Ronald Horswell

Weight Loss Maintenance Following a Primary Care Intervention for Low-income Minority Women

Although the primary care setting offers an innovative option for weight loss interventions, there is minimal research examining this type of intervention with low‐income minority women. Further, there is a lack of research on the long‐term effects of these programs. The purpose of this investigation was to examine the weight loss maintenance of low‐income African‐American women participating in a primary care weight management intervention. A randomized controlled trial was conducted with overweight and obese women (N = 144) enrolled at two primary care clinics. Women received a 6‐month tailored weight loss intervention delivered by their primary care physician and completed follow‐up assessments 9, 12, and 18 months following randomization. The weight loss maintenance of the tailored intervention was compared to a standard care comparison group. The weight loss of intervention participants (−1.52 ± 3.72 kg) was significantly greater than that of standard care participants (0.61 ± 3.37 kg) at month 9 (P = 0.01). However, there was no difference between the groups at the 12‐month or 18‐month follow‐ups. Participants receiving a tailored weight loss intervention from their physician were able to maintain their modest weight loss up to 3–6 months following treatment. Women demonstrated weight regain at the 18‐month follow‐up assessment, suggesting that more intensive follow‐up in the primary care setting may be needed to obtain successful long‐term weight loss maintenance.

Comparison of forefoot ulcer healing using alternative off-loading methods in patients with diabetes mellitus.

OBJECTIVE To compare the healing rate of forefoot ulcers in patients with diabetes treated using a total contact cast with those treated using alternative off-loading methods. DESIGN Retrospective analysis of healing rates of forefoot ulcers. SETTING Louisiana State University Health Sciences Center Diabetes Foot Program, Baton Rouge, LA. PARTICIPANTS 120 consecutive patients with diabetes mellitus referred for treatment of new, nonsurgical forefoot ulceration. INTERVENTIONS Alternative off-loading methods (an accommodative dressing, a healing shoe, a walking splint) or a total contact cast. MAIN OUTCOME MEASURE Healing time of forefoot ulcers in days and percentage healed in 12 weeks. RESULTS 113 of 120 (94%) patients with forefoot ulcers healed in an average of 45.5 ± 43.4 days. Seven of 120 (5.8%) patients with ulcers either did not heal or were lost to follow-up. Stepwise lognormal regression showed ulcer grade (P <.001, R2 = 0.11) and width (P = .024, R2 = 0.05) were significantly related to healing time. After adding ulcer grade (1, 2, or 3) and width into the model, there was no difference between healing time in the accommodative dressing (P = .253), healing shoe (P = .815), and walking splint (P = .525) when compared with the total contact cast. Forefoot ulcers were closed within 12 weeks in at least 81% of cases irrespective of the off-loading method. CONCLUSION The healing rate of forefoot ulcerations in patients with diabetes using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration.

Acceleration of spinal fusion using syngeneic and allogeneic adult adipose derived stem cells in a rat model

Posterolateral spinal fusion is the standard treatment for lumbar compression fractures. Adult adipose tissue‐derived stem cells (ASCs) promote osteogenesis in vivo and in vitro. The hypothesis tested in this study was that syngeneic and allogeneic ASCs on a biomaterial scaffold composed of tricalcium phosphate and collagen I will accelerate spinal fusion in a rat model. ASCs from male Fischer or ACI rats were loaded onto scaffolds (53,571 cells/mm3) and cultured in stromal media for 48 h. Male Fisher rats were assigned to 4 cohorts (n = 14/cohort) after bilateral decortication of the L4 and L5 transverse processes: (1) No treatment; (2) scaffold only; (3) scaffold + syngeneic ASCs; or (4) scaffold + allogeneic ASCs. Half of each cohort was harvested 4 or 8 weeks after surgery. Spinal fusion was evaluated with radiographs, microcomputed tomography, and light microscopy. Callus did not form in spines without scaffolds. There were no significant differences in callus formation among scaffold cohorts 4 weeks after surgery. Callus formation was more mature in both ASC cohorts versus scaffold alone 8 weeks after surgery based on microstructure as well as radiographic and microcomputed tomographic evidence of active bone formation. Inflammatory cell infiltrate was significantly lower in both ASC cohorts (syngeneic = 18.3 ± 0.85%; allogeneic = 23.5 ± 2.33%) versus scaffold alone (46.8 ± 11.8%) 4 weeks after surgery. Results of this study support syngeneic and allogeneic ASC acceleration of posterior lumbar spinal fusion in a rat model.

A comparison of tests for multivariate normality that are based on measures of multivariate skewness and kurtosis

The examination of coefficients of multivariate skewness and kurtosis is one of the more commonly used techniques for assessing multivariate normality (MVN). In this article, several tests for MVN based on these coefficients are compared via Monte Carlo simulation. The tests considered here include those based on Mardias affine-invariant measures of multivariate skewness and kurtosis and an omnibus procedure that combines the two. Also included are Smalls tests, which are based on combinations of the marginal skewness and kurtosis coefficients and are coordinate-dependent. These tests are compared in terms of their power against a wide variety of non-MVN distributions; included in these alternatives are distributions with iid components, as well as distributions with positively-correlated components. Among the alternatives considered are non-MVN distributions with skewed components, symmetric components, univariate normal components, and MVN values of skewness and kurtosis. The tests considered here per...

Racial Differences in the Association Between Gestational Diabetes Mellitus and Risk of Type 2 Diabetes

BACKGROUND It is recognized that a history of gestational diabetes mellitus (GDM) predicts incident type 2 diabetes in women. However, it is unclear if there is a racial disparity between the association of GDM and type 2 diabetes. METHODS We studied 1,142 women with a history of GDM and 18,856 women without a history of GDM aged 13-50 years with their first record of pregnancy in Louisiana State University Hospital-Based Longitudinal Study database between 1990 and 2009. History of GDM was used to predict incident type 2 diabetes. RESULTS During a mean follow-up of 8.6 years, 1,394 women developed type 2 diabetes. The multivariable adjusted hazard ratio (HR) of type 2 diabetes was 6.52 (95% confidence interval [CI] 5.73-7.43) among women with GDM compared to women without GDM. Stratification by age, race, and body mass index (BMI) gave similar results. Compared with African American and white women without a history of GDM, the relative risk for type 2 diabetes was higher in African American women than in white women with a history of GDM. Compared with non-GDM women compartments, GDM women after delivery for <1, 1.0-3.9, 4.0-5.9, 6.0-7.9, 8-9.9, and ≥10.0 years had 4.00, 5.44, 4.26, 3.16, 4.49, and 4.17 times higher risk of having type 2 diabetes, respectively. CONCLUSIONS A history of GDM is a strong predictor of subsequent type 2 diabetes among Louisiana women, especially among African American women.

Increasing Incidence of Gestational Diabetes Mellitus in Louisiana, 1997–2009

BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Although long-term trends are available at the national level, they are less clear for population subgroups, especially those with middle or low income and also at high risk of obesity. METHOD We conducted a retrospective study among women aged 15-50 years with live deliveries between January 1, 1997, and December 31, 2009, at the Louisiana State University Health Care Services Division hospital system. Pregnancies and GDM cases were identified by using ICD-9 code from the Louisiana State University Hospital-Based Longitudinal Study database. The annual incidence of GDM and its standard error (SE) were calculated and stratified by age group and race. RESULTS A total of 2751 GDM incident cases were identified among 62,685 pregnancies between 1997 and 2009. The crude incidence of GDM increased from 4.1% in 1997 to 4.4% in 2009 (increased by 7.3%), and the age-standardized incidence of GDM increased from 5.8% to 7.5% (increased by 29.3%). The incidence of GDM increased with age and reached a peak at 35-39 years of age and then declined in women who were 40-50 years old. Among the three studied races, Asians had significantly higher incidence of GDM than whites and African Americans. CONCLUSIONS The incidence of GDM increased in most years from 1997 to 2009 and reached a peak in 2002 in the women served by Louisiana State University Health Care Services Division hospitals. GDM has become an important public health problem, particularly among women aged 35-39 years.

Increasing prevalence of diabetes in middle or low income residents in Louisiana from 2000 to 2009.

OBJECTIVE To examine the trends in the prevalence of diabetes in patients who received medical care from the Louisiana State University Health Care Services Division (LSUHCSD) hospital system between 2000 and 2009. METHODS The study population included 969,609 unique outpatients and inpatients between 2000 and 2009. The diabetes cases were identified by using ICD-9 code (250*). The annual diabetes prevalence was calculated as the number of unique individuals with an ICD-9 diabetes during the year divided by the number of unique individuals visiting the LSUHCSD hospitals during the year. RESULTS The age-standardized prevalence of diabetes in LSUHCSC hospital patients aged ≥ 20 years increased by 36.2% during 2000-2009, from 10.5% to 14.3%. The rise in age-standardized prevalence of diabetes from 2000 to 2009 occurred in men (from 8.9% to 13.3%) and women (from 11.5% to 15.0%), and in white (from 8.9% to 13.1%), African (from 11.7% to 15.8%) and other race Americans (from 8.2% to 10.4%). The age-standardized prevalence of diabetes was higher in women than in men (p < 0.001). CONCLUSION The annual prevalence of diabetes has dramatically increased from 2000 to 2009 in both men and women and in all races of the population served by the LSUHCSD hospitals.

A Staged Management Diabetes Foot Program Versus Standard Care: A 1-Year Cost and Utilization Comparison in a State Public Hospital System

OBJECTIVE To determine whether staged management of foot ulcers reduces health care costs and utilization. DESIGN Nonrandomized retrospective study using data from 1998-1999 in the Louisiana public hospital system. SETTING Louisiana public hospital system. PARTICIPANTS Forty-five patients with diabetes foot ulcer who received staged management foot care and 169 patients with diabetes foot ulcer who received standard foot care. INTERVENTIONS Staged management of foot ulcers consisting of devices to offload pressure; self-care education; and, after healing, custom-fabricated orthoses and footwear, and monitored progressive ambulation. MAIN OUTCOME MEASURES One-year levels of the number of foot-related inpatient hospitalizations, number of amputation-related hospitalizations, total number of foot-related inpatient days, total charges for foot-related inpatient hospitalizations, all-cause outpatient visits, total charges for all-cause outpatient visits, and combined outpatient and foot-related inpatient charges. RESULTS Over the 12-month study period, the staged management group had a lower foot-related hospitalization rate than did the comparison group (.09 admissions per person vs.50 admissions per person, P=.0002); lower foot-related inpatient days (.91d per person vs 3.97d per person, P=.0289); lower foot-related inpatient charges (

HbA1c and Coronary Heart Disease Risk Among Diabetic Patients

1321 per person vs

Aggressive Blood Pressure Control Increases Coronary Heart Disease Risk Among Diabetic Patients

5411 per person, P=.0151); fewer amputation-related hospitalizations (.04 per person vs.19 per person, P=.0351); fewer emergency department visits (.60 visits per person vs 1.22 visits per person, P=.0043); lower emergency department charges (