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Biomedical subjects

Neil Greenberg

Publications and source records attributed to Neil Greenberg.

At least 19 recordsLinked to original sources
PubMed2006

The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study.

BACKGROUND: Concerns have been raised about the mental and physical health of UK military personnel who deployed to the 2003 war in Iraq and subsequent tours of duty in the country. METHODS: We compared health outcomes in a random sample of UK armed forces personnel who were deployed to the 2003 Iraq war with those in personnel who were not deployed. Participants completed a questionnaire covering the nature of the deployment and health outcomes, which included symptoms of post-traumatic stress disorder, common mental disorders, general wellbeing, alcohol consumption, physical symptoms, and fatigue. FINDINGS: The participation rate was 62.3% (n=4722) in the deployed sample, and 56.3% (n=5550) in the non-deployed sample. Differences in health outcomes between groups were slight. There was a modest increase in the number of individuals with multiple physical symptoms (odds ratio 1.33; 95% CI 1.15-1.54). No other differences between groups were noted. The effect of deployment was different for reservists compared with regulars. In regulars, only presence of multiple physical symptoms was weakly associated with deployment (1.32; 1.14-1.53), whereas for reservists deployment was associated with common mental disorders (2.47, 1.35-4.52) and fatigue (1.78; 1.09-2.91). There was no evidence that later deployments, which were associated with escalating insurgency and UK casualties, were associated with poorer mental health outcomes. INTERPRETATION: For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

Cohort Studies↗
PubMed2006

The importance of metrological traceability on the validity of creatinine measurement as an index of renal function.

The glomerular filtration rate (GFR) is currently considered the best overall index of kidney function. The possibility that laboratories might routinely report an estimated GFR has become practically feasible with the development of a formula, the "four-variable" Modification of Diet in Renal Disease study (MDRD) equation that uses age, sex, race, and serum creatinine parameters. However, a limitation of this equation for general implementation in healthcare is related to the use of differently calibrated creatinine measurement procedures among laboratories. The only way to achieve universal implementation of the GFR prediction equation, with the associated clinical benefits for patients, is, therefore, to promote worldwide standardization of methods to determine creatinine, together with the introduction of a revised GFR-estimating equation appropriate for use with standardized creatinine methods.

Carbon Radioisotopes↗
PubMed2006

Serving in Bosnia made me appreciate living in Bristol: stressful experiences, attitudes, and psychological needs of members of the United Kingdom Armed Forces.

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.

Adult↗
PubMed2005

Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program.

BACKGROUND: Reliable serum creatinine measurements in glomerular filtration rate (GFR) estimation are critical to ongoing global public health efforts to increase the diagnosis and treatment of chronic kidney disease (CKD). We present an overview of the commonly used methods for the determination of serum creatinine, method limitations, and method performance in conjunction with the development of analytical performance criteria. Available resources for standardization of serum creatinine measurement are discussed, and recommendations for measurement improvement are given. METHODS: The National Kidney Disease Education Program (NKDEP) Laboratory Working Group reviewed problems related to serum creatinine measurement for estimating GFR and prepared recommendations to standardize and improve creatinine measurement. RESULTS: The NKDEP Laboratory Working Group, in collaboration with international professional organizations, has developed a plan that enables standardization and improved accuracy (trueness) of serum creatinine measurements in clinical laboratories worldwide that includes the use of the estimating equation for GFR based on serum creatinine concentration that was developed from the Modification of Diet in Renal Disease (MDRD) study. CONCLUSIONS: The current variability in serum creatinine measurements renders all estimating equations for GFR, including the MDRD Study equation, less accurate in the normal and slightly increased range of serum creatinine concentrations [<133 micromol/L (1.5 mg/dL)], which is the relevant range for detecting CKD [<60 mL.min(-1).(1.73 m2)(-1)]. Many automated routine methods for serum creatinine measurement meet or exceed the required precision; therefore, reduction of analytical bias in creatinine assays is needed. Standardization of calibration does not correct for analytical interferences (nonspecificity bias). The bias and nonspecificity problems associated with some of the routine methods must be addressed.

Calibration↗
PubMed2005

Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners.

OBJECTIVES: To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. DESIGN: A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. SETTING: Interviews took place between 18 and 20 July. PARTICIPANTS: 1010 participants (10% of the eligible people we contacted) completed the interviews. MAIN OUTCOME MEASURES: Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. RESULTS: 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. CONCLUSIONS: Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.

Adolescent↗
PubMed2005

Does serotonin influence aggression? comparing regional activity before and during social interaction.

Serotonin is widely believed to exert inhibitory control over aggressive behavior and intent. In addition, a number of studies of fish, reptiles, and mammals, including the lizard Anolis carolinensis, have demonstrated that serotonergic activity is stimulated by aggressive social interaction in both dominant and subordinate males. As serotonergic activity does not appear to inhibit agonistic behavior during combative social interaction, we investigated the possibility that the negative correlation between serotonergic activity and aggression exists before aggressive behavior begins. To do this, putatively dominant and more aggressive males were determined by their speed overcoming stress (latency to feeding after capture) and their celerity to court females. Serotonergic activities before aggression are differentiated by social rank in a region-specific manner. Among aggressive males baseline serotonergic activity is lower in the septum, nucleus accumbens, striatum, medial amygdala, anterior hypothalamus, raphe, and locus ceruleus but not in the hippocampus, lateral amygdala, preoptic area, substantia nigra, or ventral tegmental area. However, in regions such as the nucleus accumbens, where low serotonergic activity may help promote aggression, agonistic behavior also stimulates the greatest rise in serotonergic activity among the most aggressive males, most likely as a result of the stress associated with social interaction.

Aggression↗
PubMed2005

What happens to British veterans when they leave the armed forces?

BACKGROUND: Little is known about the factors associated with leaving the armed forces, or what predicts subsequent employment success for veterans. It is likely that there is a complex interaction of adverse social outcomes and mental health status in this group. METHOD: Analysis of existing data from the King's Military Cohort, a large, randomly selected, longitudinal cohort of service personnel, many of whom have now left the armed forces. The sample consisted of 8195 service personnel who served in the armed forces in 1991; a third deployed to the Gulf (1990-91), a third deployed to Bosnia (1992-97) and the final third an 'Era' control group in the Armed Forces in 1991 but not deployed. RESULTS: The majority of service leavers do well after leaving and are in full-time employment. Those with poor mental health during service were more likely to leave and had a greater chance of becoming unemployed after leaving. Mental health problems appear to remain static for veterans after leaving. Veterans of the Gulf War enjoyed more favourable employment outcomes, provided that they came home well. CONCLUSIONS: Only a minority of veterans fare badly after service, even amongst those with active tours of duty behind them. Veterans with mental health problems during service seem to be at higher risk of social exclusion after leaving and therefore these individuals represent an especially vulnerable group of the veteran population.

Adult↗
PubMed2005

Does having an occupational mental health service make any difference?

BACKGROUND: The effects of mental disorder on UK's workforce are increasing, yet most occupational health (OH) providers have limited expertise in dealing with mental health issues. AIMS: To examine the effectiveness in terms of organizational and clinical outcomes, of an OH liaison psychiatry service in an inner city area. METHODS: A retrospective survey of case notes from the first 2 years of an OH liaison psychiatry service was carried out. RESULTS: Seventy-six cases were identified and 68% were seen within 1 month of referral. After assessment, females were significantly more likely to be given a formal psychiatric diagnosis than males. Overall, 45% of patients had mood disorders, 14% anxiety disorders and two cases of psychosis were identified. Advice was offered to the referring OH practitioner in 80% of cases. CONCLUSIONS: This study found that liaison psychiatrists were able to fulfil a useful role in an OH department. Most of the cases seen within the department would not be classed as serious mental illness and therefore it is unlikely that community mental health teams would become involved in their routine care. Specialist mental health support from an 'in house' service is likely to be of considerable benefit from both occupational and medical perspectives.

Adolescent↗
PubMed2005

'Goodbye and good luck': the mental health needs and treatment experiences of British ex-service personnel.

BACKGROUND: Little is known about the psychological health or treatment experiences of those who have left the British armed forces. AIMS: To describe the frequency and associations of common mental disorders and help-seeking behaviours in a representative sample of UK veterans at high risk of mental health problems. METHOD: A cross-sectional telephone survey of 496 'vulnerable' ex-service personnel selected from an existing epidemiological military cohort. RESULTS: The response rate was 64%; 44% of these had a psychiatric diagnosis, most commonly depression. Those with a diagnosis were more likely to be of lower rank and divorced or separated. Just over half of those with self-reported mental health problems were currently seeking help, most from their general practitioners. Most help-seekers received treatment, usually medication; 28% were in touch with a service charity and 4% were receiving cognitive-behavioural therapy. CONCLUSIONS: Depression is more common than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, and few see specialists.

Adult↗
PubMed2005

Going to war does not have to hurt: preliminary findings from the British deployment to Iraq.

We carried out a brief longitudinal mental health screen of 254 members of the UK's Air Assault Brigade before and after deployment to Iraq last year. Analysis of General Health Questionnaire (GHQ-28) scores before and after deployment revealed a lower score after deployment (mean difference=0.93, 95% CI 0.35-1.52). This indicated a highly significant relative improvement in mental health (P < 0.005). Moreover, only 9 of a larger sample of 421 (2%) exceeded cut-off criteria on the Trauma Screening Questionnaire. These findings suggest that war is not necessarily bad for psychological health.

Adolescent↗
PubMed2005

Soldier peer mentoring care and support: bringing psychological awareness to the front.

Since the Persian Gulf War of 1990-1991, the operational tempo for soldiers has steadily increased, whereas the numbers of soldiers available to fulfill these missions has decreased. As a result, soldiers and their families are experiencing increased levels of stress that continue to manifest in ways that can often be destructive for the soldiers, their families, and the Army community. Current mitigation and identification support systems such as the Chain of Command, noncommissioned officer leadership, chaplains, and family support systems have all provided critical services, but may not be expected to optimally perform necessary early risk management assessment. Behavioral health care as a self-referral system is often still perceived as career ending, shameful, or even culturally unacceptable. Our allies have also experienced similar family, operational, and combat concerns. In 1996, at the direction of their Commandant General, the British Royal Marines developed and instituted a peer-driven risk management and support system that has experienced a high degree of success and acceptance among its forces-enough so that the Royal Navy is now in the process of implementing a similar program. The Soldier Peer Mentoring and Support program, as part of the proposed deployment Cycle Support Program, is a model for peer group assessment based on the British Royal Marines psychological risk management and support system. This article presents and describes this project, which has been considered for use within the U.S. Army, as a potential augmenter of existing behavioral health support assets as a culturally acceptable, company-level support program in deployment and home stations.

Combat Disorders↗
PubMed2004

Dynamics and mechanics of social rank reversal.

Stable social relationships are rearranged over time as resources such as favored territorial positions change. We test the hypotheses that social rank relationships are relatively stable, and although social signals influence aggression and rank, they are not as important as memory of an opponent. In addition, we hypothesize that eyespots, aggression and corticosterone influence serotonin and N-methyl-D: -aspartate (NMDA) systems in limbic structures involved in learning and memory. In stable adult dominant-subordinate relationships in the lizard Anolis carolinensis, social rank can be reversed by pharmacological elevation of limbic serotonergic activity. Any pair of specific experiences: behaving aggressively, viewing aggression or perceiving sign stimuli indicative of dominant rank also elevate serotonergic activity. Differences in the extent of serotonergic activation may be a discriminating and consolidating factor in attaining superior rank. For instance, socially aggressive encounters lead to increases in plasma corticosterone that stimulate both serotonergic activity and expression of the NMDA receptor subunit 2B (NR(2B)) within the CA(3) region of the lizard hippocampus. Integration of these systems will regulate opponent recognition and memory, motivation to attack or retreat, and behavioral and physiological reactions to stressful social interactions. Contextually appropriate social responses provide a modifiable basis for coping with the flexibility of social relationships.

Aggression↗
PubMed2004

Combination of pulsed-wave Doppler and real-time three-dimensional color Doppler echocardiography for quantifying the stroke volume in the left ventricular outflow tract.

Real-time three-dimensional (3-D) color Doppler echocardiography (RT3D) is capable of quantifying flow. However, low temporal resolution limits its application to stroke volume (SV) measurements. The aim of the present study was, therefore, to develop a reliable method to quantify SV. In animal experiments, cross-sectional images of the LV outflow tract were selected from the RT3D data to calculate peak flow rates (Q(p3D)). Conventional pulsed-wave (PW) Doppler was performed to measure the velocity-time integral (VTI) and the peak velocity (V(p)). By assuming that the flow is proportional to the velocity temporal waveform, SV was calculated as alpha x Q(p3D) x VTI/V(p), where alpha is a temporal correction factor. There was an excellent correlation between the reference flow meter and RT3D SV (mean difference = -1. 3 mL, y = 1. 05 x -2. 5, r = 0. 94, p < 0. 01). The new method allowed accurate SV estimations without any geometric assumptions of the spatial velocity distributions.

Animals↗
PubMed2004

Screening for depleted uranium in the United Kingdom armed forces: who wants it and why?

BACKGROUND: Depleted uranium (DU) use has been implicated in the poor health of many service personnel who have served in the Gulf and the Balkans. Although the health related risks are thought to be small the UK government has offered to set up a voluntary screening programme for service personnel. This study aimed to find out the characteristics and possible exposures to DU for those personnel who desire DU screening. METHODS: This study looks at 2369 UK service personnel who were asked if they wanted to be screened for DU. Subjects were asked about their perceived exposure to deployment associated risks including DU and a number of psychological health measures. RESULTS: The study found that 24% of the cohort wanted screening, a figure that if extrapolated to all those who have been offered screening would represent 36720 requests for screening. Those who wanted DU screening were younger, of lower rank, and more likely to be from the Royal Navy or Army rather than the Royal Air Force. Those requesting DU screening reported poorer health both subjectively and as measured by the GHQ-12 and a symptom checklist. They also reported more exposure to DU and to other deployment associated risks while in military service. Using combat exposure as a proxy for a significant risk of having been exposed to DU, there was a significant correlation. CONCLUSIONS: This study found that the desire for DU screening is more closely linked to current health status rather than plausible exposure to DU.

Attitude to Health↗
PubMed2003

Sociality, stress, and the corpus striatum of the green anolis lizard.

The green anolis lizard, Anolis carolinensis, is a uniquely convenient species with great potential for providing insights about the causes and consequences of social behavior from an evolutionary perspective. In this species, social interactions are mediated by visual displays in which specific units of behavior are combined in various ways to communicate several more-or-less specific messages. Two related research programs that utilize this species converge in provocative ways to provide insight into this phenomenon. The first program is centered on the basal ganglia, now known to be crucial to the expression of aggressive territoriality in this species, and the second research program examines the way the physiological stress response is involved in aggression and its subsequent adaptive outcomes. Both the neural and the neuroendocrine systems affect the progress of social interactions as well as the subsequent social dominance relationships when combatants subsequently live together. Further, because body color depends almost exclusively on the stress response, skin color provides a unique in situ bioassay of otherwise inaccessible information about the animal's internal state. The fullest understanding of the physiological ethology of this model species will depend on an interdisciplinary approach that considers both proximate (physiological) and ultimate (evolutionary) causes of displays. Questions thus arising include how the nervous system controls and assembles the specific units of behavior-motor patterns and autonomic reflexes-into displays that are adaptive in specific contexts.

Animals↗
PubMed2003

Comparative value of single-beat load-independent contractility indices in dilated cardiomyopathy and mitral regurgitation.

OBJECTIVE: We sought to compare single-beat estimates of contractility indices. METHODS: Echocardiography was performed for 6 control patients, 8 patients with dilated cardiomyopathy, and 9 patients with mitral regurgitation (MR). Left ventricular volume waveform, outflow tract velocities, and mitral annulus velocities were recorded with carotid tonometry. Numeric simulations were used to generate the same data while varying contractility, compliance, and MR. Estimates of elastance (normalized systolic and bilinearly approximated), preload-recruitable stroke work, and preload-adjusted maximal power were calculated. RESULTS: Normalized systolic and bilinearly approximated elastance were decreased in patients with dilated cardiomyopathy (P <.005 for both) and MR (P =.0002 and.02, respectively). Preload-recruitable stroke work and preload-adjusted maximal power were decreased in patients with dilated cardiomyopathy only (P <.005 for both). Simulations confirmed that these differences are a result of dissimilar behavior of estimates if MR or compliance change. CONCLUSIONS: Single-beat indices are decreased in dilated cardiomyopathy, but in MR show dissimilar behavior.

Adult↗