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Articles by N Greenberg
Total Records ( 6 ) for N Greenberg
  Z. B Popovic , C Puntawangkoon , D Verhaert , N Greenberg , A Klein , J. D Thomas and R. A. Grimm

It is unknown whether longitudinal rotation (LR), often seen in cardiac resynchronization therapy candidates, may affect mitral annular early diastolic (E') velocities and tricuspid annular motion. We assessed whether (1) LR affects the amplitude and timing of septal and lateral mitral annular E' velocities and tricuspid annular systolic and E' velocities and (2) if systolic strain heterogeneity seen in cardiac resynchronization therapy patients with LR extends into diastole.

Methods and Results—

Ninety-nine cardiac resynchronization therapy candidates with suitable baseline echocardiograms were identified. Early diastolic (E') and systolic myocardial velocities of the tricuspid annulus and E' velocities of the septal and lateral part of the mitral annulus were analyzed from tissue Doppler images. Longitudinal rotation and basal systolic and diastolic strain rates were analyzed by speckle-tracking. LR correlated with lateral mitral annular E' (r=0.45, P<0.001), tricuspid annular E' (r=–0.3, P=0.003), and with a difference between septal and lateral mitral annular E' velocities (r=–0.49, P<0.001) but not with septal mitral annular E' velocity. LR also correlated with tricuspid annular systolic velocity (r=0.60, P<0.001). After categorizing the patients according to the quartiles of their LR, we showed that with decreasing quartile number, heterogeneity of systolic (P=0.003) but not diastolic (P>0.1) strain rates increased.


LR direction and magnitude correlates with the amplitude of, and relative differences between, diastolic velocities of tricuspid, lateral mitral, and septal mitral annulus, which are a cornerstone of diastolic function assessment. LR is associated with systolic but not with diastolic regional heterogeneity.

  M Misra , N Greenberg , C Hutchinson , A Brain and N. Glozier

Background This study was conducted following the London bombings of 7 July 2005.

Aims To assess the psychological impact of the 2005 London bombings on London Ambulance Service (LAS) personnel, risk factors for the development of psychological ill-health and employee awareness of post incident support.

Methods A total of 525 LAS personnel involved in the bombings, and a control group of uninvolved staff, were sent a questionnaire 2 months after the bombings. Main outcome measures were the presence of probable post-traumatic stress disorder (PTSD) measured using the Trauma Screening Questionnaire and substantial psychological distress using a tool identical to that used to assess the impact of these bombings on the population of London.

Results Fifty-six per cent of those who responded were involved in the bombings. Overall, including controls, the response rate was 32% (341). Four per cent of respondents reported probable PTSD and 13% reported substantial distress. Probable PTSD was more common in those involved in the bombings (6% overall), those working at the disaster scene and, in particular, at one of the incident locations (where 50% of all probable PTSD cases worked). The majority of staff were aware of the post incident support available and how to access this, particularly if personnel were involved in the bombings.

Conclusions The LAS did not report higher levels of probable PTSD and psychological distress than the rest of the London population; however, those more proximal to the incident were more likely to have been affected in spite of being aware of various staff support measures put in place.

  N Jones , N. T Fear , N Greenberg , L Hull and S. Wessely

Background Little is known about the longer term occupational outcome in UK military personnel who require hospital-based treatment for mental health problems.

Aims To examine the documented occupational outcomes following hospital-based treatment for mental health problems within the British Army.

Methods Hospital admission records were linked to occupational outcome data from a database used for personnel administration.

Results A total of 384 records were identified that were then linked to occupational outcome after an episode of hospitalization. Seventy-four per cent of those admitted to hospital with mental health problems were discharged from the Army prematurely, and 73% of the discharges occurred in the first year following hospitalization. Discharge from the Army was associated with holding a junior rank, completing <5 years military service, having a combat role, being male and receiving community mental health team treatment prior to admission.

Conclusions Hospitalization for a mental health problem in a military context is associated with a low rate of retention in service. Outcome was not influenced greatly by duration of hospital stay; however, those who reported receiving individual rather than group-based therapy while in hospital appeared to do better.

  J Sundin , N Jones , N Greenberg , R. J Rona , M Hotopf , S Wessely and N. T. Fear

Background Despite having high levels of combat exposure, commando and airborne forces may be at less risk of mental ill-health than other troops.

Aims To examine differences in mental health outcomes and occupational risk factors between Royal Marines Commandos (RMCs), paratroopers (PARAs) and other army infantry (INF).

Methods Three groups of personnel (275 RMCs, 202 PARAs and 572 INF) were generated from a UK military cohort study of personnel serving at the time of the 2003 Iraq war. Participants completed a questionnaire about their mental health and experiences on deployment. Differences in mental health outcomes between the groups were examined with logistic regression and negative binomial regression analyses.

Results Both RMCs and PARAs were less likely to have multiple physical symptoms or to be fatigued, and RMCs also had lower levels of general mental health problems and lower scores on the Post-traumatic Checklist than INF personnel. Differences were not explained by the level of unit cohesion.

Conclusions The effect of warfare on troops’ well-being is not universal across occupational groups. A possible explanation for this difference is that the high level of preparedness in RMCs and PARAs may lessen the psychological impact of war-zone deployment experiences.

  N Greenberg and S. Wessely

People who suffer from post-traumatic stress disorder (PTSD) are likely to find that their quality of life is substantially impaired. However, unlike other diagnoses, in order for clinicians to make a diagnosis of PTSD people have to be able to accurately recall the details of a traumatic incident. Yet recent evidence suggests that recall of such incidents is often unreliable. Clinicians should therefore exercise caution to avoid making inaccurate diagnoses.

  A. C Iversen , L van Staden , J. H Hughes , T Browne , N Greenberg , M Hotopf , R. J Rona , S Wessely , G Thornicroft and N. T. Fear


For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy.


To examine mental healthcare service use and receipt of treatment in a sample of the UK military.


Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC–PTSD), and a series of questions about service utilisation and treatment receipt.


Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive–behavioural therapy (CBT). These findings are comparable with those reported for the general population.


In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.

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