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RESULTS
PMC9854322
Sample characteristics
PCP
The final sample size included 58 participants (Figure The baseline characteristics of 58 participants included in the analysis are summarized in Table Analysis sample characteristics at baseline (Abbreviations: Pap, Papanicolaou; PCP, primary care provider.
PMC9854322
Feasibility and acceptability
We recruited and randomized the target sample size of 123 with a retention rate of 50.4% (or 60.2% after accounting for early dropouts in the intervention arm; e.g., those who completed the baseline assessment but left the study before receiving the study intervention, The CHECC‐uP intervention was highly acceptable. A...
PMC9854322
Changes in Pap test screening and psychosocial outcomes
depression
CERVICAL CANCER
At 6 months, 50% of WLH in the intervention group received a Pap test, compared to 21.9% of women in the control group (28.1% difference; Outcome changes over 6 months Abbreviation: Pap, Papanicolaou. Group difference in mean change scores from baseline to 3 months divided by the standard deviation at baseline.Group di...
PMC9854322
DISCUSSION
CERVICAL CANCER
We found that a multifaceted, health literacy‐focused intervention (CHECC‐uP) can promote Pap testing among Black WLH. However, we experienced a high attrition rate in the study sample. The findings demonstrate the preliminary efficacy of CHECC‐uP for Black WLH as a potential strategy to reduce cervical cancer disparit...
PMC9854322
CONCLUSION
CERVICAL CANCER
Pilot testing of the CHECC‐uP intervention resulted in promising effect sizes and high acceptability among low‐income Black WLH. We incorporated health literacy education as a new approach to promote Pap test screening among WLH. The findings support integrating health literacy into a future intervention framework to t...
PMC9854322
AUTHOR CONTRIBUTIONS
All authors approved the final version of the manuscript. Hae‐Ra Han originated the study and led the writing. Jeanne Murphy‐Stone and Phyllis Sharps contributed to the development of the study concept and design. Hae‐Ra Han, Kyra J. W. Mendez, Nancy Perrin, Joycelyn Cudjoe, Gregory Taylor and Dorcas Baker contributed ...
PMC9854322
CONFLICT OF INTEREST
The authors declare no conflict of interest.
PMC9854322
ETHICS STATEMENT
The study was approved by the Johns Hopkins Medicine IRB. Informed consent was obtained from all individual participants included in the study.
PMC9854322
ACKNOWLEDGEMENTS
AIDS, Dorothy
EVANS, AIDS
This study was funded by Johns Hopkins University Center for AIDS Research (P30AI094189) and Dorothy Evans Lyne Fund.
PMC9854322
DATA AVAILABILITY STATEMENT
Study data will be made available upon reasonable request to the corresponding author. De‐identified data will be made available upon reasonable request.
PMC9854322
REFERENCES
PMC9854322
Background
DISORDERS
Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with coll...
PMC10512560
Method
Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (
PMC10512560
Results
The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (
PMC10512560
Conclusions
stress-related disorders
The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed. The study was registered on 16/01/2017...
PMC10512560
Supplementary Information
The online version contains supplementary material available at 10.1186/s12875-023-02151-0.
PMC10512560
Keywords
Open access funding provided by University of Gothenburg.
PMC10512560
Background
stress-related exhaustion disorder, exhaustion disorder, stress-related mental disorders, CMD, stress disorders
DISORDERS
During the last decade, common mental disorders are the most prevalent diagnoses leading to sick leave among Swedish workers. Within this group, stress-related mental disorders were the most common diagnoses, including acute stress reaction, reaction to severe stress and stress-related exhaustion disorder (ED) [The con...
PMC10512560
Aim
stress-related disorders
The aim of this study is to evaluate whether a systematic procedure involving collaboration between GPs, RCs and employers can reduce sick-leave days for patients with stress-related disorders during a 24-month follow-up period. An intervention group will be compared to treatment as usual (TAU).
PMC10512560
Methods
PMC10512560
Study design
CMD
The study took place in Region Västra Götaland, a county council of considerable size, encompassing nearly 20% of the Swedish population, with 200 public and private primary health care centres (PHCCs). The study was conducted at the Institute of Stress Medicine (ISM), Region Västra Götaland, and the Department of Work...
PMC10512560
Recruitment, randomization and sample
post-traumatic stress disorder, PTSD, post-traumatic stress syndrome
RECRUITMENT
The recruitment of PHCCs took place between January and October 2016. A total of 30 PHCCs were invited to participate from both public and private health care centres, and 22 accepted to participate (15 from public health care centres and seven from private health care centres). The centres were matched in pairs based ...
PMC10512560
The intervention
stress-related disorders
The design of the intervention was based on the Person-Environment-Occupation model (PEO) that originates from occupational therapy, where occupational performance depends on the interaction between the person (P), the environment (E) and the occupation (O) [The intervention comprised a) a one-day training where all pa...
PMC10512560
Intervention adherence
RECRUITMENT
Among the two private and nine public intervention centres, the average proportion of enrolled patients that had a common mental health diagnosis in 2015 (the year the centres were recruited to the study) was 15% (range 13–18%). This was expected to provide a sound basis for patient recruitment. However, only five of t...
PMC10512560
Outcome measures and statistical analyses
The primary outcome measures were the number of registered sick leave days for cases and controls at three, six, 12 and 24 months after inclusion. Data was retrieved from the Swedish Social Insurance Agency’s Micro Database for Analysing Social Insurance (MiDAS). In Sweden, sick leave benefits are granted for 25%, 50%,...
PMC10512560
Results
Descriptive statistics for the intervention group and the control group (TAU) in gross and net days are presented in Table Comparisons of registered sick leave days between the intervention group and TAUMann–Whitney Test, sd = standard deviation, Q1;Q3 = first and third quartileWhen looking at net days (i.e. the numbe...
PMC10512560
Discussion
The aim of the present study was to investigate whether the application of a standardised approach in a primary health care setting in patients with stress-related diagnoses could facilitate RTW. The findings point to the contrary: the PRIMA intervention appears to have protracted RTW times during the first year of fol...
PMC10512560
Limitations
CMD
We would like to explore the possibility that TAU is adequate on its own. This has been confirmed in other studies on CMD in primary health care. Kivi et al. [In addition to the problems that have already been discussed – i.e. issues with the intervention content, lack of data on symptom development and limited knowled...
PMC10512560
Conclusion
stress-related disorders
The aim of this randomised controlled trial was to evaluate whether a systematic procedure of collaboration between general practitioners and rehabilitation coordinators, which involved the employer in the rehabilitation of sick-listed patients with stress-related disorders, could reduce the number of sick-leave days d...
PMC10512560
Acknowledgements
We would like to thank Sandra Pettersson and Marie Hagsjö for participation and help with data collection and Sandra Pettersson for assisting with data analysis.
PMC10512560
Authors’ contributions
LB had the major responsibility for the planning of the study, AB for analysis of the data and writing the first draft of manuscript. KH, MB, KG, AP and KS contributed to the planning of the study, interpretation of the data and writing of the manuscript. All authors read and approved the final version of the manuscrip...
PMC10512560
Funding
Open access funding provided by University of Gothenburg. The study received financial support from the Swedish Research Council for Health, Working Life and Welfare, grant number 2015–00703.
PMC10512560
Availability of data and materials
The datasets generated and analysed during the current study is available from the corresponding author on reasonable request.
PMC10512560
Declarations
PMC10512560
Ethics approval and consent to participate
The study was approved 11/04/2016 by the regional ethical review board in Gothenburg, Sweden, with the reference number 234–16, and conducted according to the 1964 Declaration of Helsinki. Informed consent to participate in the study was obtained from all participants.
PMC10512560
Consent for publication
Not applicable.
PMC10512560
Competing interests
The authors declare no competing interests.
PMC10512560
References
PMC10512560
Highlights
high-functioning
SECONDARY
These authors contributed equally to this work.What are the main findings?Highly functioning adults with a sedentary lifestyle benefit physically and mentally from forest therapy and mountain hiking.Women predominantly benefited highly from mountain hiking regarding hemopoietic system and aerobic capacity. Both genders...
PMC9859399
Abstract
skeletal muscle mass
Background: Lifelong physical activity is related to longer health span, which is reflected at an individual level, and is of substantial socioeconomic relevance. Sedentary lifestyles, on the other hand, pose an increasingly major public health problem. In addition, the COVID-19 pandemic had a negative impact on activi...
PMC9859399
1. Introduction
inflammation
INFLAMMATION
There is a considerable body of evidence on sustaining health benefits of being active and a scientific consensus that physical activity—in adequate dosage—should be used in the promotion, maintenance and recovering of physical as well as mental health [In order to promote the enjoyment of physical activity and, thus, ...
PMC9859399
2. Materials and Methods
PMC9859399
2.1. Study Design and Settings
The present data were collected as part of the ANKER-Study (ISRCTN43292449); this randomized, controlled clinical trial investigated the effects of two types of nature-based therapies in couples with a sedentary lifestyle on health-related quality of life, quality of relationship, psychological and physiological parame...
PMC9859399
2.2. Participants
acute infection, arteriosclerotic, fever, alcoholism, respiratory diseases, cardiac insufficiency, psychiatric, malignant neoplastic disorders, renal insufficiency
RESPIRATORY DISEASE, ACUTE INFECTION, UNCONTROLLED HYPERTENSION, EVENT, DISORDERS, METABOLIC DISEASE, IMMUNODEFICIENCY
Couples with a sedentary lifestyle were the defined group of interest in the ANKER-Study, therefore, participants had to meet the following inclusion criteria: age 50–60 years, relationship-duration > 1 year, BMI ≥ 25 and ≤30, sedentary lifestyle (International Physical Activity Questionnaire Short Form (IPAQ-SF) < 3.0...
PMC9859399
2.3. Intervention
Participants of both intervention groups spent a seven-day vacation in Algund (Italy, 46°40′57.5″ N 11°07′19.0″ E, 350 m AMSL), a region that is characterized by its mild, nearly Mediterranean climate. All participants were housed in local hotels, got the same meals, and did not receive lifestyle recommendations during...
PMC9859399
2.4. Data Collection and Outcomes
Forearm venous blood, NRS
INS
Medical examinations at T1 (day 0; before the intervention), and T2 (day 7; after the intervention) were performed at the Department of Sports Medicine, Tappeiner Hospital, Merano (Italy). Follow-up examinations at T3 (day 60) took place at the Paracelsus Medical University, Salzburg (Austria); the follow-up examinatio...
PMC9859399
2.5. Statistical Analysis
All statistical analyses were performed in the sense of an intention-to-treat analysis using the R-GNU software environment (General Public License, R Foundation for Statistical Computing, Vienna, Austria). Statistical significance was set at the level of α < 0.05. Baseline data were analyzed using unpaired Students-Fu...
PMC9859399
2.6. Randomization and Sample Size
Pairwise randomization of the couples to groups was completed according to the following stratification factors: Age, general health (PHQ-9), closeness to nature (NRS-6), BMI, activity level (IPAQ-SF) and relationship duration [
PMC9859399
3. Results
PMC9859399
3.1. Study Participants and Baseline Characteristics
ADVERSE EFFECTS
Two hundred and fifty-seven individuals were screened for eligibility to participate in this study, 165 were excluded: 49 individuals did not meet the inclusion criteria, 116 individuals declined to participate due to personal reasons or the COVID-19 pandemic. In October 2019, 24 people were enrolled in the HG and 28 i...
PMC9859399
3.2. Tour Data
On average, the mountain hikes lasted 03:29 h, the participants covered a distance of 7.36 km and 521 m of altitude. The FTG participated each day in standardized forest therapy sessions for 3–4 h, assisted by a psychologist. The sessions were characterized by low physical activity (
PMC9859399
3.3. Primary Outcomes
Results from the F1-LD-F1 analysis of primary outcomes are accessible in The F1-LD-F1 model for the SF-12 total score revealed a significant main effect for time (The F1-LD-F1 model for the EQ5D-5L visual analogue scale revealed a significant main effect for time (Regarding the quality of relationship (PFB total score)...
PMC9859399
3.6. Body Composition
Results from the F1-LD-F1 analysis of Body Parameters are presented in F1-LD-F1 model for body mass index revealed a significant main effect for time (F1-LD-F1 model for reactance revealed a significant main effect for time (Within the female subgroup, the Fat Free Mass Index presented with a significant main effect fo...
PMC9859399
3.7. Questionnaires
INS
F2-LD-F1 models revealed gender-specific effects for the connectedness to nature scale (CNS, Nature connectedness increased in both intervention groups as significant main effects for time were found for the CNS, INS and NRS-6. F1-LD-F1 model for MAAS Total revealed only a significant main effect for time (
PMC9859399
3.8. Sample Size Simulation
Consistent with the bootstrap sample size simulation for the primary outcome SF12 Total Score, a sample size of at least n = 50 per group is needed to achieve a power of 1−β = 0.87 in the case nparLD analysis for the comparison of the two interventions, mountain hiking and forest therapy. A larger sample size is requir...
PMC9859399
4. Discussion
±
ELEVATED BLOOD PRESSURE, HYPERTENSION
The ANKER-Study was conducted before and during the COVID-19 pandemic and investigated the effects of two different types of nature-based therapies in couples with a sedentary lifestyle. Effects of mountain hiking and forest therapy on health-related quality of life, relationship quality, and other psychological and ph...
PMC9859399
Strengths and Limitations
To enhance the methodological quality and evidence, while decreasing the risk of bias, as required in reviews on the topic of forest therapy [Nature relatedness in the ANKER-Study was assessed via three questionnaires (Connectedness to Nature Scale, Inclusion to Nature Scale and Nature Relatedness Scale). The results i...
PMC9859399
5. Conclusions
DISEASES
The ANKER-study, with its forest classification survey, provides for the first time a method for a more valid comparison of forest therapy interventions. The long-term results of this study showed that healthy, highly functioning women and men with sedentary lifestyles benefit mentally from contact with nature. The gen...
PMC9859399
Supplementary Materials
The following supporting information can be downloaded at: Click here for additional data file.
PMC9859399
Author Contributions
Conceptualization, A.H. and C.P.; Methodology, A.H., C.P. and J.F.; Investigation, A.H., C.P., J.F., M.B., R.W.-E., G.S., M.K., M.N., S.B. and R.Z.; Resources, G.S., S.R., V.D.N. and M.K.; Project administration, A.H., C.P. and R.W.-E.; Funding acquisition, A.H. and C.P.; Statistics, J.F. and D.H.; Writing: original dr...
PMC9859399
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Bolzano, Italy (reference number 18-2019, 14 March 2019). This article corresponds to the Consort Statement 2010 [
PMC9859399
Informed Consent Statement
Informed consent was obtained from all participants for this study.
PMC9859399
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
PMC9859399
Conflicts of Interest
The authors declare no conflict of interest. The funders had no role in the design of the study, the collection, analyses, or interpretation of data. Additionally, whether in the writing of the manuscript, nor in the decision to publish the results.
PMC9859399
References
tenderness
Study schedule [Study flowchart of included and excluded patients.Mean ± standard deviation of aerobic capacity for the female and male subgroups on days 0, 7 and 60 (forest therapy vs. mountain hiking).Sample size simulation based on data of the ANKER-Study. Upper graphic shows the comparison of the two intervention g...
PMC9859399
Purpose
pneumonitis, toxicities, toxicity, testicular cancer
PNEUMONITIS, TESTICULAR CANCER, THROMBOEMBOLIC EVENT
Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer ...
PMC10657310
Methods
vascular endothelial dysfunction
TESTICULAR CANCER
In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forc...
PMC10657310
Results
Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-gr...
PMC10657310
Conclusions
pulmonary and vascular damage
TESTICULAR CANCER
Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise inte...
PMC10657310
Trial registry
Cancer
CANCER
Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL:
PMC10657310
Supplementary Information
The online version contains supplementary material available at 10.1007/s00432-023-05469-5.
PMC10657310
Keywords
PMC10657310
Introduction
pulmonary toxicity, vascular endothelial dysfunction
TESTICULAR CANCER
The introduction of bleomycin, etoposide and cisplatin combination chemotherapy (BEP) has improved the long-term survival of patients with metastatic testicular cancer to more than 90% (Hanna and Einhorn Endothelial damage of the small vessels in the lung plays an important role in the development of bleomycin-induced ...
PMC10657310
Materials and methods
PMC10657310
Study design and participants
DER
This is an exploratory post hoc analysis of the multicenter, two-armed, randomized clinical ACT-trial. A detailed method description of the ACT-trial has been reported elsewhere (van der Schoot et al. Design of the tailored physical exercise intervention during or after BEP-chemotherapy
PMC10657310
Procedures
The intervention consisted of two components: 12 weeks of supervised exercise followed by 12 weeks home-based unsupervised exercise. The supervised exercise consisted of aerobic exercise training thrice a week, resistance exercise training twice a week and optionally once per week leisure sports game activities. The in...
PMC10657310
Outcomes
Patients visited the outpatient clinic before the start of chemotherapy, directly post-chemotherapy, post-intervention and 1-year post-intervention (Fig. Data on bleomycin pulmonary toxicity were recorded using the following classification (Nuver et al.
PMC10657310
Sample size and statistical analysis
Descriptive statistics were used to analyse patient characteristics.Intention-to-treat linear mixed model analyses were performed for within-group and between-group differences at three timepoints—directly post-chemotherapy, post-intervention and 1-year post-intervention and were adjusted for baseline values. We calcul...
PMC10657310
Discussion
testicular cancer, fatigue, pulmonary toxicity, vascular endothelial dysfunction
ENDOTHELIAL DYSFUNCTION, ADVERSE EVENTS, EVENT, EVENTS, ADVERSE EFFECTS, TESTICULAR CANCER, INFLAMMATORY RESPONSE
In this exploratory subgroup analysis of the ACT-trial, we found beneficial effects of a physical exercise intervention initiated during compared to after BEP-chemotherapy on pulmonary function parameters and markers of endothelial dysfunction in patients with metastatic testicular cancer. We found statistically signif...
PMC10657310
Conclusion
toxicity, testicular cancer
TESTICULAR CANCER, EVENT, EVENTS
In this explorative analysis, patients who started the exercise intervention during BEP-chemotherapy better preserved their pulmonary function (DLCO, FVC), measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in factor VIII and vWF, measured directly post-chemo...
PMC10657310
Acknowledgements
Cancer
CANCER
The authors would like to thank all participating patients, oncologists, research staff, and physical therapists. Also, we would like to thank the Dutch Cancer Society, Alpe d’HuZes (Grant number: DCS 2011-5265) and the MD-PhD program provided by the Junior Scientific Master class at the UMCG, the Netherlands, for maki...
PMC10657310
Author contributions
Conceptualization: AMEW, JAG. Data curation: GGFvdS, HLO, AMEW. Formal analysis: GGFvdS, HLO, AMEW, AMM. Funding acquisition: AMEW, JAG, GGFvdS. Investigation: AMEW, JAG, GGFvdS, HLO. Methodology: GGFvdS, HLO, AMEW, JAG. Project administration: GGFvdS, HLO, NLW. Resources: AMEW, NLW. Software: HLO. Supervision: AMEW, J...
PMC10657310
Funding
Cancer
CANCER
This work was supported by the Dutch Cancer Society, Alpe d’HuZes (Grant number: DCS 2011–5265) and the Graduate School of Medical Sciences, University of Groningen. The study's funders had no role in the design, data collection, management, analysis, interpretation, report writing and decision to submit the manuscript...
PMC10657310
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
PMC10657310
Declarations
PMC10657310
Conflict of interest
Cancer
CANCER
The authors declare the following financial interest/personal relationships which may be considered as potential competing interests: dr. A.M.E. Walenkamp: Grant: Dutch Cancer Society (inst). Research funding: Abbvie (inst), BMS (inst), Genzyme (inst), Karyopharm Therapeutics (inst), Roche (inst). Consulting of advisor...
PMC10657310
Consent to participate
Written informed consent was obtained from all patients.
PMC10657310
References
PMC10657310
Objective
comorbidity, cognitive behavior, chronic diseases, depressive symptoms, Diabetes distress, T2DM, diabetes
TYPE 2 DIABETES MELLITUS, CHRONIC DISEASES, DIABETES
Diabetes distress typically causes depressive symptoms; common comorbidity of diabetes unpleasantly affects patients’ medical and psychological functions. Psychotherapeutic interventions are effective treatments to treat depressive symptoms and to improve the quality of life in many chronic diseases including diabetes....
PMC9896442
Materials and Methods
T2DM
A total of 130 diagnosed patients with T2DM were taken from outdoor patients services of different hospitals in Faisalabad. Ninety patients met the eligibility criteria and were randomly assigned to experimental (
PMC9896442
Results
diabetes distress
The findings indicated that patients who received CBT got a significant reduction in their diabetes distress F(1,60) = 222.710,
PMC9896442
Conclusion
anxiety, cognitive behavior, diabetes distress, depressive symptoms
It is concluded that cognitive behavior therapy is an effective and promising intervention for depressive symptoms, diabetes distress, and health anxiety which also helps the person to promote quality of life, treatment adherence and physical activity.
PMC9896442
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-023-04546-w.
PMC9896442
Keywords
PMC9896442
Introduction
death, guilt, anxiety, depression, diabetes mellitus, depressive symptoms, psychological disturbance, metabolic disease, Diabetes, accompanies emotional disturbances, T2DM, diabetes distress, diabetes
DIABETES MELLITUS, METABOLIC DISEASE, DIABETES, TYPE 2 DIABETES, DIABETES
Diabetes or diabetes mellitus is a metabolic disease that interferes with the human body’s ability to process and absorb glucose. It is the seventh leading cause of death, and about 422 million people live with diabetes worldwide (WHO 2020). The current scenario estimates that it will rise by 25% within 10 years to 454...
PMC9896442
Research design and methods
PMC9896442
Study design
T2DM
The current research is a prospective randomized control trial (RCT) in which we assessed the effectiveness of CBT using EXP and WLC conditions with T2DM patients using pre-and post-test measures. Outcome measures were obtained at the baseline and post-interventions. The participants were taken from different public an...
PMC9896442
Participants
Type II Diabetes Mellitus, T2DM
TYPE II DIABETES MELLITUS
Consultant medical doctors first diagnosed patients with T2DM after evaluating them using medical evaluations from reliable laboratories (i.e., Agha Khan University Laboratories & Shaukat Khanum Memorial Trust Laboratories) at outpatient settings of different hospitals. and. Then the diagnosed participants were referre...
PMC9896442
Inclusion and exclusion criteria
anxiety disorder, physical/head injury, Diabetes Mellitus, depressive disorder, mood disorder, depressive symptoms, T2DM
DIABETES MELLITUS, DIABETES MELLITUS, PHYSICAL DISABILITY
In this RCT, people diagnosed with Type-II Diabetes Mellitus (T2DM) availing outpatient treatment facilities under consultant practitioners in different hospitals of Faisalabad were recruited. Participants who achieved mean item score of 3 or above (moderate distress) on DDS and were belonging to mild depressive sympto...
PMC9896442