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Ruiz-Cortés M, Múzquiz-Barberá P, Herrero R, Vara MD, Escrivá-Martínez T, Carcelén R, Rodilla E, Baños RM, Lisón JF. How the Presence of a Doctor Known to Patients Impacts a Web-Based Intervention to Promote Physical Activity and Healthy Eating Behaviour in Individuals with an Overweight/Obesity–Hypertension Phenotype: A Randomised Clinical Trial. Nutrients 2023; 15:nu15071624. [PMID: 37049465 PMCID: PMC10097159 DOI: 10.3390/nu15071624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: The ‘Living Better’ web-based programme has shown short- and long-term benefits for body composition and psychological variables in obese patients with hypertension by promoting a healthier lifestyle. To further explore the potential of this programme, in this work we aimed to explore the possible effect of the patient’s ‘own doctor’ appearing in the video content of the Living Better intervention. (2) Methods: A total of 132 patients were randomly assigned either to the experimental (EG, n = 70) or control (CG, n = 62) group (with a doctor the patient knew as ‘their own’ or an ‘unknown doctor’, respectively). The body mass index (BMI), motivation towards physical activity (PA), PA levels, motivation to change one’s eating habits, adherence to the Mediterranean diet, and eating behaviour were all assessed and compared at baseline and post-intervention (12 weeks). (3) Results: The results of this study confirmed the positive effects of the Living Better programme on BMI and external eating style, with significant improvements in these variables in both groups. In addition, in the EG there was higher intrinsic motivation to change eating behaviour (mean difference of 0.9, 95% CI [0.1, 1.6], p = 0.032) and lower amotivation (mean difference of −0.6, 95% CI [−1.2, −0.1], p = 0.027) compared to the CG. (4) Conclusions: This study suggests that the presence of the patients’ own doctor in the audiovisual content of the Living Better intervention did not have significant additional benefits in terms of BMI or external eating style. However, their presence did improve intrinsic motivation and amotivation related to eating habits.
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Affiliation(s)
- Marta Ruiz-Cortés
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
| | - Pedro Múzquiz-Barberá
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
| | - Rocío Herrero
- Department of Psychology and Sociology, Universidad de Zaragoza, 50009 Teruel, Spain
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Dolores Vara
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Tamara Escrivá-Martínez
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Raquel Carcelén
- Department of Medicine and Surgery, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
| | - Enrique Rodilla
- Department of Medicine and Surgery, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
- Hypertension and Vascular Risk Unit, Hospital Universitario de Sagunto, 46115 Valencia, Spain
| | - Rosa María Baños
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Juan Francisco Lisón
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-961369000 (ext. 64540)
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Li Y, Jiang Y, Tang Y. Is remote blood pressure monitoring and management a better approach for patients with hypertension? A narrative review. J Clin Hypertens (Greenwich) 2023; 25:121-126. [PMID: 36602447 PMCID: PMC9903197 DOI: 10.1111/jch.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
Hypertension is a global public health problem which affects the physical and mental health of individuals. The management of hypertension is a long-term process that requires the cooperation of both doctors and patients, and the blood pressure variability is closely related to the clinical prognosis. In recent years, the development of telemedicine has promoted better blood pressure monitoring and management for patients, as well as better medical intervention and health education for patients by medical staff. This article provides a review of remote blood pressure monitoring and management.
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Affiliation(s)
- Yan Li
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yi Jiang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yuping Tang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
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Amenyah SD, Waters D, Tang W, Fenge LA, Murphy JL. Systematic realist synthesis of health-related and lifestyle interventions designed to decrease overweight, obesity and unemployment in adults. BMC Public Health 2022; 22:2100. [PMCID: PMC9668709 DOI: 10.1186/s12889-022-14518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Obesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach.
Objectives
The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why.
Methods
A realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory.
Results
A total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity.
Conclusion
This realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment.
Trial registration
PROSPERO 2020 CRD42020219897.
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Múzquiz-Barberá P, Ruiz-Cortés M, Herrero R, Vara MD, Escrivá-Martínez T, Carcelén R, Baños RM, Rodilla E, Lisón JF. The Impact of a Web-Based Lifestyle Educational Program ('Living Better') Reintervention on Hypertensive Overweight or Obese Patients. Nutrients 2022; 14:2235. [PMID: 35684034 PMCID: PMC9182666 DOI: 10.3390/nu14112235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
‘Living Better’, a self-administered web-based intervention, designed to facilitate lifestyle changes, has already shown positive short- and medium-term health benefits in patients with an obesity−hypertension phenotype. The objectives of this study were: (1) to examine the long-term (3-year) evolution of a group of hypertensive overweight or obese patients who had already followed the ‘Living Better’ program; (2) to analyze the effects of completing this program a second time (reintervention) during the COVID-19 pandemic. A quasi-experimental design was used. We recruited 29 individuals from the 105 who had participated in our first study. We assessed and compared their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), eating behavior, and physical activity (PA) level (reported as METs-min/week), at Time 0 (first intervention follow-up), Time 1 (before the reintervention), and Time 2 (post-reintervention). Our results showed significant improvements between Time 1 and Time 2 in SBP (−4.7 (−8.7 to −0.7); p = 0.017), DBP (−3.5 (−6.2 to −0.8); p = 0.009), BMI (−0.7 (−1.0 to −0.4); p < 0.001), emotional eating (−2.8 (−5.1 to −0.5); p = 0.012), external eating (−1.1 (−2.1 to −0.1); p = 0.039), and PA (Time 1: 2308 ± 2266; Time 2: 3203 ± 3314; p = 0.030, Z = −2.17). Statistical analysis showed no significant differences in SPB, DBP, BMI, and eating behavior between Time 0 and Time 1 (p > 0.24). Implementation of the ‘Living Better’ program maintained positive long-term (3-year) health benefits in patients with an obesity−hypertension phenotype. Moreover, a reintervention with this program during the COVID-19 pandemic produced significant improvements in blood pressure, BMI, eating behavior, and PA.
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Affiliation(s)
- Pedro Múzquiz-Barberá
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain;
| | - Marta Ruiz-Cortés
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (M.R.-C.); (J.F.L.)
| | - Rocío Herrero
- Department of Psychology and Sociology, Universidad de Zaragoza, 50009 Teruel, Spain;
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 46115 Valencia, Spain; (M.D.V.); (T.E.-M.); (R.M.B.)
| | - María Dolores Vara
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 46115 Valencia, Spain; (M.D.V.); (T.E.-M.); (R.M.B.)
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Tamara Escrivá-Martínez
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 46115 Valencia, Spain; (M.D.V.); (T.E.-M.); (R.M.B.)
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Raquel Carcelén
- Department of Medicine and Surgery, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain;
| | - Rosa María Baños
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 46115 Valencia, Spain; (M.D.V.); (T.E.-M.); (R.M.B.)
- Polibienestar Research Institute, Universitat de València, 46022 Valencia, Spain
| | - Enrique Rodilla
- Department of Medicine and Surgery, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain;
- Hypertension and Vascular Risk Unit, Hospital Universitario de Sagunto, 46520 Valencia, Spain
| | - Juan Francisco Lisón
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (M.R.-C.); (J.F.L.)
- Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03/0052, Instituto de Salud Carlos III, 46115 Valencia, Spain; (M.D.V.); (T.E.-M.); (R.M.B.)
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Hintze LJ, Kravchychyn ACP, Ferreira YAM, Campos RMDS, Dantas ADA, Masquio DCL, Caranti DA, Thivel D, Dâmaso AR. Semi-intensive and Intensive Interdisciplinary Treatments Have Similar Effects on Metabolic Syndrome and Selected Inflammatory Markers in Adolescents with Obesity. J Obes Metab Syndr 2021; 30:386-395. [PMID: 34966004 PMCID: PMC8735820 DOI: 10.7570/jomes21049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of the present study was to compare the impact of semi-intensive and intensive interdisciplinary weight-loss therapies on the treatment of metabolic syndrome (MS) and selected inflammatory markers in adolescents with obesity. Methods The study included 166 adolescents enrolled in two groups for 22 weeks: the intensive group (in-person aerobic and resistance exercise three times a week, and psychological and nutritional counselling once a week), or the semi-intensive group (six in-person exercise orientation meetings and six in-person psychological support sessions with an online nutritional and exercise program). Anthropometric parameters, blood pressure, fasting glucose, insulin, lipid profile, triglycerides (TG), leptin and adiponectin were assessed before and after the interventions. Results Body weight and waist circumference decreased in both groups (P<0.001) and large effect sizes (η2= 0.586 and η2=0.465, respectively) were noted. Significant time and group interactions were found (P=0.001) with medium effect sizes (η2=0.095 and η2=0.105, respectively). The prevalence of MS decreased from 27.9% to 13.1% (P=0.012) and 29.4% to 5.9% (P=0.004) in the semi-intensive and intensive groups, respectively. All MS risk factors decreased significantly over time (P<0.001) and a significant time*group interaction was observed (P<0.05), except for fasting TG (P=0.832) and glucose (P=0.128, η2=0.021). Conclusion The results suggested that both approaches promoted significant clinical improvement in the condition of adolescents with MS and reduced associated risk factors. Studies that consider the cost effectiveness of both treatments are still needed to determine whether semi-intensive care, with its lower financial costs, may be a suitable option to treat obesity and MS in adolescents with obesity.
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Affiliation(s)
- Luzia Jaeger Hintze
- Department of Biosciences, Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Raquel Munhoz da Silveira Campos
- Department of Biosciences, Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Santos, Brazil
| | | | | | - Danielle Arisa Caranti
- Department of Biosciences, Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Santos, Brazil
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France
| | - Ana R Dâmaso
- Department of Biosciences, Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
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Park SH, Shin JH, Park J, Choi WS. An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010583. [PMID: 34682329 PMCID: PMC8535932 DOI: 10.3390/ijerph182010583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022]
Abstract
Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.
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Affiliation(s)
- Sang-Hyun Park
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Jong-Ho Shin
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Joowoong Park
- Research Strategy Division, Korea Aerospace Research Institute (KARI), Daejeon 34133, Korea;
| | - Woo-Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
- Keyu Internal Medicine Clinic, Daejeon 35250, Korea
- Correspondence: ; Tel.: +82-42-483-7554; Fax: +82-42-485-7554
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Cavero-Redondo I, Saz-Lara A, Sequí-Dominguez I, Gómez-Guijarro MD, Ruiz-Grao MC, Martinez-Vizcaino V, Álvarez-Bueno C. Comparative effect of eHealth interventions on hypertension management-related outcomes: A network meta-analysis. Int J Nurs Stud 2021; 124:104085. [PMID: 34601205 DOI: 10.1016/j.ijnurstu.2021.104085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increasingly, health professionals and patients have begun to be involved in eHealth interventions to assist in the self-management of hypertension. Therefore, this study was aimed at comparing the effect of different types of eHealth interventions (phone calls, blood pressure telemonitoring, emails, web-site, smartphone-app, short message service (SMS) and more than two eHealth interventions) on reducing systolic and diastolic blood pressure, increasing adherence to medication treatment, improving physical activity compliance, controlling blood pressure, and improving quality of life (QoL). METHODS A systematic search in MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to identify experimental studies addressing the effect of eHealth interventions on the self-management of hypertension. Comparative evaluation of the eHealth interventions effect were performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between eHealth interventions and control/non-intervention. RESULTS Fifty-one studies were included in the analysis showing a moderate effect size for more than two types of eHealth interventions (-0.46; 95%CI: -0.64, -0.27, p < 0.001 and -0.29; 95%CI: -0.46, -0.13, p < 0.001), phone calls (-0.37; 95%CI: -0.57, -0.17, p < 0.001 and -0.29; 95%CI: -0.52, -0.07, p = 0.011) and smartphone-app (-0.26; 95%CI: -0.50, -0.01, p = 0.040 and -0.40; 95%CI: -0.70, -0.10, p = 0.010) on reducing both systolic and diastolic blood pressure, respectively. Additionally, i) smartphone-app improved medication adherence by 45%; ii) more than two types of eHealth interventions and emails improved physical activity compliance by 18% and 57% respectively; ii) more than two types of eHealth interventions, phone calls, blood pressure telemonitoring, website and SMS improved blood pressure control between 16% and 30%; and iv) blood pressure telemonitoring showed a week effect on QoL CONCLUSIONS: Our study reported eHealth to be a suitable intervention for the self-management of hypertension. Considering our results and the population's accessibility to eHealth devices, eHealth could be a useful and largely scalable tool for the self-management of hypertension. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020187468.
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Affiliation(s)
- Iván Cavero-Redondo
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
| | - Alicia Saz-Lara
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | - Irene Sequí-Dominguez
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | | | - Vicente Martinez-Vizcaino
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Celia Álvarez-Bueno
- Health Care and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
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Choi WS, Kim NS, Kim AY, Woo HS. Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6892. [PMID: 34199019 PMCID: PMC8297065 DOI: 10.3390/ijerph18136892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.
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Affiliation(s)
- Woo-Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
- Keyu Internal Medicine Clinic, Daejeon 35250, Korea
| | - Nam-Suk Kim
- Public Health and Welfare Bureau, Daejeon City Hall, Daejeon 35242, Korea;
| | - Ah-Young Kim
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
| | - Hyung-Soo Woo
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
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Kim G, Lee JS, Lee SK. A Technology-Mediated Interventional Approach to the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E512. [PMID: 33435158 PMCID: PMC7828066 DOI: 10.3390/ijerph18020512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Technology-mediated interventions help overcome barriers to program delivery and spread metabolic syndrome prevention programs on a large scale. A meta-analysis was performed to evaluate the impact of these technology-mediated interventions on metabolic syndrome prevention. METHODS In this meta-analysis, from 30 January 2018, three databases were searched to evaluate interventions using techniques to propagate diet and exercise lifestyle programs for adult patients with metabolic syndrome or metabolic risk. RESULTS Search results found 535 citations. Of these, 18 studies met the inclusion criteria analyzed in this article. The median duration of intervention was 4 months and the follow-up period ranged from 1.5 to 30 months. The standardized mean difference (SMD) between the two groups was waist circumference -0.35 (95% CI -0.54, -0.15), triglyceride -0.14 (95% CI -0.26, -0.03), fasting blood glucose -0.31 (95% CI -0.42, -0.19), body weight -1.34 (95% CI -2.04, -0.64), and body mass index -1.36 (95% CI -2.21, -0.51). There was no publication bias in this study. CONCLUSION Technology-mediated intervention improved clinically important metabolic syndrome related indicators such as excess body fat around the waist, fasting glucose, and body mass index. These interventions will play an important role in the dissemination of metabolic syndrome prevention programs.
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Affiliation(s)
| | | | - Soo-Kyoung Lee
- Nursing College, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea; (G.K.); (J.-S.L.)
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Development and Operation of a Video Teleconsultation System Using Integrated Medical Equipment Gateway: a National Project for Workers in Underserved Areas. J Med Syst 2020; 44:194. [PMID: 33006060 PMCID: PMC7529321 DOI: 10.1007/s10916-020-01664-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
Worker health centers and health zones provide occupational healthcare services to workers in underserved areas of industrial health. Health zones cannot counsel workers on occupational disease prevention; worker health center personnel have to provide such services through in-person visits. Video teleconsultation can increase the accessibility of high-quality services to workers who visit health zones and improve professional personnel’s efficiency. This study aimed to develop a system and an infrastructure that could facilitate video teleconsultation services between worker health centers and health zones, and analyze the services’ operation status. A video teleconsultation process based on the role of local and remote institutions was designed. Based on the designed services, a web system supporting teleconsultation and an integrated gateway guaranteeing the interface with medical equipment in the web environment was developed. After analyzing the working environment, an infrastructure consisting of networks, video equipment, medical equipment, and servers necessary for teleconsultation was designed. Statistical results from the developed system and a satisfaction survey conducted by the Korea Occupational Safety and Health Agency were used to analyze the video teleconsultation services’ operation status. A system, gateway, and hardware infrastructure within 21 worker health centers and 21 health zones has been operating this service since January 1, 2018. Over two years, the total number of teleconsultation service users was 4979, and the total number of questionnaire respondents was 1270. The total number of service activities was 6388 and total satisfaction was rated as 4.58 (± 0.59) out of 5. In this study, video teleconsultation services were evaluated as being very satisfactory. In particular, service accessibility and local medical personnel service were rated highly, demonstrating that the developed system and infrastructure were well designed according to the goals of the project.
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11
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Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, Logan AG, Magid DJ, Mckinstry B, Margolis KL, Parati G, Wakefield BJ. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension 2020; 76:1368-1383. [PMID: 32921195 DOI: 10.1161/hypertensionaha.120.15873] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.
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Affiliation(s)
- Stefano Omboni
- From the Clinical Research Unit, Italian Institute of Telemedicine, Varese (S.O.).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (R.J.M.)
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, NC (H.B.B.).,Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC.,Division of General Internal Medicine (H.B.B.), Duke University, Durham, NC.,Department of Population Health Sciences (H.B.B.), Duke University, Durham, NC
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, United Kingdom (L.C.C.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.)
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Alexander G Logan
- Department of Medicine, Mount Sinai Hospital, University Health Network and University of Toronto, ON, Canada (A.G.L.)
| | - David J Magid
- Colorado Permanente Medical Group, Denver and School of Public Health, University of Colorado, Aurora (D.J.M.)
| | - Brian Mckinstry
- Emeritus Professor of Primary Care eHealth, Usher Institute, The University of Edinburgh, United Kingdom (B.M.)
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.).,Istituto Auxologico Italiano, IRCCS San Luca, Milano, Italy (G.P.)
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12
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Innovative tool for health promotion for at-risk Thai people with hypertension. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring. Curr Hypertens Rep 2020; 22:42. [PMID: 32506273 DOI: 10.1007/s11906-020-01056-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status. RECENT FINDINGS There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and cost-saving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated.
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14
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Stogios N, Kaur B, Huszti E, Vasanthan J, Nolan RP. Advancing Digital Health Interventions as a Clinically Applied Science for Blood Pressure Reduction: A Systematic Review and Meta-analysis. Can J Cardiol 2020; 36:764-774. [DOI: 10.1016/j.cjca.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/24/2019] [Accepted: 11/10/2019] [Indexed: 01/29/2023] Open
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15
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Li J, Chang X. Improving mobile health apps usage: a quantitative study on mPower data of Parkinson's disease. INFORMATION TECHNOLOGY & PEOPLE 2020. [DOI: 10.1108/itp-07-2019-0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe emergence of mobile health (mHealth) products has created a capability of monitoring and managing the health of patients with chronic diseases. These mHealth technologies would not be beneficial unless they are adopted and used by their target users. This study identifies key factors affecting the usage of mHealth apps based on user usage data collected from an mHealth app.Design/methodology/approachUsing a dataset collected from an mHealth app named mPower, developed for patients with Parkinson's disease (PD), this paper investigated the effects of disease diagnosis, disease progression and mHealth app difficulty level on app usage, while controlling for user information. App usage is measured by five different activity counts of the app.FindingsThe results across five measures of mHealth app usage vary slightly. On average, previous professional diagnosis and high user performance scores encourage user participation and engagement, while disease progression hinders app usage.Research limitations/implicationsThe findings potentially provide insights into better design and promotion of mHealth products and improve the capability of health management of patients with chronic diseases.Originality/valueStudies on the mHealth app usage are critical but sparse because large-scale and reliable mHealth app usage data are limited. Unlike earlier works based solely on survey data, this research used a large user usage data collected from an mHealth app to study key factors affecting app usage. The methods presented in this study can serve as a pioneering work for the design and promotion of mHealth technologies.
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16
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Lisón JF, Palomar G, Mensorio MS, Baños RM, Cebolla-Martí A, Botella C, Benavent-Caballer V, Rodilla E. Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial. J Med Internet Res 2020; 22:e14196. [PMID: 32286232 PMCID: PMC7189251 DOI: 10.2196/14196] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/31/2019] [Accepted: 02/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients’ average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN). Objective The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN. Methods A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up). Results A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference −0.4, 95% CI −0.1 to −0.6; P=.005), BFM (mean difference −2.4, 95% CI −1.1 to −3.6; P<.001), DBP (mean difference −1.8, 95% CI −0.2 to −3.3; P=.03), and blood glucose (mean difference −2, 95% CI 0 to −4; P=.04). Conclusions Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN. Trial Registration ClinicalTrials.gov NCT03396302; https://clinicaltrials.gov/ct2/show/NCT03396302
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Affiliation(s)
- Juan Francisco Lisón
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | | | - Marinna S Mensorio
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Foundation, Brasilia, Brazil.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Rosa M Baños
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Ausiàs Cebolla-Martí
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Cristina Botella
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Universitat Jaume I, Castellón, Spain
| | - Vicent Benavent-Caballer
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Enrique Rodilla
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Hypertension and Vascular Risk Unit, Hospital de Sagunto, Sagunto, Spain
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17
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Investigating the attitude of patients with chronic diseases about using mobile health. Int J Technol Assess Health Care 2020; 36:139-144. [PMID: 32052724 DOI: 10.1017/s0266462320000070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mobile health (mHealth) due to its popularity and accessibility can be widely applied in different health areas such as the management of chronic diseases. However, its success depends on the acceptance of their users. Therefore, the aim of this study was to survey the attitudes of patients with chronic disease toward mHealth technology and their willingness to use it. METHODS This study was conducted within a 2-year period (2016-2018) to determine and compare the attitude and willingness of patients with asthma, diabetes, and multiple sclerosis (MS) toward using mHealth technology in a province in Iran. RESULTS In total, 222 patients participated in this study. More than 93 percent of the patients with diabetes and MS, and 65 percent of the asthmatic patients preferred using mHealth services rather than consulting a physician (p < .0001). About 98, 94, and 49 percent of the MS, diabetic, and asthmatic patients, respectively felt comfortable if their health conditions checked by physicians through mHealth technology (p < .0001). CONCLUSIONS Our results showed that the majority of the patients felt comfortable and preferred using mHealth technology rather than consulting the physicians. The attitudes of diabetic and MS patients toward mHealth technology were rather more positive compared to asthmatic patient attitude. These results may be helpful for the developers of mHealth technology, and researchers who design mHelath interventions for patients with chronic disease.
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18
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Choi WS, Shin IS, Yang JS. Understanding Moderators of Home Blood Pressure Telemonitoring Systems in Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. Telemed J E Health 2019; 26:1016-1034. [PMID: 31855113 DOI: 10.1089/tmj.2019.0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Factors affecting the effectiveness of telemonitoring in home blood pressure telemonitoring (HBPT) must be examined in an integrated analysis in urban hypertensive patients. Materials and Methods: In a systematic review of electronic databases, we retrieved 1,433 citations and selected 34 comparisons. Specified moderators were the duration of the intervention, the frequency of remote transmission of blood pressure (BP) data, the additional intervention, and the intervention pathway. Results: For the duration of follow-up of HBPT, the weighted mean difference (WMD) in systolic blood pressure (SBP) between two groups was 11.900 mmHg (p-value <0.001) at 2 months and 3.024 mmHg (p = 0.002) at 12 months. The WMD in SBP was 5.512 mmHg (p < 0.001) in cases where data were transmitted daily and 1.818 mmHg (p = 0.084) for monthly transmission. For the group in which further interventions with HBPT were conducted, the WMD in SBP was 3.813 mmHg (p < 0.001). For patients who did not receive additional interventions, the WMD was 2.747 mmHg (p = 0.005). For the pathway of HBPT, the WMD was 6.800 mmHg (p = 0.053) when BP values were remote transmitted through letter, 3.041 mmHg (p = 0.001) through mobile phone/web, 2.224 mmHg (p = 0.043) through telephone-linked computer system, and 4.352 mmHg (p < 0.001) through telephone. Conclusions: The effects of moderators of HBPT systems utilized with urban hypertensive patients differ from those in interventions that did not distinguish urban from rural areas. Results for duration of implementation and frequency of data transmission were significant. Among the interventions using telecommunications, the telephone was the most effective in comparison to other channels.
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Affiliation(s)
- Woo Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Keyu Internal Medicine Clinic, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Transdisciplinary Security, Dongguk University, Seoul, Republic of Korea
| | - Jae-Suk Yang
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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19
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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20
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Apiñaniz A, Cobos-Campos R, Sáez de Lafuente-Moríñigo A, Parraza N, Aizpuru F, Pérez I, Goicoechea E, Trápaga N, García L. Effectiveness of randomized controlled trial of a mobile app to promote healthy lifestyle in obese and overweight patients. Fam Pract 2019; 36:699-705. [PMID: 31093681 DOI: 10.1093/fampra/cmz020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health advice is useful for establishing behavioural changes, but such changes tend not to last. It would therefore be good to identify mechanisms for reinforcing advice and one option is the use of information and communication technologies. Given the limited evidence on the effectiveness of such technologies, we decided to conduct a clinical trial to assess the efficacy of a mobile application (app) for supporting the provision health advice for weight loss. METHODS A randomized clinical trial with 110 obese and overweight patients from the Basque public health care network (Araba). Patients were randomly allocated to the control (health advice) or intervention (health advice + app) groups. Primary (weight) and secondary (blood cholesterol level, blood pressure, haemoglobin A1c (HbA1c) and adherence to dietary and exercise recommendations) outcome variables were assessed at 1, 3 and 6 months after the end of the intervention. RESULTS There were no significant differences in weight (0.357 kg; P = 0.7), blood cholesterol (2.6 mg/dl; P = 0.617), blood pressure (2.3 mmHg; P = 0.369) or adherence to recommendations on diet (84.6% in control and 92.9% the intervention group, P = 0.413) or physical activity (56% in controls and 75% the intervention group, P = 0.145). On the other hand, there were significant differences in HbA1c in favour of the control group (-0.095%; %; P = 0.046). DISCUSSION The use of AKTIDIET® to support health advice for weight loss cannot be recommended. More high quality studies are needed, and patients should be involved in the design of apps to increase their efficacy and usability. CLINICAL TRIAL REGISTRATION NCT02308176.
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Affiliation(s)
- Antxon Apiñaniz
- Osakidetza, OSI Araba, Lakuabizkarra Health Centre, Vitoria-Gasteiz, España.,Preventive Medicine and Public Health Department, University of Basque Country, Vitoria-Gasteiz
| | - Raquel Cobos-Campos
- Health Research Institute BioAraba, Methodology and Statistics Unit, Vitoria-Gasteiz, Spain
| | | | - Naiara Parraza
- Health Research Institute BioAraba, Methodology and Statistics Unit, Vitoria-Gasteiz, Spain
| | - Felipe Aizpuru
- Osakidetza, Sub-Department of health care, Vitoria-Gasteiz, Spain.,Preventive Medicine and Public Health Department, University of Basque Country, Vitoria-Gasteiz.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Iraida Pérez
- Osakidetza, OSI Araba, Olaguibel Health Centre, Vitoria-Gasteiz, España
| | - Enara Goicoechea
- Osakidetza, OSI Araba, Lakuabizkarra Health Centre, Vitoria-Gasteiz, España
| | - Nerea Trápaga
- Osakidetza, OSI Araba, Zabalgana Health Centre, Vitoria-Gasteiz, España
| | - Laura García
- Osakidetza, OSI Araba, Lakuabizkarra Health Centre, Vitoria-Gasteiz, España
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21
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2019; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil
- International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil
- Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
- Hospital Copa Star, Rio de Janeiro, RJ - Brazil
- Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil
- Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
- Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil
- Rede D'Or, Rio de Janeiro, RJ - Brazil
- Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil
- Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
- Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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22
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Moving toward community based telehealth services using mhealth for hypertensive patients. Int J Technol Assess Health Care 2019; 35:379-383. [PMID: 31547890 DOI: 10.1017/s0266462319000655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although self-care can control and prevent complications in hypertensive patients, self-care adherence is relatively low among these patients. Community-based telehealth services through mhealth can be an effective solution. OBJECTIVE This study aimed to evaluate the effect and acceptance of an mhealth application as a community-based telehealth intervention on self-care behavior adherence. METHOD This clinical trial included sixty hypertensive patients and their matched controls from two heart clinics affiliated to Shiraz University of Medical Sciences (SUMS). Self-care behaviors were assessed using Hill-Bone questionnaire before and after the intervention. Acceptability was evaluated in the intervention group at the end of the study period. The data were analyzed via SPSS 18 software using descriptive and inferential statistics. RESULT The results showed a significant difference between the intervention and control groups regarding the mean score of self-care behaviors (4.13 ± 0.23 versus 3.18 ± 0.27, p < .001). Additionally, a significant difference was observed between the two groups concerning the mean scores of the two subscales of self-care behaviors, including "medication taking" and "proper diet". However, no significant difference was observed between the two groups regarding the mean score of "appointment keeping" (p = .075). Overall, the intervention group participants were satisfied (4.27 ± 0.34) with this approach for managing hypertension. CONCLUSION Community-based telehealth services through mhealth had the potential to improve self-care behaviors in hypertensive patients and seemed to be accepted by the patients in the intervention group.
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Choi WS, Choi JH, Oh J, Shin IS, Yang JS. Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. Telemed J E Health 2019; 26:744-759. [PMID: 31532328 DOI: 10.1089/tmj.2019.0028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Remote home blood pressure monitoring (RBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of RBPM for urban hypertensive patients. Methods: We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of RBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control. Results: We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for RBPM for systolic BP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212, 95% confidence interval 0.148-0.275; p < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, p < 0.001) and the effect of RBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; p = 0.018). Conclusions: This review demonstrates that RBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of RBPM in preventing hypertensive cardiovascular complications.
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Affiliation(s)
- Woo Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Keyu Internal Medicine Clinic, Daejeon, Republic of Korea
| | - Jin Hyuk Choi
- Department of Philosophy, University of Warwick, Coventry, United Kingdom
| | - Jiwon Oh
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Education, Jeonju University, Jeonju, Republic of Korea
| | - Jae-Suk Yang
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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Mobile phone text messaging for improving secondary prevention in cardiovascular diseases: A systematic review. Heart Lung 2018; 47:351-359. [PMID: 29803297 DOI: 10.1016/j.hrtlng.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify, retrieve, critically appraise and synthesize information regarding existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD). METHODS A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included. RESULTS The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused on CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD. CONCLUSION Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn.
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Liu S, Brooks D, Thomas SG, Eysenbach G, Nolan RP. Effectiveness of User- and Expert-Driven Web-based Hypertension Programs: an RCT. Am J Prev Med 2018; 54:576-583. [PMID: 29456025 DOI: 10.1016/j.amepre.2018.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/30/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The effectiveness of self-guided Internet-based lifestyle counseling (e-counseling) varies, depending on treatment protocol. Two dominant procedures in e-counseling are expert- and user-driven. The influence of these procedures on hypertension management remains unclear. The objective was to assess whether blood pressure improved with expert-driven or user-driven e-counseling over control intervention in patients with hypertension over a 4-month period. STUDY DESIGN This study used a three-parallel group, double-blind randomized controlled design. SETTING/PARTICIPANTS In Toronto, Canada, 128 participants (aged 35-74 years) with hypertension were recruited. Participants were recruited using online and poster advertisements. Data collection took place between June 2012 and June 2014. Data were analyzed from October 2014 to December 2016. INTERVENTION Controls received a weekly e-mail newsletter regarding hypertension management. The expert-driven group was prescribed a weekly exercise and diet plan (e.g., increase 1,000 steps/day this week). The user-driven group received weekly e-mail, which allowed participants to choose their intervention goals (e.g., [1] feel more confident to change my lifestyle, or [2] self-help tips for exercise or a heart healthy diet). MAIN OUTCOME MEASURES Primary outcome was systolic blood pressure measured at baseline and 4-month follow-up. Secondary outcomes included cholesterol, 10-year Framingham cardiovascular risk, daily steps, and dietary habits. RESULTS Expert-driven groups showed a greater systolic blood pressure decrease than controls at follow-up (expert-driven versus control: -7.5 mmHg, 95% CI= -12.5, -2.6, p=0.01). Systolic blood pressure reduction did not significantly differ between user- and expert-driven. Expert-driven compared with controls also showed a significant improvement in pulse pressure, cholesterol, and Framingham risk score. The expert-driven intervention was significantly more effective than both user-driven and control groups in increasing daily steps and fruit intake. CONCLUSIONS It may be advisable to incorporate an expert-driven e-counseling protocol in order to accommodate participants with greater motivation to change their lifestyle behaviors, but more studies are needed. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03111836.
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Affiliation(s)
- Sam Liu
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada.
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott G Thomas
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Gunther Eysenbach
- Center for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Robert P Nolan
- Cardiac eHealth Research Unit, University Health Network, Toronto, Ontario, Canada
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Vargas G, Cajita MI, Whitehouse E, Han HR. Use of Short Messaging Service for Hypertension Management: A Systematic Review. J Cardiovasc Nurs 2018; 32:260-270. [PMID: 27111819 PMCID: PMC5085898 DOI: 10.1097/jcn.0000000000000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile phone Short Message Service (SMS) is a tool now used by the health research community, providing the capability for instant communication between patients and health professionals. Greater understanding of how to best use SMS as a means to improve healthcare delivery and outcomes will foster innovation in research and provide an opportunity to progress as a public health community. PURPOSE The purposes of this systematic review are 2-fold: (1) to provide insight on the most used mobile phone SMS practices and characteristics in hypertension (HTN) outcome-focused publications and (2) to critically evaluate empirical evidence associated with SMS utilization and BP outcomes. METHODS Two independent systematic literature searches were completed. The final selected studies each then underwent data extraction and quality-rating assessment, followed by an evaluation for a meta-analysis to measure mean difference of the change in BP. RESULTS A total of 6 studies meeting the inclusion criteria were included in the review. Feasibility assessment for a meta-analysis was found unfavorable because of the variation among studies. Short Message Service interventions focused on BP management were most effective in studies featuring 2-way communication and individual patient-tailored content, and guided by evidence-based HTN management practices. IMPLICATIONS Short Message Service interventions for HTN management were supported through evidence provided by the studies reviewed. Short Message Service holds strong potential to bring greater innovation to HTN management and care, especially in racial/ethnic minority populations that face psychosocial and structural barriers in healthcare access and utilization.
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Affiliation(s)
- Grecia Vargas
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Maan Isabella Cajita
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Erin Whitehouse
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Hae-Ra Han
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
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Lu JF, Chen CM, Hsu CY. Effect of home telehealth care on blood pressure control: A public healthcare centre model. J Telemed Telecare 2017; 25:35-45. [PMID: 29041841 DOI: 10.1177/1357633x17734258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of home telehealth care combined with case management by public health nurses, in improving blood pressure control in patients with hypertension. METHODS This cohort study examined the data of patients with hypertension obtained from a telehealth service centre database, between July 2011- June 2012. Eligible patients were adults (≥40 years old) with both prehypertension and hypertension, living alone or in the remote suburbs of metropolitan areas. Demographic data were collected from 12 district public health centre in Taipei, Taiwan. Following enrolment, patients received an appropriate and validated home telehealth device kit for automatic blood pressure monitoring and automated modem via a telephone line or a desktop computer with Internet connection to enable data transmission between the patient's home and telehealth service centre. Patients were instructed to upload the measured data immediately every day. The study outcomes included blood pressure and home telehealth service utilisation. RESULTS Of the 432 patients recruited, 408 (94%) completed data collection. Linear regression analysis found an average 22.1 mm Hg reduction in systolic blood pressure after one year. The mean slope of systolic blood pressure was classified as decreased or non-decreased. An systolic blood pressure decreasing trend was observed in 52.2% patients, while 47.8% patients showed an increasing systolic blood pressure trend. Patients in the decreased systolic blood pressure group tended to be older ( p = 0. 0001), with a greater proportion of hypertension alarms ( p = 0. 001), improved self-blood pressure monitoring behaviour ( p = 0.009) and higher self-measured blood pressure monitoring frequency ( p = 0. 010). Patients in the decreased systolic blood pressure group had a higher self-measured blood pressure monitoring frequency (odds ratio = 0.95, 95% confidence interval, 0.91-0.99, p = 0. 013) than their counterparts. CONCLUSIONS Home telehealth care combined with care management by public health nurses based in public health care centre was feasible and effective for improving blood pressure control among patients with hypertension. Further studies should conduct a thorough analysis of the cost-effectiveness of this intervention. A randomised controlled trial with a longer follow-up period is required to examine the effects of the improved home telehealth device kit on the care of patients with hypertension.
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Affiliation(s)
- Ju-Fen Lu
- 1 Department of Nursing and Geriatric Health Promotin, Jen-Te Junior College of Medicine, Nursing and Management, Taiwan
| | - Ching-Min Chen
- 2 Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Chien-Yeh Hsu
- 3 Department of Information Management, National Taipei University of Nursing and Health Sciences, and Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taiwan
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Peters RM, Shivakumar N, Xu R, Javaherian K, Sink E, Patel K, Brown A, Huynh J, Blanchard M, Ross W, Byrd J. Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study. JMIR Cardio 2017; 1:e2. [PMID: 31758763 PMCID: PMC6857956 DOI: 10.2196/cardio.7915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. OBJECTIVE The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix's EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. METHODS We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. RESULTS After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI -14.5 to -7.2, P<.001) and DBP by 6.6 mm Hg (95% CI -9.9 to -3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. CONCLUSIONS EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.
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Affiliation(s)
| | - Nishkala Shivakumar
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ran Xu
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Kavon Javaherian
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Eric Sink
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kunjan Patel
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Angela Brown
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | | | - Melvin Blanchard
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Will Ross
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jonathan Byrd
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Duan Y, Xie Z, Dong F, Wu Z, Lin Z, Sun N, Xu J. Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies. J Hum Hypertens 2017; 31:427-437. [PMID: 28332506 DOI: 10.1038/jhh.2016.99] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/11/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022]
Abstract
To summarise evidence about the effectiveness of home blood pressure telemonitoring (HBPT) and identify the key components of intervention. We comprehensively searched PubMed, EMBASE and the Cochrane Library for relevant studies. The authors were contacted for additional information. Two authors independently extracted the data and assessed the risk of bias. 46 randomised controlled trials including a total of 13 875 cases were identified. Compared with usual care, HBPT improved office systolic blood pressure (BP) and diastolic BP by 3.99 mm Hg (95% confidence interval (CI): 5.06-2.93; P<0.001) and 1.99 mm Hg (95% CI: -2.60 to -1.39; P<0.001), respectively. A larger proportion of patients achieved BP normalisation in the intervention group (relative risk (RR): 1.16; 95% CI: 1.08-1.25; P<0.001). For HBPT plus additional support (including counselling, education, behavioural management, medication management with decision, adherence contracts and so on) versus HBPT alone (or plus less intense additional support), the mean changes in systolic and diastolic BP were 2.44 mm Hg (95% Cl, 4.88 to 0.00 mm Hg; P=0.05) and 1.12 mm Hg (95% CI, -2.34 to 0.1 mm Hg; P=0.07), respectively. For those surrogate outcomes, low-strength evidence failed to show difference. In subgroup analysis, high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel. HBPT can improve BP control in the hypertensive patients. It may be more efficacious when a proactive additional support is provided during the intervention process.
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Affiliation(s)
- Y Duan
- First Clinical Medical College, Southern Medical University, Guangzhou, China
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Xie
- First Clinical Medical College, Southern Medical University, Guangzhou, China
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - F Dong
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Wu
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - Z Lin
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
| | - N Sun
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
- Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - J Xu
- The Geriatric Cardiovascular Ward, General Hospital of Guangzhou Military Command of the People's Liberation Army, Guangzhou, China
- Clinical Medical College, Guangdong Pharmaceutical University, Guangzhou, China
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McCoy P, Leggett S, Bhuiyan A, Brown D, Frye P, Williams B. Text Messaging: An Intervention to Increase Physical Activity among African American Participants in a Faith-Based, Competitive Weight Loss Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E326. [PMID: 28353650 PMCID: PMC5409538 DOI: 10.3390/ijerph14040326] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/28/2017] [Accepted: 03/17/2017] [Indexed: 11/24/2022]
Abstract
African American adults are less likely to meet the recommended physical activity guidelines for aerobic and muscle-strengthening activity than Caucasian adults. The purpose of this study was to assess whether a text message intervention would increase physical activity in this population. This pilot study used a pre-/post-questionnaire non-randomized design. Participants in a faith-based weight loss competition who agreed to participate in the text messaging were assigned to the intervention group (n = 52). Participants who declined to participate in the intervention, but agreed to participate in the study, were assigned to the control group (n = 30). The text messages provided strategies for increasing physical activity and were based on constructs of the Health Belief Model and the Information-Motivation-Behavioral Skills Model. Chi square tests determined the intervention group participants increased exercise time by approximately eight percent (p = 0.03), while the control group's exercise time remained constant. The intervention group increased walking and running. The control group increased running. Most participants indicated that the health text messages were effective. The results of this pilot study suggest that text messaging may be an effective method for providing options for motivating individuals to increase physical activity.
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Affiliation(s)
- Pamela McCoy
- School of Public Health, Jackson State University, Jackson, MS 39217, USA.
| | - Sophia Leggett
- School of Public Health, Jackson State University, Jackson, MS 39217, USA.
| | - Azad Bhuiyan
- School of Public Health, Jackson State University, Jackson, MS 39217, USA.
| | - David Brown
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA.
| | - Patricia Frye
- School of Public Health, Jackson State University, Jackson, MS 39217, USA.
| | - Bryman Williams
- College of Liberal Arts, Jackson State University, Jackson, MS 39217, USA.
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Sadeghian S, Shams M, Alipour Z, Saadat S, Hamidian R, Shahrzad M. Application of short message service to control blood cholesterol: a field trial. BMC Med Inform Decis Mak 2017; 17:32. [PMID: 28351408 PMCID: PMC5371268 DOI: 10.1186/s12911-017-0427-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023] Open
Abstract
Background Despite recommendations, many middle-age adults neglect to check their blood cholesterol levels. Short message service (SMS, also known as texting) has been seldom studied for preventive education. We estimated how SMS can be a cost-effective method in encouraging people to check their blood cholesterol levels. Methods In a field trial, 3600 cell phone users (age > 30) were randomly assigned to the intervention (N: 1200) and the control groups (N: 2400). An SMS was sent to the intervention group for five rounds every two weeks, which targeted the cognitive and affective learning and finally advised the blood cholesterol level to be checked, if not checked during the past twelve months. Two weeks after the last round, both groups were asked for the time/level of their latest blood cholesterol, family history of early cardiac death and having a family member with coronary heart disease (CHD), and to report their attitude about whether annual blood sampling is worth the cost and time to prevent CHD. Moreover, the intervention group was asked if they remembered the SMS content. The cost-effectiveness was evaluated by estimating the “number needed to treat” (NNT) and calculating the cost of sending SMS to that number of people. Results In the intervention group, 629 individuals (72.0%) recalled the SMS content. The factors associated with cholesterol screening during the past two years were older age, diabetes, family history of coronary disease, higher education, female gender and being non-smoker. In both groups, women were significantly more aware of their blood cholesterol level (68.7% vs. 53.6%). The relative frequency of respondents who believed it was not worth checking their cholesterol annually was significantly lower in the intervention group (P < 0.001). The intervention group was significantly more likely to check its blood cholesterol levels (OR:1.22) after adjustment for age, diabetes, family history of CHD and smoking. The NNT was estimated ≈ 25 for the general population and ≈ 11 for those who received SMS and had a family member with CHD. Conclusions We would postulate that SMS could affect people’s adherence to preventive programs. Relatives of patients admitted with a diagnosis of CHD should be prioritized for superior cost-effectiveness and logistical feasibility.
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Affiliation(s)
- Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shams
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Alipour
- Sina Research Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of e-Health, Virtual School, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Hamidian
- Sina Research Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shahrzad
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Sun N, Rau PLP, Li Y, Owen T, Thimbleby H. Design and evaluation of a mobile phone-based health intervention for patients with hypertensive condition. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jung H, Lee JE. The impact of community-based eHealth self-management intervention among elderly living alone with hypertension. J Telemed Telecare 2016; 23:167-173. [PMID: 26678063 DOI: 10.1177/1357633x15621467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction This study intended to examine the effect of an eHealth self-management (eHSM) intervention on elderly Korean persons who live alone in a community. Methods A quasi-experimental study was designed, and a total of 64 elderly persons (intervention n = 31, control n = 33) with hypertension (a systolic blood pressure measurement of ≥140 and/or a diastolic blood pressure ≥90 mm Hg) or taking anti-hypertensive medication participated. The eHSM intervention consisted of a four-week, in-class educational phase, community-based eHealth monitoring, and monthly telephone counselling for 24 weeks. Results The primary outcome measurement of the study was BP, and secondary outcomes included psycho-behavioural variables. Specifically, the systolic BP among intervention group participants was 133.9 mm Hg at baseline and 122.5 mm Hg after 24 weeks of follow-up. Participants in the intervention group showed greater improvement in self-efficacy, self-care behaviour, and social support than did participants in the control group 24 weeks post-intervention. Discussion The results highlight the clinical efficacy of an eHSM intervention composed of a four-week education program, self-monitoring, and follow-up counselling. The eHSM intervention should be expanded to include community-dwelling elderly persons with hypertension to improve the self-management of hypertension and control of blood pressure.
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Affiliation(s)
- Hyesun Jung
- 1 College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Eun Lee
- 2 College of Nursing, The Catholic University of Korea, Seoul, Korea
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Gopalan A, Makelarski JA, Garibay LB, Escamilla V, Merchant RM, Wolfe MB, Holbrook R, Lindau ST. Health-Specific Information and Communication Technology Use and Its Relationship to Obesity in High-Poverty, Urban Communities: Analysis of a Population-Based Biosocial Survey. J Med Internet Res 2016; 18:e182. [PMID: 27352770 PMCID: PMC4942684 DOI: 10.2196/jmir.5741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/09/2016] [Accepted: 06/04/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND More than 35% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may substitute for or complement community-based resources for weight management. However, little is currently known about health-specific ICT use among urban-dwelling people with obesity. OBJECTIVE We describe health-specific ICT use and its relationship to measured obesity among adults in high-poverty urban communities. METHODS Using data collected between November 2012 and July 2013 from a population-based probability sample of urban-dwelling African American and Hispanic adults residing on the South Side of Chicago, we described patterns of ICT use in relation to measured obesity defined by a body mass index (BMI) of ≥30 kg/m(2). Among those with BMI≥30 kg/m(2), we also assessed the association between health-specific ICT use and diagnosed versus undiagnosed obesity as well as differences in health-specific ICT use by self-reported comorbidities, including diabetes and hypertension. RESULTS The survey response rate was 44.6% (267 completed surveys/598.4 eligible or likely eligible individuals); 53.2% were African American and 34.6% were Hispanic. More than 35% of the population reported an annual income of less than US $25,000. The population prevalence of measured obesity was 50.2%. People with measured obesity (BMI≥30 kg/m(2)) were more likely to report both general (81.5% vs 67.0%, P=.04) and health-specific (61.1% vs 41.2%, P=.01) ICT use. In contrast, among those with measured obesity, being told of this diagnosis by a physician was not associated with increased health-specific ICT use. People with measured obesity alone had higher rates of health-specific use than those with comorbid hypertension and/or diabetes diagnoses (77.1% vs 60.7% vs 47.4%, P=.04). CONCLUSIONS In conclusion, ICT-based health resources may be particularly useful for people in high-poverty urban communities with isolated measured obesity, a population that is at high risk for poor health outcomes.
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Affiliation(s)
- Anjali Gopalan
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.
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Abstract
Despite a recent high funding priority on technological aspects of research and a high potential impact of Web-based interventions on health, few guidelines for the development of Web-based interventions are currently available. In this article, we propose practical guidelines for development of Web-based interventions based on an empirical study and an integrative literature review. The empirical study aimed at development of a Web-based physical activity promotion program that was specifically tailored to Korean American midlife women. The literature review included a total of 202 articles that were retrieved through multiple databases. On the basis of the findings of the study and the literature review, we propose directions for development of Web-based interventions in the following steps: (1) meaningfulness and effectiveness, (2) target population, (3) theoretical basis/program theory, (4) focus and objectives, (5) components, (6) technological aspects, and (7) logistics for users. The guidelines could help promote further development of Web-based interventions at this early stage of Web-based interventions in nursing.
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Sawesi S, Rashrash M, Phalakornkule K, Carpenter JS, Jones JF. The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature. JMIR Med Inform 2016; 4:e1. [PMID: 26795082 PMCID: PMC4742621 DOI: 10.2196/medinform.4514] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/07/2015] [Accepted: 10/09/2015] [Indexed: 01/31/2023] Open
Abstract
Background Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes.
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Affiliation(s)
- Suhila Sawesi
- School of Informatics and Computing - Indianapolis, Department of BioHealth Informatics, IUPUI, Indianapolis, IN, United States.
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Kim HS, Kim H, Lee S, Lee KH, Kim JH. Current Clinical Status of Telehealth in Korea: Categories, Scientific Basis, and Obstacles. Healthc Inform Res 2015; 21:244-50. [PMID: 26618030 PMCID: PMC4659881 DOI: 10.4258/hir.2015.21.4.244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022] Open
Abstract
Objectives Through telehealth, medical services have expanded beyond spatial boundaries and are now available in living spaces outside of hospitals. It can also contribute to patient medical knowledge improvement because patients can access their hospital records and data from home. However, concepts of telehealth are rather vague in Korea. Methods We refer to several clinical reports to determine the current clinical status of and obstacles to telehealth in Korea. Results Patients' health conditions are now reported regularly to doctors remotely, and patients can receive varied assistance. Self-improvement based on minute details that are beyond medical staff's reach is another possible benefit that may be realized with the help of a variety of medical equipment (sensors). The feasibility, clinical effect, and cost-benefit of telehealth have been verified by scientific evidence. Conclusions Patients will be able to improve their treatment adherence by receiving help from various professionals, such as doctors, nurses, nutritionists, and sports therapists. This means that the actual treatment time per patient will increase as well. Ultimately, this will increase the quality of patients' self-administration of care to impede disease progression and prevent complications.
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Affiliation(s)
- Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - Suehyun Lee
- Seoul National University Biomedical Informatics (SNUBI) and Systems Biomedical Informatics Research Center, Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Kye Hwa Lee
- Seoul National University Biomedical Informatics (SNUBI) and Systems Biomedical Informatics Research Center, Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI) and Systems Biomedical Informatics Research Center, Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
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Burke LE, Ma J, Azar KMJ, Bennett GG, Peterson ED, Zheng Y, Riley W, Stephens J, Shah SH, Suffoletto B, Turan TN, Spring B, Steinberger J, Quinn CC. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1157-213. [PMID: 26271892 PMCID: PMC7313380 DOI: 10.1161/cir.0000000000000232] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed.
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Affiliation(s)
- Neil R Poulter
- International Centre for Circulatory Health, Imperial College London, London, UK.
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India
| | - Mark Caulfield
- William Harvey Research Institute and NIHR Biomedical Research Unit in Cardiovascular Disease at Barts, Queen Mary University of London, London, UK
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Banos RM, Mensorio MS, Cebolla A, Rodilla E, Palomar G, Lisón J, Botella C. An internet-based self-administered intervention for promoting healthy habits and weight loss in hypertensive people who are overweight or obese: a randomized controlled trial. BMC Cardiovasc Disord 2015; 15:83. [PMID: 26239241 PMCID: PMC4523030 DOI: 10.1186/s12872-015-0078-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prevalence of overweight and obesity is on the rise worldwide with severe physical and psychosocial consequences. One of the most dangerous is hypertension. Lifestyle changes related to eating behaviour and physical activity are the critical components in the prevention and treatment of hypertension and obesity. Data indicates that the usual procedures to promote these healthy habits in health services are either insufficient or not efficient enough. Internet has been shown to be an effective tool for the implementation of lifestyle interventions based on this type of problem. This study aims to assess the efficacy of a totally self-administered online intervention programme versus the usual medical care for obese and overweight participants with hypertension (from the Spanish public health care system) to promote healthy lifestyles (eating behaviour and physical activity). METHOD A randomized controlled trial will be conducted with 100 patients recruited from the hypertension unit of a public hospital. Participants will be randomly assigned to one of two conditions: a) SII: a self-administered Internet-based intervention protocol; and b) MUC-medical usual care. The online intervention is an Internet-delivered, multimedia, interactive, self-administered programme, composed of nine modules designed to promote healthy eating habits and increase physical activity. The first five modules will be activated at a rate of one per week, and access for modules 5 to 9 will open every two weeks. Patients will be assessed at four points: before the intervention, after the intervention (3 months), and at 6 and 12 months (follow-up). The outcome variables will include blood pressure, and Body Mass Index, as primary outcome measures, and quality of life and other lifestyle and anthropometrical variables as secondary outcome measures. DISCUSSION The literature highlights the need for more studies on the benefits of using the Internet to promote lifestyle interventions. This study aims to investigate the efficiency of a totally self-administered Internet - +based programme for promoting healthy habits and improving the medical indicators of a hypertensive and overweight population. TRIAL REGISTRATION NCT02445833.
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Affiliation(s)
- Rosa M Banos
- Universitat de València, Facultad de Psicología, València, Spain.
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Carlos III, Spain.
| | - Marinna S Mensorio
- Universitat de València, Facultad de Psicología, València, Spain.
- CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil.
| | - Ausias Cebolla
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Carlos III, Spain.
- Universitat Jaume I, Facultad de Psicología, Castelló de la Plana, Castelló, Spain.
| | - Enrique Rodilla
- Hypertension and Vascular Risk Unit, Hospital de Sagunto, Sagunto, Spain.
- Universidad CEU Cardenal Herrera, Departamento de Medicina, Valencia, Spain.
| | | | - JuanFrancisco Lisón
- Universidad CEU Cardenal Herrera, Departamento de Medicina, Valencia, Spain.
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Carlos III, Spain.
- Universitat Jaume I, Facultad de Psicología, Castelló de la Plana, Castelló, Spain.
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Kim HS, Cho JH, Yoon KH. New Directions in Chronic Disease Management. Endocrinol Metab (Seoul) 2015; 30:159-66. [PMID: 26194075 PMCID: PMC4508259 DOI: 10.3803/enm.2015.30.2.159] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.
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Affiliation(s)
- Hun Sung Kim
- Department of Medical Informatics; Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Department of Medical Informatics; Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kun Ho Yoon
- Department of Medical Informatics; Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Slomian J, Reginster JY, Gaspard U, Streel S, Beaudart C, Appelboom G, Buckinx F, Bruyère O. Exploring the interest in and the usage of the internet among patients eligible for osteoporosis screening. Calcif Tissue Int 2015; 96:518-26. [PMID: 25837844 DOI: 10.1007/s00223-015-9987-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate the interest in the Internet and its usage for health-related issues among people eligible for osteoporosis screening. Self-administered questionnaires have been distributed to subjects who were screened for osteoporosis and to menopausal women. 177 patients have responded to the survey (64.5 ± 10.1 years, 88.1% of women). There are 78.5% of Internet users. Among them, 67.2% said searching information about their health and 74.5% said using the Internet for this purpose. All respondents attributed an average score, out of 10, of 5.7 ± 2.3 regarding the reliability of information that they could find on the Internet. The use of the Internet differs significantly depending on age: those who use the Internet are younger (62.1 ± 8.91 years) than those who do not use it (73.3 ± 9.42 years). The socioeconomic status also has an impact on the Internet use: Internet users have a higher education, are more professionally active and have a higher net monthly household income compared to the group of non-users. Even if age and socioeconomic status appear to be determining factors in the use of the Internet for the search of health information in patients eligible for osteoporosis screening, almost 75% of the study population use the Internet for this purpose. Action to promote health through an Internet platform must therefore take these parameters into account.
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Affiliation(s)
- J Slomian
- Support Unit in Epidemiology and Biostatistics, University of Liège, Avenue de l'Hôpital 3 - CHU B23, 4000, Liège, Belgium,
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Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Hypertens Res 2015; 38:491-7. [DOI: 10.1038/hr.2015.32] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 01/13/2023]
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Kim CJ, Schlenk EA, Kang SW, Park JB. Effects of an internet-based lifestyle intervention on cardio-metabolic risks and stress in Korean workers with metabolic syndrome: a controlled trial. PATIENT EDUCATION AND COUNSELING 2015; 98:111-119. [PMID: 25468401 DOI: 10.1016/j.pec.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 09/21/2014] [Accepted: 10/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study examined the effects of an Internet-based Best Exerciser Super Trainer (BEST) program on cardio-metabolic risks and stress among workers with metabolic syndrome. METHODS This study utilized a non-randomized, pretest, and posttest, controlled design with a convenience sample of 48 Korean male workers. The workers in the BEST group participated in a 16-week Internet-based program: 150 min of regular physical activity per week, 200- to 300-kcal reduced daily diet for weight control, one-on-one counseling, and mobile phone text messages. Workers in the Education group received text messages and an educational booklet. RESULTS There were significant group by time interactions in cardio-metabolic risks: body weight (p = .022), visceral fat mass (p = .033), and waist circumference (p = .037). There was no group by time interaction in stress (p > .05); however, the BEST group showed a significantly greater reduction in health-related stress than those in the Education group (p = .025). CONCLUSION This study yielded evidence of the beneficial impact of the Internet-based BEST program for workers with metabolic syndrome on selected cardio-metabolic risks and health-related stress. PRACTICE IMPLICATIONS Internet-based one-on-one counseling and mobile phone text messages can assist individuals with targeted lifestyle modifications for metabolic syndrome.
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Affiliation(s)
- Chun-Ja Kim
- Department of Adult Health Nursing, Ajou University College of Nursing, Suwon, South Korea.
| | | | - Se-Won Kang
- College of Nursing and Healthcare Science, Dong-Eui University, Busan, South Korea
| | - Jae-Bum Park
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, South Korea
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Using mobile phones in healthcare management for the elderly. Maturitas 2014; 79:381-8. [DOI: 10.1016/j.maturitas.2014.08.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/30/2014] [Indexed: 11/24/2022]
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The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial. BMC Public Health 2014; 14 Suppl 3:S4. [PMID: 25436830 PMCID: PMC4251131 DOI: 10.1186/1471-2458-14-s3-s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. Methods The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness. Discussion The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.
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Kim S. An exploratory study of inactive health information seekers. Int J Med Inform 2014; 84:119-33. [PMID: 25453277 DOI: 10.1016/j.ijmedinf.2014.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aims to identify people who do not actively seek out health information and the demographic characteristics of Inactive Seekers. The possible determinants of inactive seeking behaviors are also explored. DESIGN AND MEASUREMENTS A total of 14,420 survey respondents were drawn from the 2009 Annenberg National Health Communication Survey (ANHCS) data. K-means clustering was used to discriminate Inactive Seekers from Active Seekers. The inactive information seeker group was formed based on their experience with health information seeking. The potential determinants that were tested to predict inactive seeking included the following: health condition, health service use, health media exposure, and computer/Internet activities. RESULTS Within this national survey data, the respondents were more likely to be included in the Inactive Seekers (N=8312, 58.5%) compared to Active Seekers (N=5908, 41.5%). The demographic characteristics indicated that the Inactive Seekers were identified as younger, male, highly educated, White, and high household income people. The binary logistic regression results from the study model indicated that healthier people were less likely to seek out health information than their counterparts. In addition, those who were exposed to various media were almost 1.6 times more likely to seek out health information than those who were not exposed to such media. Within this study data, the statistically significant determinants identified were health condition and health media exposure while computer/Internet activities did not show strong indications in predicting inactive seeking behavior. CONCLUSION The development of more generalizable measures for health literacy or behavioral patterns will bolster advanced study on inactive seeking relating to knowledge of technology and health context. Further study should be directed at estimating the negative aspects of information seeking such as information ignorance or information avoidance.
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Affiliation(s)
- Sujin Kim
- 230G, Multidisciplinary Science Building, Division of Biomedical Informatics, College of Public Health & School of Library and Information Science, College of Communication and Information University of Kentucky, Lexington, KY 40536-0082, USA.
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Pietrzak E, Cotea C, Pullman S. Primary and Secondary Prevention of Cardiovascular Disease. J Cardiopulm Rehabil Prev 2014; 34:303-17. [DOI: 10.1097/hcr.0000000000000063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Proia KK, Thota AB, Njie GJ, Finnie RKC, Hopkins DP, Mukhtar Q, Pronk NP, Zeigler D, Kottke TE, Rask KJ, Lackland DT, Brooks JF, Braun LT, Cooksey T. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med 2014; 47:86-99. [PMID: 24933494 PMCID: PMC4672378 DOI: 10.1016/j.amepre.2014.03.004] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/17/2014] [Accepted: 03/12/2014] [Indexed: 01/17/2023]
Abstract
CONTEXT Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes. EVIDENCE ACQUISITION An existing systematic review (search period, January 1980-July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003-May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies. EVIDENCE SYNTHESIS Twenty-eight studies in the prior review (1980-2003) and an additional 52 studies from the Community Guide update (2003-2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg). CONCLUSIONS Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system-level organizational changes and could be an important element of the medical home.
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Affiliation(s)
- Krista K Proia
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | - Anilkrishna B Thota
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
| | - Gibril J Njie
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | - Ramona K C Finnie
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | - David P Hopkins
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | - Qaiser Mukhtar
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | | | | | | | - Kimberly J Rask
- Emory University, Georgia Medical Care Foundation, Atlanta, Georgia
| | | | - Joy F Brooks
- South Carolina Department of Health & Environmental Control, Columbia
| | | | - Tonya Cooksey
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
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Aguilar-Martínez A, Solé-Sedeño JM, Mancebo-Moreno G, Medina FX, Carreras-Collado R, Saigí-Rubió F. Use of mobile phones as a tool for weight loss: a systematic review. J Telemed Telecare 2014; 20:339-49. [DOI: 10.1177/1357633x14537777] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a systematic review of the literature on the use of mobile phones for weight loss. A total of 43 studies were identified on obese or overweight adults, aged 18 years or over. After review, ten articles met the inclusion criteria. There were 19–534 participants per study. Participants were from European, Asian and North American regions. The mean body mass index (BMI) of the subjects varied from 22 to 36 kg/m2. Two studies used text messaging or multimedia messaging. All the other studies used mobile-phone apps or web-based programmes that could be accessed from mobile phones as a part of a weight-loss intervention or for evaluating their potential for use and their acceptance. Most studies lasted 2–4 months and the maximum duration was 1 year. All but two studies showed reductions in the participants’ bodyweight, BMI, waist circumference and body fat in the various interventions. There appeared to be a proportional relationship between weight loss and programme use. The programmes most benefited those who took a pro-active approach to everyday problems. Frequent self-recording of weight seemed to be important, as was the personalisation of the intervention (counselling and individualized feedback). Finally, a social support system acted as a motivational tool.
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Affiliation(s)
| | - Josep M Solé-Sedeño
- Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Barcelona, Spain
| | - Gemma Mancebo-Moreno
- Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Barcelona, Spain
- School of Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Xavier Medina
- Department of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Ramon Carreras-Collado
- Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Barcelona, Spain
- School of Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Department of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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