A health-based coaching program for diabetes self-management (DSM) practice: A sequential exploratory mixed-method approach.

BACKGROUND: Diabetes self-management (DSM) is crucial for glycemic control among type-2 diabetic (T2D) people. METHOD: This was a sequential exploratory mixed-method approach to assess whether a health-based coaching program designed to fit the unmet needs of T2D was the best intervention for improving DSM practice. Twenty-eight participants from different backgrounds were involved in phase 1 (Qualitative study) to explore DSM knowledge and practice, any difficulties obstructing such knowledge and practice, and the feasibility of implementing an intervention program nationwide. Sixty patients were recruited for phase 2 (Quasi-experimental study). A health-based coaching program, constructed to fit the unmet needs from phase 1 was implemented among thirty patients in an experimental group. By comparison, 30 patients in the control group received their usual care. Diabetes and DSM knowledge, DSM practice, and health outcomes were measured and compared between the two groups at baseline and after the 12th week of the intervention. RESULTS: The following problems were found: (1) a low perception of susceptibility to and severity of illness, (2) inadequate DSM knowledge and skills, (3) a lack of motivation to perform DSM practice, and (4) social exclusion and feelings of embarrassment. After the implementation of the program among the experimental group, all the variables improved relative to baseline and to the control group. CONCLUSION: A health-based coaching program can improve DSM knowledge and practice and health outcomes. A nationwide program is recommended to promote DSM practice among Indonesian communities.

Barriers to Effective Diabetes Mellitus Self-Management (DMSM) Practice for Glycemic Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Socio Cultural Context of Indonesian Communities in West Sulawesi.

Diabetes mellitus self-management (DMSM) is an essential strategy used to maintain blood glucose levels and to prevent severe complications. Several barriers have been documented while implementing DMSM practices. A qualitative study aimed to explore barriers to effective DMSM practice among uncontrolled glycemic type 2 diabetes mellitus (T2DM) patients in Indonesia. We conducted in-depth interviews and focus group discussions (FGDs) among 28 key informants, including patients, family members, healthcare providers (HCPs), and village health volunteers (VHVs). The interviews and FGDs were audiotaped and transcribed verbatim. The results revealed six core themes with sub-categories of themes used by all participants to describe the barriers to effective DMSM practice among uncontrolled T2DM patients. The critical barriers of DMSM practice included low perception of susceptibility to and severity of the illness; inadequate knowledge and skill of diabetes mellitus self-management; lack of motivation to perform diabetes mellitus self-management; insufficient human resources; lack of social engagement; and social exclusion and feelings of embarrassment. Our findings provide valuable information regarding the barriers while implementing the DMSM practice. Healthcare providers should negotiate with both T2DM patients and caretakers to participate in a DMSM program at a community health care level.

Rate of Utilization of Skilled Birth Attendant and the Influencing Factors in an Urban Myanmar Population.

A survey study aimed at identifying rates and predictive factors on utilization of skilled birth attendant (SBA) among pregnant women. A stratified random sampling technique was used to select 200 Myanmar women aged 18 to 49 years in Kalay Township. Data were collected by interview questionnaire from March 1 to 15, 2012, and data were analyzed by frequency, percentage, mean and standard deviation, χ(2) test, and multiple logistic regression analysis. The utilization rate of SBA was 74%. Factors significantly predicting utilization of SBA (P < .05) were level of maternal and child health (MCH) knowledge, attitude toward SBA, and accessibility to MCH services. The women who had a moderate to good level of knowledge utilized SBA 2.7 times more than those who had a poor level of knowledge (odds ratio = 2.705, 95% confidence interval = 1.31-5.57). The women who had a positive attitude toward SBA utilized SBA 7.7 times more than those who had a negative attitude (odds ratio = 7.708, 95% confidence interval = 3.71-15.98). The women who had high accessibility to MCH services utilized SBA 1.4 times more than those who had low accessibility (odds ratio = 1.477, 95% confidence interval = 1.05-2.21). These factors were able to correctly predict utilization of SBA at 74.9%. MCH knowledge and information on utilization of SBA should be strengthened during every antenatal care visit to enhance positive attitude on utilization of SBA and to increase accessibility to MCH services by providing community antenatal care or home visits.

High prevalence of an anti-hypertriglyceridemic variant of the MLXIPL gene in Central Asia.

MLXIPL is a transcription factor integral to the regulation of glycolysis and lipogenesis in the liver. Common variants of the MLXIPL gene (MLXIPL) are known to influence plasma triglyceride levels in people of European descent. As MLXIPL has a key role in energy storage, genetic variations of the MLXIPL may be relevant to physiological adaptations to nutritional stresses that have occurred during the evolution of modern humans. In the present study, we assessed the phenotypic consequences of the Q241H variant of MLXIPL in populations of Asian and Oceanian origin and also surveyed the prevalence of Q241H variant in populations worldwide. Multiple linear regression models based on 2373 individuals of Asian origin showed that the H allele was significantly associated with decreased concentrations of plasma triglycerides (P=0.0003). Direct genotyping of 1455 individuals from Africa, Asia and Oceania showed that the triglyceride-lowering H allele was found at quite low frequencies (0.00-0.16) in most of the populations examined. The exceptions were some Central Asian populations, including Mongolians, Tibetans and Uyghurs, which exhibited much higher frequencies of the H allele (0.21-0.26). The high prevalence of the H allele in Central Asia implies that the Q241H variant of MLXIPL might have been significant for utilization of carbohydrates and fats in the common ancestors of these populations, who successfully adapted to the environment of Central Asia by relying on nomadic livestock herding.

Alcoholic beverages drinking among female students in a tourist province, Thailand.

This study aimed to investigate alcoholic beverages drinking and predictive factors among female students. The participants were 377 subjects from 3 high schools in a tourist province, of Thailand. Data collection was done through self-administered questionnaire. Scales of the questionnaire had reliability coefficients ranging from 0.84 - 0.88. The data were analyzed by using descriptive and inferential statistics. The findings revealed as follows. About half (51%) of them have ever drunk and 10.5% of drinkers have drunk once a week. In addition, 15.6% of drinkers began their first drink when they were under 10 years old. Risk factors for alcohol consumption of female student were age, GPA, drinker in family, peer pressure, advertisement and accessibility to alcoholic beverages while protective factors were perception of drinking impacts on family and moral values. Students who have a drinking family member were 4.6 times more likely to drink than those who do not have.

Factors influencing life happiness among elderly female in Rayong Province, Thailand.

OBJECTIVE: To study the factors influencing life happiness of elderly female in Rayong province, Thailand. MATERIAL AND METHOD: A cross-sectional survey research was conducted among 233 elderly female aged between 60-80 years using multi-stage random sampling. The data were collected from June 6th to July 31st 2008 by interviewing questionnaires. Data were analyzed by frequency, percentage, Pearson's product moment correlation coefficient and Stepwise multiple regression analysis. RESULTS: About half (50.2%) of the elderly female had moderate level of life happiness, followed by low level (27.1%) and high level (22.7%). The factors which significantly influenced the life happiness of the elderly female were self-esteem, social support, and family relationships (p < 0.05). In addition, self-esteem, social support, and family relationships could significantly predict life happiness of the elderly female by 91.4%. Self-esteem had the highest predictive power of life happiness among elderly female. CONCLUSION: The important factors influencing life happiness of elderly female were self-esteem, social support, and family relationships. To promote life happiness of elderly female, responsible organizations should establish activities that enhance the elderly female's self-esteem, provide sufficient social support, and promote good family relationships.

Quality of life and health promoting behaviors among disabled people in two provinces of Thailand.

OBJECTIVE: To examine health behaviors and quality of life among disabled people in two provinces of Thailand. MATERIAL AND METHOD: A cross-sectional study was conducted in 5,352 disabled people selected by multistage cluster sampling from Chiang Mai and Nakhon Ratchasima provinces during April to June 2008. The WHOQOL-BREF-THAI and health promoting behavior scales were used to measure QOL and health behavior. RESULTS: Among the health promoting behaviors, exercise and health responsibility of the disabled people were mostly at the 'need to improve' level (46.6 and 52.8%), while their nutritional behavior and stress management level were mostly at the 'good' level (80.8 and 43.8%). Overall quality of life was mostly at the 'moderate' level (79.3%). Exercise and stress management were found to have a significant positive relationship with the quality of life at low level (r = 0.18, r = 0.12) at p < 0.01. CONCLUSION: The results indicated that person who had health promoting behaviors by exercise and appropriate stress management had a good QOL. Encouraging of family and health authority support in exercise and stress management may help them having a good QOL.

Diversity in genes responsible for lifestyle-related diseases in Asia-Pacific region.

In Asia-Pacific countries, both environmental modernization and hereditary traits of Mongoloid reported to cause rapid increase in lifestyle-related diseases (LRD). However, reproducibility of reported responsive-factors is low. To examine this, a decision-tree method of complexity-model was applied to select LRD-responsive-factors. Genomic DNA was collected from Asia-Pacific regions. Single nucleotide polymorphisms (SNPs) on genomic DNA were determined as hereditary-trait-factor. Three indices of LRD (BMI, body fat, and serum leptin levels) were classified according to published criteria. WEKA Machine-learning system was used as decision-tree software. Age was added as a factor with different dimension. Selected factors were validated by other statistical methods. In Thai-males, GLUT) (glucose-transporter 1)-SNP was most-responsive to body fat, followed by USF1-SNP (transcription-factor for lipid metabolism). Differences between genotypes were validated (P = .002 for GLUT1 by Levene's, P = .071 for USF1 by ANOVA). Responsive-factors of Thai-females, Palau-males and Palau-females, were consisted with SNPs and age, and varied by groups. Convincing responsive-factors were not selected from mixed-data. Decision-tree-analysis successfully selected the convincing results. Responsive-factors differed by ethnic group and gender.

Self-esteem of the elderly in rural areas of Nakhon Sawan Province.

OBJECTIVE: Study self-esteem of the elderly and factors related. MATERIAL AND METHOD: A cross-sectional survey of two hundred and seventy elderly, aged 60 or above in rural areas of Nakhon Sawan Province. The data were collected by interview questionnaire from May 12 to May 25, 2003. Statistics used for data analysis were frequency, percentage, mean, standard deviation, Pearson product moment correlation coefficient, and Stepwise multiple regression. RESULTS: More than half of the elderly (65.6%) had a moderate level of self-esteem, followed by a low level (19.3%) and a high level (15.1%). The factors that were statistically significant related to self-esteem of the elderly (p-value < 0.05) were monthly income, activities of daily living, personality, participation in family activities, participation in social activities, and social support. In addition, social support, participation in social activities, personality, and participation in family activities could significantly predict self-esteem of the elderly by 58.2%. The factor with highest predictive power of self-esteem was social support. CONCLUSION: Elderly should be encouraged to participate in family and social activities. The level of social support should be high enough for the elderly to maintain their self-esteem so that they can have live happily without burden to family and society.

A survey of life-style diseases of inhabitants of Thailand.

To elucidate the way to prevent lifestyle-related diseases, such as diabetes mellitus and hypertension, in Asian countries, a comparative study between Mongoloids was conducted at Palau, in Oceania, the Republic of China, Thailand, Mongolia and Japan, from 1998 to October 2002. The survey comprised a social survey, nutrition survey, physical and medical examinations, biomedical analyses, urinalyses, and DNA analyses. This is an interim report for Thailand.