Emotional Exhaustion and Cognitive Performance in Apparently Healthy Teachers: A Longitudinal Multi‐source Study

We investigate how emotional exhaustion (EE), the core component of burnout, relates to cognitive performance, job performance and health. Cognitive performance was assessed by self‐rated cognitive stress symptoms, self‐rated and peer‐rated cognitive impairments in everyday tasks and a neuropsychological test of learning and memory (LGT‐3); job performance and physical health were gauged by self‐reports. Cross‐sectional linear regression analyses in a sample of 100 teachers confirm that EE is negatively related to cognitive performance as assessed by self‐rating and peer‐rating as well as neuropsychological testing (all p < .05). Longitudinal linear regression analyses confirm similar trends (p < .10) for self‐rated and peer‐rated cognitive performance. Executive control deficits might explain impaired cognitive performance in EE. In longitudinal analyses, EE also significantly predicts physical health. Contrary to our expectations, EE does not affect job performance. When reversed causation is tested, none of the outcome variables at Time 1 predict EE at Time 2. This speaks against cognitive dysfunctioning serving as a vulnerability factor for exhaustion. In sum, results underpin the negative consequences of EE for cognitive performance and health, which are relevant for individuals and organizations alike. In this way, findings might contribute to the understanding of the burnout syndrome. Copyright © 2012 John Wiley & Sons, Ltd.     

Influence of a 30-min break on divided attention and working memory in resident anaesthetists on daily routine

Background. The aim of this study is to test the hypothesisthat a standard 30-min break in a routine 7.5 h period of workmakes a difference in cognitive function. Methods. In a double-blinded, cross-over trial 30 residentsin anaesthesia were randomized to receive or not to receivea 30-min break between the assessment times of 07:30 and 14:00.in a normal working day. After at least 28 days the test wasrepeated with each resident in the opposite group. Primary outcomemeasure was the Test for Attentional Performance with the subtestof working memory and divided attention. Secondary outcomesare the Stanford Sleepiness Scale and the State-Trait AnxietyInventory test. Results. The sleep, caffeine and nicotine habits in both groupswere comparable. There was no difference between the two groupsin the Test for Attentional Performance, Stanford SleepinessScale and the State-Trait Anxiety Inventory. The correlationbetween recovery through sleep and sleep disturbance in thenight before investigation to the Stanford Sleepiness Scale(P<0.001 and P=0.003) and State-Trait Anxiety Inventory (P<0.001and P=0.001) at the 07:30 assessment is significant. For the14:00 assessment the only significant correlation is betweenthe recovery through sleep with the Stanford Sleepiness Scale(P=0.04) and the State-Trait Anxiety Inventory (P=0.05). Conclusion. A 30-min break during a 7.5 h daily routine didnot influence cognitive function tests.     

骨钙素与认知功能及其在运动改善认知功能中的作用机制

骨钙素是由成骨细胞合成分泌的一种多肽激素,与骨形成密切相关,临床上常用作骨形成标志物。但新近研究发现骨钙素可通过其代谢活跃形式即未羧化骨钙素调节许多生理活动和发育过程,包括对大脑发育、神经结构和认知功能的调节作用。已知未羧化骨钙素可穿过血脑屏障聚集于脑干、丘脑和下丘脑,与中缝背侧核和中缝核中的血清素能神经元特异性结合后,可促进血清素合成、诱导钙流、刺激动作电位频率等。此外,运动可以通过骨钙素改善认知功能并参与痴呆症的预防,但不同类型的运动模式可能会引起不同形式的骨钙素发生变化。本文综述了骨钙素对认知功能的调节以及骨钙素在运动改善认知功能中的作用和机制的研究进展,旨在为探究骨脑的相互作用提供理论参考。     

Sex differences in executive functioning and latent herpesvirus reactivation among bereaved and nonbereaved individuals

The death of a spouse is a highly stressful event. Better executive functioning has been shown to benefit men to a greater degree than women during stress. We evaluated potential sex differences in stress and immune dysregulation among control and bereaved participants who completed a self‐report measure of perceived stress, neuropsychological measures of inhibition and updating/monitoring of information in working memory, and a blood draw to measure Epstein–Barr virus (EBV) antibody titres. Moderation analyses were conducted to test the hypothesis that better inhibition would be associated with less stress and immune dysregulation among male bereaved participants compared with female bereaved participants. Bereaved females demonstrated greater EBV antibody titres than bereaved males. Male bereaved participants benefited from better inhibition, as evidenced by fewer EBV antibody titres, whereas bereaved female participants did not. In the control group, males with high inhibition reported lower stress than males with low inhibition. Present study results are an important step towards identifying those at greatest risk of stress and poor health.     

Psychological issues in cancer and non-cancer conditions

The mechanism whereby incoming noxious stimuli result in emotional and behavioural changes is centred within cognitive processes. The mechanism is activated for all forms of pain but variations in the emotions generated and coping styles and strategies adopted occur. They are related to each individual's appraisal of their pain and the condition giving rise to it--major differences in appraisal relate to the presence or absence of malignancy with its potential threat to life. The psychological treatments of cognitive behavioural therapy have a role in the management of all chronic pain but historically have been employed more in non-cancer pain conditions than in patients with cancer pain. In the United Kingdom, the facilities for the treatment of pain by cognitive behavioural therapy are very limited and for that reason counselling, long used in aiding cancer patients, is likely to remain the main form of psychological treatment in that group.     

Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort

Concerns have been raised about the effects on cognition of anaesthesia for surgery, especially in elderly people. We recorded cognitive decline in a cohort of 394 people (198 women) with median (IQR) age at recruitment of 72.6 (66.6–77.8) years, of whom 109 had moderate or major surgery during a median (IQR) follow‐up of 4.1 (2.0–7.6) years. Cognitive decline was more rapid in people who on recruitment were: older, p = 0.0003; male, p = 0.027; had worse cognition, p < 0.0001; or carried the ε4 allele of apoliprotein E (APOEε4), p = 0.008; and after an operation if cognitive impairment was already diagnosed, p = 0.0001. Cognitive decline appears to accelerate after surgery in elderly patients diagnosed with cognitive impairment, but not other elderly patients.     

Tau蛋白与认知功能

Tau蛋白为正常的生理蛋白,其高度磷酸化对认知功能有影响.围术期存在多种因素可以通过蛋白激酶和蛋白磷酸酶相对活性失衡引起tau的磷酸化,从而影响术后认知功能.     

Cognitive decline in the middle‐aged after surgery and anaesthesia: results from the Wisconsin Registry for Alzheimer's Prevention cohort

Surgery and anaesthesia might affect cognition in middle‐aged people without existing cognitive dysfunction. We measured memory and executive function in 964 participants, mean age 54 years, and again four years later, by when 312 participants had had surgery and 652 participants had not. Surgery between tests was associated with a decline in immediate memory by one point (out of a maximum of 30), p = 0.013: memory became abnormal in 77 out of 670 participants with initially normal memory, 21 out of 114 (18%) of whom had had surgery compared with 56 out of 556 (10%) of those who had not, p = 0.02. The number of operations was associated with a reduction in immediate memory on retesting, beta coefficient (SE) 0.08 (0.03), p = 0.012. Working memory decline was also associated with longer cumulative operations, beta coefficient (SE) ?0.01 (0.00), p = 0.028. A reduction in cognitive speed and flexibility was associated with worse ASA physical status, beta coefficient (SE) 0.55 (0.22) and 0.37 (0.17) for ASA 1 and 2 vs. 3, p = 0.035. However, a decline in working memory was associated with better ASA physical status, beta coefficient (SE) ?0.48 (0.21) for ASA 1 vs. 3, p = 0.01.     

A cognitive model of guilt typology in combat-related PTSD

Dysfunctional guilt is a prominent feature of combat-related, post-traumatic stress disorder (PTSD). The present article describes a model of combat-related guilt that distinguishes guilt types on the basis of specific false assumptions and errors of logic that are frequently associated with different kinds of traumatic circumstances. Two common types of combat-related guilt based on this conceptualization are described and cognitive relabeling treatment strategies which have a type specific focus are outlined. The needs for research on guilt assessment among trauma survivors and for interventions that focus explicitly on guilt management are discussed.     

针刺在防治术后认知功能障碍中的机制研究进展

术后认知功能障碍(postoperative cognitive dysfunction,POCD)可导致患者术后发展为痴呆的可能性大大增加,影响患者预后,并增加医疗护理成本和家庭负担。基础研究表明,针刺可通过多重作用机制起到一定的脑保护效应,降低POCD的发生率。文章回顾了近年针刺在POCD领域内的研究进展,综述了可能存在的几种相关机制,包括抑制神经炎症、抑制氧化应激水平、减少神经元损伤、增强突触可塑性以及调节微生物菌群脑-肠轴等。将针刺应用于POCD确实取得了一定的成果,但其作用机制仍未完全明确。随着针刺研究的不断深入,需要尽快明确其作用机制,以便于更好地指导POCD的临床治疗。     

老年人骨折术后认知功能障碍

2002年1月-2005年7月,手术治疗75岁以上骨折患者105例,其中28例出现术后认知障碍,占同期手术患者的26·7%。通过对出现术后认知功能障碍的患者进行回顾性分析,探讨老年人术后认知障碍的发生原因及治疗方法。1临床资料1·1一般资料本组28例,男11例,女17例;年龄75~89岁,平均82·5     

老年人骨折术后认知功能障碍

2002年1月-2005年7月,手术治疗75岁以上骨折患者105例,其中28例出现术后认知障碍,占同期手术患者的26·7%。通过对出现术后认知功能障碍的患者进行回顾性分析,探讨老年人术后认知障碍的发生原因及治疗方法。1临床资料1·1一般资料本组28例,男11例,女17例;年龄75⁸9岁,平均82·5岁。髋部骨折21例,股骨骨折1例,股骨髁上骨折2例,胫腓骨骨折1例,肱骨外科颈骨折1例,下肢截肢2例。26例术前合并有高血压,11例合并有糖尿病,18例心电图检查异常,15例有慢性支气管炎病史,7例有脑栓塞病史,3例肝肾功能指标异常,12例贫血。13例术中或术后脑CT检查有不同程度的脑萎缩。1·2     

炎症反应在术后认知功能障碍和阿尔兹海默病中的作用

背景术后认知功能障碍(postoperative cognitive dysfunction,POCD)是老年患者术后常见的中枢神经系统并发症,阿尔兹海默病(alzheimer's disease,AD)是一种年龄相关性神经退行性疾病,神经突触和神经细胞丢失、老年斑形成和神经原纤维缠结是其主要病理特征. 目的 现就炎症反应在POCD和AD中的研究进展作一综述,为防治POCD和AD发生发展提供新的途径.内容 研究表明炎症反应在POCD和AD的发病机制中均起着重要作用,抗炎治疗可减缓POCD和AD患者病程.趋向 深入研究炎症反应在POCD和AD中的作用机制,有效的阻断或降低炎症反应,为POCD和AD的防治提供新的思路.     

右美托咪定改善术后认知功能障碍的机制及进展

背景 术后认知功能障碍(postoperative cognitive dysfunction,POCD)是手术麻醉后出现的中枢神经系统并发症,常见于65岁以上的老年患者. 目的 分析总结右美托咪定(dexmedetomidine,Dex)改善老年患者POCD的可能机制及临床应用. 内容 简述POCD的流行病学资料及发病机制;详细分析Dex改善POCD的可能机制. 趋向 目前对于POCD的治疗还在探索之中,Dex能否改善POCD,需要进一步的研究和探索.     

神经炎症反应在术后认知功能障碍中作用的研究进展

背景 在老年患者的心脏手术和非心脏手术中,术后认知功能障碍(postoperative cognitive dysfunction,POCD)已经成为一种常见的并发症.POCD导致患者并发症增加,医疗消耗增加,患者病死率升高.近年来大量研究发现POCD各种发病机制都通过一个共同通路即神经炎症. 目的 进一步研究神经炎症反应对POCD发生、发展的作用机制和防治措施.内容 以神经炎症反应为中心,围绕神经炎症、炎症因子、抗炎和炎症抑制反应对POCD的影响进行综述. 趋向 预防性抗炎治疗防止POCD的发生、发展.     

Psychomotor and cognitive functioning in cancer patients

Psychomotor and cognitive dysfunction in cancer patients can be classified into two main categories according to etiology: disease-induced factors (metabolic disturbances, brain metastasis, pain, etc.) and treatment-related factors (drugs, antineoplastic therapy, etc.). In particular, the effects of chronic opioid administration in cancer patients have been subjected to investigations, and most studies have been engaged in assessment and treatment of the cerebral dysfunction. Early studies found that cancer patients in chronic oral opioid therapy had prolonged continuous reaction times, and that the opioids seemed to be mainly responsible for the prolongation. Significant dose escalations of opioids (≥ 30%) caused transiently impaired psychomotor and cognitive functions in cancer patients. Cancer patients in chronic oral opioid therapy did not achieve any advantages changing to epidural opioid therapy with regard to faster continuous reaction times and less pain.
Large doses of opioids are often required to control severe pain in cancer patients. As increased sedation and impaired psychomotor and cognitive functions often occur, a number of studies have investigated the use of amphetamine derivatives to counteract the sedative side-effects of opioid. These drugs seem promising during high-dose opioid therapy and their use may be particularly rewarding in poor opioid-responsive pain conditions such as incident and neuropathic pain.     

The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility

Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole‐team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non‐technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.