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Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.
Aims
To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.
Method
Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.
Results
Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).
Conclusions
These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.
Pregnancy is a time when weight increases as part of a physiological process to aid fetal growth. However, when excess weight is gained during pregnancy, and retained thereafter, the risk of obesity in the future increases. Increasing BMI between pregnancies and maternal obesity are associated with several adverse pregnancy outcomes. Although the risks of increasing BMI on future pregnancies is well defined, the predictors of this weight gain are not. This study aimed to investigate the predictors of interpregnancy BMI change.
Materials and methods
This study was conducted in one of Europe's largest maternity hospitals delivering approximately 8000 infants per annum. Women's sociodemographic and clinical data were self-reported at the first antenatal visit and computerised to an electronic recording system by trained midwives. Weight and height were measured at the first antenatal visits of both pregnancies, and body mass index was calculated. Data was extracted and analysed for women who delivered their first and second singleton infants between 2009–2018.
Results
A total of 12,056 women delivered their first and second baby over the 10-year period. The mean interval between pregnancies was 32.3months (SD15.9) and the median BMI change was 0.6units (IQR1.3). From the first to the second pregnancy the rate of obesity increased from 11.6% to 16.0%. Between pregnancies 46.1% of women maintained their BMI (-1 to + 1units), 13.3% lost > 1 BMI unit(s), whereas 15.5% gained 1–2unit(s), 9.9% gained 2–3units and 12.0% gained > 3units. Overall, 5.8% became obese by the second pregnancy. On multinomial regression analysis, having a pregnancy interval of > 3years (aOR2.1, 95%CI 1.9–2.5, p < 0.001), artificial feeding after the first pregnancy (aOR1.8, 1.5–2.0, p < 0.001), postnatal depression after the first pregnancy (aOR1.6, 1.3–2.1, p < 0.001) and taking prescribed anxiolytics or antidepressants (aOR1.6, 1.1–2.5, p = 0.013) were predictors of gaining > 3 BMI units between pregnancies after adjusting for maternal occupation and age. The predictors of becoming obese in the second pregnancy also included a pregnancy interval of > 3years (aOR1.5, 1.2–1.8, p < 0.001), artificial feeding after the first pregnancy (aOR2.1, 1.8–2.6, p < 0.001), postnatal depression after the first pregnancy (aOR1.7, 1.2–2.3, p = 0.001) and taking prescribed anxiolytics or antidepressants (aOR1.8, 1.1–3.1, p = 0.016) following the same adjustments.
Conclusion
Longer pregnancy interval, not breastfeeding and psychological health disorders are predictors of BMI increase between pregnancies and becoming obese in the second pregnancy. Interventions provided following women's first delivery should aim to promote breastfeeding, manage weight and improve mental health.
Considerable progress in explaining cultural evolutionary dynamics has been made by applying rigorous models from the natural sciences to historical and ethnographic information collected and accessed using novel digital platforms. Initial results have clarified several long-standing debates in cultural evolutionary studies, such as population origins, the role of religion in the evolution of complex societies and the factors that shape global patterns of language diversity. However, future progress requires recognition of the unique challenges posed by cultural data. To address these challenges, standards for data collection, organisation and analysis must be improved and widely adopted. Here, we describe some major challenges to progress in the construction of large comparative databases of cultural history, including recognising the critical role of theory, selecting appropriate units of analysis, data gathering and sampling strategies, winning expert buy-in, achieving reliability and reproducibility in coding, and ensuring interoperability and sustainability of the resulting databases. We conclude by proposing a set of practical guidelines to meet these challenges.
The field of Security Studies traditionally focused on military threats to states' survival, however, since the end of the Cold War the concept of security has widened and individuals and communities have gradually become viewed as appropriate referent objects of security: Multifaceted challenges facing communities at the sub-state level are increasingly regarded as security threats, including their potential to cause instability for the larger society, thus affecting states’ security. In the Arctic region, a central challenge is that inhabitants are exposed to multiple non-traditional and non-military threats resulting from environmental, economic, and societal changes, which can be understood as threats to human security. We argue that a comprehensive approach to human security overlaps with the concept of societal security, and must therefore consider threats to collective identity and the essential conditions necessary for the maintenance and preservation of a distinct society. We see the human security framework as a suitable analytical tool to study the specific challenges that threaten the Arctic population, and in turn the well-being of Arctic societies. Therefore, we argue that utilising the concept of human security can promote societal security in the context of the Arctic, and in particular, its sub-regions, for example, the Barents region.
Organisational restructuring is a pervasive strategy employed by organisations in Australia in response to changes in market competition and/or policy directives. Such restructuring often involves staff redundancies and increased demands on the remaining employees. This paper identifies important issues for workplace rehabilitation programs in response to this phenomenon of organisational restructuring. The paper notes the impact of organisational restructuring on clients in workplace rehabilitation programs and the types of issues rehabilitation professionals are likely to face at this time. A particular focus is the aspect of managerial behaviour during the process of change and the paper reports from a range of studies on employee well-being, managerial bullying and coercion in the context of organisational restructuring. Considerations for the rehabilitation professional include the need to understand communication issues, identify those at risk, and maintain the natural supports during the change program. Suggestions are given for convenors of workplace rehabilitation programs to actively collaborate with the human resource function of the organisation and disability management is outlined as a useful example of such strategies.
This research focuses on coal recovered from the debris field created when R.M.S. Titanic sank on 15 April 1912. The primary objectives are to evaluate the variety of different sources of coal represented in the Titanic sample, and to identify the specific location of these sources. The methods used to evaluate the research objectives include a variety of trace element, petrographic, and palynological analyses. The results of this study provide critical insight into the socioeconomic circumstances that contributed to the enormity of the disaster.
Although, as the quotations above indicate, the question of the importance of the ‘balancer’ in balance of power systems has generated strong opinions from both critics and proponents, it has never stimulated a specific study of the balancer. The picture of the balancer as it currently exists has to be obtained by abstracting descriptions of the balancer role from general writings on the balance of power. This is unfortunate for even those authors like Padelford and Lincoln who saw the balancer role as critical, failed to devote more then a few paragraphs to the topic. The aim of this paper therefore is to try to clarify the nature and function of the balancer by synthesizing the views of analysts of the role over the past three centuries to produce a paradigm of the balancer strategy.