Pedorthic management of the diabetic foot.

Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step in the downward spiral to lower extremity amputation. The best treatment is prevention. Prevention of foot ulcers requires a coordinated program of foot-specific patient education, prophylactic skin and nail care, and protective footwear. The goal of prescription footwear is to keep individuals ambulatory, while protecting them from ulcer formation. The complexity of pedorthic prescription increases with decreasing protective sensation and increasing structural deformity of the foot and ankle. Prescription footwear accommodates deformity, while decreasing pressure and shear forces applied to skin overlying bone prominences.

Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving.

OBJECTIVE: To evaluate the impact of a school-based interdisciplinary health behavior intervention on diet and physical activity among children in grades 4 and 5. DESIGN: A quasiexperimental field trial with 6 intervention and 8 matched control schools. Outcomes were assessed longitudinally using preintervention (fall 1995) and follow-up (spring 1997) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity. Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997. PARTICIPANTS: Longitudinal data were collected from 479 students initially in grade 4 in Baltimore, Md, public schools; 91% were African American. Repeated 24-hour recall measures in 1997 were collected for a random subsample of 336 students. Cross-sectional survey data were collected from all grade 5 students in 1995,1996, and 1997 (n = 2103). INTERVENTION: The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math, science, language arts, and social studies classes. Materials provided links to school food services and families and provided training and wellness programs for teachers and other staff members. Intervention materials focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake, as well as reducing television viewing and increasing physical activity. MAIN OUTCOME MEASURES: Dietary intake and physical activity measured via repeated 24-hour recall were primary end points, with additional food frequency and activity measures. RESULTS: The 24-hour recall measures indicated that, after controlling for baseline covariates, the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools (-1.4%; 95% confidence interval [CI], -2.8 to -0.04; P = .04 and -0.60%; 95% CI, -1.2 to -0.01; P = .05). There was an increase in fruit and vegetable intake (0.36 servings/4184 kJ; 95% CI, 0.10-0.62; P=.01), in vitamin C intake (8.8 mg/4184 kJ; 95% CI, 2.0-16; P=.01), and in fiber consumption (0.7 g/4184 kJ; 95% CI, 0.0-1.4; P=.05). Television viewing was marginally reduced (-0.55 h/d; 95% CI, -1.04 to 0.04; P=.06). Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat. CONCLUSION: Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing.