The Effectiveness of a Traditional Chinese Medicine-Based Mobile Health App for Individuals With Prediabetes: Randomized Controlled Trial.

BACKGROUND: Traditional Chinese medicine (TCM) theories assert that body constitution and meridian energy lay the foundation for disease prevention. TCM-based health concepts have not yet been incorporated into mobile health (mHealth) apps for individuals with prediabetes. OBJECTIVE: The aim of this study was to examine the effectiveness of a TCM mHealth app for individuals with prediabetes. METHODS: This randomized controlled trial recruited 121 individuals with prediabetes at a teaching hospital in New Taipei City between February 2020 and May 2021. The participants were randomly assigned to the TCM mHealth app group (n=42), ordinary mHealth app group (n=41), or control group (n=38). All participants received the usual care that included 15-20 minutes of health education about the disease, along with healthy diet and exercise encouragement. The ordinary mHealth app included physical activity (PA), diet, and disease education, along with individual records. The TCM mHealth app additionally included qi and body constitution information, along with constitution-based PA and diet advice. The control group received the usual care alone and did not have access to any app. Data were collected at baseline, at the end of the 12-week intervention, and 1 month after the intervention. Body constitution, including yang-deficiency, yin-deficiency, and phlegm-stasis, was measured according to the Body Constitution Questionnaire, with higher scores indicating a greater deficiency. Body energy was examined using the Meridian Energy Analysis Device. The Short-Form 36 questionnaire was used to evaluate health-related quality of life (HRQOL), which yielded physical component scores and mental component scores, with higher scores indicating better physical and mental aspects of HRQOL, respectively. RESULTS: Compared to the control group, the TCM mHealth app group showed greater improvement in hemoglobin A1c (HbA1c), yang-deficiency and phlegm-stasis body constitution, and BMI; however, no significant differences were found in these outcomes between the TCM mHealth app and ordinary mHealth app groups. The TCM mHealth app group showed better improvement in body energy and mental component scores than the ordinary mHealth app group. There were no significant differences in fasting plasma glucose, yin-deficiency body constitution, Dietary Approaches to Stop Hypertension dietary behavior, and total PA among the three groups after the intervention. CONCLUSIONS: Use of either the ordinary or TCM mHealth app improved HRQOL among individuals with prediabetes. Compared to the outcomes of controls not using any app, use of the TCM mHealth app was effective at improving HbA1c, BMI, yang-deficiency and phlegm-stasis body constitution, and HRQOL. Moreover, using the TCM mHealth app seemed to improve the body energy and HRQOL more than when using the ordinary mHealth app. Further studies with a larger sample size and longer follow-up period may be necessary to determine whether the differences favoring the TCM app are clinically meaningful. TRIAL REGISTRATION: ClinicalTrials.gov NCT04096989; https://clinicaltrials.gov/ct2/show/NCT04096989.

Home-based noninvasive pelvic floor muscle training device to assist women in performing Kegel exercise in the management of stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI) is a major health problem affecting approximately 50% of the female population over 45 years of age. We evaluated the therapeutic effects of a home-based non-invasive wireless sensor pelvic floor muscle training (PFMT) device with assisted Kegel exercise for SUI. METHODS: We included 60 women 40 to 60 years of age who were diagnosed with urodynamic SUI (mean pad test, 10.52 g). The PFMT device applicator was clamped on the upper inner thigh, and the patients could self-train at home. The signal was recorded and delivered to a 3G/4G smartphone via Bluetooth, which also allows guided feedback via the smartphone's voice. To evaluate the therapeutic effect, all patients completed the following questionnaires: a 3-day bladder diary, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Urogenital Distress Inventory-Short Form, and the Incontinence Impact Questionnaire-7 (IIQ-7). One-hour pad test measurements were performed before the test (M0) and at 1 (M1), 2 months (M2), and 3 months (M3) after the PFMT device-assisted Kegel exercise. RESULTS: The 1-hour pad test and the scores of the ICIQ-SF, UDI-6, and IIQ-7 questionnaires were improved at M1, M2, and M3, compared with the M0 values. The mean value of the post-voiding residual urine (PVR) significantly decreased at M2 and M3. The subjective and objective improvement rates at M3 were 80% and 72%, respectively. CONCLUSION: The data demonstrated that 3 months of Kegel exercise assisted with a home-based PFMT device improved the number and severity of episodes, PVR, and quality of life in patients with SUI, suggesting that this device might serve as an alternative non-invasive therapy for mild and moderate SUI.

How Key Stakeholders Perceive a Smart Mobile Integrated Care System for the Elderly.

Integrated care has been an important model for caring the elderly. In China, it is still at its very early stage. We proposed a new model to develop a smart mobile system, taking the CARE instrument as the base and composed of apps for stakeholders. We did an usability study using the TAMM tool and, from a convenience sample of 11 elderly and 18 nurses, the results indicated the system was well appreciated.

Design of an Intelligent Nursing Clinical Pathway and Nursing Order Support System for Traditional Chinese Medicine.

With an in-depth analysis of nursing work in 14 hospitals over a period of two years, one unique total nursing information system framework was established where the nursing clinical pathways are used as the main frame and the nursing orders as the nodes on the frame. We used the nursing order concept with the principles of nursing process. A closed-loop management model composed of the nursing orders was set up to solve nursing problems. Based on the principles of traditional Chinese medicine, we further designed an intelligent support module to automatically deduct clinical nursing pathways to promote standardized management and improve the quality of nursing care. The system has successfully been implemented in some facilities since 2015.

[Experiences of a nation-wide integrated program for healthy body weight among students].

Taiwan has good support systems for obesity prevention and management. The percentage of elementary school students with normal body weight, however, has undergone a sustained decrease to 55%. Many factors are associated with this trend, such as lack of physical activity, dissatisfaction with body image, unbalanced dietary pattern, and unsupportive environment. Even though the rate of overweight and obesity is under control, the rate of underweight among girls has undergone a sustained increase, to 28%. Nurses therefore organized the "Aid students to fit" project, which emphasizes the bipolar issue of overweight and underweight. This national project is sponsored by the Ministry of Education and is expected to establish a beneficial environment, in which students can easily adopt healthy lifestyles and increase self-esteem. The program incorporates the AID triangle concept (Active, Image, Diet) and five strategies for achieving the goals. These strategies are: 1. Develop a persuasive statement to fit in with the philosophies of parents, students and teachers. 2. Set up measurable behavior indices and slogans. (Active life: 210 minutes per week. Image: confident and elegant. Diet: balanced and wise choice of low fat and high fiber foods.) 3. Establish a nation-wide interactive surveillance system for body weight control. 4. Develop an internet system that emphasizes tailored case management for overweight students. 5. Develop a supportive teaching plan, material, and aids to promote a healthy school environment. Five modeling schools, moreover, can be used to demonstrate the program. Educators can also download a free teaching plan, material, and aids at the website for healthy weight management (www.ym.edu.tw/active/aid). The authors brought together scholars from eight universities to accomplish the program. In support of the program, the Taiwan Ministry of Education addressed the new recommendation for physical activity which is to engage in moderate intensity physical activity every day for 30 minutes. We also shared this unique Asian experience at the round table discussion addressing the practical and policy issues of implementing public health strategies to reduce physical inactivity and prevent obesity in children. This was hosted by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) Collaborating Center for Physical Activity in order to establish declarations and recommendations for the prevention of obesity in children.