Background Drinking motivations within the UK military have not been studied despite the high prevalence of alcohol misuse in this group. Aims We aimed to characterize drinking motivations and their demographic, military and mental health associations in UK serving and ex-serving personnel. Methods Serving and ex-serving personnel reporting mental health, stress or emotional problems occurring in the last 3 years were selected from an existing cohort study. A semi-structured telephone interview survey examined participants' mental health, help-seeking, alcohol use and drinking motivations. Results Exploratory factor analysis of drinking motivations in military personnel (n = 1279; response rate = 84.6%) yielded 2 factors, labelled 'drinking to cope' and 'social pressure'. Higher drinking to cope motivations were associated with probable anxiety (rate ratio [RR] = 1.4; 95% confidence interval 101 = 1.3-1.5), depression (RR = 1.3; 95% CI = 1.2-1.4) and post-traumatic stress disorder (RR = 1.4; 95% CI = 1.3 1.6). Higher social pressure motivations were associated with probable anxiety (odds ratio = 1.1; 95% CI = 1.0-1.1). Alcohol misuse and binge drinking were associated with reporting higher drinking to cope motivations, drinking at home and drinking alone. Conclusions Amongst military personnel with a stress, emotional or mental health problem, those who drink to cope with mental disorder symptoms or because of social pressure, in addition to those who drink at home or drink alone, are more likely to also drink excessively.

BACKGROUND:Rates of hazardous and harm-related drinking are higher in the military and veteran populations compared to the general population. Brief alcohol interventions (BAIs) targeting alcohol use appear to reduce harmful drinking in the general population. However, less is known about the efficacy of BAIs targeting alcohol in military and veteran populations.METHODS:A systematic review and meta-analysis was conducted to assess the type and efficacy of BAIs used to reduce alcohol use in military and veteran populations conducted from 2000 onwards. The meta-analysis was conducted using a standardised outcome measure of change in average weekly drinks (AWDs) from baseline to follow-up.RESULTS:The search revealed 10 papers that met the search criteria, and that reported data on 11 interventions included in the systematic review. 8 papers (reporting on 9 different interventions) were included in the meta-analysis after 2 papers were excluded for which the relevant outcome data were not available. There was no overall effect of BAIs; a non-significant weekly drink reduction of 0.95 drinks was found (95% CI, -0.17 to 2.07). This lack of efficacy persisted regardless of military group (conscripts, serving or veterans) and method of delivery (i.e., face-to-face, web-based or written information). Furthermore, sensitivity analyses revealed this small drink reduction was driven mainly by a single study.CONCLUSIONS:Based on these findings, existing BAIs do not seem to be efficacious in reducing alcohol use in military populations, despite some encouraging results from one electronic intervention which was of extensive duration.

Rhabdomyolysis is characterized by breakdown of striated muscle due to a great number of causes. Acute kidney injury (AKI) is a common complication as a consequence of high concentrations of circulating myoglobin (Mb). The AKI degree can vary but often requires dialysis, a condition which drastically worsens the ICU stay and prognosis. Since Mb overconcentration represents the cause of AKI, one of the therapy's aims should be its removal to prevent further kidney damage and to allow faster renal recovery. Both intermittent hemodialysis and high-volume CVVHF are poorly effective in removing Mb, while small-protein leakage membranes seem to be promising in this setting. The aim of our study was therefore to measure efficacy of Mb removal of a new high cutoff membrane (EMIC2; Fresenius, cutoff value 40 kDa) for continuous renal replacement therapies (CRRT) in the ICU setting.

Background There is considerable media, political and public interest on both sides of the Atlantic in an alleged rise in violence among military personnel returned from conflicts in Iraq and Afghanistan. This study explores violence among a large sample of UK military personnel, a proportion of whom had been deployed to Iraq/Afghanistan. The aims were to estimate the prevalence of self-reported violence, examine the impact of deployment and combat experiences on subsequent violence and the association with post-deployment mental health problems and alcohol misuse. Methods This study formed part of a questionnaire-based cohort study established to explore the impact of deployment on mental health among UK military personnel. The sample was randomly selected from all military personnel serving in the UK Armed Forces between 2003 and 2007. A total of 9986 participants from all Services were included, some had been deployed and some had been trained but not deployed. Special Forces were excluded. Data, collected by questionnaire, included information on deployment experiences, socio-demographic and military characteristics, pre-enlistment antisocial behaviour, and post-deployment health outcomes. The main violence outcomes were self –report measures of interpersonal violence. Results 6.2% of the sample reported interpersonal violence in the last month. Deployment showed a stronger association with subsequent violence among reservists (OR=2.98 (1.50–5.93),P=0.002) than among regulars (OR=1.26 (0.96–1.67),P=0.098) when compared to their non-deployed counterparts. Performing a combat role whilst deployed was associated with a significantly increased likelihood of violence among regulars (OR=1.90 (1.38–2.75), P<0.001) and the risk of violence increased with the number of traumatic events experienced (P<0.001)). Violence on homecoming was also associated with mental health problems such as PTSD (OR=4.8 (3.2–7.2) P<0.001) and alcohol misuse (OR=3.1 (2.5–3.9) P<0.001). Conclusion Military deployment, in particular combat exposure, increased the risk of subsequent violence among military personnel and the risk of violence increased with increasing number of traumatic events experienced on deployment. Valuable information on risk factors for violence among military personnel is provided, especially regarding increased risk among deployed reservists and among personnel who report post-deployment mental health problems and alcohol misuse.

Objective: Current tobacco smoking has been associated with headache. However it is not known if maternal smoking during pregnancy is associated with headache in their offspring. The aim of this research was evaluated the association between maternal smoking during pregnancy with headache in schol-aged children. Methods: Two prospective cohorts of 869 children aged 10-11 years from Ribeirao Preto (SP- Brazil) and 805 children aged 7-8 years from Sao Luis (MA- Brazil) were studied. Data on maternal smoking were collected at birth and data on headache and other confounding factors were collected at schol age using the same questionnaire completed by the mothers in the two cities. Primary headache was defined as a mother reporting that his/her child had ≥ 2 episodes of headache in the two last weeks, without any associated organic symtoms. The prevalence Rate Ratio (PRR) and its 95% confidence interval (95%CI) were calculated by Poisson regression. Results: Prevalence of headache was reported by the mother was 28.2% in RP and 12.8% in SL. After adjustment, children whose mothers smoked >= 10 cigarettes per dayduring the pregnancy presented higher prevalence of primary headache than their counterparts in both cohorts (PRR=1.63, 95%CI 1.10-2.42 in RP and PRR=2.98, 95%CI 1.34-6.63 in SL). Conclusions: In spite of adjusting for a long list of potential confounders, maternalsmoking during pregnancy was associated with headache in 7-11 years olds in two Brazilian cities of contrasting economic wealth.

BackgroundThere is considerable interest in understanding further the factors that increase the risk of post-traumatic stress disorder (PTSD) for military personnel. This study aimed to investigate the relative contribution of demographic variables; childhood adversity; the nature of exposure to traumatic events during deployment; appraisal of these experiences; and home-coming experiences in relation to the prevalence of PTSD ‘caseness’ as measured by a score of ⩾50 on the PTSD Checklist (PCL) in UK Armed Forces personnel who have been deployed in Iraq since 2003.MethodData were drawn from the first stage of a retrospective cohort study comparing UK military personnel who were deployed to the 2003 Iraq War with personnel serving in the UK Armed Forces on 31 March 2003 but who were not deployed to the initial phase of war fighting. Participants were randomly selected and invited to participate. The response rate was 61%. We have limited these analyses to 4762 regular service individuals who responded to the survey and who have been deployed in Iraq since 2003.ResultsPost-traumatic stress symptoms were associated with lower rank, being unmarried, having low educational attainment and a history of childhood adversity. Exposure to potentially traumatizing events, in particular being deployed to a ‘forward’ area in close contact with the enemy, was associated with post-traumatic stress symptoms. Appraisals of the experience as involving threat to one's own life and a perception that work in theatre was above an individual's trade and experience were strongly associated with post-traumatic stress symptoms. Low morale and poor social support within the unit and non-receipt of a home-coming brief (psycho-education) were associated with greater risk of post-traumatic stress symptoms.ConclusionsPersonal appraisal of threat to life during the trauma emerged as the most important predictor of post-traumatic stress symptoms. These results also raise the possibility that there are important modifiable occupational factors such as unit morale, leadership, preparing combatants for their role in theatre which may influence an individual's risk of post-traumatic stress symptoms. Therefore interventions focused on systematic preparation of personnel for the extreme stress of combat may help to lessen the psychological impact of deployment.

OBJECTIVES:This paper reports on a statistically significant association between alcohol use and deployment to the 2003 Iraq War. It assesses the occupational factors and deployment experiences associated with heavy drinking in regular UK servicemen deployed to Iraq in the first phase of the 2003 Iraq War (Operation TELIC 1, the military codename for the conflict in Iraq).METHODS:A random representative sample of 3578 regular male UK Armed Forces personnel who were deployed to Iraq during Operation TELIC 1 participated in a cross-sectional postal questionnaire study (response rate 61%). Participants completed a questionnaire, between June 2004 and March 2006 (ie, after deployment), about their health, including a measure of alcohol use (Alcohol Use Disorders Identification Test, AUDIT) and questions about their experiences on deployment to Iraq. Heavy drinkers were identified as those scoring 16 or above on the AUDIT.RESULTS:After adjustment for sociodemographic and military factors, and the presence of psychological distress, heavy drinkers were more likely to have had major problems at home during (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.04 to 1.70) and following their deployment (OR 1.68, 95% CI 1.32 to 2.14). Being deployed with their parent unit (OR 1.28, 95% CI 1.02 to 1.61), medium to high in-theatre unit comradeship (medium: OR 1.35, 95% CI 1.04 to 1.77; high: OR 1.35, 95% CI 1.02 to 1.79) and poor unit leadership (OR 1.78, 95% CI 1.37 to 2.31) were also associated with heavy drinking.CONCLUSIONS:Deployment experiences and problems at home during and following deployment, as well as the occupational milieu of the unit, influence personnel's risk of heavy drinking.

OBJECTIVES:To assess the distribution and risk factors of depleted uranium uptake in military personnel who had taken part in the invasion of Iraq in 2003. METHODS:Sector field inductively coupled plasma-mass spectrometry (SF-ICP-MS) was used to determine the uranium concentration and (238)U/(235)U isotopic ratio in spot urine samples. The authors collected urine samples from four groups identified a priori as having different potential for exposure to depleted uranium. These groups were: combat personnel (n = 199); non-combat personnel (n = 96); medical personnel (n = 22); and "clean-up" personnel (n = 24) who had been involved in the maintenance, repair or clearance of potentially contaminated vehicles in Iraq. A short questionnaire was used to ascertain individual experience of circumstances in which depleted uranium exposure might have occurred. RESULTS:There was no statistically significant difference in the (238)U/(235)U ratio between groups. Mean ratios by group varied from 138.0 (95% CI 137.3 to 138.7) for clean-up personnel to 138.2 (95% CI 138.0 to 138.5) for combat personnel, and were close to the ratio of 137.9 for natural uranium. The two highest individual ratios (146.9 and 147.7) were retested using more accurate, multiple collector inductively coupled plasma-mass spectrometry (MC-ICP-MS) and found to be within measurement of error of that for natural uranium. There were no significant differences in isotope ratio between participants according to self-reported circumstances of potential depleted uranium exposure. CONCLUSIONS:Based on measurements using a SF-ICP-MS apparatus, this study provides reassurance following concern for potential widespread depleted uranium uptake in the UK military. The rare occurrence of elevated ratios may reflect the limits of accuracy of the SF-ICP-MS apparatus and not a real increase from the natural proportions of the isotopes. Any uptake of depleted uranium among participants in this study sample would be very unlikely to have any implications for health.

publication. Online First articles must include the digital object identifier (DOIs) and date of initial establish publication priority; they are indexed by PubMed from initial publication. Citations to may be posted when available prior to final publication). Online First articles are citable and versions accepted for publication but have not yet appeared in the paper journal (edited, typeset contains unedited articles in manuscript form that have been peer reviewed and Online First

AIMS:To examine the childhood overweight and obesity prevalence trends between 1974 and 2003 and to assess whether these trends relate to parental social class and household income. METHODS:A school based and a general population health survey: the National Study of Health and Growth in 1974, 1984, and 1994, and the Health Survey for England, yearly from 1996 to 2003. Participants were 14,587 white boys and 14,014 white girls aged 5-10 years. Overweight and obesity prevalence were calculated using UK specific as well as international body mass index (kg/m2) cut-offs. Socioeconomic status was measured using the Registrar General's social class; household income (1997 onwards only) was adjusted for household size. RESULTS:The prevalence of obesity (UK specific definition) in boys increased from 1.2% in 1984 to 3.4% in 1996-97 and 6.0% in 2002-03. In girls, obesity increased from 1.8% in 1984 to 4.5% in 1996-97 and 6.6% in 2002-03. Obesity prevalence has been increasing at accelerating rates in the more recent years. Children from manual social classes had marginally higher odds (OR 1.14, 95% CI 0.98 to 1.33) and children from higher income households had lower odds (OR 0.74, 95% CI 0.61 to 0.89) to be obese than their peers from non-manual class, and lower income households, respectively. CONCLUSION:Childhood obesity is increasing rapidly into the 2000s in England and these increases are more marked among children from lower socioeconomic strata. There is an urgent need for action to prevent further increase in obesity among children.

Background To evaluate distribution of body mass index (BMI) and subcutaneous fat in children of African or Indian subcontinent descent living in Trinidad and Tobago.Methods A cross-sectional survey was carried out in a nationally representative sample of 66 government schools. Measurements were made of children's heights, weights, triceps and subscapular skinfold thicknesses. Data were analysed by sex and ethnic group and comparison was made with international standards for overweight and obesity and with British (1990) reference curves for BMI.Results Data were analysed for 5688/6731 (85%) eligible children including 1934 Afro-Trinidadian, 1689 Indo-Trinidadian, and 1794 of mixed ethnicity. Afro-Trinidadian and mixed children were taller, but Indo-Trinidadian children were shorter than reference. Values for BMI were lower than reference: mean standard deviation score (SDS), (95% confidence interval) Afro-Trinidadian -0.34 (-0.39 to -0.28), Indo-Trinidadian -1.32 (-139 to -1.25), mixed-0.67 (-0.74 to -0.61). Overall 486 (8.5%, 7.8 to 9.3%) of children were overweight and 138 (2.4%, 2.0 to 2.9%) were obese. Triceps skinfold thickness values were lower than reference (-0.45, -0.48 to -0.4.2 SDS) but subscapular skinfold thicknesses were higher (0.45, 0.43 to 0.47 SDS). Higher BMI,were associated with higher BMI in the child's parents, higher reported birthweight, older age of the child's mother, smaller family size, and with higher maternal educational attainment.Conclusions Overweight was prevalent and distribution of subcutaneous fat was central. Work is needed to determine whether these findings are associated with adult patterns of fat distribution and metabolic abnormalities.

The aim of the study was to estimate 95% reference ranges for blood constituents in 9-year-old children. Venepuncture was successful in 753 white children age 8-9 years in 21 areas in England and 5 in Scotland. Agreement with published reference ranges for haematological measurements from undocumented samples was good. The reference ranges were 3.22 to 5.79 mmol/l for serum total cholesterol, 0.9 to 2.1 mmol/l for high density lipoprotein cholesterol, and 13 to 61 micrograms/l for ferritin. The upper limit for total cholesterol is well above the recommended level for adults, with 9.3% of children having a value of 5.2 mmol/l or more. The results provide a scientific basis for ranges previously published for haematological measurements. Documented data should be combined from national studies to provide further reference ranges for routine use.

We did a population study to identify the prevalence of reactions to eight foods commonly perceived to cause sensitivity in the UK. A cross-sectional survey of 7500 households in the Wycombe Health Authority area and the same number of randomly-selected households nationwide was followed up by interviews of positive respondents from the Wycombe Health Authority area. Those who agreed entered a double-blind, placebo-controlled food challenge study to confirm food intolerance.20.4% of the nationwide sample and 19.9% of the High Wycombe sample complained of food intolerance. Of the 93 subjects who entered the double-blind, placebo-controlled food challenge, 19.4% (95% confidence interval 11.4% -27.4%) had a positive reaction. The estimated prevalence of reactions to the eight foods tested in the population varied from 1.4% to 1.8% according to the definition used. Women perceived food intolerance more frequently and showed a higher rate of positive results to food challenge.There is a discrepancy between perception of food intolerance and the results of the double-blind placebo-controlled food challenges. The consequences of mistaken perception of food intolerance may be considerable in financial, nutritional, and health terms.

Serum total cholesterol and ferritin and haemoglobin concentrations were measured in blood samples obtained by venepuncture in 378 of 593 children aged 5-6 or 8-9 years from seven primary schools in Canterbury. This study formed part of an investigation to assess the feasibility of including a venepuncture procedure for monitoring purposes in primary schoolchildren. Although only one child had a very low haemoglobin concentration of 61 g/l, a large percentage, 25% in the rising 6 years and 7% in the rising 9 years, had concentrations between 100 and 115 g/l--that is, less than the reference fifth centile. Eight per cent had a serum ferritin concentration less than 8 micrograms/l. Cholesterol concentrations higher than 5.2 mmol/l were found in 20% of the 5-6 year olds and 23% of the 8-9 year olds, and in 19% of boys and 25% of girls. About 5% of children had cholesterol concentrations above 6 mmol/l. The number of children with anaemia, iron deficiency, and high cholesterol raises serious concerns about the nutritional and coronary heart disease risk of British children.

The role of child health clinics in an inner London district was examined by a survey of attenders at 52 baby clinic sessions run by the health authority and a review of the uptake of screening. Differences between social groups were examined using A Classification of Residential Neighbourhoods (ACORN) which is based on census data and requires only the full postcode to classify people. Clinic attendance was frequent among all social groups when a child was aged under six months but then declined, mainly reflecting changing needs. About one-half of the attenders saw the clinic doctor, often following referral by the health visitor, with 15% consulting about physical health problems. Differences occurred between ACORN groups in their frequency and reasons for clinic attendance after six months of age and rates of referral following developmental screening. This suggests that ACORN may be of value in monitoring service use and identifying groups with particular needs for services.