Raising positive expectations helps patients with minor ailments: A cross-sectional study

Background: Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study examines to what extent GPs display both strategies during consultations for minor ailments and investigates how each of these relate to the patients' perceived health, consultation frequency and medication adherence. Methods: 524 videotaped consultations between Dutch GPs and patients aged 18 years or older were selected. All patients presented a minor ailment, and none of them suffered from a diagnosed chronic illness. The observation protocol included the validated Active Listening Observation Scale (ALOS-global), as well as three domains of positive communication, i.e. providing reassurance, a clear explanation, and a favourable prognosis. Patients completed several questionnaires before, immediately after, and two weeks after the consultation. These included measures for state anxiety (STAI), functional health status (COOP/ WONCA charts) and medication adherence (MAQ). Consultation frequency was available from an ongoing patient registration. Data were analysed using multivariate regression analyses. Results: Reassurance was related to patients' better overall health. Providing a favourable prognosis was linked to patients feeling better, but only when accompanied by a clear explanation of the complaints. A clear explanation was also related to patients feeling better and less anxious, except when patients reported a low mood pre-visit. Active listening alone was positively associated with patients feeling worse. Among patients in a good mood state, active listening was associated with less adherence. Conclusion: To some extent, it seems helpful when GPs are at the same time clear and optimistic about the nature and course of minor ailments. Yet, it does not seem helpful always and in all cases, e.g. when patients feel low upon entering the consulting room. Although communication strategies might to some extent contribute to the management of minor ailments, the results of this observational study also indicate that it is important for a physician to pay attention to the mood of the patient who enters the consulting room. (aut. ref.

Relevance of genetic testing in the gene-targeted trial era: the Rostock Parkinson\u27s disease study

\ua9 The Author(s) 2024. Estimates of the spectrum and frequency of pathogenic variants in Parkinson’s disease (PD) in different populations are currently limited and biased. Furthermore, although therapeutic modification of several genetic targets has reached the clinical trial stage, a major obstacle in conducting these trials is that PD patients are largely unaware of their genetic status and, therefore, cannot be recruited. Expanding the number of investigated PD-related genes and including genes related to disorders with overlapping clinical features in large, well-phenotyped PD patient groups is a prerequisite for capturing the full variant spectrum underlying PD and for stratifying and prioritizing patients for gene-targeted clinical trials. The Rostock Parkinson’s disease (ROPAD) study is an observational clinical study aiming to determine the frequency and spectrum of genetic variants contributing to PD in a large international cohort. We investigated variants in 50 genes with either an established relevance for PD or possible phenotypic overlap in a group of 12 580 PD patients from 16 countries [62.3% male; 92.0% White; 27.0% positive family history (FH+), median age at onset (AAO) 59 years] using a next-generation sequencing panel. Altogether, in 1864 (14.8%) ROPAD participants (58.1% male; 91.0% White, 35.5% FH+, median AAO 55 years), a PD-relevant genetic test (PDGT) was positive based on GBA1 risk variants (10.4%) or pathogenic/likely pathogenic variants in LRRK2 (2.9%), PRKN (0.9%), SNCA (0.2%) or PINK1 (0.1%) or a combination of two genetic findings in two genes (∼0.2%). Of note, the adjusted positive PDGT fraction, i.e. the fraction of positive PDGTs per country weighted by the fraction of the population of the world that they represent, was 14.5%. Positive PDGTs were identified in 19.9% of patients with an AAO ≤ 50 years, in 19.5% of patients with FH+ and in 26.9% with an AAO ≤ 50 years and FH+. In comparison to the idiopathic PD group (6846 patients with benign variants), the positive PDGT group had a significantly lower AAO (4 years, P = 9 7 10−34). The probability of a positive PDGT decreased by 3% with every additional AAO year (P = 1 7 10−35). Female patients were 22% more likely to have a positive PDGT (P = 3 7 10−4), and for individuals with FH+ this likelihood was 55% higher (P = 1 7 10−14). About 0.8% of the ROPAD participants had positive genetic testing findings in parkinsonism-, dystonia/dyskinesia- or dementia-related genes. In the emerging era of gene-targeted PD clinical trials, our finding that ∼15% of patients harbour potentially actionable genetic variants offers an important prospect to affected individuals and their families and underlines the need for genetic testing in PD patients. Thus, the insights from the ROPAD study allow for data-driven, differential genetic counselling across the spectrum of different AAOs and family histories and promote a possible policy change in the application of genetic testing as a routine part of patient evaluation and care in PD

Leaf litter traits of invasive alien species slow down decomposition compared to Spanish natives: a broad phylogenetic comparison.

Leaf traits related to the performance of invasive alien species can influence nutrient cycling through litter decomposition. However, there is no consensus yet about whether there are consistent differences in functional leaf traits between invasive and native species that also manifest themselves through their "after life" effects on litter decomposition. When addressing this question it is important to avoid confounding effects of other plant traits related to early phylogenetic divergences and to understand the mechanism underlying the observed results to predict which invasive species will exert larger effects on nutrient cycling. We compared initial leaf litter traits, and their effect on decomposability as tested in standardized incubations, in 19 invasive-native pairs of co-familial species from Spain. They included 12 woody and seven herbaceous alien species representative of the Spanish invasive flora. The predictive power of leaf litter decomposition rates followed the order: growth form > family > status (invasive vs. native) > leaf type. Within species pairs litter decomposition tended to be slower and more dependent on N and P in invaders than in natives. This difference was likely driven by the higher lignin content of invader leaves. Although our study has the limitation of not representing the natural conditions from each invaded community, it suggests a potential slowing down of the nutrient cycle at ecosystem scale upon invasion. © Springer-Verlag 2009

Studium przypadku wpływu siłowego i wytrzymałościowego treningu na lokalną redukcję podskórnej tkanki tłuszczowej

The possibility of local reduction of subcutaneous fatty tissue was investigated in the project discussed in this article. Only one male participated in the experiment. During the experiment the participant trained his abdomen doing additional cardio training for two weeks, while in the following two weeks the abdomen was not trained at all. Instead of abdomen training, only cardio training was performed. This was repeated until the end of the experiment which lasted 9 weeks. The sum of thickness of all 7 observed skin folds was counted. Then, percentage of thickness of abdomen skin folds in relation to all skin folds was calculated. Each successive measurement was compared with the previous one to assess the decrease or increase of abdomen skin fold percentage in relation to all measured skin folds. We put the decreases and increases into a contingency table and calculated probability by using the Fisher’s exact test. Statistical significance was determined at 0.05 level. The local reduction of subcutaneous fatty tissue at abdomen was proven. However, the problem needs more scientific results to conclude this question completely.W artykule przedstawiono możliwości redukcji lokalnej podskórnej tkanki tłuszczowej. Badania przeprowadzono na jednym przedstawicielu płci męskiej. Podczas eksperymentu badany trenował mięśnie brzucha w kombinacji z treningiem aerobowym przez dwa tygodnie. Następne dwa tygodnie mężczyzna wykonywał tylko trening wytrzymałościowy i nie trenował w ogóle mięśni brzucha. Powtarzano to do czasu zakończenia eksperymentu, który trwał przez dziewięć tygodni. Obliczono całkowitą grubość obserwowanych 7 fałdów skórnych. Następnie obliczono wartość procentową tworzoną przez grubość fałdu skórnego na brzuchu względem sumy wszystkich fałdów skóry. Każdy kolejny pomiar porównywano z poprzednim, aby sprawdzić, czy stosunek procentowy grubości fałdu skórnego na brzuchu do grubości wszystkich fałdów skóry wzrośnie czy zmaleje. Wyniki pomiarów zestawiono w tabeli, a prawdopodobieństwo błędu obliczono przy pomocy testu Fiszera. Jako istotną statystycznie przyjęto wartość 0,05. Badania wykazały lokalną redukcję podskórnej tkanki tłuszczowej na brzuchu, ostateczne rozstrzygnięcie przedmiotowej kwestii wymaga jednakże dalszych badań