How should the healthcare system support cancer survivors? Survivors' and health professionals' expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study.

BACKGROUND: Qualitative research on cancer survivors' need for comprehensive cancer survivorship care within the health care system is limited. Our study aimed to understand cancer survivors' and health professionals' expectations and perceptions for developing a comprehensive cancer survivorship care system in South Korea. METHODS: An exploratory qualitative study was conducted. A total of 16 subjects (11 cancer survivors and 5 health professionals) were purposively sampled from Regional Cancer Survivorship Centers or Cancer Survivor Clinics in Korea. In-depth semi-structured online or face-to-face interviews were conducted. Six steps of thematic analysis were used to analyze data. RESULTS: The following four primary themes emerged from the interviews: 1) introducing a customized follow-up care system to improve continuity of survivorship care, 2) implementing educational strategies for both survivors and health professionals to manage changed health, and 3) accepting cancer survivors as companions. These three themes included a total of nine subthemes. As a result, the comprehensive survivorship model identified needs in terms of 1) changes in the medical healthcare system and core services that can accommodate the cancer survivors' condition and 2) necessary care services and social support for cancer survivors. CONCLUSIONS: This study identified the existing gaps in Korea's current healthcare system regarding comprehensive cancer survivorship care for cancer survivors. Further research on eHealth-based counseling and educational support, the payment models of cancer survivorship care within universal health coverage, and changing social perceptions to strengthen the biopsychosocial needs of cancer survivors is needed.

The Effect of Apple-Derived Nanovesicles on the Osteoblastogenesis of Osteoblastic MC3T3-E1 Cells.

Osteoporosis is characterized by low bone mass and elevated structural deterioration of the bone tissue, resulting in bone weakness with an increased risk of fracture. Considering biological activities of various phytochemicals extracted from apples, we herein demonstrated the potential antiosteoporotic effects of apple-derived nanovesicles (apple NVs) using osteoblastic MC3T3-E1 cells. Apple NVs significantly stimulated the growth of MC3T3-E1 cells. The cellular alkaline phosphatase (ALP) activity was significantly upregulated in the 5 µg/mL apple NVs-treated group. In addition, the concentrarion of mineralized nodules was significantly increased in the apple NVs-treated groups. Furthermore, apple NVs increased the expression of the genes and proteins associated with osteoblast growth and differentiation, such as Runx2, ALP, OPN, and BMP2/4, which further activated ERK- and JNK-related mitogen-activated protein kinase signaling. These results demonstrate that apple NVs have a potential to prevent osteoporosis by promoting osteoblastogenesis in osteoblastic MC3T3-E1 cells through regulating the BMP2/Smad1 pathways.

Effects of mindfulness-based stress reduction on adults with sleep disturbance: an updated systematic review and meta-analysis.

OBJECTIVE: Mindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management. However, it is currently used to alleviate sleep disturbances. Therefore, this contemporary systematic review aimed to elucidate the clinical effects of MBSR on sleep quality and sleep-related daytime impairment in adults with sleep disturbances, including chronic insomnia disorders. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS: A comprehensive search was conducted using the following databases: Ovid MEDLINE, AMED, Ovidembase, PsycINFO, Cochrane Library, CINAHL, and four domestic databases: KoreaMed, KISS, KMbase and NDSL. The final search update was performed in June 2022. Two researchers independently selected relevant studies, assessed the risk of bias and extracted the data. RESULTS: Of the 7516 records searched, 20 RCTs and 21 reports were included. In the subgroup analysis, MBSR did not improve objective or subjective sleep quality in chronic insomnia and cancers. However, MBSR versus waitlist control might have been effective in improving subjective sleep quality, but with substantial heterogeneity (standardised mean difference=-0.32; 95% CI: -0.56 to -0.08; I2=71%). In addition, MBSR compared with active control did not improve the sleep-related daytime impairments including depression, anxiety, stress, fatigue and quality of life. The overall risk of bias included in this review was a concern because of performance and detection bias. CONCLUSIONS: MBSR might be ineffective for improving sleep quality in patients with chronic insomnia and cancers. In addition, more than half of the RCTs included in this review had small sample sizes and were vulnerable to performance and detection biases. Therefore, well-designed RCTs with larger sample sizes are required to confirm the clinical effects of MBSR in adults with sleep disturbances. PROSPERO REGISTRATION NUMBER: CRD42015027963.

Plum Prevents Intestinal and Hepatic Inflammation in the Acute and Chronic Models of Dextran Sulfate Sodium-Induced Mouse Colitis.

SCOPE: Inflammatory bowel disease (IBD), including ulcerative colitis (UC), is a chronic recurrent inflammatory disease of the digestive tract and increases the risk of colon cancer. METHOD AND RESULTS: This study evaluates the effects of dietary intervention with freeze-dried plum (FDP), a natural antioxidant and anti-inflammatory fruit with no toxicity on dextran sulfate sodium (DSS)-induced acute and chronic experimental colitis in a mouse model and studies the molecular mechanisms of protection through the gut-liver axis. The results show that FDP decreases the levels of inflammatory mediators, which is a nitrative stress biomarker in both acute and chronic models. FDP markedly reduces DSS-induced injury to the colonic epithelium in both acute and chronic models. In addition, FDP significantly decreases the levels of pro-oxidant markers such as CYP2E1, iNOS, and nitrated proteins (detected by anti-3-NT antibody) in DSS-induced acute and chronic colonic injury models. Furthermore, FDP markedly reduces markers of liver injury such as serum ALT/AST, antioxidant markers, and inflammatory mediators in DSS-induced acute and chronic colonic injury. CONCLUSION: These results demonstrate that the FDP exhibits a protective effect on DSS-induced acute and chronic colonic and liver injury through the gut-liver axis via antioxidant and anti-inflammatory properties.

The safety and effectiveness of self-administered coffee enema: A systematic review of case reports.

BACKGROUND: As the self-administration of coffee enema is being used as a mean of self-care for detoxication in various indications, it is important that evidence-based public health information is provided for effective and safe use. However, the evidence is so far rare. This systematic review was conducted to investigate the safety and effectiveness of self-administered coffee enema in a wide range of use, and to provide evidence about its benefits and risks. METHODS: Relevant studies were retrieved from Ovid MEDLINE, Ovid Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature; and also from oriental databases, KoreaMed, Korean Medical Database, Korean Studies Information Service System, National Discovery for Science Leaders, and Korea Institute of Science and Technology Information, Oriental Medicine Advanced Searching Integrated System, China National Knowledge Infrastructure, and Japan Science and Technology Information Aggregator. Considering self-administered coffee enema being used in a various indication, study population was not restricted. Any types of published studies that included outcomes of effectiveness and safety of self-administered coffee enema with or without comparators were eligible for this systematic review. Data on biomedical indications, patient-reported outcomes, and adverse events were collected. Descriptive analyses were planned because diverse health conditions and outcome variables did not allow for quantitative synthesis. RESULTS: Nine case reports that describe adverse events were identified and included in the analysis. Of these, 7 recent ones reported colitis after self-administration, mentioning that the most plausible cause assumed was the coffee fluid itself, which contained numerous chemical substances. Two others reported more critical adverse events. All 9 case reports with acceptable quality of evidence warned against the self-administration of the procedure. No study that reports the effectiveness of coffee enema was found. CONCLUSIONS: Based on the evidences reviewed, this systematic review does not recommend coffee enema self-administration as a complementary and alternative medicine modality that can be adopted as a mean of self-care, given the unsolved issues on its safety and insufficient evidence with regard to the effectiveness.

A systematic review on current status of health technology reassessment: insights for South Korea.

BACKGROUND: To systematically investigate the current status and methodology of health technology reassessment (HTR) in various countries to draw insights for the healthcare system in South Korea. METHODS: A systematic literature search was conducted on the articles published between January 2000 and February 2015 on Medline, EMBASE, the Cochrane Library, CINAHL, and PubMed. The titles and abstracts of retrieved records were screened and selected by two independent reviewers. Data related to HTR were extracted using a pre-standardised form. The review was conducted using narrative synthesis to understand and summarise the HTR process and policies. RESULTS: Forty five studies, conducted in seven countries, including the United Kingdom, Australia, Canada, Spain, Sweden, Denmark, and the United States of America, fulfilled the inclusion criteria. Informed by the literature review, and complemented by informant interviews, we focused on HTR activities in four jurisdictions: the United Kingdom, Canada, Australia, and Spain. There were similarities in the HTR processes, namely the use of existing health technology assessment agencies, reassessment candidate technology identification and priority setting, stakeholder involvement, support for reimbursement coverage, and implementation strategies. Considering the findings of the systematic review in the context of the domestic healthcare environment in Korea, an appropriate HTR model was developed. This model included four stages, those of identification, prioritisation, reassessment and decision. CONCLUSIONS: Disinvestment and reinvestment through the HTR was used to increase the efficiency and quality of care to help patients receive optimal treatment. Based on the lessons learnt from other countries' experiences, Korea should make efforts to establish an HTR process that optimises the National Healthcare Insurance system through revision of the existing Medical Service Act.

Effects of mindfulness-based stress reduction for adults with sleep disturbance: a protocol for an update of a systematic review and meta-analysis.

BACKGROUND: Sleep disturbance is a common and significant health problem that has been linked to decreased quality of life. Mindfulness-based stress reduction (MBSR) can be a potentially effective intervention for insomnia. In previous systematic review examining the effects of MBSR for people with sleep disturbance, the authors highlighted the need for additional well-designed randomized controlled trials (RCTs) to assess the effects of MBSR practice. Recently, several RCTs of the effectiveness of MBSR for individuals who have difficulties in sleep have been published. Therefore, the aim of this review is to update and synthesize evidence on the effects of MBSR for people with sleep disturbance or insomnia. METHODS/DESIGN: We will search ovidMEDLINE, ovidEMBASE, Allied and Alternative Medicine, PsycINFO, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, and four representative Korean electronic databases including KoreaMed, the Korean Studies Information Service System, the Korean Medical Database, and the National Digital Science Library. Two reviewers will independently screen and select relevant studies. The Cochrane Risk of Bias tool will be used to assess risk of bias in the included studies. The primary outcomes will be defined as the change in sleep quality before and after the intervention as evaluated by the polysomnography or self-reported questionnaires such as the Pittsburgh Sleep Quality Index. If quantitative synthesis is not appropriate, a descriptive analysis might be undertaken. DISCUSSION: Many published primary studies have investigated the positive effects of MBSR on sleep quality; however, there are no systematic reviews and meta-analyses synthesizing the evidence of up-to-date research on the effects of MBSR for sleep problems. The review findings will aid the general population and healthcare providers in making informed decisions on evidence-based intervention selection for sleep disturbance or insomnia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015027963 .

Effect of self-acupressure for symptom management: a systematic review.

OBJECTIVES: To assess the efficacy and safety of self-administered acupressure to alleviate symptoms of various health problems, including allergic disease, cancer, respiratory disease, dysmenorrhea, perceived stress, insomnia, and sleep disturbances. METHODS: We searched core, Korean, Chinese, and Japanese databases, including Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), six representative electronic Korean medical databases, China National Knowledge Infrastructure (CNKI), and Japan Science and Technology Information Aggregator (J-STAGE). We included randomized controlled trials (RCTs) and quasi-RCTs that examined disease-specific effects or symptom relief, adverse reactions, and quality-of-life (QOL) for self-administered acupressure. Data collection and assessment of the methodological quality of the included studies were conducted by two independent reviewers. RESULTS: Eight RCTs and two quasi-RCTs showed positive effects and safety of self-acupressure therapy in clinically diverse populations. Quality assessment revealed moderate quality for the RCTs, with 50% or more of the trials assessed as presenting a low risk of bias in seven domains. All of the selected 10 studies reported positive effects for primary outcomes of self-acupressure therapy for symptom management, including significant improvements in symptom scores in allergic disease, nausea and vomiting in cancer, symptom scores in respiratory disease, pain symptoms in dysmenorrhea, and stress/fatigue scores and sleep disturbances in healthy people. CONCLUSIONS: Our findings suggest that self-administered acupressure shows promise to alleviate the symptoms of various health problems. Therefore, further research with larger samples and methodologically well-designed RCTs is required to establish the efficacy of self-administered acupressure.

Effect of self-administered foot reflexology for symptom management in healthy persons: a systematic review and meta-analysis.

OBJECTIVES: Self-administered foot reflexology is unrestricted by time and space, economical, and practical because it is easy to learn and apply. This study estimated the effectiveness of self-foot reflexology for symptom management in healthy persons through a systematic review and meta-analysis. METHODS: The participants were healthy persons not diagnosed with a specific disease. The intervention was foot reflexology administered by participants, not by practitioners or healthcare providers. The comparative studies either between groups or within group comparison were included. Our search utilized core databases (MEDLINE, EMBASE, Cochrane, and CINAHL). We also searched Chinese (CNKI), Japanese (J-STAGE), and Korean databases (KoreaMed, KMbase, KISS, NDSL, KISTI, and OASIS). The search was used MeSH terminology and key words (foot reflexology, foot massage, and self). RESULTS: Analysis of three non-randomized trials and three before-and-after studies showed that self-administered foot reflexology resulted in significant improvement in subjective outcomes such as perceived stress, fatigue, and depression. However, there was no significant improvement in objective outcomes such as cortisol levels, blood pressure, and pulse rate. We did not find any randomized controlled trial. CONCLUSIONS: This study presents the effectiveness of self-administered foot reflexology for healthy persons' psychological and physiological symptoms. While objective outcomes showed limited results, significant improvements were found in subjective outcomes. However, owing to the small number of studies and methodological flaws, there was insufficient evidence supporting the use of self-performed foot reflexology. Well-designed randomized controlled trials are needed to assess the effect of self-administered foot reflexology in healthy people.

Self-administered foot reflexology for the management of chronic health conditions: a systematic review.

OBJECTIVES: To systematically review the effect of self-administered foot reflexology in patients with chronic health conditions. METHODS: Electronic databases were searched for literature published from 1948 to January 2014. The databases included MEDLINE, EMBASE, the Cochrane Library, CINAHL, CNKI, J-STAGE, Koreamed, Kmbase, KISS, NDSL, KISTI, and OASIS. Key search terms were "exp/relaxation therapy," "foot," "reflexology," "zone therapy," and "self." All study designs were included. Two raters independently extracted data and assessed study quality by using the Cochrane risk of bias tool (for randomized controlled trials) and the risk of bias assessment tool for nonrandomized studies (for nonrandomized and before-and-after studies). A qualitative and descriptive analysis was performed because of the clinical diversity associated with chronic health conditions. RESULTS: Of the 224 records assessed, 4 trials met the inclusion criteria: 3 nonrandomized controlled trials and 1 before-and-after study without comparison. Self-administered foot reflexology might have a positive effect in type 2 diabetes, but the low quality of the included study and the lack of adequately reported clinical outcomes obscure the results. Two studies of hypertensive patients and 1 study of patients with urinary incontinence showed that self-performed foot reflexology may exert a beneficial effect on lowering blood pressure and urinary incontinence; however, given the small sample size and the lack of any description of medications and other cointerventions, there was insufficient evidence to conclusively determine whether foot reflexology had any effect. CONCLUSIONS: The included studies on self-administered foot reflexology in patients with type 2 diabetes, hypertension, or urinary incontinence provided insufficient evidence to determine a treatment effect. Therefore, a well-designed, large-scale, and randomized controlled trial is needed to confirm the effect of self-administered foot reflexology for chronic conditions.

Prevalence of complementary and alternative medicine use in a community-based population in South Korea: a systematic review.

OBJECTIVES: To examine the prevalence of the use of complementary and alternative medicine (CAM) in the Republic of Korea and identify the factors responsible for variations in the reported prevalence, the socio-demographic factors associated with CAM use, and the relationship between CAM use and study methodological quality. DESIGN: Two international and 6 representative Korean medical databases were searched to identify cross-sectional studies that had surveyed the general Korean population in community settings to determine prevalence of CAM use. Data collection and assessment of the methodological quality of the studies were conducted by 3 independent reviewers. RESULTS: The prevalence of CAM use reported by the 11 studies that met the selection criteria ranged from 29% to 83%. Inclusion of Korean medicine within the definition of CAM was not found to be a significant factor in the heterogeneity, but several factors that may have contributed to it, namely, inconsistency in CAM taxonomies, recall bias, use of unrepresentative sampling strategies, and lack of pilot testing, were identified. Higher CAM use was found to be associated with female sex, high level of education, and advanced age. CONCLUSIONS: The inclusion of Korean medicine within the definition of CAM does not explain the heterogeneity in the reported prevalence of CAM use among the South Korean population. A standard questionnaire appropriate for the Korean context should be developed to define and classify the common CAM modalities and control for confounding factors.

Use of complementary and alternative medicine by self- or non-institutional therapists in South Korea: a community-based survey.

BACKGROUND: The purpose of this study is to investigate the prevalence and utilization pattern of complementary and alternative medicine (CAM) administered by oneself or by non-institutional practitioners in a general population in South Korea. METHODS: Nationwide, face-to-face surveys were conducted from September 1, 2011 to October 5, 2011. We conveniently selected the participants by using a proportional allocation method according to age, gender, and region. The use of CAM in the last year, the patterns of use, sources of information, and counseling objects were investigated in addition to respondents' demographic characteristics. RESULTS: Among the 1284 people approached, 915 respondents (71.3%) reported having had at least one CAM therapy during the past 12 months. Natural products were used the most frequently (58.8%). Unexpectedly, 82.6% out of 1740 therapies reported were self-administered CAM. Healthcare professionals were the source of information on CAM in only 5.6% of all instances of use, and only 17.7% of participants had consulted with doctors regarding CAM use. CONCLUSIONS: Owing to the widespread use of CAM in South Korea, researchers should focus on the safety and potential effectiveness of CAM therapy when self-administered by users or by unauthorized CAM practitioners.

Corrigendum to "Use of complementary and alternative medicine by self- or non-institutional therapists in South Korea: a community-based survey" [Integr. Med. Res. 2(1) (2013), 25-31].

[This corrects the article DOI: 10.1016/j.imr.2013.02.001.].

Prevalence and factors affecting glucosamine use in Korea: a survey-based study.

Glucosamine and chondroitin are widely used as pharmaceutical and dietary supplements. However, there is a lack of information regarding consumer consumption of glucosamine and chondroitin in the Republic of Korea. We investigated the prevalence and factors affecting the use of glucosamine products in the general population aged 40 years and older in the Republic of Korea. We conducted this descriptive and exploratory study using a telephone-based survey with a structured questionnaire. We randomly selected subjects using a proportional allocation method based on age, gender, and region. We started the survey on September 19, 2009, and continued the survey until we obtained 1,000 respondents who were currently taking glucosamine or chondroitin, which occured on September 30, 2009. Among the 8,135 people approached, the response rate was 29.6%. A total of 12.2% of respondents (n = 991) were current users of glucosamine, while only 0.1% (n = 9) were current users of chondroitin. Two-fifths of current glucosamine users were not diagnosed with osteoarthritis by a doctor nor did they experience arthritis pain. These participants used glucosamine to maintain and promote joint health. Information on glucosamine was mainly obtained through advertisements on television or the Internet. Seventy percent of current users indicated that they did not know the composition of the glucosamine they took. Appropriate information and guides concerning glucosamine or chondroitin usage should be provided by expert clinicians because of the accessibility of both these cartilage derivatives as supplements and medical drugs in the Republic of Korea.

Naringin alters the cholesterol biosynthesis and antioxidant enzyme activities in LDL receptor-knockout mice under cholesterol fed condition.

The purpose of the current study was to evaluate the lipid lowering and antioxidant capacity of naringin in LDL receptor knockout (LDLR-KO) mice fed a cholesterol (0.1 g/100 g) diet. As such, naringin or lovastatin (0.02 g/100 g) was supplemented in a cholesterol diet for 6 weeks. The naringin and lovastatin supplementation significantly lowered the plasma total cholesterol level compared to the control group. The plasma and hepatic triglyceride level was only lowered by the lovastatin supplement, while the hepatic cholesterol content was lowered by both the naringin and lovastatin supplements compared to the control group. The hepatic HMG-CoA reductase activity was significantly lower in the naringin and lovastatin supplemented groups than in the control group, whereas the ACAT activity was unaffected. The excretion of total sterol was significantly higher in the naringin and lovastatin groups compared to the control group due to significant changes in the acidic and neutral sterol, respectively. When comparing the hepatic antioxidant enzyme activities, the superoxide dismutase, catalase, and glutathione reductase activities were all significantly higher in the naringin-supplemented group than in the control group, while only the lovastatin supplement increased the glutathione reductase activity. Accordingly, the current results confirmed that naringin lowers the plasma cholesterol level via the inhibition of hepatic HMG-CoA reductase activity and increases the excretion of fecal sterol. Naringin was also found to improve the activities of hepatic antioxidant enzymes against oxidative stress in a hypercholesterolemic animal model, i.e. cholesterol-fed LDLR-KO mice.

Role of naringin supplement in regulation of lipid and ethanol metabolism in rats.

The current study was performed to investigate the effect of naringin supplements on the alcohol, lipid, and antioxidant metabolism in ethanol-treated rats. Male Sprague-Dawley rats were randomly divided into six groups (n = 10) based on six dietary categories: ethanol and naringin-free, ethanol (50 g/L) plus low-naringin (0.05 g/L), ethanol plus high-naringin (0.125 g/L), and three corresponding pair-fed groups. The pair-fed control rats received an isocaloric diet containing dextrin-maltose instead of ethanol for 5 wks. Among the ethanol treated groups, the naringin supplements significantly lowered the plasma ethanol concentration with a simultaneous increase in the ADH and/or ALDH activities. However, among the ethanol-treated groups, naringin supplementation resulted in a significant decrease in the hepatic triglycerides and plasma and hepatic total cholesterol compared to that in the naringin-free group. Naringin supplementation significantly increased the HDL-cholesterol and HDL-C/total-C ratio, while lowering the AI value among the ethanol-treated groups. Hepatic lipid accumulation was also significantly reduced in the naringin-supplemented groups compared to the naringin-free group among the ethanol-treated groups, while no differences were found among the pair-fed groups. Among the ethanol-treated groups, the low-naringin supplementation resulted in a significant decrease in the levels of plasma and hepatic TBARS, whereas it resulted in higher SOD and GSH-Px activities and gluthathion levels in the liver. Accordingly, naringin would appear to contribute to alleviating the adverse effect of ethanol ingestion by enhancing the ethanol and lipid metabolism as well as the hepatic antioxidant defense system.