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Hölgyesi Á, Luczay A, Tóth-Heyn P, Muzslay E, Világos E, Szabó AJ, Baji P, Kovács L, Gulácsi L, Zrubka Z, Péntek M. The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study. JMIR Pediatr Parent 2024; 7:e54807. [PMID: 38506893 PMCID: PMC10993131 DOI: 10.2196/54807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents' skills to deal with electronic health information sources. OBJECTIVE We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children's outcomes. METHODS A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents' electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children's treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. RESULTS Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents' average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children's treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=-0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children's HbA1c (r=-0.143; P=.08), PedsQL Diab (r=-0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=-0.13; P=.12). Regression analysis revealed significant associations of the child's HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=-0.66; P=.03; pump + sensor: β=-0.93; P=.007), and parents' self-efficacy (PSESDM; β=-0.08; P=.001). CONCLUSIONS Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents' diabetes management attitude but not with the child's glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.
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Affiliation(s)
- Áron Hölgyesi
- Doctoral School, Semmelweis University, Budapest, Hungary
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Andrea Luczay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | | | - Eszter Muzslay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Eszter Világos
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Petra Baji
- Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom
| | - Levente Kovács
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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2
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Tsai D, Flores Garcia J, Fogel JL, Wee CP, Reid MW, Raymond JK. Diabetes Technology Experiences Among Latinx and Non-Latinx Youth with Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:834-843. [PMID: 34225480 PMCID: PMC9264427 DOI: 10.1177/19322968211029260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources. METHODS To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D (n = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires. RESULTS Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance (P = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values (P = .003), less CGM use (P = .002), and more negative attitudes about technology (generally, P = .003; and diabetes-specific, P < .001) than either non-Latinx or Spanish-speaking Latinx participants. Barriers were encountered with equivalent frequency across groups. CONCLUSIONS Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.
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Affiliation(s)
- David Tsai
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
- David Tsai, MD, Children’s Hospital Los
Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA
90027, USA.
| | - Jaquelin Flores Garcia
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
| | - Jennifer L. Fogel
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
| | - Choo Phei Wee
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
| | - Mark W. Reid
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
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Digital Technologies for Children and Parents Sharing Self-Management in Childhood Chronic or Long-Term Conditions: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121203. [PMID: 34943399 PMCID: PMC8700031 DOI: 10.3390/children8121203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 01/20/2023]
Abstract
Worldwide, the prevalence of chronic (or long-term) conditions in children and young people from birth to 18 years (children) is increasing. Promoting competent and effective self-management skills early in the trajectory is important to improve adherence to treatment and optimise quality of life. Successful self-management, therefore, requires parents and children who are developmentally able to develop a range of complex skills, including the use of digital technologies. This scoping review aimed to identify primary research investigating digital technologies for children and parents sharing self-management in childhood chronic illnesses. A comprehensive search of electronic databases was conducted. Nineteen papers were included, assessed for quality and methodological rigour using the Hawker tool and thematically analysed. Three themes were identified: (i) the feasibility and acceptability of using technology, (ii) the usability of technologies and (iii) the effect of technologies on adherence and self-management skills. The results indicate that technologies such as mobile apps and websites can assist the management of long-term conditions, are an acceptable method of delivering information and can promote the development of effective self-management skills by parents and children. However, future technology design must include children and parents in all stages of development.
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Kang Y, Wang H, Li X, Tao Y, Yang X, Deng W, Yu J, Zhou Q, Li T, Guo W. A brief web-based screening plus emotional-disorder health education was associated with improvement of mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China. Depress Anxiety 2021; 38:571-587. [PMID: 33225571 DOI: 10.1002/da.23118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/02/2020] [Accepted: 11/01/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Low recognition and intervention rates of emotional disorders among nonpsychiatric clinical patients are primarily attributable to poor mental health awareness of patients and a paucity of mental health care resources. This study aims to investigate the association of a resource-saving brief web-based emotional-disorder self-screening plus a health self-education program (BWBED-SS + HSE) with improved mental health awareness and service-seeking attitudes among nonpsychiatric clinical patients. METHOD A sample of 2065 patients seeking health services in nonpsychiatric clinical settings underwent BWBED-SS + HSE using mobile terminals. Participants were defined as being at high risk of anxiety and/or depression according to the optimal cut-off point of ≥11 on the Huaxi emotional-distress index (HEI). RESULTS The rate of participants at high risk of anxiety and/or depression was 6.63%. Following participation in the BWBED-SS + HSE, after controlling for demographics, type of hospital, and test time, the rates of participants considering themselves as having an emotional disorder and willing to seek mental health services among those at high risk of anxiety and/or depression increased from 29.93% to 47.45% (adjusted odds ratio [aOR] = 2.28, p = .002) and from 11.68% to 29.93% (aOR = 3.65, p < .001), respectively. CONCLUSIONS The BWBED-SS + HSE were associated with improved mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China.
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Affiliation(s)
- Yukun Kang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Huiyao Wang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaojing Li
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yujie Tao
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Xia Yang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Jianying Yu
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Qian Zhou
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wanjun Guo
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Wong CA, Madanay F, Ozer EM, Harris SK, Moore M, Master SO, Moreno M, Weitzman ER. Digital Health Technology to Enhance Adolescent and Young Adult Clinical Preventive Services: Affordances and Challenges. J Adolesc Health 2020; 67:S24-S33. [PMID: 32718511 DOI: 10.1016/j.jadohealth.2019.10.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
Abstract
The lives of adolescents and young adults (AYAs) have become increasingly intertwined with technology. In this scoping review, studies about digital health tools are summarized in relation to five key affordances-social, cognitive, identity, emotional, and functional. Consideration of how a platform or tool exemplifies these affordances may help clinicians and researchers achieve the goal of using digital health technology to enhance clinical preventive services for AYAs. Across these five affordances, considerable research and development activity exists accompanied by signs of high promise, although the literature primarily reflects demonstration studies of acceptability or small sample experiments to discern impact. Digital health technology may afford an array of functions, yet its potential to enhance AYA clinical preventive services is met with three key challenges. The challenges discussed in this review are the disconnectedness between digital health tools and clinical care, threats to AYA privacy and security, and difficulty identifying high-value digital health products for AYA. The data presented are synthesized in calls to action for the use of digital health technology to enhance clinical preventive services and to ensure that the digital health ecosystem is relevant, effective, safe, and purposed for meeting the health needs of AYA.
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Affiliation(s)
- Charlene A Wong
- Division of Primary Care, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Duke Sanford School of Public Policy, Durham, North Carolina.
| | - Farrah Madanay
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina; Duke Sanford School of Public Policy, Durham, North Carolina
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California; Office of Diversity and Outreach, University of California, San Francisco, California
| | - Sion K Harris
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Megan Moore
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina
| | - Samuel O Master
- Section of Adolescent Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; NewYork-Presbyterian Hospital, New York, New York
| | - Megan Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elissa R Weitzman
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Otis M, Zhu J, Mustafa-Kutana SN, Bernier AV, Ma Shum J, Soros Dupre AA, Wang ML. Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study. JMIR Form Res 2020; 4:e16262. [PMID: 32356773 PMCID: PMC7229529 DOI: 10.2196/16262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. OBJECTIVE This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. METHODS This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool's usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. RESULTS A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). CONCLUSIONS The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy.
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Affiliation(s)
- Marisa Otis
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jack Zhu
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Suleiman N Mustafa-Kutana
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Angelina V Bernier
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL, United States
| | - Julio Ma Shum
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Arlette A Soros Dupre
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
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Jemere AT, Yeneneh YE, Tilahun B, Fritz F, Alemu S, Kebede M. Access to mobile phone and willingness to receive mHealth services among patients with diabetes in Northwest Ethiopia: a cross-sectional study. BMJ Open 2019; 9:e021766. [PMID: 30679284 PMCID: PMC6347931 DOI: 10.1136/bmjopen-2018-021766] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed at determining access to mobile phone and willingness to receive mobile phone-based diabetes health services as well as identify associated factors in Northwest Ethiopia. DESIGN An institution-based cross-sectional survey was conducted from February to March 2016. PARTICIPANTS Systematic randomly selected 423 patients with diabetes. SETTING University of Gondar Hospital diabetic clinic. MAIN OUTCOME MEASURES The main outcome measure was willingness to receive diabetic health service via mobile phone voice call or messaging services. RESULTS Out of 423 patients with diabetes, 329 (77.8%) had access to a mobile phone. Among the latter, 232 (70.5%) were willing to receive mobile phone-based health services. The educational status of patients (adjusted OR (AOR): 2.6 (95% CI: 1.2 to 5.58)), route of medication (AOR: 3.2 (95% CI: 1.44 to 7.1)), transportation mechanism (AOR: 4.1 (95% CI: 1.2 to 13.57)), travel time to health facility (AOR: 0.3 (95% CI: 0.12 to 0.82)), current use of mobile phone as appointment reminder (AOR: 2.6 (95% CI: 1.07 to 6.49)) and locking mobile phone with passwords (AOR: 4.6 (95% CI: 1.63 to 12.95)) were significantly associated with the willingness to receive mobile phone-based diabetic health services. CONCLUSION Access to a mobile phone and willingness to receive mobile phone-based health services were high. Educational status, route of medication, transportation mechanism, time to reach the service, using mobile phone as appointment reminder and locking mobile phone with passwords were significantly associated factors. Given the high proportion of access and willingness of patients to receive mobile phone-based health services, mHealth interventions could be helpful.
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Affiliation(s)
- Adamu Takele Jemere
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Yohannes Ezezew Yeneneh
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Biniam Tilahun
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Shitaye Alemu
- School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Mihiretu Kebede
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
- Faculty of Health Sciences, University of Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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McClure C, Cunningham M, Bull S, Berman S, Allison MA. Using Mobile Health to Promote Early Language Development: A Narrative Review. Acad Pediatr 2018; 18:850-854. [PMID: 30098442 DOI: 10.1016/j.acap.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/13/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
In this narrative review, we first present a brief overview of known disparities in children's language development based on socioeconomic status and efforts in the primary care setting to promote children's language development. Next, we define mobile health (m-health) and review the limited, published literature regarding the effectiveness of m-health interventions in promoting children's health, in general, and language development, in particular. Finally, we discuss the potential role of smartphone applications to increase parental behaviors that promote their children's language development, as well as challenges that should be addressed as the field of m-health continues to grow.
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Affiliation(s)
- Catherine McClure
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora
| | - Maureen Cunningham
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora; Center for Global Health , Colorado School of Public Health, Aurora
| | - Sheana Bull
- Department of Community and Behavioral Health , Colorado School of Public Health, Aurora; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (M Allison), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Stephen Berman
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora; Center for Global Health , Colorado School of Public Health, Aurora
| | - Mandy A Allison
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora.
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Jiaojiao Y, Sun C, Wei Y, Wang C, Dave B, Cao F, Liandong H. Applying emerging technologies to improve diabetes treatment. Biomed Pharmacother 2018; 108:1225-1236. [PMID: 30372824 DOI: 10.1016/j.biopha.2018.09.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022] Open
Abstract
Insulin, as the most important drug for the treatment of diabetes, can effectively control the blood glucose concentration in humans. Due to its instability, short half-life, easy denaturation and side effects, the administration way of insulin are limited to subcutaneous injection accompany with poor glucose control and low patient compliance. In recent years, emerging insulin delivery systems have been developed in diabetes research. In this review, a variety of stimuli-responsive insulin delivery systems with their response mechanism and regulation principle are described. Further, the introduction of stem cell transplantation and mobile application based delivery technologies are prudent for the diabetes treatment. This article also discusses the advantages and limitations of current strategies, along with the opportunities and challenges for future insulin therapy.
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Affiliation(s)
- Yu Jiaojiao
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | - Caifeng Sun
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | - Yuli Wei
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | - Chaoying Wang
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | | | - Fei Cao
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | - Hu Liandong
- School of Pharmaceutical Sciences, Hebei University, Baoding, China; Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China.
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Pihoker C, Forsander G, Fantahun B, Virmani A, Corathers S, Benitez-Aguirre P, Fu J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:84-104. [PMID: 30144259 DOI: 10.1111/pedi.12757] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Gun Forsander
- Division of Diabetes, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bereket Fantahun
- Department of Pediatrics and Child Health at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Anju Virmani
- Department of Pediatrics, Max, Pentamed and SL Jain Hospitals, Delhi, India
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Paul Benitez-Aguirre
- Sydney Medical School, Discipline of Child & Adolescent Health, The Children's Hospital at Westmead Clinical School Children's Hospital, Westmead, New South Wales, Australia
| | - Junfen Fu
- Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - David M Maahs
- Department of Pediatrics, Stanford University, Stanford, California
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El Shafie RA, Weber D, Bougatf N, Sprave T, Oetzel D, Huber PE, Debus J, Nicolay NH. Supportive Care in Radiotherapy Based on a Mobile App: Prospective Multicenter Survey. JMIR Mhealth Uhealth 2018; 6:e10916. [PMID: 30166275 PMCID: PMC6137282 DOI: 10.2196/10916] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Consumer electronics and Web-enabled mobile devices are playing an increasing role in patient care, and their use in the oncologic sector opens up promising possibilities in the fields of supportive cancer care and systematic patient follow-up. OBJECTIVE The objective of our study was to assess the acceptance and possible benefits of a mobile app-based concept for supportive care of cancer patients undergoing radiotherapy. METHODS In total, 975 patients presenting for radiotherapy due to breast or prostate cancer were screened; of them, 200 owned a smartphone and consented to participate in the survey. Patients were requested to complete a questionnaire at 2 time points: prior to the initiation (T0) and after the completion (T1) of radiotherapy. The questionnaire included questions about the habits of smartphone usage, technical knowledge and abilities of the participants, readiness to use a mobile app within the context of radiotherapy, possible features of the mobile app, and general attitude toward the different aspects of oncologic treatments. For quantitative analysis, sum scores were calculated for all areas of interest, and results were correlated with patient characteristics. Additionally, answers were quantitatively compared between time points T0 and T1. RESULTS Median patient age was 57 (range 27-78) years. Of the 200 participants, 131 (66.2%) reported having the ability to use their smartphones with minimal to no help and 75.8% (150/200) had not used their smartphones in a medical context before. However, 73.3% (146/200) and 83.4% (166/200) of patients showed a strong interest in using a mobile app for supportive care during radiotherapy and as part of the clinical follow-up, respectively. Patients most commonly requested functionalities regarding appointment scheduling in the clinic (176/200, 88.0%) and the collection of patient-reported outcome data regarding their illness, therapy, and general well-being (130/200, 65.0%). Age was identified as the most influential factor regarding patient attitude, with patients aged <55 years being significantly more inclined toward and versed in smartphone use (P<.001). The acceptance of mobile apps was significantly higher in patients exhibiting a Karnofsky performance index <80% (P=.01). Support in the context of therapy-related side effects was judged most important by patients with poor clinical performance (P=.006). The overall acceptance of mobile apps in the context of radiotherapy surveillance was high at a median item sum score of 71.4/100 and was not significantly influenced by tumor stage, age, gender, treatment setting, or previous radiotherapies. CONCLUSIONS The acceptance of mobile apps for the surveillance and follow-up of cancer patients undergoing radiotherapy is high; this high acceptance level will serve as a basis for future clinical trials investigating the clinical benefits of mobile app-based treatment support. Introduction of mobile apps into the clinical routine should be considered as an opportunity to improve and intensify supportive treatment for cancer patients.
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Affiliation(s)
- Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Dieter Oetzel
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Peter E Huber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Research in Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium, Partner Site Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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El Shafie RA, Bougatf N, Sprave T, Weber D, Oetzel D, Machmer T, Huber PE, Debus J, Nicolay NH. Oncologic Therapy Support Via Means of a Dedicated Mobile App (OPTIMISE-1): Protocol for a Prospective Pilot Trial. JMIR Res Protoc 2018; 7:e70. [PMID: 29510971 PMCID: PMC5861302 DOI: 10.2196/resprot.8915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 01/05/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing role of consumer electronics and Web-enabled mobile devices in the medical sector opens up promising possibilities for integrating novel technical solutions into therapy and patient support for oncologic illnesses. A recent survey carried out at Heidelberg University Hospital suggested a high acceptance among patients for an additional approach to patient care during radiotherapy based on patient-reported outcomes by a dedicated mobile app. OBJECTIVE The aim of this trial (OPTIMISE-1: Oncologic Therapy Support Via Means of a Dedicated Mobile App - A Prospective Feasibility Evaluation) is to prospectively evaluate the feasibility of employing a mobile app for the systematic support of radiooncological patients throughout the course of their radiotherapy by monitoring symptoms and patient performance, and facilitating the background-exchange of relevant information between patient and physician. METHODS The present single-center, prospective, exploratory trial, conducted at Heidelberg University Hospital, assesses the feasibility of integrating an app-based approach into patient-care during radiotherapy. Patients undergoing curative radiotherapy for thoracic or pelvic tumors will be surveyed regarding general performance, treatment-related quality of life (QoL) and symptoms, and their need to personally consult a physician by means of a mobile app during treatment. The primary endpoint of feasibility will be reached when 80% of the patients have successfully answered 80% of their respective questions scheduled for each treatment day. Furthermore, treatment-related patient satisfaction and health-related QoL is assessed by the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires at the beginning (baseline) and end of radiotherapy, and at the first follow-up. RESULTS This trial will recruit 50 patients over a period of 12 months. Follow-up will be completed after 18 months, and publication of results is planned at 24 months after trial initiation. CONCLUSIONS This study will serve as a basis for future studies aiming to exploit the constant innovation in mobile medical appliances and integrate novel patient-centered concepts into patient care in the context of radiotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT03168048; https://clinicaltrials.gov/ct2/show/NCT03168048 (Archived at WebCite http://www.webcitation.org/6wtWGgi0X).
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Affiliation(s)
- Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Dorothea Weber
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Dieter Oetzel
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | | | - Peter E Huber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Freiburg University Medical Center, Freiburg, Germany
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13
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Wu E, Torous J, Liu C. Chinese immigrant use of smartphone apps toward improving child mental health awareness and resource delivery: A pilot study. Asian J Psychiatr 2018; 33:1-6. [PMID: 29289856 PMCID: PMC6619503 DOI: 10.1016/j.ajp.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Emily Wu
- Harvard Longwood Psychiatry Residency Training Program, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Cindy Liu
- Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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14
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Hartz J, Yingling L, Powell-Wiley TM. Use of Mobile Health Technology in the Prevention and Management of Diabetes Mellitus. Curr Cardiol Rep 2017; 18:130. [PMID: 27826901 DOI: 10.1007/s11886-016-0796-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality globally, with diabetes being an independent risk factor. Adequate diabetes management has proven to be resource-intensive, requiring frequent lab work, primary care and specialist visits, and time-consuming record-keeping by the patient and care team. New mobile health (mHealth) technologies have enhanced how diabetes is managed and care is delivered. While more recent work has investigated mHealth devices as complementary tools in behavioral interventions for diabetes prevention and management, little is still known about the effectiveness of mHealth technology as stand-alone intervention tools for reducing diabetes risk. In addition, more work is needed to identify the role of mHealth technology in treating vulnerable populations to ameliorate cardiovascular health disparities. With advances in mobile health technology development for diabetes prevention and management, these modalities will likely play an increasingly prominent role in reducing cardiometabolic risk for the US population.
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Affiliation(s)
- Jacob Hartz
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Leah Yingling
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, 5-3330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Tiffany M Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, 5-3330, 10 Center Drive, Bethesda, MD, 20892, USA.
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15
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Trawley S, Browne JL, Hagger VL, Hendrieckx C, Holmes-Truscott E, Pouwer F, Skinner TC, Speight J. The Use of Mobile Applications Among Adolescents with Type 1 Diabetes: Results from Diabetes MILES Youth-Australia. Diabetes Technol Ther 2016; 18:813-819. [PMID: 27788032 DOI: 10.1089/dia.2016.0233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The use of mobile applications ("apps") for diabetes management is a rapidly developing area and has relevance to adolescents who tend to be early technology adopters. Apps may be useful for supporting self-management or connecting young people with type 1 diabetes (T1D) with their peers. However, outside controlled trials testing the effectiveness of apps, little is known about app usage in this population. Our aim was to explore app usage among adolescents with T1D. METHODS Diabetes MILES Youth-Australia is a national, online cross-sectional survey focused on behavioral and psychosocial aspects relevant to adolescents with T1D. Associations between app usage and demographic, clinical, and psychosocial variables were analyzed using logistic regression. RESULTS In total, 425 adolescents with T1D responded to the app questions (mean age, 16 ± 2 years; 62% female; diabetes duration 7 ± 4 years). Overall, 21% (n = 87) indicated that they used an app for diabetes management. Of these, 89% (n = 77) reported carbohydrate counting as the most common purpose. Of those not using apps, 44% (n = 149) indicated that this was due either to no awareness of suitable apps or a belief that apps could not help. App usage was associated significantly with shorter T1D duration, higher socioeconomic status, and at least seven daily blood glucose checks. CONCLUSIONS Only one in five respondents were using apps to support their diabetes management; most apps used were not diabetes specific. App users can be characterized as having a more recent T1D diagnosis, checking blood glucose more frequently, and being from a middle-to-high socioeconomic background.
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Affiliation(s)
- Steven Trawley
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
| | - Jessica L Browne
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
| | - Virginia L Hagger
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
| | - Christel Hendrieckx
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
| | - Elizabeth Holmes-Truscott
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
| | - Frans Pouwer
- 3 Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), TSB, Tilburg University , Tilburg, The Netherlands
| | - Timothy C Skinner
- 4 School of Psychological and Clinical Sciences, Charles Darwin University , Darwin, Australia
| | - Jane Speight
- 1 School of Psychology, Deakin University , Geelong, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Melbourne, Australia
- 5 AHP Research , Hornchurch, Essex, United Kingdom
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