot Trial ◽

Text Messages ◽

Web Based ◽

Randomized Controlled ◽

Phone Calls ◽

Diet And Exercise ◽

Level 1

Background Diet and exercise may be associated with quality of life and survival in men with prostate cancer. Objective This study aimed to determine the feasibility and acceptability of a remotely delivered web-based behavioral intervention among men with prostate cancer. Methods We conducted a multi-site 4-arm pilot randomized controlled trial of a 3-month intervention (TrueNTH Community of Wellness). Eligibility included self-reported prostate cancer diagnosis, having a personal device that connected to the internet, age ≥18 years, and ability to read English and receive text messages and emails. Men receiving chemotherapy or radiation, or those who reported contraindications to exercise, could participate with physician clearance. Participants were randomized (1:1:1:1) to additive intervention levels: website; website and personalized diet and exercise prescription; website, personalized prescription, Fitbit, and text messages; and website, personalized prescription, Fitbit, text messages, and 2 30-minute phone calls—one with an exercise trainer and one with a registered dietician. Primary outcomes were feasibility (accrual and attrition) and acceptability (survey data and website use). We described self-reported diet and exercise behavior at the time of enrollment, 3 months, and 6 months as secondary outcomes. Results In total, 202 men consented and were randomized between August 2017 and September 2018 (level 1: 49, level 2: 51, level 3: 50, level 4: 52). A total of 160 men completed the onboarding process and were exposed to their randomly assigned intervention (38, 38, 42, and 42 in levels 1, 2, 3, and 4, respectively). The follow-up rate was 82.7% (167/202) at 3 months and 77.2% (156/202) at 6 months. Participants had a median age of 70 years and were primarily White and college educated. Website visit frequency over the 3-month intervention period increased across levels (median: 2, 9, 11, and 16 visits for levels 1, 2, 3, and 4, respectively). Most were satisfied or very satisfied with the intervention (20/39, 51%; 27/42, 64%; 23/44, 52%; and 27/42, 64% for levels 1, 2, 3, and 4, respectively). The percentage of men who reported being very satisfied was highest among level 4 participants (10/42, 24% vs 4/39, 10%; 5/42, 12%; and 5/44, 11% for levels 1, 2, and 3, respectively). Dissatisfaction was highest in level 1 (5/39, 13% vs 1/42, 2%; 3/44, 7%; and 2/42, 5% for levels 2, 3, and 4, respectively). We observed small improvements in diet and physical activity at 3 months among men in level 4 versus those in level 1. Conclusions A web-based, remotely delivered, tailored behavioral intervention for men with prostate cancer is feasible. Future studies are warranted to increase the effect of the intervention on patient behavior while maintaining sustainability and scalability as well as to design and implement interventions for more diverse populations. Trial Registration ClinicalTrials.gov NCT03406013; http://clinicaltrials.gov/ct2/show/NCT03406013

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Antidiabetic Properties of Medicinal Mushrooms with Special Reference to Phellinus Species: A Review

The Natural Products Journal ◽

10.2174/2210315510666200124124540 ◽

2020 ◽

Vol 10 ◽

Author(s):

Thekkuttuparambil A Ajith ◽

Kynoor K Janardhanan

Keyword(s):

Nutritional Value ◽

Modern Medicine ◽

Lifestyle Changes ◽

Controlled Clinical Trials ◽

Chronic Complications ◽

Medicinal Mushrooms ◽

Beneficial Effects ◽

First Line Therapy ◽

Public Health Challenge ◽

Microvascular Diseases

: Diabetes remains the major public health challenge to 21st century. It is strongly related to lifestyle changes. Most chronic complications of diabetes are macrovascular and microvascular diseases resulting from the existing hyperglycemic status. Failure of first line therapy which is based on diet modifications and exercise, conventional treatment using antihyperglycemic agents with different mechanisms of action will be implemented for type II diabetes in modern medicine. Higher Basidiomycetes mushrooms are highly praised for their nutritional value and pharmacological properties. They have long been used traditionally for the maintenance of health, prevention and treatment of various human ailments. Reports indicate the beneficial effects of medicinal mushrooms in diabetes treatments. However, scientific evidences are insufficient to make definitive conclusions on the efficacy of individual medicinal mushrooms. Mushrooms belong to the genera Phellinus such as Phellinus linteus, Phellinus ribis, Phellinus rimosus and Phellinus igniarius. They possess significant hypoglycemic effect in experimental diabetic models. However, well-designed controlled clinical trials are needed to establish their safety and bioactivity.

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Patient Education and Sacubitril/Valsartan: A Randomized Comparative Trial

Hospital Pharmacy ◽

10.1177/0018578721999808 ◽

2021 ◽

pp. 001857872199980

Author(s):

Christopher Giuliano ◽

Bradley St. Pierre ◽

Jamie George

Keyword(s):

Controlled Trial ◽

Comparative Trial ◽

Text Messages ◽

Phone Call ◽

Secondary Outcome ◽

Short Term ◽

Phone Calls ◽

Video Education ◽

Pharmacist Education

Objective: To compare video to pharmacist education for patients taking sacubitril/valsartan. Methods: We conducted a randomized controlled trial comparing video to pharmacist education with a second randomized intervention of education delivered through text or phone call at 14 days. The primary outcome compared the change in short term knowledge between groups and the secondary outcome was long term knowledge at 1 month. Results: Forty-three patients were included. Scores improved significantly ( P < .05) in the pharmacist group from 54.1% to 85.9% and from 64.3% to 86.1% in the video education group, although there was no difference between groups (31.8% vs 22.9%, P = .13). At 30 days, scores were significantly higher than baseline (difference 16.5%, P < .05) although did decrease from the posttest (difference 7.4%, P < .05). There was no difference at 30 days between those that received text messages versus phone calls (−10% vs −5.5%, respectively; P = .36). Conclusion: We saw improvements in both short term and long term knowledge for patients receiving education through pharmacist or video education. Neither approach was more effective than the other. Clinicians can use either approach based on patient preference.

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AB0915-PARE DEVELOPMENT AND USABILITY OF A WEB-BASED PATIENT-TAILORED TOOL TO SUPPORT ADHERENCE TO URATE-LOWERING THERAPY IN GOUT PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1500 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1479.1-1479

Author(s):

R. te Kampe ◽

A. Boonen ◽

T. Jansen ◽

J. M. Elling ◽

M. Flendrie ◽

...

Keyword(s):

Healthcare Professionals ◽

Text Messages ◽

Change Model ◽

Adherence Behavior ◽

Cross Sectional ◽

Web Based ◽

Usability Tests ◽

Lowering Therapy ◽

Steering Group ◽

Three Phases

Background:Adherence to prescribed urate-lowering therapy (ULT) among gout patients is considered to be among the poorest of all chronic conditions. eHealth programs can be a possible opportunity to foster ULT adherence.Objectives:This study describes the development and usability evaluation of a web-based tool to support ULT adherence among gout patients, specifically designed for a complement to usual care.Methods:The Integrated Change (I-Change) model was used as theoretical basis for the development. The model combines various socio-cognitive theories and differentiates between three phases: a pre-motivational, a motivational, and a post-motivational phase. In practices, the I-Change gout tool contains three sessions, following the three phases of the I-Change model. Patients receive tailored feedback based on their answers in the form of animated videos and text messages after each session, and are prompted to set specific goals and action plans for their ULT adherence. The content and development of the I-Change gout tool was determined along an iterative process within a steering group of clinicians and researchers, supported by patient interviews and gout specific literature related to key aspects of medication adherence behavior. A cross-sectional mixed methods design was used to test usability of the support tool consisting of a think aloud method and a usability questionnaire.Results:The steering group decided on the content of the three sessions of the I-Change gout tool. Depending on the intention to change ULT adherence behavior patients were navigated through the I-Change gout tool, patients with a low intention go through all 3 sessions and patients with a high intention go through the pre- and post-motivational session (figure 1). In total, the I-Change gout tool contains three sessions with 80 questions, 66 tailored textual feedback messages, and 40 tailored animated videos.Figure 1.Flowchart of the computer-tailored I-Change gout tool for urate-lowering therapy adherence.Twenty gout patients and seven healthcare professionals participated in the usability tests. The program end score rating for the gout tool was on average 8.4±0.9 (range 6-10) for patients and 7.7±1.0 (range 6-9) for healthcare professionals. Furthermore, participants reported a high intention to use and/or recommend the program in the future. Yet, participants identified some issues for further improvement of the systems user-friendliness by addressing barriers (e.g. more explicitly navigation) and weaknesses (e.g. technical and health literacy). The I-Change gout tool was updated according suggestions of improvements of the participants.Conclusion:This study provides initial support for the usability by patients and healthcare professionals of a ULT adherence I-Change gout tool. Further studies need to be conducted to assess its efficacy and (cost-) effectiveness in daily practice.Disclosure of Interests:None declared

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Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-Sectional Survey

Diagnostics ◽

10.3390/diagnostics11071233 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1233

Author(s):

Ernest Osei ◽

Kwasi Agyei ◽

Boikhutso Tlou ◽

Tivani P. Mashamba-Thompson

Keyword(s):

Healthcare Professionals ◽

Healthcare Delivery ◽

Disease Diagnosis ◽

Text Messages ◽

Diagnosis And Treatment ◽

Cross Sectional Survey ◽

Mobile Wireless ◽

Ashanti Region ◽

Phone Calls ◽

Treatment Support

Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study’s main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants’ background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals’ demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.

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The Wheel of Change Moves On: Assessing the Severity of Stalking Behavior

Journal of Interpersonal Violence ◽

10.1177/08862605211015216 ◽

2021 ◽

pp. 088626052110152

Author(s):

Ewa B. Stefanska ◽

Nicholas Longpré ◽

Rekayla S. Harriman

Keyword(s):

Social Issue ◽

Item Response ◽

Text Messages ◽

Severity Scale ◽

Communication Behaviors ◽

Phone Calls ◽

Ranking Order ◽

Minimal Work ◽

Work Done ◽

The Continuum

Stalking is a significant social issue. The inconsistency as to what defines stalking has resulted in the creation of different methods to measure the crime. However, there has been minimal work done that assesses the severity of individual stalking behaviors. The aim of the present study was to assess the level of stalking behavior in terms of severity within a randomly selected sample of 924 cases from the database of the National Stalking Helpline. Item response theory analyses were used to assist in developing a scale that displays the ranking order of each stalking behavior. These analyses were also used to examine whether the stalking behavioral items created a single continuum of severity of stalking. Results indicated that 16 stalking behavioral items of the 28 items present in the National Stalking Helpline, best represented the severity of stalking. Unwanted communication behaviors such as text messages and phone calls were located at the lower end of the severity scale, whereas criminal damage and death threats were mapped on the higher end of the continuum. The findings also revealed that the 16 items categorized under 6 factors. The findings of the present study provide many implications for stalking agency professionals and criminal justice responses.

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Effect of Cocoa and Cocoa Products on Cognitive Performance in Young Adults

Nutrients ◽

10.3390/nu12123691 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3691

Author(s):

María Angeles Martín ◽

Luis Goya ◽

Sonia de Pascual-Teresa

Keyword(s):

Young Adults ◽

Cognitive Performance ◽

Early Adulthood ◽

Blood Oxygenation ◽

Human Cognition ◽

Beneficial Effects ◽

Randomized Controlled Studies ◽

Cocoa Products ◽

Cocoa Flavanols

Increasing evidence support a beneficial role of cocoa and cocoa products on human cognition, particularly in aging populations and patients at risk. However, thorough reviews on the efficacy of cocoa on brain processes in young adults do not exist precisely due to the limited number of studies in the matter. Thus, the aim of this study was to summarize the findings on the acute and chronic effects of cocoa administration on cognitive functions and brain health in young adults. Web of Science and PubMed databases were used to search for relevant trials. Human randomized controlled studies were selected according to PRISMA guidelines. Eleven intervention studies that involved a total of 366 participants investigating the role of cocoa on cognitive performance in children and young adults (average age ≤25 years old) were finally selected. Findings from individual studies confirm that acute and chronic cocoa intake have a positive effect on several cognitive outcomes. After acute consumption, these beneficial effects seem to be accompanied with an increase in cerebral blood flow or cerebral blood oxygenation. After chronic intake of cocoa flavanols in young adults, a better cognitive performance was found together with increased levels of neurotrophins. This systematic review further supports the beneficial effect of cocoa flavanols on cognitive function and neuroplasticity and indicates that such benefits are possible in early adulthood.

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Breast-feeding promotion in hospitals and prospective breast-feeding rates during the first year of life in two national surveys 1997–1998 and 2017–2019 in Germany

Public Health Nutrition ◽

10.1017/s1368980021001099 ◽

2021 ◽

pp. 1-13

Author(s):

Nele Hockamp ◽

Constanze Burak ◽

Erika Sievers ◽

Silvia Rudloff ◽

Anja Burmann ◽

...

Keyword(s):

Breast Feeding ◽

Infant Nutrition ◽

Feeding Habits ◽

First Year ◽

Feeding Rates ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based ◽

Phone Calls ◽

First Year Of Life

Abstract Objectives: The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier. Design: In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF. Setting: Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019). Participants: In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included. Results: In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding. Conclusions: In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.

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