Above and beyond the call. Long-term real earnings effects of British male military conscription in the post-war years

We add to the literature on the long-term economic effects of male military service. We concentrate on post-war British conscription into the armed services from 1949 to 1960. It was called National Service and applied to males aged 18 to 26. Based on a regression discontinuity design we estimate the effect of military service on the earnings of those required to serve through conscription. We argue that, in general, we should not expect to find large long-term real earnings among conscripts compared to later birth cohorts of males who were not eligible for call-up. Our empirical evidence firmly rejects the view that conscription entails relative long-term real earnings differences

Genome-wide association study of borderline personality disorder reveals genetic overlap with the bipolar disorder, schizophrenia and major depression

Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of Bipolar Disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case-control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was: (i) to detect genes and gene-sets involved in BOR; and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, Major Depression (MDD) and Schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests,and gene-set-analyses were performed in 998 BOR patients and 1,545 controls. LD score regression was used to detect genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Genebased analysis yielded two significant genes: DPYD (p=4.42x10-7) and PKP4 (p=8.67x10-7); and gene-set-analysis yielded a significant finding for exocytosis (GO:0006887, pFDR=0.019). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [p=2.99x10-3]), SCZ (rg=0.34 [p=4.37x10-5]), and MDD (rg=0.57 [p=1.04x10-3]). Our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes

publisher: Elsevier articletitle: Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes journaltitle: Cell articlelink: https://doi.org/10.1016/j.cell.2018.05.046 content_type: article copyright: © 2018 Elsevier Inc

Genetics of affective (mood) disorders

The enormous public health importance of mood disorders, when considered alongside their substantial heritabilities, has stimulated much work, predominantly in bipolar disorder but increasingly in unipolar depression, aimed at identifying susceptibility genes using both positional and functional molecular genetic approaches. Several regions of interest have emerged in linkage studies and, recently, evidence implicating specific genes has been reported; the best supported include BDNF and DAOA but further replications are required and phenotypic relationships and biological mechanisms need investigation. The complexity of psychiatric phenotypes is demonstrated by (a) the evidence accumulating for an overlap in genetic susceptibility across the traditional classification systems that divide disorders into schizophrenia and mood disorders, and (b) evidence suggestive of gene-environment interactions

Medical students observing a primary care consultation: does student gender affect patient consent?

Clinical placement is an important aspect of undergraduate education in the United Kingdom (UK) but with no national curriculum for primary care teaching, it is important to consider the learning opportunities afforded to students when on these rotations. In earlier years, observing consultations constitutes a large proportion of student experience, with patient consent an integral aspect of this teaching method. This study investigated whether patients consider the gender of a medical student when granting consent for their primary care appointment to be observed and whether this was conditional based on their presenting complaint. In total, 551 adult participants (420 females and 131 males) residing in the UK, aged 18–87 years, responded to an online questionnaire. In total, 229 (41.6%) participants stated that they would be influenced by the student’s gender when consenting to observation, notably if the presenting complaint concerned an intimate area or their sexual health. A statistically significant correlation was revealed for consent, participant age and participant gender, with younger female respondents less likely to consent to observation by male students. The findings highlight a potential concern pertaining to equal opportunities between medical students based on gender, with inclusivity and diversity considerations for medical schools and clinicians

A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health

The introduction of case-based learning (CBL) by the School of Medicine at Cardiff University has encouraged innovation in medical teaching and learning. During years one and two of the modernized MBBCh program, students complete 17 cases as part of the newly developed C21 curriculum that emphasizes a patient-oriented and student-centered approach to learning. The mental health case, which is presented in year 2, incorporates a number of novel teaching resources that aim to enhance the students’ learning experience and to further reinforce the patient-oriented and community-based philosophy of C21. These include the use of fictionalized video diaries, virtual patient cases, e-learning workbooks, an interactive practical session, and community placements. Novel teaching methods and resources were evaluated by students in terms of effectiveness and value as learning resources through the administration of a structured mixed questionnaire. The results revealed that students valued the inclusion of these resources, which they evaluated as having contributed to their understanding of the subject area. Furthermore, the case was found to have had an impact on student interest in psychiatry as a specialty as well as a career choice. The positive student evaluation of this case supports the innovations in teaching delivery inspired by C21

MP 1 Epilepsy in adults with bipolar disorder [Conference Abstract]

Objective It is known that people with epilepsy are at an increased risk of depression, anxiety, completed suicide, bipolar symptoms and personality disorders. What is not known is what effect comorbid epilepsy has on the natural history of bipolar disorder. Method 1242 adults with bipolar disorder were recruited into a genetic cohort study and undertook a structured interview and a number of scaled tests. Data were also collected for self-declared comorbid conditions including epilepsy. Results 39 people had co-existing epilepsy (3.14%) representing a RR of 4.2 for epilepsy in bipolar disorder. This increased to an RR of 38 if there was a family history of epilepsy. People with epilepsy and bipolar disorder are more likely to have more mixed episodes, worse depression, as measured by BDI, BADDS and GAS, worse current manic symptoms, as measured by AMS and less likely to have rapid cycling of attacks. Conclusion Epilepsy does not affect the onset of the first bipolar episode, nor the frequency of affective events. However, depressive symptoms are more severe during a relapse and ongoing mood has many hypomanic characteristics. The origins of hypomanic and depressive symptoms may underpin the shared genetic causes of bipolar disorder and some epilepsies. They represent an attractive tool for endophenotyping in both bipolar disorder and epilepsy