Can the group effect dominate the influence of the child on the parent's decision to care for type 1 diabetes?

AIM: To understand how the interaction of peer parents in disease-specific social media groups influences their daily treatment decisions. DESIGN AND METHODS: We examined the content of the largest Hungarian Facebook group for parents of children with type 1 diabetes mellitus, analyzing 28 days of activity using netnography. In addition, we undertook an online quantitative questionnaire to identify group members' (n = 267) attitudes. RESULTS: In exploring the influence of the community on the decisions of peer-parents, we found that the respondents could be divided into two clusters. The main difference between the clusters was that committed parents sought the online community for advice and asked questions more frequently, and the peer-support community was a more important part of their self-image. Comparing the influence of online communities and children on the parents' decisions, we observed that the community had the most significant impact on attending diabetes-specific events, while children had the greatest influence on meals and leisure time and were often in conflict with parents. CONCLUSIONS: Social media strongly support the integration of prescribed therapy into daily routine. The influence of the child with diabetes on parental decisions shows that diabetes education needs to become child-centered and that the parent-child relationship should be considered as a crucial element for therapy effectiveness. PRACTICE IMPLICATIONS: Online parenting groups provide mental support in coping with diabetes and would serve as a primary non-medical information source; the healthcare staff must be supportive or even encouraging when parents join such groups.

How online peer support affects management efficacy and mitigates difficulties of parents caring for children with type 1 diabetes.

The proper management of pediatric type 1 diabetes depends substantially on the parents of affected children. Parental psychological traits specifically related to diabetes caregiving influence the quality of their care and management of the disease in their children. Parents often use Facebook groups as sources of peer support and information about diabetes care. The present study aimed to examine the influence of devices used in diabetes management, ascertain the impact of Facebook peer-support groups on parental perceptions of problems and probe parental self-efficacy. 318 parents of children with type 1 diabetes completed an online questionnaire on demographics, diabetes-related data, and diabetes care-related psychological characteristics. Data analysis revealed three variables that determined competence in diabetes management: the utility of information and suggestions offered in the Facebook groups on diabetes; the form of insulin administration and membership in Facebook groups. Our results underpin that peer-support groups on social media platforms can serve as sources of the necessary information, support, and feedback on diabetes management competence for parents of children living with type 1 diabetes, they may thus facilitate parental diabetes management capabilities.

Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients.

OBJECTIVE: This study aimed to identify the key aspects of patients' dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors. METHODS: Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients' last dental visit. Descriptive and linear regression analyses were conducted. RESULTS: The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists' decisions, visit frequency satisfaction, clear treatment explanations, dentist's interest in symptoms, patient-dental personnel attachment, and dentist's knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement. CONCLUSIONS: The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists' awareness and consideration of the local context for optimal outcomes.

Comparison of therapeutic efficacy and treatment costs of self-expandable metal stents and plastic stents for management of malignant biliary obstruction.

BACKGROUND: According to the European Society of Gastrointestinal Endoscopy guidelines, self-expandable metal stents (SEMSs) are preferable to plastic stents (PSs) in the management of pancreatic cancer, regardless of cancer stage. The aim of this study was to compare the therapeutic efficacy and treatment costs of SEMS and PS in the management of malignant biliary obstruction. METHODS: One hundred and thirty-five patients who underwent endoscopic stent placement were retrospectively enrolled and divided into PS (41 patients), primary SEMS (39 patients) and secondary SEMS (55 patients) groups. We determined the technical and functional success rate, stent patency, and cumulative treatment cost. RESULTS: A total of 111 SEMSs and 153 PSs were placed with similar technical (100% vs. 98.69%) and functional success rate (90.10% vs. 86.27%) but with different stent patency (10.28 vs. 22.16 weeks; p < 0.001). Multiple PS implantations and larger stent diameter increased the length of stent patency compared to 7-Fr PSs (10.88 vs. 10.55 vs. 7.63 weeks, respectively). The cumulative treatment cost of patients with different survival times did not differ significantly between groups, however, among patients surviving 2-4 months it was higher in PS group than primary SEMS and secondary SEMS groups (2888€ vs. 2258€ vs. 2144€, respectively, p = 0.3369) due to increased number of biliary reintervention (2.08 ± 1.04 vs. 1.20 ± 0.42 vs. 1.50 ± 0.53; p < 0.0274) and longer hospital stay (15.77 ± 10.14 vs. 8.70 ± 7.70 vs. 8.50 ± 6.17 days, p = 0.0527). CONCLUSIONS: In view of treatment costs, the consequences of illness, and the processes of the health care system, SEMS implantation is recommended regardless of patients' life expectancy.

Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach.

OBJECTIVES: The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap. DESIGN: This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments. SETTING: Participants were recruited from the outpatient ward of a university clinic in Hungary. PARTICIPANTS: The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment. RESULTS: The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness. CONCLUSIONS: The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.

Illness knowledge of type 2 diabetes patients: the Hungarian validation of Diabetes Knowledge Test / Betegségismeret 2-es típusú diabetesszel élok körében: a Diabetes Knowledge Test magyar nyelvu validálása.

Összefoglaló. Bevezetés: Magyarországon a KSH szerint több mint 1 millió ismert cukorbeteg él. A diabetes karbantartásához elengedhetetlen a betegek tudásának, készségeinek és önhatékonyságának növelése és fenntartása. A legelterjedtebb diabetes-betegségismeretteszt a 23 kérdéses Michigan Diabetes Knowledge Test. Elso 14 tétele általános tudást mér, például az ételek tápanyagtartalmával és a vércukorszint-változás okaival kapcsolatban. További 9 kérdése az inzulinhasználatról szól. Célkituzés: Célunk ennek a tesztnek a magyar nyelvu validálása, valamint összefüggéseinek vizsgálata szociodemográfiai és betegségváltozókkal. Módszer: Keresztmetszeti kérdoíves kutatásunkban a tesztcsomagot 129, inzulint használó, 2-es típusú diabeteses beteg töltötte ki (84 no, átlagéletkor: 59,67; szórás: 12,6) elsosorban online, betegszervezeteken keresztül. Eredmények: A betegségismeret-teszt belso konzisztenciája 0,603, ami elfogadható érték. A 23 kérdés helyes kitöltési arányának átlaga 81,66%, ami az amerikai arányokhoz hasonló, más kutatások speciális csoportjaihoz képest azonban kifejezetten magas érték. A válaszadók a ketoacidosis fogalmát, az egyes ételek tápanyag-összetevoit és az elfogyasztott ételek vércukorszintre gyakorolt hatását illeto kérdésekre tudták a választ a legkevésbé. A magyar teszt a szakirodalomnak megfelelo gyenge, negatív irányú összefüggésben áll az életkorral, és pozitív a kapcsolata az inzulinhasználat hosszával, valamint a napi vércukorszintmérés és inzulinbeadás számával. A betegségismeretet függetlenül egyedül a napi vércukorszintmérés mennyisége jósolta meg. A teszt konvergens validitását mutatja gyenge, de szignifikáns összefüggése az egészségértést méro Brief Health Literacy Screening kérdésekkel. Következtetés: A magyar nyelvu Diabetes Betegségismeret Teszt alkalmas a diabetesszel élok tudásszintjének felmérésére. Mintánkban a betegségismeret magas szintje az inzulint használók megfelelo edukációjával függhet össze. Ugyanakkor eredményeink felhívják a figyelmet a betegek diétával kapcsolatos magasabb szintu tudásának szükségességére. Orv Hetil. 2021; 162(22): 870-877. INTRODUCTION: According to the Hungarian Central Statistical Office, more than 1 million diabetic patients live in Hungary. It is essential to enhance and sustain the knowledge, skills and self-efficacy of patients. The most widely used measurement of illness knowledge is the 23-item Michigan Diabetes Knowledge Test (DKT). Its first 14 items measure general knowledge: the nutritional value of food, and causes of change in blood glucose level. Its further 9 items are about insulin usage. OBJECTIVE: To examine the reliability and the validity of the Hungarian version of DKT2 as well as its association with sociodemographic and illness-related variables. METHODS: In our cross-sectional quantitative study, 129 patients (84 women, mean age: 59.67; SD = 12.6) diagnosed with type 2 diabetes mellitus using insulin therapy filled in a questionnaire online. RESULTS: The α coefficient for the test is 0.603, which is acceptable. The mean of the correct answer rate is 81.66%, which resembles the American results, but it is higher than that of other specific groups. Problem areas for our patients included interpreting ketoacidosis, the nutritional value of foods and the effect of foods on blood glucose level. The score of the Hungarian test - in accordance with the literature - correlates negatively with age, positively with the year of insulin-usage and with the number of daily insulin intake and of blood glucose measurement. Illness knowledge was independently predicted only by the number of daily blood glucose measurement. The convergent validity of the Hungarian test is supported by its weak but significant association with Brief Health Literacy Screen questions. CONCLUSION: The Hungarian DKT2 properly measures the illness knowledge of diabetic patients. Their high level of knowledge can be traced back to the speciality of the subjects as well as to the overall education of insulin users. Nevertheless, our results draw attention to the necessity of enhancing the level of dietetic knowledge of patients. Orv Hetil. 2020; 162(22): 870-877.

Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary.

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman's rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (ß = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman's rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants' behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.

Face Masks During the COVID-19 Pandemic: A Simple Protection Tool With Many Meanings.

Wearing face masks is recommended as part of personal protective equipment and as a public health measure to prevent the spread of coronavirus disease 2019 (COVID-19) pandemic. Their use, however, is deeply connected to social and cultural practices and has acquired a variety of personal and social meanings. This article aims to identify the diversity of sociocultural, ethical, and political meanings attributed to face masks, how they might impact public health policies, and how they should be considered in health communication. In May 2020, we involved 29 experts of an interdisciplinary research network on health and society to provide their testimonies on the use of face masks in 20 European and 2 Asian countries (China and South Korea). They reflected on regulations in the corresponding jurisdictions as well as the personal and social aspects of face mask wearing. We analyzed those testimonies thematically, employing the method of qualitative descriptive analysis. The analysis framed the four dimensions of the societal and personal practices of wearing (or not wearing) face masks: individual perceptions of infection risk, personal interpretations of responsibility and solidarity, cultural traditions and religious imprinting, and the need of expressing self-identity. Our study points to the importance for an in-depth understanding of the cultural and sociopolitical considerations around the personal and social meaning of mask wearing in different contexts as a necessary prerequisite for the assessment of the effectiveness of face masks as a public health measure. Improving the personal and collective understanding of citizens' behaviors and attitudes appears essential for designing more effective health communications about COVID-19 pandemic or other global crises in the future.    To wear a face mask or not to wear a face mask?    Nowadays, this question has been analogous    to the famous line from Shakespeare's Hamlet:    "To be or not to be, that is the question."    This is a bit allegorical,    but certainly not far from the current circumstances    where a deadly virus is spreading amongst us... Vanja Kopilas, Croatia.

[The role of the "compromise effect" in dental treatment choice. A pilot study in 676 Hungarian volunteers]. / A "kompromisszumos választás" szerepe a fogászati kezeléssel kapcsolatos döntések során. 676 magyar önkéntes részvételével végzett vizsgálat.

Introduction: The compromise effect is a well-known phenomenon in the world of marketing, but it is rarely examined in medical settings. In dental setting, the patient often has to make treatment-related decisions with price as the only available and comprehensible information to help informed choice. Aim: We sought to determine if the compromise effect plays a role in dental treatment choices, and if yes, how the effect is modified by factors such as perceived quality, professional jargon in the explanations, or the importance of keeping one's own teeth intact. Method: 676 volunteers participated in this questionnaire-based study. The questionnaires were filled in anonymously. Altogether 8 versions of the same questionnaire were generated, in which the following information was given in varying combinations: the names of five different dental treatments from cheap to expensive, their possible prices, and additional information about the treatment. Statistical analysis: The significance of the relationship between the relative frequency of responses and the available additional information was determined by chi-square test and Fisher's exact test. Results: The respondents did not approach dental treatment-related decisions on a heuristic basis by default, most probably because of their preconceptions and previous experiences in connection with dental treatments. Esthetics turned out to be of utmost importance and expectable lifespan was also information that significantly influenced the choices. Conclusion: Extra information can and does influence informed dental treatment choice on the patient side, provided it is offered in a clear, proper, and intelligible form, which points out the importance of professional communication. Orv Hetil. 2019; 160(38): 1503-1509.

Associations of different adherences in patients with type 2 diabetes mellitus.

PURPOSE: The objective of our cross-sectional study is to explore the adherence behavior of patients with type 2 diabetes mellitus (T2DM) by examining the association between the various types of adherence. The success of diabetic therapy partly relies on patient motivation, psych-odemographic variables (self-efficacy, health literacy, and health locus of control [HLOC]), and adherence. The aim of our research was to explore the attitudes of T2DM patients toward medication and lifestyle therapy, thus gaining a deeper insight into the role of adherence-determining parameters in disease management. PATIENTS AND METHODS: The sample for the present study consisted of 113 T2DM inpatients (75 women and 38 men) with a mean age of 60.56 years (SD=12.94, range: 20-85 years) diagnosed with T2DM for an average of 13 years (SD=8.23). Participants completed the Diabetes Adherence Questionnaire conceptualized by the research team in accordance with the mapping of psychological and psychosocial parameters. We examined the associations between variables using Spearman's rank correlation. Multivariate regression analysis was used to examine predictive variables for adherent behavior. In addition, we attempted to examine factors with a negative effect on adherence using factor analysis. RESULTS: Based on our results, a high level of medication adherence negatively correlated with lifestyle adherence. Multivariate regression analysis showed that blood glucose monitoring adherence is mostly predicted by social-external HLOC, diabetes self-efficacy, and internal HLOC, while dietary adherence is predicted by the patient's self-efficacy and duration of the illness. Additionally, understanding and following the diabetes treatment were significantly associated with dietary adherence and high levels of patient self-efficacy, while health literacy was mostly predicted by internal HLOC. CONCLUSION: Adherence to medication, diet, glucose monitoring, and physical exercise showed different levels in T2DM patients and were in association with psychodemographic factors.

Spherical LDH-Ag°-montmorillonite heterocoagulated system with a pH-dependent sol-gel structure for controlled accessibility of AgNPs immobilized on the clay lamellae.

Aqueous suspensions of spherical ZnMgAl-layered double hydroxides [LDH(sph)] and antibacterial silver nanoparticles (AgNPs) deposited on the lamellae of montmorillonite were used for the synthesis of composites, which behave like coherent gels at low pH (≲4.5) and incoherent sols at higher pH (≳4.5). The composition of the composite was chosen as LDH(sph)/Ag°-montm. = 25:75 wt % in order to ensure a sol-gel transition that can also be characterized by viscometry. This pH-sensitive heterocoagulated system consisting of oppositely charged colloid particles was suitable for the release of antimicrobial AgNPs immobilized on the clay lamellae via a pH-controlled gel-sol transition. The heterocoagulation process was also characterized by surface charge titration measurements. Spherical LDH/Ag°-montmorillonite composite samples were identified by X-ray diffraction (XRD) measurements. The morphological properties of the composites were studied, and the presence of the heterocoagulated structure was confirmed by scanning electron microscopy (SEM). The nanoscale structure of the LDH(sph)-Ag°-montmorillonite composite obtained was also verified by small-angle X-ray scattering (SAXS), and the rheological characteristics were studied at various pH values. The viscosity and yield value of the composite decreased by an order of magnitude upon increasing the pH from 3.0 to 5.5. The sol-gel transition of the composite suspension was reversible in the previously mentioned pH range.

Investigation of the antibacterial effects of silver-modified TiO2 and ZnO plasmonic photocatalysts embedded in polymer thin films.

Nanosilver-modified TiO2 and ZnO photocatalysts were studied against methicillin-resistant Staphylococcus aureus on the surface and against naturally occurring airborne microorganisms. The photocatalysts/polymer nanohybrid films were prepared by spray coating technique on the surface of glass plates and on the inner surface of the reactive light source. The photoreactive surfaces were activated with visible light emitting LED light at λ = 405 nm. The optical properties of the prepared photocatalyst/polymer nanohybrid films were characterized by diffuse reflectance measurements. The photocatalytic properties were verified with the degradation of ethanol by gas chromatography measurements. The destruction of the bacterial cell wall component was examined with transmission electron microscope. The antibacterial effect of the photocatalyst/polymer nanohybrid films was tested with different methods and with the associated standard ISO 27447:2009. With the photoreactive coatings, an extensive disinfectant film was developed and successfully prepared. The cell wall component of S. aureus was degraded after 1 h of illumination. The antibacterial effect of the nanohybrid films has been proven by measuring the decrease of the number of methicillin-resistant S. aureus on the surface and in the air as the function of illumination time. The photocatalyst/polymer nanohybrid films could inactivate 99.9 % of the investigated bacteria on different thin films after 2 h of illumination with visible light source. The reactive light source with the inner-coated photocatalyst could kill 96 % of naturally occurring airborne microorganisms after 48 h of visible light illumination in indoor air sample. The TEM results and the microbiological measurements were completed with toxicity tests carried out with Vibrio fischeri bioluminescence bacterium.