Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones. METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE). RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies. CONCLUSION: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

Interspecific Variations in the Internal Mercury Isotope Dynamics of Antarctic Penguins: Implications for Biomonitoring.

Mercury (Hg) biomonitoring requires a precise understanding of the internal processes contributing to disparities between the Hg sources in the environment and the Hg measured in the biota. In this study, we investigated the use of Hg stable isotopes to trace Hg accumulation in Adélie and emperor penguin chicks from four breeding colonies in Antarctica. Interspecific variation of Δ199Hg in penguin chicks reflects the distinct foraging habitats and Hg exposures in adults. Chicks at breeding sites where adult penguins predominantly consumed mesopelagic prey showed relatively lower Δ199Hg values than chicks that were primarily fed epipelagic krill. Substantial δ202Hg variations in chick tissues were observed in both species (Adélie: -0.11 to 1.13‰, emperor: -0.27 to 1.15‰), whereas only emperor penguins exhibited the lowest δ202Hg in the liver and the highest in the feathers. Our results indicate that tissue-specific δ202Hg variations and their positive correlations with % MeHg resulted from MeHg demethylation in the liver and kidneys of emperor penguin chicks, whereas Adélie penguin chicks showed different internal responses depending on their exposure to dietary MeHg. This study highlights the importance of considering intra- and interspecific variations in adult foraging ecology and MeHg demethylation when selecting penguin chicks for Hg biomonitoring.

Effectiveness of a home-based music-paced physical activity programme on exercise-related outcomes after cardiac rehabilitation: a randomized controlled trial.

AIMS: A randomized controlled trial was conducted to examine the effects of a home-based music-paced physical activity programme guided by Information-Motivation-Strategy (IMS) model and Self-determination theory on exercise-related outcomes for patients with coronary heart disease (CHD) after cardiac rehabilitation (CR). METHODS AND RESULTS: A total of 130 patients with CHD from a regional CR centre in Hong Kong were recruited and randomly allocated into intervention (n = 65) or control groups (n = 65). The intervention group received theory-guided practical sessions on performing prescribed home-based physical activity with individualized synchronized music, and follow-up telephone calls. The primary outcome was exercise capacity. Secondary outcomes included exercise self-efficacy, physical activity level, and exercise self-determination. Data were collected at baseline, 3 months, and 6 months after study entry. The generalized estimating equations model was used to assess the intervention effects. Patients with CHD in the intervention group demonstrated significantly greater improvements in exercise capacity at 3 months [ß = 35.68, 95% confidence interval (CI) 2.69-68.68, P = 0.034] and significantly improved exercise self-efficacy at 6 months (ß = 3.72, 95% CI 0.11-7.32, P = 0.043) when compared with the control group. However, no significant group differences were found in physical activity level and exercise self-determination. CONCLUSION: The study findings provide evidence on an innovation on improving the exercise capacity and exercise self-efficacy of patients with CHD. The music-paced physical activity guided by the IMS model and Self-determination theory requires further investigation on its long-term effects in future studies. CLINICAL TRIAL REGISTRATION: ChiCTR-IOR-17011015.

The dual role of GoPGF reveals that the pigment glands are synthetic sites of gossypol in aerial parts of cotton.

Gossypol and the related terpenoids are stored in the pigment gland to protect cotton plants from biotic stresses, but little is known about the synthetic sites of these metabolites. Here, we showed that GoPGF, a key gene regulating gland formation, was expressed in gland cells and roots. The chromatin immunoprecipitation sequencing (ChIP-seq) analysis demonstrated that GoPGF targets GhJUB1 to regulate gland morphogenesis. RNA-sequencing (RNA-seq) showed high accumulation of gossypol biosynthetic genes in gland cells. Moreover, integrated analysis of the ChIP-seq and RNA-seq data revealed that GoPGF binds to the promoter of several gossypol biosynthetic genes. The cotton callus overexpressing GoPGF had dramatically increased the gossypol levels, indicating that GoPGF can directly activate the biosynthesis of gossypol. In addition, the gopgf mutant analysis revealed the existence of both GoPGF-dependent and -independent regulation of gossypol production in cotton roots. Our study revealed that the pigment glands are synthetic sites of gossypol in aerial parts of cotton and that GoPGF plays a dual role in regulating gland morphogenesis and gossypol biosynthesis. The study provides new insights for exploring the complex relationship between glands and the metabolites they store in cotton and other plant species.

Sensitivity and specificity of conventional and new face validation in determining the incomprehensible items by older people: Empirical evidence of testing 106 quality-of-life items.

Objective: This methodological research aimed to investigate and compare the sensitivity and specificity of conventional and new face validation in identifying incomprehensible items empirically. Methods: A purposive sample of 15 older people living in three residential care homes (RCHs) in Hong Kong was used to evaluate a newly developed 106 items covering seven quality-of-life dimensions. The abbreviated Mental Test (Hong Kong version; AMT) was used as a screening tool for excluding those with impaired cognition. The interview was audiotaped, and incomprehensible items were identified by the research panel accordingly (served as the gold standard). The socio-demographics of the respondents were described. Understandability (yes/no, conventional face validation method) and interpretability (4-point Likert scale, new method) were compared and used to compute the Kappa value (representing chance agreement), sensitivity, and specificity analysis. Results: Fifteen older people were interviewed and responded to the structured interview of 106 items regarding understandability and interpretability. 61 items (57%) obtained 100% positive understandability while only 35 items (33%) obtained 100% correct interpretability.The Kappa coefficient was 0.388 (P < 0.001) of the chance agreement between understandability and interpretability. The panel confirmed that 32% of items required revision (i.e., incomprehensible items). The false negative rate of using the conventional approach was up to 70.59% while both the false positive and negative rates of using the new approach were low (0%-5.88%). Conclusion: This empirical evidence indicated that the conventional approach of face validation for checking incomprehensible items by older people encountered a high false negative rate. On the contrary, the new approach was recommended because it demonstrated high sensitivity and specificity and low false positive and negative rates in identifying incomprehensible items.

A novel fixed-time stability lemma and its application in the stability analysis of BAM neural networks.

In this paper, we put forward an interesting fixed-time (FXT) stability lemma, which is based on a whole new judging condition, and the minimum upper bound for the stability start time is obtained. In the new FXT stability lemma, the mathematical relation between the upper bound of the stability start time and the system parameters is very simple, and the judgment condition only involves two system parameters. To indicate the usability of the new FXT stability lemma, we utilize it to study the FXT stability of a bidirectional associative memory neural network (BAMNN) with bounded perturbations via sliding mode control. To match the developed FXT stability lemma, novel sliding mode state variables and a two-layer sliding mode controller are designed. According to the developed FXT stability lemma, the perturbed BAMNN can achieve FXT stability under the devised sliding mode controller. The upper bound of the stability start time can be calculated easily by virtue of the control parameters, and the sufficient conditions guaranteeing that the perturbed BAMNN can achieve FXT stability have also been derived. Last, we provide some confirmatory simulations.

Educational Program with Text Messaging for Community-Dwelling Patients with Hypertension: A Pilot Randomized Controlled Trial.

PURPOSE: Controlling blood pressure minimizes the risk of cardiovascular events among patients with hypertension. Despite regular follow-ups, the hypertension management for patients aged ≥45 years is limited as evidenced from a decreased control rate. This pilot study aimed to test a theory-guided educational program for community-dwelling patients with hypertension. METHODS: Sixty-nine patients with hypertension aged ≥45 years and having high blood pressure (>130/80 mmHg) were recruited in this two-arm pilot randomized controlled trial. Participants in the intervention group underwent a program guided by the Health Promotion Model, whereas those in the control group received usual care. Data were collected at baseline, week 8, and week 12 and used to assess the blood pressure, pulse pressure, self-efficacy, and adherence to hypertension management. Data were analyzed using a generalized estimating equation based on the intention-to-treat principle. Process evaluation was conducted to assess the feasibility and acceptability of the educational program. RESULTS: The results obtained using the generalized estimating equation revealed that the educational program led to reduction in the systolic blood pressure (ß = -7.12, p = .086) and pulse pressure (ß = -8.20, p = .007) and to improve self-efficacy (ß = 2.61, p = .269) at week 12. The program had a small-to-moderate effect on the reduction of systolic blood pressure (effect size = -0.45) and pulse pressure (effect size = -0.66) and self-efficacy (effect size = 0.23). The participants were highly satisfied with the educational program. CONCLUSIONS: The educational program was found to be feasible and acceptable and may be incorporated into current hypertension management practices at the community level. TRIAL REGISTRATION: ClinicalTrials.gov with identifier: NCT04565548.

The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial.

PURPOSE: The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy. DESIGN: A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted. METHODS: Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis. FINDINGS: Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group. CONCLUSION: The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise. CLINICAL RELEVANCE: The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.

Educational Program with Text Messaging for Community-Dwelling Patients with Hypertension: A Pilot Randomized Controlled Trial

Purpose@#Controlling blood pressure minimizes the risk of cardiovascular events among patients with hypertension. Despite regular follow-ups, the hypertension management for patients aged ≥45 years is limited as evidenced from a decreased control rate. This pilot study aimed to test a theory-guided educational program for community-dwelling patients with hypertension. @*Methods@#Sixty-nine patients with hypertension aged ≥45 years and having high blood pressure (>130/80 mmHg) were recruited in this two-arm pilot randomized controlled trial. Participants in the intervention group underwent a program guided by the Health Promotion Model, whereas those in the control group received usual care. Data were collected at baseline, week 8, and week 12 and used to assess the blood pressure, pulse pressure, self-efficacy, and adherence to hypertension management. Data were analyzed using a generalized estimating equation based on the intention-to-treat principle. Process evaluation was conducted to assess the feasibility and acceptability of the educational program. @*Results@#The results obtained using the generalized estimating equation revealed that the educational program led to reduction in the systolic blood pressure (β = −7.12, p = .086) and pulse pressure (β = −8.20, p = .007) and to improve self-efficacy (β = 2.61, p = .269) at week 12. The program had a small-to-moderate effect on the reduction of systolic blood pressure (effect size = −0.45) and pulse pressure (effect size = −0.66) and self-efficacy (effect size = 0.23). The participants were highly satisfied with the educational program. @*Conclusions@#The educational program was found to be feasible and acceptable and may be incorporated into current hypertension management practices at the community level.

Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis.

BACKGROUND: Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. METHODS: This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. RESULTS: A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. CONCLUSIONS: The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.

Actively incorporating lifestyle modifications into daily life: The key to adherence in a lifestyle intervention programme for metabolic syndrome.

Introduction: Lifestyle modifications are the first-line interventions for metabolic syndrome (MetS) management. The effectiveness of lifestyle interventions depends mostly on participants' adherence to the interventions. The current study was to explore the experiences of MetS patients in attending lifestyle intervention program (LIP) and the factors that influenced their adherence to the interventions. Methods: A descriptive qualitative study was designed following the COREQ guideline. Face-to-face semi-structured individual interviews were conducted with a purposive sample from the participants who attended the LIP using the data saturation principle. Content analysis of transcripts was conducted following the methods proposed by Graneheim and Lundman. Results: The study recruited 27 participants, including 13 males and 14 females. Four themes were identified: (i) the positive and beneficial experiences of attending the LIP, including incorporating lifestyle modifications into daily life, improved physical and psychological health, and empowerment; (ii) facilitators of adherence, including individualized lifestyle education, regular follow-ups, and adequate interpersonal support; (iii) barriers to adherence, including personal resistance, competing demands, and contextual factors; (iv) suggestions for future interventions: with multidisciplinary team, longer term intervention, and more efficient approaches. The findings also indicated that young-to-middle aged patients faced more conflicts with role-related commitments, and were open for e-approaches in lifestyle interventions. Conclusion: The LIP provided positive and beneficial experiences for the participants. Actively incorporating lifestyle modifications into daily life is the key to maintain participants' adherence to the LIP. Culturally appropriate and psycho-behavioral strategies should be adopted to overcome personal and contextual barriers. Special attentions should be paid for the young-to-middle aged population in MetS management.

Investigating the dynamics of methylmercury bioaccumulation in the Beaufort Sea shelf food web: a modeling perspective.

High levels of methylmercury (MeHg) have been reported in Arctic marine biota, posing health risks to wildlife and human beings. Although MeHg concentrations of some Arctic species have been monitored for decades, the key environmental and ecological factors driving temporal trends of MeHg are largely unclear. We develop an ecosystem-based MeHg bioaccumulation model for the Beaufort Sea shelf (BSS) using the Ecotracer module of Ecopath with Ecosim, and apply the model to explore how MeHg toxicokinetics and food web trophodynamics affect bioaccumulation in the BSS food web. We show that a food web model with complex trophodynamics and relatively simple MeHg model parametrization can capture the observed biomagnification pattern of the BSS. While both benthic and pelagic production are important for transferring MeHg to fish and marine mammals, simulations suggest that benthic organisms are primarily responsible for driving the high trophic magnification factor in the BSS. We illustrate ways of combining empirical observations and modelling experiments to generate hypotheses about factors affecting food web bioaccumulation, including the MeHg elimination rate, trophodynamics, and species migration behavior. The results indicate that population dynamics rather than MeHg elimination may determine population-wide concentrations for fish and lower trophic level organisms, and cause large differences in concentrations between species at similar trophic levels. This research presents a new tool and lays the groundwork for future research to assess the pathways of global environmental changes in MeHg bioaccumulation in Arctic ecosystems in the past and the future.

Internal Dynamics and Metabolism of Mercury in Biota: A Review of Insights from Mercury Stable Isotopes.

Monitoring mercury (Hg) levels in biota is considered an important objective for the effectiveness evaluation of the Minamata Convention. While many studies have characterized Hg levels in organisms at multiple spatiotemporal scales, concentration analyses alone often cannot provide sufficient information on the Hg exposure sources and internal processes occurring within biota. Here, we review the decadal scientific progress of using Hg isotopes to understand internal processes that modify the speciation, transport, and fate of Hg within biota. Mercury stable isotopes have emerged as a powerful tool for assessing Hg sources and biogeochemical processes in natural environments. A better understanding of the tissue location and internal mechanisms leading to Hg isotope change is key to assessing its use for biomonitoring. We synthesize the current understanding and uncertainties of internal processes leading to Hg isotope fractionation in a variety of biota, in a sequence of better to less studied organisms (i.e., birds, marine mammals, humans, fish, plankton, and invertebrates). This review discusses the opportunities and challenges of using certain forms of biota for Hg source monitoring and the need to further elucidate the physiological mechanisms that control the accumulation, distribution, and toxicity of Hg in biota by coupling new techniques with Hg stable isotopes.

Effectiveness of a Nurse-Led Support Programme Using a Mobile Application versus Phone Advice on Patients at Risk of Coronary Heart Disease - A Pilot Randomized Controlled Trial.

Purpose: Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally. This study aimed to examine the preliminary effect of a nurse-led support programme using a mobile application versus nursing telephone advice on patients at risk of CHD living in the community. Patients and Methods: A prospective randomized controlled trial was adopted. Sixty eligible CHD participants were randomized into the app group (App) or the nursing telephone advice (NTA) group to support their own health care and exercise. Data were collected at baseline (T0), 1 month (T1), and 3 months (T2). Outcomes were total amount of exercise, self-efficacy of chronic disease management, total time of exercise, blood pressure, and lipid concentrations. Data were analyzed using the generalized estimating equation models. Results: Ninety-two individuals were screened for eligibility and 60 were randomized into the app group (n = 30) or NTA group (n = 30). The mean age of the participants was 60.92. The total attrition rate at T2 was 1.66%. The app group showed a moderate effect (Cohen's d =0.43) in significant increase in exercise amount, and reduction of lipid concentration (total cholesterol d=-0.43, triglyceride d=-0.39) respectively. Other outcomes showed improvement trend but non-significant between group. Conclusion: The CHD app is effective to motivate CHD patients for maintaining exercise amount which will be beneficial to their lipid control.

Integration of text messaging interventions into hypertension management among older adults: A systematic review and meta-analysis.

BACKGROUND: An aging population and required hypertension control are global concerns that burden the healthcare system. Text messaging interventions have been developed to support hypertension management, but their effects on the older population are unknown. OBJECTIVES: This review aimed to identify the effects of a text messaging intervention on hypertension management among older adults. METHODS: Four English and two Chinese databases with randomized controlled trials published between January 2010 and December 2020 were searched. The mean age of the participants was 60 years or above. Participants were also diagnosed with hypertension. The Cochrane risk-of-bias tool was used for the critical appraisal. Data in each study were extracted, and a meta-analysis was presented in terms of mean difference (MD) and standardized mean difference (SMD). RESULTS: A total of 1670 records were screened, of which six were included in the final review. The intervention of the included studies lasted up to 6 months, and one-way text messaging was commonly used. Meta-analysis showed that a text messaging intervention significantly reduced systolic blood pressure (MD = -6.11, p < .01) but not diastolic blood pressure. Regarding medication adherence, a moderate effect was noted with the use of text messaging among older adults with hypertension (SMD = 0.65, p = .01). LINKING EVIDENCE TO ACTION: A text messaging intervention can improve hypertension management among older adults. The standardized content of one-way text messaging is suggested to be delivered weekly.

Elucidating sources of mercury in the west coast of Korea and the Chinese marginal seas using mercury stable isotopes.

Nearshore systems play an important role as mercury (Hg) sources to the open ocean and to human health via fish consumption. The nearshore system along East Asia is of particular concern given the rapid industrialization, which contributes to significant anthropogenic Hg emissions and releases. We used Hg stable isotopes to characterize Hg sources in the sediment and fish along the west coast of Korea, located at the northeast of the East China Sea. The Hg isotope ratios of the west coast sediments (δ202Hg; -0.89 to -0.27‰, Δ199Hg; -0.04 to 0.14‰) were statistically similar with other nearshore sediments (δ202Hg; -0.99 to -0.30‰, Δ199Hg; -0.04 to 0.19‰) and overlapped with the industrial Hg source end-member (δ202Hg; -0.5‰, Δ199Hg; 0.01‰) estimated from the Chinese marginal seas. Using a ternary mixing model, we estimated that industrial Hg sources contribute 83-97% in the west coast of Korea, and riverine and atmospheric Hg sources play minor roles in the Korean west coast and the Chinese marginal seas. The comparison between Hg isotope ratios of the sediment and nearshore fish revealed that the fish in the most west coast sites are exposed to MeHg produced in the sediment. At a few southwest coast sites, external MeHg produced in rivers and the open ocean water column appears to be more important as a source in fish. This is supported by much higher δ202Hg (0.74‰; similar to oceanic fish) and lower δ202Hg (-0.71‰; similar to riverine sources) compared to fish collected from other west coast sites influenced by sedimentary MeHg. The substantial Hg contributions from industrial activities suggest the national policies regulating anthropogenic Hg releases can directly mitigate human Hg exposure originating via local fish consumption. This study contributes to the growing regional and global inventories of Hg fluxes and sources exported into coastal oceans.

The beneficial and hazardous effects of selenium on the health of the soil-plant-human system: An overview.

Selenium (Se), which can be both hazardous and beneficial to plants, animals and humans, plays a pivotal role in regulating soil-plant-human ecosystem functions. The biogeochemical behavior of Se and its environmental impact on the soil-plant-human system has received broad attention in the last decades. This review provides a comprehensive understanding of Se biogeochemistry in the soil-plant-human system. The speciation, transformation, bioavailability as well as the beneficial and hazardous effects of Se in the soil-plant-human system are summarized. Several important aspects in Se in the soil-plant-human system are detailed mentioned, including (1) strategies for biofortification in Se-deficient areas and phytoremediation of soil Se in seleniferous areas; (2) factors affecting Se uptake and transport by plants; (3) metabolic pathways of Se in the human body; (4) the interactions between Se and other trace elements in plant and animals, in particular, the detoxification of heavy metals by Se. Important research hotspots of Se biogeochemistry are outlined, including (1) the coupling of soil microbial activity and the Se biogeochemical cycle; (2) the molecular mechanism of Se metabolic in plants and animals; and (3) the application of Se isotopes as a biogeochemical tracer in research. This review provides up-to-date knowledge and guidelines on Se biogeochemistry research.

Effects of dance intervention on agitation and cognitive functioning of people living with dementia in institutional care facilities: Systematic review.

INTRODUCTION: Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. METHODS: Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges' g was computed for individual studies. RESULTS: Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. DISCUSSION: This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.

Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials.

BACKGROUND: Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. OBJECTIVE: This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging. METHODS: A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors. RESULTS: Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02). CONCLUSIONS: This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension.