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Objective: To estimate the economic value of administering antiviral medications to pregnant women who have come in contact with an infectious individual with influenza.Methods: A computer-simulation model was developed to predict the potential economic effect of antiviral use for postexposure prophylaxis among pregnant women in both seasonal influenza and pandemic influenza scenarios. The model allowed us to examine the effects of varying influenza exposure risk, antiviral efficacy, antiviral cost, and the probability of different influenza outcomes such as hospitalization, preterm delivery, and mortality.Results: For a variety of pandemic influenza scenarios (attack rate 20% or more, probability of preterm birth for women with influenza 12% or more, mortality for a preterm neonate 2% or more, and probability of influenza-attributable hospitalization 4.8% or more), the postexposure prophylactic use of antiviral medications was strongly cost-effective, with incremental cost-effectiveness ratio values below $50,000 per quality-adjusted life-year. Antiviral prophylaxis became an economically dominant strategy (that is, less costly and more effective) when the influenza attack rate is 20% or more and preterm birth rate is 36% or more, and when attack rate is 30% or more and preterm birth rate is 24% or more. Antiviral prophylaxis was not cost-effective under seasonal influenza conditions.Conclusion: These findings support the use of antiviral medications for postexposure prophylaxis among pregnant women in a pandemic influenza scenario but not in a seasonal influenza setting. [ABSTRACT FROM AUTHOR]

1. Eight women with acute pyelonephritis were treated with i.v. enoxacin for 5 days. All were clinically cured and five had a bacteriological cure. Five women reported side effects. 2. During treatment there was no significant accumulation of enoxacin and the total clearance of the drug did not alter with repeated dosing. Drug elimination half-life (mean 4.3 h, s.d. 2.1) was similar to that reported in healthy volunteers. 3. Enoxacin should be compared with the aminoglycosides and beta-lactam antibiotics for the treatment of severe or complicated urinary tract infections. [ABSTRACT FROM AUTHOR]

1 The pharmacokinetics of intravenously administered labetalol were studied in four patients with severe renal failure and in three normal subjects. 2 A new and sensitive method for the assay of plasma labetalol concentrations using high performance liquid chromatography is described. 3 Labetalol has a relatively large apparent volume of distribution (3.3-7.9 l/kg, two-compartment open model) and a relatively high plasma clearance (0.3-1.6 1 h-1 kg-1). 4 There were no significant differences between the patients with severe renal failure and the controls for any of the pharmacokinetic parameters measured. 5 In the presence of renal functional impairment, no modification of labetalol dosage is required. 6 In another study of 31 patients, glomerular filtration rate was measured at 3-month intervals for 3-18 months. In ten patients there was no change, in ten there was an improvement and in 11 there was deterioration, but in only three was this attributable to treatment. 7 In our experience with over 300 patients, we conclude that labetalol plus diuretic treatment is efficacious and safe in all grades of hypertension including those with all degrees of renal insufficiency. [ABSTRACT FROM AUTHOR]

In order to gain a better understanding of post-stroke dietary behaviors (e.g., selecting, accessing, and preparing healthy foods) among chronic, community-dwelling stroke survivors, we conducted a mixed-methods study consisting of a quantitative online survey (n = 63) and follow-up focus groups with a subset of participants (n = 7). Perceived performance, assistance required, adaptive equipment and compensatory strategies used, and sources of education and training were examined. Results demonstrated (1) diminished post-stroke performance for most dietary behaviors (e.g., grocery shopping, meal preparation), (2) an increased desire to eat healthily to prevent recurrent stroke, (3) variable use of adaptive equipment and compensatory strategies, and (4) limited healthcare-based dietary behavior education and training. These results suggest that stroke survivors could benefit from increased dietary behavior intervention to improve dietary behavior performance. Findings can be used to guide clinical intervention and design future research studies.

Objectives: To examine differences in health characteristics and health behaviors between rural and non-rural stroke survivors in the USA., Methods: Data were extracted from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) to compare prevalences of health characteristics (i.e., diabetes, disability, poor health, high cholesterol, hypertension, no health care coverage, weight status) and health behaviors (i.e., fruit consumption, vegetable consumption, physical inactivity, high alcohol consumption, smoking) among community-dwelling stroke survivors, stratified by rural status (i.e., rural vs. non-rural). Logistic regression was used to calculate odds ratios (ORs) for health characteristics and health behaviors to examine the association of rural status with each variable of interest (reference group=non-rural)., Results: Data from 14,599 respondents (rural: n = 5,039; non-rural: n = 9,560) were available for analysis. The majority of respondents were female (61.4%), non-Hispanic white (83.2%), previously married (56.1%), had at least some college education (55.2%), and had an annual household income ≥USD $25,000 (56.9%). Prevalences of disability, poor health, weekly aerobic exercise, and smoking were higher among rural respondents compared to non-rural respondents. Logistic regression showed increased odds (odds ratio range: 1.1-1.2) for these variables among rural respondents; however, odds ratios were attenuated after controlling for sociodemographic and health characteristics., Conclusions: We did not find evidence of differences in the investigated health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors in the USA. Additional research is needed to confirm these findings and to identify alternative sociodemographic and health factors that may differ between rural and non-rural community-dwelling stroke survivors.

Introduction/purpose: A reduction in nonexercise physical activity (NEPA) after exercise may reduce the effectiveness of exercise interventions on weight loss in adults with overweight or obesity. Aerobic exercise (AEx) and resistance exercise (REx) may have different effects on NEPA. The purpose of this secondary analysis was to examine the effect of a single bout of AEx or REx on NEPA and sedentary behavior in inactive adults with overweight or obesity., Methods: Adults with overweight or obesity ( n = 24; 50% male; age, 34.5 ± 1.5 yr; body mass index, 28.5 ± 0.9 kg·m -2 ) not meeting current physical activity guidelines completed a single 45-min bout of AEx, REx, or a sedentary control on different days in random order. After each condition, participants' NEPA was recorded for 84 h by accelerometer. Time spent sedentary and in light, moderate, and vigorous physical activity; steps; metabolic equivalent of task (MET)-hours; and sit-to-stand transitions were calculated using activity count data., Results: No differences were observed in the percent of waking time spent sedentary and in light, moderate, and vigorous activity between conditions ( P > 0.05). No differences were observed in steps, MET-hours, or sit-to-stand transitions between conditions ( P > 0.05). NEPA responses were variable among individuals, with approximately half of participants reducing and half increasing NEPA over the 84 h after each exercise condition., Conclusion: NEPA was not reduced after an acute bout of AEx or REx in a sample of inactive adults with overweight or obesity., Competing Interests: The authors report no conflicts of interest. This work was supported by the National Institutes of Health (NIH) grants, such as NIH/National Center for Advancing Translational Sciences under award numbers UL1TR002535, 1UL01TR002538, KL2TR002539, and NIDDK P30DK048520, and NIH/National Institute of Diabetes and Digestive and Kidney Diseases grants T32DK07658 and T32DK007446. This work was also supported by a pilot grant award from the University of Colorado’s Center for Women’s Health Research. This trial was preregistered at ClinicalTrials.gov (NCT03143868). Drs. Melanson and Cornier are supported by resources from Geriatric Research, Education, and the Clinical Center at the Denver VA Medical Center.

Objective: To identify and summarize studies that have implemented dietary behavior interventions and reported dietary outcomes in community-dwelling adult stroke survivors. Design: Scoping Review; Setting: Not applicable. Participants: Studies eligible for review included peer-reviewed studies describing both a dietary intervention and a dietary outcome among community-dwelling stroke survivors published between January 2000 and June 2022. Results: We identified 14 articles that included both a dietary behavior intervention and a dietary outcome. All studies (5 pilot randomized controlled trials (RCTs), 6 non-pilot RCTs, 3 cohort studies) delivered multimodal health behavior interventions that included a dietary component. Interventions were delivered weekly to every other month and lasted for 1-24 months. Most studies did not use standardized assessments to assess dietary outcomes; however, 8 studies reported improvement in dietary outcomes. Conclusions: This review provides support for the efficacy of dietary behavior interventions in stroke survivors. Variability in intervention format and assessment measures across studies impedes the ability to conduct meta-analyses of outcomes to inform research knowledge and clinical practice. Additional research is needed to determine mechanisms-of-action for dietary behavior change in stroke survivors., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 The Author(s).)

Background: Following a healthy dietary pattern is recommended for secondary stroke prevention, but stroke-related impairments may hinder the performance of dietary behaviors (i.e., accessing, selecting, and preparing food)., Objective: The purpose of this study was to characterize facilitators and barriers to performing dietary behaviors in stroke survivors., Methods: We completed a secondary analysis of focus group data using a qualitative descriptive approach and content analysis to examine how 15 chronic (≥ 6 months) community-dwelling stroke survivors and 10 care-partners perceived dietary behavior facilitators and barriers., Results: We identified three key themes. First, changes in body functions/structures (e.g., hemiparesis, balance) result in dietary behavior activity limitations (e.g., difficulty grocery shopping, meal preparation). Second, environmental supports (e.g., care-partners, adaptive equipment) and activity modification (e.g., using pre-cut foods, dining out) are used to overcome dietary behavior limitations. Third, negative affect (e.g., dissatisfaction, frustration) and activity limitations lead to participation limitations (e.g., not being able to perform dietary behaviors independently, not being able to socialize when dining out)., Conclusions: Dietary behaviors are negatively impacted following stroke, but environmental supports and compensatory strategies may be implemented to overcome activity limitations. More research is needed to develop interventions to facilitate dietary behaviors and participation following stroke., Competing Interests: Conflicts of interest The authors report no financial conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Stroke increases risk for disability. Obesity and diabetes also increase risk for disability in the general population, but their association with disability in stroke survivors is unknown. We examined disability risk associated with obesity and diabetes in stroke survivors across six disability types: hearing, vision, cognition, mobility, and basic and instrumental activities of daily living (ADLs)., Materials and Methods: Data from 37,955 community-dwelling US stroke survivors aged ≥18 years were analyzed from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Linear regression was used to calculate prevalence of each disability type. Survivors were stratified by obesity versus normal weight and diabetes vs no diabetes, and logistic regression was used to calculate adjusted odds ratios (AOR) for each disability type, adjusted for demographic information., Results: Prevalences of disability types ranged from 14.2% to 36.0%. Among survivors with obesity, odds were elevated for mobility (AOR: 1.68) and basic ADL (AOR: 1.55) disability. Among survivors with diabetes, odds were elevated for all disability types (AOR range: 1.15-1.71)., Conclusion: Stroke survivors with obesity or diabetes experience increased risk for disability compared to survivors without these chronic conditions. Interventions for managing disability, obesity, and diabetes concomitantly may be warranted and deserve further consideration.

Importance: Physical activity (PA) is recommended for improving physical and cardiovascular function but can be challenging because of stroke-related impairments. A better understanding of how adults with stroke conceptualize PA could assist in developing effective interventions for increasing poststroke PA., Objective: To explore how adults with stroke conceptualize PA., Design: Phenomenological qualitative design., Setting: Participants' homes., Participants: Community-dwelling adults with chronic (>6 mo) stroke (N = 15)., Outcomes and Measures: Semistructured interviews were conducted with participants. Data were analyzed by means of inductive content analysis to identify key themes., Results: Three key themes emerged: (1) moderate to vigorous PA, which includes exercise-related activities (going to the gym, walking, playing sports); (2) PA necessary for performing daily activities and occupations, which includes basic and instrumental activities of daily living; and (3) avoiding sedentary behavior, which includes not wanting to sit for long periods of time, avoiding boredom, and valuing PA over being sedentary., Conclusions and Relevance: Participants broadly categorized PA, encompassing multiple activity types, which is encouraging because reducing sedentary behavior and increasing PA of any intensity can improve cardiometabolic health. Interventions that complement and enhance these conceptualizations, alone or in combination with other mechanisms of action, should be explored for their efficacy in increasing PA in adults with stroke., What This Article Adds: After stroke, perceptions of PA encompass exercise, daily activities and occupations, and avoiding sedentary behavior; these perceptions could be harnessed to promote PA among adults after stroke., (Copyright © 2021 by the American Occupational Therapy Association, Inc.)

Background: Engaging in unhealthy behaviours [poor diet, insufficient physical activity (PA)] increases risk for recurrent stroke and can be compounded by obesity and diabetes, but the association of obesity and diabetes with poor diet and insufficient PA in stroke survivors is unknown., Objective: The purpose of this study was to compare prevalences of low fruit and vegetable consumption (low FV consumption, <1 fruit and <1 vegetable daily) and low physical activity (low PA, <150 minutes of weekly moderate-intensity PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, both conditions)., Methods: Cross-sectional data from 32 876 non-institutionalized, US stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AORs) of the investigated unhealthy behaviours (adjusted for sex, age, race, income, education and marital status) and 95% confidence intervals (CIs) were calculated., Results: Prevalences of low FV consumption and low PA exceeded 50% across all obesity-diabetes categories. Compared with respondents with neither obesity nor diabetes, AORs for low PA were increased for respondents with both obesity and diabetes (2.02, 95% CI: 1.72-2.37) and respondents with obesity only (1.31, 1.13-1.53); AORs for low FV consumption did not differ across obesity-diabetes categories., Conclusions: Results indicated a joint effect of obesity and diabetes with low PA among stroke survivors. Regardless of obesity-diabetes status, however, prevalence of low FV consumption and low PA exceeded 50%. Targeted interventions that modify these unhealthy behaviours among stroke survivors should be explored., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Stroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown., Objective: To investigate the joint association of obesity and diabetes with functional disability in stroke survivors., Methods: Cross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions)., Results: Prevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%-47.4%), obesity only (55.3%, 95% CI: 52.7%-58.0%), diabetes only (60.8%, 95% CI: 57.5%-64.1%), and both conditions (70.3%, 95% CI: 67.7%-72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23-3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32-1.76) and diabetes only (1.71, CI: 1.45-2.01)., Conclusions: Our findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective . History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods . In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results . Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion . Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2019 The Author(s).)

Background: Measures of handgrip strength have not only emerged as a clinically viable screening tool for determining risk for morbidity, functional disability, and early mortality, but also for helping to identify cognitive deficits. However, the phenomena that links low handgrip strength with cognitive decline remains unclear. The role of the muscular and neural systems, and their adaptations to muscle strengthening activities over the life course, may provide important information for how age-related changes to muscle mass, strength, and neural capacity influence cognition. Moreover, disentangling how handgrip strength and cognitive function are associated may help to inform healthcare providers working with aging adults and guide targeted interventions aiming to preserve muscle and cognitive functioning., Objective: To 1) highlight and summarize evidence examining the associations of handgrip strength and cognitive functioning, and 2) provide directions for future research in this area., Methods: Articles from the PubMed database were searched from November 2018-May 2019. The search term algorithm, inclusion and exclusion criteria were pre-specified by investigators., Results: Several cross-sectional and longitudinal studies have revealed that measures of handgrip strength were associated with cognitive declines regardless of age demographics and the presence of comorbidities., Conclusion: Handgrip strength can be used in clinical and epidemiological settings for helping to determine the onset and progression of cognitive impairment. Future research should continue to examine how handgrip strength and cognitive function are linked.

Objective: History of stroke and diabetes increases risk for cardiometabolic disease, which can be mitigated through lifestyle management. To evaluate lifestyle risk behaviors among stroke survivors, we compared the prevalence of three lifestyle risk behaviors-physical inactivity, consuming one or less fruit and one or less vegetable daily, and overweight/obesity-between stroke survivors with and without diabetes., Design: Data from the 2013 and 2015 Behavioral Risk Factor Surveillance System were examined. Weighted and age-adjusted prevalence estimates as well as crude and adjusted odds ratios (adjusted for sociodemographic characteristics) were calculated to compare lifestyle risk behaviors between US stroke survivors with and without diabetes., Results: Prevalence and adjusted odds ratios for lifestyle risk behaviors were higher in respondents with diabetes compared with those without diabetes for consuming one or less fruit and one or less vegetable daily (58.8% vs. 53.7%, adjusted odds ratio = 1.14), physical inactivity (65.7% vs. 54.6%, adjusted odds ratio = 1.41), and overweight/obesity (87.2% vs. 63.1%, adjusted odds ratio = 2.42)., Conclusions: Prevalence of select lifestyle risk behaviors exceeds 50% in adults with stroke but is higher in adults with diabetes compared with adults without diabetes. Effective interventions, community programs, and healthcare policy are needed to promote lifestyle management in adults with stroke, particularly among those with diabetes.

Background: History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice., Objective: To compare population-based estimates of the prevalence of five lifestyle risk factors-low fruit and vegetable consumption, insufficient physical activity, smoking, heavy alcohol consumption, and overweight/obesity-among U.S. adults with and without stroke., Methods: Representative data from noninstitutionalized adults aged ≥18 years (stroke, n = 37,225; no stroke, n = 851,607) from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate prevalence of individual and total number of risk factors. Logistic regression models were used to determine the odds of lifestyle risk factors in adults with stroke, adjusting for sex, age, ethnicity, marital status, education, income, and disability., Results: Prevalence and adjusted odds ratios (AOR) were higher in individuals with stroke compared to those without stroke for insufficient physical activity (56.5% vs. 49.5%, AOR: 1.14) and smoking (30.1% vs. 16.6%, AOR: 1.16), but lower for heavy alcohol consumption (5.4% vs. 6.1%, AOR: 0.76). Prevalence for low fruit and vegetable consumption (51.7% vs. 46.0%) and overweight/obesity (70.2% vs. 64.5%) was higher among adults with stroke, but differences were attenuated by demographic characteristics. Additionally, clustering of 4-5 lifestyle risk factors was higher in adults with stroke (9.0% vs. 5.3%, AOR: 1.12)., Conclusion: Additional research and healthcare interventions are needed to improve lifestyle risk factors in adults with stroke., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Interventions are needed to increase physical activity throughout the day in adults with chronic stroke, but mechanisms of action for doing so have not been identified. In this descriptive, exploratory study of 36 ambulatory, community-dwelling adults with chronic stroke, participants completed questionnaires investigating self-efficacy, self-regulation, social support, and outcomes expectations for daily physical activity. In the absence of any intervention, participants consistently reported high self-efficacy and outcomes expectations but low use of self-regulation and social support strategies. Discussion of how these results can inform the development of interventions to facilitate daily physical activity in adults with chronic stroke is provided.

Introduction: Engaging in healthy lifestyle behaviors decreases risk for cardiometabolic complications, which is of particular concern for stroke survivors whose history of stroke (HOS) increases cardiometabolic risk. Population-based estimates of healthy behaviors in adults with HOS are lacking but could be used to inform research, policy, and health care practice. The objective of this study was to calculate and compare population-based estimates of the prevalence of consuming 1 or more fruit and 1 or more vegetable daily, meeting weekly aerobic physical activity recommendations, having a body mass index (BMI) of less than 25 kg/m 2 , and the number of healthy behaviors among US adults with and without HOS., Methods: We used data from the 2015 Behavioral Risk Factor Surveillance System. Weighted and age-adjusted (to the 2000 US standard population) prevalence estimates and adjusted odds ratios (AORs, adjusted for demographic variables) were computed for study variables., Results: Adults with HOS were less likely than adults without HOS to consume 1 or more fruit and 1 or more vegetable daily (AOR = 0.85; 95% confidence interval [CI], 0.79-0.91), meet weekly aerobic physical activity recommendations (AOR = 0.72; 95% CI, 0.67-0.78), and engage in 2 (AOR = 0.86; 95% CI, 0.79-0.94) or 3 (AOR = 0.73; 95% CI, 0.64-0.82) healthy behaviors. Adults with HOS were more likely to engage in 0 healthy behaviors (AOR = 1.26; 95% CI, 1.16-1.37). Having a BMI of less than 25 kg/m 2 and engaging in 1 healthy behavior were similar between groups., Conclusion: Prevalence of individual and total number of healthy behaviors was lower in adults with HOS for several healthy behaviors. Future research, policy, and health care practice is needed to promote healthy behaviors in adults with HOS.

Objective: The aim of this study is to determine the independent and joint effects of muscle weakness and diabetes on incident activities of daily living (ADL) disability in older Mexican Americans., Method: A subsample of 2,270 Mexican Americans aged at least 65 years at baseline were followed for 19 years. Handgrip strength was normalized to body weight (normalized grip strength [NGS]). Weakness was defined as NGS ≤0.46 in males and ≤0.30 in females. Diabetes and ADL disability were self-reported., Results: Compared with participants that were not weak and did not have diabetes, those that had diabetes only, were weak only, and were both weak and had diabetes experienced a 1.94 (95% confidence interval [CI] = [1.89, 1.98]), 1.17 (CI = [1.16, 1.19]), and 2.12 (CI = [2.08, 2.16]) higher rate for ADL disability, respectively., Discussion: Muscle weakness and diabetes were independently and jointly associated with higher rates for ADL disability in older Mexican Americans.

Objectives: Understanding the role of muscle strength as a preventive factor for shorter-term declines in function may provide further insights into the disabling process. This study examined if muscle strength was associated with 2-year preservation of instrumental activities of daily living (IADL) function and activities of daily living (ADL) disability status in older Mexican Americans., Design: Longitudinal, panel., Setting: Urban and rural households in the Southwestern United States., Participants: A subsample of 672 Mexican Americans aged at least 65 years was followed for 2 years., Measurements: Muscle strength was assessed with a hand-held dynamometer. IADL and ADL were self-reported. Covariate-adjusted ordinal and multinomial logistic models were used to determine the association between handgrip strength and changes in IADL function, and ADL disability status over 2 years., Results: Every 10-kg increase in handgrip strength was associated with 5% decreased odds [odds ratio (OR): 0.95; 95% confidence interval (CI): 0.92, 0.98] of experiencing a lost IADL function in 2 years. Likewise, every 10-kg increase in handgrip strength was associated with an 8% decreased odds (OR: 0.92; CI: 0.88, 0.97) for 2-year onset ADL disability, 12% decreased odds (OR: 0.88; CI: 0.83, 0.94) for 2-year ADL disability progression, and 7% decreased odds (OR: 0.93; CI: 0.89, 0.98) for 2-year ADL disability improvement, compared to those with no ADL disability at baseline and follow-up., Conclusions: Higher muscle strength was related to a lower risk for 2-year onset of IADL and ADL disability in older Mexican Americans. Future investigations are warranted to examine how potential mediators influence the association between muscle strength and function, to inform interventions aiming to retain function in vulnerable older adult populations., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)

This article reports the study design, methodological issues and early results of a pilot study testing methods for collecting nutrition, physical activity, and ultraviolet (UV) radiation exposure data in a groundbreaking study in China. Epidemiological studies suggest that exposures across the entire life course, including in utero, early childhood, and adolescence, may be important in the etiology of adult cancers and other chronic diseases. The Chinese Children and Families Cohort Study intends to follow-up subjects from the 1993 to 1995 Community Intervention Program of folic acid supplementation for the prevention of neural tube defects. This cohort is unique in that only folic acid exposure during pregnancy varies between groups as other supplements were not available, and there were nutrient deficiencies in the populations. Prior to launching a large-scale follow-up effort, a pilot study was conducted to assess the feasibility of recontacting original study participants to collect extensive diet, physical activity, and UV radiation exposure data in this population. The pilot study included 92 mothers and 184 adolescent children aged 14 to 17 years from 1 urban and 1 rural Community Intervention Program site. Subjects completed a Food Frequency Questionnaire, a 3-day food record, a physical activity questionnaire, a 3-day sun exposure diary together with 3 days of personal UV dosimetry, and 7 days of pedometry measurements and provided blood, saliva, and toenail samples. Grip strength and body composition measurements were taken, and ambient solar UV radiation was monitored in both study sites. While most of the assessments were successful, future studies would likely require different dietary intake instruments. The purpose of this report is to describe the study design and methodological issues emerging from this pilot work relevant for the follow-up of this large birth cohort., Competing Interests: The authors have no conflicts of interest to disclose.

Health behavior change is challenging for most individuals, but there are many strategies that individuals can use to facilitate their behavior change efforts. Goal setting is one such strategy that assists individuals to identify specific behaviors to change and how to go about doing so. For many, however, simply setting a goal seldom leads to actual behavior change. For some, identifying an appropriate goal is difficult, while for others, putting goals into action is the roadblock. Two strategies may be of assistance for setting and achieving goals. First, consideration of key goal characteristics (eg, approach vs avoidance goals, performance vs mastery goals, level of difficulty) may result in selection of more appropriate and feasible goals. Second, action planning can help individuals put goals into action. Clinicians can help patients utilize these strategies to set and achieve goals for health behavior change., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2017 The Author(s).)

The prevalence of cardiovascular disease, diabetes, and obesity is high in people with stroke. Risk factors for these conditions include hypertension, high cholesterol, and physical inactivity. These risk factors are common in people with stroke and often go unmanaged. Engagement in healthy behaviors is important for managing and preventing these risk factors and comorbid conditions. More specifically, physical activity and nutrition are key health behaviors for the management and maintenance of health in people with stroke. These health behaviors, by their very nature, are also occupations; thus, they are influenced by client factors, performance skills and patterns, and environments and contexts. This article discusses physical activity and nutrition within the context of the Occupational Therapy Practice Framework: Domain and Process and proposes potential roles for occupational therapy practitioners and researchers in developing, testing, and providing physical activity and nutrition interventions for people with stroke., (Copyright © 2017 by the American Occupational Therapy Association, Inc.)

Background: A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke., Objective: To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke., Methods: Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling., Results: No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants., Conclusions: Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.

Objective: This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke., Method: Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge., Results: Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles., Conclusion: UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation., (Copyright © 2016 by the American Occupational Therapy Association, Inc.)

Of nearly 800 000 strokes that occur annually, 23% are recurrent events. Risk for disability and mortality is higher following a recurrent stroke than following a first-time stroke, which makes secondary stroke prevention a priority. Many risk factors for stroke are modifiable and amenable to improvement through lifestyle modification. Lifestyle modification can be difficult for people with stroke, however, in part because of stroke-related physical and cognitive deficits. Despite these challenges, risk factor management through lifestyle modification is important. This article reviews the multiple cardiovascular and metabolic benefits associated with the modification of several lifestyle behaviors: diet, physical activity, smoking cessation, and alcohol consumption. Health behavior theories and existing lifestyle intervention programs are also reviewed to identify important behavioral and cognitive skills that can be used to facilitate modification of health behaviors, and practical skills and suggestions for health care providers are provided.

Background: Motor capability is commonly assessed inside the clinic, but motor performance in real-world settings (ie, outside of the clinic) is seldom assessed because measurement tools are lacking., Objective: To quantify real-world bilateral upper-limb (UL) activity in nondisabled adults and adults with stroke using a recently developed accelerometry-based methodology., Methods: Nondisabled adults (n = 74) and adults with chronic stroke (n = 48) wore accelerometers on both wrists for 25 to 26 hours. Motor capability was assessed using the Action Research Arm Test (ARAT). Accelerometry-derived variables were calculated to quantify intensity of bilateral UL activity (ie, bilateral magnitude) and the contribution of both ULs to activity (magnitude ratio) for each second of activity. Density plots were used to examine each second of bilateral UL activity throughout the day., Results: Nondisabled adults demonstrated equivalent use of dominant and nondominant ULs, indicated by symmetrical density plots and a median magnitude ratio of -0.1 (interquartile range [IQR] = 0.3), where a value of 0 indicates equal activity between ULs. Bilateral UL activity intensity was lower (P < .001) and more lateralized in adults with stroke, as indicated by asymmetrical density plots and a lower median magnitude ratio (-2.2; IQR = 6.2, P < .001). Density plots were similar between many stroke participants who had different ARAT scores, indicating that real-world bilateral UL activity was similar despite different motor capabilities., Conclusions: Quantification and visualization of real-world bilateral UL activity can be accomplished using this novel accelerometry-based methodology and complements results obtained from clinical tests of function when assessing recovery of UL activity following neurological injury., (© The Author(s) 2015.)