Effectiveness of a health promotion programme for farmers and fishermen with type-2 diabetes in Taiwan.

AIMS: This paper is a report of a study examining the diabetes control and foot self-care capability in farmers and fishermen following introduction of a multi-stage, multi-disciplinary team and community-based small group health promotion programme. BACKGROUND: Improving the control of diabetes is a critical issue in Taiwan because mortality rates are increasing dramatically, particularly in rural populations. METHODS: A quasi-experimental research design was deployed from January to December 2009. A total of 387 participants living in nine rural districts with previous diagnoses of type-2 diabetes were randomly selected. Three hundred and twenty-three completed the 3-stage programme, including health assessment, health promotion education and individually tailored telephone counselling and evaluation over a 1-year period. RESULTS: Most of the participants were fishermen or farmers who had <6 years of education (79%) and were elders (68·9 ± 9·5 years). Most of the physiological variables and foot self-care capabilities showed statistically significant improvement after the programme. Furthermore, 37 participants with severe high risk of diabetic foot accepted additional referral treatments, and their peripheral nerve and vascular functions improved. CONCLUSION: The research outcomes support the value of community-based health promotion programmes in rural areas, incorporating a multidisciplinary health team and culturally competent materials to help the elder rural inhabitants with diabetes enjoy better health and quality of life.

Health status and health-related behaviors among type 2 diabetes community residents.

BACKGROUND: The standardized mortality rate of type 2 diabetes is higher in Taiwan than that in other developed countries. In Taiwan, the diabetes mortality rate in Chiayi County is the highest nationwide. PURPOSE: This study was designed to explore the health status (to measure six physiological indicators), the health-related behaviors, and the associated factors among type 2 diabetes sufferers living in rural communities. METHODS: Researchers used a cross-sectional, correlation design and conducted the study at nine local health districts in Chiayi County, Taiwan. A total of 387 participants previously diagnosed with type 2 diabetes were randomly selected and invited to join in the program. RESULTS: Fifty-nine percent of participants were women; their mean age was 68.7 years, and their mean duration with diabetes was 7.9 years. Most were treated at local health centers and took oral medications (90.7%). More than 40% did not exercise regularly and 33.9% did not practice diet control. Results found a higher percentage of abnormal health indicators in terms of participant body mass index, waist circumference, HbA1C, and peripheral neurovascular function. After controlling for potential confounding factors, researchers found smaller waist circumference, participating in community support groups, better foot self-care capability, and frequent exercise to be associated with better health indicators. Diabetes duration, lower education, and being of male gender were found to be negatively associated with health status. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study found that rural residents with diabetes do not adequately control their diabetes and exhibit inadequate health-related behavior. Joining community support groups, increasing exercise frequencies, and improving foot self-care capabilities should be employed in nursing strategies and health policies for diabetes control--especially for those who have less formal education or are male.

Hyperuricemia as an independent risk factor of chronic kidney disease in middle-aged and elderly population.

INTRODUCTION: Hyperuricemia in the general population remains controversial, in terms of it being considered a risk factor for chronic kidney disease (CKD). Within this context, we evaluated the effects of hyperuricemia on renal function in older Taiwanese adults. METHODS: From January 2002 to December 2006, we conducted a community-based medical screening program involving 31,331 subjects older than 40 years. According to the National Kidney Foundation guidelines, stage 3 to 5 patients with CKD were included for analysis. Age, body mass index, systolic blood pressure, fasting plasma glucose, triglyceride, cholesterol and proteinuria were considered potential confounders. RESULTS: Participants with hyperuricemia tended to have higher systolic blood pressure, sugar levels, body mass index, and cholesterol and triglyceride levels but lower estimated glomerular filtration rate (eGFR) levels; eGFR negatively correlated with serum uric acid level. By using multiple logistic regression models before and after adjusting for any confounding factors, we noted that participants with hyperuricemia had a 4.036-fold (odds ratios = 4.036) and 3.649-fold (odds ratios = 3.649) increased risk for CKD, respectively, compared with the control group. We used multiple linear regression analysis to examine the association of serum uric acid level and eGFR at different stages of CKD; significance was found only in participants with stage 3 CKD and not in participants with stages 4 or 5. CONCLUSIONS: Hyperuricemia is an independent risk factor for CKD in middle-aged and elderly Taiwanese adults. Thus, an effective screening program that identifies people with hyperuricemia is warranted.

Hypertriglyceridemia: an independent risk factor of chronic kidney disease in Taiwanese adults.

BACKGROUND: The prevalence and incidence of chronic kidney disease (CKD) are relatively high in Taiwanese patients than in patients of other countries, particularly in the older age groups. Dyslipidemia in patients with CKD has been recognized as a risk factor for disease progression but the role of triglycerides (TGs) remains controversial. With this regard, we evaluated the effects of hypertriglyceridemia on renal function in Taiwanese adults (aged >or=40 years). METHODS: From January 2002 to December 2006, we conducted a community-based medical screening program in Chiayi County with 18,422 subjects (aged >or=40 years). The CKD was defined as an estimated glomerular filtration rate of <60 mL min 1.73 m. Age, body mass index, systolic blood pressure, fasting plasma glucose, and serum total cholesterol were considered as potential confounders. RESULT: The CKD was prevalent in 24.2% of the middle-aged and elderly population. By using multiple logistic regression models, we determined that old age and elevated levels of body mass index, systolic blood pressure, fasting plasma glucose, and cholesterol were associated with CKD. The adjusted odds ratios of CKD in participants with serum TG >==200 mg/dL was 1.901 (95% confidence interval: 1.07-3.36; P < 0.05) and in participants with serum TG > 500 mg/dL it increased to 2.205 (1.33-3.64, P < 0.05). CONCLUSION: Hypertriglyceridemia is an independent risk factor for CKD in Taiwanese adults. Thus, an effective screening program that identifies people with hypertriglyceridemia is warranted.