Forty-eight hour access to primary care: practice factors predicting patients' perceptions

Background: The government has proposed a 48-hour target for GP availability. Although many practices are moving towards delivering that goal, recent national patient surveys have reported a deterioration in patients' reports of doctor availability. What practice factors contribute to patients' perceptions of doctor availability? Method: A cross sectional patient survey (11 000 patients from 54 inner London practices, 7247 (66%) respondents) using the General Practice Assessment Survey. We asked patients how soon they could be seen in their practice following non-urgent consultation requests and related their aggregated responses to the characteristics of their practice. Results: Three factors relating to practice administration and appointments systems operation independently predicted patients' reports of doctor availability. These were the proportion of patients asked to attend the surgery and wait to be seen, the proportion of patients seen using an emergency surgery arrangement, and the extent of practice computerization. Conclusion: Some practices may have difficulty in meeting the target for GP availability. Meeting the target will involve careful review of practice administrative procedures.

Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Chestnut and mimosa tannin silages: Effects in sheep differ for apparent digestibility, nitrogen utilisation and losses

This paper reports effects of chestnut and mimosa tannins on N utilisation in sheep. Tannins were added to grass either at ensilage or incorporated into grass silage at feeding. The study used an 8 × 5 incomplete Latin Square design with eight mature wether sheep and five 21-day periods. Tannin additions reduced in vivo apparent digestibilities of dry matter (DM), organic matter (OM) and neutral detergent fibre (aNDFom) compared with the untreated control silage (P<0.001). Reductions ranged from 7.6% for DM to 8.5% for aNDFom. Chestnut compared to mimosa tannin silages produced higher values for DM intake (734 g/day versus 625 g/day) and in vivo digestibility for DM, OM and aNDFom (0.66, 0.68 and 0.69 versus 0.61, 0.63 and 0.62; P<0.001). A substantial shift occurred in the pattern of N excretion in sheep fed the tannin versus control silages. As a proportion of daily N intake, urinary N losses were lower (56.4 g/100 g N versus 65.1 g/100 g N intake) and faecal N losses were higher (40.2 g/100 g N versus 29.8 g/100 g N intake) for sheep fed the tannin silages compared with those fed the control grass silage (P<0.001). Nitrogen intake was higher in sheep fed the chestnut compared to mimosa tannin silages (16.2 g/day versus 13.4 g/day; P<0.001), reflecting the lower DM intake of sheep fed the mimosa silages. However, faecal N loss was lower for chestnut compared to mimosa tannin silage fed sheep (38.2 g/100 g N versus 42.1 g/100 g N intake; P<0.01), resulting in higher N retentions with the chestnut compared to the mimosa silage fed sheep (5.49 g/100 g N versus 1.38 g/100 g N intake). Faecal N losses were also higher when tannins were added during ensiling rather than at feeding (P<0.05). Although there was no overall effect of tannins on N retention in mature wether sheep, it is likely that productive ruminants with higher protein requirements would retain more N from silages containing chestnut tannins. Tannins added externally to grass silages may generate some benefits on N utilisation and environmental N excretions in sheep fed the silages.

Extracts of tropical African spices are active against Plutella xylostella

Extracts from Piper guineense, Aframomum melegueta, Aframomum citratum and Afrostyrax kamerunensis were investigated for their antifeedant, lethal and developmental effects against Plutella xylostella larvae through laboratory dual-choice tests and topical application. Water and ethanol extracts of P. guineense were dose-dependent antifeedants at concentrations ≥300 and 500 ppm, respectively, whilst methanol extracts required ≥1,000 ppm. Methanol and hexane extracts of A. melegueta acted at ≥100 ppm and water extracts at ≥300 ppm, but ethanol extracts were deterring feeding only slightly at ≥1,000 ppm. Hexane and methanol extracts of A. citratum inhibited feeding at ≥300 ppm and water extracts did so at ≥500 ppm. None of the Afrostyrax kamerunensis extracts deterred feeding at any of the concentrations tested. No mortality was observed at any of the concentrations after topical application of the extracts on the larvae. However, the effects on larval development varied with extract concentration and larval age. Ingestion of the water and ethanol extracts of P. guineense caused 100% mortality of second instars at ≥100 ppm two to three days after infestation (DAI). Methanol and water extracts of A. melegueta and A. citratum, respectively, achieved ≥80% mortality of larvae at concentrations of ≥500 ppm and ≥1,000 ppm, respectively. With third instars, the mortalities were significantly lower; however, the P. guineense water or ethanol extracts caused 100% mortality two to four DAI. Larvae that survived till pupation had significantly longer larval periods compared with the control after application of A. melegueta extracts. We concluded that potent extracts from Aframomum melegueta, Aframomum citratum and especially P. guineense could be used as complementary measures in the management of P. xylostella by subsistence farmers.

The effect of condensed tannins in fresh sainfoin (Onobrychis viciifolia) on in vivo and in situ digestion in sheep

This study focused on effects of structure, content and biological activity of condensed tannins (CT) in leaves, stems and whole plant of sainfoin (Onobrychis viciifolia) on its in vivo and in situ digestive characteristics in sheep. Sainfoin was studied as fresh forage during the first vegetation cycle at two phenological stages (i.e., end of flowering and green seeds) and during the second vegetation cycle (i.e., start of flowering). The feeding experiment used 12 sheep; with six dosed, through the rumen cannula, with polyethylene glycol (PEG) to neutralise CT effects. Organic matter digestibility (OMD), total tract N disappearance and N balance were measured in sheep fed the whole plant. The residues of dry matter (DM) and N from nylon bags suspended in the rumen were determined on leaves and stems. Intestinal digestibility was measured using other, intestinally fistulated sheep. PEG addition and vegetation cycle increased total tract N digestibility (P<0.001) but PEG affected OMD only at the end of flowering. PEG inactivated the CT and increased urinary N excretion (P<0.05) but this was offset by lower faecal N excretion (P<0.001). Feeding sainfoin can be used to alter the form of excreted N (i.e., urine vs faeces) and thus potentially reduce environmental N pollution without affecting body N retention. Kinetic studies of total N, ammonia N (NH3-N) and volatile fatty acids (VFA) in rumen fluid were made before and 1.5, 3 and 6 h after feeding. Sainfoin CT decreased rumen fluid soluble N (P<0.05) and NH3-N (P<0.01). Ruminal N disappearance (DisN) of leaves or stems was lower in the presence of active CT compared to PEG-inactivated CT (P<0.001) for both vegetation cycles. PEG also increased intestinal digestibility (P<0.05) of leaves and stems. Leaves had lower ruminal DisN, but higher N disappearing from intestine than stems. The biological activity and content of CT in the whole plant decreased as phenological stage increased. Prodelphinidin:procyanidin (PD:PC) ratios of leaves varied with vegetation cycle and phenological stage. The molecular size of CT in the whole plant, as indicated by their mean degree of polymerisation (mDP), was lowest at the start of flowering and coincided with the higher biological activity and content of CT.

In situ analysis and structural elucidation of sainfoin (Onobrychis viciifolia) tannins for high-throughput germplasm screening

A rapid thiolytic degradation and cleanup procedure was developed for analyzing tannins directly in chlorophyll-containing sainfoin (Onobrychis viciifolia) plants. The technique proved suitable for complex tannin mixtures containing catechin, epicatechin, gallocatechin, and epigallocatechin flavan-3-ol units. The reaction time was standardized at 60 min to minimize the loss of structural information as a result of epimerization and degradation of terminal flavan-3-ol units. The results were evaluated by separate analysis of extractable and unextractable tannins, which accounted for 63.6−113.7% of the in situ plant tannins. It is of note that 70% aqueous acetone extracted tannins with a lower mean degree of polymerization (mDP) than was found for tannins analyzed in situ. Extractable tannins had between 4 and 29 lower mDP values. The method was validated by comparing results from individual and mixed sample sets. The tannin composition of different sainfoin accessions covered a range of mDP values from 16 to 83, procyanidin/prodelphinidin (PC/PD) ratios from 19.2/80.8 to 45.6/54.4, and cis/trans ratios from 74.1/25.9 to 88.0/12.0. This is the first high-throughput screening method that is suitable for analyzing condensed tannin contents and structural composition directly in green plant tissue.

Binding of pentagalloyl glucose to two globular proteins occurs via multiple surface sites

The interaction between pentagalloyl glucose (PGG) and two globular proteins, bovine serum albumin (BSA) and ribulose-1,5-bisphosphate carboxylase oxygenase (rubisco), was investigated by isothermal titration calorimetry (ITC). ITC data fit to a binding model consisting of two sets of multiple binding sites, which reveal similarities in the mode of binding of PGG to BSA and rubisco. In both cases, the interaction is characterized by a high number of binding sites, which suggests that binding occurs by a surface adsorption mechanism that leads to coating of the protein surface, which promotes aggregation and precipitation of the PGG-protein complex. This model was confirmed by turbidimetry analysis of the PGG-BSA interaction. Analysis of tryptophan fluorescence quenching during the interaction of PGG with BSA suggests that binding of PGG leads to some conformational changes that are energetically closer to the unfolded state of the BSA structure, because small red shifts in the resulting emission spectra were observed.

Condensed tannins act against cattle nematodes

The use of natural plant anthelmintics was suggested as a possible alternative control of gastrointestinal nematodes (GIN) in ruminants. Direct anthelmintic effects of tannin-containing plants have already been shown in sheep and goat GIN. These anthelmintic properties are mainly associated with condensed tannins. In the present study, we evaluated possible in vitro effects of three tannin-containing plants against bovine GIN. Effects of Onobrychis viciifolia, Lotus pedunculatus and Lotus corniculatus condensed tannin (CT) extracts on Cooperia oncophora and Ostertagia ostertagi were determined by a larval feeding inhibition assay (LFIA) and a larval exsheathment assay (LEA). In the LFIA, all three plant extracts significantly inhibited larval feeding behaviour of both C. oncophora and O. ostertagi first stage larvae in a dose-dependent manner. The L. pedunculatus extract, based on EC50 (effective concentration for 50% inhibition), was the most effective against both nematodes, followed by O. viciifolia and L. corniculatus. The effect of CT extracts upon larval feeding behaviour correlates with CT content and procyanidin/prodelphidin ratio. Larval exsheathment of C. oncophora and O. ostertagi L3 larvae (third stage larvae) was also affected by CT extracts from all three plants. In both in vitro assays, extracts with added polyvinylpolypyrrolidone, an inhibitor of tannins, generated almost the same values as the negative control; this confirms the role of CT in the anthelmintic effect of these plant extracts. Our results, therefore, indicated that tannin-containing plants could act against cattle nematodes.

Interpretation of infant facial expression in the context of maternal postnatal depression

Postnatal maternal depression is associated with difficulties in maternal responsiveness. As most signals arising from the infant come from facial expressions one possible explanation for these difficulties is that mothers with postnatal depression are differentially affected by particular infant facial expressions. Thus, this study investigates the effects of postnatal depression on mothers’ perceptions of infant facial expressions. Participants (15 controls, 15 depressed and 15 anxious mothers) were asked to rate a number of infant facial expressions, ranging from very positive to very negative. Each face was shown twice, for a short and for a longer period of time in random order. Results revealed that mothers used more extreme ratings when shown the infant faces (i.e. more negative or more positive) for a longer period of time. Mothers suffering from postnatal depression were more likely to rate negative infant faces shown for a longer period more negatively than controls. The differences were specific to depression rather than an effect of general postnatal psychopathology—as no differences were observed between anxious mothers and controls. There were no other significant differences in maternal ratings of infant faces showed for short periods or for positive or neutral valence faces of either length. The findings that mothers with postnatal depression rate negative infant faces more negatively indicate that appraisal bias might underlie some of the difficulties that these mothers have in responding to their own infants signals.

Structural diversity of sainfoin (Onobrychis viciifolia) tannins

Tannins are oligomeric and polymeric polyphenols that are produced by many plants. The study of their biological activities is of interest because they can generate valuable nutritional, veterinary and environmental effects in ruminant livestock production [1]. Isolated tannin fractions from sainfoin (Onobrychis viciifolia), which is potentially a very useful animal feed, were characterised by MALDI-TOF MS and thiolytic degradation with benzyl mercaptan. Condensed tannins were analysed and characterised in more than different 40 sainfoin varieties to provide guidelines for future plant breeding programmes. Several different techniques were used to study these complex tannin mixtures.