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Galvez SJ, Altice FL, Meteliuk A, Ivasiy R, Machavariani E, Farnum SO, Fomenko T, Islam Z, Madden LM. High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine. Front Public Health 2023; 11:1231581. [PMID: 38098837 PMCID: PMC10720365 DOI: 10.3389/fpubh.2023.1231581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Background The COVID-19 pandemic resulted in marked disruptions in healthcare delivery in Ukraine related to emergency guidance in response to treating opioid use disorder (OUD). Patients with OUD, a group with high levels of comorbid medical and psychiatric disorders, and prescribed opioid agonist therapies (OAT) were rapidly shifted to take-home dosing if they were deemed clinically stable. The impact of these shifts on patient stress and related substance use during the pandemic, however, is unknown. Methods In early May 2020, 269 randomly selected OAT patients in Ukraine were surveyed to assess their stress level and substance use using the validated Perceived Stress Scale and examined correlates of severe perceived stress. Results Overall, 195 (72.5%) met criteria for moderate to severe levels of stress, which was independently correlated with having started OAT within the past 12 months (aOR: 1.33; 95%CI: 1.15-1.55), living in a large metropolitan area (aOR: 1.31; 95%CI: 1.18-1.46), having been asked by others to share their medication (aOR: 1.13; 95%CI: 1.02-1.25), and having an increase of over 10 min in transportation time to get to treatment (aOR: 1.16; 95%CI: 1.04-1.29). Twenty seven (10%) patients felt at high risk of relapse, while 24 (8.9%) patients reported purchasing drugs. Conclusion During a time of great uncertainty soon after emergency guidance to the COVID-19 pandemic, there was extraordinary high levels of perceived stress reported. In response to emergency guidance, OAT patients should be screened for perceived stress and certain subgroups should be targeted for additional psychosocial support.
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Affiliation(s)
- Samy J. Galvez
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Frederick L. Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
| | - Anna Meteliuk
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Eteri Machavariani
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | | | | | - Zahedul Islam
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Lynn M. Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
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Limbachia J, Ajmeri M, Keating BJ, de Souza RJ, Anand SS. Effects of lifestyle interventions on cardiovascular risk factors in South Asians: a systematic review and meta-analysis. BMJ Open 2022; 12:e059666. [PMID: 36600330 PMCID: PMC9743295 DOI: 10.1136/bmjopen-2021-059666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The cardiovascular disease (CVD) burden among South Asians is high. Lifestyle interventions have been effective in the primary prevention of CVD, but this has not been replicated, through a synthesis of randomised trials, in South Asians. METHODS Four electronic databases (MEDLINE, Embase, CENTRAL and CINAHL), two clinical trial registries and references of included articles were searched through June 2022 (featuring ≥90% South Asian participants). Random-effects pairwise meta-analyses were performed, and heterogeneity was quantified with the I2 statistic. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to report on the quality of evidence (International Prospective Register of Systematic Reviews registration (PROSPERO). RESULTS Thirty-five studies were included. Twelve tested diet and physical activity interventions; 18 tested diet alone; and 5 tested physical activity alone. All reported effects of the intervention(s) on at least one established risk factor for CVD, including blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood lipids (high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc) or triglycerides). No trials reported clinical CVD. There is moderate-quality evidence that diet and physical activity interventions improve SBP (mean difference (MD) -2.72 mm Hg, 95% CI -4.11 to -1.33) and DBP (MD -1.53 mm Hg, 95% CI -2.57 to -0.48); high-quality to moderate-quality evidence that diet-only interventions improve DBP (MD -2.05 mm Hg, 95% CI -2.93 to -1.16) and blood lipids (triglycerides (MD -0.10 mmol/L, 95% CI -0.14 to -0.06) and LDLc (MD -0.19 mmol/L, 95% CI -0.32 to -0.06)); and moderate-quality evidence that physical activity-only interventions improve SBP (MD -9.7 mm Hg, 95% CI -11.05 to -8.35), DBP (MD -7.29 mm Hg, 95% CI -8.42 to -6.16) and HDLc (MD 0.08 mmol/L, 95% CI 0.04 to 0.11) compared with usual care. CONCLUSIONS Lifestyle interventions improve blood pressure and blood lipid profiles in adult South Asians at risk of CVD. Tailored interventions should be used to modify cardiovascular risk factors in this at-risk group. PROSPERO REGISTRATION NUMBER CRD42018090419.
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Affiliation(s)
- Jayneel Limbachia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Mohitkumar Ajmeri
- Family and Community Medicine, SIU School of Medicine, Springfield, Illinois, USA
| | - Benjamin J Keating
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ghasemi F, Vakilian K, Khalajinia Z. Comparing the effect of individual counseling with counseling on social application on self-care and quality of life of women with gestational diabetes. Prim Care Diabetes 2021; 15:842-847. [PMID: 34215552 DOI: 10.1016/j.pcd.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The present study aimed to compare the effect of two different forms of face-to-face and counseling on a social application, i.e., WhatsApp, on self-care and quality of life of women with gestational diabetes. METHODS The present research was an educational trial with control group, which was conducted on diabetic women between 24 and 26 weeks of pregnancy. A total of 126 subjects were included in the study using the convenient sampling method. They were assigned into three groups. All of the participants answered the questionnaires gestational diabetes self-care, and quality of life at the beginning and end of the study. The GATHER approach to counseling (G = Greeting, A = Ask, T = Tell, H = Help, R = Return) was performed in four 45-min sessions for face-to-face and WhatsApp groups in the pregnancy weeks of 27, 28, 29, and 30. The subjects in the control group received only the routine cares for gestational diabetes. T test, Chi squared test, and ANOVA repeated measurement test were used to analyze the data. RESULTS Findings showed a significant difference among the three groups in self-care and quality of life (p = 0.001). There was also a significant difference among the three groups in fasting blood sugar after the intervention (p = 0.005). CONCLUSION Self-care counseling, both in the form of face-to-face and on social networks, improved the score of self-care and quality of life as well as glucose tolerance test (GTT) in women with gestational diabetes.
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Affiliation(s)
- Fatemeh Ghasemi
- Arak University of Medical Sciences, School of Medicine, Arak, Iran.
| | - Katayon Vakilian
- Department of Midwifery, School of Medicine, Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Basij Square, Sardasht Region, Peyambare-Azam Building, Arak, Iran.
| | - Zohre Khalajinia
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Alley West 2, Thecher Street, Nursing Midwifery Department, Qom, Iran.
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Bondre A, Pathare S, Naslund JA. Protecting Mental Health Data Privacy in India: The Case of Data Linkage With Aadhaar. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:467-480. [PMID: 34593574 PMCID: PMC8514037 DOI: 10.9745/ghsp-d-20-00346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
In an underprepared and under-resourced digital mental health system, the linkage of health and personal data with Aadhaar, a biometric system that provides a unique identification number to all Indian residents, poses significant privacy risks to individuals seeking mental health care. We discuss the challenges in protecting mental health data privacy due to these emerging digital health technologies.
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Affiliation(s)
- Ameya Bondre
- Digital Mental Health Research Consultant, Mumbai, India
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, Kaur R, Uppuluri M, Sribhashyam M, Bhattacharya S. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health 2019; 5:2055207619896153. [PMID: 31897307 PMCID: PMC6920343 DOI: 10.1177/2055207619896153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background A high burden of non-communicable diseases (NCDs) is contributing to high
mortality and morbidity in India. Recent advancements in digital health
interventions, including mHealth, eHealth, and telemedicine, have
facilitated patient-centered care for NCDs. Objective This systematic review aims to evaluate the current evidence on digital
interventions for people living with NCDs in India and the outcomes of those
interventions. Methods We adopted PRISMA guidelines and systematically reviewed articles from
MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following
criteria: journal articles presenting digital intervention(s) used by people
with at least one of the NCDs, reporting health outcomes following the
intervention, studies conducted in India among Indian population. Results Among 1669 articles retrieved from multiple sources, only 13 articles met our
criteria. Most (n = 7) studies were conducted in southern
states of India; eight studies included patients with diabetes, followed by
neuropsychiatric disorders and other NCDs. Five studies recruited
participants from tertiary hospitals; six interventions used text-messaging
for delivering health services, and 10 studies reported randomized
controlled trials. All the studies reported positive health outcomes
following the intervention, including better self-management, increased
patient–provider communication, improved medication adherence, and reduced
disease symptoms. Most studies scored moderate to high in quality assessment
checklist of Downs and Black. Conclusion Current evidence suggests a low number of interventions with positive
outcomes. Future research should explore avenues of advanced technologies
ensuring equitable and sustainable development of digital health
interventions for people living with NCDs in India.
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Affiliation(s)
- Md Mahbub Hossain
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Abida Sultana
- Gazi Medical College, Mojid Sarani, Sonadanga, Khulna, Bangladesh
| | | | - Farah Faizah
- The United Nations Population Fund (UNFPA), Dhaka, Bangladesh
| | - Ravneet Kaur
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Madhuri Uppuluri
- School of Public Health, Texas A&M University, College Station, TX, USA
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Donevant SB, Estrada RD, Culley JM, Habing B, Adams SA. Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature. J Am Med Inform Assoc 2019; 25:1407-1418. [PMID: 30137383 DOI: 10.1093/jamia/ocy104] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.
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Affiliation(s)
- Sara Belle Donevant
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | | | - Joan Marie Culley
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Brian Habing
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- College of Nursing/Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Hearn J, Ssinabulya I, Schwartz JI, Akiteng AR, Ross HJ, Cafazzo JA. Self-management of non-communicable diseases in low- and middle-income countries: A scoping review. PLoS One 2019; 14:e0219141. [PMID: 31269070 PMCID: PMC6608949 DOI: 10.1371/journal.pone.0219141] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. Objective The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Methods Using the scoping review methodology proposed by Arksey and O’Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Results Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Conclusions Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.
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Affiliation(s)
- Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Isaac Ssinabulya
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Bassi A, John O, Praveen D, Maulik PK, Panda R, Jha V. Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e11440. [PMID: 30368435 PMCID: PMC6229512 DOI: 10.2196/11440] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. Objective We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. Methods A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. Results The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. Conclusions In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.
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Affiliation(s)
- Abhinav Bassi
- George Institute for Global Health, India, New Delhi, India
| | - Oommen John
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia
| | - Devarsetty Praveen
- University of New South Wales, Sydney, Australia.,George Institute for Global Health, India, Hyderabad, India
| | - Pallab K Maulik
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia.,George Institute for Global Health, Oxford University, Oxford, United Kingdom
| | - Rajmohan Panda
- George Institute for Global Health, India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, India, New Delhi, India.,University of Oxford, Oxford, United Kingdom
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Bidzan M, Yousaf O, Lipowski M, Lipowska M. How Health-Related Behaviors Predict Body-Esteem in Men. Am J Mens Health 2018; 12:1901-1907. [PMID: 30255718 PMCID: PMC6199447 DOI: 10.1177/1557988318801634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
While there is a general consensus on the biological implications of health-related behaviors, there is little research on the implications of health-related behaviors on body-esteem in a nonclinical population of men. This study aimed to examine, using a multidimensional measure of health-related behaviors and controlling for body mass index (BMI), whether body-esteem in men can be predicted by health-related behaviors. Five hundred and sixty-one men between the ages of 30 and 45 years ( M = 35.42, SD = 4.41) completed the Body-Esteem Scale (BES), the Health Behaviour Inventory (HBI), and a questionnaire covering anthropometric measures including height and weight. Multiple regression analyses revealed that health-related behaviors (including positive nutrition habits, positive attitude, and healthy practices) significantly predicted body-esteem, R2adj = 0.05, F(5, 540) = 6.91, p < .001. The results are discussed in relation to healthy lifestyle promotion interventions targeting men.
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Affiliation(s)
- Monika Bidzan
- 1 Department of Epidemiology and Public Health, University College London, London, UK
| | - Omar Yousaf
- 2 Department of Psychology, Bath Spa University, Bath, UK
| | - Mariusz Lipowski
- 3 Department of Health Psychology, Gdansk University of Physical Education and Sport, Poland
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Effectiveness of Resilience Teaching via Short Message Service on Stress of Mothers of Educable Mentally Retarded Children. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.59966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Sinha Deb K, Tuli A, Sood M, Chadda R, Verma R, Kumar S, Ganesh R, Singh P. Is India ready for mental health apps (MHApps)? A quantitative-qualitative exploration of caregivers' perspective on smartphone-based solutions for managing severe mental illnesses in low resource settings. PLoS One 2018; 13:e0203353. [PMID: 30231056 PMCID: PMC6145572 DOI: 10.1371/journal.pone.0203353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background Mobile application based delivery of psycho-social interventions may help reduce the treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but they suffer from lack of applicability in low resource scenarios due to the difference in technology penetration, affordability, and acceptance. Objective This study aimed to understand health technology usage, perceived needs, and acceptability of app based interventions in patients with SMIs to improve illness management and reduce caregiver burden. Methods The study was conducted in inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed smartphone and health app usage. Further, three focus group discussions evaluated the needs and apprehensions in using apps in management of SMIs. Results A total of 176 participants including 88 patients and 88 caregivers completed the survey. Smartphone ownership was similar to the national average (30%) in both caregivers (38.6%) and in patients (31.8%). Although subjects regularly used a third party app, health app usage was very low. Cost, unfamiliarity, and language were significant barriers to adoption. The focus group discussions provided insight into the various apprehensions of caregivers in using and in allowing patients to use smartphones and such apps. Caregivers wanted mobile apps for accessing information regarding services and resources available for people with SMI, and they felt such apps can be helpful if they could automate some of their routine caregiving activities. However, the significant difficulty was perceived in regards to the cost of the device, language of the medium, and unfamiliarity in using technology. Apprehensions that SMI patients might misuse technology, or damage the device were also prevalent. Conclusions The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings. With only one-third of the patients and caregivers having access to smartphones and internet, parallel outreach strategies like IVRS should be actively considered while designing interventions. The difficulty of understanding and searching in a non-native language needs to be addressed. Hand holding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehensions related to using technology. To make the solution acceptable and useful to the already over-burdened caregivers, developers need to work closely with patients’ family members and follow a ground-up collaborative approach to app development. The scope of delivering mental health services through technology is immense in resource constrained settings like India, provided we, researchers, appreciate and accept the fact that in the varied landscape of a divergent economic, educational, and cultural milieu, a single solution will never suffice for all, and intervention modality matching with end user capacity will be of paramount importance in determining the success of the endeavor.
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Affiliation(s)
| | - Anupriya Tuli
- Department of Computer Science, IIIT-Delhi, Delhi, India
| | - Mamta Sood
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Rohit Verma
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Ragul Ganesh
- Department of Psychiatry, AIIMS, New Delhi, India
| | - Pushpendra Singh
- Department of Computer Science, IIIT-Delhi, Delhi, India
- * E-mail:
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Beratarrechea A, Moyano D, Irazola V, Rubinstein A. mHealth Interventions to Counter Noncommunicable Diseases in Developing Countries: Still an Uncertain Promise. Cardiol Clin 2017; 35:13-30. [PMID: 27886783 DOI: 10.1016/j.ccl.2016.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
mHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.
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Affiliation(s)
- Andrea Beratarrechea
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina.
| | - Daniela Moyano
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Adolfo Rubinstein
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
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Achuko O, Walker RJ, Campbell JA, Dawson AZ, Egede LE. Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes. Diabetes Technol Ther 2016; 18:151-8. [PMID: 26866351 PMCID: PMC4790216 DOI: 10.1089/dia.2015.0305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Discrimination is a social determinant that has been linked to poor physical and mental health outcomes. This study aimed to examine the pathway whereby discrimination influences quality of life in patients with type 2 diabetes. SUBJECTS AND METHODS Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Measures included perceived discrimination, perceived stress, social support, and social cohesion and were based on a theoretical model for the pathways by which perceived discrimination influences mental and physical health. Quality of life was measured using the SF-12 questionnaire. RESULTS The final model [χ(2)(106) = 157.35, P = 0.009, R(2) = 0.99, root mean square error of approximation = 0.03, comparative fit index = 0.99] indicates direct effects of higher perceived stress (r = -1.02, P < 0.05) and lower social support (r = 0.36, P < 0.001) significantly related to decreased mental health component score (MCS) of quality of life. Discrimination and social cohesion were not significantly directly related to MCS. However, higher discrimination (r = 0.47, P < 0.001), higher social cohesion (r = 0.14, P < 0.05), and lower social support (r = -0.43, P < 0.001) were significantly directly related to increased stress. No significant paths were found for the physical component score of quality of life. CONCLUSIONS Perceived discrimination was significantly associated with stress and served as a pathway to influence the mental health component of quality of life (MCS). Social support had a direct and an indirect effect on MCS through a negative association with stress. These results suggest that future interventions should be developed to decrease stress and increase social support surrounding discrimination to improve the MCS of quality of life in patients with diabetes.
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Affiliation(s)
- Obinna Achuko
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston VA Health Services Research and Development COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Aprill Z. Dawson
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston VA Health Services Research and Development COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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