Glycemic Self Control in Type 2 Diabetes Mellitus Patients

Abstract Glycemic Self Control in Type 2 Diabetes Mellitus Patients Wisit                    Chaveepojnkamjorn        DVM, MPH* Natchaporn        Pichainarong                     DrPH* Muhsin                 Thabirauta                          MPH** *Department of Epidemiology, Faculty of Public Health, Mahidol University **Nursing Academy, Health Department, Banda Aceh, Indonesia Objective: To study factors of knowledge, self care and social support affecting the glycemic control in type 2 diabetes mellitus patients. Study design: Cross-sectional descriptive study. Setting: Diabetes Clinic, BMA Medical College and Vajira Hospital. Subjects: Two hundred and fifteen type 2 diabetes mellitus patients who attended the Diabetes Clinic, BMA Medical College and Vajira Hospital from January to February 2001 were divided into glycemic control group and non control group. Methods: Data were collected by questionnaires which comprised five parts: part 1 general characteristics including demography and socio-economy, part 2 knowledge of diabetes, part 3 self care, part 4 social support, and part 5 fasting blood glucose result. The obtained data were analyzed by statistical program. Main outcome measures: Mean and standard deviation of knowledge, self care and social support factors. Results: The average knowledge of diabetes was in high level (\> 80%) while the average self care and social support were in moderate level. Both groups were similar in general except gender (p=0.047), monthly family income (p=0.017) and marital status (p=0.012). Knowledge of diabetes, self care and social support were compared between groups of FBS control and group of disable FBS control. The result revealed that knowledge of diabetes in the aspect of prevention and an overview of the former group was better than the latter one (p = 0.006 and 0.013 respectively). However the average of knowledge in cause, sign and symptom, and treatment and self care in food, exercise, and drug of the former group were higher than the latter one. Conclusion: Knowledge of diabetes mellitus in both groups was in high level. However, the knowledge of prevention in fasting blood sugar control group was statistically higher than the other while self care and social support were in moderate level in both groups. Key words: diabetes mellitus, type 2, self controlVajira Med J 2002 ; 46 : 125 - 133

Maternal Size and the Development of Pregnancy-induced Hypertension

Abstract Maternal Size and the Development of Pregnancy-induced Hypertension Wisit                Chaveepojnkamjorn   DVM, MPH Natchaporn    Pichainarong                DrPH Department of Epidemiology, Faculty of Public Health, Mahidol University Objective:  To study the relation between maternal size and the development of pregnancy-induced hypertension (PIH) Study design:  Prospective cohort study. Setting:  Four Maternal and Child Hospital (Ratchaburi, Khon Kaen, Yala and NaKhon Sawan ) and Rajvithi Hospital. Subjects:  Two thousand and three hundred pregnant women who attended prenatal services and delivered at 4 Maternal and Child Hospital and Rajvithi Hospital during 9 months between 1st July 1995 and  31st March 1996. Methods: Data were collected by questionnaires, record forms and medical instruments which comprised 3 parts: part 1 general characteristics including demography and socio-economy, part 2 specific information including gestational age, history of illness during pregnancy, and part 3 measurement data including body weight, height, blood pressure etc, The obtained data were analyzed by statistical program. Main outcome measures: Mean and standard deviation of body mass index (BMA) before pregnancy and delivery, weight gain during gestational age and infant birth weight. Results:  Group of BMI \< 23 kg/m2 before pregnancy had the proportion of PIH higher than those of BMI \< 21 kg/m2 and 21-23 kg/m2 (p \< 0.001, p = 0.001 respectively).  Group of weight gain during pregnancy \> 16 kg had the proportion of PIH higher than those of \< 12 kg and 12-16 kg (p \< 0.001 in both groups).  Group of BMI at delivery  25 kg/m2 had the proportion of PIH higher than group of BMI \< 25 kg/m2 (p \< 0.001), and infant birth weight group of lesser than 2,800 g had the proportion of PIH higher than those of  3,000 g and 2,801-2,999 g (p \< 0.001 in both groups). In the aspect of PIH status, the results revealed that the average figures of BMI before pregnancy and during the following delivery, and weight gain during gestational age in the PIH group were higher than the non-PIH group (P \< 0.001).  On the reverse association, mean of birth weight in the PIH group was lesser than the latter one. Conclusion: Pregnant women of BMI \> 23 kg/m2 before pregnancy and weight gain \> 16 kg had chance more likely to develop PIH than other groups. Therefore, controlling of body weight before and during pregnancy was the essential measure to decrease the occurrence of PIH. Key words: maternal size, pregnancy-induced hypertension, birth weightVajira Med J 2003 ; 47 : 47 - 55

Maternal Weight Gain and the Occurrence of Low Birth Weight

Abstract Maternal Weight Gain and the Occurrence of Low Birth Weight Wisit             Chaveepojorn DVM, MPH Natchaporn    Pichainarong  DrPH Department of Epidemiology, Faculty of Public Health, Mahidol University Objective:  To study the relation between maternal weight gain during pregnancy and the occurrence of infant low birth weight. Study design:    Prospective cohort study. Subjects:  Two thousand and three hundred pregnant women who attended prenatal services and delivered at 4 Maternal and Child Hospitals and Rajvithi Hospital during 9 months between 1st July 1995 and  31st March 1996. Methods:  Data were collected by questionnaires, record forms and medical instruments which comprised 3 parts: part 1 general characteristics including demography and socio-economy, part 2 specific information including gestational age, history of illness during pregnancy, and part 3 measurement data including body weight, height, blood pressure etc.  The obtained data were analyzed by statistical program. Main outcome measures: Mean and standard deviation of body mass index before pregnancy and delivery, weigh gain during gestational age and infant birth weight. Results: Group of weight gain during pregnancy \< 12 kg had the proportion of LBW higher than groups of 12-16 kg and \> 16 kg (p = 0.012, p = 0.025).  The average of weight gain in LBW group was less than the other one (p \< 0.001).  Group of BMA at delivery \< 25 kg/m2 had the proportion of LBW higher than group of BMI ≥ 25 kg/m2 (p = 0.001). Group of being pregnancy-induced hypertension and group of pre-term birth had the proportion of LBW higher than group of none (p \< 0.001, p = 0.001). Conclusion:  Pregnant women of weight gain \< 12 kg and BMA at delivery \< 25 kg/m2 had chance more likely to develop LBW than other groups.  Therefore, appropriate control of body weight during pregnancy was the essential measure to decrease the occurrence of LBW Key word:  maternal weight gain, low birth weightVajira Med J 2003 ; 47 : 123 - 131

Factors Associaed with Diabetic Retinopathy in Type 2 Diabetes

Abstract Factors Associaed with Diabetic Retinopathy in Type 2 Diabetes Supatra             Chaikaew                             BNS, MSc (Public Health)* Natchaporn      Pichainarong                      DrPH (Epidemiology)** Wisit                  Chaveepojnkamjorn         DVM, MPH** Piangchan        Rojanavipart                       MHS (Biostatistics)*** Petch                 Rawdaree                            MD,MSc (Epidemiology)****       * Amnatchareon Hospital     ** Department of Epidemiology, Faculty of Public Health, Mahidol University   *** Department of Biostatistic, Biostatic, Faculty of Public Health, Mahidol University **** Department of Medicine, BMA Medical college and Vajira HospItal   Objective: To determine factors associated with diabetic retinopathy in type 2 diabetes. Study design: Hospital based case-control study. Setting: Diabetes Clinic, BMA Medical college and Vajira Hospital from May 2003 to September 2003. Subjects: Two hundred and sixty type 2 diabetes mellitus. One hundred and thirty patients with diabetic retinopathy were     case and 130 patients without diabetic retinopathy were control. Methods: Data were collected from medical record and interview questionnaire. It is divided into 3 sections: Information from interview; part 1 general information including demography and socio-economy, part 2 illness factors, part 3 laboratory data which was obtained from medical record. The obtained data were analyzed by statistical program. Main outcome measures: Odds ratio and 95% CI of odds ratio of hyperglycemia, hypertension, type of therapy, smoking, (Body mass index : BMI), age at onset, alcohol consumption, dyslipidemia and duration of diabetes. Results: There were only five variable that were significantly associated with diabetic retinopathy. After adjusting the effect of each variables, the magnitude of association between each variables and diabetic retinopathy were fasting plasma glucose (FPG) between 161-180 mg/dl and \>180 mg/dl (OR=3.82, 95% CI 1.02-14.24 and OR=5.98, 95% CI 1.66-21.56), HbA1c \>9%(OR=4.09, 95% CI 1.69-9.92), hypertension (OR=5.00, 95% CI 2.64-9.46), systolic blood pressure between 140-159 mmHg and 160 mmHg (OR=3.22, 95% CI 1.50-6.88 and OR=9.98, 95% CI 1.38-58.41) and BMI between 23-24.9, 25-29 and 30 kg/m (OR=0.20, 95% CI 0.08-0.49, OR=0.36, 95% CI 0.16-0.83 and OR=0.10, 95% CI 0.03-0.32) respectively. Other variables consisted of diastolic blood pressure, cholesterol, triglyceride, type of therapy, age at onset duration of diabetes, smoking and alcohol consumption did not show significant association with diabetic retinopathy. Conclusion: The factors found to be significantly associated with diabetic retinopathy were FPG, HbA1c, BMI, hypertension and systolic blood pressure. Key words: Type 2 diabetes, diabetic retinopathy, risk factors Vajira Med J 2004 ; 48 : 97 - 106

The Effectiveness of Teaching Patterns, Emphasizing Student Center Management Technique for Sex Education Course of Enrolled Students at Mahasarakham University

This quasi-experimental research aimed to evaluate sexual attitude, self perception of sexual behavior and effectiveness learning process of students who enrolled and studied in sex-education and family life preparation course (SFLP) in Mahasarakham University. The student samples were simple random sampling and divided into two groups such as experiment group (100 students) and control group (100 students) and the learning method in experimental group was integrative teaching with student center orientation while conventional teaching orientation in controlled group. The data were collected by using questionnaire and observing. The percentage, mean, standard deviation, independent sample t-test and pair sample t-test were applied for statistic used.Results found that: both experimental groups and control group are similar in sex and the average age of 19 years. Most of them who enrolled in SFLP achievement learning (GPAX) are moderate level (experimental group 63.0%, and control group 74%). The average difference achievement learning score after intervention found a statistical significant difference (p \< 0.001). Most of students have self perception on attitude, such as a female should remain a virgin until her wedding (experimental group 57.0% and control group 62.0%), sexual relationship during adolescence lead to parent’s disappointment (experimental group 57.0% and control group 61.0%), and better sexual relationship occurs when older than this (experimental group 42.0% and control group 44.0%). The sexual nude book is interesting (experimental group 42.0% and control group 44.0%), sexual arousal (experimental group 28.0% and control group 26.0%) and imitation were initialized by male adolescence and sexual intercourse decision (experimental group 25.0% and control group 23.0%). The perception for sexual behavior both male (73.4%) and female (75.0%) agree with their parents are the major role model for sexual adolescence explicit behavior such as having lover partnership (female 64.1%, male 62.5%) be normally behavior and get more opportunity for sexual behavior with other at entertainment and internet places (female 54.7%, male 38.8%). Loving couple should have sexual intercourse on Valentine’s Day (female 34.4%, male 19.4% ) and also be homosexual (female 60.1%, male 38.9%). The attitude level of students for teaching in this subject found that: the student center learning method let them open opportunity for more discussion (level good in experimental group 39% and control group 38%) and share experience about sexual theme. The appropriate sexual media (level good in experimental group 50% control group 26%) had mutual inclusion on sexual context and linkage knowledge and experience or virtual experience and student can get more skill on human sex (level good in experimental group 36% control group 37%).The conclusion of the student center learning method management in SFLP gives more learning participatory, knowledge and attitude also right sexual skill perception.

Emergency Contraceptive Pill Use Among Female Adolescents

This cross-sectional analytic study was conducted among 1,434 female teenage students at educational institute in Mahasarakham Province and aimed to study emergency contraceptive pills (ECPs) use and determine the relationship among related factors and the emergency contraceptive pills use. Data were collected using interview questionnaire. Statistical analysis such as frequency, percentage, Chi-square, Odds Ratio and multiple logistic regressions were used. The results revealed that the 65.06% of the teenagers had heard of emergency contraceptive pills (ECPs). The majority of them were between 19-22 years (64.52%), and 27.26% had experience of using ECPs. Most of them received information from friends (63.99%). One third of their friends or known persons (35.69%) had previously used ECPs. There were some common misperception among the subjects, i.e., 38.48% believed that emergency contraceptive pills could prevent pregnancy, 100%, and 56.06% believed that ECPs could prevent pregnancy with the same efficacy as oral contraceptive pills. Pills were always used when having intercourse for 58.30% with the average of 3.45 tablets/month. About 41.70% used ECPs because it is easy to purchase. The highest pills used came from friends advice (78.38%). More than half (56.37%) arrange ready pills before having sexual intercourse, only ECPs used 40.54%. Multiple logistic regression analysis indicated that pill cost and friends or known persons having previously used ECPs were significantly associated with emergency contraceptive pills used (p \< 0.05). The more increase in age the more association of those variables with emergency contraceptive pills used increased.It can be concluded that ECPs have the highest usage among teenagers. ECPs are easy to purchase, and buyers have been influenced by their friends who suggest pills usage. In addition teenagers still have misunderstandings about ECPs utilisation. So, it is necessary to give them the correct information by the responsible organizations.

Self-Esteem and Drinking Refusal Self-Efficacy among Upper Secondary School Students with Hazardous Alcohol Consumption

The objective of this research was to study self-esteem and drinking refusal self-efficacy related to hazardous alcohol consumption among upper-secondary school students. Eight hundred and fifty upper-secondary school students from Amphoe Muang, Nakhon Ratchasima Province were classified into 2 groups according to hazardous drinking (yes=107, no=743). Data were collected by questionnaires which comprised 4 parts: part 1 general characteristics, part 2 the Alcohol Use Disorders Identification Test (AUDIT), part 3 The Rosenberg Self-Esteem Questionnaire, and part 4 The Drinking Refusal Self-Efficacy Questionnaire. The obtained data were analyzed by using descriptive statistics and analytic statistics by computerized statistical package. The results revealed the percent of student’s hazardous drinking was 12.6%. Demographic factors related to hazardous drinking were age, gender and Grade Point Average (p \< 0.05). In addtion, factors of self-esteem and drinking refusal self-efficacy associated with hazardous alcohol consumption (p \< 0.001). Therefore, Evaluation of self-esteem and drinking refusal self-efficacy are the tools for surveillance of alcohol risk groups.

The Relationship of Serum Resistin Concentration and Body Mass Index (BMI) of Obese Adolescent in Mahasarakam Province

Resistin is a newly discovered peptide hormone with impact on insulin sensitivity was proposed as a new mechanism to explain the pathogenic sequence of adipocyte-obesity-insulin resistance. This research aimed to determine serum resistin concentration levels in adolescents and the relationship between resistin concentration and body mass index (BMI), in selected high school students in Mahasarakam province. The research protocol and 77 consented students who enrolled in this study were ethical approved by Mahasarakam research ethic committee division. The students weight, height, BMI, fasting blood sugar (FBS) and triglyceride (TG) were examined during March to June 2008. This study found that: 16 male and 61 female adolescent students with average weight 71.27±13.87 kg, height 1.6±0.07 m, BMI 27.67±4.24 kg/m² , biceps skinfold thickness 15.27±6.89 mm, triceps skinfold thickness 23.55±7.54 mm, TG 77.13±43.92 mg/dL, FBS 87.74±8.21 mg/dL and resistin 5.69±0.93 mg/dL. The weight and height of male is higher than female (p =0.003, p \< 0.001 respectively), but biceps skinfold thickness, triceps skinfold thickness, TG of female is higher than male. Resistin was detected in female; concentrations ranged from 3.83 mg/dL to 7.82 mg/dL and in male 3.91 mg/dL to 6.52 mg/dL. In female resistin levels were higher (5.87±0.84) than male (4.98±0.94) (p \< 0.001). The relationship analysis found that: resistin serum levels in both male and female related to BMI, biceps skinfold thickness, triceps skinfold thickness statistical significantly. The furthermore it should be the parameter used as association of serum resistin with markers of obesity (eg. weight, BMI, FBS) was strongly statistical significantly (p \< 0.05) in both gender groups, this may be determinant to indicated insulin resistance prior fasting blood sugar was elevated, but vise-versa for FBS in male.