The Association Between Physical Activity and Maternal and Neonatal Outcomes: A Prospective Cohort

Some evidence, but not enough to be conclusive, suggests that physical activity in pregnancy reduces the risk of perinatal complications. Our objective was to examine if physical activity in the year before pregnancy and in the first half of pregnancy is associated with maternal and neonatal outcomes. Associations between physical activity and maternal and neonatal outcomes were examined in a prospective cohort (n = 1,749) in Halifax, Canada. The Kaiser Physical Activity Survey, completed at approximately 20 weeks’ gestation, requested information regarding physical activity during the year before the pregnancy and the first 20 weeks of pregnancy. Outcomes were assessed by medical chart review. Multiple logistic regression was used to estimate odds ratios (OR) with 95 % confidence intervals (CI). Women with prepregnancy physical activity levels in the middle and highest tertiles were more likely to have high gestational weight gain relative to women in the lowest tertile [OR (CI): 1.40 (1.06–1.85) and 1.57 (1.18–2.09), respectively]. Higher physical activity in the first half of pregnancy decreased the odds of delivering a macrosomic infant (p trend = 0.005). Associations were not observed between total physical activity and gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth, and low birth weight. Physical activity before, but not in the first half of pregnancy, is associated with high gestational weight gain. Physical activity in the first half of pregnancy may reduce the occurrence of macrosomia without affecting preterm birth or low birth weight.     

Beyond Bricks and Mortar: Recent Research on Substance Use Disorder Recovery Management

Serious scholarly inquiry into juvenile sex offending represents a relatively new field, dating from the mid 1940s. During the next 4 decades, a mere handful of articles exploring aspects of juvenile sex offending were added to the available literature. By the 1980s, however, the literature began to increase rapidly, a trend that continues today. The purpose of this article is a focused review of the juvenile sex offender literature cited in PubMed over the last 5 years (2009-2013). The authors have chosen studies that will bring readers up to date on research they believe impacts our current understanding of best practices in the management of juvenile sex offending. For convenience, our review is organized into topical categories including research into characteristics and typologies of juvenile sex offenders, risk assessment and recidivism, assessment and treatment, the ongoing debate about mandatory registration of sex offenders as it applies to juveniles, and other thought provoking studies that do not fit neatly into the aforementioned categories. The studies included contain findings that both reinforce and challenge currently held notions about best practices concerning treatment and public policy, suggesting that our knowledge of the field continues to evolve in important ways.     

Prevalence,correlates and management of type 2 diabetes mellitus in Lebanon: Findings from a national population-based study

Aims

This study aims to examine the prevalence, associated risk factors and complications of diabetes, as well management and preventive care in Lebanon, a small, middle-income country of the Mediterranean region.

Methods

Using a comprehensive multi-dimensional questionnaire, a cross-sectional national survey of 2195 Lebanese adults aged ≥25 years was conducted based on the WHO STEPwise guidelines. The outcome variable, diabetes, was self-reported. Measures for diabetes management included frequency of blood glucose testing and regular eye and foot exams. Macrovascular and microvascular complications were also recorded.

Results

The prevalence of type 2 diabetes was 8.5% (95%CI = 7.3–9.7). Factors associated with an increased risk of having diabetes were: being divorced or widowed (OR = 2.56; 95%CI = 1.07–5.42) compared to single, being obese (OR = 1.50, 95%CI = 1.00–2.57), and having a family history of diabetes (OR = 3.40;95%CI = 2.48–5.19). Vigorous physical activity significantly decreased the odds of diabetes (OR = 0.42; 95%CI = 0.24–0.72). Diabetes management and self-care goals were as follows: 82% were not measuring their blood sugar via dextro on a daily basis, 64.2% did not have a foot exam within the past year, and 52.4% did not obtain the recommended yearly eye exam. The most common complications included heart disease (27.8%) and retinopathy (16.6%).

Conclusions

Prevalence of diabetes in Lebanon was comparable to that found in the West, yet remained lower than estimates in other resource-rich neighboring countries. Adherence to management and self-care measures was sub-optimal resulting in high complication rates. Contextual factors play a role in increasing diabetes risk. Population-based interventions to enhance and promote self-management behaviors are essential to improve complication rates.     

Battery of behavioral tests in mice that models age-associated changes in human motor function

Motor function in humans can be characterized with tests of locomotion, strength, balance, and endurance. The aim of our project was to establish an analogous test battery to assess motor function in mice. Male C57BL/6 mice were studied at 3 (n = 87), 20 (n = 48) and 26 (n = 43) months of age. Tests assessed locomotion, strength, balance/coordination, and endurance capacity in mice. Motor function was reduced in the older groups of mice for the locomotion, strength, and endurance subdomains (p < 0.001). As indicated with a summary score, motor function declined by 7.4 % from 3 to 20 months and by 13.5 % from 20 to 26 months. Based on comparison with previously published data in humans, the magnitude and relative time course of changes were similar in mice and humans in each subdomain except balance/coordination. Power calculations confirmed that the age-associated differences depicted by several of the individual tests and domain summary scores would be sufficient to assess the efficacy of interventions aimed at prevention or treatment of motor dysfunction with aging. The current study describes a mouse model that characterizes age-associated changes in clinically relevant domains of motor function and indicates that the preclinical model can be used to test strategies to attenuate age-associated declines in motor function.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-013-9589-9) contains supplementary material, which is available to authorized users.     

Coordinating principles of art therapy and DBT

Coordinating treatment modalities may offer patients more than what any one treatment may offer alone. Art therapy and Dialectical Behavior Therapy (DBT) are effective treatments for a wide range of clinical disorders and are often applied in conjunction with other forms of therapy. Common clinical symptoms, such as emotional dysregulation, may be particularly amenable to a combined art therapy and DBT approach. Informed by the theoretical foundations of interdisciplinary care including both art therapy and DBT, this paper offers an approach and examples of strategic use of art therapy and DBT together as part of an interdisciplinary treatment plan. Advantages of using treatments simultaneously may include reinforcement of learning skills, contribution to interdisciplinary team synergy, and enactment of bilateral integration. A common factor approach is used to coordinate theoretical principles of art therapy and DBT and a case study illustrates coordination of the two therapeutic approaches. Implications for populations at varying levels of care are discussed.     

Technique of per-oral endoscopic myotomy (POEM) of the esophagus (with video)

Background

Per-Oral Endoscopic Myotomy (POEM) is becoming an acceptable alternative to laparoscopic cardiomyotomy for esophageal motility disorders. The aim of this video is to provide key technical steps to completing this procedure.

Method

Each patient underwent diagnostic investigations including high resolution manometry (HRM), esophageogastroduodenoscopy (EGD), and timed-barium swallow for primary esophageal motility disorders preoperatively. Patients undergoing POEM procedures are preoperatively prepared by taking Nystatin swish-and-swallow for 3 days, 24 h of clear liquid diet, and 12 h of NPO. Preoperative antibiotics are given. Under general anesthesia and with the patient in the supine position, endoscopy with CO₂ insufflation is prepared. Special endoscopic instruments and electrocautery settings are required to perform the POEM procedure, as illustrated in the slides. POEM is performed in six key/critical steps: (1) diagnostic endoscopy; (2) taking measurements; (3) esophageal mucosotomy creation; (4) submucosal tunneling; (5) selective circular myotomy of the anterior lower esophageal sphincter; and (6) closure of the mucosotomy. According to our protocol, all patients get an esophogram the next morning after surgery prior to discharge. The patient receives objective testing (HRM with 24 PH Impedance test, EGD, and timed-barium swallow) 6 months postoperatively.

Conclusion

In six key steps, POEM can be accomplished as described in the video.     

Profiles of ethnic-racial socialization from family,school, neighborhood,and the Internet: Relations to adolescent outcomes

Given that ecological models of development highlight the interacting influences of multiple environments, further research is needed that explores ethnic-racial socialization from multiple contexts. The current study explores how families, schools, neighborhoods, and the Internet jointly impact academic outcomes, critical consciousness, and psychological well-being in adolescents, both through socialization messages and experiences with racial discrimination. The research questions were: (a) What profiles of multiple contexts of socialization exist? and (b) How are the different profiles associated with academic outcomes, critical consciousness, and psychological well-being? The sample consisted of 1,084 U.S. adolescents aged 13–17 (M = 14.99, SD = 1.37; 49% girls) from four ethnic-racial groups: 25.6% Asian American, 26.3% Black/African American, 25.3% Latinx, and 22.9% White. The participants completed online surveys of socialization and discrimination from four contexts and three types of outcomes: academic outcomes, critical consciousness, and well-being. A latent profile analysis revealed three profiles: Average, High Discrimination, and Positive School. The Positive School class had the most positive academic outcomes and well-being. The High Discrimination class reported the highest critical consciousness. Their academic outcomes and well-being were similar to the Average group. The findings support complexity in perceptions of socialization from different contexts and the associations of socialization with youth outcomes.