Integrated population modelling reveals a perceived source to be a cryptic sink.

Demographic links among fragmented populations are commonly studied as source-sink dynamics, whereby source populations exhibit net recruitment and net emigration, while sinks suffer net mortality but enjoy net immigration. It is commonly assumed that large, persistent aggregations of individuals must be sources, but this ignores the possibility that they are sinks instead, buoyed demographically by immigration. We tested this assumption using Bayesian integrated population modelling of Greenland white-fronted geese (Anser albifrons flavirostris) at their largest wintering site (Wexford, Ireland), combining capture-mark-recapture, census and recruitment data collected from 1982 to 2010. Management for this subspecies occurs largely on wintering areas; thus, study of source-sink dynamics of discrete regular wintering units provides unprecedented insights into population regulation and enables identification of likely processes influencing population dynamics at Wexford and among 70 other Greenland white-fronted goose wintering subpopulations. Using results from integrated population modelling, we parameterized an age-structured population projection matrix to determine the contribution of movement rates (emigration and immigration), recruitment and mortality to the dynamics of the Wexford subpopulation. Survival estimates for juvenile and adult birds at Wexford and adult birds elsewhere fluctuated over the 29-year study period, but were not identifiably different. However, per capita recruitment rates at Wexford in later years (post-1995) were identifiably lower than in earlier years (pre-1995). The observed persistence of the Wexford subpopulation was only possible with high rates of immigration, which exceeded emigration in each year. Thus, despite its apparent stability, Wexford has functioned as a sink over the entire study period. These results demonstrate that even large subpopulations can potentially be sinks, and that movement dynamics (e.g. immigration) among winters can dramatically obscure key processes driving subpopulation size. Further, novel population models which integrate capture-mark-recapture, census and recruitment data are essential to correctly ascribing source-sink status and accurately informing development of site-safeguard networks.

Mortality trajectory analysis reveals the drivers of sex-specific epidemiology in natural wildlife-disease interactions.

In animal populations, males are commonly more susceptible to disease-induced mortality than females. However, three competing mechanisms can cause this sex bias: weak males may simultaneously be more prone to exposure to infection and mortality; being 'male' may be an imperfect proxy for the underlying driver of disease-induced mortality; or males may experience increased severity of disease-induced effects compared with females. Here, we infer the drivers of sex-specific epidemiology by decomposing fixed mortality rates into mortality trajectories and comparing their parameters. We applied Bayesian survival trajectory analysis to a 22-year longitudinal study of a population of badgers (Meles meles) naturally infected with bovine tuberculosis (bTB). At the point of infection, infected male and female badgers had equal mortality risk, refuting the hypothesis that acquisition of infection occurs in males with coincidentally high mortality. Males and females exhibited similar levels of heterogeneity in mortality risk, refuting the hypothesis that maleness is only a proxy for disease susceptibility. Instead, sex differences were caused by a more rapid increase in male mortality rates following infection. Males are indeed more susceptible to bTB, probably due to immunological differences between the sexes. We recommend this mortality trajectory approach for the study of infection in animal populations.

Self-report reasons for alcohol use in bipolar disorders: why drink despite the potential risks?

High rates of alcohol use and misuse are commonly reported for bipolar disorder (BD) and in many cases, these impact detrimentally on the course and treatment of the disorder. Therefore, knowing the reasons individuals with a diagnosis of BD give for drinking alcohol is essential for understanding this association and for treatment. This paper aimed to systematically review the literature relating to self-reported reasons and motives for alcohol use in BD. By using internet-based search engines such as PsycINFO and Medline, six relevant studies were identified and then quality-assessed using a set of criteria specifically developed for this review. Overall, the findings supported the intuitive notion that individuals with a diagnosis of BD use alcohol to relieve distressing mood states. However, there was evidence of other mood-related and mood--unrelated reasons--e.g., drinking to enhance euphoric mood or to be sociable. These findings are discussed in relation to the self-medication hypothesis and cognitive motivational models of alcohol use developed in the general population. The quality assessment also revealed several limitations including diagnostically heterogeneous samples and inconsistencies in measurement between studies, and recommendations for addressing these limitations are given.

Human influences shape the first spatially explicit national estimate of urban unowned cat abundance.

Globally, unowned cats are a common element of urban landscapes, and the focus of diverse fields of study due to welfare, conservation and public health concerns. However, their abundance and distribution are poorly understood at large spatial scales. Here, we use an Integrated Abundance Model to counter biases that are inherent in public records of unowned cat sightings to assess important drivers of their abundance from 162 sites across five urban towns and cities in England. We demonstrate that deprivation indices and human population densities contribute to the number of unowned cats. We provide the first spatially explicit estimates of expected distributions and abundance of unowned cats across a national scale and estimate the total UK urban unowned cat population to be 247,429 (95% credible interval: 157,153 to 365,793). Our results provide a new baseline and approach for studies on unowned cats and links to the importance of human-mediated effects.

Sleep leadership in the army: A group randomized trial.

OBJECTIVES: Examine impact of training military leaders in sleep health on leaders and unit members. DESIGN: Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey. SETTING: Classroom-style areas on a US military base. PARTICIPANTS: US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team. INTERVENTION: One-hour training in sleep leadership. MEASUREMENTS: Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems. RESULTS: Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition. CONCLUSIONS: Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.

Results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument Study.

INTRODUCTION: Recent reports have demonstrated behavioral health (BH) system and individual provider challenges to BH readiness success. These pose a risk to winning on the battlefield and present a significant safety issue for the Army. One of the most promising areas for achieving better BH readiness results lies in improving readiness decision-making support for BH providers. The Walter Reed Army Institute of Research (WRAIR) has taken the lead in addressing this challenge by developing and empirically testing such tools. The results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument (B-REDI) field study are herein described. METHODS: The B-REDI study received WRAIR Institutional Review Board approval, and BH providers across five U.S. Army Forces Command installations completed surveys from September 2018 to March 2019. The B-REDI tools/training were disseminated to 307 providers through random clinic assignments. Of these, 250 (81%) providers consented to participate and 149 (60%) completed both initial and 3-month follow-up surveys. Survey items included a wide range of satisfaction, utilization, and proficiency-level outcome measures. Analyses included examinations of descriptive statistics, McNemar's tests pre-/post-B-REDI exposure, Z-tests with subgroup populations, and chi-square tests with demographic comparisons. RESULTS: The B-REDI resulted in broad, statistically significant improvements across the measured range of provider proficiency-level outcomes. Net gains in each domain ranged from 16.5% to 22.9% for knowledge/awareness (P = .000), from 11.1% to 15.8% for personal confidence (P = .001-.000), and from 6.2% to 15.1% for decision-making/documentation (P = .035-.002) 3 months following B-REDI initiation, and only one (knowledge) failed to maintain a statistically significant improvement in all of its subcategories. The B-REDI also received high favorability ratings (79%-97% positive) across a wide array of end-user satisfaction measures. CONCLUSIONS: The B-REDI directly addresses several critical Army BH readiness challenges by providing tangible decision-making support solutions for BH providers. Providers reported high degrees of end-user B-REDI satisfaction and significant improvements in all measured provider proficiency-level domains. By effectively addressing the readiness decision-making challenges Army BH providers encounter, B-REDI provides the Army BH health care system with a successful blueprint to set the conditions necessary for providers to make more accurate and timely readiness determinations. This may ultimately reduce safety and mission failure risks enterprise-wide, and policymakers should consider formalizing and integrating the B-REDI model into current Army BH practice.

Assessing the Well-being of Sexual Minority Soldiers at a Military Academic Institution.

INTRODUCTION: The goal of the present study was to characterize behavioral health rates, behavioral health care utilization, loneliness, and perceived prejudice and support among sexual minority soldiers. MATERIALS AND METHODS: Cross-sectional survey data were obtained from 640 active-duty U.S. soldiers enrolled in an academic training institute who provided information on their sexual orientation. Survey topics included demographics, behavioral health, behavioral health care utilization, and mitigating factors (eg, perceived prejudice, perceived support, and loneliness). Chi-square analyses were utilized to determine any differences between groups for behavioral health rates and behavioral health care utilization. Robust regression was used for analysis of self-reported loneliness. RESULTS: A higher proportion of lesbian, gay, bisexual (LGB) soldiers than heterosexual soldiers screened positive for anxiety, post-traumatic stress disorder, and suicidality. No between-group differences in behavioral health care utilization were found; however, a higher proportion of LGB soldiers sought help from military family life counselors. No between-group differences for loneliness were found. Finally, perceived prejudice was higher for LGB soldiers and perceived support was lower. CONCLUSION: Organizational barriers, such as perceived prejudice and lack of support, appear to still exist for sexual minority soldiers. Increasing organizational support and implementing training and education for health care providers in order to better support the LGB soldier community may mitigate these barriers.

Soldier Attitudes Toward Behavioral Health Profiles in the US Army.

INTRODUCTION: Behavioral health (BH) readiness is a critical component of U.S. Army personnel readiness. Medical providers issue BH profiles in order to communicate BH-related duty limitations to the commander and reflect BH force readiness on both micro/macro-levels. A recent report indicates BH profile underutilization may be significantly elevating U.S. Army safety and mission-failure risks, and a study of BH provider decision-making suggests some providers may be hesitant to use profiles due to concerns that soldiers' attitudes toward BH profiles may negatively impact treatment utilization. This potential link, however, has not been empirically examined. This study addresses this gap by assessing soldiers' attitudes towards BH profiles to better understand how BH profiles may impact treatment utilization and explore for any BH profile-related stigma effect. METHODS: Approved by the Walter Reed Army Institute of Research (WRAIR) Institutional Review Board as part of the Land Combat Study II, the survey specific to this study included eight WRAIR-developed items assessing soldier attitudes toward BH profiles. Soldiers (N = 1,043) from two active duty U.S. Army brigades completed cross-sectional, anonymous surveys in 2017-2018. Soldier self-reported BH care utilization was assessed and used to create sub-groups for analysis. RESULTS: A majority of soldiers indicated that being placed on a BH profile would make them as or more likely to seek (71%) and no more or less likely to drop out (84%) of BH care. Among soldiers who had received BH care, BH profiles were associated with more favorable treatment seeking attitudes among those inclined to access conventional BH services and less favorable treatment seeking and maintenance attitudes among those inclined to access BH services from sources incapable of issuing profiles. Negative attitudes towards BH profiles were significantly more prevalent when compared to physical injury profiles, except in the group who had received BH care from a source incapable of issuing a profile. No significant proportional differences were observed among soldiers toward the rationale for BH profiles. Almost all soldiers (95% or greater) preferred their BH condition not come to the commander's attention during pre-deployment screening (SRP), choosing either BH profile or crisis options instead. CONCLUSIONS: Results suggest soldiers who would be less likely to seek or more likely to drop out of BH care due to a BH profile may be those that are less likely to access conventional BH services in the first place. This may provide some preliminary reassurance to conventional providers that increased BH profiling practices may not be inversely proportional to the amount of BH care delivered and may encourage treatment-seeking behaviors among the population they serve. Soldiers seeking BH care from sources incapable of issuing a profile may be sensitive to a potential BH profile-related stigma effect (possibly more global profile-related effect in this group), which should be factored into policy outreach efforts. A BH profile represents a more palatable BH duty limitation disclosure option for many soldiers, and supports the merits of a disclosure process that is earlier than SRP for promoting risk mitigation and more honest appraisals of BH mission-readiness levels.

Sleep knowledge, goals, and habits in soldiers.

OBJECTIVES: The present study examines the link between these individual sleep knowledge, goals, and habits and self-reported sleep quantity in a military setting. METHODS: Survey data from active duty US soldiers were analyzed using a modified Poisson regression to provide relative risk ratios. RESULTS: Soldiers who had better sleep knowledge and endorsed healthy sleep goals and habits were more likely to report adequate sleep (7 or more hours of sleep per 24 hours) than those who did not. Specifically, soldiers who endorsed a goal of trying to get at least 7 hours of sleep per night had a 2.8 fold increase in the probability of reporting adequate sleep relative to short sleep (≤6 hours of sleep per 24 hours). CONCLUSIONS: These findings identify areas of focus for sleep education programs designed to target soldiers at-risk for insufficient sleep.

Combining targeted sampling and fluorometry to identify human fecal contamination in a freshwater creek.

Many bacterial source tracking (BST) methods are too expensive for most communities to afford. In an effort to develop an inexpensive method of detecting human sources of fecal contamination in a freshwater creek during baseflow and stormflow conditions, we combined targeted sampling with fluorometry. Targeted sampling is a prelude to BST and finds sources of fecal contamination by continued sampling and resampling over ever-decreasing distances. Fluorometry identifies human fecal contamination in water by detecting fluorescing compounds, optical brighteners, from laundry detergents. Potato Creek, a freshwater creek in Georgia (U.S.A.), had three reaches identified as containing high numbers of fecal bacteria, and these reaches were sampled by targeted sampling and fluorometry. Targeted sampling quickly and inexpensively identified humans, cattle, and dogs as the major sources of fecal contamination in the first, second, and third reaches, respectively. Fluorometric values were consistent with these identifications, but high fluorometric values were sometimes observed in areas with no fecal contamination. One likely cause of these false-positive signals was fluorescence from organic matter. For targeted sampling, the cost of each sample was $6, with a one-time equipment cost of $3,650; for fluorometry, the cost of each sample was negligible, with a one-time equipment cost of $14,250. This was the first study of this relatively inexpensive combination in freshwater during both baseflow and stormflow conditions.

Integrating Trap-Neuter-Return Campaigns Into a Social Framework: Developing Long-Term Positive Behavior Change Toward Unowned Cats in Urban Areas.

Cat management is often discussed in terms of population reduction, with trap-neuter-return (TNR) campaigns commonly organized to manage unowned urban cat populations. However, long-term effectiveness is only possible if positive neutering practices are continued by local residents. Here we discuss how implementing TNR within a wider framework of social engagement has the potential to tackle cat overpopulation and instill long-term positive behavior change toward them. We demonstrate how community engagement pre-TNR can help establish a baseline of the attitudes, knowledge and behavior concerning cats. Using a case study, we explore whether this information can be linked with positive intended behavior based on intentions to arrange for neutering of unowned cats. Structural equation modeling indicated that negative attitudes toward cats and reduced knowledge around neutering reduced the likelihood of positive intended behavior. This result was underpinned by the indirect effects of perceptions of unowned cats and reduced understanding of their needs. Utilizing these results alongside an understanding of the values and motivation of the community allows for tailored and targeted education and intervention. In turn, this addresses the underlying knowledge gaps and perceptions regarding cat welfare. This framework can help address the challenge of cat management because it: (1) takes an integrative approach to identifying the motivations of communities to take responsibility for unowned cats; (2) changes the structure of the social environment, encouraging positive neutering practices for unowned cats. In turn this improves the impact and longevity of TNR campaigns whilst promoting positive welfare change for unowned and owned cats; and (3) appreciates that opinions are likely to vary hugely between areas, therefore providing an adaptable community level approach.

BMS-747158-02: a novel PET myocardial perfusion imaging agent.

BACKGROUND: BMS-747158-02 is a fluorine 18-labeled pyridaben derivative designed as a new myocardial perfusion imaging agent for use with positron emission tomography (PET). This study evaluated BMS-747158-02 in animal models of cardiac perfusion and compared it with established single photon emission computed tomography agents. METHODS AND RESULTS: In a rat biodistribution study, BMS-747158-02 (15 microCi) had substantially higher myocardial uptake than technetium 99m sestamibi (100 microCi) at 15 minutes (3.5% +/- 0.3% %ID/g vs 1.9% +/- 0.1% %ID/g) and 120 minutes (3.2% +/- 0.4% of injected dose per gram vs 1.8% +/- 0.0% of injected dose per gram) after intravenous administration. Uptake ratios of heart to lung and liver at 60 minutes were also higher for BMS-747158-02 (12.7 +/- 1.4 and 3.7 +/- 0.2, respectively) than Tc-99m sestamibi (5.9 +/- 0.5 and 2.4 +/- 0.4, respectively). In an isolated rabbit heart model at flow rates of 1.66 to 5.06 mL x min(-1).g(-1) wet left ventricular weight, the net BMS-747158-02 heart uptake increased proportionally (0.93 +/- 0.15 to 2.44 +/- 0.40 mL.min(-1) x g(-1)) and to a greater extent than that of thallium 201 (0.76 +/- 0.02 to 1.11 +/- 0.02 mL x min(-1) x g(-1)) or Tc-99m sestamibi (0.49 +/- 0.03 to 0.77 +/- 0.08 mL x min(-1) x g(-1)). PET imaging with BMS-747158-02 showed a clear and sustained cardiac uptake in rats, rabbits, and nonhuman primates with minimal lung interference and rapid liver clearance. Myocardial perfusion deficit zones created by either permanent left coronary ligation or reperfusion after ligation in rats were both clearly identified on PET cardiac images of BMS-747158-02 and had good agreement with in vitro histology. CONCLUSIONS: BMS-747158-02 exhibited high and sustained cardiac uptake that was proportional to blood flow, and it represents a new class of PET myocardial perfusion imaging agent.

Exposing water samples to ultraviolet light improves fluorometry for detecting human fecal contamination.

Fluorometry identifies human fecal contamination by detecting optical brighteners in environmental waters. Because optical brighteners are sensitive to sunlight, we determined if we could improve fluorometry by exposing water samples to ultraviolet (UV) light to differentiate between optical brighteners and other fluorescing organic compounds. Optical brighteners were likely present when the relative percentage difference in fluorometric value of the water before and after UV light exposure was >30% (glass cuvettes, 30 min exposure) or >15% (polymethacrylate cuvettes, 5 min exposure). In a blind study, we correctly identified the presence or absence of optical brighteners in 178 of 180 (99%) of the samples tested with a more expensive field fluorometer and in 175 of 180 (97%) of the samples tested with a less expensive handheld fluorometer. In the field, the method correctly identified two negative and three positive locations for human fecal contamination. When combined with counts of fecal bacteria, the new fluorometric method may be a simple, quick, and easy way to identify human fecal contamination in environmental waters.

Identifying sources of fecal contamination inexpensively with targeted sampling and bacterial source tracking.

Most bacterial source tracking (BST) methods are too expensive for most communities to afford. We developed targeted sampling as a prelude to BST to reduce these costs. We combined targeted sampling with three inexpensive BST methods, Enterococcus speciation, detection of the esp gene, and fluorometry, to confirm the sources of fecal contamination to beaches on Georgia's Jekyll and Sea Islands during calm and stormy weather conditions. For Jekyll Island, the most likely source of contamination was bird feces because the percentage of Ent. faecalis was high (30%) and the esp gene was not detected. For the Sea Island beach during calm conditions, the most likely sources of fecal contamination were leaking sewer lines and wildlife feces. The leaking sewer lines were confirmed with fluorometry and detection of the esp gene. For the Sea Island beach during stormflow conditions, the most likely sources of fecal contamination were wildlife feces and runoff discharging from two county-maintained pipes. For the pipes, the most likely source of contamination was bird feces because the percentage of Ent. faecalis was high (30%) and the esp gene was not detected. Sediments were also a reservoir of fecal enterococci for both Jekyll and Sea Islands. Combining targeted sampling with two or more BST methods identified sources of fecal contamination quickly, easily, and inexpensively. This combination was the first time targeted sampling was conducted during stormy conditions, and the first time targeted sampling was combined with enterococcal speciation, detection of the esp gene, and fluorometry.

Reconciling actual and perceived rates of predation by domestic cats.

The predation of wildlife by domestic cats (Felis catus) is a complex problem: Cats are popular companion animals in modern society but are also acknowledged predators of birds, herpetofauna, invertebrates, and small mammals. A comprehensive understanding of this conservation issue demands an understanding of both the ecological consequence of owning a domestic cat and the attitudes of cat owners. Here, we determine whether cat owners are aware of the predatory behavior of their cats, using data collected from 86 cats in two UK villages. We examine whether the amount of prey their cat returns influences the attitudes of 45 cat owners toward the broader issue of domestic cat predation. We also contribute to the wider understanding of physiological, spatial, and behavioral drivers of prey returns among cats. We find an association between actual prey returns and owner predictions at the coarse scale of predatory/nonpredatory behavior, but no correlation between the observed and predicted prey-return rates among predatory cats. Cat owners generally disagreed with the statement that cats are harmful to wildlife, and disfavored all mitigation options apart from neutering. These attitudes were uncorrelated with the predatory behavior of their cats. Cat owners failed to perceive the magnitude of their cats' impacts on wildlife and were not influenced by ecological information. Management options for the mitigation of cat predation appear unlikely to work if they focus on "predation awareness" campaigns or restrictions of cat freedom.

Targeted sampling protocol as prelude to bacterial source tracking with Enterococcus faecalis.

Recent studies suggest that host origin databases for bacterial source tracking (BST) must contain a large number of isolates because bacterial subspecies change with geography and time. A new targeted sampling protocol was developed as a prelude to BST to minimize these changes. The research was conducted on the Sapelo River, a tidal river on the Georgia coast. A general sampling of the river showed fecal enterococcal numbers ranging from <10 (below the limit of detection) to 990 colony-forming units (CFU) per 100 mL. Locations with high enterococcal numbers were combined with local knowledge to determine targeted sampling sites. Fecal enterococcal numbers around one site ranged from <10 to 24,000 CFU per 100 mL. Bacterial source tracking was conducted to determine if a wastewater treatment facility at the site was responsible for this contamination. The fecal indicator bacterium was Enterococcus faecalis. Ribotyping, automated with a RiboPrinter (DuPont Qualicon, Wilmington, DE), was the BST method. Thirty-seven ribotypes were observed among 83 Ent. faecalis isolates obtained from the Sapelo River and the wastewater lagoon. Sixteen ribotypes were associated with either the river or the lagoon, and only five ribotypes (14%) were shared. Nevertheless, these five ribotypes represented 39 of the 83 Ent. faecalis isolates, almost a majority (47%). These results suggest that the fecal contamination in the river came from the wastewater treatment facility. As a prelude to BST, targeted sampling minimized subspecies changes with geography and time, and eliminated the need for a permanent host origin database by restricting BST to a small geographic area and requiring sampling to be completed in one day.

Utilization patterns of second-line antibiotics in a health plan setting.

Increased utilization of second-line antibiotics where first-line agents are appropriate, and the use of antibiotics for viral infections, are leading to the development of resistance. This retrospective study evaluated antibiotic utilization patterns of cephalosporins, macrolides, and quinolones for community-acquired infections in a health plan's patient population. Patients were identified through the health plan's computerized pharmacy claims database. Patients were considered eligible if they had been enrolled with the health plan for at least one year, and had a prescription claim for a cephalosporin, macrolide, or quinolone antibiotic between February 1, 2001 and April 30, 2001. Six hundred fifty patients were randomly selected to undergo chart review. A total of 128 patients (25.2%) from an eligible cohort of 508 health plan members had no documented diagnosis of infection in their chart. Gram staining was checked in 14 patients. Cultures were ordered for only 19 patients. Comparisons were made with regard to first-, second-, and third-line drug use in select documented infections. Of all the patients in the study, only 10.4% (53/508) had chart documentation of previous antibiotic failure. Of the 456 patients who had documentation, 63% had no known antibiotic allergies, and 19% had allergies to penicillin. The results of this study will be used to educate providers and consumers on appropriate antibiotic prescribing.

Badger social networks correlate with tuberculosis infection.

Although disease hosts are classically assumed to interact randomly [1], infection is likely to spread across structured and dynamic contact networks [2]. We used social network analyses to investigate contact patterns of group-living European badgers, Meles meles, which are an important wildlife reservoir of bovine tuberculosis (TB). We found that TB test-positive badgers were socially isolated from their own groups but were more important for flow, potentially of infection, between social groups. The distinctive social position of infected badgers may help explain how social stability mitigates, and social perturbation increases, the spread of infection in badgers.

Do patients with bipolar disorder drink alcohol for different reasons when depressed, manic or euthymic?

OBJECTIVE: Many studies report high prevalence rates for co-morbid alcohol problems in bipolar disorder (BP). Some hypothesize that individuals use alcohol to self-medicate, but few studies examine the range of possible reasons and none explicitly explores the role of mood state. We examined drinking motives in BP depression, (hypo)mania and euthymia according to Cooper's cognitive motivational model of alcohol use (Cooper, 1994). METHODS: Twenty-seven participants with BP were interviewed using the Drinking Motives Questionnaire. A calendar-based measure of alcohol use--the FORM90--was used to aid recall of drink-related behaviours and estimate alcohol intake. Each participant reported drinking motives and alcohol consumption for 30 consecutive days of euthymia, plus one past depressive and one past (hypo)manic episode. RESULTS: Estimated alcohol intake was higher when depressed or (hypo)manic compared with euthymia. Drinking motives varied between mood states. Negative internal coping motives were specifically related to depression, whilst positive internal and external motives were more specifically related to (hypo)mania. During euthymia, the patients' motives did not differ from norms. CONCLUSIONS: This is the first clinical study utilising a clearly defined cognitive motivational model demonstrating that the reasons to drink alcohol in patients with BP are mood-dependent. Interventions aimed at modifying problematic drinking behaviours in this population must take into account both individual and mood state variations in reasons for alcohol consumption. Self-medication or inadequate coping is not sufficient to generally explain alcohol intake across mood states and individuals.