VA Black Hills Health Care System

This study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons. Four treatment sessions were held, during which participants were given a pre-test, participated in 30 min of NMT that focused on one aspect of rehabilitation (attention, memory, executive function, or emotional adjustment), which was followed by post-testing. Control participants engaged in a pre-test, 30 min of rest, and then a post-test. Treatment participants showed improvement in executive function and overall emotional adjustment, and lessening of depression, sensation seeking, and anxiety. Control participants improved in emotional adjustment and lessening of hostility, but showed decreases in measures of memory, positive affect, and sensation seeking.

OBJECTIVE: To compare the efficacy of doxycycline plus methotrexate (MTX) versus MTX alone in the treatment of early seropositive rheumatoid arthritis (RA), and to attempt to differentiate the antibacterial and antimetalloproteinase effects of doxycycline. METHODS: Sixty-six patients with seropositive RA of <1 year's duration who had not been previously treated with disease-modifying antirheumatic drugs were randomized to receive 100 mg of doxycycline twice daily with MTX (high-dose doxycycline group), 20 mg of doxycycline twice daily with MTX (low-dose doxycycline group), or placebo with MTX (placebo group), in a 2-year double-blind study. Treatment was started with an MTX dosage of 7.5 mg/week, which was titrated every 3 months until remission was reached (maximum dosage of 17.5 mg/week). The primary end point was an American College of Rheumatology 50% improvement (ACR50) response at 2 years. RESULTS: ACR50 responses were observed in 41.6% of patients in the high-dose doxycycline group, 38.9% of those in the low-dose doxycycline group, and 12.5% of patients in the placebo group. Results of chi-square analysis of the ACR50 response in the high-dose doxycycline group versus that in the placebo group were significantly different (P = 0.02). Trend analysis revealed that the ACR20 response and the ACR50 response were significantly different between groups (P = 0.04 and P = 0.03, respectively). MTX doses at 2 years were not different among groups. Four patients in the high-dose doxycycline group, 2 patients in the low-dose doxycycline group, and 2 patients in the placebo group were withdrawn because of toxic reactions. CONCLUSION: In patients with early seropositive RA, initial therapy with MTX plus doxycycline was superior (based on an ACR50 response) to treatment with MTX alone. The therapeutic responses to low-dose and high-dose doxycycline were similar, suggesting that the antimetalloproteinase effects were more important than the antibacterial effects. Further studies to evaluate the mechanism of action of tetracyclines in RA are indicated.

BACKGROUND: A study was undertaken to assess patient navigation utilization and its impact on treatment interruptions and clinical trial enrollment among American Indian cancer patients. METHODS: Between February 2004 and September 2009, 332 American Indian cancer patients received patient navigation services throughout cancer treatment. The patient navigation program provided culturally competent navigators to assist patients with navigating cancer therapy, obtaining medications, insurance issues, communicating with medical providers, and travel and lodging logistics. Data on utilization and trial enrollment were prospectively collected. Data for a historical control group of 70 American Indian patients who did not receive patient navigation services were used to compare treatment interruptions among those undergoing patient navigation during curative radiation therapy (subgroup of 123 patients). RESULTS: The median number of contacts with a navigator was 12 (range, 1-119). The median time spent with the navigator at first contact was 40 minutes (range, 10-250 minutes), and it was 15 minutes for subsequent contacts. Patients treated with radiation therapy with curative intent who underwent patient navigation had fewer days of treatment interruption (mean, 1.7 days; 95% confidence interval [CI], 1.1-2.2 days) than historical controls who did not receive patient navigation services (mean, 4.9 days; 95% CI, 2.9-6.9 days). Of the 332 patients, 72 (22%; 95% CI, 17%-26%) were enrolled on a clinical treatment trial or cancer control protocol. CONCLUSIONS: Patient navigation was associated with fewer treatment interruptions and relatively high rates of clinical trial enrollment among American Indian cancer patients compared with national reports.

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions. These efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers. We describe our collaborative approach and illustrate it with the example of improved treatment for patients with uncomplicated headache, for which we have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases. As a model for improving quality while reducing cost, the Virginia Mason experience demonstrates that a multispecialty group practice, hospital, employers, and health plans can define quality and align performance and payment along common goals.

Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.

As providers of health care face the multiple challenges of today's health care environment, many believe that integrated delivery systems promise the structure needed to provide high-quality, cost-efficient care. They make structural and process changes with the expectation that those changes will improve system performance. But few systems actually measure progress in creating an integrated system. This article describes one health care system's strategy for introducing organizational measures to create an integrated system scorecard and focuses on the development, results, and use of the staff survey. The survey provides reliable indicators of system integration. Linking the survey results with network performance measures, in turn, provides managers with tools for judging whether system integration is associated with improved system performance.

Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting for 1-5 days followed by asymptomatic periods. The etiology of CVS is unknown, but it shares similar characteristics to migraine headaches. CVS is generally classified as having four phases: prodromal, acute/vomiting/hyperemesis, recovery, and remission/interepisodic. Current management strategies include trigger avoidance, abortive and prophylactic medication therapies, and supportive care. The goal of therapy for the remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine medications show an overall reduction or remission of CVS symptoms in more than 70% of patients. This article provides a summary of diagnostic strategies and reviews current management strategies for CVS.

Abstract The disruptive behavior of two agitated nursing home residents, one who suffered a cerebrovascular accident (CVA) and one with Alzheimer's Disease (AD), was observed for two weeks. Eight to 10 personalized 10-minute interventions consisting of reading/book exploration or music therapy were presented during the following two weeks. Changes were measured during and immediately after intervention and during the following week. The interventions were then switched, so that each participant received both interventions. Both participants were observed during and immediately after the second intervention and during the following week. Both music and reading interventions were effective for the AD participant, while the CVA participant improved after reading but became worse during and after the music intervention. The reading intervention was then repeated with the CVA participant, after which his agitation improved. These findings stress the need for individualized planning and allowance for daily participant changes when using behavioral interventions. Key Words: Music therapydementiacerebrovascular accidentAlzheimer's diseaseagitation

Indiplon is a novel pyrazolopyrimidine, nonbenzodiazepine gamma-aminobutyric acid (GABA) agonist studied for the treatment of insomnia. This article reviews the chemistry, pharmacology, clinical pharmacokinetics, drug interactions, clinical trials, safety, tolerability, contraindications, use in special populations, and dosing of indiplon. OVID, International Pharmaceutical Abstracts (IPA), and PubMed databases were searched (1966 to February 2009) for the keywords indiplon, NBI-34060, and insomnia. References of key articles were also reviewed to identify additional publications. Only English language articles were selected for review. Indiplon has been shown to have high affinity and selectivity for the GABAalpha(1) receptor subunit associated with sedation. In clinical studies, indiplon has demonstrated efficacy in improving latency to sleep onset, latency to persistent sleep, total sleep time, wake time after sleep onset, number of awakenings after sleep onset, and overall sleep quality when compared to placebo. Indiplon has a favorable safety profile with limited rebound insomnia and no tolerance. Neurocrine Biosciences, Incorporated received an Approvable Letter from the United States Food and Drug Administration in December 2007 for the indiplon IR 5 mg and 10 mg capsules based on meeting three additional requirements. At the time of this writing, indiplon remains unapproved.

Objective: To report a case of rapid hepatotoxicity seen within days of initiating azathioprine therapy as a possible adverse reaction. Case Summary: A 62-year-old female with Crohn’s disease was being maintained on occasional oral prednisone when more aggressive therapy became indicated. The patient was started on azathioprine and continued a prednisone taper. Liver enzymes became elevated by the third day of therapy. Peak liver enzyme values on day 10 of therapy were aspartate aminotransferase 119 U/L, alanine aminotransferase 210 U/L, and alkaline phosphatase 460 U/L. The patient did not develop any symptoms of hepatotoxicity. Azathioprine was discontinued and liver enzyme levels returned to baseline within 3 weeks. Discussion: Azathioprine hepatotoxicity has been reported previously. A MEDLINE search (1966 to August 2013) found 39 articles related to various types of azathioprine hepatotoxicity. Previous literature predominately involves male patients and a general onset of 2 to 12 months after starting azathioprine therapy. Our case involves a female patient with an onset of days. According to the Naranjo probability scale, this reaction is considered possible, whereas the Council for International Organizations of Medical Sciences Probability Scale categorized this reaction as probable. The concurrent prednisone therapy may have increased the patient’s risk of azathioprine hepatotoxicity, but is not likely the sole cause as prior to and after discontinuing azathioprine the liver enzymes remained normal despite prednisone therapy. Conclusions: Prescribers should be aware that monitoring liver enzymes when initiating azathioprine may be warranted within the first week, especially if the patient is taking corticosteroids or other high-risk medications that cause hepatotoxicity.

PURPOSE: Gabapentin is an analog of gamma-aminobutyric acid (GABA), but its complete mechanism is not well understood. Common adverse effects from gabapentin include somnolence, sedation, and dizziness. Hyperglycemia is listed as a possible adverse drug reaction in the labeling. Case reports describe hypoglycemia in patients with diabetes, peritoneal dialysis, and/or incomplete medication records. The following case report details a hypoglycemia episode as a potential result of a gabapentin use in a patient without diabetes. SUMMARY: A 47-year old, 68 kg, white female presented to the emergency department with altered mental status. Her blood glucose level was 33 mg/dL. Gabapentin was started 1 week prior to the hypoglycemia episode. Her past medical history, concomitant medications, and other laboratory findings were not likely causes of her severe hypoglycemia. CONCLUSION: delta subunit of the calcium channels in the pancreas. Future research should investigate gabapentin and the potential for hypoglycemia.

AbstractObjective:To review the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, precautions, dosing recommendations, and patient counseling for gabapentin enacarbil for the treatment of restless legs syndrome (RLS) in adults.Data Sources:A literature search was conducted using the terms gabapentin enacarbil, XP13512/GSK1838262, and restless legs syndrome. MEDLINE, Books@Ovid, Journals@Ovid Full Text, BIOSIS Previews, and EMED databases were the primary search sites (2004-October 2011). All English-based articles and abstracts obtained from the literature searches were reviewed. Additional information was obtained from references cited in the articles.Study Selection and Data Extraction:All gabapentin enacarbil information related to RLS was considered. Study selection included human trials evaluating safety and efficacy of gabapentin enacarbil for the treatment of RLS.Data Synthesis:Gabapentin enacarbil is a prodrug of gabapentin that is Food and Drug Administration (FDA) approved for the treatment of moderate-to-severe primary RLS in adults. In placebo-controlled trials, gabapentin enacarbil demonstrated efficacy in reducing the symptoms of RLS. Most clinical trials assessed gabapentin enacarbil at dosages greater than the FDA-approved 600-mg dosage. For the approved dose of 600 mg, the most commonly reported adverse effects are somnolence and dizziness.Conclusions:Clinical trials have evaluated gabapentin enacarbil for safety and efficacy in treating moderate-to-severe RLS symptoms for up to 64 weeks It offers a pharmacokinetic advantage over gabapentin by having improved absorption and a longer duration of action, but clinically significant differences are yet to be determined. Potential disadvantages of gabapentin enacarbil include cost, concerns of suicide risk and pancreatic cancer, and a lack of data for the FDA-approved 600-mg dosage. Overall, gabapentin enacarbil is a viable therapeutic option for adults with moderate-to-severe RLS for whom more conventional therapies have failed. ResumenObjetivo:Revisar la farmacología, la farmacocinética, la eficacia clínica, los efectos adversos, las interacciones con fármacos, las precauciones, las recomendaciones de dosificación y la consejería al paciente de enacarbilo de gabapentina para el tratamiento del síndrome de piernas inquietas (RLS) en pacientes adultos.Fuentes De Datos:Una búsqueda de la literatura fue llevada a cabo usando los términos enacarbilo de gabapentina, XP 13512/GSK1838262 y síndrome de piernas inquietas. El texto completo de MEDLINE, Books@Ovid, Journals@Ovid y avances en BIOSIS, y la fuente de datos EMED fueron los sitios primarios de búsqueda desde el año 2004 hasta octubre de 2011. Todos los artículos en inglés y extractos obtenidos de la literatura fueron revisados. Información adicional fue obtenida de las referencias de los artículos citados.Selección De Estudios Y Extracción De Datos:Toda la información sobre enacarbilo de gabapentina relacionada con RLS fue tomada en cuenta. La selección de estudios incluyó ensayos en humanos evaluando la seguridad y la eficacia de enacarbilo de gabapentina para el tratamiento de RLS.Síntesis De Datos:Enacarbilo de gabapentina es una prodroga de gabapentina que está aprobada por la Administración de Alimentos y Fármacos (FDA, por sus siglas en inglés) para el tratamiento del síndrome de piernas inquietas de moderado a severo en adultos. En ensayos controlados por placebo, enacarbilo de gabapentina demostró eficacia en reducir los síntomas de RLS. La mayoría de los ensayos clínicos evaluaron enacarbilo de gabapentina en dosificaciones más altas de la dosis aprobada de 600 mg. Para la dosis aprobada de 600 mg los efectos adversos reportados más comúnmente fueron soñolencia y mareos.Conclusiones:Ensayos clínicos han evaluado el enacarbilo de gabapentina para seguridad y eficacia en el tratamiento de síntomas de RLS moderado a severo hasta por 64 semanas. Este ofrece la ventaja farmacocinética de tener mejor absorción y más larga duración de la acción que gabapentina, pero las diferencias clínicamente significativas están por determinarse. Las desventajas potenciales de enacarbilo de gabapentina incluyen el costo, temores por riesgo de suicidio y cáncer pancreático y una falta de datos para la dosis de 600 mg aprobada por FDA. En general, enacarbilo de gabapentina es una opción terapéutica viable para pacientes adultos con RLS de moderado a severo que han tratado y fallado tratamientos más convencionales. RésuméObjectif:Revoir la pharmacologie, la pharmacocinétique, l'efficacité clinique, les effets secondaires, les interactions médicamenteuses, les précautions, le dosage et les conseils aux patients reliés à l'enacarbil de gabapentine pour le traitement du syndrome des jambes sans repos (SJSR) chez l'adulte.Provenance Des Données:Une revue de la littérature médicale a été effectuée en utilisant les termes: enacarbil de gabapentine, XP13512/GSK1838262,et syndrome des jambes sans repos. Les sites primaires de recherche (janvier 2004 à octobre 2011) incluaient les banques de données MEDLINE, Books@Ovid, Journals@Ovid Full Text, BIOSIS Previews, et EMED. Toutes les publications et résumés de publications de langue anglaise identifiés par la recherche de littérature ont été revus. La bibliographie des publications identifiées a aussi été revue pour d'éventuelles études supplémentaires.Sélection Des Données:Toute information sur l'enacarbil de gabapentine reliée au SJSR a été considérée. Les publications étaient sélectionnées si elles rapportaient des données primaires d'études cliniques évaluant l'efficacité et l'innocuité de l'enacarbil de gabapentine pour le traitement du SJSR.Resume:L'enacarbil de gabapentine est un pro-médicament que la FDA des États-Unis d'Amérique a approuvé pour le traitement du SJSR modéré à sévère. Lors d'études contrôlées, l'enacarbil de gabapentine s'est avéré plus efficace qu'un placebo pour réduire les symptômes du SJSR. Dans la plupart des études cliniques, les doses d'enacarbil de gabapentine étaient plus élevées que celles présentement approuvées, ie, 600 mg. Avec des doses de 600 mg, les effets secondaires les plus fréquemment rapportés incluaient la somnolence et les étourdissements.Conclusions:L'efficacité et l'innocuité de l'enacarbil de gabapentine dans le traitement du SJSR modéré à sévère a été évaluée lors d'essais cliniques portant sur des périodes allant jusqu'à 64 semaines. L'enacarbil de gabapentine possède une meilleure absorption et une plus grande durée d'action que la gabapentine, mais l'impact de ceci sur l'utilisation et l'efficacité clinique reste à démontrer. Les désavantages potentiels incluent son coût, le risque de suicide et de cancer du pancréas. De plus, les évidences avec la dose de 600 mg (approuvée par la FDA) sont plutôt limitées. En résumé, l'enacarbil de gabapentine semble une option thérapeutique viable pour l'adulte souffrant de SJSR modéré à sévère qui ne répond pas aux thérapies conventionnelles.

Journal Article Neurologic Music Therapy and Group Psychotherapy for Treatment of Traumatic Brain Injury: Evaluation of a Cognitive Rehabilitation Group Get access James C. Gardiner, PhD, James C. Gardiner, PhD Search for other works by this author on: Oxford Academic PubMed Google Scholar Javan L. Horwitz, PsyD Javan L. Horwitz, PsyD Search for other works by this author on: Oxford Academic PubMed Google Scholar Music Therapy Perspectives, Volume 33, Issue 2, 2015, Pages 193–201, https://doi.org/10.1093/mtp/miu045 Published: 15 February 2015 Article history Received: 24 April 2014 Revision received: 17 September 2014 Accepted: 21 September 2014 Published: 15 February 2015

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, precautions, dosing recommendations, and patient counseling of sodium oxybate for the treatment of cataplexy in patients with narcolepsy. DATA SOURCES: OVID and PubMed databases were searched (1966-January 2006) using the key words sodium oxybate, gamma-hydroxybutyrate, narcolepsy, and cataplexy. Only English-language articles were selected. STUDY SELECTION AND DATA EXTRACTION: All information on sodium oxybate related to narcolepsy and cataplexy was considered. Study selection included human trials evaluating safety and efficacy of sodium oxybate for the treatment of cataplexy. DATA SYNTHESIS: Sodium oxybate is approved by the Food and Drug Administration for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy. In placebo-controlled trials, sodium oxybate demonstrated efficacy in reducing the number of cataplexy attacks. The dosing regimen includes a split dose given at bedtime and 2.5-4 hours later due to its short elimination half-life. The drug is generally well tolerated, with headache, nausea, dizziness, pain, and somnolence being the most common adverse events. CONCLUSIONS: Sodium oxybate is safe and effective for the treatment of cataplexy. Potential disadvantages include a multiple dosing regimen, abuse potential, cost, and a closed distribution system. Potential advantages demonstrated in clinical trials include significant decreases in the number of weekly cataplexy attacks, improvement in daytime sleepiness, and improvement in the Clinical Global Impression of Change score and nighttime awakenings. Overall, sodium oxybate provides a new option for the treatment of cataplexy.

Prior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician should complete a medical and audiological case history. Additionally, clinicians need accurate results from a comprehensive audiologic evaluation. The evaluation should include the following: pure-tone testing, word recognition testing, speech-in-noise testing, and loudness discomfort level measures. This article will outline the process and procedures for acquiring this information in line with the Audiology Practice Standards Organization (APSO) Guidelines for Adult Hearing Aid Fittings Standards 1 and 4. This article will also discuss how results can affect decision-making during the hearing aid selection and fitting process.

Brivaracetam is an analogue of levetiracetam that is Food and Drug Administration-approved for adjunctive treatment of partial-onset seizures in patients 16 years and older. In placebo-controlled trials adjunct brivaracetam demonstrated efficacy in reducing the frequency of seizures. The most commonly reported adverse effects are somnolence, dizziness, and fatigue. Clinical trials have evaluated brivaracetam for safety and efficacy in adjunctive treatment of partial-onset seizures in patients 16 years and older for up to 16 weeks. Brivaracetam's mechanism is similar to that of levetiracetam but with greater receptor binding affinity on synaptic vesicle protein 2A and inhibitory effects on sodium channels. Clinically significant differences between these agents are undetermined. Brivaracetam is available as oral tablets, oral solution, and intravenous solution. The Food and Drug Administration-approved dose is 50 mg twice daily, and titration is not required. Brivaracetam does not need dose adjustment for renal impairment and has minimal drug-drug interactions. Current limitations of brivaracetam include lack of head-to-head trials, limited long-term safety and efficacy data, and cost. Overall, brivaracetam is a viable adjunct therapeutic option for refractory partial-onset seizures in those who have failed conventional therapies.

Roddy, Shirley J. NP, PhD; Walker, Susan Noble RN, EdD, FAAN; Larsen, Jennifer MD; Lindsey, Ada RN, FAAN, PhD; Shurmur, Scott MD; Yates, Bernice RN, PhD Author Information

Occipital neuralgia (ON) is described as a shooting, stabbing pain in the posterior part of the scalp that involves the occipital nerve. The epidemiology and pathophysiology are uncertain, but ON is considered distinct from other headache types. At the time of this writing, memantine for the treatment of ON has not been described in the literature. The following details a case report of successful treatment of ON with memantine. A 64-year-old, 91-kg, White man presented with severe headache associated with ON. Previous trials of oral medications, acupuncture, or physical therapy did not provide relief. The patient reported 15 ON headache days per month, use of 18 sumatriptan tablets per month, and daily use of as-needed ibuprofen. Because of inadequate relief of ON from other treatments, memantine was started. After titration to memantine 10 mg by mouth twice daily, the patient reported he was "100% headache free" from his ON pain. The patient tolerated memantine well without adverse effects. This case report displays safe, effective, and novel treatment of ON with memantine 10 mg by mouth daily, twice daily. The known safety, tolerability, and pharmacodynamics of memantine may warrant its off-label use in future studies exploring efficacy in ON.

Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting 1 to 5 days, followed by asymptomatic periods. The etiology and pathophysiology of CVS are unknown, but CVS shares similar characteristics to those of migraine headaches. Tricyclic antidepressants have the most evidence and are generally effective for prophylaxis of further episodes in patients with CVS. Second-line pharmacotherapies typically target specific comorbid symptoms or conditions and may include antiepileptic or antimigraine drugs, benzodiazepines, antispasmodics, proton pump inhibitors, antiemetics, and analgesics. OnabotulinumtoxinA (ONABoNT-A) injections have not been studied in the population with CVS but are regarded as a pharmacotherapeutic option for migraine headaches. We describe a 45-year-old woman with a 5-year history of CVS who had failed previous typical prophylactic migraine and CVS pharmacotherapies and was referred to the neurology clinic for management of both of these conditions. On review, the neurologist noted a correlation of the patient's headaches with her CVS symptoms. ONABoNT-A injections were started at 155 units intramuscularly every 12 weeks for her migraine headaches, which also dramatically improved her CVS. The main adverse effect reported by the patient was numbness and weakness in her left shoulder after the injections, which are symptoms consistent with ONABoNT-A injection use; however, these symptoms typically resolved a few days later. Regarded as a pharmacotherapeutic option for migraine headache prophylaxis, ONABoNT-A injections have demonstrated modest efficacy in preventing migraine headaches. Clinicians should be aware that ONABoNT-A injections may also have a role in the prophylaxis of CVS.

PROBLEM: Excessive weight and obesity have been identified as the most serious health problems facing American Indian (AI) children. Thirty-eight percent of the preschool and kindergarten children who participated in this study were either overweight or obese. Potential reasons for this prevalence include the physical activity transition of AI people to sedentary lifestyles, in utero exposure to diabetes, and social determinants of health, especially poverty. In 2013, 29.8 percent of single-race AI/Alaska Native people were living in poverty. Childhood trauma and stress have also been linked to obesity. The experience of numerous negative life events in childhood increases the risk for being overweight by age 15. PURPOSE: Early-life home and preschool interventions with children between the ages of five and 14 have a greater impact on preventing childhood obesity, primarily with children who enter kindergarten already overweight. The purpose of this study was to examine the feasibility and preliminary effects of the Strengthening Family Program (SFP) on the physical health (primarily weight) of AI young children. The goal of this study was to promote strong AI families and improve childhood health; however, the nutrition and exercise activities within the SFP were minimal and not adapted to the AI culture. Therefore, a nutrition and exercise program for AI children between the ages of three to five was developed. The primary objective for this study was then revised to evaluate the feasibility and preliminary effects of the newly developed AI physical activity and nutrition adjunct program for preschool and kindergarten children. METHOD: Two 14-week sessions of the SFP were implemented with an AI activity and nutrition program that incorporated curricula from the Eagle Books and Health is Life in Balance. A mixed methods approach was used with a quasi-experimental wait-list control group design. Quantitative data gathered included child BMI pre- and post-intervention. A focus group was then conducted to identify the strengths and weaknesses of the SFP and the AI activity and nutrition program. RESULTS: Twenty-five children participated in either one of two intervention groups or one waitlist control group. The obesity rates of the preschool and kindergarten intervention groups stayed at 14 percent and at 38 percent pre- and post-intervention, respectively. The obesity rates for the waitlist control group, however, increased from 30 percent at pre-test to 50 percent at post-test. Focus group narratives resulted in two categories of strengths (positive child behaviors and meaning to child) and one weakness (adult disconnect). CONCLUSION: Caregiver participation was limited and challenging. Further community-based dialogue is needed to ensure sustainability.