Patient-physician alliance and patient's sense of self-efficacy are negatively associated with resistance to treatment among patients with type 2 diabetes.

AIMS: Resistance to treatment is prevalent among patients diagnosed with chronic conditions, including type 2 diabetes (T2DM). The current study aimed to examine the relationship between patient characteristics, patient-physician relationship, and resistance to treatment in T2DM. METHODS: A sample of 120 T2DM patients were recruited by means of non-randomized sampling and through a public post on Facebook. Participants were asked to fill-in several questionnaires online: Rotter's Locus of Control questionnaire (short version); the General Self-efficacy (GSE) questionnaire; the Working Alliance Inventory - Short Revised (WAI-SR) - evaluating patient-physician relationship; and, finally, the Resistance to Treatment Questionnaire (RTQ) - which meant to capture the intensity of resistance to treatment and served as the dependent variable in this study. RESULTS: Interestingly, better patient-physician relationship and higher sense of self-efficacy among patients were found to negatively associate with patient's resistance to treatment (r = -.53, p < .001, and, r = -.26, p < .01, respectively). Patient-physician relationship explained 22% of the variance of resistance to treatment, and self-efficacy explained 6% of the variance. CONCLUSIONS: Stronger patient-doctor relationship and higher sense of self-efficacy are shown to robustly associate with lower resistance to treatment among patients with T2DM. Current findings may instructor educate physicians as to the importance of the alliance with these chronic patients.

Psycho-behavioral Factors Related to Weight Regain After Bariatric Surgery.

OBJECTIVE: The purpose of this study was to examine the connection between weight regain 2 to 5 years after bariatric surgery and three psycho-behavioral factors: mental health, general health efficacy, and emotional regulation. METHOD: A convenience sample of 120 participants was recruited, 80 of whom had already had bariatric surgery 2 to 5 years earlier, whereas 40 were candidates for such procedure but did not undergo it yet. Each participant filled a consent form, a socio-demographic one, and extra three questionnaires related to socio-behavioral characteristics: Mental Health Inventory (MHI), General Self-efficacy (GSE), and Difficulty in Emotional Regulation Scale (DERS). SPSS version 25 was used to analyze the data, and a one-sample Kolmogorov-Smirnov test was conducted to examine the distribution of the continuous variables. RESULTS: Those in the non-reducers group experienced (2.19 ± 0.63) greater difficulties than the reducers group (1.82 ± 0.39) when it came to their emotional regulation, whereas the candidate group (1.96 ± 0.47) were situated in-between the groups already operated in terms of their DERS scores (p = 0.008). The reducers group had higher GSE scores (2.75 ± 0.35) than the non-reducers group (2.59 ± 0.39) (p = 0.03). CONCLUSIONS: Effective emotional regulation is linked to weight loss maintenance after bariatric surgery. Difficulties in emotional regulation are negatively correlated with maintaining weight loss among bariatric patients who undergo surgery. General self-efficacy is positively correlated with weight loss maintenance after bariatric surgery.

Long term follow-up of EGFR mutated NSCLC cases.

PURPOSE: A substantial fraction of all non-small cell lung cancers(NSCLC) carry a mutation in the EGFR gene for which an effective treatment with anti-tyrosine kinases(TKIs) is available. We studied the long term survival of these patients following the introduction of TKIs. EXPERIMENTAL DESIGN: All consecutive cases of NSCLC newly diagnosed with advanced disease were referred for free tumor EGFR mutation testing at Clalit's national personalized medicine laboratory. Mutations and deletions in target codons 18-21 of EGFR were sought using RT-PCR and fragment analysis. Comprehensive EMRs were used to collect full data on treatments and clinical status. RESULTS: A cohort of 3,062 advanced NSCLC cases, included 481(15.7%) somatic EGFR mutation carriers (17.5% of all adenocarcinomas, 26.7% of females with adenocarcinomas). TKIs treatment to EGFR mutation carriers was provided to 85% of all eligible. After a median follow up period of 15.9 months for EGFR mutated cases the hazard ratio for overall survival of EGFR-mutated NSCLC treated with TKIs was 0.55(0.49-0.63, p<0.0001) when compared with EGFR wild-type(WT) tumors under usual care. After adjusting for age, sex, ethnicity, smoking history and tumor histology, all of which had an independently significant effect on survival, the HR for TKI-treated, EGFR-mutated tumors, was 0.63 (0.55-0.71, p<0.0001). Treating EGFR-WT cases with TKIs yielded a high HR=1.32 (1.19-1.48). CONCLUSIONS: TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years. Squamous histology, smoking, male sex and Arab ethnicity were associated with higher NSCLC mortality hazard. Treating non-EGFR-mutated NSCLC with TKIs seems detrimental. Statement of Significance: • TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years but not much longer. • Treating non-EGFR-mutated NSCLC with TKIs seems detrimental and should probably be avoided. • Squamous histology of non-small cell lung cancer, smoking history, male sex and Arab ethnicity were associated with altogether higher NSCLC mortality hazard.

Association between dairy intake and the risk of contracting type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis with subgroup analysis of men versus women.

CONTEXT: The association between dairy product intake and the risk of developing type 2 diabetes (T2D) or cardiovascular disease (CVD) has been investigated in several studies, but little attention was given to the role of sex as a moderator of these associations. (In this article, the term "sex" is used to denote the biologically-based differences between males and females.). OBJECTIVE: This meta-analysis examines whether dairy consumption has different effects on T2D and CVD in men and women. DATA SOURCES: The PubMed database and previous reviews were searched for cohort studies published between 2006 and 2016. DATA EXTRACTION AND ANALYSIS: Reported risk ratios (RRs) for T2D/CVD with high versus low dairy intake were extracted. A random-effects model has been used to calculate the pooled RR. A subgroup analysis was conducted to compare the results for men and women. RESULTS: The present meta-analysis of 201 studies found that T2D (n = 16 studies) and CVD (n = 13 studies) are inversely associated with dairy intake. Subgroup analysis for sex showed that the association between dairy intake and T2D and between dairy intake and CVD are significant in women (RR for T2D = 0.868; 95%CI, 0.82-0.92; P < 0.001; RR for CVD = 0.837; 95%CI, 0.75-0.93; P < 0.001) but not in men. CONCLUSIONS: There is an inverse association between high dairy intake and the risk of developing T2D and CVD in women.

[WHO AFFECTS THE PATIENT, DR. GOOGLE OR THE DOCTOR?].

In the last decade the World Wide Web has become one of the prime sources for medical data searches. The abundance of information and emphasis on consumer communication, which are the main characteristics of the new generation of the web named "Web 2.0", enable users to engage and educate others by sharing and collaborating knowledge. It also enables them to receive medical information based on the experience of other patients, while the duration of the traditional physician's visit has shortened. However, using Web 2.0 for health collaboration has drawbacks as well: When alternative ways of "knowing" replace objective medical facts, there is danger of misinformation and truth "flattening". This article examines the distribution of medical misinformation online: Its characteristics, the nature of the messages presented online and the means that might help protect users and patients from it. The authors hold positions in the Israeli Dairy Board (IDB): Dr. Averch manages the health field on the IDB, and the findings in this article are based on research that she is leading as part of this position, and Dr. Mishali is a trained psychologist, and acts as a strategic consultant for IDB in the field of coping with the opposition to milk and its products. In this article it is initially shown how the characteristics of information distribution in general help spreading medical misinformation online: The decline of doctors' authority as sole providers of medical information, disillusionment and suspicion towards science and the notion of expertise, and the emergence of new ways to evaluate information, based on community ties. The nature of this pseudo-medical information will then be discussed, including the range of the phenomenon and the probability of users to be affected by it. Furthermore, we will raise specific tactics in which anti-establishment messages are portrayed; examples will be given of the use of emotion evoking content in the anti-establishment messages in order to arouse comment. It will be demonstrated in anti-dairy products and anti-vaccination campaigns. The impact of pseudo-medical language on consumers will be debated, although the content can easily be scientifically disproved. Finally, recommendations for a better medical dialogue with the patient, based on the online arena of medical knowledge described, will be provided.

Reducing resistance to treatment, through group intervention, improves clinical measurements in patients with type 2 diabetes.

BACKGROUND: Studies have shown that group Therapeutic Patient Education (TPE) may empower patients with type 2 diabetes to better manage their disease. The mechanism of these interventions is not fully understood. A reduction in resistance to treatment may explain the mechanism by which TPE empowers participants to improve self-management. The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease. METHODS: In a program evaluation study, we administered validated questionnaires to measure resistance to treatment (RTQ) in 3 time periods: before the intervention (T1), immediately after the intervention (T2) and six months later (T3). Clinical measures (HbA1C, blood pressure, HDL, LDL and total cholesterol, Triglycerides and BMI) were retrieved from Maccabi Healthcare Services computerized systems, for T1;T2 and a year post intervention (T3). Linear mixed models were used adjusting for age, gender, social support and family status. RESULTS: 157; 156 and 106 TPE participants completed the RTQ in T1; T2 and T3 respectively. HbA1C and systolic and diastolic blood pressure were significantly reduced in the group which achieved a reduction in three out of the five RTQ components. For the other clinical measurements no significant changes were observed. CONCLUSION: Our findings suggest that reducing resistance to treatment, through an educational program for patients with diabetes, is associated with a better disease control. Identifying patients with higher resistance to treatment, and including components that reduce resistance in patient education programs, have the potential to increase the effectiveness of these programs.

Reducing resistance to diabetes treatment using short narrative interventions.

OBJECTIVE: This article presents a narrative-based technique, which allows medical personnel to empower patients with diabetes and improve adherence. METHODS: The study was undertaken in Maccabi Healthcare Services, among 123 patients diagnosed with diabetes. Four empathic narratives were constructed, referring to different factors influencing resistance to treatment, as were identified by the Resistance to Treatment Questionnaire. Each narrative contains statements typical for patients whose resistance to treatment is influenced by a particular factor. An Empathic Narratives Evaluation Questionnaire was designed for this study. It contained three items, assessing the correlation of a specific empathic narrative with the patient's attitude and their reasons for resistance to treatment. The patients were asked to indicate whether they recognize these narratives as describing their reasons for resistance. Three empathic narratives were read to each patient: two narratives were matched for the two major categories of resistance for each patient and one narrative related to a category of resistance that received the lowest score. RESULTS: The narratives were found to correspond to the core reasons for resistance to diabetes treatment. Significant difference was found also between the scores of the empathic narrative related to the second strongest reason for resistance to treatment and the empathic narrative related to the weakest reason for resistance to treatment. This finding supports testimonial validity of the narratives. CONCLUSION: Short narrative interventions demonstrated in this study can be used by health care professionals as a working tool that provides the possibility reducing the patient's reasons for resistance to treatment.