Assessing Feasibility and Readiness to Address Obesity through Policy in American Indian Reservations

The Institute of Medicine and Centers for Disease Control and Prevention (CDC) have identified policy and environmental strategies as critical to the prevention and control of obesity. However such strategies are rare in American Indian communities despite significant obesity-related disparities. Tribal policymaking processes differ by tribal nation and are often poorly understood by researchers and public health practitioners, hindering the dissemination, implementation, and successful scale-up of evidence-base obesity strategies in tribal communities. To address these gaps in knowledge we surveyed 138 diverse stakeholders in two American Indian reservations to assess the feasibility of and readiness to implement CDC-recommended obesity policy strategies within their communities. We assessed general community readiness to address obesity using 18 questions from the Community Readiness Handbook. Means and standard deviations were evaluated and scores ranged from 1 (no readiness) to 9 (high readiness). We then assessed stakeholder attitudes regarding the feasibility of implementing specific strategies given tribal culture, infrastructure, leadership, and funding support. Average scores were calculated and mean values ranked from highest (best strategy) to lowest. Despite significant differences in their geographic and sociodemographic characteristics, both communities identified increasing the availability of healthy foods in tribal venues as the most feasible strategy and scored in the “preplanning” readiness stage. The survey design, implementation process, and findings generated significant community interest and discussion. Health planners in one of the communities used the survey findings to provide tribal decision-makers with measurable information to prioritize appropriate strategies for implementation

Intensity of acute aerobic exercise but not aerobic fitness impacts on corticospinal excitability

Aerobic exercise (AE) modulates cortical excitability. It can alter both corticospinal excitability and intra-cortical networks, which has implications for its use as a tool to facilitate processes such as motor learning, where increased levels of excitability are conducive to the induction of neural plasticity. Little is known about how different intensities of AE modulate cortical excitability or how individual-level characteristics impact on it. Therefore, we investigated whether AE intensities, lower than those previously employed, would be effective in increasing cortical excitability. We also examined whether the aerobic fitness of individual participants was related to the magnitude of change in AE-induced cortical excitability. In both experiments we employed transcranial magnetic stimulation to probe corticospinal excitability before and after AE. We show that 20 min of continuous moderate- (40 and 50% of heart rate reserve, HRR), but not low- (30% HRR) intensity AE was effective at increasing corticospinal excitability. We also found that while we observed increased corticospinal excitability following 20 min of continuous moderate-intensity (50% HRR) AE, aerobic fitness was not related to the magnitude of change. Our results suggest that there is a lower bound intensity of AE that is effective at driving changes in cortical excitability, and that while individual-level characteristics are important predictors of response to AE, aerobic fitness is not. Overall these findings have implication for the way that AE is used to facilitate processes such as motor learning, where increased levels of cortical excitability and plasticity are favourable.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Virgins, Terrorists, and Ten Children : Immigrants' Humorous Play with Ethnic Stereotypes in Bonding with Danes in the Workplace

Drawing on fieldwork in a multi-ethnic workplace (an industrial kitchen in Denmark), this article explores immigrants' self-directed ethnic humor in collegial relationships with Danes as it spontaneously develops and plays out in everyday work settings. Approaching ethnic humor from a symbolic interactionist perspective rather than adopting the dominant conflict approach, this article emphasizes the bonding functions of ethnic humor. The article argues that immigrants' engagement in playful behavior with ethnic stereotypes in interactions with Danes is a form of “impression management” in which they defuse ethnic stereotypes and dissociate themselves from them by building joking relationships in the workplace with Danes. A video abstract is available at https://tinyurl.com/esholdt

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive–behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention’s impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care