A randomized controlled trial to improve the quality of life of type 2 diabetic patients using a self-help group program.

The purpose of study was to determine the effect of a self-help group program on the quality of life among type 2 diabetic patients. The study subjects were type 2 diabetic patients attending one of six studied health centers or a community hospital in Saraburi Province, Thailand. At each health center/hospital, the patients were randomly allocated into the intervention group attending the self-help group program or the control group receiving diabetic services. Information was collected from September 2007 to April 2008 using a structured questionnaire with interview technique at baseline, 12 and 24 weeks. One hundred forty-six patients completed the program. Five self-help group programs carried out for 16 weeks gave instruction regarding building-up good relationships, improvement of knowledge about diabetes and skills for dietary control, skills in physical exercise, improvement of group structure, improvement of training skills for group leaders, self-monitoring, motivation in self-care activities and sharing experiences among group members. Descriptive statistics were used to provide basic information regarding the two groups. For analytical purposes the chi-square test and t-test were applied. The majority (77.4 %) of study participants were females. Most patients were either > or = 50 years old (52%) or 40-49 years old (37%). The intervention resulted in significantly higher scores in quality of life compared to controls at 12 and 24 weeks (p < 0.05). The findings indicate the program is effective for improving perceived quality of life. The program focused on enhancement of experience sharing among group members and participation in problem-solving. We recommend implementing this program for diabetic patients and patients with other chronic diseases at primary health care level.

Quality of life and compliance among type 2 diabetic patients.

A cross-sectional study was conducted to explore the quality of life (QOL) and compliance among type 2 diabetic patients in Saraburi Province, Thailand. Compliance was assessed by evaluating dietary intake and life style patterns useful for diabetes patients to maintain health and prevent complications of the disease. A multistage sampling technique was used for selecting patients from 2 districts (Wihan Daeng and Nong Don) and subjects were classified into 2 groups according to a quality of life (QOL) score (good = 70, poor to moderate = 94) using WHOQOL-BREF-THAI criteria. Data were collected from September to December 2007 using a self-administered questionnaire. Simple descriptive statistics were used to provide basic information about the two groups and for analytical purposes the chi-square test and multiple logistic regression were applied. The majority (78.7%) of study participants were females. Most patients belonged to the age groups of either > 50 years (50%) or 40-49 years (36.6%). Bivariate analysis revealed socio-demographic factors were not significantly associated with QOL (p > 0.05). As far as compliance was concerned dietary control and drug intake were significantly associated with QOL (p < 0.05). Multivariate analysis indicated that overall compliance was associated with QOL (OR = 1.91, 95% CI = 1.02-3.57). We conclude that good QOL is significantly related to good compliance. Therefore, diabetic patients should be made aware that following the suggestions to prevent side effects of the disease and trying to stay healthy despite suffering from the disease will significantly improve their QOL.

Low birth weight infants born to HIV-seropositive mothers and HIV-seronegative mothers in Chiang Rai, Thailand.

The low birth weight (LBW) infant has a much higher risk of mortality and morbidity in infancy and early childhood. This study examined the effects of maternal HIV infection and other risk factors for LBW (< 2,500 g). A retrospective study of mothers who delivered at Mae Chan Hospital from 1997 to 2002 was conducted. Logistic regression was used to adjust for confounding factors. There were 266 infants born to HIV-seropositive mothers and 5,872 infants born to HIV-negative mothers. Low birth weight was significantly associated with maternal HIV status, gestational age, antenatal care, maternal age less than 20 years, and > 35 years. Maternal HIV positive status, young maternal age and gestational age were significant factors after adjusting for potential confounders. No significant effect of hilltribe on LBW was found. The results underline the need for nutritional surveillance and dietary counseling. HIV-seropositive women must receive early and continuing antenatal care for good pregnancy outcomes.

Methylenetetrahydrofolate reductase (MTHFR) polymorphism (C677T) in relation to homocysteine concentration in overweight and obese Thais.

We analyzed the association between MTHFR (C677T) gene polymorphism with serum concentrations of homocysteine, folate, and vitamin B12 in 37 male and 112 female overweight/ obese Thai volunteers (BMI > or = 25.00 kg/m2), and compared them with 23 male and 90 female control subjects (BMI = 18.5-24.99 kg/m2). Statistically significant higher levels of serum homocysteine were found in the overweight/obese subjects than the control subjects (p < 0.05). Serum folic acid levels in the overweight/obese subjects were significantly lower than the control subjects (p < 0.05). When the data were grouped according to homocysteine concentration and MTHFR gene polymorphism, there were significantly higher homocysteine concentrations in the overweight/obese subjects than the control subjects in wild type gene polymorphism (CC) in the hyperhomocysteine group (homocysteine >10.0 mmol/l) (p < 0.05), but in genotype polymorphism (CC, CT, TT) there were lower folic acid and vitamin B12 concentrations in the overweight/obese subjects than in the control subjects. In the hyperhomocysteine groups, there was no significant difference in the frequencies of MTHFR (C677T) gene polymorphism between the overweight/obese subjects and the control subjects. Folic acid and gene polymorphism were found to be significantly related to the overweight/ obese and control groups in logistic regression analysis (p < 0.05). The results support the supposition that folic acid is more important than vitamin B12.

Serum copper, zinc, ceruloplasmin and superoxide dismutase in Thai overweight and obese.

The serum copper, selenium, ceruloplasmin, superoxide dismutase (SOD) (specific activities of antioxidant enzymes), anthropometric measurements, including waist/hip ratio 51 male and 190 female overweight subjects (body mass index (BMI) > or = 25.0 kg/m2) compared with a 26 male and 83 female control group (BMI = 18.5-24.9 kg/m2) Thai volunteers who attended the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok, for a physical check-up from March to October, 1998, were investigated. There was no age difference between the overweight group and the controls. All of the anthropometric variables, except the height of the overweight group, were significantly higher than those of the normal subjects. The medians of weight and waist/hip ratio of overweight and obese males were significantly higher than those of overweight and obese females. Serum ceruloplasmin, copper were statistically significantly higher in overweight subjects than in the controls. However, serum zinc and superoxide dismutase activity in the overweight group were found to be lower than in the control group. Higher serum ceruloplasmin, copper, zinc and superoxide dismutase activity were shown in the female overweight group than in the male overweight group. Ceruloplasmin was found to correlate positively with copper concentration but negatively related with superoxide dismutase enzyme activity. A negative correlation was found between serum copper and zinc concentrations in both sexes of the overweight and obese subjects. Low SOD activity found in the overweight and obese subjects might be caused by low zinc intake.

The effect of cigarette smoking on ceruloplasmin and C3 complement: risk of cardiovascular disease (atherosclerosis).

Serum ceruloplasmin, C3 complement and albumin in 119 male smokers and 65 male non-smoker; from a military unit in Bangkok were investigated in this study. The serum ceruloplasmin concentration was found to be significantly higher in smokers than in non-smokers. However, the serum albumin concentration in smokers was statistically significantly lower than in non-smokers. Significant associations were also found between ages, albumin levels and the quantity of cigarettes smoked. There was a significant positive correlation between serum ceruloplasmin and C3 complement concentrations. An association between the quantity of cigarettes smoked and albumin was also found, as well as a significant relationship between smoking and the quantities of cigarettes smoked to serum ceruloplasmin levels when smoking and the quantity of cigarettes smoked were taken as independent variables, and the serum ceruloplasmin levels as a dependent variable. This might suggest that high concentrations of the acute-phase protein, i.e. ceruloplasmin, might constitute a risk of developing atherosclerosis or cardiovascular disease in smokers.

B vitamins, vitamin C and hematological measurements in overweight and obese Thais in Bangkok.

The dynamic changes of socio-economics leading to the industrialisation of countries are known to affect lifestyle and nutritional behaviours of the population. Review of the literature on the prevalence of obesity showed increasing numbers of the overweight and obese during the past decade. However, information on health and nutritional status of the obese in Thailand has not been widely publicized. This study reveals the vitamin status and hematological picture in 270 overweight and obese Thais in Bangkok, Thailand, compared with 175 normal subjects. No statistically significant differences in haemoglobin and hematocrit were observed in the overweight compared with the control subjects. The prevalence of anaemia was 9.8 per cent among male and 17.2 per cent among female overweight and obese subjects compared with 2.6 per cent and 21.2 per cent in male and female normal controls using the cut-off point of haemoglobin concentration as an indicator of anaemia. Prevalence of hypertension was exhibited in both male and female overweight and obese subjects. Even if there were no statistically significant differences in vitamin B1, B2 and B6 in overweight and obese subjects compared with the controls, high percentages of vitamin C and vitamin B2 deficiencies were observed. Vitamin B2 deficiency was detected in 19.7 per cent of overweight and obese males as well as in 28.7 per cent of overweight and obese females using glutathione reductase activity coefficient (alpha EGR) < 1.5 as the cut-off point. However, clinical signs of vitamin B2 deficiencies were rare. There was also a high percentage of vitamin C (antioxidant vitamin) deficiency in 51.5 per cent of the overweight and obese subjects and 41.7 per cent of the controls, respectively. The results suggest more attention should be paid to health study and nutritional problems for the overweight and obese population, especially concerning vitamins and oxidative stress. Further research is still needed in these aspects.