The development of a bilingual interactive video to improve physical activity and healthful eating in a head start population.

The prevalence of obesity in the Hispanic preschool population remains elevated, particularly among children in low income families below the poverty level. Obesity leads to the early onset of metabolic syndrome and Type 2 diabetes. The Head Start population of Texas is largely comprised of this high risk group. Their physical activity level is suboptimal in part due to lack of available outside play areas and time spent watching television and playing sedentary video games. Dietary intake is frequently high in sugar sweetened beverages and low in vegetables. The group is frequently bilingual with limited vocabulary and has not learned to read. Preserving their Mexican American culture is a concern. This article describes the development and assessment of a group of bilingual interactive video interventions to improve age appropriate physical activity while providing basic nutrition education focusing on increasing vegetable and water intake and decreasing sugar sweetened beverages. Suggestions for development and assessment of content were provided by focus groups of Head Start teachers, managers and dietitians in the Texas counties of Bastrop, Hidalgo and McLennon. A demonstration of the videos was conducted in Bastrop County. Teachers, students and managers felt that the videos provided excellent information, improved exercise participation and engaged the children.

A pilot study of a pictorial bilingual nutrition education game to improve the consumption of healthful foods in a head start population.

The prevalence of early childhood obesity has increased dramatically particularly among the Mexican American population. Obesity leads to earlier onset of related diseases such as type 2 diabetes. The Head Start population of Texas is largely Mexican American. Dietary intake in this population demonstrated a diet very low in fiber, high in salt, and containing excessive calories with a low intake of fruit and vegetables. This study was performed in a Texas Head Start population to evaluate a bilingual pictorial nutrition education game. Acceptance of the bilingual concept and the game had been previously studied in a Head Start population in five Texas counties. The effectiveness in producing a change in eating habits was studied as a pilot project 413 children and their parents at the Bastrop County Head Start. Parents were asked to supply data about at home food frequency at the beginning and the end of the school year and the results compared. The parents were given a demonstration of the educational objectives and the students played the game throughout the year. By the end of the school year there was a statistically significant increase in the vegetables offered to this population both during the week at home (p = 0.009) and on the weekends (p = 0.02).

An effective team approach to improve postoperative hip fracture care.

OBJECTIVE: To develop an initiative using standardized discharge orders to improve the posthip fracture care of patients aged 50 years or older. DESIGN: Prospective nonrandomized study. SETTING: Hospital orthopaedic service. PARTICIPANTS: Patients at our institution older than age 50 years sustaining a hip fracture who were followed for at least 6 months and qualified for osteoporosis medication. INTERVENTION: The endocrinology and orthopaedic areas agreed to add calcium/vitamin D supplementation, a dual-energy x-ray absorptiometry scan request, and a consult with endocrinology to the hospital discharge orders. OUTCOME MEASURES: The proportions of patients using calcium or bisphosphonate before and after the intervention were compared using the McNemar test. The designated level of significance was 0.05. RESULTS: Originally, 37 of 137 patients were taking calcium/vitamin D supplements. Following this initiative, 92 of 137 were taking the supplement (P < 0.0001). Seventeen of 137 patients were taking bisphosphonate initially and 65 of 137 after the initiative (P < 0.0001). After the initiative, 100% of the discharged patients were offered calcium/vitamin D, a dual-energy x-ray absorptiometry scan, and an endocrinology appointment. All of the patients who reported for the endocrinology consult appointment were offered bisphosphonate therapy. Eighty-two patients kept the appointment for the dual-energy x-ray absorptiometry scan, and 54 saw the endocrinologist. CONCLUSION: The addition of a calcium/vitamin D supplement and an endocrinology appointment to the hospital discharge orders was an effective method of improving treatment and enhancing compliance.

Elevated body mass index in Texas Head Start children: a result of heredity and economics.

OBJECTIVE: The problem of high body mass index (BMI) for age in the Head Start population in Texas is of great concern. The primarily Mexican American population is at high risk for diabetes and cardiovascular disease. This study examines the prevalence of elevated BMI for age in the Head Start population in a sampling of South Texas border counties and a Central Texas county from 2003-2008, and compares it to the Centers for Disease Control and Prevention (CDC) and National Health and Nutrition Examination Survey (NHANES) data for Hispanic preschool children. METHODS: 18,462 age/gender-adjusted BMI measurements obtained by Texas Head Start centers for 2-5 year old children were analyzed to determine the prevalence of BMI for age at the 97th, 95th, and 85th percentiles. RESULTS: In the overall Texas population, 40.79% of males and 36.73% of females were overweight (85th percentile and above) and 20.01% of the males and 19.04% of the females were obese (95th percentile and above). The prevalence of high BMI for age was stable between 2003-2008; however, the overweight cohort increased with the age of the children over that period of time. CONCLUSION: The observed prevalence of elevated BMI in the Texas population is significantly higher than the results for the 2000 age-adjusted gender specific CDC growth charts for Mexican-American children ages 2-5 years old in the NHANES data for 2003-2006. The Texas-Mexico border counties had the highest prevalence of elevated BMI, demonstrating a critical need for dietary and exercise interventions in this medically underserved area.

Adherence to and gastrointestinal tolerability of monthly oral or quarterly intravenous ibandronate therapy in women with previous intolerance to oral bisphosphonates: a 12-month, open-label, prospective evaluation.

BACKGROUND: Gastrointestinal (GI) symptoms and high dosing frequency have been cited as reasons for inadequate adherence to daily or weekly oral bisphosphonate therapy. Inadequate adherence may lead to poor therapeutic outcomes. OBJECTIVE: The PRIOR study evaluated adherence to and GI tolerability of monthly therapy with oral and quarterly intravenous ibandronate in postmenopausal women with osteoporosis or osteopenia. METHODS: This 12-month, multicenter, prospective, nonrandomized, open-label, noninferiority study included postmenopausal women with osteoporosis or osteopenia who had discontinued previous daily or weekly oral bisphosphonate therapy because of GI intolerance. Participants chose to receive either monthly oral ibandronate 150 mg or quarterly intravenous ibandronate 3 mg and were permitted to switch formulations once during the study. For oral treatment, adherence was assessed based on doses taken, as recorded on the case-report form; for intravenous treatment, adherence was assessed based on doses administered, as recorded by study site personnel. Participants who took >or=75% of protocol-specified doses were considered adherent. The rate of adherence to oral ibandronate was protocol defined as noninferior to that of intravenous ibandronate if the upper limit of the 2-sided 90% CI for the adjusted difference in adherence rates was >20%. At screening, participants assessed the tolerability of their previous bisphosphonate therapy using the GI Experience Survey; using the same instrument, they assessed the tolerability of ibandronate 1 month from baseline and at months 4, 7, and 10. RESULTS: Of 543 participants in the intent-to-treat population, 147 (27.1%) chose to receive oral treatment and 396 (72.9%) chose to receive intravenous treatment. The mean age of participants was approximately 66 years in both groups, and >90% of participants were white. A significantly greater proportion of participants who selected intravenous versus oral treatment had a primary diagnosis of osteoporosis (72.2% vs 57.1%, respectively; P<0.001) and a history of fracture as an adult (35.6% vs 22.4%; P >or= 0.004); significantly fewer recipients of intravenous versus oral ibandronate were currently working (29.0% vs 39.5%; P >or= 0.021). Overall, 82.9% of participants had previously received alendronate and 44.9% had previously received risedronate. Eleven participants switched from oral to intravenous therapy and 16 switched from intravenous to oral therapy during the study. In the perprotocol population, 69.7% of participants in the oral group (101/145) and 82.9% of participants in the intravenous group (325/392) were adherent to their originally selected therapy. Adherence to oral therapy fell within the prespecified boundary for noninferiority to intravenous therapy (adjusted difference: 12.4%; 90% CI, 5.1-19.7). Mean GI tolerance scores were significantly improved from screening at all subsequent assessment times in both treatment groups (P < 0.001); >75% of participants had a >or=10% increase in GI tolerability scores from screening. Both dosing regimens were generally well tolerated. CONCLUSION: Self-selected monthly oral or quarterly intravenous ibandronate therapy was associated with high adherence rates among these postmenopausal women with osteoporosis or osteopenia who had previously discontinued oral bisphosphonate treatment because of GI intolerance.

Nutrition provided to Mexican-American preschool children on the Texas-Mexico border.

The purpose of this study was to assess whether nutrients offered to border Mexican-American preschool children met the Recommended Dietary Allowances. Nutrient contents of two dietary patterns were examined in this study, one composed exclusively of home foods and one containing a combination of both home and school foods. The sample consisted of 198 Mexican-American preschoolers living on the Texas-Mexico border, who were recruited using a convenience sampling technique. A self-administered, precoded 24-hour recall questionnaire was used. Nutrient values of home foods were collected during a weekend day, and nutrient values containing a combination of both home and school foods were collected during a weekday. Fisher's exact test or chi2 test and t test were used for analyses. Mean nutrient contents of foods provided to the border Mexican-American children exceeded recommendations for total energy (P<0.001), total fat (P<0.001), saturated fat (P<0.001), carbohydrates (P<0.001), protein (P<0.001), sodium (P<0.001), and niacin (P<0.001). Foods offered were also significantly insufficient in fiber (P<0.001), vitamin A (P<0.001), and potassium (P<0.001). Nutrition interventions targeting low-income border Mexican-American families should emphasize the need and importance of providing children with diets that meet the Recommended Dietary Allowances.

Relationship of health related quality of life to prevalent and new or worsening back pain in postmenopausal women with osteoporosis.

OBJECTIVE: To examine the association between back pain and health related quality of life (HRQOL) in postmenopausal women with osteoporosis. METHODS: The Fracture Prevention Trial was a prospective double blinded, placebo controlled study designed to compare the proportion of women receiving teriparatide who experienced a new fracture to the proportion of women receiving placebo who experienced a new fracture. Subjects were ambulatory postmenopausal women with osteoporosis and prior vertebral fracture. As part of this trial, English-speaking women from Canada, New Zealand, Australia, and the United States participated in a HRQOL substudy using the Osteoporosis Assessment Questionnaire (OPAQ). OPAQ was administered at baseline, 12 months, and at study termination (median treatment duration 19 mo). Back pain data were collected as part of the adverse event monitoring during the trial. Subjects considered to have experienced back pain reported this event spontaneously and were not queried specifically. We examined the influence of prevalent back pain on HRQOL after controlling for spine deformity index score, and the influence of new or worsening back pain on HRQOL after controlling for incident vertebral fracture. RESULTS: Of 471 women who completed OPAQ at baseline, 172 reported back pain that was associated with a mean decrease in all OPAQ dimension scores (p < 0.05). Of 429 women who completed OPAQ at all timepoints, 88 experienced new or worsening back pain that was associated with a mean decrease in physical function, emotional status, and symptoms scores (p < 0.01 for each). In a subset of 65 women who experienced moderate to severe back pain, all OPAQ dimensions were significantly reduced (p < 0.05). CONCLUSION: Both prevalent back pain and new or worsening back pain affected HRQOL negatively. Osteoporosis therapies that prevent the development of back pain in postmenopausal women may also prevent decreases in HRQOL.