Psychological, cognitive and motor effects of mindfulness meditation : study in different populations

La méditation de pleine conscience (MPC) est une pratique mentale, impliquant des mécanismes cognitifs et émotionnels, qui consiste à porter son attention sur le moment présent (pensées, sensations, émotions), sans attente, sans filtre et sans jugement. Des résultats encourageants sont en faveur de bénéfices comportementaux de la MPC dans les domaines psychologique, cognitif et moteur. Cependant, des zones d'ombre persistent concernant leurs modérateurs, leurs mécanismes d'action, et l'efficacité de la modalité de pratique en ligne. L'objectif de cette thèse est d'apporter une meilleure compréhension des effets comportementaux de la MPC en cherchant à lever ces verrous scientifiques à travers une investigation chez différentes populations saines (adultes, étudiants, pratiquants ou novices en MPC). Premièrement, nous avons étudié l'efficacité de la MPC en ligne sur la santé mentale et les capacités attentionnelles d'étudiants pendant la crise sanitaire de la COVID-19. Deuxièmement, nous avons investigué les effets aigus de la MPC sur les capacités cognitives de pratiquants et novices en MPC. Pour finir, également chez des pratiquants et novices, nous avons étudié les effets aigus de la MPC sur le contrôle moteur, en cherchant à déterminer s'ils pouvaient être médiés par ses bénéfices cognitifs. Ce travail apporte des preuves de l'efficacité à court et moyen termes de la MPC dans les domaines psychologique, cognitif et moteur, tout en suggérant certains modérateurs de ses effets. De plus, à travers l'étude du lien cognition-motricité, il apporte les premières données concernant les potentiels mécanismes d'action de la MPC dans le domaine moteur.Mindfulness meditation (MM) is a mental practice that involves cognitive and emotional processes. It consists in focusing attention on the present moment (thoughts, feelings, emotions) without expectations, filters or judgment. Currently, encouraging results are in favor of its behavioral benefits in psychological, cognitive and motor domains. Nevertheless, uncertainties remain regarding their moderators, their underlying mechanisms of action, and the efficacy of online practice. Accordingly, this PhD thesis aimed to provide a better understanding of the behavioral effects of MM by overcoming these scientific bottlenecks through an investigation in different healthy populations (adults, students, meditators or novices in MM). First, we studied the efficacy of an online MM intervention on students' mental health and attentional abilities during the COVID-19 sanitary crisis. Secondly, we investigated the acute effects of MM on cognitive abilities in meditation-naïve (novices) and meditation-experienced (meditators) participants. Finally, also in meditators and novices, we studied the acute effects of MM on motor control and whether they could be mediated by the cognitive benefits. This doctoral work provides evidence on the efficacy of short- and mid-term MM practice in the psychological, cognitive and motor domains, while suggesting certain moderators. In addition, through the investigation of the link between cognition and motor control, it provides a first insight regarding the potential mechanisms of action of MM in the motor domain

Online Mindfulness Intervention, Mental Health and Attentional Abilities: A Randomized Controlled Trial in University Students During COVID-19 Lockdown

The COVID-19 pandemic has led to worldwide restrictive measures, raising concerns about mental health in young adults who were not particularly vulnerable to the virus itself. This study investigated the impact of these restrictions on mental and cognitive health of university students, and tested the efficacy of a brief online mindfulness meditation intervention in countering psychological distress and improving attentional abilities. Ninety-six university students forced into remote learning due to COVID-19 pandemic restrictions and with no experience in meditation were randomly assigned to either a passive control group (n = 48) or to an experimental group (n = 48) following daily, for 17 days, an online mindfulness intervention (10-20 min per day). Due to drop-out, 38 participants in each group were finally analyzed. Pre- and post-tests assessed participants' mental health (psychological well-being, depression, anxiety, stress) and attentional abilities. The analysis of baseline data in comparison with normative scores and pre-pandemic statistics confirmed the expected psychological distress, but it did not reveal any attentional deficits in our participants. Pre-post change scores analyses showed a reduction in stress (p = 0.006, eta(2)(p) = 0.10), anxiety (p = 0.002, eta(2)(p) = 0.13), and depression (p = 0.025, eta(2)(p) = 0.07), and an improvement in well-being (p = 0.013, eta(2)(p) = 0.12) in the experimental group, but not in the control group. In both groups, no significant effect was found on attentional abilities. Our results confirmed the psychological vulnerability of higher education students in the midst of the remote learning period during the second COVID-19 lockdown in France, while suggesting preservation of attentional functioning. Although the tested mindfulness intervention did not enhance the attentional abilities in already good performing students, it did promote their mental health. This study offers additional evidence on the feasibility and efficacy of mindfulness-based interventions in students during psychologically straining periods, like the COVID-19 pandemic

Intentional maintenance of antiphase bimanual pattern at transition frequency: Is it associated with inhibition processes?

This study aimed at demonstrating the intentional modulation of bimanual coordination dynamics at transition frequency and determining whether it is associated with perceptual and/or motor inhibition capacities. Healthy adults (N = 29) performed in a random order: i) bimanual anti-phase (AP) movements at the maximal individual transition frequency, with the instruction to either let go, or intentionally maintain the initial movement pattern and oppose to the spontaneous transition to in-phase (IP) movements, and ii) The Motor and Perceptual Inhibition Test, giving separate scores for perceptual and motor inhibition. Results showed that in the intentional condition participants were able to delay (more movement cycles before the transition) and suppress (more trials without transition) the spontaneous transition from AP to IP. A statistically significant, though weak, correlation was found between motor performance and perceptual inhibition scores. We interpreted our findings as an indicator of the presence of an inhibitory mechanism underlying intentional dynamics that is partially associated to perceptual inhibition in healthy adults. This could have implications in populations with compromised inhibitory capacities, which might entail motor repercussions, and suggests the possibility of using bimanual coordination as means to stimulate both cognitive and motor capacities

Mindfulness meditation and bimanual coordination control: study of acute effects and the mediating role of cognition

International audienceMindfulness meditation (MM) involves and benefits cognitive functioning, especially attention and inhibition processes, which are also implicated in the control of complex motor skills, such as bimanual coordination. Thus, MM practice could potentially enhance bimanual coordination control through its cognitive benefits. Accordingly, in this study, we investigated the acute effects of a brief MM session on bimanual coordination dynamics, attention, and inhibition abilities, as well as the mediation link between MM’s cognitive and motor improvements. Methods Healthy meditation-naïve (novices, n = 29) and meditation-experienced participants (meditators, n = 26) were randomly assigned to either an active control intervention (attentive listening to a documentary podcast) or a MM intervention (breathing and open monitoring exercise), both lasting 15 min. In the motor domain, pre- and post-tests assessed participants’ ability to intentionally maintain the anti-phase coordination pattern at maximal movement frequency and resist the spontaneous transition to the in-phase pattern. In the cognitive domain, the participants’ attentional, perceptual inhibition and motor inhibition abilities were assessed. Results Following both interventions, meditators and novices improved the stability of their anti-phase coordination pattern ( p = 0.034, η p 2 = 0.10) and their attentional performance ( p ’s < 0.001, η p 2 > 0.40). Only following the MM intervention, meditators and novices improved their ability to intentionally maintain the anti-phase pattern by delaying or even suppressing the spontaneous transition to in-phase ( p ’s < 0.05, η p 2 ≥ 0.11), and improved concomitantly their motor inhibition scores ( p = 0.011, η p 2 = 0.13). No effects were found on perceptual inhibition. The increase in motor inhibition capacities did not however statistically mediate the observed acute effects of MM on bimanual coordination control. Conclusion We showed that a single MM session may have acute benefits in the motor domain regardless of the familiarity with MM practice. Although these benefits were concomitant to enhanced attentional and motor inhibition abilities, no formal mediation link could be established between the observed motor and cognitive benefits. This study paves the way for the investigation of the mechanisms underlying MM effects on motor control, as well as longer-term benefits

A single session of mindfulness meditation may acutely enhance cognitive performance regardless of meditation experience

The present study investigated acute cognitive effects of mindfulness meditation (MM) compared to an active control intervention in meditators (n = 22) and novices (n = 20) using a within-subject design. We analyzed reaction times in a digitized Stroop task at baseline, after a 10-minute MM session with a fundamental breathing exercise, and after a 10-minute attentive listening intervention. Interventions order was randomized and a 10 min delay was respected before testing. Relative to baseline, meditators and novices showed faster reaction times after both interventions, but more so after MM for the congruent and incongruent Stroop task conditions that are associated with attention, inhibition and cognitive flexibility. Although the two interventions showed cognitive effects independent of previous meditation experience, MM appeared to induce larger benefits. Our findings are encouraging and support MM’s potential as a means to enhance cognitive performance on the short-term without the need of any previous practice

Non-Steroids Anti-Inflammatory Drugs and Risk of Peritonsillar Abscess in Pharyngitis: A French Longitudinal Study in Primary Care\textdagger

Abstract Background The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature. Objective To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care. Method A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model. Results During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6\textendash 5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3\textendash 7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5\textendash 13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7). Conclusion Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis

General practice undergraduate and vocational training: ambulatory teaching and trainers’ curriculum and remuneration – a cross-sectional study among 30 member countries of WONCA Europe

International audienceBackground: After a long phase without any propositions for real ambulatory training inside general practitioners’ offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe. Method: We carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses. Results: Representatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations. Conclusion: This study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners

General Practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France

Purpose: Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers.Methods: This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs' characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis.Results: Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%.Conclusion: These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced

Proposal for a shared definition of « primary healthcare» by health professionals: A national cross-sectional survey

International audienceIntroduction Forty years passed between the two most important definitions of primary health care from Alma Alta Conference in 1978 to WHO’s definition in 2018. Since then, reforms of healthcare systems, changes in ambulatory sector and COVID 19, have created a need for reinterpretations and redefinition of primary healthcare. The primary objective of the study was to precise the definitions and the representations of primary healthcare by healthcare professionals. Methods We conducted a descriptive cross-sectional study using a web-based anonymized questionnaire including opened-ended and closed-ended questions but also “real-life” case-vignettes to assess participant’s perception of primary healthcare, from September to December 2020. Five case-vignette, describing situations involving a specific primary health care professional in a particular place for a determined task were selected, before the study, by test/retest method. Results A total of 585 healthcare practitioners were included in the study, 29% were general practitioners and 32% were midwives. Amongst proposed healthcare professions, general practitioners (97.6%), nurses (85.3%), midwives (85.2%) and pharmacists (79.3%) were those most associated with primary healthcare. The functions most associated with primary healthcare, with over 90% of approval were “prevention, screening”, “education to good health”, “orientation in health system”. Two case-vignettes strongly emerged as describing a situation of primary healthcare: Midwife/Hospital/Pregnancy (74%) and Pharmacist/Pharmacy/Flu shot (90%). The profession and the modality of practice of the responders lead to diverging answers regarding their primary healthcare representations. Conclusions Primary healthcare is an ever-evolving part of the healthcare system, as is its definition. This study explored the perception of primary healthcare by French healthcare practitioners in two complementary ways: oriented way for the important functions and more practical way with the case-vignettes. Understanding their differences of representation, according to their profession and practice offered the authors a first step to a shared and operational version of the primary healthcare definition

Patients’ experiences of being touched by their general practitioner: a qualitative study

Objective This study aimed to explore patients’ experiences and perceptions of touch, as practised by their general practitioner during their medical appointment.Design Qualitative study using grounded theory method, based on individual interviews. Data collection and analysis occurred iteratively; themes were identified using constant comparison.Setting Recruitment among general practitioners’ private practices and health centres in Ile-de-France.Participants Twenty-one patients aged 19–88 years old, interviewed between June 2018 and May 2019.Results Physical examination was described as a ritual enabling the establishment of patients’ and doctors’ roles, the verification of the doctor’s skills and the construction of a caring experience. Touch was also a media for the doctor to exercise power that the patient authorised. Finally, it had relational and emotional value.Discussion and conclusion Physical examination is so internalised by the patients that it becomes unquestionable. It may be inappropriate when this touch does not belong to physical examination or on the contrary represents a proof of the doctor’s humanity. The patient is not necessarily aware of the relational dimension that underpins touching and, in particular, clinical examination. This raises the question of why should doctor use it and how they can communicate about it, so that it may become an active tool in favour of trust and the construction of the relationship