The Relationship Between Earlobe Creases and the Presence, Extent, and Severity of Coronary Artery Atherosclerosis: A Regional Population-Based Autopsy Study.

ABSTRACT: The association between earlobe crease(s) and coronary artery atherosclerosis has stimulated debate and controversy over the years. Most available published studies have been conducted on living patients. Although these studies offer valuable insight into such associations in patients who exhibit symptoms, no information is available from these studies on the prevalence of earlobe creases among an asymptomatic population. Postmortem studies offer the advantage of including individuals free of symptomatic cardiovascular disease, thus providing an inbuilt control group. The atherosclerotic pathological findings of 1298 individuals who underwent coronial postmortem examination at Wellington Regional Hospital, New Zealand, between 2006 and 2013 were retrospectively studied. Earlobe creases and atherosclerosis involving the coronary arteries were semiquantitatively appraised. The presence of an earlobe crease was found to be significantly associated with coronary artery atherosclerosis.

Fatal coastal drowning incidents: A 10-year review of body recovery times in New Zealand.

Despite drowning being a leading cause of unintentional injury worldwide, gaps in the data still exist. One area where limited data is available to guide lifeguards, police, search and rescue agencies, accident and forensic investigators, ocean scientists, and the coroner, is how far from the last known point (displacement) a missing person is likely to be found, and the time frame for this to occur. This lack of certainty can exacerbate the emotional toll on family, friends, and rescuers. This study aimed to describe body recovery times and displacement for fatal coastal drowning incidents in New Zealand. Using DrownBase™, the National Coronial Information System, and media reports, data were extracted for all fatal coastal-missing-person drowning incidents from 2008 to 2017. A total of 219 cases were selected. Almost all incidents involved males (92%) and minority groups (e.g., Maori and Pasifika) were over-represented. Older adults (> 42 years) were more likely to be engaged in boating, whereas for younger adults (≤ 42 years), it was swimming. Most missing persons were described as good swimmers (51%) and wearing everyday clothing (48%), yet only 4% wore a lifejacket. Most incidents were observed (63%), and rescue was attempted in 86% of cases. Most bodies (58%) were recovered within 24h, and only 15% were not found (9%) or not reported (6%). Most missing persons (64%) were either found in the same location (57%) or <1km from where they entered the water (7%). The quality of on-scene data limited some analysis, and the results of this study may not apply to all aquatic locations. Improved data collection could inform real-time predictive modelling of where and when a missing person might be found. The involvement of forensic and ocean scientists in future study design to widen applicability to these domains is also recommended. Fewer lives would be lost to drowning, however, if safer practices were adopted when recreating or working in, on, or around water.

Liver toxicity from vitamin A.

Hepatic toxicity secondary to hypervitaminosis A is extremely rare. We report the case of a 27-year-old Caucasian female who presented for an investigation of abdominal pain, cholestatic liver function tests, and abnormal computerized tomography findings. She had been prescribed isotretinoin for her acne and had subsequently purchased vitamin A online, which she consumed daily for over 18 months.

Understanding differences in access to water fountains and sugar-sweetened beverages in children׳s environments: a pilot study in high and low deprivation neighbourhoods.

Access to water fountains and sugar-sweetened beverages (SSBs) in children׳s environments may impact on child obesity and may vary with neighbourhood deprivation. Our pilot analyses of access to water fountains and SSBs in Wellington, New Zealand revealed that water fountain access was high in school environments and low in recreational environments. There were also differences in water fountain and SSB access points by neighbourhood deprivation. The methods piloted in this study could be translated in a larger study, more capable of detecting significant differences in access and allowing for more sophisticated analyses. Such future studies may provide important evidence for the improvement of children׳s health and well-being.

Stigma and mental health in the Royal Navy: a mixed methods paper.

BACKGROUND: US research suggests that military personnel suffering from mental health problems are reluctant to seek help because of stigma. AIMS: First, to identify the prevalence of mental health stigma beliefs in a UK military sample. Second, to investigate whether distressed personnel report more stigma than those who are not distressed. METHOD: A survey of 1599 naval personnel was undertaken as part of a larger trial prior to examining the effectiveness of a novel trauma support program. RESULTS: The presence of internal stigma was substantial and significantly higher for distressed personnel. The prevalence of stigma about other people's mental health problems was low. Junior personnel reported being more uncomfortable in discussing emotional issues with their peer group than senior staff. CONCLUSIONS: Internal stigma remains a significant barrier to help seeking within the Royal Navy, especially for distressed personnel. This may be especially problematic for junior personnel who are known to be particularly vulnerable to developing mental health problems.

Use of psychological decompression in military operational environments.

This article reviews the use of psychological decompression as applied to troops returning from active service in operational theaters. Definitions of the term are considered and a brief history is given. Current policies and practices are described and the question of mandatory decompression is considered. Finally, the evidence base for the efficacy of decompression is examined and some conclusions are drawn. This article highlights variations in the definition and practice of decompression and its use. Although there is, as yet, no evidence that decompression works, there is also no evidence to the contrary. Given the lack of knowledge as to the balance of risks and benefits of decompression and the absence of any definitive evidence that decompression is associated with improved mental health outcomes or that lack of decompression is associated with the reverse, it is argued that the use of decompression should remain a matter for discretion.

A novel histological technique for distinguishing between epithelial cells in forensic casework.

There are a number of forensic cases in which the identification of the epithelial cell type from which DNA originated would provide important probative evidence. This study aimed to develop a technique using histological staining of fixed cells to distinguish between skin, buccal and vaginal epithelium. First, 11 different stains were screened on formalin-fixed, wax-embedded cells from five women. Samples were analysed qualitatively by examining staining patterns (colour) and morphology (absence or presence of nuclei). Three of the staining methods--Dane's, Csaba's and Ayoub-Shklar--were successful in distinguishing skin epithelial cells from buccal and vaginal. Second, cells were smeared directly onto slides, fixed with one of five fixatives and stained with one of the three stains mentioned above. Methanol fixation, coupled with the Dane's staining method, specific to keratin, was the only technique that distinguished between all three cell types. Skin cells stained magenta, red and orange and lacked nuclei; buccal cells stained predominantly orange-pink with red nuclei; while vaginal cells stained bright orange with orange nuclei and a blue extracellular hue. This staining pattern in vaginal cells was consistent in samples collected from 50 women aged between 18 and 67. Identification of cell type from unlabelled micrographs by 10 trained observers showed a mean success rate of 95%. The results of this study demonstrate that histological staining may provide forensic scientists with a technique for distinguishing between skin, buccal and vaginal epithelial cells and thus would enable more conclusive analyses when investigating sexual assault cases.

Transition back into civilian life: a study of personnel leaving the U.K. armed forces via "military prison".

OBJECTIVE: The purpose of this study was to identify the factors associated with poor outcomes for personnel leaving the United Kingdom Armed Forces early. METHOD: We studied a population thought to be at high risk of poor outcomes: those leaving the Services early via the United Kingdom Military Corrective Training Centre. Participants were interviewed 1 week before leaving (predischarge) and followed up 6 months later. One hundred eleven participants completed predischarge interviews. Seventy-four (67%) were successfully followed up and interviewed 6 months later. RESULTS: Thirty-eight of those followed up (56%) were classed as being disadvantaged after leaving. Being disadvantaged at follow-up was associated with: having predischarge mental health problems, receiving an administrative discharge, or having a short sentence length. CONCLUSION: Factors associated with poor outcomes on leaving were often interrelated, making causal relationships complex. However, this study does provide a basis from which to identify, at the point of discharge, those most at risk of further disadvantage.

Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq.

BACKGROUND: Deployment to the 2003 Iraq War was associated with ill health in reserve armed forces personnel. AIMS: To investigate reasons for the excess of ill health in reservists. METHOD: UK personnel who were deployed to the 2003 Iraq War completed a health survey about experiences on deployment to Iraq. Health status was measured using self-report of common mental disorders, post-traumatic stress disorder (PTSD), fatigue, physical symptoms and well-being. RESULTS: Reservists were older and of higher rank than the regular forces. They reported higher exposure to traumatic experiences, lower unit cohesion, more problems adjusting to homecoming and lower marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather than events in Iraq. CONCLUSIONS: The increased ill-health of reservists appears to be due to experiences on deployment and difficulties with homecoming.

The meaning of self-perception of health in the UK armed forces.

OBJECTIVES: We assessed the characteristics of self-perception of health (SPH) in relation to psychological distress and physical symptoms, and willingness of servicemen to see their Medical Officer (MO) by their SPH rating. DESIGN: We randomly selected 4,500 servicemen to receive either a full or an abridged screening questionnaire. MEASURES: The full questionnaire included 6 items from the short-form 36 and the question on SPH, the General Health Questionnaire-12, the post-traumatic stress disorder checklist and 15 symptoms. The abridged questionnaire included a subset of items from the full questionnaire. All 'screen-positive' and a random 'screen-negative' sample were invited to see an MO. RESULTS: 67.1% out of 4,500 servicemen completed the questionnaires. SPH was strongly associated with a summary short form-36 (SF-36) measure. There was a strong association between SPH and all assessment scales regardless of length of the questionnaires (p<.001). Even among those with very good or excellent SPH, high scores denoting psychological distress were prevalent (8.1%). Good SPH provided the largest variations in symptoms and scores. Servicemen with a poor/fair SPH were no more likely to accept a visit to the MO than the rest. CONCLUSIONS: SPH is an excellent question for surveillance because it is highly associated with psychological health but, at an individual level, it may convey different meanings depending on the person's individual interpretation of the term health. Symptomatic social avoidance may be high among servicemen who have a poor/fair SPH and methods, such as buddy support, may be helpful in decreasing isolation among those who may need professional support.

Is the increased reporting of symptomatic ill health in Gulf War veterans related to how one asks the question?

BACKGROUND: Following the 1991 Gulf War (GW) there was much controversy surrounding service-related health effects. Evidence from the Vietnam experience suggested that self-reported ill health following that conflict might be related to how service during the conflict is framed. The aim of this article is to determine if a GW health effect persisted when the same questions were asked in a "non-GW" context. METHOD: Prevalence of physical and psychological health problems were ascertained in a study assessing health screening from a random sample of UK Armed Forces. Record linkage between the screening survey and service history was conducted to obtain information on participation in the GW. RESULTS: Differences in health outcomes were found between the GW and the non-GW groups. This difference existed for symptomatic measures (OR=1.84, 95% CI, 1.17-2.91) rather than psychological or behavioral measures. No differences were found in psychological measures such as PTSD or behavioral measures such as alcohol consumption. Those deployed to the GW had a poorer self-perception of health (OR=1.47, 95% CI 1.02-2.11). CONCLUSIONS: Even in the absence of framing, a Gulf-related ill health effect was found.

Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study.

BACKGROUND: Questionnaires completed respectively by doctor and patient may give conflicting views of what actions the doctor took during a consultation in primary care. This disagreement will affect an assessment of whether patient expectations of care were met, and may itself be influenced by fulfillment of expectations. OBJECTIVE: To investigate how patient expectations, and patient and doctor reports of doctor's actions in a primary care setting are associated. DESIGN: Questionnaire survey. SETTING: Fifty Royal Navy, Army and Royal Air Force medical centres. PARTICIPANTS: A total of 117 members of the British Armed Forces with a health problem identified by a screening questionnaire, and their medical officers. MAIN OUTCOME MEASURES: Patient and doctor reports following a consultation indicating whether the doctor gave a prescription, made a referral or did tests, and patient expectations of these outcomes. RESULTS: Agreement between patient and doctor (kappa) was 0.81 for prescribing, 0.69 for referral and 0.54 for tests. The prevalence of unmet expectations was higher when estimated from doctors' reports than from patients' reports (prescription P=0.016; referral P=0.065; tests P=0.092; difference of 6% in each case). Patient and doctor were more likely to disagree on what happened if the action reported by the doctor did not match the patient's expectations (all P<0.01, except for when doctor reported doing tests P=0.058). CONCLUSION: Whether or not a doctor's actions appear to fulfil patient expectations in a primary care consultation depends on whether those actions are reported by the doctor or the patient.