Double-Shock Stimulation of the Superficial Radial Nerve Compared With Standard Medial Plantar Nerve Conduction in the Early Detection of Asymptomatic Diabetic Neuropathy: A Pilot Study.

PURPOSE: Diabetes mellitus is a major public health problem. Diabetic polyneuropathy (DP) is one of the most common complications of diabetes mellitus. The early detection of DP is very important for timely treatment of symptoms and preventative foot care. METHODS: Participants were sorted into 3 age- and sex-matched groups: 20 "healthy" individuals; 21 diabetic patients without DP symptoms, "asymptomatic"; and 24 diabetic patients suffering from symptoms consistent with DP, "symptomatic." All study participants had normal results on conventional nerve conduction studies. All groups underwent both medial plantar mixed nerve conduction (as a single-shock stimulation technique) and superficial radial nerve conduction (double-shock stimulation) measurements. Interstimulus intervals of 2 to 8 ms were used to record sensory nerve action potentials (SNAP) 1 and SNAP 2 for both stimuli. RESULTS: We found statistically significant decreases in medial plantar NAPs' amplitude and conduction velocity, and SNAP1/SNAP2 ratios between the three groups, especially at smaller interstimulus intervals. CONCLUSIONS: Both medial plantar mixed nerve conduction and double-shock superficial radial nerve stimulation are reliable methods for the early detection of asymptomatic DP. However, the medial plantar mixed nerve technique is easier and less time-consuming.

Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.

OBJECTIVE: To examine the association between a mobile phone intervention and skilled delivery attendance in a resource-limited setting. DESIGN: Pragmatic cluster-randomised controlled trial with primary healthcare facilities as the unit of randomisation. SETTING: Primary healthcare facilities in Zanzibar. POPULATION: Two thousand, five hundred and fifty pregnant women (1311 interventions and 1239 controls) who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. All pregnant women were eligible for study participation. METHODS: Twenty-four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention (n = 12) or standard care (n = 12). The intervention consisted of a short messaging service (SMS) and mobile phone voucher component. MAIN OUTCOME MEASURES: Skilled delivery attendance. RESULTS: The mobile phone intervention was associated with an increase in skilled delivery attendance: 60% of the women in the intervention group versus 47% in the control group delivered with skilled attendance. The intervention produced a significant increase in skilled delivery attendance amongst urban women (odds ratio, 5.73; 95% confidence interval, 1.51-21.81), but did not reach rural women. CONCLUSIONS: The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence. Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5, and should be considered by maternal and child health policy makers in developing countries.