Gender differences in barriers to mental healthcare for UK military veterans: a preliminary investigation.

INTRODUCTION: Limited UK research focuses on female military veterans' gender-related experiences and issues when accessing civilian mental healthcare support. This study sought to illuminate a preliminary understanding of any gender differences in barriers that may discourage them accessing mental healthcare support. METHODS: A total of 100 participants completed an open online survey of UK triservice veterans who identified as having experienced postmilitary mental health problems. They completed a 30-item Barriers to Access to Care Evaluation scale and were asked to elaborate using free-text questions. Resulting quantitative data were analysed for gender-related differences, while the qualitative text was thematically explored. RESULTS: While stigma, previous poor experience of mental healthcare and a lack of trust in civilian providers were found to act as barriers to postmilitary support for both men and women, significantly more women reported that their gender had also impacted on their intention to seek help. Women also commented on the impact of gender-related discrimination during service on their help-seeking experiences. CONCLUSIONS: While efforts are being made by the UK Ministry of Defence to reduce barriers to mental healthcare for those still serving in the Armed Forces, it has been more difficult to provide a similar level of support to the veteran population. With little veteran research focusing on the specific experiences of women, this study suggests that female veterans encounter specific access barriers and issues related to their gender. Further research is therefore needed to ensure these findings are addressed.

Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome.

OBJECTIVES: Stroke-associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce. MATERIALS AND METHODS: This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003-April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer-term mortality at predefined time periods (0-90 days, 90 days-1 year, 1-3 years, and 3-10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression. RESULTS: A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97-6.93]), 0-90 days (2.17 [1.97-2.40]), and 91-365 days (HR 1.31 [1.03-1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67-2.22]) and worse functional outcome (OR 7.17 [5.44-9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post-stroke, but it was associated with reduced mortality beyond 3 years. CONCLUSIONS: Stroke-associated pneumonia is not associated with increased long-term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.

Longevity of daily oral vitamin D3 supplementation: differences in 25OHD and 24,25(OH)2D observed 2 years after cessation of a 1-year randomised controlled trial (VICtORy RECALL).

To determine how long vitamin D lasts after supplementation ceases, the marker of status was measured 2 and 3 years after a 1-year trial. Compared to placebo, the proportion of vitamin D-deficient women was still lower, if they had taken daily vitamin D3, after 2 years, indicating its longevity. INTRODUCTION: The purpose of this study was to determine longevity of vitamin D status following cessation of vitamin D3 supplementation, 2 and 3 years after a 1-year randomised, double-blind placebo controlled trial and to investigate possible predictive factors. METHODS: Caucasian non-smoking postmenopausal women randomised to ViCtORY (2009-2010), who had not taken vitamin D supplements since the trial ended, were invited to attend follow-up visits. Total 25-hydroxyvitamin D (25OHD) and 24,25-dihydroxyvitamin D (24,25OH2D) were measured by dual tandem mass spectrometry of serum samples following removal of protein and de-lipidation; the original randomised controlled trial (RCT) samples were re-analysed simultaneously. Vitamin D-binding protein (VDBP) was measured by monoclonal immunoassay. RESULTS: In March 2012 and March 2013, 159 women (mean (SD) age 67.6 (2.1) years) re-attended, equally distributed between the original treatment groups: daily vitamin D3 (400 IU, 1000 IU) and placebo. One month after the RCT ended (March 2010), the proportion of women in placebo, 400 IU and 1000 IU vitamin D3 groups, respectively, with 25OHD < 25 nmol/L was 15, 0 and 0 (chi-square p < 0.001, n = 46, 44, 54). After 2 years (March 2012), it was 22, 4 and 4% (p = 0.002, n = 50, 48, 57); after 3 years, it was 23, 13 and 15% (p = 0.429, n = 48, 45, 52). The respective proportions of women with 24,25OH2D < 2.2 nmol/L were 50, 2 and 2% (1 month, p < 0.001, n = 46, 44, 54); 42, 33 and 12% (2 years, p = 0.002, n = 50, 48, 57); and 45, 27 and 29% (3 years, p = 0.138, n = 47, 45, 51). VDBP was a predictor of circulating 25OHD longevity (beta for VDBP in µg/mL 0.736; 95% CI 0.216-1.255, p = 0.006) but not 24,25OH2D. CONCLUSION: Four hundred international units or 1000 IU of daily vitamin D3 showed benefits over placebo 2 years after supplementation ceased in keeping 25OHD > 25 nmol/L.

Addition of sodium criterion to SOAR stroke score.

OBJECTIVES: To examine the usefulness of including sodium (Na) levels as a criterion to the SOAR stroke score in predicting inpatient and 7-day mortality in stroke. MATERIALS AND METHODS: Data from the Norfolk and Norwich University Hospital Stroke & TIA register (2003-2015) were analysed. Univariate and then multivariate models controlling for SOAR variables were used to assess the association between admission sodium levels and inpatient and 7-day mortality. The prognostic ability of the SOAR and SOAR Na scores for mortality outcomes at both time points were then compared using the Area Under the Curve (AUC) values from the Receiver Operating Characteristic curves. RESULTS: A total of 8493 cases were included (male=47.4%, mean (SD) 77.7 (11.6) years). Compared with normonatremia (135-145 mmol/L), hypernatraemia (>145 mmol/L) was associated with inpatient mortality and moderate (125-129 mmol/L) and severe hypontraemia (<125 mmol/L) with 7-day mortality after adjustment for stroke type, Oxfordshire Community Stroke Project classification, age, prestroke modified Rankin score and sex. The SOAR and SOAR-Na scores both performed well in predicting inpatient mortality with AUC values of .794 (.78-.81) and .796 (.78-.81), respectively. 7-day mortality showed similar results. Both scores were less predictive in those with chronic kidney disease (CKD) and more so in those with hypoglycaemia. CONCLUSION: The SOAR-Na did not perform considerably better than the SOAR stroke score. However, the performance of SOAR-Na in those with CKD and dysglycaemias requires further investigation.

Validation of a short questionnaire for estimating dietary calcium intakes.

UNLABELLED: Concern about calcium supplements, and mainly minor side effects (e.g. constipation) impacting on compliance, means that assessing dietary calcium intake is important. There is no suitable biomarker. Compared to food diaries, a short questionnaire was an efficient way of confirming that patients had adequate calcium intakes (>700 or >1,000 mg) INTRODUCTION: Calcium is usually given alongside treatments for osteoporosis, but recent concerns about potential side effects have led to questioning whether supplements are always necessary. It is difficult to assess calcium intake in a clinical setting and be certain that the patient is getting enough calcium. The aim of this study was to determine whether a short questionnaire for estimating dietary calcium intakes in a clinical setting was fit for purpose. METHODS: We assessed dietary calcium intakes using a short questionnaire (CaQ) in patients attending an osteoporosis clinic (n = 117) and compared them with calcium intakes obtained from a 7-day food diary (n = 72) and a food frequency questionnaire (FFQ) (n = 33). RESULTS: Mean (SD) daily calcium intakes from the CaQ were 836 (348) mg; from the diaries, 949 (384) mg; and from the FFQ, 1,141 (387) mg. The positive predictive value (PPV) was >80% for calcium cut-offs > 700 mg and 70% for cut-offs > 1,000 mg. The calcium intakes for the false positives results were not far below the cut-off. For 1,200 mg, the PPV was 67% or less. CONCLUSION: The CaQ is an adequate tool for assessing whether a patient has daily calcium intakes above 700 or 1,000 mg; if below these cut-offs, it is possible that the patient still has enough calcium in the diet, which could be clarified by questioning the patient further. As there were few patients with calcium intakes above 1,200 mg a day, the CaQ cannot be recommended as a tool for confirming higher dietary calcium intakes.

A parallel group double-blind RCT of vitamin D3 assessing physical function: is the biochemical response to treatment affected by overweight and obesity?

UNLABELLED: Vitamin D may affect skeletal muscle function. In a double-blind, randomised, placebo-controlled trial, we found that vitamin D3 supplementation (400 or 1,000 I.U. vs. placebo daily for 1 year with bimonthly study visits) does not improve grip strength or reduce falls. INTRODUCTION: This study aimed to test the supplementation effects of vitamin D3 on physical function and examine associations between overweight/obesity and the biochemical response to treatment. METHODS: In a parallel group double-blind RCT, healthy postmenopausal women from North East Scotland (latitude-57° N) aged 60-70 years (body mass index (BMI), 18-45 kg/m(2)) were assigned (computer randomisation) to daily vitamin D3 (400 I.U. (n = 102)/1,000 I.U. (n = 101)) or matching placebo (n = 102) (97, 96 and 100 participants analysed for outcomes, respectively) from identical coded containers for 1 year. Grip strength (primary outcome), falls, diet, physical activity and ultraviolet B radiation exposure were measured bimonthly, as were serum 25(OH)D, adjusted calcium (ACa) and phosphate. Fat/lean mass (dual energy X-ray absorptiometry), anthropometry, 1,25-dihydroxyvitamin D and parathyroid hormone were measured at baseline and 12 months. Participants and researchers were blinded throughout intervention and analysis. RESULTS: Treatment had no effect on grip strength (mean change (SD)/year = -0.5 (2.5), -0.9 (2.7) and -0.4 (3.3) kg force for 400/1,000 I.U. vitamin D3 and placebo groups, respectively (P = .10, ANOVA)) or falls (P = .65, chi-squared test). Biochemical responses were similar across BMI categories (<25.25-29.99, ≥30 kg/m(2)) with the exception of a small change at 12-months in serum ACa in overweight compared to non-overweight participants (P = .01, ANOVA; 1,000 I.U. group). In the placebo group, 25(OH)D peak concentration change (winter to summer) was negatively associated with weight (r = -.268), BMI (r = -.198), total (r = -.278) and trunk fat mass (r = -.251), with total and trunk fat mass predictive of winter to summer 25(OH)D change (P = .01/.004 respectively, linear regression). CONCLUSION: We found no evidence of an improvement in physical function following vitamin D3 supplementation for 1 year.

Fluorescence spectroscopy of an in vitro model of human cervical neoplasia identifies graded spectral shape changes with neoplastic phenotype and a differential effect of acetic acid.

BACKGROUND: The clinical utility of spectroscopic methods for the diagnosis of cervical cancer is limited by significant inter-patient variation in the spectroscopic properties of the cervix. Improved understanding of the contributions of the components of cervical tissue to the observed spectra would therefore be helpful in the development of spectroscopic approaches to the study of cervical disease in vivo. METHODS: In this study, we used organotypic epithelial raft culture as an in vitro model system to analyse the fluorescence properties of the surface squamous epithelium specifically. The spectrum of cervical dysplasia was modelled by producing rafts lined by primary human keratinocytes (PHKs) and the HaCaT, SiHa and CaSki human keratinocyte cell lines and fluorescence emission spectra were recorded at a wide range of excitation wavelengths. RESULTS: Statistically significant differences in spectral shape were identified between the different rafts at excitation wavelengths between 250nm and 310nm. A graded, differential effect of acetic acid on fluorescence intensity was also observed, consistent with the visible effects of acetic acid on clinical examination at colposcopy. CONCLUSION: These data suggest that the development of neoplastic changes in the squamous epithelium of the cervix are associated with alterations in its fluorescence properties and that the application of acetic acid has a demonstrable effect on these properties. Identification of these alterations may aid the discrimination of cervical lesions in vivo.

Partial lipectomy, but not PVN lesions, increases food hoarding by Siberian hamsters.

We tested the inverse relationship between body fat and food hoarding in Siberian hamsters by decreasing or increasing body fat through partial surgical lipectomy (LIPX) or by making obesity-inducing lesions of the paraventricular nucleus of the hypothalamus (PVNx), respectively. We asked three questions. 1) Is food hoarding increased after body fat loss due to LIPX? 2) Is food hoarding decreased after PVNx? 3) Does PVNx affect the hoarding response to LIPX? Hamsters housed in a simulated burrow system increased food hoarding after LIPX followed by a decrease to pre-LIPX levels as body fat was partially compensated through an increase in the mass of their unoperated fat pads. PVNx hamsters had increased body mass and food intake but did not have decreased food hoarding, nor was food hoarding increased by LIPX in PVNx hamsters. The partial body fat compensation by LIPX + PVNx hamsters suggests that the damaged PVN did not cause a general failure to sense energy deficits but did affect the ability to integrate internal and external energy stores.

Food deprivation-induced increases in hoarding by Siberian hamsters are not photoperiod-dependent.

Siberian hamsters increase food hoarding in response to chronic food restriction and food deprivation, conditions that lead to a loss of body mass and fat. Therefore, the first purpose of the present experiments was to test further the effects of food deprivation on food hoarding by varying the length and order of repeated fasts to address the following questions: 1. Does the magnitude of the food-hoarding response increase as food deprivation length increases? 2, Is the effect of good deprivation on food hoarding experience-dependent? Second, we were interested in testing the effects of short winter-like days (SDs) on food hoarding. We tested this by measuring food hoarding in long days (LDs) and SDs during baseline conditions and after food deprivation to address the following question: Does SD exposure increase baseline and food deprivation-induced hoarding due to the naturally occurring SD-induced decreases in body fat? During each experiment, we were interested in determining how hamsters utilize their food hoard (i.e., add to it and eat from it). Our results extended those of our previous studies in showing that: 1. Food-deprivation length and the initial food-hoard size were not related to one another; 2. The maintenance of food-hoard size was proportional to the length of the fast; 3. The effects of a bout of food deprivation on food hoarding were dependent upon the lengths of previous fasts; 4. Baseline food hoarding was not different between LD- and SD-exposed hamsters; 5. The maintenance of food-hoard size, but not the initial fast-induced increases in food-hoard size, were increased in SDs; 6. Hamsters ate approximately 25-33% of their daily food intake from the food hoard under all conditions, with the degree of food replacement increasing as fast length was increased; and 7. The typical SD-induced decrease in food intake was reflected in the food eaten from the food supply found outside the burrow, but food eaten from the hoard was increased. Collectively, the results of the present experiments suggest that the initiation of food hoarding may be associated with short-term fluctuations in energy metabolism associated with fasting, but that the more long-term decreases in body mass (fat) are involved in the maintenance of food-hoard size.

Caloric density affects food hoarding and intake by Siberian hamsters.

Siberian hamsters respond to food deprivation or restriction by increasing their food hoarding and do so proportionately to the degree of body mass (fat) loss. These data suggest that Siberian hamsters integrate their internally stored energy as body fat with their externally stored energy as hoarded food such that when internal energy stores are decreased, external stores are increased. The purpose of the present experiments was to test whether the caloric value of the food hoard is regulated. This was accomplished by challenging the hamsters with diets of varying caloric density and assessing whether their hoarded food is changed accordingly. Specifically, in Experiment 1 hamsters were switched from the control food pellets to a diet where the caloric density was increased by creating a high fat diet (HFD). In Experiment 2, the caloric density of the control diet was decreased by diluting it with cellulose such that 25% and 50% (kcal/wt) reduced calorie diets (RCDs) were created. HFD-fed hamsters decreased their food hoarding, increased their body mass, and decreased the grams of food eaten, but not enough to compensate exactly for the increased caloric density of the diet. When refed the control diet, food hoarding increased to pre-HFD levels as body mass and food intake decreased. RCD feeding resulted in caloric density-dependent effects on all measures. Food hoarding and intake (grams and calories) increased when hamsters were given the 25% RCD and did so to an even greater degree when given the 50% RCD. Thus, Siberian hamsters responded to increases or decreases in the caloric density of their food by attempting to regulate the number of calories hoarded and eaten; however, the adjustments in food hoarding: 1) were not precise, 2) were largely opposite of food intake, 3) tended to be inversely related to body mass and 4) were caloric density dependent.

Effects of zeranol implants on post-castration response in calves.

Suckling and yearling calves were surgically castrated and one half of each group implanted with 36 mg zeranol at time of castration. Both treated and control cattle of each class were maintained as a group and evaluated for swelling of the scrotum, inflammation and healing, plasma prostaglandin levels and weight gain. Swelling and inflammation of the scrotum were less in treated suckling calves than in controls at both 7 and 14 d after castration, though this difference was not statistically significant. In yearlings at 7 d after castration, treated cattle had more swelling than controls; however at 14 d, treated cattle had less swelling and inflammation with only one treated yearling having an open scrotal wound versus 6 (P less than .03) in the control group. Plasma prostaglandin levels as indicated by plasma malondialdehyde increased from d 0 to 14; however no significant treatment differences were observed for either age group. Suckling calves treated with zeranol gained 9.79 kg more (P less than .03) than non-treated calves during the 97 d of trial while the yearlings treated with zeranol gained 16.78 kg more (P less than .01) than controls during 102 d. It is concluded from the increased growth and reduced scrotal swelling and inflammation in treated cattle that zeranol implantation could possibly have a beneficial effect in improving the healing process after castration.

Factors influencing occupational back pain in Bedfordshire.

This paper reports on a pilot study of occupational back pain among a sample of 68 men aged 16 to 65 years in the North Bedfordshire Health District, England. In a multidisciplinary appraoch, measurements of 126 variables for each case were made. It was found that driving high mileages was a significant factor affecting both occurrence and location of pain. Certain personality factors were also significant.

Pneumonia associated with Bordetella bronchiseptica in captive koalas.

Bordetella bronchiseptica was isolated from 12 cases of purulent bronchopneumonia from a captive koala colony near Brisbane, Queensland. An initial epizootic in March 1967 causing 13% mortality was followed by annual outbreaks causing 2% mortality usually in newly weaned and aged koalas in late winter to early spring. High population density and a low plane of nutrition in winter were thought to predispose to the occurrence of the disease.

Angiostrongylus cantonesis infection of the brain of a captive Bennett's wallaby (Macropus rufogriseus).

Eleven immature adult Angiostrongylus cantonensis were recovered from beneath the meninges of a captive Bennett's wallaby (Macropus rufogriseus) which died after displaying posterior paresis followed by paralysis and intermittent opisthotonic spasms of increasing frequency for 7 days. Congestion and focal malacia with haemorrhage were seen in the brainstem and cerebellum. Sections of worms with scanty inflammatory response were seen beneath the congested haemorrhagic leptomeninges of cerebrum and in a cerebellar folium. Infection was thought to have originated from feed or water contaminated with larvae released from a molluscan intermediate host.

Effects of 10.6-mu Laser Induced Air Chemistry on the Atmospheric Refractive Index.

Atmospheric absorption of 10.6-mu radiation can either heat or cool the air, depending upon atmospheric conditions. Absorption by CO(2) is essentially from the (100) to the (001) states. The depleted (100) state is rapidly replenished by energy transfer from translation, cooling the atmosphere. The (001) state slowly transfers energy through the N(2) back to translation, eventually heating the atmosphere. Cooling increases the density and index of refraction, and the resulting gradient tends to focus a gaussian beam. This partially offsets the usual heating effects and associated ray divergence.