Determinants of peak bone mass in young premenopausal women

Peak bone mass is defined as the highest level of bone mass attained during life through normal growth, and small increases in peak bone mass may prevent osteoporotic fractures later in life. Non-modifiable genetic factors account for as much as 50-70% of the variation in peak bone mass, but to achieve full genetic potential an individual must work to optimize the modifiable environmental and lifestyle factors that also contribute to the variation in peak bone mass. Thus, understanding these modifiable factors affecting peak bone mass is important for osteoporosis prevention. The first paper of this dissertation examines the association between peak bone mass and body composition. Previous studies of this association are based on size-dependent bone mass measures, so the true association between body composition and peak bone mass has remained unclear. In size-adjusted analyses, we found that lean mass was positively associated peak bone mass, while fat mass measures were inversely associated with peak bone mass. This analysis clarifies that lean mass, and not fat mass, is important to peak bone mass in young premenopausal women. Women in this group should maintain a healthy body fat percentage to ensure attainment and maintenance of optimum peak bone mass. The second paper of this dissertation examines the association between overall diet quality and peak bone mass using established indices of diet quality. We found no association between these established diet quality scores and bone mass, suggesting these scores may not be appropriate for use in studies related to bone. Because scores measuring overall diet are important for epidemiologic research, a score specifically tailored to reflect bone-specific dietary components would benefit future research. The third paper of this dissertation evaluates the relative contribution of bone-related clinical and lifestyle factors to peak bone mass. We found that waist circumference explained the most variation in peak bone mass, and that physical activity measures, dietary factors, and age at menarche were also important. These findings inform osteoporosis prevention, and factors identified in this analysis are appropriate for use in a clinical setting as part of a prescreening tool for low peak bone mass

Motivational interviewing delivered by diabetes educators: Does it improve blood glucose control among poorly controlled type 2 diabetes patients? ☆ ☆☆

AIMS: To determine whether glycemic control is improved when Motivational Interviewing (MI), a patient-centered behavior change strategy, is used with Diabetes Self Management Education (DSME) as compared to DSME alone. METHODS: Poorly controlled type 2 diabetes (T2DM) patients (n=234) were randomized into 4 groups: MI+DSME or DSME alone, with or without use of a computerized summary of patient self management barriers. We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change. RESULTS: Study patients attended the majority of intervention visits (mean 3.4/4), but drop-out rate was high at follow-up research visits (35%). Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower (less improved) than those not receiving MI (t=2.10; p=0.037). Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress; no between-group differences were found. CONCLUSIONS: DSME improved blood glucose control, underlining its benefit for T2DM management. However, MI+DSME was less effective than DSME alone. Overall, weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators

Treating psychological insulin resistance in type 2 diabetes

Aims: The phenomenon of psychological insulin resistance (PIR) has been well documented for two decades, but interventions to treat PIR have not been well described. The aim of this study was to describe interventions used to treat psychological insulin resistance by certified diabetes educators (CDE’s). Methods: A secondary data analysis study using empirical data from a trial (N = 234) that included four CDEs providing counseling for psychological insulin resistance. Participants not currently using insulin completed the 10-item Barriers to Insulin Therapy measure. The four CDE interventionists documented their approach to addressing participants’ barriers to taking insulin using a standard form. Recommendations were collated and summarized. Results: Strong PIR was shown by 28.4% of participants reporting that they “would not start insulin” and a moderate degree of PIR was shown by 61.2% who said they “would be upset, but would start insulin.” The CDE’s treated PIR with four primary interventions: 1) teaching and providing explanations, 2) demonstrations and sharing examples of success using insulin therapy, 3) return demonstrations, and 4) addressing feelings and positively managing expectations. Conclusion: This is the first study to describe in some detail potentially effective patient management strategies for PIR. A randomized controlled trial testing the efficacy of PIR interventions is needed

An internet-based diabetes management platform improves team care and outcomes in an urban latino population

OBJECTIVE: To compare usual diabetes care (UDC) to a comprehensive diabetes care intervention condition (IC) involving an Internet-based diabetes dashboard management tool used by clinicians. RESEARCH DESIGN AND METHODS: We used a parallel-group randomized design. Diabetes nurses, diabetes dietitians, and providers used the diabetes dashboard as a clinical decision support system to deliver a five-visit, 6-month intervention to 199 poorly controlled (HbA1c \u3e 7.5% [58 mmol/mol]) Latino type 2 diabetic (T2D) patients (mean age 55 years, 60% female) at urban community health centers. We compared this intervention to an established, in-house UDC program (n = 200) for its impact on blood glucose control and psychosocial outcomes. RESULTS: Recruitment and retention rates were 79.0 and 88.5%, respectively. Compared with UDC, more IC patients reached HbA1c targets of \u3c 7% (53 mmol/mol; 15.8 vs. 7.0%, respectively, P \u3c 0.01) and \u3c 8% (64 mmol/mol; 45.2 vs. 25.3%, respectively, P \u3c 0.001). In multiple linear regression adjusting for baseline HbA1c, adjusted mean +/- SE HbA1c at follow-up was significantly lower in the IC compared with the UDC group (P \u3c 0.001; IC 8.4 +/- 0.10%; UDC 9.2 +/- 0.10%). The results showed lower diabetes distress at follow-up for IC patients (40.4 +/- 2.1) as compared with UDC patients (48.3 +/- 2.0) (P \u3c 0.01), and also lower social distress (32.2 +/- 1.3 vs. 27.2 +/- 1.4, P \u3c 0.01). There was a similar, statistically significant (P \u3c 0.01) improvement for both groups in the proportion of patients moving from depressed status at baseline to nondepressed at follow-up (41.8 vs. 40%; no significance between groups). CONCLUSIONS: The diabetes dashboard intervention significantly improved diabetes-related outcomes among Latinos with poorly controlled T2D compared with a similar diabetes team condition without access to the diabetes dashboard. long as the work is properly cited, the use is educational and not for profit, and the work is not altered

Recreational Physical Activity and Premenstrual Syndrome in Young Adult Women: A Cross-Sectional Study.

It is estimated that up to 75% of premenopausal women experience at least one premenstrual symptom and 8-20% meet clinical criteria for premenstrual syndrome. Premenstrual syndrome substantially reduces quality of life for many women of reproductive age, with pharmaceutical treatments having limited efficacy and substantial side effects. Physical activity has been recommended as a method of reducing menstrual symptom severity. However, this recommendation is based on relatively little evidence, and the relationship between physical activity, premenstrual symptoms, and premenstrual syndrome remains unclear.We evaluated the relationship between physical activity and premenstrual syndrome and premenstrual symptoms among 414 women aged 18-31. Usual premenstrual symptom experience was assessed with a modified version of the Calendar of Premenstrual Experiences. Total, physical, and affective premenstrual symptom scores were calculated for all participants. Eighty women met criteria for moderate-to-severe premenstrual syndrome, while 89 met control criteria. Physical activity, along with dietary and lifestyle factors, was assessed by self-report.Physical activity was not significantly associated with total, affective, or physical premenstrual symptom score. Compared to the women with the lowest activity, women in tertiles 2 and 3 of activity, classified as metabolic equivalent task hours, had prevalence odds ratios for premenstrual syndrome of 1.5 (95% CI: 0.6-3.7) and 0.9 (95% CI: 0.4-2.4), respectively (p-value for trend = 0.85).We found no association between physical activity and either premenstrual symptom scores or the prevalence of premenstrual syndrome

Comprehensive Diabetes Management Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center

Abstract available at publisher's web site

Odds ratios and confidence intervals for the association of physical activity and PMS^*.

<p>Odds ratios and confidence intervals for the association of physical activity and PMS^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0169728#t004fn001" target="_blank">*</a>}.</p

Association between METs^* and premenstrual symptom scores, among all participants (n = 414).

<p>Association between METs^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0169728#t003fn001" target="_blank">*</a>} and premenstrual symptom scores, among all participants (n = 414).</p

Severity of premenstrual symptoms^* of all study participants (n = 414) and of women meeting PMS case (n = 80) and control criteria (n = 89).

<p>Severity of premenstrual symptoms^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0169728#t002fn001" target="_blank">*</a>} of all study participants (n = 414) and of women meeting PMS case (n = 80) and control criteria (n = 89).</p