Objective To examine the independent and combined impact of cognitive dysfunction and spasticity on driving tasks involving high cognitive workload and lower-limb mobility in individuals with multiple sclerosis (MS). Design Single-visit cohort study. Setting Clinical research center. Participants Seventeen drivers with MS and 14 normal controls. The MS group exhibited a broad range of cognitive functioning and disability. Eight MS patients had significant spasticity in the knee proximal to the pedals (based on the Modified Ashworth Scale). Interventions Not applicable. Main Outcome Measures A brief neuropsychologic test battery and 2 driving simulations. Simulation 1 required participants to maintain a constant speed and lane position while attending to a secondary task. Simulation 2 required participants to adjust their speed to accelerations and decelerations of a lead car in front of them. Results MS patients demonstrated greater variability in lane position (effect size g=1.30), greater difficulty in maintaining a constant speed (g=1.25), and less ability to respond to lead car speed changes (g=1.85) compared with controls. Within the MS group, in a multivariate model that included neuropsychologic and spasticity measures, cognitive functioning was the strongest predictor of difficulty in maintaining lane position during the divided attention task and poor response time to lead car speed changes, whereas spasticity was associated with reductions in accuracy of tracking the lead car movements and speed maintenance. Conclusions In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving, and assessment of these factors may help guide the clinician regarding the types of driving behaviors that would put MS patients at increased risk for a crash.

Previous research has found HIV-associated neuropsychological (NP) dysfunction to be associated with impaired driving skills. To determine whether specific impairments in visual attention impart an increased accident risk, we assessed 21 HIV seronegative (HIV-) and 42 seropositive (HIV+) participants on NP tests and the Useful Field of View (UFOV), a computerized test of visual attention. HIV+ participants performed significantly worse than the HIV- participants on the UFOV, particularly on the Divided Attention subtest. Poor UFOV performance was associated with higher accident rates in the past year, with a trend for NP impairment to also predict more accidents. The highest number of accidents occurred in the group with a "high risk" UFOV designation and NP impairment; this category correctly classified 93% of HIV+ participants as to who did, and did not, have an accident. Clinicians should attend to visual attention as well as general cognitive status in estimating which patients are at risk for impaired driving.

Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally-led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally-driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.

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Objective: Participatory research has proven an effective method for improving health equity among American Indians/Alaska Natives (AI/ANs) by addressing power imbalances between communities and researchers, incorporating community knowledge and theory, ensuring mutual benefit and improving community capacity and programme sustainability. However, few studies have examined the implementation of these methods with urban Indian (UI) communities, a growing population currently comprising 71% of AI/ANs. This paper describes the experiences of two academic researchers (one a Native doctoral student and another a White assistant professor) who sought to engage in participatory research with an UI community in Maryland. Method: The methodology employed was a literature review of Indigenous participatory research methods that aimed to inform the work of a youth-led project, and a reflexive case-study analysis. Results: Researchers discuss the social, structural and political inequalities that challenged their ability to engage in this process and identify three lessons learned associated with conducting participatory research with this population: logistics and recruitment, identifying the constraints and/or competing priorities of the community, and the importance of reflexivity and communication throughout the process. In an epilogue, the researchers highlight and reflect upon how they have since applied these lessons to strengthen their relationship with the community, yielding new and mutually beneficial participatory research projects. Conclusion: The findings presented advance research on participatory methodologies with UI communities and call for increased economic and political support of and long-term commitment to UI organisations to address the structural inequalities underpinning existing health inequities.