The aim in the present study was to assess the effect of small-moderate red wine ingestion on the level of serum insulin and plasma glucose when nutritional status is varied. Twenty nondiabetic males (19-22 years) participated in the study. In the fasting trial, all participants underwent a 6 h fast prior to consuming 4 standard units of red wine (40 g alcohol) or the equivalent amount of placebo as dealcoholized wine (containing <0.5% alcohol, 0% resveratrol) over a 135 min period. Alternatively, in the feeding trial, participants consumed food for 45 min prior to ingesting 4 standard units of red wine (40 g alcohol) or placebo over 135 min. Serum insulin and plasma glucose were assessed at regular 45 min intervals during all trials. The results showed a significant decrease in the level of serum insulin and no significant change in plasma glucose concentration in the fasting trial. Alternatively, a significant alcohol-induced decrease in plasma glucose and no change in serum insulin occurred when red wine alone was consumed after food. It was concluded that red wine can alter the glucose-insulin relationship and ingesting red wine alone (without food) should not be encouraged in nondiabetic individuals.

Background/Aims: Early work suggests that migraine may be triggered by a diet-induced reactive hypoglycemia. The aim here is to report on the efficacy of dietary therapy in the management and treatment of headache symptoms in a chronic migraine (without aura) patient. Methods: A 51-year-old man previously diagnosed with chronic migraine (without aura) presented for treatment. The patient, upon request by his treating medical practitioner, had maintained a comprehensive headache diary, which included details of headache frequency and severity, time of headache onset, and headache-related medication usage for a period of six months. Several interviews were conducted to determine medical and complimentary health treatment history prior to the introduction of dietary therapy. As part of the dietary regimen the patient was required to: (1) completely eliminate alcohol, monosodium glutamate, artificial sweeteners, sugar, and food containing sucrose natural or otherwise from the diet; (2) modify the consumption of fruit, dairy, and fat; (3) eat at least six small meals per day; (4) ensure the interval between meals did not exceed 3 hours; (5) consume complex carbohydrate and a small glass of water at every meal and upon waking in the middle of the night; and (6) avoid all medication deemed to be unsuitable for hypoglycemic patients. The patient was also required to maintain his headache diary at all times. The results showed that the implementation of the dietary regimen successfully reduced the need for headache-related pain medication by at least 70% when compared to pre-treatment levels. Alternatively, subsequent deviation from the prescribed dietary regimen immediately resulted in a 2.5 fold increase in headache related pain medication usage. Conclusions: Dietary therapy may be effective in reducing headache frequency and should be explored when deciding on the best treatment and management strategy for migraine patients.

Background: Psychosocial distress can contribute to avoidance, refusal, or discontinuation of cancer treatment, which could impact recovery and survival. Aims: The aim of the present study was to evaluate the effectiveness of a community based psychosocial program on alleviating mood disturbance in breast cancer survivors at different stages of their breast cancer journey. Method: A total of 37 women participated in an 8-week psychosocial program at their local community centre. The weekly 3-hour program was delivered in a small group format. Program components included health education, behavioural training, cognitive behavioural therapy, art therapy and stress-management. Questionnaires aimed at assessing psychiatric morbidity and mood adjustment were administered at the beginning of the program (Pre) and at the completion of the program (Post). Results: Group data revealed a significant reduction in psychiatric morbidity and improved psychological adjustment. When participants were divided into degree of psychiatric morbidity (mild, moderate, severe, very severe) a significant reduction in the reporting of anxiety symptoms in the mild, moderate, severe and very severe groups was reported; depression symptoms in the severe and very severe groups were noted, and anger, confusion and somatic symptoms in the mild group were noted. The level of activity was also significantly improved in the very severe group. Conclusions: A structured community based psychosocial program is beneficial to women struggling to come to terms with the emotional consequences of breast cancer at all stages of recovery.

In this study, an aspect of psychodrama, a little-known, action-oriented form of group psychotherapy, will be examined. Psychodrama was founded by the psychiatrist Dr Jacob Moreno in the 1920s, and was regarded as a major alternative to Freudian psychoanalysis in the United States of America during the 1930s and 1940s. Today, although practised worldwide, psychodrama has been overshadowed by less action-oriented and more talking-oriented, non-psychoanalytic psychotherapies, and therefore lacks visibility. Further, due to a lack of outcome research published in scholarly journals, it is not being included among evidencedbased psychotherapies.

Reviews of outcome studies published between 1970 and 2016 have shown that psychodrama researchers regard the single psychodrama enactment as the basic therapeutic unit, while other group psychotherapies regard the whole multi-session group process as such. Although some psychodrama researchers acknowledge the possible influence of group process on psychodrama outcomes, none have studied this influence. The reviewers saw this as a gap in the research. They also noted that no researcher has mentioned client psychosocial themes that arise during single enactments or during multi-session psychodrama groups.

This study examined the development of client psychosocial themes in a multisession psychodrama group, and used Young’s early maladaptive schema (EMS) framework to assess these themes. A collective case study approach was used with both within-case and across-case data being analysed. As no other universally accepted theme theoretical framework exists, schemas—which comprise cognitive, affective and somatic elements—were used to assess psychosocial themes. Young’s EMS framework was chosen because it offered an accepted, standardised system of naming and defining schemas, and his EMS questionnaires have been shown to be valid and reliable.

Ethics approval was obtained to video-record a multi-session psychodrama group that ran for nine three-hour sessions over three consecutive days. There were nine participants. The psychodramatist and group leader was a registered psychotherapist accredited with the Australian and Aotearoa New Zealand Psychodrama Association (AANZPA). The researcher was not present in the group.

The group leader, who was recruited through an email sent from the AANZPA research committee to its members, recruited participants from among his clients and psychodramatist trainees. All participants consented to being video-recorded for research purposes. The contents of each video-recorded session were catalogued in detail. Researcher-developed schema rating sheets based on Young’s EMS were used to assess and record each client’s schemas arising in psychodrama enactments. Two raters completed the assessment separately and achieved significant inter-rater agreement.

A qualitative descriptive approach was used to analyse the within-case and across-case data. Due to the paucity of multiple enactments for most participants, it was not possible to examine within-case schema development. However, it was possible to examine across-case data for the nine sessions as a whole.

The data was also examined as possible support for Moreno’s assertion that there is a deficit of spontaneity among people in the civilised world. He saw spontaneity as a pre-requisite to finding new solutions to old, dysfunctional, psychosocial problems and adequate solutions to new ones, in a creative way. The occurrence of the emotional inhibition schema in 92% of enactments supported his assertion.

The data was also examined to assess whether the psychodramatic techniques of doubling, mirroring and role-reversal effectively reduced emotional inhibition and increased spontaneity. Most enactments demonstrated this through a reduction of dysfunctional interpersonal behaviours and increase in new functional ones. Transcripts of three enactments are provided to support this. This change did not occur as strongly as a result of member-to-member group interaction outside the enactments. The next most frequently occurring schemas came from the disconnection and rejection domain, which had implications for the participants’ ability to establish and maintain intimate relationships.

This study is significant for future research into the connection between the therapeutic effects of psychodrama and group process, and moves psychodrama closer to becoming accepted as evidence-based. It will also add to the knowledge and skill base of psychodrama practitioners.

Early work has highlighted that a large percentage of migraineurs may have an altered glucidic methabolis due to carbohydrate-induced hyperinsulinism. The aim of this study was to assess the effect of sucrose on biomarkers of energy metabolism and utilization in migraineous females. A total of 16 participants (8 = Migraine, 8 = Non-migraine) at the mid-point of their menstrual cycle underwent a 15-h fast prior to ingesting 75 g sucrose dissolved in 175 g water. Blood sampling for the assessment of serum insulin, serum cortisol and serum dehydroepiandrosterone sulfate (DHEAS) and plasma glucose was conducted upon arrival at 09:00 h and then at regular 15-min intervals across a 150-min experimental period. The results showed a significant alteration in serum insulin and plasma glucose following sucrose ingestion in the migraine and non-migraine groups. In addition, significant group differences were observed in the level of serum insulin, serum DHEAS, and the cortisol:DHEAS ratio with migraine participants on average recording a higher sucrose-induced serum insulin level and lower DHEAS level and cortisol:DHEAS ratio when group data was compared. It was concluded that while sucrose consumption may potentiate serum insulin in migraineurs this does not result in the development of sucrose-induced hypoglycemia in migraine or non-migraine participants.

The aim of this study was to compare the effect of sucrose on biomarkers of energy metabolismand utilization in migrainous men and women. A total of 20 participants (7=Migraine (female), 5=Migraine (male), 8=Non-migraine control) submitted to an oral sucrose tolerance test (OSTT), which required them to fast for 15 h overnight and then ingest 75 g sucrose dissolved in 175 g water at 9 AM the next morning. Blood sampling for the assessment of serum insulin, serum cortisol and plasma glucose was conducted upon arrival at 0900 h and then at regular 15-min intervals across a 150-min period. Comparison of insulin sensitivity indexes that rely on fasting glucose and insulin data failed to find evidence of insulin resistance in migraineurs or controls. Prior to sucrose consumption the level of fasting serum cortisol at 0-min on average was significantly higher in migraineurs. However, no significant group differences in the level of fasting serum insulin and plasma glucose at 0-min were noted. Following sucrose consumption: the level of serum insulin was significantly higher in female migraineurs; the level of serum cortisol was significantly higher in male migraineurs; glucose/insulin (G/ I) ratio was significantly higher in male migraineurs at 135-min and 150-min; insulin/cortisol (I/C) ratio was significantly differentwith the I/C ratio lower in male migraineurs and higher in female migraineurs; area under the curve (AUC) insulin was significantly different across groups with AUC insulin lower in male migraineurs and higher in female migraineurs; and AUC cortisol was significantly higher in male migraineurs. It was concluded that the effect of sucrose on biomarkers of energy metabolism and utilization in male and female migraineurs is not the same. Therefore, the factors underlying migraine pathogenesis in men and women may also be different.

Background: Excessive gestational weight gain (GWG) is associated with adverse maternal-child health outcomes. Managing energy intake and GWG versus optimising nutrient intake can be challenging. The present study aimed to examine the relationships between dietary portion size, GWG and nutrient intakes during pregnancy. It is hypothesised that, after adjustment for potential confounders, portion size would be positively associated with both GWG and nutrient intakes during pregnancy. Methods: Prospective data were obtained for 179 Australian women from the Women and Their Children's Health Study. A validated food frequency questionnaire was used at 18-24 and 36-40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy. Nutrient intakes were compared with Australian Nutrient Reference Values (NRVs). GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations (WtAdh). Results: In multivariate regression models, portion size factor (PSF) was positively associated with GWG in women with high socio-economic status (SES; b = 0.20, P = 0.04) and those with an overweight/obese pre-pregnancy body mass index (BMI) (b = 0.28, P = 0.04). PSF uniquely accounted for 8.2% and 3.7% of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMIs, respectively. Nutrient intakes and PSF were similar regardless of WtAdh. Women achieved NRVs for calcium and zinc in all PSF categories. Most of the women with large PSF still failed to achieve the NRVs for folate (95.7%), iron (89.6%) and fibre (85.5%). Conclusions: All women require advice on quality food choices during pregnancy to optimise health outcomes. Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and/or those who are overweight/obese pre-pregnancy.

Long-term alcohol intake can decrease the total amount of food consumed when food is freely available and over time this can promote the development of a severely malnourished state. Alcoholic beverages are high in calories but low in nutrients and how the body uses the energy contained in alcohol is complex and not well understood. Assessment of meal composition has highlighted that the alcohol-induced alteration in food intake may be highly specific and linked to impaired appetite for carbohydrate (in particular). The aim of this chapter is to explore this very specific alcohol effect (i.e. decrease in appetite for carbohydrate). We will begin by investigating whether alcohol is a food for the human body and then briefly look at the biochemical processes associated with regulation of appetite for carbohydrate. It is well accepted that appetite for carbohydrate is largely dependent on the efficient performance of cortisol, a steroid under the control of the hypothalamic-pituitary-adrenal axis, and insulin a pancreatic peptide hormone. In the last section we will look at data from a number of studies aimed at assessing the effect of alcohol on cortisol and insulin under variable nutritional conditions in order to conclude that a decreased appetite for carbohydrate may be a physiological consequence of alcohol consumption.

Alcohol consumption can induce the development of nutritional disorders as alcohol ingestion often replaces food intake [1]. The long-term intake of alcohol decreases the amount of food consumed when food is freely available [2], and the degree of malnutrition may be related to the irregularity of feeding habits and intensity of alcohol intake [3]. The repercussions of alcohol abuse (over time) can involve damage to most of the major organs and systems in the body [4]. However, despite the overwhelming evidence linking alcohol to ill health the role (if any) alcohol plays in the development of disease remains uncertain. The hypothalamic-pituitary-adrenal (HPA) axis is responsible for the synthesis and release of steroid hormones, the most abundant being dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), cortisol, and aldosterone [e.g. 5]. The release of either corticotropin-releasing factor or arguinine vasopressin by the hypothalamus stimulates the anterior pituitary to release adrenocorticotropin (ACTH), which promotes the synthesis and release of steroid hormones that have glucocorticoid (i.e. cortisol), mineralocorticoid (i.e. aldosterone), and androgenic (i.e. DHEA, DHEAS) functions [6]. Steroid hormones have a diverse and highly important role in the body and any dysregulation in steroid activity can lead to the development of disease. The adrenocortical system is markedly altered by food availability and an elevation in cortisol is commonly observed under fasting conditions [7-9]. Cortisol plays a major role in the regulation of carbohydrate, protein, and lipid metabolism [10,11] and during prolonged fasting by stimulating gluconeogenesis acts to protect the body from cellular damage until food once again becomes available [7,8,10-14]. ... The aim of this study was to clarify the effect (if any) of consuming a small-moderate amount of white wine on cortisol by comparing the effect (if any) of consuming a small-moderate amount of white wine on salivary cortisol and serum cortisol, and salivary cortisol alone.

The aim of this study was to assess the effect of a small-moderate dose of red wine on the level of serum insulin and plasma glucose before and after a meal. A total of 18 non-diabetic males aged between 19-22 years participated in the current investigation. In the fasting trial participants underwent a 6 hour fast before consuming 4 standard units of red wine (40g alcohol) or the equivalent amount of placebo over a period of 135-min. Food was then presented alone for 45-min. Alternatively, in the feeding trial food was consumed for 45-min prior to participants ingesting 4 standard units of red wine (40g alcohol) or the equivalent amount of placebo over a 135-min period. The serum insulin and plasma glucose level was assessed at regular 45-min intervals across the four 180-min experimental periods. The results showed a significant alcohol-induced decrease in postprandial glucose and no significant change in serum insulin concentration when red wine is consumed alone following a meal. Alternatively, the ingestion of red wine alone prior to food promoted a significant reduction in serum insulin concentration despite preprandial glucose remaining unchanged. It was concluded that red wine may promote an alteration in the feedback mechanism by which plasma glucose controls the insulin rate, which under specific conditions could potentially provide some health benefits to diabetic individuals.