Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. OBJECTIVE: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. RESULTS: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001). CONCLUSIONS: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.

Validation and psychometric testing of the Chinese version of the prenatal body image questionnaire.

BACKGROUND: The body image during pregnancy potentially affects both short- and long-term maternal and child health outcomes, including pregnancy mood, postpartum weight recovery, and the quality of mother-child interactions. However, research on the impact of body changes during pregnancy in the Chinese population is scarce. A comprehensive, practical, and reliable tool for assessing pregnant women is needed to detect, intervene in, and implement the reduction of physical dissatisfaction risk. This study translated the Prenatal Body Image Questionnaire (PBIQ) into the Chinese version (PBIQ-C) to assess the body image of pregnant women and evaluated its reliability and validity. METHODS: An improved Brislin translation model was used for the translation. A panel of experts determined the content validity. A convenience sample of 429 pregnant women was chosen from three third-class hospitals in different regions of Fujian Province, China. Factor analysis, Pearson's correlation, retest reliability, and Cronbach's alpha were employed to evaluate structural validity and reliability. RESULTS: The final PBIQ-C had five dimensions with 21 items. Exploratory factor analysis obtained a five-factor solution, which accounted for a total of 60.34%. Confirmatory factor analysis showed that the model fit of the five-factor model also reached a satisfactory model fit after modifying: The Comparative Fit Index was 0.93, and the Tucker-Lewis Index was 0.92; the Root Mean Square Error of Approximation was 0.079. The content validity index of the scale ranged from 0.63 ~ 1.00. The Cronbach's alpha coefficient was 0.95 for the total scale, and the test-retest reliability was 0.80. CONCLUSIONS: The findings indicated that the PBIQ-C is a valid and reliable instrument for assessing women's body image during pregnancy, which helps in the early identification of body dissatisfaction during pregnancy and enables the early prevention of postpartum depression.

Individual cascade annealing in BCC tungsten: effects of size and spatial distributions of defects.

To investigate effects of size and spatial distributions of defects from primary damage to annealing of an individual cascade, molecular dynamics (MD) and object kinetic Monte Carlo (OKMC) are applied for simulating cascade generation and annealing. MD cascade simulations of tungsten are carried out with two typical embedded atom method potentials for cascade energies in the range from 0.1 to 100 keV at 300 K. The simulation results show that even though the number of survival defects varies slightly, these two potentials produce very different interstitial cluster (IC) size distribution and defect spatial distribution with cascade energies larger than 30 keV. Furthermore, OKMC is used to model individual cascade annealing. It demonstrates that larger-sized ICs and closely distributed SIAs in the cascade region will induce a much higher recombination fraction for individual cascade annealing. Therefore, special attention should be paid to the size and spatial distributions of defects for primary damage in the multi-scale simulation framework.

Integrated Proteomics and Metabolomics Analysis in Pregnant Rat Hippocampus After Circadian Rhythm Inversion.

To investigate the changes in proteins, metabolites, and related mechanisms in the hypothalamus of pregnant rats after circadian rhythm inversion during the whole pregnancy cycle. A total of 12 Wistar female rats aged 7 weeks were randomly divided into control (six rats) and experimental (six rats) groups at the beginning of pregnancy. The control group followed a 12-h light and dark cycle (6 a.m. to 6 p.m. light, 6 p.m. to 6 a.m. dark the next day), and the experimental group followed a completely inverted circadian rhythm (6 p.m. to 6 a.m. light the next day, 6 a.m. to 6 p.m. dark). Postpartum data were collected until 7-24 h after delivery, and hypothalamus samples were collected in two groups for quantitative proteomic and metabolism analyses. The differential proteins and metabolites of the two groups were screened by univariate combined with multivariate statistical analyses, and the differential proteins and metabolites enriched pathways were annotated with relevant databases to analyze the potential mechanisms after circadian rhythm inversion. A comparison of postpartum data showed that circadian rhythm inversion can affect the number of offspring and the average weight of offspring in pregnant rats. Compared with the control group, the expression of 20 proteins and 37 metabolites was significantly changed in the experimental group. The integrated analysis between proteins and metabolites found that RGD1562758 and lysophosphatidylcholine acyltransferase 1 (LPCAT1) proteins were closely associated with carbon metabolism (choline, NAD+, L-glutamine, theobromine, D-fructose, and pyruvate) and glycerophospholipid metabolism (choline, NAD+, L-glutamine, phosphatidylcholine, theobromine, D-fructose, pyruvate, and arachidonate). Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that the differential metabolites enriched in adenosine triphosphate (ATP)-binding cassette (ABC) transporters. Our study suggested that circadian rhythm inversion in pregnant rats may affect the numbers, the average weight of offspring, and the expressions of proteins and metabolism in the hypothalamus, which may provide a comprehensive overview of the molecular profile of circadian rhythm inversion in pregnant groups.