BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality ...BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.展开更多
Current research into the supply chain coordination problem of product quality focuses mainly on the two-echelon supply chain,and most coordination models neglect the demand relationship between quantity and quality.E...Current research into the supply chain coordination problem of product quality focuses mainly on the two-echelon supply chain,and most coordination models neglect the demand relationship between quantity and quality.Even in a direct sale pattern,an agrifood supply chain involves at least four actors,and the contract between different actors may be different.Here,we present a four-echelon agri-food supply chain that consists of one agricultural producer,one processing enterprise,one distributor,and many consumers.We also analyze the quality decision of each actor based on Stackelberg game theory and develop a combined multiple strategy(profit sharing,quality commitment,and risk sharing)for coordinating quality control in the agri-food supply chain.The results show that these strategies affect quality control at the level of the processing enterprise;however,only the profit-sharing strategy and a quality commitment to consumers affect the product quality from agricultural producers.Product quality is not associated with the profit-sharing contract between the processing enterprise and the distributor.Thus,the quality commitment to consumers is the only way for a processing enterprise to control the food market price.Furthermore,enforcing and enhancing this quality commitment to consumers by the processing enterprise will improve the quality of primary agricultural products and food.展开更多
基金The Preventive Medicine Research Projects of Jiangsu Province Health Department,No.Y2015010 and No.Y2018016The Science and Technology projects of Xuzhou city,No.KC15SM046the Youth Medical Talent Project of“Ke Jiao Qiang Wei Projects”in Jiangsu Province,No.QNRC2016375.
文摘BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.
文摘Current research into the supply chain coordination problem of product quality focuses mainly on the two-echelon supply chain,and most coordination models neglect the demand relationship between quantity and quality.Even in a direct sale pattern,an agrifood supply chain involves at least four actors,and the contract between different actors may be different.Here,we present a four-echelon agri-food supply chain that consists of one agricultural producer,one processing enterprise,one distributor,and many consumers.We also analyze the quality decision of each actor based on Stackelberg game theory and develop a combined multiple strategy(profit sharing,quality commitment,and risk sharing)for coordinating quality control in the agri-food supply chain.The results show that these strategies affect quality control at the level of the processing enterprise;however,only the profit-sharing strategy and a quality commitment to consumers affect the product quality from agricultural producers.Product quality is not associated with the profit-sharing contract between the processing enterprise and the distributor.Thus,the quality commitment to consumers is the only way for a processing enterprise to control the food market price.Furthermore,enforcing and enhancing this quality commitment to consumers by the processing enterprise will improve the quality of primary agricultural products and food.
