Peri-conceptional diet patterns and the risk of Gestational diabetes mellitus in South Indian women.

OBJECTIVE: To identify peri-conceptional diet patterns among women in Bangalore, and examine their associations with risk of gestational diabetes mellitus. DESIGN: BANGLES, started in June 2016, was a prospective observational study, in which women were recruited at 5-16 weeks' gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire. GDM was assessed by a 75-gram oral glucose tolerance test at 24-28 weeks' gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis and diet pattern-GDM associations were examined using multivariate logistic regression, adjusting for 'a priori' confounders. SETTING: Antenatal clinics of two hospitals, Bangalore, South India. PARTICIPANTS: 785 pregnant women of varied socio-economic status. RESULTS: GDM prevalence was 22%. Three diet patterns were identified: a) High-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; b) Rice-fried snacks-chicken-sweets (RFCS), characterised by low diet-diversity, was associated with younger, less-educated, and lower income, rural and joint families; c) Healthy, traditional vegetarian (HTV), characterised by home-cooked-vegetarian and non-processed foods was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (aOR: 0.80 per SD, 95% CI: 0.64, 0.99, p=0.04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet-GDM associations. CONCLUSIONS: The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet-diversity. Both healthy and unhealthy foods in the patterns indicate low-awareness about healthy foods and a need for public-education.

[24-Hour arterial pressure variability and 24-hour variability of pulse carries unidirectional character and is not associated with left ventricular hypertrophy (results of population study)].

Alternative prognostic interpretation of variability of arterial pressure (AP) and pulse seems contradictory if one considers classical conceptions of close physiological connection between AP and pulse. It is logical to expect that elevated variability of AP should be associated with elevated variability of pulse and vice versa. Within framework of the project EPOCH we examined a populational sample of inhabitants of Novosibirsk (129 men and 170 women) formed according to the family principle. Ambulatory 24-hour registration of AP and pulse was carried out with 15-30 minutes interval. Variability of AP turned out to be unidirectionally interconnected with variability of pulse and was not an independent marker of hypertrophy of the left ventricle but was associated with it at the account of concealed dependence on mean 24-hour AP. Cornell voltage index in persons with normal AP, "white coat" arterial hypertension (AH), "masked" AH was comparable and significantly lower than in subjects with sustained AH.

Interaction of the tumor promoter 12-O-tetradecanoylphorbol-13-acetate with cells in mixed-lymphocyte culture.

12-O-Tetradecanoylphorbol-13-acetate (TPA) inhibits DNA synthesis in bovine lymph node lymphocytes in mixed-lymphocyte cultures. Using a radioautographic study, we determined that TPA also blocked morphological changes in these cultures. Pretreatment of cultures of isologous lymphocytes with 10(-7) M TPA for three days prior to mixing was sufficient to block their subsequent response in mixed culture. Thus, TPA did not need to be present during the initial cell-to-cell interactions of the mixed lymphocyte response. The inhibition was not due to the death of the responding cell population because the effect was reversible. In one-way mixed-lymphocyte cultures, TPA pretreatment of either responding or stimulating cells could block DNA synthesis. The responding cells were more sensitive to TPA than were the stimulating cells. The inhibitory effect of the stimulators increased with an increase in the stimulating-to-responding cell ratio. In one-way cultures, it was also seen that lymphocytes from different animals varied both in their sensitivity to TPA and in their response to TPA-treated cells from other animals. The data taken together are consistent with the idea that TPA acts by changing cell surface recognition structures and/or indirectly, through activation of a subpopulation of cells to block the proliferative response. TPA may prove to be a valuable tool in studying cell-cell interactions and lymphocyte differentiation in vitro.

Anti-GM1/GD1b M-proteins damage human spinal cord neurons co-cultured with muscle.

IgM M-proteins in some motor neuron disease (MND) patients bind immunologically to shared determinants on gangliosides GM1 and GD1b. Since patients with these M-proteins have improved with immunotherapy the antibodies may be important in the pathogenesis of MND. To study how the M-proteins might damage motor neurons, we established co-cultures of human neurons from spinal cord explants and human myotubes. Antibodies from patient but not control serum bound to the cultured neurons. Neurons in co-cultures degenerated after incubation with patient but not control serum. These results demonstrate that anti-GM1 antibodies can bind to and destroy spinal cord neurons that are cultured with muscle. Nerve-muscle co-cultures can serve as a system to examine effects of anti-GM1/GD1b M-proteins on motor neurons.

The consumer-run business: people with psychiatric disabilities as entrepreneurs.

Consumer-run businesses create job opportunities for people with psychiatric disabilities through the production of goods and services for sale to the community. The success of the consumer-run business is determined by the extent to which it is economically viable, owned and operated by persons with psychiatric disabilities, enhances the well being of its individual members and strengthens the consumer community. This paper provides an overview of the consumer-run business as it has emerged in the area of mental health. It describes the limitations of traditional rehabilitation services approaches which have served as a catalyst for the development of these businesses. It outlines the key characteristics of the consumer-run business. Finally, the paper argues that the consumer-run business represents a fundamental shift away from vocational rehabilitation service models.

Determining the effectiveness of thresholds, an intervention to enhance the career development of young people with physical disabilities.

People with disabilities have lower work force participation rates than the general public. One factor that has been attributed to this is a lack of vocational programs for adolescents with disabilities. Thresholds is a vocational program designed to enhance the career development strategies of adolescents with physical disabilities. In a three-part series, participants reflect on who they are, clarify their career future and explore the world of work, and test out strategies for investigating career opportunities and addressing obstacles to career success. Following pilot testing, Thresholds was field tested with two groups of adolescents in two urban centres in Canada. Findings suggested that this program could enhance the vocational decision-making abilities and self-appraisal skills of participants. Entry level characteristics of participants were critical in determining the extent of change. Feedback encouraged modifications to make the program more useful and effective.

Stress, coping and the job search process: the experience of people with psychiatric disabilities in supported employment.

Ten people with psychiatric disabilities and their supported employment coordinators responded to a standardized, open-ended interview about the stresses experienced during the job search process and the coping strategies used to deal with these stresses. The stress inherent in the potential for rejection and negative valuation was a major theme. The respondents described both problem based and emotion focused coping strategies. The people with psychiatric disabilities also identified cognitive strategies they employ to maintain their motivation and ego integrity. While these cognitive strategies are used to neutralize the impact of a stress, they can be a source of tension within the rehabilitation relationship. Current conceptualizations may not adequately address the struggles inherent in the job search process.

Occupational therapists as case managers: responding to current approaches to community mental health service delivery.

Case management has been identified as an effective approach to service delivery which can assist persons with severe psychiatric disabilities to live in the community. The conceptualization and development of case management services have been the focus of much discussion. Occupational therapists are attempting to define their role in relation to case management. The purpose of this paper is to explore the relationship between occupational therapy and the case management approach to service delivery. The case management approach will be described including its objectives, models, functions and training requirements for case managers. A discussion of some of the philosophical, educational and professional issues facing occupational therapists in the role of case manager will be examined.

Involving clients in programme evaluation and research: a new methodology for occupational therapy.

Eliciting client satisfaction with services has become common in mental health settings and in the planning of service delivery systems. It is also compatible with the client-centred practice of occupational therapy. The traditional approach to collecting satisfaction information involves staff interviewing clients using questionnaires developed by staff. However, there is often a lack of variability in responses and the vast majority of clients report being satisfied. A review of the literature reveals that these favourable reports may be a result of social desirability and of clients being interviewed by treatment providers who have the power to give or withhold care. This paper reviews the relationship between occupational therapy and client involvement, examines the rationale for involving clients in programme evaluation and research, reviews the limitations with traditional methods of collecting information about client satisfaction, and discusses how clients are involved in evaluation and research in today's mental health care setting.

Occupational therapy issues in the treatment of the long-term mentally ill.

In this paper, a single case study is used to facilitate discussion of problems encountered by occupational therapists engaged in working with the long-term mentally ill. The achievement of the long-range and multi-faceted approach necessary for the management of this population is a recognized challenge. Some of the paradoxes and dilemmas involved in programming and the measurement of outcome and success are clarified. As well, sources of stress to individuals involved in working with the long-term mentally ill are considered. Issues addressed include: philosophy of approach, professional and personal conflicts patients' wishes and involvement, and the low priority given to working with this group. Two main objectives of the paper are to: bring an appreciation for the complexity of the difficulties presented and demonstrate how occupational therapists can offer valuable contributions in working with the long-term mentally ill.

Community integration for persons with disabilities: working together to make it happen.

In summary, the common themes for therapists working in these three areas are very evident. The content of each paper seemed relevant to all of the client populations. The current trends toward integration and increased consumer control are impacting on occupational therapy practice with all three groups. These trends have significant implications for service delivery and all health care professionals. Occupational therapy has already begun to recognize and value these trends (Canadian Association of Occupational Therapists, 1991; Law et al., 1991). Occupational therapists need to work together and align their efforts to promote the establishment of a comprehensive community service system that enables people to receive the support that they require in their home communities. Service approaches must be designed for empowerment and the full participation of persons with disabilities in all aspects of community living. Treatments that focus solely on minimizing an individual's disabilities will not be successful in achieving this stated goal. There is a need for approaches that creatively adapt environments and reallocate resources so as to enhance the formation of relationships and participation in typical community activities. Service providers must be prepared to respond with the assistance that individuals need to achieve their goals. This is only made possible by the participation of persons with disabilities in the decision making process and in the development of services to meet their needs. Such efforts are supported by government initiatives and strategic plans. The realization of full community participation of persons with disabilities is dependent on the quality of the partnerships that are formed between the community, the service providers, and (ABSTRACT TRUNCATED AT 250 WORDS)

Voices, Opportunities & Choices Employment Club: transforming sheltered workshops using an affirmative business approach. The VOCEC Board of Directors.

Voices, Opportunities & Choices Employment Club (VOCEC) is a non-profit "umbrella" corporation that facilitates the development of affirmative businesses to create jobs for consumers of mental health services. To date, 5 independent businesses have been developed by transforming the resources of sheltered workshops within Kingston Psychiatric Hospital and 2 businesses have been established in collaboration with a local public library. This paper provides a description of VOCEC, including an overview of the affirmative business approach, the structure of the organization, and the process of business development. Personal reflections provide insights into the experiences of consumers, staff, and Board members associated with the corporation.

Returning to productive activities: Perspectives of individuals with long-standing acquired brain injuries.

PRIMARY OBJECTIVE: The primary objective of this study was to understand how intrinsic and extrinsic factors influence productive involvement over time. RESEARCH DESIGN: Given this relatively unexplored area of study, an interpretive research paradigm was incorporated using the grounded theory methodology. METHODS AND PROCEDURES: Six participants were recruited based on inclusion criteria. They had been living with a brain injury for an average of 14 years. The primary method of data collection was semi-structured interviews, which was supplemented by programme reports to enhance methodological triangulation. RESULTS: The results revealed that factors influencing involvement in productive activities over time were conceptually linked to learning about one's capacity. These factors involved: an opportunity to try, support and feedback from others, experimenting, and participants' appraisals of themselves. CONCLUSIONS: Recommendations for clinical practice include incorporating the postulates of the social cognitive theory in rehabilitation and moving from a deficits approach towards a strengths model of practice.

Structural biochemistry. 17. Synthesis of tryptophan dipeptides.

Boc-Trp-Leu hydrazide has been found to significantly inhibit growth of the L-1210 and P388 murine lymphocytic leukemias. A series of related tryptophan dipeptides were prepared and found to be devoid of such activity. The tryptophan dipeptides were most conveniently obtained employing the DCCI-NHS peptide bond-forming procedure.