Offering a Health Empowerment Program in a Faith-Based Community Clinic.

Introduction. Given the excess burden of overweight/obesity in low-income communities, the objective of this pilot study was to examine the feasibility and effectiveness of a healthy living program (Health Empowerment Program) for improving physical activity, eating habits, and mental health outcomes. Adapted from the Diabetes Prevention Program (DPP), a 7-week biopsychosocial intervention that included spirituality was created. Methods. Participants (n = 153) recruited from a faith-based neighborhood health center were assessed using self-report measures for depressive and anxiety symptoms, self-regulation, physical activity, and eating habits at baseline, postintervention, and 3-month follow-up. Results. Participants had significant decreases in depressive symptoms (ß = -1.21; SE = 0.27; P < .001) and anxiety symptoms (ß = -0.69; SE = 0.24; P = .005) and significant increases in self-regulation (ß = 2.42; SE = 0.82; P = .003), time spent in physical activity (ß; = 3.56; SE = 1.48; P = .016), and total healthy eating habits (ß = 0.97; SE = 0.16; P < .001). Conclusion. Although including spirituality in a healthy living program is feasible and is associated with improvements in outcomes, future research needs to consider how best to incorporate a modified DPP into community settings allowing access to all community members.

Intra-Arterial Lidocaine Blunts the Trigeminocardiac Reflex during Endovascular Treatment of a Carotid-Cavernous Fistula.

Carotid-cavernous fistulas (CCFs) are vascular shunts that allow blood to flow from the carotid artery or its branches into the cavernous sinus. Endovascular embolization is the treatment modality of choice. The trigeminocardiac reflex (TCR) is a vagally mediated reflex that can lead to hemodynamic instability. It can be activated during embolization procedures due to the proximity of vagal efferent neurovascular structures within the cavernous sinus. This case report describes the intraoperative management of recurrent, profound bradycardia due to TCR during endovascular CCF embolization.

Metabolism and pharmacokinetics of naronapride (ATI-7505), a serotonin 5-HT(4) receptor agonist for gastrointestinal motility disorders.

The absorption and disposition of the serotonin 5-HT(4) receptor agonist, naronapride (6-[(3S,4R)-4-(4-amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-yl]-hexanoic acid 1-aza-bicyclo[2,2,2]oct-(R)-3-yl ester dihydrochloride; ATI-7505), were evaluated in healthy males given a single 120-mg oral dose of (14)C-labeled compound. Serial blood samples and complete urine and feces were collected up to 552 h postdose. Naronapride was extensively metabolized, undergoing rapid hydrolysis to 6-[(3S,4R)-4-(4-amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-yl]-hexanoic acid (ATI-7500) with stoichiometric loss of quinuclidinol. ATI-7500 was either N-glucuronidated on the phenyl ring or its hexanoic acid side chain underwent two-carbon cleavage, probably through a ß-oxidation metabolic pathway, to form 4-[(3S,4R)-4-(4-amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-yl]-butanoic acid (ATI-7400). ATI-7400 underwent further side-chain oxidation to form 2-[(3S,4R)-4-(4-amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-yl]-acetic acid (ATI-7100). Quinuclidinol, ATI-7500, ATI-7400, and ATI-7100 were the major metabolites, with plasma area under the curve values approximately 72-, 17-, 8-, and 2.6-fold that of naronapride. Naronapride, ATI-7500, ATI-7400, and ATI-7100 accounted for 32.32, 36.56, 16.28, and 1.58%, respectively, of the dose recovered in urine and feces. ATI-7400 was the most abundant radioactive urinary metabolite (7.77%), and ATI-7500 was the most abundant metabolite in feces (35.62%). Fecal excretion was the major route of elimination. Approximately 32% of the dose was excreted unchanged in feces. Naronapride, ATI-7500, and quinuclidinol reached peak plasma levels within 1 h postdose. Peak ATI-7400 and ATI-7100 concentrations were reached within 1.7 h, suggesting rapid ATI-7500 metabolism. Naronapride plasma terminal half-life was 5.36 h, and half-lives of the major metabolites ranged from 17.69 to 33.03 h. Naronapride plasma protein binding was 30 to 40%. The mean blood/plasma radioactivity ratio indicated minimal partitioning of (14)C into red blood cells.

Staying active, staying strong: pilot evaluation of a once-weekly, community-based strength training program for older adults.

ISSUE ADDRESSED: Little is known about the effectiveness of once-weekly strength training programs for older adults based in community settings. This pilot study evaluated such a program to assess changes in the functional fitness of participants. METHODS: A pre-test/post-test within subjects study design was used with new participants in the 10-week Staying Active, Staying Strong (SASS) program (all aged 50+ years). The Seniors Fitness Test (SFT) and SF-36 were used to assess functional fitness and health-related quality of life respectively. Perception of physical ability was assessed using a study-specific questionnaire. Pre- and post-test SFT and SF-36 scores were compared using paired t-tests. Frequency of responses was used to describe participant perceptions. RESULTS: 110 evaluation participants (mean age 68.2 years; 85% female), 49% of those who completed the pre-test, also completed the post-test. Evaluation participants significantly improved their strength (assessed using arm curls and sit-to-stand); endurance (two-minute step test); flexibility (sit and reach, back scratch); and agility/dynamic balance (eight-foot up and go). SF-36 physical-functioning domain scores also significantly improved. Most participants reported improved strength, fitness, mobility, general well-being and confidence in performing daily activities. CONCLUSION: Weekly, community-based strength training programs show promise in improving the functional capacity, including the strength, of older adults. More thorough evaluation is now required to confirm these findings.

Social support moderates caregiver life satisfaction following traumatic brain injury.

Social support is an important determinant of adjustment following traumatic brain injury (TBI) sustained by a family member. The present study examined the extent to which social support moderates the influence of characteristics of the person with injury on caregiver subjective well-being. Sixty pairs of individuals who had sustained a moderate to severe TBI and their caregivers (N=120) participated. Years postinjury ranged from 0.3 to 9.9 ( M=4.8, SD=2.6). Cognitive, functional, and neurobehavioral functioning of participants with TBI were assessed using neuropsychological tests and rating scales. Caregiver life satisfaction and perceived social support were assessed using self-report questionnaires. Results indicated that time since injury was unrelated to life satisfaction. Neurobehavioral disturbances showed an inverse relation with life satisfaction. Social support emerged as an important moderator of life satisfaction. Only among caregivers with low social support was cognitive dysfunction adversely related to life satisfaction. Similarly, a trend suggested that patient unawareness of deficit was associated with caregiver life dissatisfaction only among caregivers with low social support. In contrast, these characteristics were unrelated to life satisfaction among caregivers with adequate social support.

Predictors of driving outcome after traumatic brain injury.

OBJECTIVE: To examine predictors of driving status and fitness to drive after traumatic brain injury (TBI). DESIGN: Retrospective and prospective follow-up of a cohort ranging from 4 months to 10 years post-TBI. SETTING: A Midwestern, urban university-affiliated rehabilitation hospital. PARTICIPANTS: Seventy-one pairs of adults who had sustained a TBI and their significant others. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving status (whether the patient resumed driving), driving frequency (estimated miles driven per week), and postinjury driving records compiled by the Department of Motor Vehicles. RESULTS: Logistic and hierarchical regression analyses indicated that the significant other's perceptions of the patient's fitness to drive were the strongest predictor of patients' driving status and driving frequency. However, years postinjury, disability at discharge, and current neuropsychologic functioning best predicted postinjury driving safety as measured by actual incidents. The relation between perception of patients' fitness and actual driving incidents, however, was modest. CONCLUSIONS: Neuropsychologic and medical information available by traditional methods showed unique value in predictive driving safety. However, caregiver perception of patients' fitness was the overwhelming determinant of whether and how much patients drive. The bases on which caregivers form their opinions affect the safety of patients and the public. The rehabilitation setting is a unique resource for family education regarding abilities essential to safe driving.

Predictors of caregiver and family functioning following traumatic brain injury: social support moderates caregiver distress.

OBJECTIVE: This study examined predictors of family dysfunction and caregiver distress among 60 pairs of persons who sustained a traumatic brain injury and their caregivers. DESIGN: A cross-sectional design that used hierarchical multiple regression analyses evaluated the relative influences of time since injury, awareness of deficit, and neurobehavioral and neuropsychological functioning of the person with injury, and caregiver perceived social support. RESULTS: The predictor model accounted for 52% of the variance in family dysfunction and 39% in caregiver psychological distress. Neurobehavioral disturbance in the person with injury was the strongest predictor of caregiver distress. Social support showed a direct and linear relationship to family functioning, and it was the strongest predictor of family functioning. Social support was a powerful moderator of caregiver psychological distress. In the absence of adequate social support, caregiver distress increased with longer time after injury, cognitive dysfunction, and unawareness of deficit in care recipients, whereas these characteristics were not associated with distress among caregivers with adequate social support. CONCLUSIONS: Rehabilitation professionals should stress the importance of caregivers and families of persons with TBI seeking and obtaining adequate social support.