Job stressors and coping strategies as predictors of mental health and job satisfaction among Irish general practitioners.

Previous research has shown that many general practitioners were experiencing stress levels detrimental to their well-being. To examine coping strategies of Irish general practitioners and the possible impact of their stress on mental health and job satisfaction. Anonymous questionnaires were posted to 226 general practitioners in the Western Health Board. Just over one third of stressors caused moderate to considerable stress. Coping was important in the stress process. Sometimes, coping strategies predicted stress-related outcomes better than stressors. General practitioners' mental health was slightly better than that of a normative group. They tended to be satisfied with all aspects of the job, except hours of work. The provision of counselling services for general practitioners suffering from stress should be encouraged. Stress-management strategies should include training in coping skills and time management. The increased use of co-operatives could help alleviate the stress of out-of-hours work.

Rural general practitioners' experience of the provision of out-of-hours care: a qualitative study.

BACKGROUND: Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers. AIM: To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision. DESIGN OF STUDY: A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews. SETTING: Ten general practices in rural Ireland. METHOD: The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed, and analysed for themes and issues. RESULTS: Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However, the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time off, restrictions on family life, and interruptions. CONCLUSION: System difficulties, such as difficulty with obtaining locums and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families.

What aspect of handedness is general motor programming related to?

As general motor programming had previously been found to be related to consistency of hand preference (Keane, 1999), the present study attempted to elucidate what general motor programming involves by reinvestigating responses to the Edinburgh Handedness Inventory in order to see if there was some consensus with regards to the items that tended to differentiate the consistent handers from the inconsistent handers. It was found that the opening a box item did differentiate the consistent handers from the inconsistent handers. Control of this type of bimanual task seems to be specifically related to the general motor programmer, and not hand preference as such.

Direction of hand preference: the connection with speech and the influence of familial handedness.

Taking familial handedness into account, right- and left-handers with differing degrees of hand preference were monaurally presented with verbal stimuli (CVs) to which they responded using their right and left hands at separate times. This reaction time design was used to ascertain the relative cognitive functioning capacity of each hemisphere for verbal processing. However, the results disclosed more about the determination of direction of hand preference than about cognitive processing, per se. It was found that in both strong right-handers and strong left-handers with an incongruent hand preference (i.e., own handedness incongruent with family history of handedness) direction of hand preference is the result of suppression of the nonpreferred hand in the left hemisphere. Strong right- and strong left-handers with a congruent hand preference (i.e., hand preference congruent with family history of handedness) appear to have a more direct hand preference-left hemisphere mechanism. The findings of the present study are used to form part of a new theory of hand preference determination.

Motor control of the hands: the effect of familial sinistrality.

Left- and right-handed subjects, selected on the basis of degree of hand preference and for the presence or absence of familial sinistrality, responded to monaurally presented tonal stimuli (440 Hz note played on four different instruments) using their right and left hands on separate occasions. It was found that in both the strong left-handers and the inconsistent strong right-handers, motor control of the hands was related to familial sinistrality (FS). Specifically, strong left-handers and inconsistent strong right-handers with FS have a difference in the motor control of the hands in the left hemisphere, with a left hemisphere-left hand advantage. Strong left-handers and inconsistent strong right-handers with no FS have a difference in the motor control of the hands in the right hemisphere, with a right hemisphere-left hand advantage.

Cerebral organization of motor programming and verbal processing as a function of degree of hand preference and familial sinistrality.

Seventy-six right- and left-handed subjects responded to monaurally presented verbal stimuli (CVs) using their right and left hands on separate occasions. Both degree of hand preference and familial sinistrality (FS) were taken into account. It was found that, contrary to expectation, the manual response interfered with the verbal perception task, but only in the consistent strong handers. The pattern of interference suggests that those with a consistent hand preference (right or left) have general motor programming in the left hemisphere. Those with an inconsistent strong hand preference probably have some degree of general motor programming in both hemispheres. No effect for FS was found for the lateralization of verbal processing or general motor programming.

Peptide mimetics of an actin-binding site on myosin span two functional domains on actin.

The sites on the myosin heavy chain that interact with actin and are responsible for force generation are ill-defined: crosslinking and experiments with isolated domains of the myosin head implicate regions in both the 50K and 20K (molecular weights in thousands) domains of the myosin head (subfragment 1, S1) in this process. We have synthesized peptides from the sequence around the fast-reacting SH1 thiol residue in the 20K domain of S1 in order to delineate precisely an actin-binding site. We used a combination of 1H-NMR and enzyme inhibition assay and also assessed the effects of peptides on skinned rabbit psoas muscle fibres to show that the region of amino acids 690-725 contains an actin-binding site. Peptides from this region bind to actin, act as mixed inhibitors of the actin-stimulated S1 Mg2(+)-ATPase, and influence the contractile force developed in skinned fibres, whereas peptides flanking this sequence are without effect in our test systems. Remarkably, peptides from the N-terminal half of this segment 690-725 increase force development in skinned fibres at submaximal activating concentrations of Ca2+, that is, they behave as calcium-sensitizers; C-terminal peptides, however, inhibit force development without effecting sensitivity to calcium. These different responses indicate that this region is probably binding at two functionally distinct sites on actin.

Single, high-dose intramuscular triamcinolone acetonide versus weekly oral methotrexate in life-threatening asthma: a double-blind study.

Effective and less toxic treatments are needed for patients with severe, steroid-dependent asthma. Both low-dose oral methotrexate and high-dose intramuscular triamcinolone have been recommended for these patients. We compared the effects of these two medications on pulmonary function, peak flow rates, airway reactivity, oral steroid use, emergency room (ER) visits, and hospitalizations in patients with steroid-dependent, life-threatening asthma. In a randomized, placebo-controlled, double-blind study, we investigated 19 such patients. Six of the patients (Group I) received a single dose of 360 mg triamcinolone intramuscularly with placebo methotrexate; seven patients (Group II) received placebo triamcinolone followed by low-dose oral methotrexate (a first dose of 7.5 mg followed by 15 mg weekly); and six patients (Group III) received placebo triamcinolone with placebo methotrexate. All patients used the same high-dose inhaled steroids. The patients took tapering courses of oral steroids when needed, but attempted to reduce their oral steroid use whenever possible. Methacholine challenge testing was performed every 6 wk, pulmonary function tests every 4 wk, and home peak-flow measurements twice daily. Oral steroid use, ER visits, and hospitalizations were also monitored. The patients in the triamcinolone treatment group showed a significant and sustained increase in home peak-flow rates, and their FEV1 persistently improved by a mean of 40% (p < 0.05), whereas the FEV1 of the patients in the methotrexate treatment and placebo groups remained near baseline. The PC20 in the triamcinolone group increased progressively (p > 0.05), and the improvements in total mean reactivity were greater in this group than in either of the other two groups (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)