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Caldwell HAT, Arthur M, Simms A, Mawhinney H, Hancock Friesen CL, Kirk SFL. Development and implementation of a municipal outdoor play policy for children and youth in Nova Scotia, Canada: a community case study. Front Public Health 2024; 12:1334767. [PMID: 38510347 PMCID: PMC10950929 DOI: 10.3389/fpubh.2024.1334767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.
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Affiliation(s)
| | - Mike Arthur
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | | | - Hannah Mawhinney
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Camille L. Hancock Friesen
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Children’s Nebraska and University of Nebraska Medical Center, Omaha, NE, United States
| | - Sara F. L. Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
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2
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Holland TJ, Simms A, Lamb D, King K. Influence of employment characteristics on seeking help for mental health conditions in the UK Defence Medical Services. BMJ Mil Health 2023:e002570. [PMID: 37989533 DOI: 10.1136/military-2023-002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Toby James Holland
- Academic Department of Military General Practice, Research and Clinical Innnovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - D Lamb
- Academic Department of Military Nursing, Research and Clinical Innovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
| | - K King
- Academic Department of Military General Practice, Research and Clinical Innnovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
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Adler AB, Gutierrez IA, McCuaig Edge H, Nordstrand AE, Simms A, Willmund GD. Peer-based intervention for acute stress reaction: adaptations by five militaries. BMJ Mil Health 2023:military-2022-002344. [PMID: 37280014 DOI: 10.1136/military-2022-002344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023]
Abstract
Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.
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Affiliation(s)
- Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - I A Gutierrez
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - H McCuaig Edge
- Director General Military Personnel Research and Analysis, National Defence, Ottawa, Ontario, Canada
| | - A E Nordstrand
- Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - G D Willmund
- Centre for Psychiatry and Psychotraumatology, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Gorecka M, Jex N, Thirunavukarasu S, Chowdhary A, Poenar AM, Sharrack N, Swoboda PP, Xue H, Vassiliou V, Kellman P, Plein S, Simms A, Greenwood JP, Levelt E. Evaluation of cardiac involvement in patients with clinical post-COVID-19 syndrome. Eur Heart J 2022. [PMCID: PMC9619493 DOI: 10.1093/eurheartj/ehac544.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magnetic resonance spectroscopy (31P-MRS) allows non-invasive assessment of the myocardial energetic state. Purpose We sought to assess whether Post-COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and tissue characteristics or energetic derangement. Methods Prospective case-control study. A total of 20 patients with a clinical diagnosis of Post-COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and ten matching controls underwent 31P-MRS and CMR at 3T at a single time point. (Figure 1) All patients had been symptomatic with acute COVID-19, but none required hospital admission. Results Between the Post-COVID-19 syndrome patients and matched contemporary controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes, left ventricular mass), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 and extracellular volume [ECV] fraction mapping, late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with Post-COVID-19 syndrome showed subepicardial hyperenhancement on the late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, ECV, T1, T2 mapping or energetics. This patient was excluded from statistical analyses. (Table 1) Conclusion In this study, the overwhelming majority of patients with a clinical Post-COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Welcome Trust Clinical Career Development Fellowship (221690/Z/20/Z);NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254)ESC Training Grant
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Affiliation(s)
- M Gorecka
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - N Jex
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - S Thirunavukarasu
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A M Poenar
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - N Sharrack
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - P P Swoboda
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - V Vassiliou
- University of East Anglia , Norwich , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - S Plein
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A Simms
- Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - J P Greenwood
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - E Levelt
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
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Lamb D, Simms A, Greenberg N, Withnall RDJ. Caring for the carers: a COVID-19 psychological support programme. BMJ Mil Health 2021; 168:153-159. [PMID: 34144951 DOI: 10.1136/bmjmilitary-2021-001854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 11/03/2022]
Abstract
The outbreak of COVID-19 and the subsequent pandemic brought unprecedented worldwide challenges born out of a rapidly escalating health and economic crisis. From emergency planners to healthcare workers on the front line, and everyone in between, the pandemic, and the uncertainty surrounding it, was likely to become a significant stressor, one with no immediate solution but with the potential to cause enduring distress beyond its conclusion. The UK Defence Medical Services recognised the need to provide an evidence-based programme of care intended to support personnel transitioning from assisting the national response back to normal duties. This was informed by a narrative review that targeted literature exploring strategies for supporting the mental health and well-being of healthcare workers during 21st-century infectious disease outbreaks. The literature identified the experiences most likely to cause enduring distress, which comprised morally challenging decisions, vulnerability, death and suffering, professional and personal challenges, and expectations. The opportunity to find meaning in these experiences, by discussing them with peers who share a contextual understanding, is important to limit the longer-term psychosocial impact of such events. This paper will discuss the design considerations and planned implementation strategy of the Recovery, Readjustment and Reintegration Programme to limit the incidence of distress or longer-term mental ill health among military personnel.
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Affiliation(s)
- Di Lamb
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - R D J Withnall
- Headquarters DMS, Defence Medical Services, Lichfield, UK
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Lawrence EG, Jones N, Greenberg N, Fear NT, Wessely S, Michael G, Taylor-Beirne S, Simms A. Mental well-being interventions in the military: The ten key principles. BMJ Mil Health 2021; 168:179-180. [PMID: 33911012 DOI: 10.1136/bmjmilitary-2020-001740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/04/2022]
Abstract
Organisations including the United Kingdom Armed Forces should seek to implement mental health interventions to increase the psychological well-being of their workforce. This editorial briefly presents ten key principles that military forces should consider before implementing such interventions. These include job-focused training; evaluating interventions; the use of internal versus external training providers; the role of leaders; unit cohesion, single versus multiple session psychological interventions; not overgeneralising the applicability of interventions; the need for repeated skills practice; raising awareness and the fallibility of screening.
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Affiliation(s)
- Erin G Lawrence
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Wessely
- Academic Department of Military Mental Health, King's College London, London, UK.,King's Centre for Military Health Research, King's College London, London, UK
| | - G Michael
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Taylor-Beirne
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
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Harden L, Jones N, Whelan C, Phillips A, Simms A, Greenberg N. A systematic review of psychological training or interventions given to UK military personnel prior to deployment. BMJ Mil Health 2020; 167:63-69. [PMID: 33109732 DOI: 10.1136/bmjmilitary-2019-001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.
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Affiliation(s)
- Larissa Harden
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - C Whelan
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
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Abstract
Background Concerns are being raised about the impact of inadequate safety equipment on the mental health of healthcare workers during the COVID-19 medical response. Aims To assess the impact of inadequate safety equipment on the mental health of service personnel deployed on operations in order to better understand the impact on those working under the similarly demanding conditions of the COVID-19 medical response. Methods Self-report surveys were conducted in four operational environments with 3435 personnel providing data. Surveys recorded data on socio-demographic, military and operational characteristics, mental health measures and specific occupational stressors. Analysis through logistic regression explored the association between inadequate equipment and all other factors. Results A total of 3401 personnel provided data on their perceptions of the adequacy of their equipment, of which 532 (15%) stated that they had a lot of concerns that they did not have the right equipment in working order. Analysis found significantly greater odds of reporting symptoms of common mental health disorders (CMD), 2.49 (2.03–3.06), post-traumatic stress disorder (PTSD), 2.99 (2.11–4.24), poorer global health 2.09 (1.62–2.70) and emotional problems 1.69 (1.38–2.06) when individuals reported working with inadequate equipment. Analyses remained significant when adjusted for confounding factors such as rank, sex and operational environment. Conclusions An individual’s perception of having inadequate equipment is significantly associated with symptoms of CMD, probable PTSD, poorer global health and increased reporting of emotional problems. This in turn may impact on their ability to safely carry out their duties and may have longer-term mental health consequences.
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Affiliation(s)
- A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Health Protection Research Unit, Weston Education Centre, King's College London, London, UK
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Lee E, Singh H, Simms A, Restall G, Shafer L, Walker J, Park J. A169 DEVELOPMENT OF A DECISION TOOL TO IMPROVE UTILISATION OF RECOMMENDED SURVEILLANCE INTERVALS FOR INDIVIDUALS WITH COLORECTAL POLYPS: A FOCUS GROUP ANALYSIS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Several studies have demonstrated a high utilization of colonoscopy at shorter and longer time intervals than guideline recommendations. Innovative methods are required to increase adherence to recommended timing.
Aims
1) Explore current approaches used by endoscopist (EPs) and primary care providers (PCPs) to determine and communicate colonoscopy surveillance intervals (SI) between EPs, PCPs, and patients.
2) Obtain feedback for refining a decision tool to facilitate recommended SI.
3) Determine participant agreement of recommended SIs with current guidelines.
Methods
We conducted 4 focus groups (FGs); 3 FGs included EPs (n=12) and EPs in training (n=6); 1 FG included PCPs (n=4). FG questions explored use of guidelines, communication and follow-up practices with PCPs, EPs and patients, and challenges to follow-up.
Participants were also asked for feedback about a prototype polyp SI decision tool that was developed using an algorithm synthesizing current Canadian Association of Gastroenterology, US Multisociety Task Force, and expert panel guidelines on SI. FGs were audio-recorded and transcribed for qualitative content analysis. FGs were analysed separately, then compared for similarities and differences. Finally, participants individually made interval recommendations for 7 common endoscopy scenarios. Responses were analyzed for agreement with the guidelines used to develop the decision tool.
Results
EPs reported not routinely referring to guidelines and were confident in their memory of the intervals although some reported checking occasionally. Many indicated they may use the tool in a web based or mobile application for more complicated scenarios, although some would never use it. Concerns regarding the tool included being up to date with research evidence and having required data to input on hand. PCPs reported the tool may be useful as a communication aid to involve patients in decision making. A challenge noted in all FGs was role confusion regarding communicating, tracking, and scheduling patients’ future procedures on time.
Analysis of EPs (n=9) responses to the 7 scenarios showed that percent agreement with guidelines was low: 44% scored below 50% correct. Participants with the highest agreement scored 6/7; responses with the lowest agreement scored 0/7. The most common score was 3/7.
Conclusions
EPs appeared to be overconfident in their recommendations, but many were open to trying a website or mobile application decision tool to make evidence-based colonoscopy SI recommendations. Understanding, among PCPs and EPs, regarding responsibility for communicating results and scheduling follow-up surveillance for patients was inconsistent. Participant feedback informed development of a mobile application that is currently being pilot tested.
Funding Agencies
Research Manitoba
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Affiliation(s)
- E Lee
- University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
| | - A Simms
- University of Manitoba, Winnipeg, MB, Canada
| | - G Restall
- University of Manitoba, Winnipeg, MB, Canada
| | - L Shafer
- University of Manitoba, Winnipeg, MB, Canada
| | - J Walker
- University of Manitoba, Winnipeg, MB, Canada
| | - J Park
- University of Manitoba, Winnipeg, MB, Canada
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Jones N, Jones M, Greenberg N, Phillips A, Simms A, Wessely S. UK military women: mental health, military service and occupational adjustment. Occup Med (Lond) 2020; 70:235-242. [DOI: 10.1093/occmed/kqaa019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Recently, the UK Armed Forces have revised the ground close combat role to include women.
Aims
To assess the potential mental health impact of this initiative we examined gender differences in deployment patterns, work strain, occupational factors, mental health, alcohol use and help-seeking following operational deployment.
Methods
The study was a secondary analysis of self-report survey data; 8799 men (88%) and 1185 women (12%) provided data. A sub-sample (47%, n = 4659) provided data concerning post-deployment help-seeking. The latter consisted of 408 women (8.8%) and 4251 men (91%).
Results
With the exception of alcohol misuse, which was significantly lower for women, women reported significantly more common mental disorder symptoms, subjective depression and self-harm. Women were significantly more likely to seek help from healthcare providers. Men were significantly more likely to have deployed operationally and for longer cumulative periods. Subjective work strain, but not job control, was significantly lower for women whose military careers were significantly shorter. Post-traumatic stress disorder (PTSD) symptom intensity was similar to men.
Conclusions
With the exception of PTSD and alcohol misuse, UK military women experience more mental health-related problems than military men. This finding was not related to the more arduous aspects of military service as women served for shorter times, deployed less and for shorter cumulative periods and were less likely to report work-related stress.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - M Jones
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - S Wessely
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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12
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Affiliation(s)
- E R Brown
- ERS Brown, Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK.
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Bowden JCS, Williams LJ, Simms A, Price A, Campbell S, Fallon MT, Fearon KCH. Prediction of 90 Day and Overall Survival after Chemoradiotherapy for Lung Cancer: Role of Performance Status and Body Composition. Clin Oncol (R Coll Radiol) 2017; 29:576-584. [PMID: 28652093 DOI: 10.1016/j.clon.2017.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 01/26/2023]
Abstract
AIMS If appropriate patients are to be selected for lung cancer treatment, an understanding of who is most at risk of adverse outcomes after treatment is needed. The aim of the present study was to identify predictive factors for 30 and 90 day mortality after chemoradiotherapy (CRT), and factors that were prognostic for overall survival. MATERIALS AND METHODS A retrospective cohort study of 194 patients with lung cancer who had undergone CRT in South East Scotland from 2008 to 2010 was undertaken. Gender, age, cancer characteristics, weight loss, body mass index (BMI), performance status (Eastern Cooperative Oncology Group; ECOG) and computed tomography-derived body composition variables were examined for prognostic significance using Cox's proportional hazards model and logistic regression. RESULTS The median overall survival was 19 months (95% confidence interval 16.3, 21.7). Four of 194 patients died within 30 days of treatment completion, for which there were no independent predictive variables; 22/194 (11%) died within 90 days of treatment completion. BMI < 20 and ECOG performance status ≥2 were independent predictors of death within 90 days of treatment completion (P = 0.001 and P = 0.004, respectively). Patients with either BMI < 20 or ECOG performance status ≥ 2 had an odds ratio of death within 90 days of 5.97 (95% confidence interval 2.20, 16.19), rising to an odds ratio of 13.27 (1.70, 103.47) for patients with both BMI < 20 and ECOG performance status ≥ 2. Patients with low muscle attenuation had significantly reduced overall survival (P = 0.004); individuals with low muscle attenuation had a median survival of 15.2 months (95% confidence interval 12.7, 17.7) compared with 23.0 months (95% confidence interval 18.3, 27.8) for those with high muscle attenuation, equating to a hazard ratio of death of 1.62 (95% confidence interval 1.17, 2.23, P = 0.003). CONCLUSION Poor performance status, low BMI and low muscle attenuation identify patients at increased risk of premature death after CRT. Risk factors for adverse outcomes should inform personalised discussions with patients about the potential harms as well as the intended benefits of treatment.
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Affiliation(s)
- J C S Bowden
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; University of St Andrews, St Andrews, UK; NHS Fife, Kirkcaldy, UK.
| | - L J Williams
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - A Price
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
| | | | - M T Fallon
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
| | - K C H Fearon
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
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Evans T, Siah T, Simms A. Audit of the use of screening computed tomography (CT) head in Stage III non-small cell lung cancer patients. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Lown M, Munyombwe T, Harrison W, West R, Hall C, Morrell C, Jackson B, Sapsford R, Kilcullen N, Pepper C, Batin P, Hall A, Gale C, Simms A. P2-206 Association of FAAR score on admission ECG with mortality in 1843 patients admitted with an acute coronary syndrome. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Accurate information on short-term prognosis is needed to help patients, their doctors, and society to make appropriate decisions concerning starting dialysis. We sought to develop a clinically applicable prognostic scoring system to aid in the prediction of death within 6 months of starting maintenance dialysis. Factors potentially predictive of early death were examined retrospectively in an inception cohort of all 325 patients starting dialysis for irreversible renal failure between 1980 and 1991 at a single tertiary care center. The overall mortality rate was 22% at 6 months. Age, cardiac failure, ischemic heart disease, dysrhythmia requiring therapy, severe peripheral vascular disease, advanced neoplasia, ventilator dependency, coma, systemic sepsis, and hepatic failure were independent, significant, prognostic indicators for early death. Multivariate models were used to suggest weights for these variables in a simplified scoring system. Patients with scores < or = 4 (N = 201) had a 6-month mortality rate of 4%, whereas those with a score higher than 9 (N = 21) had a 6-month mortality rate of 100%. Thus, when age and multiple comorbid illnesses were taken into account, it was possible to identify with 100% accuracy 29% of the patients who died within 6 months of starting maintenance dialysis therapy, accounting for 6.5% of the cohort studied. A larger prospective study is warranted to validate this scoring system.
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Affiliation(s)
- R N Foley
- Division of Clinical Epidemiology, Memorial University of Newfoundland, St John's
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