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The Royal College of Obstetrics and Gynaecology advocated replacing OGTT with HbA1c for gestational diabetes (GDM) screening for women with risk factors during the Covid-19 pandemic. HbA1c >=48mmol/mol/random plasma glucose (RPG) >=11.1mmol/l at booking indicated diabetes, and 41-47mmol/ mol/9-11mmol/ l prediabetes or possible GDM. Testing was repeated at 26 weeks if normal previously, with HbA1c >=39mmol/mol, fasting PG >=5.6mmol/l, or RPG >=9mmol/l diagnostic for GDM. A) At her clinic booking visit at 10 weeks gestation, 36 year-old South Asian female had HbA1c 55mmol/mol/RPG 9.5mmol/l suggesting undiagnosed type 2 diabetes. Initially managed with dietary advice and home blood glucose monitoring, metformin was added when self-monitored glucose above pregnancy targets (fasting and pre-meal <5.3mmol/l or 1 h post meal <7.8mmol/l) but insulin was required later. Metformin and insulin were stopped after delivery at 38 weeks with HbA1c 50mmol/mol three months postpartum, supporting the earlier diagnosis of type 2 diabetes. B) 32 year-old White Caucasian female was screened for GDM on booking at 11 weeks as BMI 38 kg/m2. HbA1c 44mmol/mol and RPG 6.9mmol/l confirmed GDM which was managed by dietary/lifestyle changes with glucose and pregnancy targets achieved until 28 weeks when metformin added. Normal delivery at 40 weeks with HbA1c 40mmol/mol three months postpartum triggered advice on long-term dietary/lifestyle changes and annual HbA1c checks. HbA1c was useful during the pandemic but most centres reverted to OGTT for GDM screening due to a significant fall in diagnoses using HbA1c >=39mmol/mol at 26 weeks. But, HbA1c testing was advantageous at booking to diagnose type 2 diabetes earlier.
ABSTRACT
The recent Covid-19 pandemic has created many challenges and barriers in healthcare, which includes the treatment and management of patients with type 2 diabetes (Robson & Hosseinzadeh, 2021). The purpose of this Evidence-Based Project (EBP) project is to evaluate the effectiveness of type 2 diabetes management through telehealth and answers the following PICOT question: In patients with diabetes type 2 who have difficulties with medical visit compliance (P), will the telehealth platform (I), compared to patient's previous visit HbA1c (C) improve the Hemoglobin A1c (HbA1c) diagnostic marker (O) over a 12-week period(T)? An extensive literature search of five databases was performed, citation chasing, and a hand search yielded fourteen pieces of evidence ranging from level I to VI (Melnyk & Fineout-Overholt, 2019). The pieces of evidence selected for this project support the evidence that telehealth implementation is as effective as the "usual care" or in-person visits to treat type 2 diabetes. The John Hopkins Nursing Evidence-Based Practice (JHNEBP) model was selected. Patients with a HbA1c of greater than 6.7% have been asked to schedule two six-week telehealth visits. During the live video visit, a review of medications, and diabetes self-management education (DSME) will be conducted. Participants will be provided with education to promote lifestyle modifications. The visits will be conducted through an Electronic Medical Record (EMR) system that is Health Insurance Portability and Accountability Act (HIPAA) compliant. A paired t-Test will be used with the data collected from the pre-and post-HbA1c. Improve the management of type 2 diabetes with the incorporation of telemedicine in primary care. Research supports the need to further expand the use of telehealth in primary care, to improve patient outcomes and decrease co-morbidities related to type 2 diabetes.
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Background. Surveys on Public Knowledge, Attitude, and Practice (PKAP) have been conducted in various countries with respondents from the public as well as health workers. Measuring the knowledge of the public about COVID-19 is very important to determine the knowledge gap among the public and also as an evaluation of the preventive efforts for COVID-19. Objective. The purpose of this research was to determine whether education level is a factor that affects one's literacy about COVID-19. Materials and Methods. This is cross-sectional research with online-based data collection using the Kobo toolbox application. The data collection was carried out from the 19th of April until the 2nd of May 2020. The number of people under study is 792. The level of knowledge was measured using 12 research questions with true or false question types. the multivariable logistic regression was carried out. Results. Most of the respondents (52.5%) were in the young age group (15-35 years old), were male (57.3%), and had a bache-lor or diploma education level (62.1%). Furthermore, most of the respondents had good knowledge (65.4%). The higher the respon-dents' educational level means, the better knowledge they had concerning COVID-19 (P=0.013). Conclusions. Public knowledge about COVID-19 is affected by their level of education. A good level of knowledge about COVID-19 was found among respondents with master's and doctoral degrees. This finding can contribute to the prevention of COVID-19, in which the priority of educating communities about COVID-19 should be given to those having an educational level below a master's degree.Copyright © the Author(s), 2023.
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Air pollution, climate and population health are closely related in terms of their impacts on respiratory health and lung cancer. Air pollutants contribute to the exacerbation of chronic respiratory problems such as COPD and asthma. Air pollutants are also toxic and carcinogenic, initiating and promoting lung cancer development. Climate change in relation to environmental pollution affects the geographical distribution of food supply and diseases such as pneumonia in adults and children. The threat of air pollution, and hence global warming and climate changes, and their effects on population and respiratory health, is an imminent threat to the world and deserves immediate and sustainable combating strategies and efforts. The goals are to increase public awareness and engagement in action, with alignment of international collaboration and policy, and with steering towards further research. Now is the prime time for international collaborative efforts on planning and actions to fight air pollution and climate change before it is too late.Copyright © ERS 2021.
ABSTRACT
Breast cancer (BC) is the most common cancer in Korean American (KA) women. In view of its high prevalence in these women, their low screening rates, and the cultural influence of BC risk factors in their lifestyles, we developed a community-based culturally tailored BC prevention program, the Korean Breast Cancer Risk Reduction Program (KBCRRP). Guided by the PRECEDE-PROCEDE and health belief models, the KBCRRP was developed to achieve four goals: (1) healthy weight, (2) physically active lifestyle, (3) healthy diet, and (4) BC screening and adherence. KBCRRP combines effective multicomponent strategies for BC screening and a group-based lifestyle intervention incorporating traditional Korean health beliefs and is tailored for BC risk reduction. In this paper, we provide an overview of the program, the process of program development, implementation, and evaluation, and modification during the COVID-19 pandemic. The initial program involved 8 weeks of in-person group education sessions led by interdisciplinary healthcare professionals and 16 weeks of follow-up involving smartphone applications, phone calls, and text messaging from trained lifestyle coaches. Participants received opportunities to obtain free mammography during the program. After feasibility testing, the program was modified by incorporating participants' feedback. During the COVID-19 pandemic, we provided the program using the Zoom video platform. Participants' recruitment and retention during the pandemic was successful, reflecting the fact that virtual delivery of group-based education was a feasible and acceptable alternative to in-person sessions. Collaboration with community organizations serving the target population is the key to developing and sustaining a successful community-based educational program.
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Obesity is one of the main severe COVID-19 risk factors. SARS-CoV-2 causes endothelitis that lead to inflammation and prothrombotic state. Also visceral adipose tissue is a source of different prothrombogenic and proinflammatory cytokines that make prognosis and survival of patients with COVID-19 worse. The synergy of the COVID-19 and obesity pandemics is a double blow to health, especially in young patients. Weight loss due to lifestyle modifications and vaccination are effective methods of the severe COVID-19 prevention in obese patients. This review presents the main pathogenetic aspects of cardiovascular disease development and progression in obese patients with COVID-19 and possible methods of adverse outcomes prevention in this group of patients.Copyright © 2022 Authors. All rights reserved.
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Introduction: Adopting diabetes self-care behaviors to control blood glucose is essential, but adherence to them has been challenged due to restrictions related to Covid-19. These restrictions have negatively impacted the psychosocial condition of individuals with diabetes, which could lead to poor self-care. Accordingly, this study aimed to explore the experiences of individuals with type 2 diabetes regarding self-care behaviors and diabetes management during the COVID-19 pandemic. Material(s) and Method(s): This qualitative study was conducted using conventional content analysis, the data of which were collected through interviews with people over 18 years of age with type 2 diabetes who were selected from the Endocrinology Clinic of Erfan Hospital in Tehran. Using telephone and WhatsApp, semi-structured interviews were conducted with 20 participants (15 women). Content analysis was done using the constant comparative method, and the open and axial coding method was applied. The data were manually coded, and the main themes and categories emerged from data. Result(s): Two main themes emerged from the data: 1) challenges and limitations toward diabetes self-care and 2) facilitators of efficient self-care. Challenges and limitations included 4 sub-themes: Inevitable lifestyle changes, psychosocial problems, limited/lack of access to health care services and medication, and adverse physical effects. Facilitators had 2 sub-themes: improved individual capability and maintaining social interaction. Conclusion(s): Our findings indicated that inevitable lifestyle changes, limited access to health care, and adverse psychosocial consequences were the most critical challenges for diabetes management during the COVID-19 pandemic. Improving stress management skills and effective coping strategies can facilitate the adoption of self-care behaviors.Copyright © 2022, Research Institute for Endocrine Sciences. All rights reserved.
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Background and aims: The impact of the COVID-19 pandemic on mental health and well-being is a matter of significant concern. Besides the depression associated with diabetes mellitus (DM) diagnosis and management, the COVID-19 pandemic has also imposed significant distress among people with DM. Method(s): This is a narrative review of the interplay between DM management and depression amid the COVID-19 pandemic. Electronic databases, namely;PubMed, CINAHL, EMBASE and Google Scholar were searched for literature. Search terms were "diabetes", "depression", and ''corona virus", "COVID-19","diabetes self-care","diabetes self-care in low income countries and diabetes management in Zimbabwe". Result(s): This paper discusses the interaction between DM and depression, amid the COVID-19 pandemic. We further explain the implications on DM management, screening and elaborate on possible solutions to effective prevention and management of depression. Conclusion(s): We have made recommendations for prevention and management of depression such as collaborative practice, early and routine screening, meticulous self-care and use of non-pharmacological strategies.Copyright © 2020 FSG Communications Ltd. All rights reserved.
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The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly - Alzheimer's disease (AD) - is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.Copyright © 2023 Ima-Press Publishing House. All rights reserved.
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Objective: In this study, we aimed to retrospectively assess the change in weight before and after the COVID-19 mandatory lockdown in Colombia among adults who received nutritional and healthy lifestyle recommendations at weight loss and wellness clinics by telehealth. The primary objective was to describe and compare the mean weight reduction measured at the baseline and by the end of the lockdown. Secondary objectives include describing and comparing body fat percentage, muscle mass percentage, and BMI measured at the baseline and by the end of the lockdown. Method(s): One hundred and seventy-two middle-aged (18-68 years old) women and men received online nutritional and healthy lifestyle advice during the COVID-19 lockdown in Colombia. Weight, fat (%), muscle mass (%), and BMI were assessed before and after the lockdown. We included baseline measurements taken before the lockdown from March 1st to June 20th, 2020, and post-lockdown measurements from August 31st to October 20th, 2020. Exclusion criteria included pregnancy or breastfeeding women, acutely decompensated diabetes, hypertension, CKD, Hypothyroidism or taking any of the obesity treatment medications approved in Colombia, including liraglutide, semaglutide or orlistat. A retrospective analysis was completed to compare the change in mean body anthropometrics. Shapiro Wilk test was used to assess for normality. Paired T Test and Wilcoxon sign test were used to compare the distribution of body anthropometrics before and after the lockdown. IRB approval was obtained before exporting and analyzing the collection of data. Result(s): Out of 205 subjects and after a review of exclusion criteria, 172 subjects were included in the data analysis. 90.1% (155) were women. 52.3% (135) had overweight or obesity. After the COVID-19 lockdown, the mean weight loss reduction was 8.79 kg (SD +/- 5.45, p<0.0001), corresponding to an 11.4% weight loss reduction. The mean fat mass percentage loss was 2.89 % (SD +/- 2.64, p<0.0001), and the mean BMI presented a reduction of 3.16 (SD +/- 1.96, p <0.0001). The mean muscle percentage loss was 0.10% (SD +/- 2.67, p 0.482). Discussion/Conclusion: Subjects receiving telehealth nutritional advice in Colombia during the COVID-19 lockdown had significant clinical and statistical weight, BMI, and fat loss reduction. Muscle mass was preserved;however, this mean change was not statistically significant. Physical inactivity during the lockdown period was a potential contributor to a nonsignificant mean muscle mass change. The subjects in this study were highly motivated to virtually attend weight loss and wellness clinics and to improve body anthropometrics by optimizing lifestyle changes. Telehealth weight loss strategies should always be considered when in-person patient interaction is not available.Copyright © 2023
ABSTRACT
Active involvement of workers in the implementation of Worksite Health Promotion Programs (WHP) is important to increase the support, compliance and potential effect of the program. However, most programs in an occupational setting lack the continuing involvement of workers like a citizen science approach. This study aims to evaluate the process of a Citizen Science approach in which the target group of workers have been actively involved in the design of the WHP. The study took place in a terminal and a construction company. Mixed methods using questionnaires and interviews were applied to evaluate the process of the Citizen Science approach. The Nielsen and Randall framework was used to cover process indicators on the intervention, context and mental models. The majority of employees felt actively involved, resulting in overall positive experience of the intervention and approach. Suggestions regarding the communication and tailoring were addressed to improve reach, satisfaction and readiness for change. The elements culture and events appeared to have a hindering effect on the facilitation and implementation of the intended intervention, such as a conservative attitude towards lifestyle change and the covid-19 outbreak. Overall, the Citizen Science approach and the resulting intervention was well received by the employees. Besides the room for improvement of reach, communication and readiness to change, the company's culture and events appeared to play a vital role in the appeal, satisfaction and participation.Copyright © Occupational Safety and Health Research Institute, Published by Elsevier Korea LLC.
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Professional-driven mental health services are often predicated on westernized beliefs of mental health and distress. This presumptuous view results in treatment solutions that are not suitable to (many) non-western contexts because they are neither culturally valid nor practically sufficient. Instead of promoting imported ideas of mental health, we encourage communities, including Hong Kong, from and for where the authors primarily theorize the current thesis, to turn to and strengthen the resources they employed before the medicalization of distress and suffering. Basic foundational elements in one's everyday life, which we present here as the Health Hexagon Model, should be promoted, especially healthy sleep, healthy diet, regular physical activity, closeness with nature, supportive kinships and friendships, and a sense of purpose, meaning, or sacredness. These elements are not novel;the importance of these basic elements has been recognized, distilled, and transmitted generation after generation. We advocate for communities to identify the missing or hampered fundamental elements in their lives and focus on finding methods that would help them adopt a lifestyle conducive to individual and collective health. This call-to-action is particularly timely as the global community fights for its survival against the coronavirus and ponders ways to cope with the seismic changes in lifestyle it has brought.Copyright © 2022 The Authors
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The article is about topical issues of the psychological features of the long-term consequences of post-COVID syndrome in children and adolescents. We have described the most frequent residual manifestations of SARS-CoV-2 infection alongside with an analysis of the characteristics of the emotional and behavioral health of children and adolescents. The authors of article have analyzed modern approaches and recommendations for changing the lifestyle, psychological support of patients with the elimination of stress factors and body stress resistance increase. Also in article are presented main symptoms and signs associated with emotional and behavioral responses to stress in children and adolescents. The necessity of early detection and psychological correction of the symptoms of post-COVID syndrome and its inherent stress manifestations is substantiated as well as the stress resistance increase using physiological approaches of micronutrient correction with bioorganic magnesium substances.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.
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Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Method(s): This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Result(s): Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 +/- 11.4. The average resting pressure decreased in response to treatment;however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion(s): Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.Copyright © 2023 The Author(s).
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Each year about 400 000 people in Russia get strokes. Whereas an acute treatment takes place in specialized intensive care units in hospitals, follow-up is handed over to general (rarely - private) practitioner. The majority of stroke survivors show low adherence to follow-up resulting in repeated hospitalizations and growth of multi-morbidity burden. With COVID-19 pandemic negatively affecting availability of medical services and increasing health risks for stroke survivors, a physician-patient relation becomes the means of persuading patients to health-promoting behaviour.Copyright © 2022 University of Latvia. All Rights Reserved.
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Objective: The objectives of the study were: (1) To assess life style changes among children of <=15 years of age during COVID-19 pandemic and (2) to find out the effect of the life style changes on health of children of <=15 years of age. Method(s): The cross-sectional comparative study conducted at department of pediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow for duration of 1 year and sample size found to be 276 on calculation by applying the formula. Result(s): Out of 278 children, about 39% (108) were female children. Most of children were studying in primary level classes (52.51%) and most of enrolled children had joint family (66.18%). Level of physical activity reduced significantly due to closure of school and restriction on outdoor activities. Weight of children increased significantly during COVID-19 pandemic seems to be due to decreased in physical activities and consumption of more fast food/fried food (high calorie intake) and sedentary life style. Conclusion(s): During COVID-19 pandemic due to closure of schools and restricted outdoor activities results in decrease level of physical activities, increased consumption of high calorie food and sedentary behavior lead to increase in weight of children and changes in sleeping pattern of children.Copyright © 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd.
ABSTRACT
The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly - Alzheimer's disease (AD) - is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.Copyright © 2023 Ima-Press Publishing House. All rights reserved.