Pouran D. Faghri

Surveying food and beverage liking: a tool for epidemiological studies to connect chemosensation with health outcomes.

Genetics, environmental exposures, and aging interact to produce variations in the perception or liking of taste, olfaction, and somatosensory sensations (i.e., chemosensation). Chemosensory variation can affect disease risk by influencing what people like and choose to eat from abundant supplies of desirable high‐fat, sweet, and salty foods and alcoholic beverages at the expense of less‐available or less‐liked vegetables. We contend that assessing dietary preference via liking–disliking surveys holds promise for linking chemosensation with dietary intake and health outcomes in population‐based studies. Typical intake measures (e.g., frequency surveys, dietary records) are difficult to complete and interpret. Because of memory issues and dietary restraint, individuals under‐ or overreport intakes, leading to inaccurate conclusions about diet–disease relationships. Surveying food and beverage liking is a time‐efficient, simple task that minimizes the cognitive limitations of intake measures. In the present study, women in a worksite health risk appraisal completed brief food frequency and liking surveys and reported their height and weight, and blood pressure was measured. While liking and intake measures for high‐fat and high‐fiber foods were correlated, only liking was associated with disease risk. In multiple regression models, women reporting greater liking for high‐fat foods and less liking for spicy foods had greater adiposity and/or blood pressure, controlling for age. These data, along with previous laboratory and community‐based studies, support that reported liking of high‐fat foods explains variability in adiposity and adiposity‐related outcomes. Hedonic measures appear to capture habitual intake of foods and beverages, are easy to implement in the field, and thus may increase understanding of how chemosensory variation modifies disease risk.

A Conceptual Framework for Integrating Workplace Health Promotion and Occupational Ergonomics Programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health—especially /sc>ergonomics—with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Workplace health protection and promotion through participatory ergonomics: an integrated approach.

A multidisciplinary team of researchers at the Center for the Promotion of Health in the New England Workplace (CPH-NEW) developed an evidencebased approach to address three recognized challenges to workplace programs designed to improve employee health: establishing employee ownership, integrating with work organization, and sustainability. The two main innovations being introduced in combination were (1) integrating traditional workplace health protection (e.g., ergonomics, industrial hygiene) with health promotion (e.g., assisting workers in improving health behaviors) and (2) introducing a bottom-up participatory model for engaging employees in innovative iterative design efforts to enhance both components of this integrated program. In the program, which was modeled after participatory ergonomics programs, teams of workers engage in the iterative design of workplace interventions to address their prioritized health concerns with the support of a multilevel steering committee. The integrated approach being tested can complement existing worksite safety and health initiatives and promote organizational learning, with expected synergistic effects.

The effects of neuromuscular stimulation-induced muscle contraction versus elevation on hand edema in CVA patients

The purpose of this study was to evaluate the efficacy of the use of neuromuscular stimulation (NMS)-induced contraction of the paralyzed muscles to produce an active muscle pump for removing excess fluid and compare its effect with elevation of the upper extremity. The effects of 30 minutes of NMS of the finger and wrist flexors and extensors were compared with the effects of 30 minutes of limb elevation alone. Each of eight cerebrovascular accident (CVA) patients with visible hand edema received both treatments, one on each of 2 consecutive days. Measures of hand and arm volume and upper and lower arm girth were taken before and after each treatment. Analyses comparing mean percentage change scores for both treatments showed large and significant treatment effects for all dependent measures. The finding suggests that NMS was more effective for reduction of hand edema than limb elevation alone for this sample of eight CVA patients.

Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals

Objective: To evaluate the central haemodynamic responses during position changes from supine to sitting and during 30 min of standing between able-bodied and spinal cord-injured subjects. Also to assess the effects of the physiologic muscle pump in both groups during 30 min of standing. Design: A repeated measure design. Both groups were tested on two different days under two conditions of 30 min of stationary standing and 30 min of dynamic standing (voluntary activation of the lower leg muscles in able-bodied and FES-induced activation of these muscles in spinal cord injured). The order of testing was random. Setting: Rehabilitation hospital. Subjects: Fifteen healthy able-bodied and 14 healthy spinal cord-injured subjects. Main outcome measured: Stroke volume, cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and total peripheral resistance during supine–pre sitting, sitting–pre standing and during 30 min of standing. Results: Significant reductions (p< 0.05) in systolic blood pressure, diastolic blood pressure and mean arterial pressure were found when spinal cord-injured subjects moved from sitting to standing during stationary standing; these values were maintained during dynamic standing. These values were maintained during both standing sessions in able-bodied subjects. During 30 min of stationary standing, there were significant reductions in stroke volume, cardiac output in both able-bodied and spinal cord-injured while their total peripheral resistance increased (p< 0.05). During 30 min of dynamic standing, both groups maintained their haemodynamics at pre-standing values with the exception of significant reduction in stroke volume at 30 min of standing. Conclusion: FES-induced activation of the physiologic muscle pump during change in position from sitting to standing prevented orthostatic hypotension in spinal cord-injured subjects. During standing it had equal or even greater effect on improving blood circulation when compared with voluntary activation in able-bodied subjects. The use of FES during standing and tilting in spinal cord-injured individuals may prevent orthostatic hypotension and circulatory hypokinesis and improve tolerance to tilting and standing.

Venous hemodynamics of the lower extremities in response to electrical stimulation

OBJECTIVE To evaluate the calf muscle pump function using an air plethysmograph (APG) applied to the lower leg of subjects during three different tiptoe exercises. DESIGN A controlled trial design was selected to compare the hemodynamic effects of three exercise conditions on a group of able-bodied, healthy patients. SETTING Testing was performed in an outpatient clinic at a rehabilitation hospital. SUBJECTS Patient groups were selected from a convenience sample of 10 healthy volunteers with normal venous capacitance and no reflux, determined through impedance pleythysmography before the study. INTERVENTIONS Three exercise conditions undertaken by each subject consisted of loaded and unloaded lower leg muscle contractions produced by (1) voluntary contraction (VOL), (2) electrical stimulation of the gastocnemius-soleus and tibialis anterior muscles (ES), and (3) combined ES and VOL (ES/VOL). MAIN OUTCOME MEASURE Hemodynamic measurements of venous filling index upon standing from the supine (VFI), ejection fraction (EF), ejection volume (EV), residual volume (RV), and residual volume fraction (RVF) were recorded after each protocol. These results were used to compare the lower leg hemodynamic effects of the treatments. RESULTS Combined ES/VOL single tiptoe exercise produced the highest EV (97.8mL), followed by VOL (80.6mL) and ES (51.7mL) (p < .0008). The EF was also highest for combined ES/VOL (73.1%), followed by VOL (64.5%) and ES (37.8%) (p < .0001). Ten tiptoe ES exercises produced the highest RV (96.2mL), followed by ES/VOL (44.7mL) and VOL (28.2mL) (p < .0001). RVF was also highest in the ES group (71%), followed by ES/VOL (33.4%) and VOL (22.8%) (p < .0001). CONCLUSION Periodic single ES-induced calf muscle contractions produced significant muscle pump function and could be used to improve venous blood flow and reduce stasis in the lower leg. Continuous ES-induced contractions, on the other hand, could improve lower leg peripheral perfusion while eliciting the physiologic venous muscle pump. Higher RV and RVF after 10 ES-induced contractions in this sample of healthy subjects with normal VFI may be caused by an increase in arterial blood perfusion after repeated ES-induced contractions.

Technology for mobility and quality of life in spinal cord injury [Analyzing a Series of Options Available]

The purpose of this article is to provide a review of mobility devices available for the rehabilitation of individuals with (spinal cord injury) SCI. The technologies that improve mobility and potentially enhance community participation that will be discussed include those devices that are used to improve ambulation, wheeled mobility, and functional electrical stimulation (FES) systems. This review should provide a guide to biomedical engineers to understand the tools developed, the design characteristics, and the functionality of such technologies that strive to improve functional mobility of individuals with SCI. This review is not intended to suggest the optimal device(s) geared for a given individual with SCI. Conversely, since it is important to match the person with the technology, the purpose of this review is to offer a series of mobility options that may be available to a person with SCI.

Improving pedal power during semireclined leg cycling

Using time-sequence analysis of EMG measurements to determine if changes in muscle activation timing, sequencing, and stimulation can improve pedaling effectiveness.

Kinematic analyses of semireclined leg cycling in able-bodied and spinal cord injured individuals.

Study design:Retrospective descriptive study.Objectives:To evaluate the leg kinematics and motion characteristics within able-bodied (AB) and spinal cord injured (SCI) individuals during stationary semireclined cycling.Setting:Functional Performance Laboratory, Connecticut, USA.Methods:Three SCI and three AB subjects participated in steady-state leg pedaling (50 revolutions per minute). The SCI group participated in electrical stimulation (FES)-induced cycling at resistances of 0, 6.25, and 12.5 Watts (W). The AB group cycled on the same ergometer without FES at resistances of 0, 60, and 120 W. Motion capture analysis recorded joint angular position, velocity, and acceleration at hip, knee, and ankle. Joint kinematics of hip, knee, and ankle were measured during steady-state leg cycling and comparisons were made between AB and SCI subjects as resistance proportionally and relatively increased.Results:Intrasubject hip and knee movement patterns showed minimal variability across resistance levels. Comparisons between AB and SCI subjects showed that the hip and knee kinematics were very similar at all resistance levels. However, ankle movement patterns appeared to increase in variability (increased dorsiflexion) with increased resistance level in AB subjects and less so with SCI subjects. Overall, the ankle kinematics for AB and SCI subjects were dissimilar at resistance levels greater than zero.Conclusions:The joint kinematics of the hip, knee, and ankle were found to be periodic, but the differences in ankle kinematics in AB and SCI subjects suggest more emphasise should be placed on the current design of the bike-pedal and subject-specific seat configurations.

Cost-effectiveness of a workplace-based incentivized weight loss program.

Objective: To evaluate the cost-effectiveness ratios of a nursing home–based incentivized Behavioral Weight Management Program (BWMP) from the employers perspective. Methods: Seventy-two overweight and obese health care workers completed the BWMP (n = 35 incentivized; n = 37 nonincentivized). Weight change outcomes were compared for the pre- (0) and postintervention (28 weeks) follow-up periods within and between sites. Comprehensive estimates of BWMP direct program costs and avoided costs of absenteeism and productivity improvements were estimated to evaluate a business case. Results: There was a significant difference (P = 0.01) between the average per-participant weight change between incentivized sites (−7.4 lb) and nonincentivized sites (−2.2 lb). The cost-effectiveness ratios per pound of weight loss were