Narrative review of the impact of clinical psychiatry attachments on attitudes to psychiatry

Aims and method Psychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.Results We identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.Clinical implications The results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed

Glutathione S-Transferase M1 Genetic Polymorphism Is Associated With Salivary 17-βestradiol Levels: A Study Based On Hormonal Profiles From Entire Menstrual Cycles

Introduction: Studies suggest that enzymes involved in the estrogen metabolic pathway are susceptibility factors for breast cancer; however, there is limited direct evidence in relation to estradiol levels. The glutathione-S-transferase M1 enzyme (GSTM1) enzyme is involved in estrogen peroxidation, and a shortage seems to enhance estrogen exposure. A homozygous deletion of the GSTM1 gene leads to total absence of enzyme activity, and studies indicate that an association with breast cancer risk may be modified by body mass. So far, parallel studies on intermediate biomarkers (i.e. estradiol) are largely missing. Thus, in the present study, we assessed the association between a GSTM1 genetic polymorphism (null/rs1065411) and daily salivary levels of 17-βestradiol throughout one entire menstrual cycle and evaluated modification of genotype effects according to metabolic profile in 190 premenopausal women aged 25-35 years. Methods: The women participated in the Energy Balance and Breast Cancer Aspects study (EBBA-I, 2000-2002) in Tromsø, North Norway (inclusion criteria: healthy, non-pregnant, non-lactating, no current use of exogenous hormones). Salivary levels of 17-βestradiol were assessed by radioimmunoassay (The Reproductive Ecology Laboratory, Harvard University). Height and weight were measured. Genomic DNA was extracted from EDTAwhole blood. GSTM1 genotyping was done on the ABI PRISM® 3100 Genetic Analyzer (Fred Hutchinson Cancer Research Center). The GSTM1 assay distinguishes between the GSTM1*Aallele (G nucleotide, Lys at aminoacid 173), the GSTM1*B allele (C nucleotide, Asn at aminoacid 173), and the homozygous gene deletion. Regression models were used to study the relation between genetic (null genotype versus all other alleles combined) and metabolic susceptibility factors, and levels of 17-βestradiol. Results: Mean body mass index (BMI) was 24.4 kg/m2. The homozygous gene deletion of GSTM1 had a prevalence of 52%, and the frequency of the null genotype was similar in heavy women (BMI ≥26.3 kg/m2, upper quartile) as compared to other women (p = .18). The null genotype was associated with lower levels of 17-βestradiol by cycle day compared to other alleles (p = .04). However, the association was confined to women that were normal weight to slightly overweight (p for interaction = .01). In women with BMI < 26.3 kg/m2, the null genotype was associated with significantly lower levels of 17-βestradiol by cycle day compared to other alleles (p = .02) and an 18% reduction in overall average level of 17-β estradiol throughout the cycle (p = .02), while in heavy women no association with estradiol levels was observed. Conclusion: In our study, GSTM1 genotype was a significant determinant of circulating estradiol levels in premenopausal women without marked adiposity. Thus, interestingly our results strongly support that the effect of body mass on estradiol levels and subsequent breast cancer development may be modified by GSTM1 genotype.AnthropologyHuman Evolutionary Biolog

Editorial: Zooplankton and Nekton: Gatekeepers of the Biological Pump

International audienceEditorial on the Research Topic Zooplankton and Nekton: Gatekeepers of the Biological Pump Zooplankton and nekton organisms create and destroy particles in manifold ways. They feed on the diverse components of the plankton community and on detrital matter. They disaggregate these components, but also repackage them into fecal pellets. Zooplankton and nekton thereby contributes to the attenuation, but also to the export of vertically settling particles. Many zooplankton and nekton organisms also ascend to the surface layer of the ocean at dusk to feed during the dark hours, and return to midwater at the break of dawn. This diurnal vertical migration (DVM) shuttles organic matter from the surface ocean to deeper layers, where it is metabolized and excreted. This active flux (as opposed to the passive flux of sinking particles) can contribute substantially to the biological pump, the downward export of carbon and nutrients into the oceans interior. Due to their multiple roles in oceanic particle dynamics, zooplankton and nekton organisms can actually be considered the gatekeepers of the biological pump. Several articles in this Research Topic deal with the contribution of zooplankton and nekton-mediated active flux to the total export of organic matter. Using biomass and enzyme transport system (ETS) assessments of respiratory flux for both mesozooplankton and micronekton communities, Hernández-León et al. estimated the total active transport of carbon (respiration, excretion, mortality, and egestion) along a transect in the Atlantic from the Canary Islands to Brazil. They found that active flux by these communities ranged from 25 to 80% of the total particulate organic carbon export at 150 m depth and that the importance of active flux increased with increasing surface productivity. Kwong et al. compared biomass, diel vertical migration, and active flux of mesozooplankton and micronekton across a range of mesoscale eddy structures along the east-coast of Australia during winter and spring. They found that although all eddy regimes had similar integrated biomass of mesozooplakton and micronekton, the organisms in the individual eddies had different migratory behavior, which resulted in contrasting importance of active flux. Kiko et al. assessed the impact of mesozooplankton DVM on elemental cycling at three stations in the Eastern Tropical North Atlantic. They found that approximately 31 to 41% of the total nitrogen loss from the upper 200 m of the water column was attributable to DVM mediated fluxes. They also suggest that gut flux-the flux created by migrators when they evacuate their gut at DVM-depth-and migrator mortality at DVM-depth contribute to an Intermediate Particle Maximum. In their study conducted in the Peruvian upwelling system (which features a severe midwater oxygen minimum zone), Kiko and Hauss concluded that the metabolic suppressio

'Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school'.

BACKGROUND: The use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure. METHODS: Zimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4-5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback. RESULTS: Post-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was "helpful", "enjoyable" and "boosted confidence". CONCLUSIONS: In Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors

The early Neolithic of Iraqi Kurdistan: current research at Bestansur, Shahrizor Plain

Human communities made the transition from hunter-foraging to more sedentary agriculture at multiple locations across southwest Asia through the Early Neolithic (ca. 10,000-7000 BC). Societies explored strategies involving increasing management and development of plants, animals, materials, technologies and ideologies specific to each region whilst sharing some common attributes. Current research in the eastern Fertile Crescent is contributing new insights into the Early Neolithic transition and the critical role that this region played. The Central Zagros Archaeological Project (CZAP) is investigating this transition in Iraqi Kurdistan, including at the earliest Neolithic settlement so far excavated in the region. In this article, we focus on results from ongoing excavations at the Early Neolithic site of Bestansur on the Shahrizor Plain (Sulaimaniyah province), in order to address key themes in the Neolithic transition

Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers

Background Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/ Afghanistan or who have post-traumatic stress disorder (PTSD). Aims To examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD. Method Fathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview. Results In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age. Conclusions This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study

<p>Abstract</p> <p>Background</p> <p>The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts.</p> <p>Methods</p> <p>Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants).</p> <p>Results</p> <p>The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants.</p> <p>Conclusion</p> <p>The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.</p