Engaging faith-based resources to initiate and support diabetes self-management among African Americans: a collaboration of informal and formal systems of care.

Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.

Prevalence of 25-hydroxyvitamin D deficiency in an urban general internal medicine academic practice.

Vitamin D deficiency has received increased academic interest because of its association with many common disease processes. The goal of our study was to document the prevalence of vitamin D deficiency. A retrospective chart review of 25-hydroxyvitamin D (ng/mL) levels at the University of Tennessee Health Science Center was conducted on general internal medicine patients over an 18-month period. The 25-hydroxyvitamin D deficient patients were divided into four groups: severe (<7 ng/mL), moderate (7.0-20.9 ng/mL), mild (21-31.9 ng/mL), and sufficient (>32 ng/mL). We found that an overwhelming majority of our patients were mildly to severely deficient (87 percent) with 17 percent severely deficient, 53 percent moderately deficient, 17 percent mildly deficient, and only 13 percent sufficient. The prevalence of 25-hydroxyvitamin D deficiency among this population was higher than expected based on the prevalence of 25-hydroxyvitamin D deficiency reported in literature. Based on this data, we believe a greater percentage of the general population needs to be studied in order to discover the true prevalence of vitamin D deficiency.

Prevalence of 25-hydroxyvitamin D deficiency in an urban general internal medicine academic practice.

Vitamin D deficiency has received increased academic interest because of its association with many common disease processes. The goal of our study was to document the prevalence of vitamin D deficiency. A retrospective chart review of 25-hydroxyvitamin D (ng/ml) levels at the University of Tennessee Health Science Center was conducted on general internal medicine patients over an 18-month period. The 25-hydroxyvitamin D deficient patients were divided into four groups: severe (<7 ng/ml), moderate (7.0-20.9 ng/ml), mild (21-31.9 ng/ml), and sufficient (>32 ng/ml). We found that an overwhelming majority of our patients were mildly to severely deficient (87 percent) with 17 percent severely deficient, 53 percent moderately deficient, 17 percent mildly deficient, and only 13 percent sufficient. The prevalence of 25-hydroxyvitamin D deficiency among this population was higher than expected based on the prevalence of 25-hydroxyvitamin D deficiency reported in literature. Based on this data, we believe a greater percentage of the general population needs to be studied in order to discover the true prevalence of vitamin D deficiency.

Evidence of endemic goiter and iodine deficiency in a mountainous area of Haiti.

OBJECTIVE: To investigate reports of iodine-deficiency disorder in a specific area of Haiti. METHODS: In March 2008, this cross-sectional study was performed in an area 15 miles northeast of Jacmel, Haiti, within the Chaîne de la Selle Mountains. Before arrival of the study team, an announcement was made throughout local villages soliciting volunteers to meet at a central location. Of those who arrived, participants were selected in an attempt to sample individuals from all age groups, regardless of goiter status. After providing verbal informed consent, each participant was photographed and assigned a number to be used to protect privacy. An examiner performed palpation of the thyroid gland on each participant in accordance with World Health Organization criteria. Results of palpation were classified into 3 grades: grade 0, the thyroid gland was not palpable; grade 1, the thyroid gland was palpable but not visible; and grade 2, the thyroid gland was palpable and visible while the patient was in a normal position. Casual urine samples were collected from each participant and analyzed spectrophotometrically for urinary iodine concentration. RESULTS: Eighty-eight individuals aged 2 to 72 years participated in the study. Median urinary iodine concentration was 39 microg/L. Of the 88 participants, 82 (93%) were iodine deficient (18 [20%] were severely deficient), and 45 (51%) had goiter on physical examination, including 27 with grade 1 goiters and 18 with grade 2 goiters. CONCLUSIONS: We have documented iodine deficiency with associated endemic goiter in this previously uninvestigated Haitian population, for which world health agencies currently lack definitive data. These data have potential implications for both the local area and the country as a whole where further evaluation and treatment are needed for persons at high risk for iodine-deficiency disorder.

Thyrotoxicosis presenting as hypogonadism: a case of central hyperthyroidism.

Herein, we present a case of central thyrotoxicosis with well-documented serial therapeutic interventions. Thyroid-stimulating hormone (TSH)-secreting pituitary tumors represent a rare cause of hyperthyroidism. It is being diagnosed more frequently with the third-generation TSH assay. Many conditions can produce normal or elevated TSH levels in combination with elevated thyroid hormone levels. The differential diagnosis includes resistance to thyroid hormone (RTH, Refetoff's syndrome), assay interference from anti-T4/T3 and heterophile antibodies, elevated or altered binding proteins, drugs affecting peripheral metabolism, and noncompliance with thyroid replacement therapy. In contrast to RTH, our patient presented had high alpha-subunit-to-TSH molar ratio, failed TSH response to thyrotropin-releasing hormone stimulation, and a large pituitary mass. Normal or high TSH in the presence of elevated T4 or T3 is a fairly common clinical scenario with many etiologic possibilities. This TSH-producing adenoma represents an unusual initial clinical presentation, as hypogonadism appeared before features of thyrotoxicosis were appreciated. This case represents the most modern therapeutic approach to the management of this rare disease. Our patient has done well on octreotide with control of thyrotoxicosis and an additional 30% shrinkage of his tumor mass.