Population-Based Study on Cancer Incidence in Pharmacist: A Cohort Study in Taiwan

Cancer is increasing in rate globally and is leading cause of death among no communicable chronic diseases (NCDs) after cardiovascular disease (CVD). Most of the research focuses on the risk of occupational injury, job stress, mental illness, substance abuse and workplace safety in physicians and nurses. However, fewer studies have investigated the risk of cancer in pharmacists. We compared the matched general population to investigate the risk of cancer in pharmacists in Taiwan. Data were obtained from the Health and Welfare Data Science Center of the Ministry of Health and Welfare in Taiwan. We established a pharmacist group that included 11,568 pharmacists and selected a 4-fold comparison (n = 46,272) for the non-clinics comparison group, frequency being matched by age, gender and Charlson Comorbidity Index (CCI) score. The pharmacists had a lower but non-significant risk of all cancer (Adjusted hazard ratio [aHR] = 0.96; 95% confidence interval [CI] = 0.85–1.07) compared with the general population. Female pharmacists had a higher risk of cancer than male pharmacists ([aHR] = 1.23; 95% CI = 1.06–1.43). Pharmacists had higher risks of breast cancer in females (aHR = 1.68; 95% CI = 1.35–2.08) and of prostate cancer in males (aHR = 2.18; 95% CI = 1.35–2.08) when compared with the general population. Occupational risk factors could play a role, but they were not evaluated. These epidemiological findings require additional studies to clarify cancer risk mechanisms in pharmacists.

Evaluation of psychological training for nurses and midwives to optimise care for women with perinatal depression: a systematic review and meta-analysis

Objective Perinatal depression is linked to poor maternal health and infant development outcomes. The World Health Organization recommends expanding the mental health education and training of primary care providers to improve the quality of perinatal depression care. The present study evaluated the effect of various psychological training methods on nurses' and midwives' competence in administering care to and alleviating symptoms in patients with perinatal depression. Methods A comprehensive search of the PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases was performed. The data were independently extracted by two reviewers, and the critical appraisal tools of the Joanna Briggs Institute were used for quality assessment. Random-effects meta-analysis was conducted using Review Manager 5.4 software. Findings A total of 13 articles including 246 nurses and midwives and 4,381 perinatal women were reviewed. Care administered through both face-to-face (relative risk [RR] 0.70, 95% confidence interval [CI] 0.61-0.74) and digital training (RR 0.44, 95% CI 0.26-0.74) significantly mitigated symptoms of perinatal depression. Significant benefits were observed after 3- to 5-day and 8-day training, for which the RR were 0.75 (95% CI 0.59-0.97) and 0.72 (95% CI 0.66-0.85), respectively. Studies with high intervention fidelity more effectively reduced the risk of depressive symptoms in perinatal women than those with low intervention fidelity. Key conclusions and implications for practice Compared with face-to-face, digital training methods were more effective in reducing the risk of depressive symptoms. High intervention fidelity and 3- to 5-day and 8-day training resulted in better outcomes. The present findings can serve as a reference for the design of psychological training programs for nurses and midwives to equip them with effective strategies for administering care to patients with perinatal depression.

Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial

AIMS

This study aimed to explore the effects of a health technology education program on long-term glycemic control and the self-management ability of adults with type 2 diabetes (T2D).

METHODS

The study was a randomized controlled trial with repeated measures design. The experimental group (n = 53) received a novel health technologies education program plus focus groups and routine shared care, the control group (n = 55) received routine shared care. Glycosylated hemoglobin (HbA1c) level and self-management ability were the primary and secondary outcomes. Subject self-management ability was evaluated using the Chinese version of Perceived Diabetes Self-Management Scale (PDSMS). A linear mixed-effect model for repeated measures was used to analyze changes in HbA1c level and self-management ability after controlling for pretest effects.

RESULTS

The mean HbA1c levels in the experimental group decreased by 0.692% (7.564 mmol/mol) and 0.671% (7.332 mmol/mol) at 3 and 6 months after the intervention (p < 0.05) while the mean increase in the PDSMS scores at 3 and 6 months after the intervention were significantly higher than those in the control group (p < 0.05).

CONCLUSION

The health technology education program was more effective than routine shared care alone in lowering HbA1c and increasing self-management ability in T2D patients.

Effectiveness of nurses and midwives-led psychological interventions on reducing depression symptoms in the perinatal period: A systematic review and meta-analysis

Aim

To evaluate the effectiveness of nurses and midwives‐led psychological interventions on the perinatal depressive symptoms.

Design

A systematic review and meta‐analysis based on the PRISMA guidelines.

Methods

Six databases were searched, including PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science and CINAHL. The search date range was before 30 September 2019. We used the Cochrane risk of bias tool to evaluate the quality of the included studies and Review Manager software 5.3 to conduct a meta‐analysis. The data were pooled using a random‐effect model.

Results

Studies (N = 827) were retrieved with 12 studies included. Psychological interventions provided by nurses and midwives have a significant effect on reducing perinatal depressive symptoms (RR: 0.72, 95% CI [0.64–0.82]). Among the approaches of psychological intervention, supportive counselling was the most effective (RR: 0.58, 95% CI [0.42–0.80]). The best intensity of intervention was six to eight sessions (RR: 0.66, 95% CI [0.55–0.79]).

The effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes: A systematic review and meta-analysis

The objective of this study was to systematically review the effectiveness of different types of regular leisure-time physical activities and pooled the effect sizes of those activities on long-term glycemic control in people with type 2 diabetes compared with routine care. This review included randomized controlled trials from 1960 to May 2014. A total of 10 Chinese and English databases were searched, following selection and critical appraisal, 18 randomized controlled trials with 915 participants were included. The standardized mean difference was reported as the summary statistic for the overall effect size in a random effects model. The results indicated yoga was the most effective in lowering glycated haemoglobin A1c (HbA1c) levels. Meta-analysis also revealed that the decrease in HbA1c levels of the subjects who took part in regular leisure-time physical activities was 0.60% more than that of control group participants. A higher frequency of regular leisure-time physical activities was found to be more effective in reducing HbA1c levels. The results of this review provide evidence of the benefits associated with regular leisure-time physical activities compared with routine care for lowering HbA1c levels in people with type 2 diabetes.

Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population-based, retrospective cohort study

Background

Musculoskeletal pain in people with type 2 diabetes is a common issue even to this day. The study aimed to explore the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location in people with type 2 diabetes, compared with respective values for people without diabetes.

Methods

The study utilized a population-based retrospective cohort study design. The subjects were randomly obtained from the Taiwan National Health Insurance Research Database. The diabetic group included 6586 people with type 2 diabetes aged 18–50 years, while the non-diabetic group consisted of 32,930 age- and sex-matched people. Based on the medical records of individuals with musculoskeletal pain in the two groups from 2001 to 2010, the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location were calculated and compared, with the aim of identifying differences between the two groups.

Results

Showed that people in the diabetic group had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group (p < 0.05). The relative risk (RR) of the 10-year cumulative incidence of musculoskeletal pain in the two groups was the highest (RR = 1.39) for people between 30 and 39 years of age. The mean number of doctor visits for musculoskeletal pain by location was significantly different between the two groups. However, the mean number of doctor visits for limb pain registered the largest difference between the two groups.

Conclusion

People with type 2 diabetes aged 18–50 years had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group. Musculoskeletal pain might directly or indirectly interfere with or decrease the physical activity levels of people with diabetes. Therefore, it is important to detect and treat musculoskeletal pain early in order to promote physical activity and optimize blood sugar control.

Risk of musculoskeletal disorder among Taiwanese nurses cohort: a nationwide population-based study

BACKGROUND

Musculoskeletal disorders (MSDs) represent the leading causes of occupational injuries among nursing staff. This population-based study was designed to assess the incidence and age-specific incidence of MSDs among a Taiwanese nurse cohort compared with non-nurses.

DESCRIPTION

Data from the Taiwan National Health Insurance Research Database were used to identify MSDs in the study population. A total of 3914 nurses with a diagnosis of MSD were included, together with 11,744 non-nurses as a comparison group. The comparison subjects were randomly selected at a ratio of 3:1 relative to the nurse population and were matched by gender and age. The incidence of MSDs was calculated for the study group, with nurse-to-reference risk ratios presented as odds ratios with 95% confidence intervals (CIs). During the period 2004-2010, 3004 MSDs occurred among the nurses (76.24%) and 7779 (65.79%) in the non-nurses. The annual incidence of MSDs for the nurses increased from 28.35% in 2006 to 33.65% in 2010. The nurse-to-reference risk ratio was 1.27 (95% CI 1.19-1.35) in 2004 and 1.46 (1.37-1.55) in 2010. Herniation of intervertebral disc, lumbago, rotator cuff syndrome, medial epicondylitis, trigger finger and carpal tunnel syndrome were the most common problems.

CONCLUSIONS

Nurses are at higher risk of MSDs and the trend is increasing. Incorrect work-related posture/movement, psychological issues and the rolling shift system may be the major causes of MSDs among nurses in Taiwan.

The effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2: A Systematic Review

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2.The specific review question is:What is the effectiveness of physical leisure time activities on glycaemic control in patients with diabetes type 2?

BACKGROUND

Type 2 diabetes results from the body's ineffective use of insulin. Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. According to 2011 National Diabetes Fact Sheet, diabetes affected 25.8 million people of all ages of United States population during 2005-2008, include 18.8 million diagnosed people and seven million undiagnosed people. Among United States residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010. Recent World Health Organization (WHO) calculations indicate diabetes kills more than one million people annually, almost 80% of which occur in low- and middle-income countries. Almost half of diabetes deaths occur in people aged under 70 years; 55% of diabetes deaths are in women. WHO projects that diabetes deaths will double between 2005 and 2030.Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race. It is a common outcome of uncontrolled blood sugar and over time leads to serious complications including hypertension, blindness, kidney damage, lower-limb amputations, heart disease, and stroke. Good glycaemic control is a major goal in the treatment of type 2 diabetes mellitus to prevent and delay those severe long-term complications. Physical activity is considered to be a substantial part of the treatment of type 2 diabetes mellitus, as well as diet and medication. Physical activity is a common physiological stressor that causes perturbation to glucose homeostasis and energy needs.Several studies have reported the effects of physical activity on improving insulin sensitivity, cardio-respiratory fitness, glycaemic control, and psychosocial well-being. The American Diabetes Association suggests that people with type 2 diabetes spend at least 150 minutes a week on moderate-intensity physical activity (50-70% of maximum heart rate), or at least 90 minutes a week on vigorous physical activity (>70% of maximum heart rate). Recent studies also indicate that moderate-intensity aerobic physical activity could help type 2 diabetes patients to maintain ideal glycaemic control. Boule et al found physical activity training could reduce haemoglobin A1c (HbA1c) (control group vs. exercise group: 8.31% vs. 7.65%) by 0.66%. This is close to the effect of intense glucose-lowering pharmacological treatment found in the United Kingdom Prospective Diabetes Study. A 1% absolute decrease in the HbA1c value is associated with a 15% to 20% decrease in major cardiovascular events and a 37% reduction in microvascular complications.According to Zhao, Ford, Chaoyang's report (2011), only 25-42% of older adults with diabetes mellitus met recommendations for total physical activity based on the 2007 American Diabetes Association and 2008 Department of Health and Human Services guidelines. Various barriers to regular physical activity had been described, such as health problems, lack of time or energy, no exercise partner, lack of family support, and motivation and working time. An active lifestyle does not require complex exercise programmes. Instead, regular daily physical activity is believed to enable individuals to reduce the risk of chronic diseases and may enhance their quality of life. Recently, it has been thought that, instead of structured physical activity, lifestyle physical activity is a better alternative for diabetes patients. Moderate or vigorous lifestyle or leisure time physical activities included jogging, walking, gardening, tai chi chuan, and qigong (an ancient Chinese breathing exercise that combines aerobics, isometric and isotonic movements and meditation). According to data from recent studies, moderate physical leisure time activities for at least 60 minutes every week can effectively improve glycaemic control in patients with diabetes type 2.Those measure indicators of glycaemic control including glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) were used to assess glycaemic control in diabetic patients. HbA1c value reflects the mean plasma glucose concentration over two to three months. Fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) reflect short-term plasma glucose change. Glycated haemoglobin is a form ofhaemoglobin that is measured primarily to identify the averageplasmaglucoseconcentration over prolonged periods of time. The fasting plasma glucose test measures fasting blood sugar levels and the postprandial plasma glucose test is often used to test the effectiveness of the body's carbohydrate metabolism and the ability to produce insulin. In 2010, Psaltopoulou et al gathered current information from meta-analyses on dietary and lifestyle practices concerning reduction of risk to develop type 2 diabetes. In 2009, Thomas et al completed a systematic review in which fourteen randomised controlled trials involving a total of 377 participants comparing exercise against no exercise in type 2 diabetes were identified. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6%. This systematic review will differ from these two previously published reviews in that it aims to explore the effectiveness of different kinds of moderate or vigorous physical leisure time activities in improving glycaemic control in patients with diabetes type 2. A search of MEDLINE, DARE database, CINAHL, the Cochrane Library of Systematic Reviews and Joanna Briggs Institute Library of Systematic Reviews found no existing reviews or review underway on this topic.