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Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.
We examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
Declaration of interest:
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
This study examined the effectiveness of a formal postdoctoral education program designed to teach skills in clinical and translational science, using scholar publication rates as a measure of research productivity.
Participants included 70 clinical fellows who were admitted to a master’s or certificate training program in clinical and translational science from 1999 to 2015 and 70 matched control peers. The primary outcomes were the number of publications 5 years post-fellowship matriculation and time to publishing 15 peer-reviewed manuscripts post-matriculation.
Clinical and translational science program graduates published significantly more peer-reviewed manuscripts at 5 years post-matriculation (median 8 vs 5, p=0.041) and had a faster time to publication of 15 peer-reviewed manuscripts (matched hazard ratio = 2.91, p=0.002). Additionally, program graduates’ publications yielded a significantly higher average H-index (11 vs. 7, p=0.013).
These findings support the effectiveness of formal training programs in clinical and translational science by increasing academic productivity.
The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families.
OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed.
EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders).
Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.
A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.
Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.
Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use.
NiehausMT, PechulisRM, WuJK, FreiS, HongJJ, SandhuRS, GreenbergMR. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series. Prehosp Disaster Med. 2016;31(5):570–571.
A brief summary of the observed infrared and other properties of interstellar dust is given. Chemical, physical and morphological criteria are discussed concerning the degree to which there are constraints relating comets to interstellar dust chemistry representative of the presolar nebula. Results of theoretical modelling of dust and gas evolution in dense clouds are used to compare with observed dust composition. Sources of the distribution of simple as well as complex molecules in the coma are related to what is presently known about the volatile ices in interstellar dust and to processes leading to evaporation of organic “refractory” grain mantle material represented by laboratory residues produced by photoprocessing of ices. The criterion of preservation of interstellar volatiles in comets leads to the further criterion that the ice in comets is amorphous. Criteria for relating interstellar dust volatiles to asteroids are discussed.
Background: Menkes disease is a rare, X-linked recessive disorder of the ATP7A gene, a copper transporter; resulting in systemic copper deficiency. The deficient function of copper-dependent enzymes manifests clinically with failure to thrive, seizures, hypotonia, coarse hair, connective tissue abnormalities, and neurodegeneration. Cerebral arteries are often elongated, tortuous, and fragile. Methods: This case report was prepared using the patient’s hospital chart, and a review of the literature undertaken using PubMed. Our case was subsequently compared and contrasted to known Menkes’ literature. Results: We present the case of a 2 month old male with Menkes disease who presented with new seizure onset in the setting of a Grade III intraventricular hemorrhage with hydrocephalus. He deteriorated into status epilepticus, and palliative care was instituted. On autopsy, pronounced tortuosity of his cerebral vasculature was noted, as well as a bilaterally cystic brain with an organizing hemorrhage on the ventral surface of the brainstem. Conclusions: Although Menkes disease often presents with seizures, neurologic deterioration, and abnormal cerebral vasculature; the quick demise subsequent to an intraventricular hemorrhage is somewhat unusual and discussed.
A cyclic evolutionary picture is presented which follows the sources and nature of organics from interstellar space to comets. The three major organic components discussed are the grain mantles, the carbonaceous particles responsible for the 216 nm hump in the extinction, and the large molecules/small particles polycyclic aromatic hydrocarbons (PAHs). The variability in the oxygen and hydrogen abundances relative to carbon is followed.
The past three years have seen not only a growth in the activities of our commission, but an extension of its activities into important areas which have heretofore motivated too little activity. Of particular interest have been the many activities directed towards elucidating the question of the abundance of extrasolar planetary systems. There have been a number of observations showing the presence of disks of dust around nearby stars, disks which fit the idea that stars are often formed with an accompanying disk of dust which may in many or perhaps all cases produce a planetary system. Infra-red evidence for dust disks exists for something like twenty stars. The disk of Beta Pictoris has even been clearly imaged at optical wavelengths, showing without a doubt that such disk structures exist. One very impressive detection of an apparent brown dwarf object has also been made; should this be confirmed by other observations, it would be clear evidence for the existence of planet-like bodies in the systems of other stars.
Although additional surveys with large Schmidt telescopes continue to yield small catches of additional planetaries (Kohoutek) one cannot escape the conclusion that most planetaries available to existing equipment have been detected. Much remains to be done with powerful Schmidt equipment in the southern hemisphere, especially in the Magellanic Clouds. A vast body of photometric and spectroscopic observation needs to be garnered for the numerous faint nebulae so far discovered.
Spectroscopic and spectrophotometric studies have been carried out for most bright planetaries (λ < 5800) but much remains to be done in the red and near infrared. Important advances have been made in the far infrared (~10μ) (Gillett, Low, Stein, Woolf) where a number of planetaries seem to show abnormally strong continua. This abnormally intense radiation has been attributed to non-thermal emission, effects of many faint lines, and to thermal emission by dust grains (Krishna Swamy, O’Dell) with perhaps the bulk of the evidence favoring the last-mentioned hypothesis. An increasing number of radio observations from 9·5 mm to 73 cm (Thompson, Colvin, Stanley, LeMarne, Kaftan-Kassim, Babieri and Ficarra, Terzian, L. Aller and Milne, Hughes) all indicate that planetaries are thermal sources.
The near-infrared spectrum of many sources associated with molecular clouds shows a broad absorption feature at 3.08 μm (e.g. Merrill et al., 1976; Harris et al., 1978). This feature has usually been attributed to absorption by H2O ice frozen on grains, but it has been impossible to satisfactorily reproduce the observed band shape (Merrill et al., 1976; Mukai et al., 1978). We have been able to obtain a complete fit of this absorption feature in the laboratory using very low temperature mixtures of H2O with other polar molecules. The preparation of these interstellar dust grain-mantle analogs has been described elsewhere (Greenberg, 1979; Hagen et al., 1979). They are prepared by allowing a gas mixture of simple molecules (e.g. CO, H2O, NH3, CH4 etc.) to condense on a low temperature (10 K) substrate. This frozen mixture can be heated and recooled. The samples are analyzed with an infrared spectrometer.
The composition and physical properties of interstellar grain mantles continues to be an important problem in astrophysics. Part of this importance comes from the fact that grain mantle composition, photochemistry and photophysics are involved in interstellar chemistry (Greenberg et al. 1972, Greenberg, 1979, Greenberg et al. this volume). Because most molecules have a number of fundamental modes of vibration which possess activity between 2.5 and 25 μm (the middle infrared), spectroscopic measurement in this region can provide a direct probe of the molecules making up grain mantles. In addition to molecular composition, under favorable conditions, such measurements can yield molecular abundances, the solid/gas ratio for specific molecules and give an indication of such physical grain properties as temperature and thermal history.
We consider the consequences of the assumption that the interplanetary particles which produce the zodiacal light have evolved from interstellar dust via comets. The chemical evolution of interstellar dust followed by the process of aggregation into the cometary nucleus and the subsequent ejection of cometary debris provide the basis for a model for the interplanetary particles. The scattering properties of these particles are reasonably consistent with current observations of the variation with elongation angle of the brightness and polarization of the zodiacal light. The major chemical constituents of the model are in the form of a matrix of volatile ices and complex nonvolatile molecules containing C, N and O in which are imbedded silicate and metallic inclusions.
Laboratory and theoretical studies have been made of the effects of ultraviolet photolysis of interstellar grain mantles. It has been shown that grain photolysis should be important even in dense clouds. A large number of molecules and radicals observed in the interstellar gas appear in the irradiated ices of CO, H2O, NH3 and CH4 which are deposited at 10 K. Energy released during warm-up is seen from visible and infrared luminescence and inferred from vapor pressure enhancement relative to unirradiated samples. Grains are pictured as a source as well as a sink (capture) of molecules. The photolysis of an individual grain provides the stored chemical energy which is sporadically released by relatively mild triggering events (such as low velocity grain-grain collisions in turbulent molecular clouds) to produce the impulsive heating needed to eject or evaporate a portion of the grain mantle. An extremely complex and non-volatile substance possessing the infrared signatures of amino and carboxylic acid groups and having a mass of 514 amu has been produced at a rate corresponding to a mass conversion rate of interstellar grains of between 2% and 20% in 107 years.