Evaluation of a Diabetes Education Call Center intervention.

Patients require education and information as they engage in self-help, self-care, and disease management activities. The purpose of this study was to determine how effective voice technologies are in diabetes patient education. A pretest-posttest study was conducted to evaluate the effectiveness of prerecorded educational messages delivered via the telephone to participants with diabetes. The intervention consisted of 24 four-minute messages on the topics of knowledge and prevention, glucose level, diet and activity, and management and coping. Eighteen persons with diabetes participated in the pretest-posttest trial. A total of 324 educational messages were listened to over a 12-week intervention period. The pretest-posttest trial demonstrated that a brief telephone-based diabetes education intervention can have a significant impact on increasing frequency of checking blood for glucose (p = 0.017), improving general diabetes knowledge (p = 0.048), and improving insulin-specific knowledge (p = 0.020). Automated educational interventions should be based on scientifically sound evidence and can be effectively delivered by telephone. Automated telephone-based diabetes education may be used alone or as a supplement to existing diabetes education. Automated education is a viable solution when healthcare organizations and regions that as a result of a lack of human and financial resources cannot afford a diabetes educator.

Estrogen agonist (zeranol) treatment in a castrated male lamb model: effects on growth and bone mineral accretion.

The mechanism of estrogen's action on bone mineralization in children has received little attention. Our objective was to determine the effect of time (developmentally) and duration of exposure to an estrogen agonist (zeranol) on bone growth and mineralization using a castrated male lamb model. At birth, 40 male lambs were castrated and within 14 days of birth (day = 0) they were assigned (n = 10 per group) to age-matched control lambs (C-AGE) or to receive a 12.5-mg zeranol implant as follows: E-0, implanted on days 0, 45, 90, and 135; E-90, implanted on days 90 and 135; and E-0, 90, implanted on days 0, 90, and 135. Lambs were studied for 163 days. Serum was collected on days 28, 73, 118, 135, and 163 and analyzed for minerals (Ca, P, and Mg), markers of bone remodeling (bone alkaline phosphatase [ALP] and tartrate resistant acid phosphatase [TRAP]), 1,25-dihydroxyvitamin D [1,25(OH)2D], growth hormone (GH), and insulin-like growth factor I (IGF-I). Whole-body bone mineral content (BMC), bone mineral density (BMD), fat mass, and lean mass were determined by dual energy X-ray absorptiometry (DEXA) on days 28, 73, 118, and 163. There was a linear increase in growth at all time points. Whole-body BMC, weight, and lean mass of C-AGE and E-90 lambs were less than E-0, and E-0, 90 lambs at all time points. Whole-body BMD of C-AGE and E-90 lambs was less than E-0 and E-0, 90 lambs at 28 days and 73 days; however, after implantation at day 90 whole-body BMD of E-90 lambs was similar to E-0 and E-0, 90 lambs at day 118 and day 163 and all three were greater than C-AGE lambs. There was no effect of treatment on calcium absorption, serum minerals, hormones, or markers of bone remodeling. We conclude from these data that treatment of growing castrated lambs with an estrogen agonist from birth augments growth, whereas delaying estrogen agonist treatment does not facilitate growth but appears to augment bone mineral accretion. We suggest these observations may have clinical relevance, and deserve consideration when treating children with delays in growth and bone mineral accretion.

Intraabdominal adipose tissue and anthropometric surrogates in African American women with upper- and lower-body obesity.

It is well established that visceral adipose tissue (VAT) is associated with increased morbidity and mortality in white women. In a recent study, we found that African American women had smaller depots of VAT. To test the relation of VAT to the commonly used anthropometric surrogates for fat patterning, including waist-to-hip ratio (WHR), waist circumference, subscapular skinfold thickness, and ratio of triceps to subscapular skinfold thickness, we recruited 48 normotensive African American women > 120% of ideal body weight on the basis of WHRs > 0.85 [upper-body obesity (UBO); n = 23] and < 0.76 [lower-body obesity (LBO); n = 25]. There were no differences between groups in age, height, weight, body mass index, or percentage of body fat. VAT was determined by magnetic resonance imaging at L4-5; percentage of fat was determined by dual-energy X-ray absorptiometry. Women with UBO had significantly larger mean (+/- SEM) depots of VAT at L4-5 than did women with LBO (0.26 +/- 0.02 compared with 0.19 +/- 0.02 L). Waist circumference was the single best predictor of VAT at L4-5 in both groups of women whereas WHR was significantly associated with VAT at L4-5 only in women with UBO. In African American women, waist circumference is a better surrogate for VAT than is WHR.

Nutritional status of urban Nigerian school children relative to the NCHS reference population.

The present study assessed the growth problems in an indigenous African population of Nigerian urban public school children. The study population consisted of 1390 Nigerian children (predominantly Igbo), 718 boys and 672 girls, ages 4-10 years. Compared to the National Center for Health Statistics (NCHS) reference population, the Nigerian children had an excess prevalence of both short stature and underweight. The prevalence of short stature was 14.2% for the boys and 17.4% for the girls. Approximately 20% of the children were underweight whereas less than 1% were considered overweight. These data demonstrate an excess of both acute and chronic malnutrition relative to the NCHS reference population.

PIP: In 2 urban primary schools in Benin City, Nigeria, over a 3-month period, research assistants came to the classrooms of 1390 children aged 4-10 years to take anthropometric measurements so researchers could compare the nutritional status of these school children with that of a US reference population. The Nigerian school children were much shorter than the US reference population. Specifically, boys were at the 32.4 percentile and girls were at the 31.5 percentile. Further, more than 66% of the children fell in percentiles lower than the 40th percentile for height for age. 19.9 and 19.7 were the mean weight for age percentiles for boys and girls. Almost 85% of the children were below the 40th percentile of the US reference population for weight for age. More than 80% were below the 40th percentile for weight for height. 14.2% of boys and 17.4% of girls were short for their age. 19.5% of boys and 21.1% of girls were undernourished (i.e., underweight). Just less than 1% were overweight. The researchers called for further research to learn more about interpretation of growth patterns and problems between developing and developed countries, since a US reference may not be suitable for all populations.