Why do we sleep?

Slow-wave sleep consists in slowly recurring waves that are associated with a large-scale spatio-temporal synchrony across neocortex. These slow-wave complexes alternate with brief episodes of fast oscillations, similar to the sustained fast oscillations that occur during the wake state. We propose that alternating fast and slow waves consolidate information acquired previously during wakefulness. Slow-wave sleep would thus begin with spindle oscillations that open molecular gates to plasticity, then proceed by iteratively 'recalling' and 'storing' information primed in neural assemblies. This scenario provides a biophysical mechanism consistent with the growing evidence that sleep serves to consolidate memories.     

How much sleep do we need?

There is increasing concern for sleeplessness-related risks in modern society. Some recent epidemiological data seem to support the view that many segments of the adult population have chronically inadequate sleep. On the other hand, some experts have claimed that our core, basic amount of sleep is around 6 h per night, and that the rest of our sleep can be easily curtailed, being unnecessary to fulfill any sleep need. However, experimental data on the effects of both acute and cumulative partial sleep deprivation (PSD) consistently point out that sleep restriction has substantial negative effects on sleepiness, motor and cognitive performance and mood, as well as on some metabolic, hormonal and immunological variables. As chronic PSD may have serious long-term adverse health effects, it should be avoided in the general population. In the short-term, the effects of sleep curtailment seem to accumulate linearly, while the effects of long-term PSD should be further investigated, as the few available studies are flawed by methodological weaknesses. On the other hand, there is evidence that extending sleep by 2-3 h beyond the norm produces only marginal benefits for an average individual. Finally, it is underlined that, as large individual differences do exist in the need for sleep, the search for the sleep need may be vain. A somnotypology, taking into account age, gender and the position in both the sleep-alert and the morningness-eveningness continuum, should help in the search for the actual individual sleep need. 2001 Harcourt Publishers Ltd     

Stroke care in Spain. What do we have? What do we need?

The high level of scientific evidence which supports the recommendations for the care of acute stroke in Stroke Units (SU) with a good health care network, it does not correspond to the level of introduction in Spain. In this regard, the Cerebrovascular Diseases Study Group (GEECV) of the Spanish Society of Neurology has taken the initiative to conduct the "National Survey of Stroke Care" that will help to determine the real situation in acute stroke management in Spain just before the approval of the National Stroke Strategy (NSS) by the Ministry of Health and concludes that in the first semester of 2009 there were 39 SUs, unevenly distributed with higher concentration in Madrid and Barcelona. Although the approval of the NSS was a major achievement, much remains to be done to meet the objectives. We thank the GEECV?s initiative, which gives us an "X-ray" of the, not very satisfactory, state of stroke care in Spain in December 2008, and highlighting some achievements and the many shortcomings. Therefore, we must continue to improve, refine our data collection with records that include all available resources and all the stroke patients attended. We invite GEECV to carry out a second study to evaluate the impact of NSS and to serve as a stimulus to achieve a substantial improvement in stroke care in Spain, closer to the recommendations of the new PASI document.     

Pediatric stroke: what do we know and what do we need to know?

Stroke is a heterogeneous disorder and an important cause of mortality and chronic morbidity in children. Estimates of international incidence rates for childhood stroke have varied widely. Arterial ischemic stroke is reported to be more common than hemorrhagic stroke in children. The clinical presentation of stroke in children differs according to the child's age and stroke type and location. Several risk factors for ischemic and hemorrhagic stroke in children have been reported and include cardiac disorders, blood disorders, vasculopathies, viral infections, and arteriovenous malformations. Current treatment recommendations for stroke in children are based on small nonrandomized trials, adult stroke studies, case series, or consensus or individual expert opinion. Over half of children with stroke will develop lifelong cognitive or motor disability, and up to a third will have a recurrent stroke. International studies have provided important information on stroke in children, but major gaps in our knowledge of the disorder still exist. Currently, there is a need for prospective cohort studies in diverse populations, which utilize a consensus pediatric stroke classification system and a standard evaluation of risk factors and outcome, so that treatment and prevention strategies can be developed.     

Why do we yawn? Primitive versus derived features

Guggisberg et al. (2010) reviewed the evidence for the origin and function of yawning, and conclude that theories describing a physiological role lack support. Instead, they argue research supports the notion that yawning has a communicative function. Contrary to the authors’ claim that the social/communication hypothesis has the “best experimental evidence”, there is in fact no definitive experimental support for the predictions of this model. Furthermore, the authors claim to take an evolutionary perspective, but sufficient examples across the comparative (non-primate) literature are missing, and they fail to acknowledge phylogenic history. Due to the ubiquity of this behavior across vertebrates, and the regularity of its occurrence in a number of different physiological states and social contexts, it is likely that instead of serving one purpose, yawning is multifunctional across a number of species. The most parsimonious explanation for the origin of yawning suggests that any social value is a derived feature, while the primitive feature or function is physiological. The current paper addresses these concerns, and identifies a number of other weaknesses in the social/communication hypothesis as a global explanation for the origin and function of yawning.     

How many assertive community treatment teams do we need?

OBJECTIVE: Assertive community treatment (ACT) reduces hospitalizations for persons with severe mental illness. However, not everyone who needs ACT receives it. Without empirical guidelines for ACT planning, communities are likely to underestimate or overestimate the number of teams they need; thus the capacity of the programs will not meet current needs. In this study, administrative data were used to develop empirical estimates for the number of required ACT teams. These estimates were then used to examine current conceptual guidelines for developing the number of ACT teams that communities need. METHODS: Administrative data from a large, urban county were used to enumerate all persons with a severe mental illness who had three or more hospitalizations within one year (ACT eligible). RESULTS: Fifty-one percent of persons with a severe mental illness were found to be eligible for ACT (743 of 1,453 persons). This figure represents 2.2 percent of the county's mental health users and .06 percent of its adult population. CONCLUSIONS: Communities should develop enough ACT teams to serve approximately 50 percent of their populations of persons with severe mental illness or roughly .06 percent of their adult populations.     

How many forensic assertive community treatment teams do we need?

Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed-severe and persistent mental illness and three jail detentions in a one-year period-and modeled by using 5.5 years of administrative data (July 1, 1993, through December 31, 1998) from a large, urban county in the western United States. Findings suggest that large, urban communities should develop enough FACT teams to serve approximately 44% of their populations of persons with severe mental illness, or roughly .05% of their adult populations. Developing standardized eligibility criteria for FACT is an important first step toward developing its evidence base.     

Postpartum depression: do we still need this diagnostic term?

OBJECTIVE: The diagnostic term 'postpartum depression' is still widely used. This paper attempts to discuss if this is still justified in the light of recent research. METHOD: Comprehensive review of literature. RESULTS: Postpartum depression is not a specific entity in terms of having a specific aetiology. Rather, giving birth to a child with all its biological and psychosocial consequences seems to act as a major stressor, which - within a general vulnerability-stress model - can trigger the outbreak of the disease in predisposed women. Nevertheless, it might still be justified to continue the use of this diagnostic term, as depression in early motherhood confronts us with specific needs. Thus, help-seeking is often delayed due to shame and stigma, and diagnosis is often missed due to misinterpretation of symptoms. Services often do not meet these women's needs adequately, as they do not take into account their specific situation, problems and fears. Untreated, postpartum depression can have especially severe long-term consequences, not only for the mother but also for the child and the whole family. Therefore, special attention and special treatment is necessary. This necessitates modifications of our pharmacological, non-pharmacological and psychotherapeutic treatment and also provision of new low-threshold mother-infant services. CONCLUSION: Although postpartum depression is not a specific entity from an aetiological point of view, the diagnostic term [as 'specifier', as in the Diagnostic and Statistical Manual (DSM)-IV)] should not be abandoned, as depression in the postpartum period confronts us with specific needs for care.     

Absolute quantitation in neurological PET: do we need it?

This article addresses the question posed in the title by examining the effects of parameters traditionally associated with improved absolute quantitation, on the analysis of 12 acquired immune deficiency syndrome dementia complex (ADC) patients compared to a normal control group. Results are discussed within the framework of the subprofile scaling model (SSM) for analyzing patterns of regional covariation. It is demonstrated that the ability to extract measures of group discrimination and disease progression are unaffected by (1) limited improvements in image resolution, (2) the use of transmission scan smoothing, (3) the application of a scatter deconvolution correction, and (4) converting region-of-interest measurements of counts per voxel to measurements of regional CMRglc. This "robustness" of the SSM approach is partly due to the extraction of disease-related subject weights, independent of any subject's global scaling effects. It is argued that other analysis techniques that initially reduce intersubject variation (e.g., using regional ratios or normalizing by global metabolic rates before applying traditional multivariate procedures) lack analytic features that may be important to identify multidimensional, disease-related image patterns. Based on the ADC patient data, it is concluded that measures of group discrimination and disease progression will not necessarily benefit from the organization of parameters traditionally associated with improved absolute quantitation.     

Do we need theory?

In response to the question raised by Lindon in his paper, "Does Technique Require Theory?" the author replies in the affirmative, arguing that theory is inherently involved in the application of psychoanalytic treatment. In contrast to Lindon's view that theory must be downplayed in treatment, the author contends that this perspective is itself part of a theory--the intersubjective theory of self psychology. The author concludes that theory provides numerous benefits to therapists; indeed, Lindon's own account suggests the value of the sensitive use of theory.     

Outcome measures in pediatric neurology: why do we need them?

Outcome measures should include the patient's values and preferences (from the patient's perspective) in addition to performance ratings and physiologic states. Outcome measures can assess relationships between services and interventions and their end results, can clarify which therapies are worth providing and which therapies need more evidence about their effectiveness, and can measure the burdens of different disorders and interventions. Researchers recently have shown the feasibility of creating and using outcome measures for children with neurodevelopmental disorders. Clinicians may wish to familiarize themselves with the concepts of outcome measures and health-related quality of life in order to understand the rationale, utility, properties, and various types of outcome measures in order to select the most appropriate instruments that will best serve their patient populations. Ongoing research efforts are currently using such measures in children with central nervous system tumors, with neural tube defects, and of extremely low birthweight; in childhood and adolescent epilepsy; and in adolescents with headaches.     

Why do you need to move beyond first-line therapy for major depression?

Primary care clinicians need to move beyond first-line therapy for major depression. While initial treatment is ineffective in about two-thirds of patients, patients who have not responded to such initial treatments can be managed effectively. The severity of depression is as high in primary care as in specialty care settings. The risk of depression is currently elevated because economic hardship, job insecurity, and low socioeconomic status increase the likelihood of depression and treatment resistance. Depression worsens outcomes for medical comorbidities, such as cardiac disease, chronic obstructive pulmonary disease, and diabetes mellitus, and it increases the risk of rehospitalization. When depression is treatment-resistant (generally defined as not responding to 2 courses of treatment of adequate dose and duration), morbidity and mortality are increased, quality of life and function are reduced, and long-term brain changes may occur. Opportunities for change in care are available. Screening for depression in primary care settings with staff-assisted support, adopting the concepts of the patient-centered medical home and stepped care, and using new treatment options such as atypical antipsychotics and other treatment modalities can improve outcomes for these patients. Now is the time to make these moves because new tools, systems, and treatments offer ways to help these patients.