Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis

Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police

Robotic-arm assisted versus conventional unicompartmental knee arthroplasty : exploratory secondary analysis of a Randomised Controlled Trial

Objectives: This study reports on a secondary exploratory analysis of the early clinical outcomes of an randomised clinical trial comparing Robotic-arm Assisted Uni-compartmental Knee Arthroplasty (UKA) for medial compartment osteoarthritis of the knee compared to Manual UKA performed using traditional surgical jigs. This follows reporting of primary outcomes of implant accuracy and gait analysis that showed significant advantages in the Robotic-arm assisted group.Methods139 patients were recruited from a single centre. Patients were randomised to receive either a manual UKA implanted with the aid of traditional surgical jigs, or a UKA implanted with the aid of a tactile guided Robotic-arm Assisted system. Outcome measures included: American Knee Society Score (AKSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Hospital Anxiety Depression (HAD) Scale, University of California at Los Angeles (UCLA) Activity Scale, SF-12, Pain Catastrophising Scale (PCS), Somatic Disease (Primary care evaluation of mental disorders [PRIME-MD] score), Pain Visual Analogue Scale (VAS), Analgesic use, Patient Satisfaction, complications relating to surgery, 90 day Pain diaries and the requirement for revision surgery.ResultsFrom day 1 post-operation through to week 8 post-operation the median pain scores for Robotic-arm Assisted group were 55.4% lower than those observed in the Manual surgery group (p = 0.040). A greater proportion of patients receiving Robotic-arm Assisted surgery improved their UCLA activity score.At 3 months post-operation, the Robotic-arm Assisted group had better AKSS scores (Robotic median 164 (Quarter 1 131, Quarter 3 178), Manual 143 (Quarter 1 132, Quarter 3 166)), although no difference was noted with the OKS.At 1 year post-operation, the observed differences with the AKSS had narrowed from 21 points to 7 points (p = 0.106) (Robotic median=171 (Quarter 1 153, Quarter 3 179), Manual median=164 (Quarter 1 144, Quarter 3 182 No difference was observed with the OKS, and almost half of each group reached the ceiling limit of the score (OKS > 43).The key factors associated with achieving excellent outcome on the AKSS were a pre-operative activity level > 5 on the UCLA activity score and use of Robotic-arm surgery. Factors associated with a poor outcome were manual surgery and pre-operative depression.Conclusions: Robotic-arm assisted surgery results in improved early pain scores and early function scores in some patient reported outcomes measures, but no difference was observed, at 1 year post operatively. Although improved results favoured the Robotic arm assisted group in active patients (i.e. UCLA > = 5), these do not withstand more stringent multiplicity adjustments

Electromagnetic navigation in total knee arthroplasty—a single center, randomized, single-blind study comparing the results with conventional techniques

We report on the results of a randomized study (n = 200) to compare total knee arthroplasty performed using conventional instrumentation or electromagnetic computer assisted surgical technique. 92% of navigated and 85% of conventional knees were implanted within ± 3° from neutral mechanical alignment; there was no statistically significant difference between these proportions. There was also no difference in femoral or tibial rotation assessed by CT scan. At 1 year follow up there was no statistical difference between the two groups in American Knee Society Score, Oxford Knee Scores, patient satisfaction, quality of life, hospital length of stay, complication rates or other adverse events. Tourniquet time in the navigated group was longer. Proving value for navigation in total knee arthroplasty surgery remains a challenge

Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty : a prospective randomized controlled trial

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001)

Are professional young rugby league players eating enough? Energy intake, expenditure and balance during a pre-season.

Due to the unique energetic demands of professional young collision sport athletes, accurate assessment of energy balance is required. Consequently, this is the first study to simultaneously investigate the energy intake, expenditure and balance of professional young rugby league players across a pre-season period. The total energy expenditure of six professional young male rugby league players was measured via doubly labelled water over a fourteen-day assessment period. Resting metabolic rate was measured and physical activity level calculated. Dietary intake was reported via Snap-N-Send over a non-consecutive ten-day assessment period, alongside changes in fasted body mass and hydration status. Accordingly, energy balance was inferred. The mean (standard deviation) difference between total energy intake (16.73 (1.32) MJ.day-1) and total energy expenditure (18.36 (3.05) MJ.day-1) measured over the non-consecutive ten-day period was unclear (-1.63 (1.73) MJ.day-1; ES = 0.91 ±1.28; p = 0.221). This corresponded in a most likely trivial decrease in body mass (-0.65 (0.78) kg; ES = 0.04 ±0.03; p = 0.097). Resting metabolic rate and physical activity level across the fourteen-day pre-season period was 11.20 (2.16) MJ.day-1 and 1.7 (0.2), respectively. For the first time, this study utilises gold standard assessment techniques to elucidate the distinctly large energy expenditures of professional young rugby league players across a pre-season period, emphasising a requirement for equally large energy intakes to achieve targeted body mass and composition adaptations. Accordingly, it is imperative that practitioners regularly assess the energy balance of professional young collision-sport athletes to ensure their unique energetic requirements are achieved

Stage-Specific Inhibition of MHC Class I Presentation by the Epstein-Barr Virus BNLF2a Protein during Virus Lytic Cycle

gamma-herpesvirus Epstein-Barr virus (EBV) persists for life in infected individuals despite the presence of a strong immune response. During the lytic cycle of EBV many viral proteins are expressed, potentially allowing virally infected cells to be recognized and eliminated by CD8+ T cells. We have recently identified an immune evasion protein encoded by EBV, BNLF2a, which is expressed in early phase lytic replication and inhibits peptide- and ATP-binding functions of the transporter associated with antigen processing. Ectopic expression of BNLF2a causes decreased surface MHC class I expression and inhibits the presentation of indicator antigens to CD8+ T cells. Here we sought to examine the influence of BNLF2a when expressed naturally during EBV lytic replication. We generated a BNLF2a-deleted recombinant EBV (ΔBNLF2a) and compared the ability of ΔBNLF2a and wild-type EBV-transformed B cell lines to be recognized by CD8+ T cell clones specific for EBV-encoded immediate early, early and late lytic antigens. Epitopes derived from immediate early and early expressed proteins were better recognized when presented by ΔBNLF2a transformed cells compared to wild-type virus transformants. However, recognition of late antigens by CD8+ T cells remained equally poor when presented by both wild-type and ΔBNLF2a cell targets. Analysis of BNLF2a and target protein expression kinetics showed that although BNLF2a is expressed during early phase replication, it is expressed at a time when there is an upregulation of immediate early proteins and initiation of early protein synthesis. Interestingly, BNLF2a protein expression was found to be lost by late lytic cycle yet ΔBNLF2a-transformed cells in late stage replication downregulated surface MHC class I to a similar extent as wild-type EBV-transformed cells. These data show that BNLF2a-mediated expression is stage-specific, affecting presentation of immediate early and early proteins, and that other evasion mechanisms operate later in the lytic cycle

Review of the effectiveness of on-site habitat management to reduce atmospheric nitrogen deposition impacts on terrestrial habitats

1. Given the widespread impacts on habitats in the UK it is essential to understand how habitat management measures could mitigate N deposition impacts and promote recovery. This project reviews the effectiveness of ‘on-site’ land management methods to mitigate nitrogen deposition impacts on sensitive habitats; assesses what effect current management practice has on habitat response to nitrogen deposition; considers how measures may be affected by climate change; and recommends realistic and practical management measures for different habitat types which could be used to mitigate nitrogen impacts or speed recovery. 2. The potential for management to mitigate N deposition impacts was considered across the following broad habitats: broadleaved, mixed and yew woodland & (natural) coniferous woodland; neutral grassland; calcareous grassland; acid grassland; dwarf shrub heath; bog; coastal dunes and slacks; other coastal habitats. For all habitats we were able to identify management techniques with some potential to mitigate N deposition impacts. 3. Management techniques may improve habitat suitability (e.g. control dominant species), remove nitrogen from the system, or both. 4. However, all management techniques also have unintended consequences meaning that their implementation might conflict with other conservation priorities. 5. There are a range of schemes and handbooks providing habitat management advice in the UK. The following techniques were reviewed in detail: grazing; cutting; burning; fertilisation; liming; hydrological management; scrub and tree management; disturbance. 6. Current management may already be partially offsetting the impact of N deposition. 7. Management for N is unlikely to make habitats more vulnerable to climate change. There is complementarity in the management options required to tackle N deposition and climate change. The frequency or intensity of measures such as grazing, cutting or burning will all need to increase. Regional variation in climate change may lead to different emphasis of management options in the wetter north west and the drier south east. 8. Climate change will alter habitat sensitivity to N deposition, via changes in ecosystem processes. Overall, climate change will make woodlands less sensitive to N deposition, but will make heathlands more sensitive to N deposition. Effects on other habitats have not yet been evaluated. 9. There is some potential for mitigating the impacts of N deposition through on-site management although this varies greatly between habitat and management practice. It is likely that small changes in management and adherence to appropriate guidelines could partially improve habitat suitability and/or increase N removal. 10. The majority of management practices do not remove significant quantities of N (with the exception of removing biomass or topsoil). Furthermore, management of a suitable intensity to remove sufficient N to fully offset N added by atmospheric deposition is likely to damage the habitat and result in a number of unintended consequences. 11. Further research is needed to determine the impacts of individual management practices on the N budget in different habitats. Further research is also needed to explore the potential for novel management techniques to remove N from sites. 12. For an individual site where N is identified as a pressure, a manager can look at current management and compare this with the management recommendations in the report to make changes where appropriate. 13. All management recommendations that remove N from the site move it elsewhere and have the potential for unintended consequences. Consequently there is no substitute for reducing the amount of N deposited onto a site which can only be achieved through emission controls

Improving pneumonia case-management in Benin: a randomized trial of a multi-faceted intervention to support health worker adherence to Integrated Management of Childhood Illness guidelines

<p>Abstract</p> <p>Background</p> <p>Pneumonia is a leading cause of death among children under five years of age. The Integrated Management of Childhood Illness strategy can improve the quality of care for pneumonia and other common illnesses in developing countries, but adherence to these guidelines could be improved. We evaluated an intervention in Benin to support health worker adherence to the guidelines after training, focusing on pneumonia case management.</p> <p>Methods</p> <p>We conducted a randomized trial. After a health facility survey in 1999 to assess health care quality before Integrated Management of Childhood Illness training, health workers received training plus either study supports (job aids, non-financial incentives and supervision of workers and supervisors) or "usual" supports. Follow-up surveys were conducted in 2001, 2002 and 2004. Outcomes were indicators of health care quality for Integrated Management-defined pneumonia. Further analyses included a graphical pathway analysis and multivariable logistic regression modelling to identify factors influencing case-management quality.</p> <p>Results</p> <p>We observed 301 consultations of children with non-severe pneumonia that were performed by 128 health workers in 88 public and private health facilities. Although outcomes improved in both intervention and control groups, we found no statistically significant difference between groups. However, training proceeded slowly, and low-quality care from untrained health workers diluted intervention effects. Per-protocol analyses suggested that health workers with training plus study supports performed better than those with training plus usual supports (20.4 and 19.2 percentage-point improvements for recommended treatment [p = 0.08] and "recommended or adequate" treatment [p = 0.01], respectively). Both groups tended to perform better than untrained health workers. Analyses of treatment errors revealed that incomplete assessment and difficulties processing clinical findings led to missed pneumonia diagnoses, and missed diagnoses led to inadequate treatment. Increased supervision frequency was associated with better care (odds ratio for recommended treatment = 2.1 [95% confidence interval: 1.13.9] per additional supervisory visit).</p> <p>Conclusion</p> <p>Integrated Management of Childhood Illness training was useful, but insufficient, to achieve high-quality pneumonia case management. Our study supports led to additional improvements, although large gaps in performance still remained. A simple graphical pathway analysis can identify specific, common errors that health workers make in the case-management process; this information could be used to target quality improvement activities, such as supervision (ClinicalTrials.gov number NCT00510679).</p

Hypothalamic volume loss is associated with reduced melatonin output in Parkinson's disease.

BACKGROUND: Recent studies have suggested that melatonin-a hormone produced by the pineal gland under circadian control-contributes to PD-related sleep dysfunction. We hypothesized that degenerative changes to the neural structures controlling pineal function (especially the suprachiasmatic nuclei of the anterior hypothalamus) may be responsible for reduced melatonin output in these patients. We compared hypothalamic volumes in PD patients with matched controls and determined whether volume loss correlated with reduced melatonin output in the PD group. METHODS: A total of 12 PD patients and 12 matched controls underwent magnetic resonance imaging to determine hypothalamic volume. In addition, PD patients underwent 24-hour blood sampling in a controlled environment to determine serum melatonin concentrations using enzyme-linked immunosorbent assays. RESULTS: PD patients had significantly reduced hypothalamic gray matter volume when compared with matched controls. Melatonin levels were significantly associated with hypothalamic gray matter volume and disease severity in PD patients. CONCLUSION: Melatonin levels are associated with hypothalamic gray matter volume loss and disease severity in PD patients. This provides anatomical and physiological support for an intrinsic sleep and circadian phenotype in PD. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.The authors would like to acknowledge the study funders: the Big Lottery Fund (C498A738) and Parkinson’s UK (J-0802). The research was supported by a National Institute of Health Research Biomedical Research Award (to Addenbrooke’s Hospital/University of Cambridge), the Wellcome Trust (103838, 100333/Z/12/Z) and a Raymond and Beverly Sackler Studentship (to DPB). We would like to thank staff at the Wellcome Trust Clinical Research Facility in Addenbrooke’s Hospital, Cambridge for performing the melatonin blood sampling.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/mds.2659

Narrative explorations into the professional development of lecturers teaching higher education in English further education colleges

The diversification of settings in which higher education is delivered has resulted in a growing proportion of lecturers entering teaching from professional backgrounds. This is a challenging transition as lecturers are rarely given the space to consider the implications of this move on their identities and practice styles. Writing is recognised as a powerful methodology through which individuals can make sense of experiences and conceptualise them in light of historical, theoretical and social perspectives. In this paper we consider the experiences of 10 college lecturers who used writing to explore this transition as part of a professional development initiative to promote their writing skills. They were providing higher education in further education colleges across South West England. This project ran over two years, involving a year-long professional development intervention and a subsequent evaluation. Over this time the lecturers produced a number of written pieces. We present the different styles and forms of writing used, and how these engaged with their emergent voices and growing sense of legitimacy. We highlight how writing can provide a reflexive medium and assist in the identification of developmental goals, something particularly valuable during professional transitions