Hypoparathyroidism is a rare endocrine disorder whose incidence and prevalence have not been well defined. This study aimed to 1) estimate the number of insured adult patients with hypoparathyroidism in the United States and 2) obtain physician assessment of disease severity and chronicity. Prevalence was estimated through calculation of diagnoses of hypoparathyroidism in a large proprietary health plan claims database over a 12-month period from October 2007 through September 2008 and projected to the US insured population. Incidence was also calculated from the same database by determining the proportion of total neck surgeries resulting in either transient (6 months) or chronic (>6 months) hypoparathyroidism. A physician primary market research study was conducted to assess disease severity and determine the percentage of new nonsurgical patients with hypoparathyroidism. Incidence data were entered into an epidemiologic model to derive an estimate of prevalence. The diagnosis-based prevalence approach estimated 58,793 insured patients with chronic hypoparathyroidism in the United States. The surgical-based incidence approach yielded 117,342 relevant surgeries resulting in 8901 cases over 12 months. Overall, 7.6% of surgeries resulted in hypoparathyroidism (75% transient, 25% chronic). The prevalence of chronic hypoparathyroidism among insured patients included in the surgical database was estimated to be 58,625. The physician survey found that 75% of cases treated over the past 12 months were reported due to surgery and, among all thyroidectomies and parathyroidectomies and neck dissections performed in a year, 26% resulted in transient hypoparathyroidism and 5% progressed to a chronic state. In conclusion, the two claims-based methods yielded similar estimates of the number of insured patients with chronic hypoparathyroidism in the United States (58,700). The physician survey was consistent with those calculations and confirmed the burden imposed by hypoparathyroidism.

The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The goal of the trial is to evaluate the impact of the paraprofessional-delivered "Family Spirit" home-visiting intervention to reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research (CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006 and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian paraprofessionals to teen mothers from 28 weeks gestation until the baby's third birthday. A mixed methods assessment administered at nine intervals measures intervention impact on parental competence, mother's and children's social, emotional and behavioral risks for drug use, and maladaptive functioning. Participants are young (mean age = 18.1 years), predominantly primiparous, unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug use were ~2-4 times higher and ~5-6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced communities.

Objective: To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children. Design: Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables. Setting: Four Southwestern American-Indian reservation communities. Subjects: A total of 425 parents/caregivers of young children completed the survey. Results: Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as 'food insecure'. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk 5 2?19, P , 0?001) and less likely to have healthy foods available at home (relative risk 5 0?45, P , 0?01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1?46 times more likely to be adult food insecure than respondents without transportation barriers (P , 0?001). High food costs were significantly associated with greater likelihoods of adult (relative risk 5 1?47, P , 0?001) and child (relative risk 5 1?65, P , 0?001) food insecurity. Conclusions: Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed. Keywords American Indian Food insecurity Early childhoodFood insecurity is defined as 'limited or uncertain availability of nutritionally adequate and safe foods and limited or uncertain ability to acquire foods in socially acceptable ways'. According to the US Department of Agriculture, 14?7 % of US households experienced food insecurity in 2009. Rates of food insecurity were substantially higher for households with low income, single parents and ethnic minorities (2) . American Indians (AI) have the lowest health, economic and social status of any ethnic or racial group in the USA; they also have the highest food insecurity rates in the country. Recent data suggest that approximately twice as many American-Indian (AI) households with children are food insecure as non-AI households (3) . Diet and activity patterns of AI have changed dramatically in the past three generations. Traditional foods, such as wild game, nuts, fruits and berries, have been replaced by less diverse, processed commodities and convenience foods (4,5) . Thus, in rural A...

Targeting drug prevention among young AI men during early fatherhood may provide special opportunity to reduce substance use and improve parenting. Intergenerational approaches may hold special promise.

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