Family medicine practitioners' stress during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization's decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. METHODS: We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of "not stressed" (≤20), "borderline" (21 ≤ PSS-10 ≤ 26), and "stressed" (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. RESULTS: Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40-3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model. CONCLUSION: The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.

Accelerated and amplified neural responses in visual discrimination: Two features are processed faster than one.

Psychological and neurophysiological models of visual processing have traditionally emphasized hierarchical models to explain how separate features of visual stimuli are combined. This concept has been challenged recently with the demonstration of simultaneous activation of multiple visual areas and rapid feedback to primary cortices. Here, we show human visual processing may involve similar mechanisms. Subjects discriminated targets from nontargets as a function of shape, color, or the conjunction of these features while event-related brain potentials (ERPs) were recorded. ERP components from 100 to 200 ms across posterior occipital-temporal cortices were fastest and largest for conjunction targets. These enhanced early responses were followed by task-specific sustained posterior activity (300-500 ms). Faster reaction times were correlated with enhanced and faster early processing in the visual ventral areas. These data demonstrate the human visual system conjoins features rapidly, accelerating and amplifying the processing of relevant stimulus dimensions.

Effect of caudal epidural xylazine on intraoperative distress and post-operative pain in Holstein heifers.

OBJECTIVE: To compare the effects of caudal epidural xylazine versus saline on tolerance of paravertebral nerve block and flank surgery and on post-operative pain in heifers used for a veterinary student training laboratory. STUDY DESIGN: Randomized controlled prospective study. ANIMALS: Fourteen one-year-old, nongravid, healthy Holstein heifers, weighing 360 +/- 5 kg. METHODS: Xylazine (0.05 mg kg(-1)) or 0.9% saline (5 mL) was injected using a caudal epidural technique to seven heifers undergoing a flank surgery. Nerve block of the right paravertebral fossa was performed using equal parts of lidocaine 2% and bupivacaine 0.5%. Heart and respiratory rates, rectal temperature, rumination frequency, and appetite were recorded before and at 4, 8, and 24 hours after surgery. Scores were recorded for: tolerance of local anesthesia injections (pre-operatively), sedation, ataxia and distress (intraoperatively, every 30 minutes), and pain (4, 8, and 24 hours post-operatively). RESULTS: The animals reaction to local anesthetic injection was judged to be less in the xylazine group by both an experienced observer (p<0.001) and student surgeons (p<0.01). The xylazine group required less local anesthetic (82.9 +/- 13.8 mL) versus the saline group (108.4 +/- 19.6 mL, p=0.035). Intraoperatively, xylazine heifers were more sedated at all times (p-values from <0.001 to 0.017), were more ataxic for the first 1.5 hours (p-values from <0.001 to 0.026), and lower in distress at all times (p-values from <0.001 to 0.007). No difference in post-operative pain or physiologic variables was found, except immediately post-operatively, rectal temperature was higher in the xylazine group (39.5 +/- 0.3 degrees C) than in the saline group (38.6 +/- 0.2 degrees C, p<0.001). CONCLUSION AND CLINICAL RELEVANCE: Compared with epidural saline, caudal epidural xylazine reduced distress of anesthetic injection and surgical manipulation in heifers and an improvement in animal well-being was apparent. This effect may have been as a result of sedation. Pre-operative epidural xylazine did not appear to improve post-surgical analgesia in our study.

Accuracy and precision of a point-of-care hemoglobinometer for measuring hemoglobin concentration and estimating packed cell volume in horses.

OBJECTIVE: To determine accuracy and precision of a point-of-care hemoglobinometer for measuring hemoglobin concentration and estimating PCV in horses. DESIGN: Prospective trial. ANIMALS: 55 horses. PROCEDURE: Blood samples were obtained from 43 horses examined at a veterinary teaching hospital. Hemoglobin concentration was measured with the hemoglobinometer and by means of the standard cyanmethemoglobin method; PCV was measured by centrifugation. Blood samples were also obtained from 12 healthy horses, and PCV of aliquots of these samples was altered to approximately 5 to 80% by removing or adding plasma. Hemoglobin concentration and PCV were then measured. RESULTS: For samples from the clinic patients, hemoglobin concentrations obtained with the hemoglobinometer were less than concentrations obtained with the cyanmethemoglobin method; however, there was a linear relationship between concentrations obtained with the 2 methods. Breed, sex, body weight, and duration of sample storage did not significantly affect the difference between hemoglobin concentrations obtained with the 2 methods. There was a significant linear relationship between PCV and hemoglobinometer hemoglobin concentration (PCV = [2.83 x hemoglobin concentration] - 0.62). For samples from the healthy horses, a substantial negative bias was evident with the hemoglobinometer when hemoglobin concentration exceeded 16 g/dL. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that this hemoglobinometer is reasonably accurate and precise when used to measure hemoglobin concentration in blood samples from horses with a hemoglobin concentration < 16 g/dL.

Developmental changes in distinguishing concurrent auditory objects.

Children have considerable difficulties in identifying speech in noise. In the present study, we examined age-related differences in central auditory functions that are crucial for parsing co-occurring auditory events using behavioral and event-related brain potential measures. Seventeen pre-adolescent children and 17 adults were presented with complex sounds containing multiple harmonics, one of which could be 'mistuned' so that it was no longer an integer multiple of the fundamental. Both children and adults were more likely to report hearing the mistuned harmonic as a separate sound with an increase in mistuning. However, children were less sensitive in detecting mistuning across all levels as revealed by lower d' scores than adults. The perception of two concurrent auditory events was accompanied by a negative wave that peaked at about 160 ms after sound onset. In both age groups, the negative wave, referred to as the 'object-related negativity' (ORN), increased in amplitude with mistuning. The ORN was larger in children than in adults despite a lower d' score. Together, the behavioral and electrophysiological results suggest that concurrent sound segregation is probably adult-like in pre-adolescent children, but that children are inefficient in processing the information following the detection of mistuning. These findings also suggest that processes involved in distinguishing concurrent auditory objects continue to mature during adolescence.