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Objective: The aim of this study was to propose individual placement and support (IPS) as an important component of modern labor market policies and as a paradigm to be considered while drafting and adopting them. Background: Modern European labor market policies, termed activation policies, aim to support a personal commitment to seek employment by linking welfare benefits to active engagement in job search. Method: In this essay, the authors describe European "activation policies," outline labor market regulations in Italy in the last 3 decades, and analyze core components of IPS in the light of labor policies. Findings: IPS, which provides individual psychological and practical support, has become a highly successful method for helping people with mental disorders to reach competitive employment in Italy. It has been effective in many countries, regardless of local employment conditions and market regulations. Its effectiveness may be greater in places with weaker employment protection legislation and integration efforts and less generous disability benefits, as is the case in Italy. Conclusions and Implications for Policies: Labor market policies should carefully balance financial benefits, integration efforts, and individual support. They should include IPS for people with mental disorders. Modified versions of IPS may also be beneficial to nonpsychiatric unemployed populations. Impact and Implications: Labor policies of Italy and other European countries have shifted over the last 4 decades toward "activation paradigms." Individual placement and support is a highly successful method for helping people with mental disorders to reach competitive employment and its core components perfectly fit with "activation." Labor market policies should comprise IPS for people with mental disorders, and modified versions of IPS may help nonpsychiatric unemployed populations. [ABSTRACT FROM AUTHOR]

Impaired glucose effectiveness (i.e., a diminished ability of glucose per se to facilitate its own metabolism), increased gluconeogenesis, and endogenous glucose release are, together with insulin resistance and beta-cell abnormalities, established features of type 2 diabetes. To explore aspects of the pathophysiology behind type 2 diabetes, we assessed in a group of healthy people prone to develop type 2 diabetes (n = 23), namely first-degree relatives of type 2 diabetic patients (FDR), 1) endogenous glucose release and fasting gluconeogenesis measured using the 2H2O technique and 2) glucose effectiveness. The FDR group was insulin resistant when compared with an age-, sex-, and BMI-matched control group without a family history of type 2 diabetes (n = 14) (M value, clamp: 6.07 +/- 0.48 vs. 8.06 +/- 0.69 mg x kg(-1) lean body weight (lbw) x min(-1); P = 0.02). Fasting rates of gluconeogenesis (1.28 +/- 0.06 vs. 1.41 +/- 0.07 mg x kg(-1) lbw x min(-1); FDR vs. control subjects, P = 0.18) did not differ in the two groups and accounted for 53 +/- 2 and 60 +/- 3% of total endogenous glucose release. Glucose effectiveness was examined using a combined somatostatin and insulin infusion (0.17 vs. 0.14 mU x kg(-1) x min(-1), FDR vs. control subjects), the latter replacing serum insulin at near baseline levels. In addition, a 360-min labeled glucose infusion was given to simulate a prandial glucose profile. After glucose infusion, the integrated plasma glucose response above baseline (1,817 +/- 94 vs. 1,789 +/- 141 mmol/l per 6 h), the ability of glucose to simulate its own uptake (1.50 +/- 0.13 vs. 1.32 +/- 0.16 ml x kg(-1) lbw x min(-1)), and the ability of glucose per se to suppress endogenous glucose release did not differ between the FDR and control group. In conclusion, in contrast to overt type 2 diabetic patients, healthy people at high risk of developing type 2 diabetes are characterized by normal glucose effectiveness at near-basal insulinemia and normal fasting rates of gluconeogenesis. [ABSTRACT FROM AUTHOR]