Sustained mental workload does not affect subsequent sleep intensity

Mental activity is a neglected factor in sleep research. The few investigations on sleep that manipulate prior mental activity are inconclusive with respect to the possible effects of mental activity on recovery. In the present study, the effects of two levels of mental activity on subsequent sleep were studied. Thirteen male subjects (range 18-28 years) participated in one lightly and two heavily mentally strenuous conditions in a counterbalanced order. Light mental activity included 8 h of relaxed video watching. The second condition consisted of performing computer tasks involving sustained attention, memory, logical thinking and calculations for eight consecutive hours. In the third condition, the same heavy mental workload was interspersed with breaks. Subjectively, the subjects rated the condition with heavy mental activity (without breaks) as mentally more strenuous than the condition with light mental activity. Subjects were significantly less awake shortly after sleep onset in the heavy-workload condition than in the light-workload condition. There were no differences between the conditions in any of the other visually scored sleep variables. The total amount of slow wave activity (SWA) and its discharge during the night was not affected by the level of mental activity or by the presence of breaks. These findings fail to support the proposition that SWA reflects a need for sleep that accumulates at a rate depending on mental activity during prior wakefulness.     

What general practitioners and paediatricians think about their patients' asthma

The Asthma Insight and Reality in Europe (AIRE) study showed that the current management and treatment of asthma in Europe falls short of the goals set in the GINA guidelines. Patient care may be negatively influenced by the physicians' underestimation of their patients' disease state, and overestimation of their patients' knowledge of asthma management. We interviewed 118 paediatricians and 152 general practitioners (response rate 70 and 86%, respectively) in order to get an insight into the physicians view on his patients' asthma management. A questionnaire containing similar items to those used in the AIRE study was used. Dutch physicians believe that the asthma of the majority of their patients is well controlled and underestimate the prevalence of daytime symptoms. They believe that their patients are aware of the differences between reliever medication and maintenance medication and overestimate the number of patients in possession of a written action plan. Dutch paediatricians and general practitioners underestimate the severity of their patients' disease state and overestimate their patients' knowledge of disease management.     

Complementary medicine: are patients' expectations being met by their general practitioners?

Complementary, or alternative, medicine has increased in popularity among patients during the past 20 years. The purpose of this study was to determine whether general practitioners met their patients' expectations with regard to complementary medicine. In a postal survey all 71 accredited general practitioners in the district of Kassel, Germany, received a structured questionnaire about their experience with complementary medicine. Forty (56%) replied. In 10 of these practices 310 patients were interviewed about their attitudes towards and expectations of such treatment. Of the responding doctors 95% used, at least occasionally, some form of complementary medicine (most commonly herbal medicine, neural therapy or homeopathy). All but three patients accepted the value of complementary medicine, 58% of them (especially younger, more highly educated patients and those from rural practices) preferred it to orthodox medicine and 40% of the patients had received some form of complementary therapy. Nearly 70% of the patients requested that complementary medicine be practised by their general practitioner more frequently than at present. There was no significant link between patient satisfaction with the doctor and patients' view of, or demand for, complementary medicine. Although both patients and practitioners were interested in complementary therapy, there was a gap between the willingness, or the ability, of general practitioners to use complementary medicine and the patients' demand for these alternative forms of treatment.     

Detecting psychological distress: can general practitioners improve their own performance?

BACKGROUND: Many studies have suggested that general practitioners fail to detect a substantial minority of their patients who are psychologically distressed, and there is concern about the possible sequelae of this. Individual patients may suffer unresolved problems, and there are potential costs to the health service in consequent recurrent consultations, inappropriate referrals or treatment. Educational interventions based on small groups led by facilitators have been shown to alter the consultation behaviours of general practitioners that are known to be related to accurate detection of psychological distress. AIM: This controlled study aimed to show that, by utilizing a brief self-directed educational intervention focusing on detection of psychological distress, general practitioners can improve their performance significantly. For this purpose, a new educational intervention was designed: the second aim of the study was thus to assess the effectiveness of this specific intervention. METHOD: An educational intervention was designed which focused on skills relevant to detecting psychological distress, using the principles of reflection on general practitioner performance and consultation skill work. It was designed to be used by individual general practitioners without outside support, using a combination of written background material, feedback on performance and analysis of video material. The effectiveness of the intervention was tested by comparing a trial and control cohort of general practitioners, using detection rates as an outcome measure. RESULTS: The detection rate of the general practitioners who underwent the intervention improved significantly compared with their performance before intervention and with that of the control group. CONCLUSION: General practitioners can improve their ability to detect psychological distress in their patients utilizing this self-directed educational approach.     

Narratives about patients with psychological problems illustrate different professional roles among general practitioners

General practitioners are not trained in psychotherapy. They are, however, experienced in hearing people's stories. This qualitative interview study aimed to explore the stories GPs recounted about psychological interventions with patients. It showed that the GPs had recounted very different types of narrative, and that the same GP recounted the same type of narrative throughout the interview. Some told detailed narratives including the patient's life situation, whereas others kept to biomedical matters. Co-creation of patients' narratives had a therapeutic function, and patients obtained agency and power in these stories. The narrative style reflected the professional identity of the GP.     

Survey of patients' satisfaction with access to general practitioners

The north west England faculty patients' liaison group, supported by community health councils and family practitioner committees, surveyed patients' perceptions of accessibility to general practitioners in seven districts in 1985 and 1986. Findings on appointment systems, telephone access and out-of-hours calls are compared with those from other surveys. The results show that patients' satisfaction with appointment systems is related to the efficiency of their own general practitioner's system. The results also show higher levels of dissatisfaction with waiting times for outof- hours visits than in studies 10 years ago and that a large proportion of patients would like direct telephone access to their general practitioner.     

Cooling does not affect knee proprioception

The effect of cooling on proprioception of the knee has not been studied extensively. In this study, we investigated the movement reproduction (timing and accuracy) aspect of proprioception. Subjects were tested under two conditions: a 20-minute application of ice and control. Proprioceptive accuracy and timing were measured by passively moving the knee, then comparing the subject's active reproduction of the passive movement. Subjects were blindfolded, then tested in three sectors of the knee's range of motion: 90 degrees to 60 degrees , 60 degrees to 30 degrees , and 30 degrees to full extension. Ice application had no apparent effect on the subject's ability to perform accurate movement reproductions in the sectors tested. However, accuracy of the subject's final angle reproduction varied between the sectors as did the total time of the movement. One possible explanation for the difference between sectors is that different receptors are active at different points in the knee's range of motion. We conclude that cooling the knee joint for 20 minutes does not have an adverse effect on proprioception.     

How does the content of consultations affect the recognition by general practitioners of major depression in women?

BACKGROUND. Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM. The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD. The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS. A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION. General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.     

The workload of GPs: consultations of patients with psychological and somatic problems compared

BACKGROUND: GPs report that patients' psychosocial problems play a part in 20% of all consultations. GPs state that these consultations are more time-consuming and the perceived burden on the GP is higher. AIM: To investigate whether GPs' workload in consultations is related to psychological or social problems of patients. DESIGN OF STUDY: A cross-sectional national survey in general practice, conducted in the Netherlands from 2000-2002. SETTING: One hundred and four general practices in the Netherlands. METHOD: Videotaped consultations (n = 1392) of a representative sample of 142 GPs were used. Consultations were categorised in three groups: consultations with a diagnosis in the International Classification of Primary Care chapter P 'psychological' or Z 'social' (n = 138), a somatic diagnosis but with a psychological background according to the GP (n = 309), or a somatic diagnosis and background (n = 945). Workload measures were consultation length, number of diagnoses and GPs' assessment of sufficiency of patient time. RESULTS: Consultations in which patients' mental health problems play a part (as a diagnosis or in the background) take more time and involve more diagnoses, and the GP is more heavily burdened with feelings of insufficiency of patient time. In consultations with a somatic diagnosis but psychological background, GPs more often experienced a lack of time compared to consultations with a psychological or social diagnosis. CONCLUSION: Consultations in which the GP notices psychosocial problems make heavier demands on the GP's workload than other consultations. Patients' somatic problems that have a psychological background induce the highest perceived burden on the GP.     

Endothelin does not affect aggregation of human platelets

Endothelin (ET-1) is a recently discovered endothelial-derived peptide with pronounced vasoconstrictor activity. The present study addressed whether ET-1, in analogy with several other vasoactive agents, can induce or modulate aggregation of human platelets in vitro. Venous blood from healthy donors was collected in citrate or heparin and platelet-rich plasma (PRP) was prepared. Portions of the PRP were added to drugs, and platelet aggregation was recorded according to Born & Cross (1963). ET-1 added to the PRP (final concentrations 1-100 nM) did not induce aggregation of platelets, either in citrate- or heparin-containing plasma. Adenosine-diphosphate (0.5-2 microM) or thrombin (0.1-0.4 NIH units ml-1) induced dose-dependent aggregation of platelets in citrate- or heparin-containing PRP; such aggregation was, however, not affected by ET-1 (1-100 microM) either. We conclude that ET-1, in contrast to other endothelial-derived vasoactive agents, lacks direct effect on platelet aggregation in vitro.     

Blockage of pituitary-adrenal activity does not affect conditioned suppression

Previous research has shown that exposure to stressful experimental procedures results in increased activity of the pituitary-adrenal system. In the present experiment, although normal animals showed elevated steroid levels during exposure to a conditioned suppression procedure, characteristic behavioral results were also obtained in animals for which pituitary-adrenal activity had been blocked by hypothalamic implants of cortisol.     

Denervation does not affect the growth of rat vibrissae

This study examines the hypothesis that neural factors influence the growth of rat vibrissae. We divided the vibrissae in rows alpha-delta, 1 and 2 and examined their regrowth during the first complete growth period in normal and nerve-lesioned rats. The lesions used were denervation through neonatal capsaicin treatment, surgical sympathecomy in adult rats, neurectomy of the mandibular and buccal branches of the facial nerve in adult rats or division of the infraorbital nerve in adult rats. Normal vibrissae developed a length of 51.1 mm and a diameter of 178 microm (row alpha-delta), 44.1 mm and 181 microm (row 1) and 33.2 mm and 165 microm (row 2). In all experimental groups the examined vibrissae developed a normal final length and proximal diameter. This indicates that local nerves do not influence vibrissal growth to any major extent.     

Surveying general practitioners: does a low response rate matter?

BACKGROUND: Primary care has long been of interest to policy research. Recently, there is evidence to suggest that it is becoming more difficult to encourage GPs (general practitioners) to participate in surveys. As low response rates can introduce bias into survey results, it is important to study the effects of non-response. AIM: To assess the validity of a response rate of 44% obtained in a national postal study of GPs surveyed about their work with alcohol-misusing patients by assessing the extent of any non-response bias. METHOD: A telephone survey of 148 GPs who had not responded to repeated mailings of a postal questionnaire was undertaken. In addition to personal and practice structure characteristics, the GPs were asked three questions taken from the original questionnaire about their work with alcohol-misusing patients. RESULTS: Of the 148 GPs telephoned, 64 responded to the telephone questionnaire in full; all had previously failed to respond to the postal questionnaire. Younger GPs were more likely to respond to both the national postal and telephone surveys, but more so to the latter. Telephone responders were more likely to be GPs in a single-handed practice. The work of GPs with alcohol-misusing patients highlighted differences between the two response groups. Male telephone responders were found to be identifying a significantly higher average of alcohol misusers than male postal responders. Telephone responders were more likely to feel trained in treating alcohol misuse and to feel better supported to deal with this patient group. CONCLUSION: Some significant differences were identified, indicating the presence of non-response bias. A low response rate need not affect the validity of the data collected, but it is still necessary to test for non-response effects and make corrections to the original data in order to maximize validity.     

The neurotoxin MPTP does not affect striatal superoxide dismutase activity in mice

Intraneuronal superoxide generation may be a possible mechanism of the dopaminergic (DA) neurotoxicity of MPTP. In such case, MPTP might theoretically affect superoxide dismutase (SOD) activity. We determined SOD activity and DA levels in striata of mice at 0.5, 1, 4, 16, 24 h or 7 days after an acute single injection of MPTP (40 mg/kg, s.c.). MPTP produced marked striatal DA depletions from 4 h post-treatment but SOD activity remained unaltered and similar to controls at all time points. Intrastriatal injections of purified SOD 15 min prior to systemic administration of MPTP did not attenuate the MPTP-induced striatal DA depletions in mice at 7 days post-treatment. Combined administration of MPTP with the SOD inhibitor diethyldithiocarbamate markedly enhanced striatal DA decreases produced by MPTP alone. Findings suggest that MPTP does not act via inhibition of SOD. Therefore, potentiation of MPTP toxicity by diethyldithiocarbamate may be due to interference with other enzymatic systems.     

Mental fatigue does not affect maximal anaerobic exercise performance

Purpose

Mental fatigue can negatively impact on submaximal endurance exercise and has been attributed to changes in perceived exertion rather than changes in physiological variables. The impact of mental fatigue on maximal anaerobic performance is, however, unclear. Therefore, the aim of the present study was to induce a state of mental fatigue to examine the effects on performance, physiological and perceptual variables from subsequent tests of power, strength and anaerobic capacity.

Methods

Twelve participants took part in the single-blind, randomised, crossover design study. Mental fatigue was induced by 90 min of the computer-based Continuous Performance Task AX version. Control treatment consisted of 90 min of watching emotionally neutral documentaries. Participants consequently completed countermovement jump, isometric leg extension and a 3-min all-out cycling tests.

Results

Results of repeated measures analysis of variance and paired t tests revealed no difference in any performance or physiological variable. Rating of perceived exertion tended to be greater when mentally fatigued (mental fatigue = 19 ± 1 vs control = 18 ± 1, p = 0.096, \(\eta^{2}_{\text{p}}\) = .232) and intrinsic motivation reduced (mental fatigue = 11 ± 4 vs control = 13 ± 6, p = 0.063, d = 0.597) in the mental fatigue condition.

Conclusions

Near identical responses in performance and physiological parameters between mental fatigue and control conditions suggest that peripheral mechanisms primarily regulate maximal anaerobic exercise. Whereas mental fatigue can negatively impact submaximal endurance exercise, it appears that explosive power, voluntary maximal strength and anaerobic work capacity are unaffected.