Introduction: After the completion of rehabilitative interventions, following stroke, there is an expressed need from patients and families to continue with exercise.    Since stroke patients may not be appropriate for most community based elderly programs due to unique motor, coordination, balance and perceptual problems, a Fit 4 Life After Stroke program was designed to meet these needs.  There is evidence that aerobic activity can improve physiological function in neurological diseases.  The objective of our study is to test the effectiveness of a fitness program designed for the stroke patient.
Methods: The effectiveness of this program is being determined through the assessment of exercise capacity, function, and quality of life.   Inclusion criteria involve participants who have suffered a stroke, have a Mini Mental Status Examination (MMSE) score 24 or higher, have a completed liability waiver form, and Exercise Readiness Questionnaire (ERQ), filled and signed permission from their physician, have an exercise partner, if needed, and have available transportation to and from Burke.  Exclusion criteria includes a MMSE score below 24,  a recent history of cardiac events requiring treatment, have Congestive Heart Failure (CHF) class 3 or 4 or Ejection Fraction (EF) below 30 percent. 
Each study participant is stratified in one of three levels, based on level of function, and are randomized into the control group who are deferred from exercise program for a period of three months or the experimental group who start participating in the exercise groups soon after completing initial assessments.   The exercise program for each level meets three times per week for one hour and includes flexibility and strengthening exercises, balance activities and aerobic activities at Reported Perceived Exertion (RPE) of 13.  Both groups are being assessed for Frugle Myer motor scores, exercise capacity, function and quality of life assessments, at baseline, three month and six month time frames.  Phone call follow-ups will be conducted at nine and twelve months.  
Interim Results: At present time, there are 19 study participants with 17 participants completing the baseline and three follow-up sessions.  Preliminary data analysis indicates that group stratification based on functional level appears effective.  Further analysis includes only participants from the level 2 (medium function) and the level 3 (highest function) groups due to small number of participants so far. The data indicates trends of improvement in these areas primarily with the highest functioning level group.  For better data comparison with this study, additional participants will need to be recruited for all levels, especially the lowest functioning level. 

This Study is Supported by Burke Foundation

Background : The etiology of increased nutritional risk in the elderly population is multifactorial. These factors include physical function, mood, cognition, alcohol use, polypharmacy, living arrangement, poor finances, poor dentition or difficulty swallowing, inadequate or inappropriate food intake.
Objective: The purpose of this study is to determine the prevalence of nutritional risk factors among community- dwelling elderly (60 years and older) participants in Jamaica Food and Nutrition (FAN) program and to assess the effect of the program on their knowledge, attitude and practice of healthy nutrition. This study also evaluated the effectiveness of the FAN food supplementation program.
Method : Questionnaires were designed based on a literature review and the DETERMINE nutritional health screening questionnaire developed by the Nutrition Initiative, a project of American Academy of Family Physicians, The American Dietician Association and the National Council on the Aging. Translations were made into Spanish and Russian.  Total sampling of interested elderly participants that attended the program on the days and times the investigator was in the facility was done. The questionnaires were self-administered except for those who for reasons such as poor vision and tremors, were assisted with the completion. Those respondents were interviewed using the questionnaire as a guide. A total of 150 questionnaires were distributed, 100 were completed during the month-long data collection period, representing about 6% of the target population (~1720). Surveys were analyzed in Excel. The FAN program gives food supplementation to participants monthly. Therefore limiting the study to 1 month eliminated the chance of duplicates in the sample. 
Results: The study showed that:
About 3 in 4 (75%) of the participants were aged between 60 and 70 years.
Only 8% were 75 and older.
91% were unemployed; 9% were employed.
55% were on social security/pension; 19% on disability and 11% on public assistance.
The majority of the participants have income <$1288 per month (75%) which is required income eligibility level for one member family, 6% have income between $1288 and $1734.
Most of the respondents live in a amily size of 2 (45%) followed by single person family (19%) and 3 person family (17%).
45% of participants were overweight while 28% were obese; only 19% had normal BMI.
73% of the elderly were at high nutritional risk; 18% at moderate risk and 9% at low risk, based on a combination of socioeconomic and nutritional risk factors. Eating few vegetables, fruits and milk appears to be the most predominant nutritional risk factor (63%).
At least 42% were unaware of the other equally important services provided by FAN for example nutritional counseling.
At least 49% of participants admitted that FAN had significant positive effect on their knowledge of healthy nutrition. The greatest effect was in the area of learning the kinds of nutrients available; better cooking methods and eating the right food  for their medical conditions.
The greatest behavioral changes effected by FAN were adopting low cholesterol diet (56%); increased consumption of vegetables, fruits and milk products (55%); eating food appropriate for the medical condition (50%); boiling/steaming food instead of frying (47%) and regular medical follow up (38%). Over 50% are willing to participate in health and nutrition classes. The theme of highest interest was cholesterol (37%) followed by depression (30%) and disease prevention (28%).
Conclusion: The prevalence of nutritional risk factors in the elderly population in this low income Jamaica, New York community is high. Since the majority of the participants are willing to partake in nutritional education classes, the opportunity should be utilized to target the reduction of the identified modifiable nutritional risk factors. Finally, the FAN program is achieving its goal of food supplementation to the needy elderly.

Objective:  To determine what factors are associated with obesity in preschool age WIC clients.
Design: Randomized Cross Sectional Survey
Setting : Special Supplemental Nutrition Program for Women, Infants, And Children (WIC), in low income area of Queens, NY.
Participants: One hundred clients of WIC ages 3-5
Measurements:  Maternal demographics variables, maternal self reported height and weight, children’s measured height and weight.  Mothers were asked whether they considered themselves or their children overweight. A chart review was also conducted to determine the percentage of children who were obese by definition.
Introduction:  Approximately 25% of the nation’s children are obese, of which 20% stay obese into adulthood.  There are now twice as many overweight children in the United States as there were 20 years ago, and this trend is not explained by changes in the prevalence of genes associated with obesity. Although children can inherit a genetic susceptibility to obesity, not all children born to obese parents become obese. Thus, there is a strong "nurture" component to childhood obesity that begins at birth and remains poorly understood. If this component were better identified, it could be targeted in obesity-prevention efforts early in life.
Also noted is that although obese infants, less than 3y/o, are heavier than normal weight infants, they are not more likely to be obese adults unless obesity persists by ages 3-5. Overweight school age children are more at risk of becoming obese adults, and an  overweight school age child with an obese parent(s) has a 70% chance of being an obese adult.  Obesity is defined as weight for height 120% more than the median (using height for weight chart/ gender specific).  Some of the reasons sited for obesity in children are eating and cooking practices, physical activity, whether or not children were breastfed, and genetics. Mother’s level of education has also been identified as a related factor.    The objective of this study was to investigate whether the risk factors speculated upon in numerous studies apply to an inner city minority population of children at high risk for obesity.  Because obesity that persists into adulthood is associated with a host of adverse medical conditions, (hypertension, cardiovascular disease, hypercholesterolemia, and depression), it would be beneficial for family practitioners to be aware of characteristics that are associated with childhood obesity,  and advocate dietary interventions to mothers of obese pre-school age children in order to prevent  adult obesity.
Methods:  A chart review was conducted to determine the percentage of children who were obese by definition, whether or not they were breastfed, and the duration of breastfeeding.  A questionnaire was also administered to the parents to determine eating/ cooking practices, level of physical activity, and parent’s weight, and whether  parent perceived that child was overweight or obese.
Results:   The chart review revealed that of the children served (42.8% males; 57.1% female) at the WIC center,  41.7% were obese by definition.(31% male and 69% female).  It also showed that  34% of the kids were breastfed, of which 54% were obese.  The duration of breastfeeding ranges from 1month to 1 year (mean =6.52;SD =4.88).  The entire sample of children were reported as being very active, and did not watch much TV, and eating/ cooking practices were observed to be culturally linked.  Obesity among the parents (mostly mothers) i.e. a BMI > 30kg/m2, was observed to be more common among the low education mothers and their children tended to be also overweight. Also noted was that many mothers did not perceive their child as being obese. 
Conclusion:  The results of the chart review and survey helped to determine if the risk factors stated above held true. Methods of cooking/ eating was be the number one risk factor in this age group, secondary to culture.  The children in this age group were reported to be very active; 100% of parents stated the above, so inactivity was not a factor in this age group.  Therefore, the main intervention would be to teach proper eating habits, and healthy ways of cooking, and also make the clients of the WIC program aware of the community resources available whereby they could maintain adequate physical activity. Interventions therefore should begin early in life starting in preschool or even earlier. The American Academy of Pediatrics recommends proper eating habits from infancy; not using food as a reward; and not using food to pacify children.  Parents are the ones who instill and are influential in shaping early eating and physical activity patterns. Parents are also the ones who control what food is made available to children. Therefore, parental involvement is crucial for successful obesity interventions/prevention.  This includes making the parents aware as to recognizing that adult overweight/obesity and its sequelae is preventable, if addressed early.