Percent true calcium absorption, mineral metabolism, and bone mass in children with arthritis: effect of supplementation with vitamin D3 and calcium.

OBJECTIVE: To assess whether percent true calcium absorption (alpha) is normal and whether supplementation with placebo, vitamin D3 (2,000 IU/day), calcium (1,000 mg/day), or vitamin D3 plus calcium improves alpha, mineral metabolism, or bone mass accrual in children with arthritis. METHODS: Eighteen children received all 4 treatments, each for 6 months, in 4 different, randomly assigned orders. Changes in levels of 25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25[OH]2D), parathyroid hormone, bone turnover markers, and minerals and in bone mineral content were measured. Calcium absorption was determined with a dual stable isotope method using 48Ca administered intravenously and 46Ca administered orally, and measuring 48Ca, 46Ca, and 42Ca in a 24-hour urine specimen by high-resolution inductively coupled plasma mass spectroscopy. Wilcoxon's signed rank test was used both to identify significant change over the treatment period with a given regimen and to compare change with an experimental treatment versus change with placebo. RESULTS: Percent true calcium absorption was in the lower-normal range and did not differ by treatment (mean+/-SD 28.3+/-20.2% with placebo, 26.1+/-12.1% with calcium, 19.2+/-11.7% with vitamin D3, and 27.1+/-16.5% with vitamin D3 plus calcium). With vitamin D3 and vitamin D3 plus calcium treatment, 25(OH)D levels were increased and 1,25(OH)2D levels were maintained. Serum calcium levels were increased only with vitamin D3 and vitamin D3 plus calcium treatment. Levels of bone turnover markers and increases in bone mineral content did not differ by treatment. CONCLUSION: The findings of this study indicate that percent true calcium absorption is low-normal in children with arthritis. Vitamin D3 at 2,000 IU/day increases serum 25(OH)D and calcium levels but does not improve bone mass accretion. Calcium at 1,000 mg/day also failed to improve bone mass.

Racial disparities in diabetes-related preventive care: results from the Missouri Behavioral Risk Factor Surveillance System.

INTRODUCTION: Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri. METHODS: We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview. RESULTS: Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.22-0.99) but more likely to report having received foot examinations (OR, 1.99; 95% CI, 1.21-2.39). There was no difference between blacks and whites in the probability of dilated eye examinations (OR, 1.49; 95% CI, 0.94-2.36). CONCLUSION: Compared with whites, non-Hispanic blacks in Missouri receive adequate screening for diabetic complications but not for glycemic control. Further studies are needed to investigate whether these disparities are linked to differences in the rate of diabetes complications in Missouri.

Active and passive smoking among asthmatic Missourians: implications for health education.

OBJECTIVES: To estimate the prevalence of smoking and exposure to secondhand smoke among asthmatic Missourians and to describe associated predisposing factors. METHOD: The Missouri County-level Behavioral Risk Factor Survey, conducted among 15,059 non-institutionalized Missourians aged 18 years or older using random-digit-dialed telephone interviews during 2002-2003, was used in this study. RESULTS: Current smoking (28.4%) and regular exposure to secondhand smoke (19.9%-36.4%, depending on the setting) were prevalent among asthmatic Missourians. Among asthmatics, those with college or technical school education were less likely to be current smokers compared to those with less than a high school education [odds ratio (OR)=0.25, 95% confidence interval (CI): 0.11, 0.57]; African Americans were less likely to be current smokers than white (OR=0.24, 95% CI: 0.07, 0.83); however, among asthmatic non-current smokers, African Americans were more likely to expose to secondhand smoke one or more days per week inside home than whites. Of the asthmatic current smokers who had visited a physician in the past 12 months, 30.0% were not advised by health care professionals to quit smoking. CONCLUSIONS: Asthma intervention programs should strengthen smoking cessation components and should educate health care professionals about the importance of advising asthmatic patients to quit smoking.