Effects of Buerger Exercise Combined Health-Promoting Program on Peripheral Neurovasculopathy Among Community Residents at High Risk for Diabetic Foot Ulceration.

BACKGROUND: Peripheral neuropathy and vasculopathy are important risk factors for diabetic foot ulceration (DFU). Buerger exercises for patients with arterial occlusive disease have previously been noted; however, current evidence to support this intervention is limited. AIM: We established a standardized procedure for Buerger exercises combined with a health-promoting program and investigated its effectiveness in reducing peripheral neurovasculopathy among rural Taiwanese residents with type 2 diabetes who were at high risk of developing DFU. METHODS: A one group quasi-experimental pretest-posttest design was used. The Buerger exercise protocol composed of a three-step posture change with 9 minutes for each cycle. The health-promoting program composed of six dimensions of healthy habits. Outcome measurements 1 year after the beginning of the intervention included the ankle brachial pressure index (ABI), the Michigan neuropathy screening instrument (MNSI), blood pressure, frequency of self-reported leg discomfort, and a type 2 Diabetes Health Promoting Score. FINDINGS: Thirty-one of 66 (47%) subjects completed this study. Buerger exercises combined with the health-promoting program significantly improved (a) the ABI in the legs, (b) health-promoting behaviors, (c) MNSI values, and (d) leg discomfort symptoms. LINKING EVIDENCE TO ACTION: This study supports the use of Buerger exercises combined with the health-promoting program to improve symptoms of peripheral neuropathy and peripheral circulation in patients with type 2 diabetes.

Insufficient early detection of peripheral neurovasculopathy and associated factors in rural diabetes residents of Taiwan: a cross-sectional study.

BACKGROUND: Diabetic peripheral neuropathy (PN) and peripheral vasculopathy (PV) are major causes of foot ulcers in patients with diabetes. The early detection of PN/PV with appropriate health counseling is the best strategy for preventing foot lesions. The objective of this study is to examine the prevalence and associated risk factors of PN/PV among rural community residents with type 2 diabetes mellitus (T2DM). METHODS: This cross-sectional descriptive study was conducted in Taiwan from February to October 2012. Type 2 diabetes mellitus and health promotion scale, Michigan neuropathy screening instrument, and ankle-brachial pressure index values were measured. RESULTS: A total of 404 (55% women) participated in and completed the program. The overall prevalence of PN and PV was 34.5 and 17.1%, respectively. The majority of the participants (90%) did not receive early PN/PV detection by health care providers. After adjustment for the potential confounding factors, multivariate analysis indicated that the factors determining PN/PV were age (P <0.001), living around sea coastal regions (P <0.001), high HbA1C level (P <0.01), and fewer regular health-promoting behaviors (P <0.01). CONCLUSION: There was a high prevalence of PN/PV among rural T2DM residents who received insufficient early detection. The early detection of PN/PV and provision of health education with customized health-promoting behaviors of people with diabetes in the rural community are important issues.

Depression and Its Associated Factors Among Rural Diabetic Residents.

BACKGROUND: Type 2 diabetes is a huge burden both for individuals and society as a whole. Although depression has been negatively associated with ideal glycemic control, little is known about the prevalence of depression or its associated factors among rural Taiwanese adults with Type 2 diabetes mellitus (type2 DM). PURPOSE: The purposes of this study were to investigate the prevalence of depression in rural-dwelling sufferers of type2 DM and to highlight the relationships between their depression status and health promoting behaviors such as physical activity, keeping active in life, sleep sufficiency, and adopting a diabetic diet. METHODS: A cross-sectional, correlational design was used to recruit 696 participants from local healthcare centers in rural areas of Chiayi County, Taiwan. Data were collected from March 30, 2010, to August 30, 2012. The Chinese version of the Geriatric Depression Scale and its associated physiological biomarkers were used as screening tools. Logistic regression was used to identify the factors that were associated with depression status. RESULTS: The prevalence of depression in this study was 16.8%. Factors found to be associated with depression included being female, having a low level of education, receiving reduced family support, having little physical activity, failing to follow a diabetic diet, frequent inactivity, and having insufficient sleep. There were no significant differences in the physiological indicators between the depressive and nondepressive groups. After controlling for confounding factors, a logistic regression model showed that depression status was associated with a lack of sleep (OR = 2.85, p < .001), less frequent exercise (OR = 2.67, p < .001), and frequent inactivity (OR = 2.35, p = .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study showed that the prevalence of depression among adults with type2 DM living in rural areas is relatively high. From the perspective of health promotion, future research should focus on how to improve quality of sleep by enhancing daily physical activity and on investigating the effect of promoting a more active lifestyle among those at risk on depression.

The relationship between geriatric depression and health-promoting behaviors among community-dwelling seniors.

BACKGROUND: People older than 65 years old account for about 10.9% of Taiwan's total population; it is also known that the older adults experience a higher incidence of depression. Public health nurses play an important role in promoting community health. Policymaking for community healthcare should reflect the relationship between health-promoting behavior and depression in community-dwelling seniors. Therefore, the encouragement of healthy aging requires strategic planning by those who provide health promotion services. OBJECTIVE: This study was designed to elicit the health-promoting behaviors of community seniors and investigate the relationship between geriatric depression and health-promoting behaviors among seniors who live in rural communities. METHODS: We used a cross-sectional, descriptive design and collected data using a demographic information datasheet, the Health Promotion for Seniors and Geriatric Depression Scale short forms. RESULTS: The study included 427 participants. Most were women; mean age was 75.8 years. Most were illiterate; roughly half engaged in a limited number of health-promoting activities. The Geriatric Depression Scale score was negatively associated with health-promoting behavior. Social participation, health responsibility, self-protection, active lifestyle, and total Health Promotion for Seniors score all reached statistical significance. Multivariate analysis indicated that geriatric depression and physical discomfort were independent predictors of health-promoting behavior after controlling the confounding factors. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Participants practiced less than the recommended level of health-promoting behaviors. We found a negative correlation between the geriatric depression score and health-promoting behavior. Results can be referenced to develop strategies to promote healthy aging in the community, especially with regard to promoting greater social participation and increased activity for community-dwelling older adults experiencing depression.