الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 197 |  |  |
| | | from | 197 | | |
Abstract
Diabetes is a chronic illness requiring continuous medical care with risk-reduction strategies beyond glycemic control. Patient self-management education and support are important to prevent acute complications and reducing the risk of long- term complications.
Diabetes in childhood and adolescence presents very different challenges from diabetes in adults. Diabetes impacts on every aspect of a child’s life and experience. It imposes a burden to the child, his or her parents, siblings and the rest of the family, the school and local community. Many children and adolescents are facing a greater burden associated with early appearance of diabetes and an increased risk of complications as cardiovascular diseases with longer duration of disease.
This study was conducted to fulfill the following aims:
The general objective of the study was to study selected cardiovascular disease risk factors among diabetic adolescents in Alexandria.
Specific objectives:
1) To determine the prevalence of cardiovascular risk factors among diabetic adolescents in Alexandria. 2) To assess knowledge and perceptions of diabetic adolescents concerning cardiovascular disease risk factors. 3) To construct and implement an educational program for diabetic adolescents concerning cardiovascular disease risk factors. 4) To evaluate the impact of the educational program on their self-care behavior.
The study was conducted in three phases:
I- Preparatory phase:
This phase included protocol preparation, preparation of the study tools, literature review and pilot study.
II- Operational phase:
A cross sectional approach was used followed by an intervention approach (quasiexperimental design, non-randomized pre-test – posttest control group design). The target population was diabetic adolescents (diabetes type 1 and type 2, their age between 11 -19 years).
The study was conducted in outpatient clinics in El-Shatby Pediatric Hospital and Sporting Student’s Hospital outpatient clinic in Alexandria. Three hundred cases were included in the study. For the application of the intervention program, a sub-sample of
SUMMARY
127
adolescents was chosen at random from the previous sample. Around 200 adolescents were included, 50% of them (100 patients) were subjected to intervention group and the other 50% were considered as a control group. Both groups were subjected to the pre and follow up test. Data collection methods: The required data were collected using the following tools: I-Interviewing questionnaire composed of four sections to collect the following data: Part (1): Personal data and socio-demographic data, personal history of diabetes, family history of diabetes and cardiovascular disease.
Part (2) Knowledge about cardiovascular Disease: causes, prevention, and cardiovascular disease risk factors was obtained. Part (3) Health Belief Model including adolescents’ perception (susceptibility, severity, benefit, and barrier) regarding the possibility of having cardiovascular diseases.
Part (4) Self – care behavior of adolescents including dietary habits, physical activity, smoking, diabetes management, measuring blood pressure and keeping their weight within normal ranges.
II – Measurements:
(1) Blood pressure measurement: Blood pressure was measured by the standardized mercury sphygmomanometer.
(2) Anthropometric Measures: Weight, height, and waist circumference were measured and body mass index, waist circumference percentiles were calculated.
III. Record review: laboratory investigations (glycosylated hemoglobin (HbA1c) and lipid profiles (triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol).
Intervention program:
Four educational sessions were carried out in El-Shatby Pediatric waiting room and Sporting Student’s Hospital education room using different educational methods; booklet, group discussion, demonstration and power point presentations. The time for each session was about 40-60 minutes.
General objectives of program:
1. The cognitive objective of the intervention was to improve knowledge about prevention of cardiovascular diseases. 2. The affective objective was to perceive adolescents responsibility to prevent cardiovascular diseases.
SUMMARY
128
3. The behavioral objective was to take actions and skills for preventing cardiovascular diseases. The contents of the program:
1. Cardiovascular diseases. 2. Risk factors of cardiovascular diseases. 3. Healthy diet. 4. Hypertension.
Post intervention:
The same interview questionnaire was introduced to the participants immediately after the end of the intervention program sessions for intervention group and three months for both intervention and control groups for the assessment of impact of intervention program on adolescents’ knowledge, attitudes, and behavior toward prevention of cardiovascular diseases.
III- Analytical phase:
The collected data were reviewed for completeness and accuracy, coded, computed and analyzed using SPSS and appropriate statistical procedures. The 5% level was used as the cut off value for statistical significance.
The study revealed the following main results:
Description of the studied sample of diabetic adolescents: The mean age of all adolescents was 14.88±2.2 years. The proportion of males and females were 48.7% and 51.3% respectively. The majority of the adolescents (81.3 %) were from urban area. Almost half of studied sample belonged to middle socioeconomic level (56.7%). The highest proportion of the studied sample (98%) had type 1 DM (97.9% males and 98.1% females). Only 2% of the studied sample had type 2 DM. More than half of the sample had diabetes since 1-5 years.
Prevalence of cardiovascular diseases risk factors:
The majority of diabetic adolescents (87.7%) had abnormal HbA1c with 82.9% among males and 92.2% among female with statistically significant difference. The prevalence of systolic prehypertension and stage I hypertension among diabetic adolescents were 9.7% and 3.7% respectively. The prevalence of diastolic prehypertension, stage I and stage II hypertension were 14.7%, 5% and 0.7% respectively. About one quarter (24%) of the studied sample had abnormal blood pressure. The prevalence of positive family history of diabetes was 73.3% among diabetic adolescents.
SUMMARY
129
About half (58%) of the studied sample had positive family history of CVDs. About one fifth (19.2%) of the studied adolescents were overweight and 8.9% of the adolescents were obesity, while 10% of them had central obesity. Fifteen percent of the studied sample had one risk factor of CVDs and 13.7% of them had elevated HbA1c. Diabetic adolescents who had 2 risk factors of CVDs constituted 21.3%. The most common 2 risk factors was elevated HbA1c and positive family history of DM. About one third of the studied sample (37.3%) had 3 risk factors of CVDs. Elevated HbA1c and positive family history of DM and CVDs were the most common combination. Adolescents who had 4 risk factors of CVDs constituted 15.3%. The most common combination was positive family history of DM and CVDs, elevated HbA1c, and overweight or obesity. Logistic regression analysis of risk factors of CVDs revealed that socioeconomic level and sex were significantly and independently associated with prevalence of two and more CVDs risk factors.
Adolescents’ knowledge about cardiovascular diseases and its risk factors:
About half (47.7%) of the diabetic adolescents had fair level of knowledge regarding CVDs and the physician was the main source of knowledge about CVDs. Analysis by logistic regression showed that age, residence, socioeconomic level, and source of knowledge were significantly and independently associated with adolescents’ knowledge regarding CVDs.
Adolescents’ perception of cardiovascular diseases and its risk factors:
The proportions of diabetic adolescents who had moderate levels of perception of susceptibility, severity, benefit, and barrier about CVDs ranged from 58.7% - 68.6%.
Adolescents’ self - care behavior:
About half of the studied sample had moderate dietary habit (moderate consumption of salt (50%) and fat (50.7%), high consumption of fruits and vegetables (46.7%) and eating fish twice or one per week (64.3%) and physically inactive (61.3%). Although, the prevalence of smoking among studied sample was low (only 3.3%), more than half of them (61.3%) were exposed to passive smoking. About one third of adolescents (29.3%) mentioned that they measure their blood pressure. About two thirds of the studied sample (63.3%) maintained their ideal weight. About two thirds (66%) of diabetic adolescents had fair level of self-care behavior. After using multivariate analysis, only three factors found to be significantly affecting the adolescents’ self-care behavior (sex, socioeconomic level and total score of knowledge about CVDs).
SUMMARY
130
Evaluation of the impact of an intervention program for diabetic adolescents concerning cardiovascular diseases:
The mean scores of knowledge, perception, and self- care behavior about CVDs were significantly improved after implementation of the intervention program. Adolescents in intervention group were two times more likely to have good and fair level of knowledge compared to adolescents in the control group. The main independent factors that were associated with an improvement in the diabetic adolescents’ level of knowledge after implementing the intervention were the adolescents’ level of knowledge before the intervention and the intervention program.
It can be concluded from the study that:
The most prevalent risk factor was abnormal HbA1c. Despite the majority of diabetic adolescents were taking diabetic medication regularly, measuring blood sugar, and visiting diabetic clinic, they did not have good glycemic control. The intervention program had positive impact on increasing adolescents’ knowledge, perception and self-care behavior about CVDs.
The main recommendations are: A health providers’ team composed of a diabetologist, a nurse, a dietitian, a social worker, a psychologist, and a health educator should be responsible for the treatment and care of diabetic children and adolescents. All the health providers’ team should be trained for effective communication skills such as active listening, patient directed goals, clear presentation of information, use of nonverbal cues Health education programs should be given for adolescents and their parents regularly. The programs should include the following topics; a. Good compliance and adherence to diabetic medication. b. Healthy life style. c. Diabetes complication and ways of good control especially for newly discovered patients. Early detection of risk factors of CVDs among diabetic adolescents in hospital, primary health care setting and school clinics. School curricula are important source of knowledge and practice and should include topics to improve healthy life style of children and adolescents. School health education program can reduce risk behavior such as tobacco use, improper nutrition, lack of physical activity and prevention of obesity. Self-management support for diabetic adolescents includes support groups such as peer support, family support, and school support. Improving public awareness about diabetes and its complication, importance of good glycemic control and CVDs risk factors through mass media.