Antidepressants for generalized anxiety disorder (GAD)

Background Pharmacological treatments have been successfully used to treat Generalized Anxiety Disorder (GAD). Benzodiazepine and non benzodiazepine anxiolytics used to be the mainstay for the pharmacological treatment of GAD. However, data emerging over the last two decades have shown that antidepressants may be as effective as anxiolytics in this condition. The use of antidepressants may also be beneficial , because GAD often coexists with major depressive disorder (62% comorbidity) and dysthymia (37%). Objectives To assess the efficacy and acceptability of antidepressants for treating generalized anxiety disorder. Search methods Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register - CCDANCTR (up to May 2002), Anxiety Neurosis (up to May 2002) and Cochrane Controlled Trials Register (CENTRAL/CCTR) (up to May 2002), MEDLINE (1966 to May 2002), LILACS (1982 to May 2002); reference searching; personal communication; conference abstracts and book chapters on the treatment of generalized anxiety disorder. Selection criteria Randomized controlled trials were included. Non randomized studies and those that included patients with both GAD and another Axis I co-morbidity were excluded. Data collection and analysis The data from studies were extracted independently by two reviewers. Relative risks, weighted mean difference and number needed to treat were estimated. People who died or dropped out were regarded as having had no improvement. Main results Antidepressants (imipramine, venlafaxine and paroxetine) were found to be superior to placebo in treating GAD. The calculated NNT for antidepressants inGADis 5.15.Dropout rates did not differ between antidepressants. Only one study presented data on imipramine and trazodone. Imipramine was chosen as the reference drug and, therefore, data on trazodone could not be included in the meta analysis. Only one study was conducted among children and adolescents (Rynn 2000). This showed very promising results of sertraline in children and adolescents with GAD, which warrants replication in larger samples. Authors’ conclusions The available evidence suggests that antidepressants are superior to placebo in treating GAD. There is evidence fromone trial suggesting that paroxetine and imipramine have a similar efficacy and tolerability. There is also evidence from placebo-controlled trials suggesting that these drugs are well tolerated by GAD patients. Further trials of antidepressants for GAD will help to demonstrate which antidepressants should be used for which patients

Compositions created with constraint programming

This chapter surveys music constraint programming systems, and how composers have used them. The chapter motivates and explains how users of such systems describe intended musical results with constraints. This approach to algorithmic composition is similar to the way declarative and modular compositional rules have successfully been used in music theory for centuries as a device to describe composition techniques. In a systematic overview, this survey highlights the respective strengths of different approaches and systems from a composer's point of view, complementing other more technical surveys of this field. This text describes the music constraint systems PMC, Score-PMC, PWMC (and its successor Cluster Engine), Strasheela and Orchidée -- most are libraries of the composition systems PWGL or OpenMusic. These systems are shown in action by discussing the composition process of specific works by Jacopo Baboni-Schilingi, Magnus Lindberg, Örjan Sandred, Torsten Anders, Johannes Kretz and Jonathan Harvey

Trabalho em turnos de profissionais de enfermagem e a pressão arterial, burnout e transtornos mentais comuns

Objetivo: Analisar a influência do trabalho em turnos na pressão arterial, na presença de burnout e transtornos mentais comuns em profissionais de enfermagem. Método: Estudo transversal. O burnout foi avaliado pelo Maslach Burnout Inventory, e os Transtornos Mentais Comuns, pelo Self Reporting Questionnaire. Realizaram-se a medida casual da pressão e a Monitorização Ambulatorial da Pressão Arterial. Resultados: Participaram 231 profissionais. A maioria (59,7%) trabalhava em turnos, e essa condição associou-se (p≤0,05) com: maior carga de trabalho semanal; fazer plantão noturno; menor tempo de formado e de trabalho na instituição; etilismo; atividade de lazer; e alteração na monitorização ambulatorial da pressão arterial do período do sono. Os profissionais com transtornos mentais comuns e que trabalhavam em turnos apresentaram menores níveis de pressão casual diastólica (p=0,039) e maior prevalência de hipertensão (p=0,045). A presença de exaustão emocional associou-se com pressão arterial de vigília normal e despersonalização com pressão arterial de sono alterada. Conclusão: O trabalho em turnos associou-se à maior prevalência de fatores negativos relacionados ao trabalho, hábitos e estilos de vida inadequados e alteração da pressão no período de sono.Objective: To analyze the influence of shift work on blood pressure, the presence of burnout and common mental disorders in nursing professionals. Method: A crosssectional study. Burnout was assessed by the Maslach Burnout Inventory, and Common Mental Disorders by the Self-Reporting Questionnaire. Casual blood pressure measurement and Ambulatory Blood Pressure Monitoring (ABPM) were performed. Results: 231 professionals participated. The majority (59.7%) worked in shifts, and this condition was associated (p≤0.05) with: higher weekly workload; doing the night shift; shorter training and work time at the institution; alcoholism; leisure activity; and alteration in ambulatory blood pressure monitoring of the sleep period. The professionals with common mental disorders and who worked in shifts had lower casual diastolic pressure levels (p = 0.039) and higher hypertension prevalence (p = 0.045). The presence of emotional exhaustion was associated with normal waking blood pressure and depersonalization with altered sleep blood pressure. Conclusion: Shift work was associated with a higher prevalence of work-related negative factors, inadequate habits and lifestyles, and change in sleep blood pressure.Objetivo: Analizar la influencia del trabajo en turnos en la presión arterial, presencia de burnout y trastornos mentales comunes en profesionales enfermeros. Método: Estudio transversal. El burnout fue evaluado por el Maslach Burnout Inventory y los Trastornos Mentales Comunes, por el Self Reporting Questionnaire. Se realizaron la medida casual de la presión y el Monitoreo Ambulatorio de la Presión Arterial. Resultados: Participaron 231 profesionales. La mayoría (59,7%) trabajaba en turnos, y dicha condición se asoció (p≤0,05) con: mayor carga de trabajo semanal; hacer turno nocturno; menor tiempo de licenciado y de trabajo en el centro; etilismo; actividad de ocio; y modificación en el monitoreo ambulatorio de la presión arterial del período del sueño. Los profesionales con trastornos mentales comunes y que trabajaban en turnos presentaron menores niveles de presión casual diastólica (p=0,039) y mayor prevalencia de hipertensión (p=0,045). La presencia de agotamiento emotivo se asoció con presión arterial de vigilia normal y despersonalización con presión arterial de sueño modificado. Conclusión: El trabajo en turnos se asoció con la mayor prevalencia de factores negativos relacionados con el trabajo, hábitos y estilo de vida inadecuados y modificación de la presión en el período de sueño

Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux

Objectives. To determine the prevalence and distribution of primary venous re truncal saphenous reflux.Design. Prospective cohort study.Patients and methods. One thousand and seven hundred and twelve patients with suspected venous disease were examined by duplex ultrasonography. Seven hundred and thirty-five patients had primary varicose veins with competent saphenous trunks. Limbs With truncal saphenous reflux, deep vein reflux or obstruction, previous injection sclerotherapy or vein surgery, arterial disease and inflammation of non-venous origin were excluded from further consideration. the CEAP classification system was used for clinical staging. Systematic duplex ultrasound examination was undertaken to assess the distribution a incompetent saphenous tributaries.Results. the prevalence of primary reflux with competent saphenous trunks was 43%. Reflux of GSV calf tributaries was the most common. the majority of the limbs (96%) belonged to chronic venous disease classes C1 and C2 of the CEAP classification.Conclusions. Superficial venous reflux causing varicose veins in the presence competent saphenous trunks is very prevalent in this series in contrast to other studies, presumably reflecting differing patient populations. Our data clearly show that varicose veins may occur in any vein and do not depend on truncal saphenous incompetence. Careful duplex ultrasound evaluation allows the pattern of venous reflux to be established in this group of patient ensuring appropriate management of varices.Maringa State Univ, BR-87050610 Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilSanto Amaro Univ, São Paulo, BrazilMaringa Reg Hosp, Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilWeb of Scienc

Atributos físicos de um latossolo vermelho amarelo sob diferentes coberturas vegetais.

O objetivo deste estudo foi avaliar as modificações dos atributos físicos de um Latossolo Vermelho Amarelo em três diferentes coberturas vegetais e em duas profundidades. O experimento foi realizado na Fazenda Experimental da Escola Agrotécnica Federal de Alegre (EAFA), município de Alegre – ES, Brasil. Os tratamentos foram constituídos por três coberturas vegetais, solo descoberto, manga (Mangifera indica L.), café (Coffea canephora Pierre.) e por duas profundidades (0 a 0,20 e 0,20 a 0,40 m). Para cada cobertura vegetal, foram coletadas cinco amostras deformadas aleatoriamente distribuídas na área. O uso excessivo ao longo dos 10 anos no solo descoberto antes ocupado com horticultura, fez com que apresentasse valores maiores de areia fina e argila em relação aos outras coberturas de solo. A profundidade de 0 a 0,20 m apresentou maiores teores de areia grossa, areia fina em relação à profundidade de 0,20 a 0,40m. A argila apresentou maior concentração na profundidade de 0,20 a 0,40m e a argila dispersa em água apresentou concentrações diferentes nos ambientes avaliados

SEEDLING PRODUCTION CATTLEYA ELDORADO IN SUBSTRATES WITH NUTRITIVE SOLUTION UNDER SHADING SCREENS

Further researches are necessary to better understand the various technical and physiological aspects entailed by the use of substrates, shading and mineral fertilization resulting otimization in their application in the production of Cattleya eldoradoseedlings. The study was conducted with the aim of verify the effect of shading screens in the initial growth of Cattleya eldoradoseedlings in substrates fertilized with nutritive  solution. The experimental design was completely randomized 2x3x2 factorial with four replications. The studied factors: (T1)= crushed cupuaçupeel (sub1); (T2)= industrialized coconut fiber (sub2); (T3)= blend 50% sub1 + 50% sub2 with and without nutritive solution under red or black cromatinet. The analyzed variables were: aerial part height, number of leaves and chlorophyll a and b throught 300 days. Fertilization with nutritive solution promotes height growth and number of leaves results in higher levels of chlorophyll a and b, under red as black cromatinet, indicated for seedlings growth.Pesquisas adicionais são necessárias para se entender melhor os vários aspectos técnicos e fisiológicos acarretados pelo uso de substratos, sombreamento e fertilização mineral, a fim de otimizar sua aplicação na produção de mudas de C. eldorado. Diante do exposto, o trabalho foi realizado com objetivo de verificar o efeito de telas de sombreamento no crescimento inicial de mudas de C. eldoradoem substratos fertilizados com adição de solução nutritiva. O delineamento experimental utilizado foi o inteiramente casualizado em esquema fatorial 2x3x2 com quatro repetições. Os fatores em estudo foram: (T1)= casca de frutos de cupuaçu triturada (sub1); (T2)= fibra de coco industrializada (sub 2); (T3)= 50% mistura de sub1 + 50% mistura de sub2 com e sem adição de solução nutritiva sob cromatinet vermelha e cromatinet preta. As variáveis avaliadas foram: a altura da parte aérea, número de folhas e clorofila a e b, ao longo de 300 dias após o transplantio. A fertilização com adição de solução nutritiva favorece o crescimento em altura e o número de folhas e resulta em maiores índices de clorofila a e b tanto em cromatinet vermelha quanto preta, sendo indicada para crescimento de mudas de C. eldorado

Impacto de la pandemia de COVID-19 en los trastornos del sueño de profesionales de enfermería

Objective: to analyze the factors related to sleep disorders reported by Nursing professionals during the COVID-19 pandemic. Method: this is a cross-sectional and analytical study conducted with Nursing professionals from all Brazilian regions. Sociodemographic data, working conditions and questions about sleep disorders were collected. The Poisson regression model with repeated measures was used to estimate the Relative Risk. Results: 572 answers were analyzed, which revealed that non-ideal sleep duration, poor sleep quality and dreams about the work environment were predominant during the pandemic, with 75.2%, 67.1% and 66.8% respectively; as well as complaints of difficulty sleeping, daytime sleepiness and non-restorative sleep during the pandemic were reported by 523 (91.4%), 440 (76.9%) and 419 (73.2%) of the Nursing professionals, respectively. The relative risk of having such sleep disorders during the pandemic was significant for all variables and categories studied. Conclusion: non-ideal sleep duration, poor sleep quality, dreams about the work environment, complaints regarding difficulty sleeping, daytime sleepiness and non-restorative sleep were the predominant sleep disorders among Nursing professionals during the pandemic. Such findings point to possible consequences on health, as well as on the quality of the work performed.Objetivo: analisar os fatores relacionados às alterações no sono relatadas pelos profissionais de enfermagem durante a pandemia de COVID-19. Método: trata-se de um estudo transversal e analítico, realizado com profissionais de enfermagem de todas as regiões do Brasil. Foram coletados dados de caracterização sociodemográfica, condições de trabalho e questões sobre alterações de sono. Para estimar o Risco Relativo foi utilizado o modelo de regressão de Poisson com medidas repetidas. Resultados: foram analisadas 572 respostas, as quais revelaram que a duração não ideal do sono, a má qualidade do sono e os sonhos com o ambiente de trabalho foram predominantes durante a pandemia, com 75,2%, 67,1% e 66,8% respectivamente, assim como as queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador durante a pandemia foram relatadas por 523 (91,4%), 440 (76,9%) e 419 (73,2%) dos profissionais de enfermagem, respectivamente. O risco relativo de apresentar tais alterações de sono, durante a pandemia foi significativo para todas as variáveis e as categorias estudadas. Conclusão: duração não ideal do sono, má qualidade do sono, sonhos com o ambiente de trabalho, queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador foram as alterações do sono predominantes entre os profissionais de enfermagem durante a pandemia. Estes achados apontam para possíveis consequências na saúde, bem como na qualidade do trabalho realizado.Objetivo: analizar los factores relacionados con los trastornos del sueño que informaron los profesionales de enfermería durante la pandemia de COVID-19. Método: se trata de un estudio transversal y analítico realizado con profesionales de enfermería de todas las regiones de Brasil. Se recolectaron datos sobre caracterización sociodemográfica, condiciones de trabajo y preguntas sobre trastornos del sueño. Para estimar el Riesgo Relativo se utilizó el modelo de regresión de Poisson con medidas repetidas. Resultados: se analizaron 572 respuestas, que revelaron que durante la pandemia predominaron la duración del sueño no ideal, la mala calidad del sueño y los sueños sobre el ambiente laboral, con 75,2%, 67,1% y 66,8% respectivamente, además 523 (91,4%), 440 (76,9%) y 419 (73,2%) profesionales de enfermería manifestaron quejas de dificultad para conciliar el sueño, somnolencia diurna y sueño no reparador durante la pandemia, respectivamente. El riesgo relativo de padecer trastornos del sueño durante la pandemia fue significativo para todas las variables y categorías estudiadas. Conclusión: la duración del sueño no ideal, la mala calidad del sueño, los sueños sobre el ambiente laboral, las quejas de dificultad para conciliar el sueño, la somnolencia diurna y el sueño no reparador fueron los trastornos del sueño predominantes en los profesionales de enfermería durante la pandemia. Estos hallazgos indican posibles consecuencias para la salud, así como para la calidad del trabajo realizado

Epidemiological study in Brazilian women highlights that syphilis remains a public health problem

yphilis, an infectious disease considered a global public health concern, can cause stillbirths and neonatal deaths. This highlights the importance of continuous surveillance studies among women of reproductive age. A cross-sectional study was carried out to analyze the prevalence and risk factors associated with Treponema pallidum infection in women assisted by primary health care units in Dourados, a city located in Mato Grosso do Sul State, Brazil, which borders Paraguay. A questionnaire was applied to a population-based sample, blood samples were collected for syphilis testing and multivariable analyses were performed to screen associations with T. pallidum infection. The prevalence of T. pallidum infection was 6.04%. Bivariate analysis showed that women referring multiple sexual partners (c2: 6.97 [p=0.014]), income less 2 minimal wages (c2: 15.93 [p=0.003]), who did not have high school (c2: 12.64 [p=0.005]), and reporting history of STIs (c2: 7.30 [p=0.018]) are more likely to have syphilis. In the multivariate analysis, a highest prevalence ratio was observed in women with income less than 2 minimal wages (PR: 0.96 [95% CI: 0.85 - 0.97]), and who did not have high school (PR: 0.94 [95% CI: 0.90 - 0.98]). In addition, 80% of the women reported irregular use of condoms and 63.89% declared having sexual intercourses with multiple partners, which creates more opportunities for the transmission of the infection. These results highlight the need for healthcare systems to implement initiatives to monitor syphilis screening and the commitment of patients and their sexual partners to the treatment in order to achieve a decrease of new cases