RESUMO
OBJECTIVES: In South Asian populations, little is known about the effects of intensive interventions to reduce the risk of type 2 diabetes on health behaviour. We examined the effectiveness at 2 years of a culturally targeted lifestyle intervention on diet, physical activity and determinants of behaviour change among South Asians at risk for diabetes. DESIGN: Randomised controlled trial with de facto masking. SETTING: Primary care. PARTICIPANTS: A total of 536 18- to 60-year-old South Asians at risk for diabetes (ie, with impaired glucose tolerance, impaired fasting glucose or relatively high insulin resistance) were randomised to the intervention (n=283) or a control (n=253) group. Data of 314 participants (n=165 intervention, n=149 control) were analysed. INTERVENTIONS: The culturally targeted intervention consisted of individual counselling using motivational interviewing (six to eight sessions in the first 6 months plus three to four booster sessions), a family session, cooking classes and a supervised physical activity programme. The control group received generic lifestyle advice. OUTCOME MEASURES: We compared changes in physical activity, diet and social-cognitive underlying determinants between the two groups at 2-year follow-up with independent-sample t-tests, chi-square tests and Fisher's exact tests. RESULTS: At the 2-year follow-up, participants in the intervention group were more moderately to vigorously active than at baseline, but compared with changes in the control group, the difference was not significant (change min/week 142.9 vs 0.5, p=0.672). Also, no significant difference was found between the two groups in changes on any of the components of the diet or the social-cognitive determinants of diet and physical activity. CONCLUSIONS: The culturally targeted lifestyle intervention led to high drop-out and was not effective in promoting healthy behaviour among South Asians at risk for diabetes. Given the high a priori risk, we recommend to develop new strategies, preferably more acceptable, to promote healthy behaviour. TRIAL REGISTRATION: NTR1499; Results. www.trialregister.nl/trialreg/admin/rctview.asp?TC=1499.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Dieta , Exercício Físico , Atenção Primária à Saúde , Prevenção Primária/métodos , Adulto , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Estilo de Vida Saudável , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Países Baixos , Pacientes Desistentes do Tratamento , Fatores de Risco , Autoeficácia , Apoio Social , Suriname/etnologiaRESUMO
BACKGROUND: Direct comparisons of the effect of a glycated haemoglobin measurement or an oral glucose tolerance test on the uptake and yield of screening in people of South Asian origin have not been made. We evaluated this in 18 to 60-year-old South Asian Surinamese. MATERIALS AND METHODS: We invited 3173 South Asian Surinamese for an oral glucose tolerance test between June 18th 2009- December 31st 2009 and 2012 for a glycated hemoglobin measurement between April 19th 2010-November 11th, 2010. Participants were selected from 48 general practices in The Hague, The Netherlands. We used mixed models regression to analyse differences in response and participation between the groups. We described differences in characteristics of participants and calculated the yield as the percentage of all cases identified, if all invitees had been offered screening with the specified method. RESULTS: The response and participation in the glycated hemoglobin group was higher than in the group offered an oral glucose tolerance test (participation 23.9 vs. 19.3; OR: 1.30, 95%-confidence interval1.01-1.69). After adjustment for age and sex, characteristics of participants were similar for both groups. Overall, glycated hemoglobin identified a similar percentage of type 2 diabetes cases but a higher percentage of prediabetes cases, in the population than the oral glucose tolerance test. CONCLUSION: We found that glycated hemoglobin and the oral glucose tolerance test may be equally efficient for identification of type 2 diabetes in populations of South Asian origin. However, for programs aimed at identifying people at high risk of type 2 diabetes (i.e. with prediabetes), the oral glucose tolerance test may be a less efficient choice than glycated hemoglobin.
Assuntos
Povo Asiático , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobinas Glicadas/metabolismo , Adolescente , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Suriname/epidemiologiaRESUMO
BACKGROUND: South Asian babies born in developed countries are generally lighter than babies from other ethnic groups born in the same country. While the mean birth weight of Caucasian babies in the Netherlands has increased the past decades, it is unknown if the mean birth weight of South Asian babies born in the Netherlands has increased or if the prevalence of low birth weight (LBW) or small-for-gestational-age (SGA) has decreased.The aims of this study are: 1. to investigate secular changes in mean birth weight and the prevalence of LBW and SGA in Surinamese South Asian babies, and 2. to assess differences between Surinamese South Asian and Dutch Caucasian neonates born 2006-2009. METHODS: A population based study for which neonatal characteristics of 2014 Surinamese South Asian babies, born between 1974 and 2009 in the Netherlands, and 3104 Dutch Caucasian babies born 2006-2009 were obtained from well-baby clinic records. LBW was defined as a birth weight <2500 g. SGA was based on a universal population standard (the Netherlands) and three ethnic specific standards (the Netherlands, UK, Canada). RESULTS: In Surinamese South Asian babies from 1974 to 2009 no secular trend in mean birth weight and prevalence of LBW was found, whereas SGA prevalence decreased significantly.Surinamese South Asian babies born in 2006-2009 (2993 g; 95% CI 2959-3029 g) were 450 g lighter than Dutch Caucasian babies (3448 g; 95% CI 3429-3468 g), while LBW and SGA prevalences, based on universal standards, were three times higher. Application of ethnic specific standards from the Netherlands and the UK yielded SGA rates in Surinamese South Asian babies that were similar to Dutch. There were considerable differences between the standards used. CONCLUSION: Since 1974, although the mean birth weight of Surinamese South Asian babies remained unchanged, they gained a healthier weight for their gestational age.
Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido Pequeno para a Idade Gestacional , Adulto , Povo Asiático/etnologia , Estudos de Coortes , Estudos Transversais , Etnicidade , Feminino , Retardo do Crescimento Fetal/etnologia , Humanos , Recém-Nascido , Masculino , Países Baixos/epidemiologia , Prevalência , Suriname/etnologiaRESUMO
OBJECTIVES: Asians have a smaller muscle mass and a larger fat mass at the same body mass index (BMI) than most other ethnic groups. Due to a resulting higher cardiometabolic risk, the BMI cut-offs for overweight and obesity were lowered for adults. For Asian children universal criteria apply. The objectives of this study were to determine the normal BMI distribution and assess the BMI class distribution in a reference cohort of affluent South Asian children born before the obesity epidemic and to assess the influence of the obesity epidemic on the distributions. METHODS: Historical cohort study with 4350 measurements of height and weight of two cohorts (born 1974-1976 and 1991-1993) of Surinamese South Asian children living in The Netherlands, analysed with WHO Child Growth References and International Obesity Task Force (IOTF) BMI cut-offs. RESULTS: The reference cohort 1974-1976 was significantly lighter (BMI Z-score=-0.63; 95% CI -0.69 to -0.58) and more variable (SD=1.19) than WHO reference. Total thinness prevalence was exceptionally high, both in cohort 1974-1976 (WHO 38.3%; IOTF 36.4%) and 1991-1993 (WHO 23.6%; IOTF 23.9%). Overweight and obesity prevalences were low in the reference cohort (WHO respectively 6.0% and 2.1%; IOTF 5.3%, 0.9%), but much higher in cohort 1991-1993 (WHO 13.6%, 9.1%; IOTF 11.7%, 6.0%). CONCLUSIONS: The low mean BMI Z-score and high prevalence of thinness are likely expressions of the characteristic body composition of South Asians. Universal BMI cut-offs should be applied carefully in South Asian populations as thinness prevalence is likely to be overestimated and obesity underestimated. The development of ethnic specific cut-offs is recommended.
Assuntos
Obesidade/etnologia , Sobrepeso/etnologia , Magreza/etnologia , Povo Asiático , Índice de Massa Corporal , Peso Corporal/etnologia , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Prevalência , Padrões de Referência , Análise de Regressão , Suriname/etnologiaRESUMO
BACKGROUND: South Asian migrants are at particularly high risk of type 2 diabetes. Previous studies have shown that intensive lifestyle interventions may prevent the onset of diabetes. Such interventions have not been culturally adapted and evaluated among South Asians in industrialized countries. Therefore, we have set up a randomized controlled trial to study the effectiveness of a targeted lifestyle intervention for the risk of type 2 diabetes and cardiovascular risk factors among 18 to 60-year-old Hindustani Surinamese (South Asians) in The Hague, the Netherlands. Here we present the study design and describe the characteristics of those recruited. METHODS: Between May 18, 2009 and October 11, 2010, we screened 2307 Hindustani Surinamese (18-60 years old) living in The Hague. We sent invitations to participate to those who had an impaired fasting glucose of 5.6-6.9 mmol/l, an impaired glucose tolerance of 7.8-11.0 mmol/L, a glycated hemoglobin level of 6.0% or more and/or a value of 2.39 or more for the homeostasis model assessment of estimated insulin resistance. In total, 536 people (56.1% of those eligible) participated. People with a higher level of education and a family history of type 2 diabetes were more likely to participate. The control and intervention groups were similar with regard to important background characteristics. The intervention group will receive a culturally targeted intervention consisting of dietary counseling using motivational interviewing and a supervised physical activity program. The control group will receive generic lifestyle advice. To determine the effectiveness, a physical examination (anthropometrics, cardiorespiratory test, lipid profile, and measures of oral glucose tolerance, glycated hemoglobin, and insulin) and interview (physical activity, diet, quality of life, and intermediate outcomes) were carried out at baseline and will be repeated at 1 year and 2 years. The process and the costs will be evaluated. DISCUSSION: This trial will provide insight into the feasibility and effectiveness of a targeted, intensive, lifestyle intervention for the risk of type 2 diabetes and cardiovascular risk factors among 18 to 60-year-old South Asians. TRIAL REGISTRATION: Dutch Trial Register: NTR1499.
Assuntos
Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/etnologia , Diabetes Mellitus/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Medição de Risco/métodos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Antropometria , Doenças Cardiovasculares/sangue , Grupos Controle , Diabetes Mellitus/sangue , Estudos de Viabilidade , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Suriname/etnologia , Inquéritos e Questionários , Migrantes/psicologiaRESUMO
BACKGROUND: Compared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications. They encounter specific barriers that hinder optimal diabetes self-management, including a lack of social support and other psychosocial mechanisms in their immediate social environments. Powerful Together with Diabetes is a culturally sensitive social network intervention specifically targeted to ethnic Dutch, Moroccan, Turkish, and Surinamese diabetic patients in lower socioeconomic groups. For ten months, patients will participate in peer support groups in which they will share experiences, support each other in maintaining healthy lifestyles, and learn skills to resist social pressure. At the same time, their significant others will also receive an intervention, aimed at maximizing support for and minimizing the negative social influences on diabetes self-management. This study aims to test the effectiveness of Powerful Together with Diabetes. METHODS/DESIGN: We will use a quasi-experimental design with an intervention group (Group 1) and two comparison groups (Groups 2 and 3), N = 128 in each group. Group 1 will receive Powerful Together with Diabetes. Group 2 will receive Know your Sugar, a six-week group intervention that does not focus on the participants' social environments. Group 3 receives standard care only. Participants in Groups 1 and 2 will be interviewed and physically examined at baseline, 3, 10, and 16 months. We will compare their haemoglobin A1C levels with the haemoglobin A1C levels of Group 3. Main outcome measures are haemoglobin A1C, diabetes-related quality of life, diabetes self-management, health-related, and intermediate outcome measures. We will conduct a process evaluation and a qualitative study to gain more insights into the intervention fidelity, feasibility, and changes in the psychosocial mechanism in the participants' immediate social environments. DISCUSSION: With this study, we will assess the feasibility and effectiveness of a culturally sensitive social network intervention for lower socioeconomic groups. Furthermore, we will study how to enable these patients to optimally manage their diabetes.
Assuntos
Atitude Frente a Saúde/etnologia , Cultura , Diabetes Mellitus , Classe Social , Meio Social , Apoio Social , Protocolos Clínicos , Diabetes Mellitus/etnologia , Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Feminino , Humanos , Masculino , Marrocos , Avaliação das Necessidades , Países Baixos , Rede Social , Fatores Socioeconômicos , Suriname , TurquiaRESUMO
BACKGROUND: Suicidal behavior is a severe public health problem. AIMS: To determine the rates of attempted and completed suicide among ethnic groups in The Hague, The Netherlands (2002-2004). METHODS: By analyzing data on attempted and completed suicide (from the psychiatric department of general medical hospitals; the psychiatric emergency service and the municipal coroners). RESULTS: Turkish and Surinamese females aged 15-24 years were at highest risk for attempted suicide (age-specific rate 545 / 100,000 and 421 / 100,000 person-years, respectively). Both rates were significantly higher than in the same age group of Dutch females (246 / 100,000 person-years). Turkish (2%) and Surinamese (7%) had lower repeat suicide-attempt rates than did Dutch (16%) females aged 15-24. Significantly lower suicide-attempt rates were found for Surinamese than for Dutch females aged 35-54 years. Differences were not explained by socioeconomic living conditions. The ratio fatal/nonfatal events was 4.5 times higher in males than in females and varied across age, gender, and ethnicity strata. Completed suicide was rare among migrant females. No completed suicides were observed in the Turkish and Surinamese females aged 15-24 years. CONCLUSIONS: The study demonstrates a high risk of attempted suicide and a low risk of completed suicide among young Turkish and Surinamese females.
Assuntos
Comparação Transcultural , Etnicidade/estatística & dados numéricos , Tentativa de Suicídio/etnologia , Tentativa de Suicídio/estatística & dados numéricos , Suicídio/etnologia , Suicídio/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos , Razão de Masculinidade , Suriname/etnologia , Turquia/etnologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
The South Asians in The Netherlands have a high diabetes prevalence in combination with a low socio-economic position. A new, culture-specific type of care was developed. This intervention study investigates which patient characteristics are associated with success and whether those in the lowest socio-economic position have been reached. Before and after the end of the intensive guidance, the HbAlc of the patients (n=101) was measured. The following variables were significantly related to success (defined as a decrease in HbAlc > or = 0.8%): a high initial HbAlc, a low BMI and presence of complications. The average improvement in HbAlc was significant only in the group with a higher socio-economic position. Although the patients with the lowest socio-economic position did not sufficiently benefit from this intervention, an overall improvement was achieved in this poorly educated study population. The further improvements in the care after the completion of this study should be evaluated.