Questionnaire design in diabetes care and research. 1: Getting the question right

Cardiovascular disease and risk factors among 345 adults in rural India—the Andhra Pradesh Rural Health Initiative

BACKGROUND

Heart attack and stroke are problems already faced by some urban populations of India, but less is known about cardiovascular disease and risk factors in rural areas. The aim of the study was to investigate the levels and management of major cardiovascular risk factors and the prevalence of cardiovascular disease in two villages in rural Andhra Pradesh, India.

METHODS

A cross-sectional survey was done by selecting a random sample stratified by age and gender from each village using census lists compiled in 2002. For each individual, trained study staff administered a Telugu-translation of a structured questionnaire, performed a brief physical examination and collected a fasting venous blood sample. Weighted estimates of mean (or percentages with) risk factor levels in the population were calculated and are reported with confidence intervals unless otherwise specified.

RESULTS

Data was collected from 345 adults aged 20 to 90. The average household size was 4.2 and the mean combined household income was about Indian Rupees 25,454 (580 US dollars) per year. The mean systolic blood pressure was 116 (114-117) mm Hg, diastolic blood pressure 73 (114-120) mm Hg, total cholesterol 4.6 (4.5-4.7) mmol/L, HDL-cholesterol 0.8 (0.8-0.9) mmol/L, LDL-cholesterol 3.2 (3.1-3.3) mmol/L and triglyceride 1.3 (1.2-1.4) mmol/L. The prevalence of current smoking was 19.9% (15.4-24.4%), hypertension 20.3% (16.2-24.4%), diabetes 3.7% (1.8-5.5%), overweight 16.9% (12.3-21.5%) and obesity 4.4% (1.9-6.8%). A medical diagnosis of cardiovascular disease (previous heart attack, stroke or angina) was reported by 2.5% (1.1-3.9%) and a further 1.1% (0.1-2.1%) had angina by the 'Rose' classification.

CONCLUSIONS

The possibility of increasing cardiovascular risk factors and prevalence of vascular disease in areas of rural India represent a public health concern. Larger and repeated epidemiological studies focusing on chronic diseases are required to inform treatment and prevention strategies suitable for use in these areas and other resource poor settings.

The relationship among six psychosocial domains, age, health care adherence, and metabolic control in adolescents with IDDM

This pilot study examined the relationship among six psychosocial factors, age, health care compliance, and metabolic control in adolescents with IDDM. Four objectives were identified: 1) to determine whether specific compliance areas predict metabolic control; 2) to determine whether specific psychosocial factors predict metabolic control; 3) to determine whether compliance and psychosocial issues change with age; and 4) to determine whether the parent or the youth is the more accurate predictor of metabolic control. Twenty-one adolescents age 13 through 18 years participated in this study. Dietary compliance was found to be the best predictor of metabolic control. Parents more accurately predicted metabolic control for youths younger than 16 years old, while the reverse was true for older youths. A negative relationship was identified among strong self-concept, high knowledge of IDDM, parental support, and poor metabolic control. Several possible explanations are discussed, including power struggles, coping difficulties, and fear of peer reactions.