Development of a tailored intervention targeting sedentary behavior and physical activity in people with stroke and diabetes: A qualitative study using a co-creation framework.

Purpose: Type 2 diabetes and sedentary behavior pose serious health risks in stroke survivors. Using a co-creation framework, this study aimed to develop an intervention in collaboration with stroke survivors with type 2 diabetes, relatives, and cross-sectoral health care professionals to reduce sedentary behavior and increase physical activity. Materials and methods: This qualitative explorative study used a co-creation framework consisting of a workshop and focus group interviews with stroke survivors with type 2 diabetes (n = 3), relative (n = 1), and health care professionals (n = 10) to develop the intervention. A content analysis was used to analyze data. Results: The developed "Everyday Life is Rehabilitation" (ELiR) intervention consisted of a tailored 12-week home-based behavior change intervention with two consultations of action planning, goal setting, motivational interviewing, and fatigue management including education on sedentary behavior, physical activity, and fatigue. The intervention has a minimalistic setup using a double-page paper "Everyday Life is Rehabilitation" (ELiR) instrument making it implementable and tangible. Conclusions: In this study, a theoretical framework was used to develop a tailored 12-week home-based behavior change intervention. Strategies to reduce sedentary behavior and increase physical activity through activities of daily living along with fatigue management in stroke survivors with type 2 diabetes were identified.

The influence of diabetes and or periodontitis on inflammation and adiponectin level.

BACKGROUND: In Indonesia, most of diabetic patients had periodontitis and 75.3% of them had severe periodontitis. Previous study found that hyperglycemia and or local inflammation (such as periodontitis) modulated systemic pro-inflammatory and anti-inflammatory cytokines. AIMS: This study aimed to investigate the effect of DM and or periodontitis on systemic cytokines and adipocytokines levels. METHODS AND MATERIALS: A total of 57 participants with age of 29-71 years were recruited for this study. We divided them into three groups; DM-periodontitis (n = 22), periodontitis without DM (n = 16) and control (n = 19). All participants underwent physical examinations (BMI, WC, periodontal status examination) and laboratory examinations (FBG, fasting insulin, CRP, adiponektin, leptin, TNF-α and IL-10). RESULTS: The proportion of severe periodontitis were higher in DM-periodontitis group compared to periodontitis without DM (77.3% vs 6.2%). DM-periodontitis group had lower adiponectin levels than that of periodontitis without DM group [5860.78 ±â€¯4182.40 vs 9553.13 ±â€¯6794.73; p = 0.046]. TNF-α/IL-10 ratio was significantly higher in the periodontitis without DM compared to control group [1.96 (1.68-2.32) vs 1.55 (1.27-1.85); p = 0.015]. CONCLUSION: Local inflammation such as periodontitis, elevated systemic inflammatory markers (TNF-α/IL-10 ratio). Meanwhile chronic hyperglycemia alter adipocytokines level. The changes of systemic inflammation among diabetic group had not been shown yet in this study since some antidiabetic and antilipid drugs possess anti-inflammtory effect. Age, WC and FBG correlated with severe periodontitis. Adiponectin, leptin, TNF-α and IL-10 levels did not correlated with severe periodontitis.