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Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated.
We aimed to determine the effectiveness of the ‘Foundations’ application (app) on general (non-psychotic) psychiatric morbidity.
We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD).
Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34–53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = −1.39, 95% CI −2.05 to −0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported.
The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.
Having a critically ill baby in the NICU is very difficult to cope with, and mothers may feel a whole host of emotions as they cope with the loss of the last part of pregnancy, the dream of a healthy birth, the loss of the first weeks or months of their baby's life. This distress may resemble posttraumatic stress disorder (PTSD).
To examine mothers’ responses to having a baby (preterm or full term) in neonatal intensive -care unit and to determine if they fulfill the criteria for PTSD or depression.
Forty nine mothers of pre term babies and ten mothers of full term babies who had been hospitalized in NICU of Schneider Children's Hospital, Israel, were interviewed at the follow up clinic between 4–17 months after birth. The evaluation was carried out by one senior psychiatrist and was based on diagnostic criteria for PTSD and depression according to DSM-4. Severity of PTSD was measured by PSS-sr and the severity of depression by HAMD-Distress factors in NICU setting were evaluated by Parental Stressor Scale (M&F&C Scale).
1. 50% of mothers of preterm babies and 40% of mothers of full term babies fulfill the criteria for PTSD (N.S.).
2. 25% (15/59) of the whole sample had moderate to severe PTSD.
3. A strong correlation between PTSD and severity of stress during hospitalization in NICU was found.
The development of later ptsd and depression can be predicted by maternal responses to hospitalization of her baby in nicu.
This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners.
In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses.
Overall 74.8% (n = 729) of personnel RTD on completion of care. Of those that underwent evacuation home (n = 246), 69.1% (n = 170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm.
Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.
Dementia is currently incurable, irreversible and a major cause of disability for the world's older population. The association between mental health difficulties, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), and dementia has a long history within the civilian population. Despite the increased importance of this link within the military veteran population, who suffer a greater propensity of mental health difficulties and consist largely of over 65s, attention is only recently being paid to the salience of such an association for this group. This paper aims to explore the relationship between PTSD and MDD with dementia within the military veteran population.
A systematic review was conducted on articles from 1990 to July 2016 on MEDLINE, EMBASE, EBSCO and Web of Science electronic databases with an update conducted in February 2017.
Six empirical studies were identified from the review, the majority of which originated from the USA. Five of the studies asserted that veterans with a diagnosis of either PTSD or MDD are at a significantly greater risk of developing dementia than ‘healthy’ controls. The final study, conducted in Australia, found only a small, but non-significant, correlation between earlier MDD and future dementia, but no concurrent correlation.
While causality cannot be determined, it is likely that PTSD and depressive disorders are related to an increased risk of dementia in military veterans. Potential pathological explanations and risk factors are reviewed and the clinical and neuroscience implications of these findings are explored.
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.
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.
In contrast with the notion of complexity, a set A is called anti-complex if the Kolmogorov complexity of the initial segments of A chosen by a recursive function is always bounded by the identity function. We show that, as for complexity, the natural arena for examining anti-complexity is the weak-truth table degrees. In this context, we show the equivalence of anti-complexity and other lowness notions such as r.e. traceability or being weak truth-table reducible to a Schnorr trivial set. A set A is anti-complex if and only if it is reducible to another set B with tiny use, whereby we mean that the use function for reducing A to B can be made to grow arbitrarily slowly, as gauged by unbounded nondecreasing recursive functions. This notion of reducibility is then studied in its own right, and we also investigate its range and the range of its uniform counterpart.
Employers such as the Armed Forces (AF) and emergency services, who predictably expose their staff to potentially traumatic events (PTEs), often provide psycho-educational briefings in an attempt to mitigate possible adverse psychological sequelae. Within the military, psycho-educational briefings are widely used, particularly following exposure to PTEs on operations. The aim of this review was to evaluate the efficacy of these interventions and make appropriate recommendations.
A search of Medline, PsycINFO and EMBASE was conducted, bibliographies of retrieved articles were searched and experts in the field were consulted.
Two surveys and seven intervention studies were identified for inclusion in the review. Only three studies were randomized controlled trials (RCTs). Overall, the review found some evidence of benefit of psycho-educational interventions but it was not consistent across studies or outcomes and effects were small. However, there was also little evidence to suggest that they caused harm. There was some evidence that the beneficial effects may be greater for those who have been exposed to a higher number of PTEs.
Given the high operational tempo currently faced by coalition forces personnel, there remains a pressing need to identify the most effective way of minimizing the impact of exposure to potentially traumatic deployment incidents. To date, few psycho-educational interventions designed to prevent deployment-related psychological ill-health have been evaluated systematically in methodologically robust studies. The review recommends that future interventions are theoretically based and evaluated in cluster RCTs that examine both process and outcome variables.
Mild traumatic brain injury (mTBI) is being claimed as the ‘signature’ injury of the Iraq war, and is believed to be the cause of long-term symptomatic ill health (post-concussional syndrome; PCS) in an unknown proportion of military personnel.
We analysed cross-sectional data from a large, randomly selected cohort of UK military personnel deployed to Iraq (n=5869). Two markers of PCS were generated: ‘PCS symptoms’ (indicating the presence of mTBI-related symptoms: none, 1–2, 3+) and ‘PCS symptom severity’ (indicating the presence of mTBI-related symptoms at either a moderate or severe level of severity: none, 1–2, 3+).
PCS symptoms and PCS symptom severity were associated with self-reported exposure to blast whilst in a combat zone. However, the same symptoms were also associated with other in-theatre exposures such as potential exposure to depleted uranium and aiding the wounded. Strong associations were apparent between having PCS symptoms and other health outcomes, in particular being a post-traumatic stress disorder or General Health Questionnaire case.
PCS symptoms are common and some are related to exposures such as blast injury. However, this association is not specific, and the same symptom complex is also related to numerous other risk factors and exposures. Post-deployment screening for PCS and/or mTBI in the absence of contemporaneous recording of exposure is likely to be fraught with hazards.
Heretofore, we learned that bilinguals better detected letters in inter-lingual homographs when the context language ascribed a content role to the homograph as compared to a function role. In previous work the target homographs appeared in passages that were of a single language. The present work investigated whether this letter detection pattern would hold if both languages were activated by intermixing languages in a passage. Results suggested that despite intermixing of languages that would excite competing function and content meanings, local sentence context was sufficient to engender a content over function word advantage for inter-lingual homographs that was reminiscent of that obtained with homogenous text.
There is considerable interest in understanding further the factors that increase the risk of post-traumatic stress disorder (PTSD) for military personnel. This study aimed to investigate the relative contribution of demographic variables; childhood adversity; the nature of exposure to traumatic events during deployment; appraisal of these experiences; and home-coming experiences in relation to the prevalence of PTSD ‘caseness’ as measured by a score of ⩾50 on the PTSD Checklist (PCL) in UK Armed Forces personnel who have been deployed in Iraq since 2003.
Data were drawn from the first stage of a retrospective cohort study comparing UK military personnel who were deployed to the 2003 Iraq War with personnel serving in the UK Armed Forces on 31 March 2003 but who were not deployed to the initial phase of war fighting. Participants were randomly selected and invited to participate. The response rate was 61%. We have limited these analyses to 4762 regular service individuals who responded to the survey and who have been deployed in Iraq since 2003.
Post-traumatic stress symptoms were associated with lower rank, being unmarried, having low educational attainment and a history of childhood adversity. Exposure to potentially traumatizing events, in particular being deployed to a ‘forward’ area in close contact with the enemy, was associated with post-traumatic stress symptoms. Appraisals of the experience as involving threat to one's own life and a perception that work in theatre was above an individual's trade and experience were strongly associated with post-traumatic stress symptoms. Low morale and poor social support within the unit and non-receipt of a home-coming brief (psycho-education) were associated with greater risk of post-traumatic stress symptoms.
Personal appraisal of threat to life during the trauma emerged as the most important predictor of post-traumatic stress symptoms. These results also raise the possibility that there are important modifiable occupational factors such as unit morale, leadership, preparing combatants for their role in theatre which may influence an individual's risk of post-traumatic stress symptoms. Therefore interventions focused on systematic preparation of personnel for the extreme stress of combat may help to lessen the psychological impact of deployment.
Tests of inter-lingual homographs that have different meanings across two languages support models postulating initial non-selective access to competing language representations, e.g. Bilingual Interactive Activation (BIA) model. Most such research assessed inter-lingual homographs in the absence of connected text. Here a letter detection paradigm was used that required subjects to detect letters in words in connected text. Prior work with this paradigm suggested that readers respond to only one interpretation of an intra-lingual homograph when detecting letters. Three experiments described here indicate that letter detection patterns to inter-lingual homographs are similar, i.e. detection reflects only a context appropriate interpretation. However, the demonstration that text role, text cohesiveness and bilingual fluency affect inter-lingual letter detection (Experiments 1 and 2), and that word role affects detection even though target frequency is constant across inter-lingual meanings (Experiment 3) indicates that selectivity is in response to post-lexical processes. Thus, results are seen as compatible with tenets of the BIA model.
It was found that severe plastic deformation of orthorhombic alloys caused phase transformations of the displacement type and those associated with a change in the degree of long-range order, namely B2→ω(B82 ), B2→B19 and B2→β (BCC) (in the case of alloy with initial B2-phase structure) and O→B19→A20 (initial O-phase structure, Ti2AlNb). Unlike to ordinary metals, severe plastic deformation of the titanium aluminum intermetallics leads to decreasing of the strength of the material. The B19 and A20 phases are metastable. They are absent in the equilibrium phase diagrams of the compounds under investigation. The formation of the disordered phase states with extensive sliding and having great plasticity under severe deformation makes possible to consider severe deformation as the way for increasing of plasticity of the titanium aluminides.
Praziquantel, the drug of choice against schistosomiasis, disrupts calcium (Ca2+) homeostasis in schistosomes via an unknown mechanism. Voltage-gated Ca2+ channels are heteromultimeric transmembrane protein complexes that contribute to impulse propagation and also regulate intracellular Ca2+ levels. β subunits modulate the properties of the pore-forming α1 subunit of high voltage-activated Ca2+ channels. Unlike other Ca2+ channel β subunits, which have current stimulatory effects, a β subunit subtype found in S. mansoni (SmβA) and S. japonicum (Sjβ) dramatically reduces current levels when co-expressed with Ca2+ channel α1 subunits in Xenopus oocytes. It also confers praziquantel sensitivity to the mammalian Cav2.3 α1 subunit. The Beta Interaction Domains (BIDs) of SmβA and Sjβ lack 2 conserved serines that each constitute a consensus site for protein kinase C (PKC) phosphorylation. Here, we use site-directed mutagenesis of schistosome β subunits to show that these unique functional properties are correlated with the absence of these consensus PKC sites in the BID. Furthermore, a second schistosome β subunit subtype contains both serines in the BID, enhances currents through α1 subunits, and does not confer praziquantel sensitivity. Thus, phosphorylation sites in the BID may play important roles in defining the modulatory properties and pharmacological sensitivities of schistosome Ca2+ channel β subunits.
Much has been learned from studies of Limulus photoreceptors
about the role of the circadian clock and light in the removal of
photosensitive membrane. However, little is known in this animal about
mechanisms regulating photosensitive membrane renewal, including the
synthesis of proteins in, and associated with, the photosensitive
membrane. To begin to understand renewal, this study examines diurnal
changes in the levels of mRNAs encoding opsin, the integral membrane
protein component of visual pigment, and the relative roles of light
and the circadian clock in producing these changes. We show that at
least two distinct opsin genes encoding very similar proteins are
expressed in both the lateral and ventral eyes, and that during the day
and night in the lateral eye, the average level of mRNA encoding opsin1
is consistently higher than that encoding opsin2. Northern blot assays
showed further that total opsin mRNA in the lateral eyes of animals
maintained under natural illumination increases during the afternoon (9
& 12 h after sunrise) in the light and falls at night in the dark.
This diurnal change occurs whether or not the eyes receive input from
the circadian clock, but it is eliminated in eyes maintained in the
dark. Thus, it is regulated by light and darkness, not by the circadian
clock, with light stimulating an increase in opsin mRNA levels. The
rise in opsin mRNA levels observed under natural illumination was
seasonal; it occurred during the summer but not the spring and fall.
However, a significant increase in opsin mRNA levels could be achieved
in the fall by exposing lateral eyes to 3 h of natural illumination
followed by 9 h of artificial light. The diurnal regulation of opsin
mRNA levels contrasts sharply with the circadian regulation of visual
arrestin mRNA levels (Battelle et al., 2000).
Thus, in Limulus, distinctly different mechanisms regulate the
levels of mRNA encoding two proteins critical for the
Acute mastoiditis in children remains an otological problem. Although the widespread use of antibiotics has reduced the need for surgical intervention, surgery is frequently used in the treatment of acute mastoiditis and its complications. The charts of 44 patients hospitalized with signs of acute mastoiditis were reviewed. In 43.2 per cent of all patients, acute mastoiditis was the presenting sign of acute middle-ear infection. Post-auricular erythema and protrusion of the auricle were the most frequent signs at presentation. All four signs (post-auricular erythema, oedema, tenderness, and protrusion of the auricle) were present in 40.9 per cent of patients. No bacterial pathogen was isolated in 45.5 per cent of ear cultures. Complicated acute mastoiditis was diagnosed in 13.7 per cent of the patients. Eighty-seven per cent of patients responded well to intravenous antibiotics and myringotomy, and in 11.4 per cent mastoidectomy or abscess drainage were performed. We conclude that nearly all patients with uncomplicated mastoiditis recover following intravenous antibiotics and myringotomy. Mastoidectomy should be perfonned in selected cases, such as cases of complicated acute mastoiditis.