Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

Purpose: Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods: We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945–1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results: There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21–1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50–1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions: The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated

Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants

<b>Background:</b> The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.<p></p> <b>Method:</b> We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score <4, and poor mental health as a GHQ score ≥4. Logistic regression models were applied. Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87–0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05–1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p < 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.<p></p> <b>Conclusions:</b> The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.<p></p&gt

Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level

Childhood IQ and risk of bipolar disorder in adulthood: prospective birth cohort study

Background: Intellectual ability may be an endophenotypic marker for bipolar disorder. Aims: Within a large birth cohort, we aimed to assess whether childhood IQ (including both verbal IQ (VIQ) and performance IQ (PIQ) subscales) was predictive of lifetime features of bipolar disorder assessed in young adulthood. Method: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK birth cohort, to test for an association between measures of childhood IQ at age 8 years and lifetime manic features assessed at age 22–23 years using the Hypomania Checklist-32 (HCL-32; n=1881 individuals). An ordinary least squares linear regression model was used, with normal childhood IQ (range 90–109) as the referent group. We adjusted analyses for confounding factors, including gender, ethnicity, handedness, maternal social class at recruitment, maternal age, maternal history of depression and maternal education. Results: There was a positive association between IQ at age 8 years and lifetime manic features at age 22–23 years (Pearson's correlation coefficient 0.159 (95% CI 0.120–0.198), P>0.001). Individuals in the lowest decile of manic features had a mean full-scale IQ (FSIQ) which was almost 10 points lower than those in the highest decile of manic features: mean FSIQ 100.71 (95% CI 98.74–102.6) v. 110.14 (95% CI 107.79–112.50), P>0.001. The association between IQ and manic features was present for FSIQ, VIQ and for PIQ but was strongest for VIQ. Conclusions: A higher childhood IQ score, and high VIQ in particular, may represent a marker of risk for the later development of bipolar disorder. This finding has implications for understanding of how liability to bipolar disorder may have been selected through generations. It will also inform future genetic studies at the interface of intelligence, creativity and bipolar disorder and is relevant to the developmental trajectory of bipolar disorder. It may also improve approaches to earlier detection and treatment of bipolar disorder in adolescents and young adults

Early adoption of screening and the changing pattern of cervical cancer in UK Military women: evidence from the Scottish Veterans Health Study

Objective: To examine the risk of cervical cancer in a large national cohort of military veteran women followed up for up to 30 years. Methods: Retrospective cohort study of 5235 veteran women born between 1945 and 1985, and 20 703 women with no record of service matched for age and area of residence, using Cox proportional hazard models to compare the overall risk of cervical cancer and by year of birth. Results: During the follow-up period 1981–2012, there were 18 (0.34%) cases of cervical cancer in the veteran women compared with 81 (0.39%) in the non-veterans. The difference was not statistically significant overall (adjusted HR 0.95, 95% CI 0.57 to 1.59). When analysed by the year of birth, veteran women born in 1958 and earlier had a non-significantly higher risk than non-veterans (adjusted HR 1.24, 95% CI 0.68 to 2.26), while veteran women born after 1958 had a non-significant reduction in risk (adjusted HR 0.51, 95% CI 0.18 to 1.44). Conclusions: Women born after 1958 who have served in the Armed Forces are at reduced risk of cervical cancer compared with women who have never served, and compared with older veteran women. Small numbers of cases precluded statistical significance. The change in risk pattern in veteran women coincided with the introduction of cervical screening in the Armed Forces, which predated the UK national programme, and provides evidence for the long-term effectiveness of the Armed Forces’ sexual health strategy. The impact of recent changes in the screening age, and of human papillomavirus immunisation, should be monitored in the future

Screening families of patients with premature coronary heart disease to identify avoidable cardiovascular risk: a cross-sectional study of family members and a general population comparison group

<b>Background:</b> Primary prevention should be targeted at individuals with high global cardiovascular risk, but research is lacking on how best to identify such individuals in the general population. Family history is a good proxy measure of global risk and may provide an efficient mechanism for identifying high risk individuals. The aim was to test the feasibility of using patients with premature cardiovascular disease to recruit family members as a means of identifying and screening high-risk individuals. <b>Findings:</b> We recruited family members of 50 patients attending a cardiology clinic for premature coronary heart disease (CHD). We compared their cardiovascular risk with a general population control group, and determined their perception of their risk and current level of screening. 103 (36%) family members attended screening (27 siblings, 48 adult offspring and 28 partners). Five (5%) had prevalent CHD. A significantly higher percentage had an ASSIGN risk score >20% compared with the general population (13% versus 2%, p < 0.001). Only 37% of family members were aware they were at increased risk and only 50% had had their blood pressure and serum cholesterol level checked in the previous three years. <b>Conclusions:</b> Patients attending hospital for premature CHD provide a mechanism to contact family members and this can identify individuals with a high global risk who are not currently screened

Time trends in survival and readmission following coronary artery bypass grafting in Scotland, 1981-96: retrospective observational study

Improvements in coronary revascularisation techniques and an increase in the use of percutaneous interventions1 have led to a rise in the number of coronary artery bypass grafting operations in older patients with more severe cardiac disease and worse comorbidity and who have previously undergone revascularisation procedures. 2 3 Advances in surgical and anaesthetic techniques have prevented a worsening risk profile from being translated into an increase in perioperative deaths. 2 3 The aim of our study was to examine time trends in major outcomes up to two years after coronary artery bypass grafting

Fluorescence from a few electrons

Systems containing few Fermions (e.g., electrons) are of great current interest. Fluorescence occurs when electrons drop from one level to another without changing spin. Only electron gases in a state of equilibrium are considered. When the system may exchange electrons with a large reservoir, the electron-gas fluorescence is easily obtained from the well-known Fermi-Dirac distribution. But this is not so when the number of electrons in the system is prevented from varying, as is the case for isolated systems and for systems that are in thermal contact with electrical insulators such as diamond. Our accurate expressions rest on the assumption that single-electron energy levels are evenly spaced, and that energy coupling and spin coupling between electrons are small. These assumptions are shown to be realistic for many systems. Fluorescence from short, nearly isolated, quantum wires is predicted to drop abruptly in the visible, a result not predicted by the Fermi-Dirac distribution. Our exact formulas are based on restricted and unrestricted partitions of integers. The method is considerably simpler than the ones proposed earlier, which are based on second quantization and contour integration.Comment: 10 pages, 3 figures, RevTe

Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: a systematic review

Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery.  The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched.  Last search was 5 th August 2016.  Studies were included if they reported gestational age, IQ measure and the ages assessed.  The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472).  Two independent reviewers assessed the studies.  Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included.  For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing.  Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion:  Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks).  This should be considered when discussing timing of delivery.  For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores