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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.
Life has been described as information flowing in molecular streams (Dawkins, 1996).Our growing understanding of the impact of horizontal gene transfer on evolutionary dynamics reinforces this fluid-like flow of molecular information (Joyce, 2002). The diversity of nucleic acid sequences, those known and yet to be characterized across Earth's varied environments, along with the vast repertoire of catalytic and structural proteins, presents as more of a dynamic molecular river than a tree of life. These informational biopolymers function as a mutualistic union so universal as to have been termed the Central Dogma (Crick, 1958). It is the distinct folding dynamics-the digital-like base pairing dominating nucleic acids, and the environmentally responsive and diverse range of analog-like interactions dictating protein folding (Goodwin et al., 2012)-that provides the basis for the mutualism. The intertwined functioning of these analog and digital forms of information (Goodwin et al., 2012) unified within diverse chemical networks is heralded as the Darwinian threshold of cellular life (Woese, 2002).
The discovery of prion diseases (Chien et al., 2004; Jablonka and Raz, 2009; Paravastu et al., 2008) introduced the paradigm of protein templates that propagate conformational information, suggesting a new context for Darwinian evolution. When taking both protein and nucleic acid moelcular evolution into consideration (Cairns- Smith, 1966; Joyce, 2002), the conceptual framework for chemical evolution can be generalized into three orthogonal dimensions as shown in Figure 5.1 (Goodwin et al., 2014). The 1st dimension manifests structural order through covalent polymerization reactions and includes chain length, sequence, and linkage chemistry inherent to a dynamic chemical network. The 2nd dimension extends the order in dynamic conformational networks through noncovalent interactions of the polymers. This dimension includes intramolecular and intermolecular forces, from macromolecular folding to supramolecular assembly to multicomponent quaternary structure. Folding in this 2nd dimension certainly depends on the primary polymer sequence, and the folding/assembly diversity yields an additional set of environmentally constrained supramolecular folding codes. For example, double-stranded DNA assemblies are dominated by the rules of complementary base pairing, while the self-propagating conformations of prions are based on additional noncovalent, environmentally-dependent interactions.
Although the military is considered to be a stressful occupation, there are remarkably few studies that compare the prevalence of common mental disorder (CMD) between the military and the general population. This study examined the prevalence of probable CMD in a serving UK military sample compared to a general population sample of employed individuals.
Data for the general population was from the 2003 and 2008 collections for the Health Survey for England (HSE) and for the serving military from phases 1 (2004–2006) and 2 (2007–2009) of the King's Centre for Military Health Research (KCMHR) cohort study. Probable CMD was assessed by the General Health Questionnaire (GHQ-12). The datasets were appended to calculate the odds of CMD in the military compared to the general population.
The odds of probable CMD was approximately double in the military, when comparing phase 1 of the military study to the 2003 HSE [odds ratio (OR) 2.4, 95% confidence interval (CI) 2.1–2.7], and phase 2 to the 2008 HSE (OR 2.3, 95% CI 2.0–2.6) after adjustment for sex, age, social class, education and marital status.
Serving military personnel are more likely to endorse symptoms of CMD compared to those selected from a general population study as employed in other occupations, even after accounting for demographic characteristics. This difference may be partly explained by the context of the military study, with evidence from previous research for higher reports of symptoms from the GHQ in occupational compared to population studies, in addition to the role of predisposing characteristics.
People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.
To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.
Cross-sectional observational study followed by treatment evaluation.
Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.
Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.
The goal of this study was to quantify the impact of the suggested education correction on the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA).
Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.
For the total MoCA score, unadjusted for education, a cut-off score of 26 yielded the best balance between sensitivity and specificity (80% and 89% respectively) in identifying cognitive impairment (people with either dementia or aMCI, versus controls). When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). The cut-off score yielding the best balance between sensitivity and specificity for the education adjusted MoCA score fell to 25 (61% and 97%, respectively).
Adjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. Clinically, this loss in sensitivity can lead to an increased number of false negatives, as education level does not always correlate to premorbid intellectual function. Clinical judgment about premorbid status should guide interpretation. However, as this effect may be cohortspecific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.
In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment.
The sample comprised 8261 regular UK armed forces personnel who deployed to Iraq, Afghanistan or other operational areas or were not deployed. Participants completed the PTSD CheckList – Civilian Version (PCL-C) and provided information about deployment history, demographic and service factors, serious accidents and childhood experiences.
Deployment to Iraq or Afghanistan [odds ratio (OR) 1.2, 95% confidence interval (CI) 0.6–2.2] or elsewhere (OR 1.1, 95% CI 0.6–2.0) was unrelated to PTSD although holding a combat role was associated with PTSD if deployed to Iraq or Afghanistan (OR 2.7, 95% CI 1.9–3.9). Childhood adversity (OR 3.3, 95% CI 2.1–5.0), having left service (OR 2.7, 95% CI 1.9–4.0) and serious accident (OR 2.1, 95% CI 1.4–3.0) were associated with PTSD whereas higher rank was protective (OR 0.3, 95% CI 0.12–0.76).
For the majority of UK armed forces personnel, deployment whether to Iraq, Afghanistan or elsewhere confers no greater risk for PTSD than service in the armed forces per se but holding a combat role in those deployed to Iraq or Afghanistan is associated with PTSD. Vulnerability factors such as lower rank, childhood adversity and leaving service, and having had a serious accident, may be at least as important as holding a combat role in predicting PTSD in UK armed forces personnel.
Hyperemesis gravidarum (HG), severe nausea and vomiting of pregnancy, is characterized by prolonged maternal stress, undernutrition and dehydration. Maternal stress and malnutrition of pregnancy are linked to poor neonatal outcome and associated with poor adult health, and we recently showed that in utero exposure to HG may lead to increased risks of psychological and behavioral disorders in the offspring. In addition, we have shown familial aggregation of HG, which is strong evidence for a genetic component to the disease. In this study, we compare the rates of psychological and behavioral disorders in 172 adults with and 101 adults without a sibling with HG. The rate of emotional/behavioral disorders is identical (15%) in both groups. The results suggest that the etiology of HG is not likely to include genetic factors associated with emotional and behavioral disorders. In addition, this study provides evidence that the increased incidence of psychological/behavioral disorders among offspring of women with HG is attributable to the HG pregnancy itself, rather than to confounding genetic factors linked to HG.
Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability.
To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population.
Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls.
Antipsychotic treatment comprised: risperidone 48%, olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years; median daily chlorpromazine equivalent dose 108mg (range 16–667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100% and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men.
Antipsychotics, on average, did not increase metabolic risk, although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.
It has become commonplace to attribute the twentieth-century recovery of the doctrine of the Trinity to the Swiss theologian Karl Barth (1886–1968). Barth, though not alone, was indeed a major figure in the modern trinitarian renaissance. In his massive Kirchliche Dogmatik (Church Dogmatics), published in fourteen volumes from 1932 to 1967, Barth developed and expounded the thesis that the doctrine of the Trinity was foundational for Christian theological discourse. In the inaugural volume, he argued, “The doctrine of the Trinity is what basically distinguishes the Christian doctrine of God as Christian, and therefore what already distinguishes the Christian concept of revelation as Christian, in contrast to all other possible doctrines of God and concepts of revelation” (Church Dogmatics, i/1, 301). These words are emblematic of Barth's effort to place the doctrine of the Trinity back in the center of Christian theology. Indeed, following his own advice, Barth placed the doctrine of the Trinity at the very beginning of the Church Dogmatics, arguing that it constituted the internal dynamic of God's speech to humanity and as such functioned as the basic grammar of Christian discourse.
Hyperemesis gravidarum (HG), severe nausea and vomiting of pregnancy, is characterized by long-term maternal stress, undernutrition and dehydration. While maternal stress and malnutrition of pregnancy are linked to poor neonatal outcome and associated with poor adult health, long-term outcome of fetal exposure to HG has never been explored. The purpose of this study is to determine whether long-term emotional and behavioral diagnoses may be associated with fetal exposure to HG. Emotional and behavioral diagnoses of adults born of a pregnancy complicated by HG were compared to diagnoses from non-exposed controls. Offspring exposed to HG in utero were significantly more likely to have a psychological and behavioral disorder (OR = 3.6, P < 0.0001) with diagnoses primarily of depression, bipolar disorder and anxiety. In utero exposure to HG may lead to increased risks of psychological and behavioral disorders in the offspring.
PrBa2Cu2NbO8 (PrBCNO) is an insulating analog to the YB2CU3O7 (YBCO) system, which is interesting as a thin film buffer layer in YBCO/PrBCNO/YBCO tunnel junctions as well as a potential high Tc superconductor if proper doping could be achieved. PrBCNO has a similar structure to PrBCO, with NbO2 planes replacing the CuO chains. Single phase polycrystalline samples of RBCNO have been synthesized with R = La, Pr and Nd. Attempts to synthesize this structure with the smaller ions Y and Gd have been unsuccessful. The PrBCNO samples show a signature in the magnetization of a magnetic ordering at 12 K. No such magnetic phase transition is observed down to 2 K in the NdBCNO material.
Neutron diffraction was used to measure the residual stress distribution in an FeAl weld overlay on steel. It was found that the residual stresses accumulated during welding were essentially removed by the post-weld heat treatment that was applied to the specimen; most residual stresses in the specimen developed during cooling following the post-weld heat treatment. The experimental data were compared with a plasto-elastic finite element analysis. While some disagreement exists in absolute strain values, there is satisfactory agreement in strain spatial distribution between the experimental data and the finite element analysis.
Six of 12 men wintering at an isolated Antarctic base sequentially developed symptoms and signs of a common cold after 17 weeks of complete isolation. Examination of specimens taken from the men in relation to the outbreak has not revealed a causative agent.
When Jürgen Moltmann's Theology of Hope first appeared in 1965, it was seen as ushering in a new era of theological thinking. Karl Barth, however, sharply criticised the work as too heavily dominated by a ‘principle of hope’ that he believed Moltmann had inherited from the Marxist philosopher Ernst Bloch. This interpretation has largely been taken as fact among interpreters of Moltmann's theology of hope. This has caused most interpreters to see his turn to panentheism and ecotheology in God in Creation (1983) as being less of a shift of emphasis than a total change of trajectory or even break. There is evidence, however, that a different source contributed to the overall orientation of Moltmann's theology – an orientation that has remained throughout his life. This other source is the life and thought of the radical Schwäbean Pietists, Johann Christoph Blumhardt (1805–80) and his son Christoph Blumhardt (1842–1919). In this article the authors flesh out the thesis that the Blumhardts are the prior, deeper and more long-lasting influence on Moltmann by focusing on three key theological motifs that permeate his theology: 1) Christianity as eschatology; 2) the ‘theology of the earth’; and 3) the ethics of hope. Furthermore, they argue that when the ‘hidden’ influence of the Blumhardts is acknowledged, Moltmann's later ‘shift’ can be understood as essentially in continuity, rather than discontinuity, with his earlier thought.
Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18–23 years.
Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood.
Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood.
Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.
The renowned British obstetrician Smellie is credited with the first medical description of an obstetric brachial plexus palsy. In his 1768 treatise on midwifery, he reported a case of transient bilateral arm paralysis in a newborn after difficult labour with a face presentation. In 1861, Duchenne coined the term “obstetric palsy of the brachial plexus” after analyzing 4 infants with paralysis of identical muscles in the arm and shoulder. In 1875, Erb concluded in his thesis on adult brachial plexus injuries that associated palsies of the deltoid, biceps, and subscapularis are derived from a radicular lesion at the level of C5 and C6 rather than isolated peripheral nerve lesions. In the same year, Klumpke described lesions of C8 and thoracic nerve T1 in birth palsy and associated the Horner sign with lower trunk lesions of the brachial plexus. Perhaps the most famous case of brachial plexus palsy was that of Prince William of Germany, who subsequently became Kaiser Wilhelm II in 1888. Apparently, William was in breech presentation and manipulated by several physicians and a midwife during delivery. Three days after delivery, the midwife noticed that William's left arm was slack. For the rest of his life, William's withered left arm was concealed from the public by careful posing for photographs.