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Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population.
Design:
Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration.
Setting:
Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009.
Participants:
Women were recruited when presenting for prenatal care in the early second trimester.
Results:
In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration.
Conclusions:
We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Method:
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Results:
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Conclusion:
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.
Aims
To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.
Method
The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).
Results
Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).
Conclusions
Management of mental health may play a role in HIV and STI prevention.
The Navy of the English Commonwealth and Protectorate did as much as the New Model Army to crush the Royalist cause, and a good deal more to establish the international power and prestige of the English Republic. Even after Cromwell's 1653 coup d’état created the quasi-monarchy of the Protectorate, the Navy's officers remained with few exceptions those selected by the Commonwealth for their loyalty to republicanism and religious radicalism. Yet the restored royal government of Charles II embraced the Navy which it had inherited with unfeigned enthusiasm. Forgetting all that it had done to blight their own cause, the Royalists remembered only how it had fulfilled the promise of the Elizabethan seafarers and restored their country's status as a great power after two hundred years of humiliation.
This, however, did not eliminate the practical difficulty faced by Charles II and his brother James Duke of York, the Lord High Admiral, in dealing with the Navy. Precisely because it represented the wealth, safety and strength of the kingdom, it demanded officers of proven loyalty and ability – but the few available Royalist sea officers were mostly former privateer commanders with no experience of handling squadrons, while those who had learned the business of naval command in the hard school of the Dutch and Spanish wars were republicans and sectaries. The choice was summed up by the catch-phrase ‘Gentlemen or Tarpaulins’ – ‘tarpaulins’ meaning professional merchant seamen, named from the oiled canvas from which they made their foul-weather coats. Charles and James handled this dilemma with skill. A large proportion of the former officers were won to the new regime, and trusted with high command. With them were mixed former Royalist sea commanders and new, post-Restoration entries who were themselves of diverse social origins. Charles was well aware from the beginning of the importance of the Navy to the survival of his fragile throne, and in 1661 instituted the new position of ‘volunteer per order’ or ‘king's letter boy’, ‘to give encouragement to such young gentlemen as are willing to apply themselves to the learning of navigation, and fitting themselves for the service of the sea’.
How important has the sea been in the development of human history? Very important indeed is the conclusion of this ground-breaking four volume work. The books bring together the world's leading maritime historians, who address the question of what difference the sea has made in relation to around 250 situations ranging from the earliest times to the present. They consider, across the entire world, subjects related to human migration, trade, economic development, warfare, the building of political units including states and empires, the dissemination of ideas, culture and religion, and much more, showing how the sea was crucial to all these aspects of human development. The Sea in History - The Modern World covers the nineteenth and twentieth centuries, when the global reach of major powers frequently brought them into conflict with each other, including conflict at sea. The many majors wars at sea of the period are discussed, as are the planning and strategic thinkingof the major powers in cases both where war followed and where it did not, and in addition the role and thinking of less important powers such as Portugal and Denmark are analysed. The book considershow in this first great age of 'globalisation' seaborne trade helped many countries to prosperity by participation in the global economy, a process halted by the First World War and not resumed untilthe 1950s. The book also examines maritime resources including fishing and whaling; ships, shipbuilding, ports and navigation; and the logistics of supporting long distance maritime activity. One very interesting chapter on late imperial China shows how China's then failure to take maritime issues seriously was a major factor in the empire's collapse.
58 of the contributions are in English; 6 are in French.
N. A. M. RODGER is a Senior Research Fellow at All Souls College, Oxford CHRISTIAN BUCHET is Professor of Maritime History, Catholic University of Paris, Scientific Director of Océanides and a member of l'Académie de marine.
This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.
N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.
J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.
Benjamin Darnell is a D.Phil. candidate at New College, Oxford.
Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.
Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson
