GP-initiated preconception counselling in a randomised controlled trial does not induce anxiety

BACKGROUND: Preconception counselling (PCC) can reduce adverse pregnancy outcome by addressing risk factors prior to pregnancy. This study explores whether anxiety is induced in women either by the offer of PCC or by participation with GP-initiated PCC. METHODS: Randomised trial of usual care versus GP-initiated PCC for women aged 18–40, in 54 GP practices in the Netherlands. Women completed the six-item Spielberger State Trait Anxiety Inventory (STAI) before PCC (STAI-1) and after (STAI-2). After pregnancy women completed a STAI focusing on the first trimester of pregnancy (STAI-3). RESULTS: The mean STAI-1-score (n = 466) was 36.4 (95% CI 35.4 – 37.3). Following PCC there was an average decrease of 3.6 points in anxiety-levels (95% CI, 2.4 – 4.8). Mean scores of the STAI-3 were 38.5 (95% CI 37.7 – 39.3) in the control group (n = 1090) and 38.7 (95% CI 37.9 – 39.5) in the intervention group (n = 1186). CONCLUSION: PCC from one's own GP reduced anxiety after participation, without leading to an increase in anxiety among the intervention group during pregnancy. We therefore conclude that GPs can offer PCC to the general population without fear of causing anxiety. Trial Registration: ISRCTN5394291

Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial

<p>Abstract</p> <p>Background</p> <p>Patients with Chronic Tension Type Headache (CTTH) report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being) and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles.</p> <p>We present the design of a randomised clinical trial (RCT) evaluating the effectiveness of manual therapy (MT) compared to usual care by the general practitioner (GP) in patients with CTTH.</p> <p>Methods and design</p> <p>Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS).</p> <p>Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques), exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks.</p> <p>Discussion</p> <p>This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible.</p> <p>The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.</p

Historie van het slaaponderzoek

Scientific research to sleep starts about hundred years ago. At that time technologies became available to record the electrical brain activity. The tiny electrical currents could be measured and written on paper with primitive amplifiers and galvanometers. Moreover, the stereotactic method to place electrodes adequately in every nucleus of the brain were developed. This allowed not only recordings of structures deep in the brain, but also electrical stimulation of these structures. In 1929 Hans Berger succeeded to transfer the animal EEG recordings of Caton and Beck, to humans. He described the alpha and beta waves. In 1935 the first classification of sleep-wake states became available. But with the discovery of the REM-sleep, the classification was revised by Rechtschaffen and Kales in 1968. This classification is still in general use. The concept of the reticular formation in the brainstem paved the way for new theoretical views. The active sleep theory replaced the old view in that sleep was merely a passive process. The association between REM-sleep and dreaming stimulated both research towards REM-sleep and dreaming. Recall of dreams showed that most dream content is a reflection of all day life. The mechanism of REM-sleep is thoroughly investigated, but its function still remains a mystery

Historie van het slaaponderzoek

Item does not contain fulltextScientific research to sleep starts about hundred years ago. At that time technologies became available to record the electrical brain activity. The tiny electrical currents could be measured and written on paper with primitive amplifiers and galvanometers. Moreover, the stereotactic method to place electrodes adequately in every nucleus of the brain were developed. This allowed not only recordings of structures deep in the brain, but also electrical stimulation of these structures. In 1929 Hans Berger succeeded to transfer the animal EEG recordings of Caton and Beck, to humans. He described the alpha and beta waves. In 1935 the first classification of sleep-wake states became available. But with the discovery of the REM-sleep, the classification was revised by Rechtschaffen and Kales in 1968. This classification is still in general use. The concept of the reticular formation in the brainstem paved the way for new theoretical views. The active sleep theory replaced the old view in that sleep was merely a passive process. The association between REM-sleep and dreaming stimulated both research towards REM-sleep and dreaming. Recall of dreams showed that most dream content is a reflection of all day life. The mechanism of REM-sleep is thoroughly investigated, but its function still remains a mystery

Benzodiazepinen

Item does not contain fulltextBenzodiazepines are the most popular and prescribed anxiolytics and hypnotics over the world. They are relatively safe and have a broad field of action. Benzodiazepines induce relaxation and sedation, reduce anxiety, facilitate sleep, cause muscle relaxation and have anti-convulsive effects. The biological profile of all benzodiazepine-derivatives is almost the same. A clear difference exists only in half-life, a measure for the time of action. Besides induction of sedation and sleepiness, benzodiazepines affect psychomotor functions as car-driving, give rise to anterograde amnesia and influence the EEG. When used for a longer time, tolerance may develop, efficacy decreases and dependence can be the result. Benzodiazepines relieve the symptoms of psychic problems, but do not cure the underlying problems. Nevertheless, they are of great value for patients in order to reduce anxiety and to promote sleep. Ideally, they should be used in supporting a causal therapy. Benzodiazepines mediate their effects by facilitating inhibitory processes in the brain; they act as GABA-agonists. Recently, the benzodiazepine-receptor was identified and new insights in the mechanisms of actions of the benzodiazepines indicate that more specific benzodiazepine-like drugs with less side-effects will be available in the future

Benzodiazepinen

Item does not contain fulltextBenzodiazepines are the most popular and prescribed anxiolytics and hypnotics over the world. They are relatively safe and have a broad field of action. Benzodiazepines induce relaxation and sedation, reduce anxiety, facilitate sleep, cause muscle relaxation and have anti-convulsive effects. The biological profile of all benzodiazepine-derivatives is almost the same. A clear difference exists only in half-life, a measure for the time of action. Besides induction of sedation and sleepiness, benzodiazepines affect psychomotor functions as car-driving, give rise to anterograde amnesia and influence the EEG. When used for a longer time, tolerance may develop, efficacy decreases and dependence can be the result. Benzodiazepines relieve the symptoms of psychic problems, but do not cure the underlying problems. Nevertheless, they are of great value for patients in order to reduce anxiety and to promote sleep. Ideally, they should be used in supporting a causal therapy. Benzodiazepines mediate their effects by facilitating inhibitory processes in the brain; they act as GABA-agonists. Recently, the benzodiazepine-receptor was identified and new insights in the mechanisms of actions of the benzodiazepines indicate that more specific benzodiazepine-like drugs with less side-effects will be available in the future