bluuebunny/crossref_metadata_2025 huggingface dataset:
Short‐term effects of physiotherapy versus counselling for the treatment of myofascial pain of the jaw muscles
Authors: MICHELOTTI A. , STEENKS M. H. , FARELLA M. , PARISINI F.
Published: March 2003

The aim of the present study was to compare the efficacy of physiotherapy and counselling for the treatment of myofascial pain of the jaw muscles. Sixty‐three consecutive myogenous TMD patients, diagnosed according to the RDC‐TMD criteria, were assigned to two treatment groups with a balanced‐block randomization. The first group received only counselling with general information about self‐care of jaw musculature. The second group received the same general information supplemented by self‐massage, application of moist heating pads and stretching exercises of the masticatory muscles.

Treatment success was decided on treatment contrast (TC), based on relative changes of sufficiently large anamnestic and clinical scores (van der Glas and van Grootel, 2000). Additional measurements included pressure pain threshold (PPT) of the masseter, anterior temporalis and Achilles' tendon, pain during gum chewing and spontaneous muscle pain scores rated on visual analogue scales (VAS). Data were collected at baseline and 3 months after start of treatment. Mann–Whitney's test and Fisher's exact test were used for statistical analysis. Sixteen patients dropped out from the study: eight from the counselling and eight from the physiotherapy group. The success rate was 13 of 23 (57%) patients for counselling and 18 of 24 (75%) for the physiotherapy group (P > 0·05). There was no significant difference between groups in all the other variables.

Over a short‐term period, physiotherapy, as used in this protocol, does not appear superior to counselling for the treatment of TMD myofascial pain.
Measurement of condylar motion: a plea for the use of the condylar kinematic centre
Authors: Naeije M.
Published: March 2003

summary  In this study, a plea is given for the use of the kinematic centre in studies of the kinematics of the human temporomandibular condyle. The concept of the kinematic centre is based upon the assumption that the movements of the condyle–disc complex within the temporomandibular joint can reasonably well be described by those of a ball‐shaped condyle–disc complex. The kinematic centre is then the centre of the sphere. Its movement traces have the advantage that they are smooth and have a good reproducibility between consecutive movements. Moreover, the open and close traces are just a few tenths of a millimetre apart and show no crossings. This makes the kinematic centre a suitable choice in order to avoid false‐positive diagnoses in the study of internal derangements by means of condylar movement recordings. However, the kinematic centre has the disadvantage that the mandibular movements have to be recorded by rather complicated six degrees of freedom recording equipment and that the exploration algorithm for its location may sometimes have difficulties in finding the right location.
Managed mental health care: problems and possibilities
Authors: Jones Adrian , Norman
Published: March 2003

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as ‘managed care’ has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.
Staff perceptions of substance use among acute psychiatry in‐patients
Authors: Ryrie  , McGowan
Published: March 2003

This paper reports on a small‐scale study undertaken in two inner city acute psychiatric wards to identify the proportion of patients known to use drugs or alcohol and the perceptions of staff regarding these patients. Data collection involved a retrospective audit of patient notes and the administration of a questionnaire to nursing staff. The findings were broadly consistent with other research studies. Over half of the patient sample was reported to use illicit drugs or alcohol and in one third of cases this use was thought to have contributed to their current admission. Questionnaire results indicated that staff felt ill‐equipped to offer an adequate response although all respondents welcomed opportunities to develop their knowledge and skills. The findings are discussed in light of the existing literature, and some tentative conclusions are drawn concerning the development and provision of effective integrated services for individuals with psychiatric and psychoactive substance use disorders.
Compulsory community treatment: ethical considerations
Authors: Heffern  , Austin
Published: March 2003

Compulsory community treatment (CCT) of people with serious mental health problems is analysed using the bioethical principles of autonomy and beneficence. Feminist ethical theory is then used to clarify these principles as they relate to community commitment of the severely and persistently mentally ill. Finally, a model of practice is proposed as an alternative to CCT in which both autonomy and beneficence are better served.
Effects of systematic clinical supervision on psychiatric nurses’ sense of coherence, creativity, work‐related strain, job satisfaction and view of the effects from clinical supervision: a pre‐post test design
Authors: Berg A. , Hallberg I. R.
Published: March 2003

There are few investigations of the type and the outcome of interventions aimed at supporting nurses caring for psychiatric patients. Therefore a prepost–test design study was used in which 22 psychiatric nurses, on a general psychiatric ward were examined before, during and after one year of systematic clinical supervision combined with supervised documented, planned, individualized care. The methods used were the Sense of Coherence scale (SOC), the Creative Climate Questionnaire (CCQ), the Work‐Related Strain Inventory and 34 statements from the Satisfaction with Nursing Care and Work Questionnaire (SNCW). In addition 14 statements were developed to evaluate the nurses’ view of the effects from clinical supervision. The baseline values for the CCQ indicated a stagnant organization and a high score in the conflict dimension indicated personal and emotional tensions within the organization. The intervention led to a significantly increased creative and innovative climate in the dimensions for trust, idea time and reduced conflicts. However, the organizational climate remained stagnant. The nurses’ view of the effects from clinical supervision also increased significantly. There were no significant changes in the nurses’ SNCW, WRSI or SOC score. The result of the correlation analysis indicated that a strong sense of coherence was related to low work‐related strain but not to unsatisfactory working conditions/milieu. The results gave some support to the idea that systematic clinical supervision and supervised nursing care plans constitute one type of support strategy that improves creativity and the organizational climate. It may, not, however, buffer for interpersonal problems. Further research is required to explore the need for and effects of various support systems depending on the circumstances in the organization.
‘Something always comes up’: nurse–patient interaction in an acute psychiatric setting
Authors: Cleary M. , Cleary M.
Published: March 2003

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse–patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses’ attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses’ attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses’ role and nursing education.
Education for community psychiatric nurses: content, structure and trends in recruitment
Authors: HANNIGAN B.
Published: March 2003

Under the auspices of the Standing Advisory Group for Community Psychiatric Nursing Education, annual surveys of the leaders of the UK's post‐registration courses for community psychiatric nurses (CPNs) have taken place since the 1987–88 academic year. In this paper, findings are reported from the 1997–98 survey. Thirty‐two of the 39 course leaders running post‐qualifying programmes for CPNs (English National Board course 812 or equivalent, and Specialist Practitioner courses) in the 1997–98 academic year responded to a nine‐page postal questionnaire. Responses suggested that the majority of courses for CPNs are now offered at first degree level, with most students completing their programmes of study and clinical practice in one full‐time academic year. Most courses appeared to include education in key areas of specialist content pertinent to contemporary CPN practice. Examples included: evidence‐based psychosocial interventions; collaborative working with users of mental health services; interprofessional issues; cognitive‐behavioural interventions; reflective practice and clinical supervision and medication‐related issues. Overall, however, courses for CPNs appeared to be characterized by considerable variations in specialist content. Possible explanations for this are offered, along with suggestions for future research.
The role of reflection in the development of practice theory: a case study
Authors: McKENNA H.
Published: March 2003

Many authors view practice theory as the strongest form for an applied discipline like nursing. It is based upon the idea that theory emanates from practice, is strengthened and is returned to inform practice. The first part of this paper is concerned with identifying the contribution that practice theory can make to patient care. While there are many positivistic ways of generating practice theory, one method which is getting increasing attention is reflection. In this paper, Boud et al.'s framework for reflection is used to identify phenomena related to the empowerment of patients and staff in psychiatric hospitals (Boud et al. 1985). A real life case study is described and concepts and beginning propositions are uncovered. Conclusions are drawn which form the basis for theory development and testing.
Employment, social inclusion and mental health
Authors: Evans J. , Repper J.
Published: March 2003

Whereas unemployment is clearly linked to mental health problems, employment can improve quality of life, mental health, social networks and social inclusion. Yet in the UK only 15% of people with serious mental health problems are employed – despite an overwhelming consensus from surveys, case studies and personal accounts that users want to work. This paper aims to challenge common misconceptions surrounding employment, work and mental health problems. Drawing on a range of research evidence and legislative guidance it discusses significant barriers to work and proposes feasible solutions. The need for mental health staff and services to become involved in the provision of work opportunities is considered, as is the vital role they can play in changing communities. The potency of work as a vehicle for improving the social inclusion and community tenure of people with mental health problems is highlighted.
Constructing normality: a discourse analysis of the DSM‐IV
Authors: Crowe M.
Published: March 2003

The purpose of this research was to explore how the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) 1994, (American Psychiatric Association, 1994) defines mental disorder and the theoretical assumptions upon which this is based. The analysis examines how the current definition has been constructed and what the criteria for specific mental disorders suggest about what is regarded as normal. The method employed for the research was a critical discourse analysis. This critical approach to research is primarily concerned with analysis of the use of language and the reproduction of dominant belief systems in discourse. It involves systematic and repeated readings of the DSM‐IV (1994) to examine what evidence was employed by the text to substantiate its definition of mental disorder and how in the process some assumptions are made about what constitutes normality. This study challenges a central assumption in the DSM‐IV’s (1994) definition: that it is a pattern or syndrome ‘that occurs in an individual’. The proposal that it occurs in an individual implies that it is a consequence of faulty individual functioning. This effectively excludes the social and cultural context in which experiences occur and ignores the role of discourse in shaping subjectivity and social relations. This study proposes that the definition and criteria for mental disorder are based on assumptions about normal behaviour that relate to productivity, unity, moderation and rationality. The influence of this authoritative image of normality pervades many areas of social life and pathologises experiences that could be regarded as responses to life events.
What can we do about acute extrapyramidal symptoms?
Authors: Gray R. , Gournay K.
Published: March 2003

Antipsychotic drugs are the most effective treatment for psychotic disorders such as schizophrenia. However, they are known to cause a range of side‐effects including acute extrapyramidal symptoms (EPS) that are both distressing and disabling. Mental health nurses play a critical role in both the detection and the management of these symptoms. A review of the literature was conducted to identify strategies for managing acute EPS. Despite a widely held belief that EPS are associated with noncompliance with medication, the data to support this hypothesis are weak. Although akathisia may negatively affect the treatment outcome, there was little evidence to suggest that parkinsonism or dystonia do. Whilst the use of anticholinergic medication may be helpful in treating acute parkinsonism and dystonia they were associated with their own side‐effects and the benefit of long‐term prophylactic treatment is doubtful. The literature suggests that logical prescribing and rapid detection and management of acute EPS will result in a substantial reduction in the incidence of these disabling side‐effects.
An exploration of community psychiatric nursing: a Northern Ireland perspective
Authors: Mckenna H. , Keeney S. , Bannon D. , Finn A.
Published: March 2003

The Audit Commission's (1994) report Finding a Place states that mental health problems are a major cause of disruption and difficulty in people's lives and that in any one year more than a quarter of all people suffer to some degree. The report asserts that the majority visit their general practitioner (GP) and less than half of the people concerned are recognized as having a mental health problem. Many recover over a period of weeks or months and are best served by community services. Only those with the most serious conditions need specialized care or admission to hospital. On a local level in Northern Ireland, the policy of reducing the number of long‐stay patients began in the 1960s with a call for people with mental illness to be integrated into the community. This has had major implications for community mental health services and for community psychiatric nursing. The aim of this study into one community psychiatric nursing service (CPNS) in Northern Ireland is to inform managers and professionals about the nature and shape of this service and to facilitate wider discussion on how to plan and deliver it in the future.
The therapeutic relationship: historical development and contemporary significance
Authors: O'Brien A. J.
Published: March 2003

The therapeutic relationship is a concept held by many to be fundamental to the identity of mental health nurses. While the therapeutic relationship was given formal expression in nursing theory in the middle of the last century, its origins can be traced to attendants' interpersonal practices in the asylum era. The dominance of medical understandings of mental distress, and the working‐class status of asylum attendants, prevented the development of an account of mental health nursing based on attendants' relationships with asylum inmates. It was left to Peplau and other nursing theorists to describe mental health nursing as a therapeutic relationship in the 1940s and later. Some distinctive features of colonial life in New Zealand suggest that the ideal of the attendant as the embodiment of bourgeoisie values seems particularly unlikely to have been realized in the New Zealand context. However, New Zealand literature from the 20th century shows that the therapeutic relationship, as part of a general development of a therapeutic discourse, came to assume a central place in conceptualizations of mental health nursing. While the therapeutic relationship is not by itself a sufficient basis for professional continuity, it continues to play a fundamental role in mental health nurses' professional identity. The way in which the therapeutic relationship is articulated in the future will determine the meaning of the therapeutic relationship for future generations of mental health nurses.
An integrated model for adolescent inpatient group therapy
Authors: Garrick D. , Ewashen C.
Published: March 2003

This paper proposes an integrated group therapy model to be utilized by psychiatric and mental health nurses; one innovatively designed to meet the therapeutic needs of adolescents admitted to inpatient psychiatric programs. The writers suggest a model of group therapy primarily comprised of interpersonal approaches within a feminist perspective. The proposed group focus is on active therapeutic engagement with adolescents to further interpersonal learning and to critically examine their contextualized lived experiences. Specific client and setting factors relevant to the selection of therapeutic techniques are reviewed. Selected theoretical models of group therapy are critiqued in relation to group therapy with adolescents. This integrated model of group therapy provides a safe and therapeutic forum that enriches clients’ personal and interpersonal experiences as well as promotes healthy exploration, change, and empowerment.
Effect of modafinil on plasma melatonin, cortisol and growth hormone rhythms, rectal temperature and performance in healthy subjects during a 36 h sleep deprivation
Authors: BRUN JOCELYNE , CHAMBA GENEVIEÉVE , KHALFALLAH YADH , GIRARD PASCAL , BOISSY ISABELLE , BASTUJI HÉLEÉNE , SASSOLAS GENEVIEÉVE , CLAUSTRAT BRUNO
Published: March 2003

Modafinil is an alerting substance which has been used successfully to treat narcolepsy. Nothing is known about its effect on hormone secretions. For this purpose, eight healthy young men were enrolled in a double blind trial to test the effects of modafinil on daily plasma melatonin, cortisol and growth hormone (GH) rhythms. Blood was sampled for hormone assays, every hour during the daytime and every 30 min during the nighttime. In addition, rectal temperature and mental performances were determined during the study which comprised 3 sessions, two weeks apart: a 24 h control session including a night with sleep (S1) and two 48 h sessions S2 and S3 with a sleep‐deprived night (N1) followed by a recovery night (N2). Modafinil (300 mg×2) or placebo were randomly attributed during N1 at 22 h and 8 h.

As expected, performance was improved after modafinil administration and body temperature was maintained or increased. Plasma melatonin and cortisol profiles were similar after modafinil and placebo administration. The levels observed during the recovery and the control nights (N2) displayed no difference. For GH, during both sleep deprived nights, secretion was dramatically reduced compared with the control one, although the number of secretory episodes was unchanged.

These data show that the alerting property of modafinil is not related to an alteration of hormone profiles and suggest that the acute modafinil administration is devoid of short‐term side‐effects.
Delayed sleep phase syndrome: A placebo‐controlled cross‐over study on the effects of melatonin administered five hours before the individual dim light melatonin onset
Authors: NAGTEGAAL J. E , KERKHOF G. A , SMITS M. G , SWART  , VAN DER MEER Y. G
Published: March 2003

In a double‐blind placebo‐controlled cross‐over study, 30 patients with Delayed Sleep Phase Syndrome (DSPS) were included, of whom 25 finished the study. Melatonin 5 mg was administered during two weeks in a double‐blind setting and two weeks in an open setting successively or interrupted by two weeks of placebo. The study's impact was assessed by measurements of the 24‐h curves of endogenous melatonin production and rectal temperature (n=14), polysomnography (n=22), actigraphy (n=13), sleep log (n=22), and subjective sleep quality (n=25). Mean dim light melatonin onset (DLMO) (±SD), before treatment, occurred at 23.17 hours (±138 min). Melatonin was administered five hours before the individual DLMO. After treatment, the onset of the nocturnal melatonin profile was significantly advanced by approximately 1.5 hour. Body temperature trough did not advance significantly. During melatonin use, actigraphy showed a significant advance of sleep onset and polysomnography, a significant decreased sleep latency. Sleep architecture was not influenced. During melatonin treatment patients felt significantly more refreshed in the morning. These results show that analysis of DLMO of patients suffering from DSPS is important both for diagnosis and therapy. These results are discussed in terms of the biochemistry of the pineal.
Evening administration of melatonin and bright light: Interactions on the EEG during sleep and wakefulness
Authors: CAJOCHEN CHRISTIAN , KRÄUCHI KURT , DANILENKO KONSTANTIN V. , WIRZ‐JUSTICE ANNA
Published: March 2003

Both the pineal hormone melatonin and light exposure are considered to play a major role in the circadian regulation of sleep. In a placebo‐ controlled balanced cross‐over design, we investigated the acute effects of exogenous melatonin (5 mg p.o. at 20.40 hours) with or without a 3‐h bright light exposure (5000 lux from 21.00 hours–24.00 hours) on subjective sleepiness, internal sleep structure and EEG power density during sleep and wakefulness in healthy young men. The acute effects of melatonin, bright light and their interaction were measured on the first day (treatment day), possible circadian phase shifts were assessed on the post‐treatment day. On the treatment day, the evening rise in subjective sleepiness was accelerated after melatonin and protracted during bright light exposure. These effects were also reflected in specific changes of EEG power density in the theta/alpha range during wakefulness. Melatonin shortened and bright light increased sleep latency. REMS latency was reduced after melatonin administration but bright light had no effect. Slow‐wave sleep and slow‐wave activity during the first non‐rapid eye movement (NREMS) episode were suppressed after melatonin administration and rebounded in the second NREMS episode, independent of whether light was co‐administered or not. Self rated sleep quality was better after melatonin administration whereas the awakening process was rated as more difficult after bright light. On the post‐treatment day after evening bright light, the rise in sleepiness and the onset of sleep were delayed, independent of whether melatonin was co‐administered or not. Thus, although acute bright light and melatonin administration affected subjective sleepiness, internal sleep structure and EEG power density during sleep and wakefulness in a additive manner, the phase shifting effect of a single evening bright light exposure could not be blocked by exogenous melatonin
Functional magnetic resonance imaging neuroactivation studies in normal subjects and subjects with the narcoleptic syndrome. Actions of modafinil
Authors: Ellis C.M. , Monk C. , Simmons A. , Lemmens G. , Williams S.C.R. , Brammer M. , Bullmore E. , Parkes J.D.
Published: March 2003

Functional magnetic resonance imaging (fMRI) can be used to detect regional brain responses to changes in sensory stimuli. We have used fMRI to determine the amount of visual and auditory cortical activation in 12 normal subjects and 12 subjects with the narcoleptic syndrome, using a multiplexed visual and auditory stimulation paradigm. In both normal and narcoleptic subjects, mean cortical activation levels during the presentation of periodic visual and auditory stimulation showed no appreciable differences with either age or sex. Normal subjects showed higher levels of visual activation at 10:00 hours than 15:00 hours, with a reverse pattern in narcoleptic subjects (P=0.007). The group differences in spatial extent of cortical activation between control and narcoleptic subjects were small and statistically insignificant. The alerting action, and imaging response, to a single oral dose of the sleep‐preventing drug modafinil 400 mg were then determined and compared with placebo in both the 12 normal (8 given modafinil, 4 placebo) and 12 narcoleptic subjects (8 modafinil, 4 placebo). Modafinil caused an increase in self‐reported levels of alertness in 7 of 8 narcoleptic subjects, but there was no significant difference between mean pretreatment and post‐treatment activation levels as determined by fMRI for either normal or narcoleptic syndrome subjects given modafinil. However, in the modafinil‐treated group of 8 normal and 8 narcoleptic subjects, there was a clock time independent correlation between the initial level of activation as determined by the pretreatment scan and the post‐treatment change in activation (visual, P=0.002; and auditory, P=0.001). No correlation was observed in placebo‐treated subjects (P=0.99 and 0.77, respectively).

Although limited by the small number of subjects, and the lack of an objective measure of alertness, the findings of this study suggest that low cortical activation levels in both normal and narcoleptic subjects are increased following the administration of modafinil. Functional magnetic resonance imaging may be a valuable addition to established studies of attention.
Atrial natriuretic peptide levels and pulmonary artery pressure awake, at exercise and asleep in obstructive sleep apnoea syndrome
Authors: Schäfer Harald , Ehlenz Klaus , Ewig Santiago , Hasper Ekkhard , Koehler Ulrich , Latzelsberger Jan , Tasci Selcuk , Lüderitz Berndt
Published: March 2003

Elevated nocturnal plasma atrial natriuretic peptide (ANP) levels were found in patients with obstructive sleep apnoea (OSA). The purpose of our study was to examine the secretion of ANP during the night and to measure changes in oxygen saturation, pulmonary artery pressure and intrathoracic pressure swings in patients with OSA. Moreover, we analysed the secretion of ANP and the pulmonary artery pressure in different behavioural states, e.g. awake, at exercise and asleep. Consecutive apnoeas in non‐rapid eye movement (NREM) sleep at the beginning, middle and end of the sleep study were analysed in six patients with obstructive sleep apnoea. In addition, we measured the plasma levels of ANP. The apnoea duration was significantly longer (P< 0.05) at the middle of the sleep study than at the beginning or end. Correspondingly, the end‐apnoeic oxygen saturation and end‐apnoeic oesophageal pressure were both significantly lower (P< 0.05) in the middle of the sleep study than at the beginning or end. No significant differences were found in the end‐apnoeic systolic transmural pulmonary artery pressure (PPA™) and the levels of ANP. Evaluation of the ANP levels during different behavioural states revealed that the asleep levels were slightly, but not significantly, higher than the awake levels (0.235±0.088 vs. 0.207±0.057 nmol/L). However, the highest levels were found during exercise (0.334±0.170 nmol/L) with a significant difference compared with the awake and asleep levels. These data suggest that volume effects may be a potent factor in liberating ANP during exercise, but the role of OSA in ANP secretion when asleep is questionable.
Comparison between subjective and actigraphic measurement of sleep and sleep rhythms
Authors: Lockley Steven W. , Skene Debra J. , Arendt Josephine
Published: March 2003

Sleep is often assessed in circadian rhythm studies and long‐term monitoring is required to detect any changes in sleep over time. The present study aims to investigate the ability of the two most commonly employed methods, actigraphy and sleep logs, to identify circadian sleep/wake disorders and measure changes in sleep patterns over time. In addition, the study assesses whether sleep measured by both methods shows the same relationship with an established circadian phase marker, urinary 6‐sulphatoxymelatonin. A total of 49 registered blind subjects with different types of circadian rhythms were studied daily for at least four weeks. Grouped analysis of all study days for all subjects was performed for all sleep parameters (1062–1150 days data per sleep parameter). Good correlations were observed when comparing the measurement of sleep timing and duration (sleep onset, sleep offset, night sleep duration, day‐time nap duration). However, the methods were poorly correlated in their assessment of transitions between sleep and wake states (sleep latency, number and duration of night awakenings, number of day‐time naps). There were also large and inconsistent differences in the measurement of the absolute sleep parameters. Overall, actigraphs recorded a shorter sleep latency, advanced onset time, increased number and duration of night awakenings, delayed offset, increased night sleep duration and increased number and duration of naps compared with the subjective sleep logs. Despite this, there was good agreement between the methods for measuring changes in sleep patterns over time. In particular, the methods agreed when assessing changes in sleep in relation to a circadian phase marker (the 6‐sulphatoxymelatonin (aMT6s) rhythm) in both entrained (n= 30) and free‐running (n= 4) subjects.
Level of arousal and the ability to maintain wakefulness
Authors: Bonnet Michael H. , Arand Donna L.
Published: March 2003

The ability to maintain wakefulness under baseline and sleep deprivation conditions was examined in a group of 14 normal young adults. Subjects participated in both standard and manipulation Maintenance of Wakefulness tests after being awake for 7, 19, and 31 h. In the manipulation Maintenance of Wakefulness tests, subjects performed varying degrees of physical activity at the onset of stage 1 to allow them to preserve wakefulness. As expected, ability to maintain wakefulness declined as time awake increased. With amount of time awake held constant, wakefulness was enhanced most after standing and doing knee bends, less after standing, less after sitting up, and least after subjects were spoken to. The improvement in alertness after doing knee bends as compared to being spoken to was of the same relative magnitude as the decrease in alertness after one night of total sleep deprivation. As expected, heart rate also increased consistently as activity increased. Each subject had a negative correlation between their EEG sleep latencies and their minimum r‐r interval during the manipulation, i.e. the higher the heart rate, the longer the latency. These data were interpreted as a demonstration of the impact of discrete phasic arousal on the ability to maintain wakefulness.
Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard
Authors: Johns Murray W.
Published: March 2003

Excessive daytime sleepiness (EDS) is an important symptom that needs to be quantified, but there is confusion over the best way to do this. Three of the most commonly used tests: the multiple sleep latency test (MSLT), the maintenance of wakefulness test (MWT) and the Epworth sleepiness scale (ESS) give results that are significantly correlated in a statistical sense, but are not closely related. The purpose of this investigation was to help clarify this problem. Previously published data from several investigations were used to calculate the reference range of normal values for each test, defined by the mean±2 SD or by the 2.5 and 97.5 percentiles. The ‘rule of thumb’ that many people rely on to interpret MSLT results is shown here to be misleading. Previously published results from each test were also available for narcoleptic patients who were drug‐free at the time and who by definition had EDS. This enabled the sensitivity and specificity of the three tests to be compared for the first time, in their ability to distinguish the EDS of narcolepsy from the daytime sleepiness of normal subjects. The receiver operator characteristic curves clearly showed that the ESS is the most discriminating test, the MWT is next best and the MSLT the least discriminating test of daytime sleepiness. The MSLT can no longer be considered the gold standard for such tests.
Individual differences in the phase and amplitude of the human circadian temperature rhythm: with an emphasis on morningness–eveningness
Authors: Baehr Erin K. , Revelle William , Eastman Charmane I.
Published: March 2003

We studied the relationship between the phase and the amplitude of the circadian temperature rhythm using questionnaires that measure individual differences in personality variables, variables that relate to circadian rhythms, age and sex. The ambulatory core body temperature of 101 young men and 71 young women was recorded continuously over 6 days. The temperature minimum (Tmin) and amplitude (Tamp) were derived by fitting a complex cosine curve to each day’s data for each subject. Participants completed the Horne–Ostberg Morningness–Eveningness Questionnaire (MEQ), the Circadian Type Inventory (CTI) and the MMPI‐2, scored for the Psychopathology‐5 (PSY‐5) personality variables. We found that the average Tmin occurred at 03.50 h for morning‐types (M‐types), 05.02 h for the neither‐types and 06.01 h for evening‐types (E‐types). Figures were presented that could provide an estimate of Tmin given an individual’s morningness–eveningness score or weekend wake time. The Tmin occurred at approximately the middle of the 8‐h sleep period, but it occurred closer to wake in subjects with later Tmin values and increasing eveningness. In other words, E‐types slept on an earlier part of their temperature cycle than M‐types. This difference in the phase‐relationship between temperature and sleep may explain why E‐types are more alert at bedtime and sleepier after waking than M‐types. The Tmin occurred about a half‐hour later for men than women. Another interesting finding included an association between circadian rhythm temperature phase and amplitude, in that subjects with more delayed phases had larger amplitudes. The greater amplitude was due to lower nocturnal temperature.
Urinary free cortisol and sleep under baseline and stressed conditions in healthy senior women: effects of estrogen replacement therapy
Authors: Prinz Patricia , Bailey Sandra , Moe Karen , Wilkinson Charles , Scanlan James
Published: March 2003

The purpose of this study was to examine the effects of a mild 24‐h stress (indwelling IV catheter) on cortisol and sleep in postmenopausal women, and to evaluate differences due to estrogen replacement therapy (ERT) status. This study, conducted in the General Clinical Research Center at the University of Washington Medical Center, examined sleep, cortisol and sleep‐cortisol relationships in both baseline and stress conditions, and compared women on ERT with women not on ERT. Forty‐two women (age=69.6 ± 6.2 years [SD]), of whom 20 were on ERT, participated. Urinary free cortisol (UFC) levels and sleep polysomnography were measured over both 24‐baseline and stress condition. Sleep was impaired in the stress condition for both groups; mean UFC levels were higher, sleep efficiency and minutes of stages 2, 3 and 4 sleep were reduced, and morning risetime was earlier in the stress than baseline condition. For the combined groups, age‐controlled correlations between 24‐h UFC and sleep were significant in both conditions: at baseline, UFC levels were associated with earlier time of rising and less REM sleep, and under stress with reduced sleep efficiency, there was reduced minutes of stages 2, 3, 4 sleep, reduced REM sleep, and an earlier risetime. The pattern of negative significant correlations between UFC and sleep/sleep timing remained when plasma estrogen was statistically controlled; however, when groups were examined separately, the significant negative UFC‐sleep relationships were confined to the non ERT group. Elevated 24‐h UFC is associated with impaired sleep and earlier awakening in older women not on ERT, but not in women on ERT.
Age, gender and early morning highway accidents
Authors: Åkerstedt Torbjörn , Kecklund Göran
Published: March 2003

Accident register data, time budget studies and road traffic flow data were used to compute the age and gender‐dependent relative risk [odds ratio (OR)] of being involved in a driving accident in which the driver was injured or killed. Alcohol‐related accidents were excluded from the analysis. The results showed that the night‐time risk, compared with that of the forenoon, was dramatically increased (OR=5) for young drivers (18–24 years) and reduced for old (65+) drivers. In direct comparison, the young drivers had 5–10 times higher risk of being involved in an accident during late night than during the forenoon, with the excess risk during the daytime being considerably lower. Women had a less pronounced night‐time peak than men. In direct comparison, men had twice as high a risk as women during the late night hours. The results clearly demonstrate a strong effect of young age on night‐time accident risk, together with a moderate effect of (male) gender.
Slow‐release caffeine as a countermeasure to driver sleepiness induced by partial sleep deprivation
Authors: De Valck Elke , Cluydts Raymond
Published: March 2003

The effect of partial sleep deprivation (PSD) on driving abilities, as measured with a driving simulator, and the value of slow‐release caffeine as a countermeasure to the expected performance decrements, were studied. Twelve subjects, between 20 and 25 years of age, underwent four experimental conditions, 4.5 or 7.5 h time in bed (TIB) with 300 mg slow‐release caffeine or placebo, according to a Latin square design. Driving performance was measured twice by a 45‐min driving task on a simulator. Subjective sleepiness/alertness and mood were assessed four times, by means of the Stanford Sleepiness Scale (SSS) and Profile of Mood States (POMS). After 4.5 h as compared with 7.5 h TIB lane drifting and speed deviation were higher, but only the effect on the first variable reached significance. In the placebo condition at 13.00 h, accident liability increased after PSD. Subjective sleepiness was higher in the 4.5 h TIB group. Caffeine intake gave rise to a decrease in lane drifting and after PSD it led to a smaller speed deviation and accident liability. The findings suggest that a lack of sleep can lead to a significant driving performance impairment, with drivers having problems to maintain an appropriate road position and a posted speed and more drivers getting involved in an accident. Secondly, the results indicate that caffeine – more specifically slow‐release caffeine – can serve as a valuable countermeasure to these performance decrements, in the absence of any important side‐effects, especially when its application is of an acute nature and when there is no opportunity to take a nap.
CSF hypocretin‐1 (orexin‐A) concentrations in narcolepsy with and without cataplexy and idiopathic hypersomnia
Authors: KANBAYASHI TAKASHI , INOUE YUICHI , CHIBA SHIGERU , AIZAWA RIKA , SAITO YASUSHI , TSUKAMOTO HARUKO , FUJII YUKIHARU , NISHINO SEIJI , SHIMIZU TETSUO
Published: March 2003

We measured cerebrospinal fluid (CSF) hypocretin‐1 levels in 11 patients with narcolepsy–cataplexy, five with narcolepsy without cataplexy and 12 with idiopathic hypersomnia (IHS). All patients were Japanese. As reported in Caucasian patients, undetectable or very low hypocretin‐1 levels were observed in most (9 out of 11) Japanese narcolepsy–cataplexy patients. Our hypocretin‐deficient narcoleptics included three prepubertal cases within few months after the disease onset. All nine hypocretin‐deficient patients were human leuckocyte antigen (HLA) DR2 positive, while two who had normal CSF hypocretin‐1 levels were HLA DR2 negative. In contrast, none of the narcolepsy without cataplexy and IHS subjects had undetectable low levels. Low CSF hypocretin‐1 is therefore very specific for HLA DR2 positive narcolepsy–cataplexy, and the deficiency is likely to be established at the early stage of the disease.
Electrodermal activity during total sleep deprivation and its relationship with other activation and performance measures
Authors: Miró E. , Cano‐Lozano M. C. , Buela‐Casal G.
Published: March 2003

The present study analyses the variations of the skin resistance level (SRL) during 48 h of total sleep deprivation (TSD) and its relationship to body temperature, self‐informed sleepiness in the Stanford Sleepiness Scale (SSS), and reaction time (RT). All of the variables were evaluated every 2 h except for the SSS, which was evaluated every hour. A total of 30 healthy subjects (15 men and 15 women) from 18 to 24 years old participated in the experiment. Analyses of variance (ANOVAs) with TSD days and time‐of‐day as factors showed a substantial increase of SRL, SSS, and RT, and a decrease in body temperature marked by strong circadian oscillations. The interaction between day by time‐of‐day was only significant for RT. Furthermore, Pearson's correlations showed that the increase of SRL is associated to the decrease in temperature (mean r=−0.511), the increase of SSS (mean r=0.509), and the deterioration of RT (mean r=0.425). The results support previous TSD reports and demonstrate the sensitivity of SRL to TSD. The non‐invasive character of SRL, its simplicity, and its relationships with other activation parameters, widely validated by previous literature, convert SRL into an interesting and useful measure in this field.
Correlates of nap taking in mothers of young infants
Authors: Cottrell Lesley , Karraker Katherine Hildebrandt
Published: March 2003

Many researchers and clinicians have promoted nap taking to combat the deleterious effects of disrupted sleep. Unfortunately, only a small portion of sleep‐deprived individuals take naps. The goal of the present study was to identify cognitive and opportunity factors related to nap taking of mothers of young infants. Fifty‐one mothers of young infants completed measures that recorded various characteristics of their nighttime sleep patterns, their perceptions of their sleep, and factors influencing their opportunities to take naps. Results revealed that mothers' perceptions of sleep disturbance and opportunity factors were more predictive of napping than total nighttime sleep or actual time spent caring for the infant during the night.
The 3111 Clock gene polymorphism is not associated with sleep and circadian rhythmicity in phenotypically characterized human subjects
Authors: Robilliard Donna L. , Archer Simon N. , Arendt Josephine , Lockley Steven W. , Hack Lisa M. , English Judie , Leger Damien , Smits Marcel G. , Williams Adrian , Skene Debra J. , Von Schantz Malcolm
Published: March 2003

Mutations in clock genes are associated with abnormal circadian parameters, including sleep. An association has been reported previously between a polymorphism (3111C), situated in the 3′‐untranslated region (3′‐UTR) of the circadian gene Clock and evening preference. In the present study, this polymorphism was assessed in: (1) 105 control subjects with defined diurnal preference, (2) 26 blind subjects with free‐running circadian rhythms and characterized with regard to circadian period (τ) and (3) 16 delayed sleep phase syndrome patients. The control group was chosen from a larger population (n = 484) by Horne‐Östberg questionnaire analysis, from which three subgroups were selected (evening, intermediate and morning preference). Data from sleep diaries completed by 90% of these subjects showed a strong correlation between preferred and estimated timings of sleep and wake. The mean timings of activities for the evening group were at least 2 h later than the morning group. Genetic analysis showed that, in contrast with the previously published finding, there was no association between 3111C and eveningness. Neither was there an association between 3111C and τ, nor a significant difference in 3111C frequency between the normal and delayed sleep phase syndrome groups. To assess the effect of this polymorphism on messenger RNA (mRNA) translatability, luciferase reporter gene constructs containing the two Clock polymorphic variants in their 3′‐UTR were transfected into COS‐1 cells and luciferase activity measured. No significant difference was observed between the two variants. These results do not support Clock 3111C as a marker for diurnal preference, τ, or delayed sleep phase syndrome in humans.
Pharmacokinetics and pharmacodynamics of tilmicosin in sheep and cattle
Authors: Modric  , Webb  , Derendorf
Published: March 2003

Tilmicosin is a long‐acting macrolide antibiotic currently approved for treatment of bovine respiratory disease in the USA. Serum pharmacokinetics of tilmicosin were compared between cattle (major species) and sheep (minor species) after subcutaneous injection in order to evaluate a new potential application of the drug in currently nonapproved species. There were no significant differences in the elimination rates, maximum serum concentrations, half‐lives (t1/2), areas under the curve (AUC), areas under the first‐moment curve (AUMC), and mean residence times. Volume of distribution (Vdarea) and clearance (Cl), when normalized by body weight, were also similar. The only significantly different parameter was time at which maximum drug concentration was reached (tmax), with sheep having the tmax of 3.9 h, compared to 0.5 h in cattle.

 Although macrolides are considered to be one of the safest anti‐infective drugs, adverse cardiovascular effects of several macrolides have been reported. The cardiopulmonary effects of tilmicosin were monitored in healthy adult sheep after receiving a single subcutaneous (s.c.) injection of tilmicosin at the dose of 10 mg/kg, and no significant changes were found. The study indicates that tilmicosin can be used safely and effectively in sheep at the given dose, with no adverse cardiopulmonary effects.