Objectives: A meta-analysis of the literatures was conducted to evaluate the cost-effectiveness of medical nutrition therapy by dietitians. Methods : The 30 studies were identified from a computerized search of published research on MEDLINE, Science-Direct and the PQD database until May, 2002 and a review of reference lists. The main search terms were“dietitian”,“dietary intervention”,“nutrition intervention”, “cost”,“cost-effectiveness”and“cost-benefit analysis”. The subgroup analysis was performed by publication year, study design, intervention provider, type of patient (in/out-patient) and type of cost (total cost/direct cost). Two reviewers independently selected trials for inclusion, assessed the quality and extracted the data. Results : The 30 studies were identified using the electric database search and bibliographies. The 17 trials were eligible for inclusion criteria, then the systematic review and a meta-analysis were conducted on effectiveness and cost-effectiveness of medical nutrition therapy. The quality of the studies was evaluated using the quality assessment tool for observational studies. The quality score was 0.515 $\pm$ 0.121 (range : 0.279-0.711, median : 0.466). The meta-analysis of 17 studies based on the random effect model showed that medical nutrition therapy was highly effective in treating the diseases (effect size 0.3092 : 95% confidence interval 0.2282-0.3303). The vote-counting method, one of meta-analysis methods, was applied to evaluate the cost-effectiveness of medical nutrition therapy conducted by dietitians. Two criteria (method 1, method 2) for voting were used. The calculated p-values for method 1 (more conservative method) and method 2 (less conservative method) were 0.1250 and 0.0106, respectively. Medical nutrition therapy by dietitians was significantly cost-effective in the method 2. Conclusion. This meta-analysis showed that the effectiveness of medical nutrition therapy was statistically significant in treating disease (effect size 0.3092), and that the cost-effectiveness of medical nutrition therapy was statistically significant in the method 2 (less conservative method) of vote counting. (Korean J Nutrition 36(5): 515~527, 2003)
In this study, we investigated the effects of lowering the fat and cholesterol in the diets of 26 Korean hypercholesteolemic men($\geq$240mg/dl). They consumed 2378kcal/day with 20.9% of the energy deriving from fat, and a cholesterol intake of 282mg(118mg/1000kcal). The experimental diet consisted of 2400kcal, the same as their usual diet, but the fat content was restricted to 15%, and the cholesterol level to below 100mg/1000kcal. The subjects kept to this diet for four weeks and were asked to maintain their usual life activities during the experimental period. The dietary intake and levels of plasma lipid, lipoprotein-cholesterol and apoprotein of the subjects were analyzed before, two weeks into, and after four weeks dietary intervention. After two of the dietary intervention, there were no significant changes of plasma total cholesterol or triglyceride levels but there was some changes of phospholipid level. However, after four weeks, the levels of plasma total cholesterol, triglyceride, and phospholipid had decreased significantly: 18.2%, 32.9%, and 11.9%, respectively. And the LDL-cholesterol and VLDL-cholesterol levels also showed a marked reduction of 18.1%, and 33.0% respectively without change of HDL-cholesterol level. There were no changes in the levels of Apo-A 1, Apo-B, or Lp(a). The changes of the plasma lipid levels were significantly associated with the changes in dietary fat intake but not the cholesterol intake. In conclusion, although the responses to the dietary intervention varied among the individual subjects, the lowering of dietary fat component from 21% to 15% of energy intake seems to be an effective way to reduce plasma cholesterol and triglyceride levels without decreasing HDL-cholesterol level. It was also found that the restriction of dietary cholesterol to below 100mg/1000kcal not seem to be effective for the hypercholesterolemic patient who already consuming below 300mg/day of cholesterol.
Purpose: Recently, Neurofeedback training system that based on biofeedback of brain wave was introduced. This study was performed to identify the effects of the improvement of brain function by Neurofeedback training on elders(the 2nd or 3rd grade of long-term care insurance services). Methods: A quasi-experimental design using a nonequivalent control group, pre-post test was used. Total 11 elderly were enrolled in this study (experimental group 5, control group 6). The intervention was conducted 3 times a week for 30 minutes from January to June, 2012 (total 60 times). Chi-square test and Mann-Whitney U-test were used to analyze the data. Results: After the Neurofeedback intervention, attention quotient (AQ), anti-stress quotient (ASQ), emotion quotient (EQ) and brain quotient (BQ) of the experimental group were significantly better than those of the control group. Conclusion: The findings indicate that the Neurofeedback training program was effective in reducing fatigue by AQ, increasing the physical and mental stress resistance by ASQ, emotional balance by EQ and improving of total brain function by BQ. Therefore Neurofeedback training be used as an effective training intervention for the health of elderly in geriatric facility.
The purpose of this study was to determine the effectiveness of sit-to-stand training on unstable surfaces in individuals with stroke. Nineteen subjects with chronic stroke were divided into two groups: an experimental group (10 subjects) and a control group (9 subjects). They received 30 minutes of Neuro-developmental therapy (NDT) treatment, and sit-to-stand exercise for 15 minutes three times a week for four weeks. During the sit-to-stand training, the experimental group performed on an unstable AIREX balance pad, but the control group performed on a stable surface. Balance ability and weight-bearing distribution during quiet standing were measured before and after training period using the 7-item Berg balance scale-3P (BBS-3P) and the Five-times-sit-to-stand test (FTSST). In addition, the muscle strength of the knee extensor was evaluated before and after the training period. The results were as follows: 1) The weight-bearing distribution forward of the affected leg, increased significantly in the experimental group after the four-week intervention (p<.05), 2) The 7-item BBS-3P and FTSST increased significantly in the experimental group after the four-week intervention (p<.05), 3) The knee extensor muscle strength in both groups increased significantly after the four-week intervention (p<.05). In conclusion, the results of this study did not show that the sit-to-stand training on an unstable surface was more effective than on a stable surface. However, the results suggested that sit-to-stand training is effective in the balance training of stroke patients.
Journal of the Korean Society of Physical Medicine
/
v.13
no.1
/
pp.11-26
/
2018
PURPOSE: The aim of this study was to review the effects of exercise intervention on blood glucose control in obese type 2 diabetic patients. METHODS: The PubMed and KERISS search engines were used and 61 papers that met the key questions were selected. RESULTS: Exercise is an effective intervention for the control of blood glucose in type 2 diabetic patients because it does not impair glucose transport in the skeletal muscle induced by muscle contractions. Insulin resistance, which is characteristic of type 2 diabetes, is caused by decreased insulin sensitivity or insulin responsiveness. Acute exercise improves the glucose metabolism by increasing the insulin-independent signaling pathways and insulin sensitivity in the skeletal muscle, and regular long-term exercise improves the skeletal muscle insulin responsiveness and systemic glucose metabolism by increasing the mitochondrial and GLUT4 protein expression in the skeletal muscle. CONCLUSION: The improvement of the glucose metabolism through exercise shows a dose-response pattern, and if exercise consumes the same number of calories, high intensity exercise will be more effective for the glucose metabolism. On the other hand, it is practically difficult for a patient with obese type 2 diabetes to control their blood glucose with high intensity or long-term exercise. Therefore, it will be necessary to study safe adjuvants (cinnamic acid, lithium) that can produce similar effects to high-intensity and high-volume exercises in low-intensity and low-volume exercises.
A practical methodology for the determination of derived intervention levels (DILs) on relocation following an accidental release of radionuclides was designed based on dose rate on the ground. The influence of DILs was investigated with respect to the change of parameter values, which are dependent on socio-environmental characteristics in distinction from temporary and permanent relocations. The DILs on relocation showed a distinct difference depending on effective removal half-life of radionuclides following a deposition, delay time in measurement and residential characteristics. In particular, the delay time. In measurement was an important factor in determination of DILs in the case of an assumption that dose rate on the ground declines in a power function, not in an exponential function. The DILs showed lower numerical values as longer effective half-life, longer delay time In measurement and longer exposure time.
This study is to design an effective fall-prevention nursing program. Researchers investigated the current condition and risk factors for falls in the small-medium sized rehabilitation hospital with descriptive research. We conducted integrative literature review to reflect the current approach of fall-prevention nursing program. We found that the risk factors for falls are related to the characteristics of clinical setting of the hospital. We suggested the nursing intervention with applying fall risk assessment scale that is sensitive to the elderly population and the intervention that shows maximum effect. In conclusion, this study proposed the way of selecting an effective fall-prevention nursing program based on a clinical setting and prospective of its application. This will contribute to the improvement in nursing practice with the critical view in hospital fall.
The purpose of this study was to examine bowel habits, dietary habits, and nutrient intake of constipated adults, and the effects of prune products on relieving constipation symptoms. Fifty one adults with self-reported constipation (mean age 23 years, range 19-41 years, 10 males and 41 females) participated in this study. After a baseline survey on bowel habits and dietuy habits, participants were asked to consume at least 50 g of prune and 200 ml of prune juice per day during a 4-week period in addition to usual diet. Nutrient intake was estimated by a 24 hour recall at the baseline and once every week by diet records during the intervention. Data were analyzed after classifying the subjects into mild constipation group and severe constipation group by the severity of the symptoms. During the intervention, the subjects with mild constipation consumed 56 g of prunes (about 5.6 fruits) and 200 ml of prune juice, and the subjects with severe constipation consumed 59 g of prunes (about 5.9 fruits) and 207 ml of prune juice. Average intakes of energy, dietary fiber and water of the subjects in the mild constipation and severe constipation group increased during the intervention compared to the baseline. Average dietary fiber intake of the mild constipation and severe constipation groups significantly increased from 12.5 g and 11.6 g at the baseline to 18.5 g and 16.8 g after consuming prune products, respectively. These changes were accompanied by an increase in the number of bowel movements, a decrease of defecation time, a change to a softer stool consistency, and a decrease of abdominal pain during defecation. Seventy two subjects answered that prune products were effective to improve their overall constipation symptoms. Our data show that supplementation of prune products is effective to provide energy, dietary fiber and water, and to relieve constipation symptoms for constipated adults.
Objectives : This study was conducted to investigate effective treatment point selection method using oppressive pain in acupoints as elementary attempt for standard methodology of clinical acupuncture studies. Methods : Twenty seven subjects with hypertension or within prehypertension category - systolic and diastolic blood pressure (BP) over 120/80mmHg - were divided into two groups, oppressive pain point treatment group and oppressive painless point treatment group. In oppressive pain point treatment group, single point acupuncture (SPA) was conducted for 16 sessions during 8 weeks on most oppressive painful point among 6 selected acupuncture points used in previous trials and clinic. As a SPA intervention, 15 minutes with deqi sensation- elevating manipulation was conducted on the treatment acupoint. Same process was conducted in oppressive painless point treatment group on most oppressive painless point with subject blinding. Results : Significant reduction was observed in both systolic and diastolic BP after short time intervention (15.5/8.8 mmHg, 10.7/7.1 mmHg, P<0.05, respectively at 1 week) and maintained for 8 weeks intervention period in all groups (12.8/8.0 mmHg, 19.4/12.6 mmHg, P<0.05, respectively). No significant difference of BP change between oppressive pain point treatment group (N=10) and oppressive painless point treatment group (N=9) was observed during 8 weeks study period. Conclusions : SPA treatment as used in this pilot study was effective for lowering BP in mild hypertensive population, but oppressive pain in acupoint had no effect on treatment. This present result suggests the possibility of SPA for hypertension treatment regardless of oppressive pain.
Purpose: The purpose of this study was to identify the effects of a supportive program on uncertainty, anxiety, and maternal-fetal attachment in high-risk pregnant women. Methods: The participants were 59 high-risk pregnant women admitted to the maternal-fetal intensive care unit. The control group (n=30) received usual treatment and antenatal care, while the experimental group (n=29) received an additional supportive program. Uncertainty, anxiety, and maternal-fetal attachment were measured in both groups prior to the intervention and at 3 days and 10 days after the intervention (or at discharge). Data were analyzed with the t-test, chi-square test, repeated-measures analysis of covariance, and the Greenhouse-Geisser correction in SPSS version 23.0. Results: A supportive program including information provision, nutritional care, emotional care, and exercise care was developed from the literature. All variables except women's length of stay were found to be homogeneous the between experimental and control groups in the pre-test. Length of stay was calculated as a covariate for testing hypotheses. There was a significant difference in state anxiety over time between the two groups, while there were no differences in uncertainty or maternal-fetal attachment. Conclusion: This supportive program was identified as an effective nursing intervention on state anxiety in high-risk pregnant women during their stay in the maternal-fetal intensive care unit. It is suggested that nurses could apply this program to alleviate high-risk pregnant women's state anxiety, and that this program could be modified to be more effective on uncertainty and maternal-fetal attachment in high-risk pregnant women.
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