Poor sleep after military deployment: associations with mental health difficulties.

BACKGROUND: Sleep difficulties, alcohol use and mental illness are often related; military studies suggest that post-deployment is a high-risk period for sleep problems. AIMS: To examine the prevalence of post-deployment sleep difficulties in UK Armed Forces (UKAF) personnel and associations with alcohol use disorders (AUD) and any mental disorder (AMD) symptoms. METHODS: A prospective, self-report, observational study of UKAF members returning from Afghanistan, questionnaire data were collected immediately following and 6 months post-deployment. RESULTS: A total of 1636 participants provided study data at both time points. Twenty-three per cent of personnel reported sleep difficulties at follow-up; 11% reported sleep-related interference with daily functioning. Sleep problems were significantly associated with AUD and AMD. Initial post-deployment sleep problems were predictive of AMD but not AUD at follow-up. CONCLUSIONS: The disclosure of alcohol misuse and mental ill-health in UKAF personnel is often inhibited by stigmatizing beliefs; detection could be enhanced by inquiring about sleep problems which may be less stigmatizing than direct enquiries about alcohol misuse and psychological well-being.

The Arabidopsis thaliana/Myzus persicae model system demonstrates that a single gene can influence the interaction between a plant and a sap-feeding insect.

We have developed an Arabidopsis thaliana/Myzus persicae model system to allow the dissection of plant/insect interactions at a molecular genetic level. This allows the examination of the role of single plant genes in the interaction between the plant and an aphid. Our initial studies have exploited an Arabidopsis genotype in which the function of the amino acid transporter ANT1 has been abolished. This mutation results in a change in the proportions of several amino acids within the phloem sieve elements (SEs) resulting in an increase in the proportion of essential amino acids. This has been measured using aphid stylectomy to collect SE samples, followed by a novel micellar electrokinetic chromatography method for amino acid analysis. The SE content represents the aphid's diet, and use of electrical penetration graph technology and honeydew clocks have demonstrated that this altered diet results in a change in the feeding rate of the aphid. Balance sheets can be produced to show the amount (nmoles/24 h) of each of 18 amino acids taken up and excreted by aphids feeding on wild type and ant1 mutant plants. The data show that aphids feeding on the ant1 mutant take up larger amounts of amino acids. However, we could not detect any effect on the reproductive rate of the aphids. The results show that, under experimental conditions, this model system can be used to identify plant genes that control the behaviour and fecundity of an insect pest.

Effect of St. John's wort on free radical production.

St. John's wort (Hypericum perforatum) is an herbal compound used in the treatment of burns, bruises, swelling, anxiety, and most recently, mild to moderate depression. The present study was designed to evaluate the antioxidant properties of St. John's wort in both cell-free and human vascular tissue. The experiment was performed initially in a cell-free system using Krebs buffer and a combination of xanthine/xanthine oxidase to initiate the production of the superoxide radical. Additionally, human placental vein was incubated in Krebs buffer without xanthine or xanthine oxidase to study the effects of St. John's wort on human tissue in vitro. Commercially available formulations of St. John's wort, standardized to either hypericin or hyperforin, were dissolved in an alkaline solution, and the following dilutions were made: 1:1, 1:2.5, 1:5, 1:7.5, 1:10, and 1:20. Lucigenin chemiluminescence was used to measure free radical production in both systems. A pro-oxidant effect was seen at the highest concentration, 1:1. Lower concentrations revealed antioxidant properties of the compound. All dilutions below 1:1 in both systems showed a dose-related inverse relationship of superoxide inhibition. The largest suppression was seen at the most dilute concentration, 1:20. The addition of 10(-3) M tiron inhibited the chemiluminescence signal, thereby confirming the production of superoxide. The results of this study suggest that St. John's wort inhibits free radical production in both cell-free and human vascular tissue.

Prospective study of patients' subjective responses to botulinum toxin injection for spasmodic dysphonia.

Adductor spasmodic dysphonia (SD) is a speech disorder resulting from involuntary contractions of the laryngeal muscles. Botulinum toxin (BT) injection of the thyroarytenoid muscle is an effective, though temporary, treatment for most SD patients. Though there are reports of objective improvements in voice quality, there are no large studies of patients' subjective responses to treatment over time. In the present study, patients were given voice diaries to rate vocal spasms, hoarseness, breathiness, volume problems, and dysphagia before and the after treatment. Analysis of these diaries revealed that: (1) most side effects had resolved 4 to 6 weeks after injection, whereas vocal spasm relief persisted; (2) vocal spasm relief and severity of side effects peaked within 1 week; and (3) unilateral injections, though as effective in relieving vocal spasms, caused less volume and swallowing problems than did bilateral injections.

Effects of botulinum toxin type A injections on aerodynamic measures of spasmodic dysphonia.

The effects of botulinum toxin type A (BOTOX) injections on aerodynamic measures of phonation were examined in 30 patients with adductor spasmodic dysphonia. Patients received bilateral injections of 2.5 U of botulinum toxin type A in each thyroarytenoid muscle. Measures of air pressure, average airflow, coefficient of variation (CV) of airflow, and laryngeal resistance were obtained before the injections and at 2 and 10 weeks after the injections. These measures were also obtained from 12 normal subjects. Compared with normal subjects, the spasmodic dysphonia patients had significantly higher preinjection values for air pressure, CV of airflow, and laryngeal resistance. At 2 and 10 weeks after the botulinum toxin type A injections, the spasmodic dysphonia patients showed a significant increase in the average airflow values and a significant decrease in the CV of airflow values and the laryngeal resistance values. At 10 weeks after the injections, the values for the three measures began to approach the preinjection values. It is concluded that these aerodynamic measures of phonation can provide useful measures of treatment outcome in adductor spasmodic dysphonia.

Comparison of botulinum toxin injection procedures in adductor spasmodic dysphonia.

This study compares the effects of unilateral and bilateral thyroarytenoid muscle injections of botulinum toxin in 50 patients with adductor spasmodic dysphonia. Patients were randomly assigned to two treatment groups of 25 patients each and a group of 15 normal control subjects was also included. Using a standard electromyographic guidance procedure, one patient group received unilateral thyroarytenoid muscle injections of 15 units of botulinum toxin, while the second patient group received bilateral thyroarytenoid muscle injections of 2.5 units of botulinum toxin on each side. Follow-up data were obtained at 2- and 6-week intervals. Acoustic and perceptual measures of vocal performance included maximum phonation time, fundamental frequency, standard deviation of fundamental frequency, jitter, shimmer, signal/noise ratio, voice break frequency, spasm severity rating, and vocal breathiness rating. Unilateral and bilateral group comparisons at 2-weeks postinjection revealed no significant difference on any of the measures examined. At 6-weeks postinjection, maximum phonation time was significantly lower in the bilateral group. All other measures failed to differentiate the two patient groups. These results suggest that standard unilateral and bilateral botulinum toxin injections provide equivalent degrees of improvement in the symptoms of spasmodic dysphonia. However, bilateral injections appear to be associated with a longer period of excessive phonatory airflow than do unilateral injections.

Effect of neuromuscular activity on the response to botulinum toxin injections in spasmodic dysphonia.

Spasmodic dysphonia (SD), a neurologic disorder characterized by involuntary vocal spasms during speech, has been effectively treated by injections of botulinum toxin (BT) into the laryngeal muscles. The aim of the present study was to determine if the therapeutic response to BT is enhanced by immediate and continuous activation of the injected muscles. Twenty SD patients were randomized into two groups following bilateral injections: vocal rest for 30 minutes and continuous vocalization for 30 minutes. Evaluations consisted of voice ratings by expert observers, acoustic measurements using computer analyses, and laryngeal aerodynamic measurements. The findings suggest that vocal rest, rather than vocalization, produces a superior and longer lasting response in SD patients receiving BT injections. It is recommended that SD patients refrain from post-injection vocalization to maximize the therapeutic effects of BT.

Laryngeal image analysis following botulinum toxin injections in spasmodic dysphonia.

The injection of botulinum toxin (BT) into laryngeal muscles has proven to be an effective treatment for spasmodic dysphonia (SD), a neurologic disorder characterized by intermittent vocal spasms during speech. BT treatment has reduced abnormal laryngeal muscle hyperactivity in SD patients, when measured by subjective visual rating scales. This paper utilizes images obtained from endoscopic laryngeal video recordings to quantify changes in pre- and post-injection parameters of 17 patients following bilateral BT injections. A previous study, utilizing perceptual, acoustic, and laryngeal aerodynamic measures, showed significant improvements following treatment with BT. In addition, post-injection vocal rest, rather than vocalization, enhanced therapeutic responses. Results of these measures are compared with data from the image analyses and those parameters that proved to be the most useful are highlighted.

Unilateral versus bilateral botulinum toxin injections in spasmodic dysphonia: acoustic and perceptual results.

The present study compared the effects of unilateral and bilateral thyroarytenoid injections of botulinum toxin (botox) for the treatment of adductor spasmodic dysphonia. Using electromyographic guidance, 15 patients received unilateral botox injections of 15 units each and 11 patients received bilateral injections of 2.5 units in each site. Acoustic recordings of the patient's voice were made prior to injection and at two- and six-week intervals after injection. Both the unilateral and bilateral botox injections were associated with significant improvements in spasmodic dysphonia. This was determined by the acoustic measures of vocal shimmer and the number of voice breaks per second and by the perceptual measures of voice spasm severity. Both types of injections were also associated with a significant increase in vocal breathiness at two weeks post-injection. In addition, a number of acoustic measures including maximum phonation time, vocal jitter, and the number of voice breaks/second indicated that unilateral botox injections may provide both superior and longer lasting benefits than bilateral botox injections.

Formation and persistence of a DNA adduct in rodents treated with N-nitrosopyrrolidine.

The rate of formation and the persistence of an exocyclic guanine adduct formed in DNA of rodents treated with various doses of N-nitrosopyrrolidine (NPYR) have been determined. NPYR is hepatocarcinogenic to the rat and forms a covalent adduct in liver DNA; this adduct was recently identified as 2-amino-6,7,8,9-tetrahydro-9-hydroxypyrido[2, 1-f]purine-4[3H]-one. Dose-dependent amounts of adduct formed in liver, kidney and lung DNA of rats, hamsters and mice given oral doses (56-900 mg/kg body wt) of NPYR. The persistence of the adduct in DNA after administration of low doses of NPYR to rats was greatest in the target organ, i.e. the liver; at high doses of NPYR, adduct levels in DNA changed little over a period of at least 72 h. In the hamster, in which NPYR is carcinogenic to the lung but apparently not the liver, the adduct level in liver DNA was an order of magnitude greater than in lung or kidney DNA for a dose of NPYR of 225 or 900 mg/kg body wt; persistence of the adduct in lung DNA was only slightly longer than in liver DNA. The formation and persistence of the 7,8-pyridoguanine adduct in the rat appeared to be consistent with the organotropy of this carcinogen, but this was not true for the hamster, a species that seems to be more resistant to induction of liver and kidney cancer by this carcinogen. Imidazole, an inhibitor of microsomal amine oxidase, and disulfiram, an inhibitor of aldehyde dehydrogenase, decreased metabolic activation of NPYR to an alkylating intermediate; inducers and inhibitors of cytochrome P450 monooxygenases had little effect on the metabolic activation of NPYR to an alkylating agent.

Child custody mediation: an interdisciplinary synthesis.

The high divorce rate and increasing number of children affected by divorce have paralleled major changes both in divorce law and in the ways in which social conflicts are resolved. Principles of contemporary law and conflict resolution are joined with the findings of research on child development in families of divorce in a conceptual synthesis relevant to the practice of child custody mediation.

An outbreak of Salmonella typhimurium gastroenteritis in a psychiatric hospital.

An outbreak of Salmonella typhimurium (phage type 12) infection involving 11 patients and 12 members of staff occurred in a psychiatric hospital in Merseyside during a 3-week period in September and October 1984. Bacteraemia did not occur in any patients, those affected having a mild self-limiting diarrhoea. The source of the organism remained unknown but the most probable means of transmission was by person to person contact. The outbreak was controlled by transferring affected patients to an isolation ward. Staff were encouraged to report gastrointestinal symptoms and remain off work until symptom free or until the results of cultures were known. The problems of managing the outbreak are discussed.

Inhibition of methacholine-induced bronchoconstriction with reproterol, a new beta agonist-xanthine derivative.

This study compared the efficacy of single oral doses of a new beta adrenergic agonist-xanthine derivative, reproterol, with placebo by measuring the degree of induced bronchodilation and inhibition of response to methacholine challenge in patients with bronchial asthma. In comparison with placebo, 30 mg reproterol was an effective bronchodilator. Attenuation of the response, but not complete blockage of the methacholine-induced bronchoconstriction, was observed with 30 mg reproterol. Methacholine-induced bronchoconstriction is of use in assessing effect and mechanism of the action of new pharmacologic agents.