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BACKGROUND AND PURPOSE: Individuals post traumatic brain injury (TBI) are likely to experience cognitive, sensory, and motor impairments. Tremor is a common movement disorder that can affect this patient population. The purpose of this case report was to describe the effects that progressive muscle relaxation, meditation, and mental practice-based interventions have on the treatment of chronic right upper extremity tremor in a patient post-TBI. CASE DESCRIPTION: A 47-year-old male with a traumatic brain injury presented with a resting and postural tremor of the right wrist flexors and deficits in cognition, sensation, proprioception, balance, and motor function. The patient's primary goal for therapy was to decrease the tremor to improve his quality of life and ability to perform activities of daily living. METHODS: Progressive muscle relaxation, breath-focused meditation, and mental practice-based intervention were administered to the patient. Active range of motion activities occurred during weekly in-person sessions and daily practice occurred at home. RESULTS: The patient demonstrated improvements in quality of life, self-ratings of tremor severity, ratings of tremor impact on ADL's, gross motor object manipulation, frequency of tremor via surface electromyography, and visual inspection of a spirograph. CONCLUSION: A combination of progressive muscle relaxation, meditation, and mental practice-based interventions appeared to positively impact tremor across physical and psychosocial domains in a patient with a chronic tremor. Further investigation is needed to verify these findings.
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OBJECTIVE To determine and compare mean standing extension and maximum flexion angles of various joints in healthy adult alpacas and llamas, and determine the reliability of goniometric data within and between 2 observers for each joint of interest. SAMPLE 6 healthy adult llamas and 6 healthy adult alpacas. PROCEDURES The shoulder joint, elbow joint, carpal, and metacarpophalangeal (MCP) joints of the forelimbs and the hip joint, stifle joint, tarsal, and metatarsophalangeal (MTP) joints of the hind limbs were investigated. Each articulation was measured with a universal goniometer by 2 observers, who each obtained 2 measurements when each joint was maintained in standing extension and in maximal passive flexion. Two sample (unpaired) t tests were performed for comparisons of mean standing extension and maximum passive flexion angles between alpacas and llamas. Intraclass correlation coefficients were calculated for each articulation to assess interobserver and intra-observer reliability of measurements. RESULTS Llamas had larger mean standing extension angles than alpacas for the tarsal and elbow joint, but there were no significant differences between species for all other joints. For all joints, flexion measurements did not differ significantly between the 2 species. For most joints, the reliability of goniometric data between observers was good to excellent (intraclass correlation coefficients, 0.6 to 0.95) CONCLUSIONS AND CLINICAL RELEVANCE Except for the elbow joint and tarsus in extension, the angle of limb articulations during flexion and extension can be considered similar for alpacas and llamas. These measurements have relevance for veterinary surgeons when assessing joint mobility and conformation and determining appropriate angles for arthrodesis.
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Artrometría Articular/veterinaria , Camélidos del Nuevo Mundo/anatomía & histología , Rango del Movimiento Articular , Animales , Femenino , Miembro Anterior/anatomía & histología , Articulación de la Cadera/anatomía & histología , Masculino , Articulación Metacarpofalángica/anatomía & histología , Articulación Metatarsofalángica/anatomía & histología , Reproducibilidad de los Resultados , Rodilla de Cuadrúpedos/anatomía & histología , Huesos Tarsianos/anatomía & histologíaRESUMEN
Binge eating is a prominent feature of bulimia nervosa and binge eating disorder. Stress or perceived stress is an often-cited reason for binge eating. One notion is that the neural pathways that overlap with stress reactivity and feeding behavior are altered by recurrent binge eating. Using young adult female rats in a dietary-induced binge eating model (30 min access to binge food with or without 24-h calorie restriction, twice a week, for 6 weeks) we measured the neural activation by c-Fos immunoreactivity to the binge food (vegetable shortening mixed with 10% sucrose) in bingeing and non-bingeing animals under acute stress (immobilization; 1 h) or no stress conditions. There was an increase in the number of immunopositive cells in the dorsal medial prefrontal cortex (mPFC) in stressed animals previously exposed to the binge eating feeding schedules. Because attention deficit hyperactive disorder (ADHD) medications target the mPFC and have some efficacy at reducing binge eating in clinical populations, we examined whether chronic (2 weeks; via IP osmotic mini-pumps) treatment with a selective alpha-2A adrenergic agonist (0.5 mg/kg/day), guanfacine, would reduce binge-like eating. In the binge group with only scheduled access to binge food (30 min; twice a week; 8 weeks), guanfacine increased total calories consumed during the 30-min access period from the 2-week pre-treatment baseline and increased binge food consumption compared with saline-treated animals. These experiments suggest that mPFC is differentially activated in response to an immobilization stress in animals under different dietary conditions and chronic guanfacine, at the dose tested, was ineffective at reducing binge-like eating.
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Agonistas de Receptores Adrenérgicos alfa 2/farmacología , Bulimia/fisiopatología , Guanfacina/farmacología , Corteza Prefrontal/fisiopatología , Animales , Bulimia/inducido químicamente , Bulimia/etiología , Corticosterona/sangre , Dopamina/sangre , Ingestión de Alimentos/efectos de los fármacos , Ingestión de Alimentos/fisiología , Epinefrina/sangre , Femenino , Norepinefrina/sangre , Ratas Sprague-Dawley , Restricción Física/fisiología , Estrés Psicológico/fisiopatologíaRESUMEN
Stress is often associated with binge eating. A critical component of the control of stress is the central norepinephrine system. We investigated how dietary-induced binge eating alters central norepinephrine and related behaviors. Young male Sprague Dawley rats received calorie deprivation (24 h) and /or intermittent sweetened fat (vegetable shortening with sucrose; 30 min) twice a week for 10 weeks. The groups were Restrict Binge (calorie deprivation/sweetened fat), Binge (sweetened fat), Restrict (calorie deprivation), and Naive (no calorie deprivation/no sweetened fat). Dietary-induced binge eating was demonstrated by Restrict Binge and Binge, which showed an escalation in 30-min intake over time. Feeding suppression following nisoxetine (3 mg/kg; IP), a selective norepinephrine reuptake inhibitor, was not evident in Restrict Binge (Restrict Binge: 107±13, Binge: 52±9, Restrict: 80±8, Naive: 59±13% of saline injection at 1 h). In subsequent experiments with Restrict Binge and Naive, Restrict Binge had reduced corticosterone (Restrict Binge: 266±25; Naive: 494±36 ng/ml) and less feeding suppression (Restrict Binge: 81±12, Naive: 50±11% of non-restraint intake at 30 min) following restraint stress (1 h). Dietary-induced binge eating in Restrict Binge was not altered by a dorsal noradrenergic bundle lesion caused by N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP4), but frontal cortex norepinephrine was positively correlated with the average 30-min intake post-lesion (0.69; p<0.01). In a separate set of animals, single-unit in vivo electrophysiological recording of locus coeruleus-norepinephrine neural activity demonstrated reduced sensory-evoked response as a consequence of the Restrict Binge schedule (Restrict Binge: 8.1±0.67, Naive: 11.9±1.09 Hz). These results, which suggest that a consequence of dietary-induced binge eating is to attenuate the responsiveness of the brain norepinephrine system, will further our understanding of how highly palatable foods dampen the stress neuraxis.
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Encéfalo/metabolismo , Bulimia , Conducta Alimentaria/efectos de los fármacos , Fluoxetina/análogos & derivados , Norepinefrina/metabolismo , Animales , Peso Corporal , Ingestión de Energía , Fluoxetina/farmacología , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
Extracts from the immature fruit of Citrus aurantium are often used for weight loss but are reported to produce adverse cardiovascular effects. Root extracts of Rhodiola rosea have notable antistress properties. The hypothesis of these studies was that C aurantium (6% synephrine) and R rosea (3% rosavins, 1% salidroside) in combination would improve diet-induced obesity alterations in adult male Sprague-Dawley rats. In normal-weight animals fed standard chow, acute administration of C aurantium (1-10 mg/kg) or R rosea (2-20 mg/kg) alone did not reduce deprivation-induced food intake, but C aurantium (5.6 mg/kg) + R rosea (20 mg/kg) produced a 10.5% feeding suppression. Animals maintained (13 weeks) on a high-fat diet (60% fat) were exposed to 10-day treatments of C aurantium (5.6 mg/kg) or R rosea (20 mg/kg) alone or in combination. Additional groups received vehicle (2% ethanol) or were pair fed to the C aurantium + R rosea group. Although high-fat diet intake and weight loss were not influenced, C aurantium + R rosea had a 30% decrease in visceral fat weight compared with the other treatments. Only the C aurantium group had an increased heart rate (+7%) compared with vehicle. In addition, C aurantium + R rosea administration resulted in an elevation (+15%) in hypothalamic norepinephrine and an elevation (+150%) in frontal cortex dopamine compared with the pair-fed group. These initial findings suggest that treatments of C aurantium + R rosea have actions on central monoamine pathways and have the potential to be beneficial for the treatment of obesity.
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Tejido Adiposo Blanco/efectos de los fármacos , Citrus/química , Hipotálamo/metabolismo , Obesidad/tratamiento farmacológico , Fitoterapia , Extractos Vegetales/farmacología , Rhodiola/química , Tejido Adiposo Blanco/metabolismo , Animales , Dieta Alta en Grasa , Disacáridos/farmacología , Dopamina/metabolismo , Glucósidos/farmacología , Hipotálamo/efectos de los fármacos , Caolín/administración & dosificación , Masculino , Monoaminooxidasa/sangre , Norepinefrina/sangre , Obesidad/inducido químicamente , Obesidad/metabolismo , Fenoles/farmacología , Raíces de Plantas/química , Corteza Prefrontal/efectos de los fármacos , Corteza Prefrontal/metabolismo , Ratas , Ratas Sprague-Dawley , Sinefrina/farmacología , Pérdida de Peso/efectos de los fármacosRESUMEN
Central noradrenergic pathways are involved in feeding and cardiovascular control, physiological processes altered by obesity. The present studies determined how high-fat feeding and body weight gain alter the sensitivity to the feeding suppression and neural activation to a selective norepinephrine reuptake inhibitor, nisoxetine. Acute administration of nisoxetine (saline: 0, 3, 10, and 30 mg/kg; i.p.) resulted in a dose-dependent reduction in the 24 h refeeding response in male Sprague Dawley rats maintained on standard chow. In a similar fashion, nisoxetine resulted in reductions in blood pressure and a compensatory increase in heart rate. From these studies, the 3 mg/kg dose was subthreshold. In a separate experiment, however, 10 wk exposure to a high-fat diet (60% fat) resulted in weight gain and significant feeding suppression following administration of nisoxetine (3 mg/kg) compared with animals fed a control diet (10% fat). Nisoxetine (3 mg/kg) also resulted in greater neural activation, as measured by c-Fos immunohistochemistry, in the arcuate nucleus of the hypothalamus in animals exposed to the high-fat diet. Such data indicate acute nisoxetine doses that suppress food intake can impact cardiovascular measures. It also suggests that the feeding suppression to a low-dose nisoxetine is enhanced as a result of high-fat diet and weight gain.
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Dieta Alta en Grasa/efectos adversos , Ingestión de Alimentos/efectos de los fármacos , Fluoxetina/análogos & derivados , Norepinefrina/antagonistas & inhibidores , Norepinefrina/fisiología , Animales , Regulación del Apetito/efectos de los fármacos , Regulación del Apetito/fisiología , Núcleo Arqueado del Hipotálamo/química , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Fluoxetina/administración & dosificación , Frecuencia Cardíaca/efectos de los fármacos , Inmunohistoquímica , Masculino , Proteínas Proto-Oncogénicas c-fos/análisis , Ratas , Ratas Sprague-Dawley , Aumento de Peso/efectos de los fármacosRESUMEN
OBJECTIVE: To identify predictors of changes in staff morale and burnout associated with participation in a quality improvement (QI) initiative at community health centers (HCs). DATA SOURCES: Surveys of staff at 145 HCs participating in the Health Disparities Collaboratives (HDC) program in 2004. DATA COLLECTION AND STUDY DESIGN: Self-administered questionnaire data collected from 622 HC staff (68 percent response rate) were analyzed to identify predictors of reported change in staff morale and burnout. Predictive categories included outcomes of the QI initiative, levels of HDC integration, institutional support, the use of incentives, and demographic characteristics of respondents and centers. PRINCIPAL FINDINGS: Perceived improvements in staff morale and reduced likelihood of staff burnout were associated with receiving personal recognition, career promotion, and skill development opportunities. Similar outcomes were associated with sufficient funding and personnel, fair distribution of work, effective training of new hires, and consistent provider participation. CONCLUSIONS: Having sufficient personnel available to administer the HDC was found to be the strongest predictor of team member satisfaction. However, a number of low-cost, reasonably modifiable, organizational and leadership characteristics were also identified, which may facilitate improvements in staff morale and reduce the likelihood of staff burnout at HCs participating in the HDC.
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Actitud del Personal de Salud , Agotamiento Profesional/prevención & control , Centros Comunitarios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Moral , Administración de Personal/estadística & datos numéricos , Adulto , Centros Comunitarios de Salud/normas , Planes para Motivación del Personal/estadística & datos numéricos , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Lealtad del Personal , Autonomía Profesional , Garantía de la Calidad de Atención de Salud , Desarrollo de Personal/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos , Recursos Humanos , Carga de Trabajo/estadística & datos numéricosRESUMEN
In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.
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Disparidades en Atención de Salud , Neoplasias de la Mama/epidemiología , Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Modelos Teóricos , Grupos Raciales/etnología , Reembolso de Incentivo , Estados UnidosRESUMEN
There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points -- system, community, provider, and individual patient -- in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future research should focus on identifying key components of case management and sociocultural tailoring that are essential for effective interventions and developing new low-cost dissemination mechanisms for treatment and preventive programs that could be tailored to racial and ethnic minorities.
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Trastorno Depresivo/prevención & control , Trastorno Depresivo/terapia , Etnicidad , Disparidades en Atención de Salud , Población Blanca , Manejo de la Enfermedad , Humanos , Evaluación de Resultado en la Atención de Salud , Sociología Médica , Estados UnidosRESUMEN
BACKGROUND: Leaders and policymakers need an accurate appraisal of the federally qualified community health center (CHC) quality improvement (QI) literature to make informed decisions for the CHC program. OBJECTIVES: This paper aims to (1) summarize the content and findings of CHC QI studies to date, (2) systematically rate the quality of those studies, and (3) outline 10 important areas for future CHC QI research. METHODS: We searched medical and nonmedical databases to identify QI studies in CHC settings. We systematically reviewed identified studies for the features of their QI interventions and for the methodological quality of their evaluations. We combined results from the review with input from the CHC community to generate an agenda for future CHC QI research. RESULTS: Eighteen studies were identified and reviewed. Interventions mainly targeted chronic conditions and screening practices and used 1 to 11 of 14 different QI tactics; evaluations comprised 14 observational and 4 randomized study designs. CHC QI interventions have been effective in improving processes of care for diabetes and cancer screening in the short term; their effectiveness in the long term and regarding outcomes of care have not been demonstrated. CONCLUSIONS: QI interventions in CHC setting are promising, but future interventions and evaluations should answer critical basic questions about QI, including the following: What are the best models of QI? How can QI improvements be effectively implemented and sustained? What are the global effects of QI (positive and negative)? How can QI be made financially viable and sensible from both the CHC and societal perspectives?