Adjunctive tianeptine treatment for bipolar disorder: A 24-week randomized, placebo-controlled, maintenance trial.

OBJECTIVE: The purpose of this study was to assess the efficacy and tolerability of tianeptine as an adjunctive maintenance treatment for bipolar depression. METHODS: This is a multicenter double-blind randomized placebo-controlled maintenance trial of adjunctive tianeptine 37.5 mg/day. Participants ( n=161) had a Montgomery-Asberg Depression Rating Scale ⩾12 at entry. After eight weeks of open-label tianeptine treatment, those who responded to tianeptine ( n=69) were randomized to adjunctive tianeptine ( n=36) or placebo ( n=33) in addition to usual treatment. Kaplan-Meier estimates and the Mantel-Cox log-rank test were used to evaluate differences in time to intervention for a mood episode between the tianeptine and placebo groups. We also assessed overall functioning, biological rhythms, quality of life, rates of manic switch and serum brain-derived neurotrophic factor levels. RESULTS: There were no differences between adjunctive tianeptine or placebo regarding time to intervention or depression scores in the 24-week double-blind controlled phase. Patients in the tianeptine group showed better performance in the letter-number sequencing subtest from the Wechsler Adult Intelligence Scale at the endpoint ( p=0.014). Tianeptine was well tolerated and not associated with higher risk for manic switch compared to placebo. CONCLUSION: Tianeptine was not more effective than placebo in the maintenance treatment of bipolar depression. There is preliminary evidence suggesting a pro-cognitive effect of tianeptine in working memory compared to placebo.

[Quality of primary care as measured by preventable hospitalizations in the South of Brazil]. / Qualidade da atenção básica mediante internações evitáveis no Sul do Brasil.

This study assessed the quality of primary care in Pelotas, Rio Grande do Sul, Brazil, through preventable hospitalization rates (1995-2004). Preventable hospitalizations were defined as those related to the following diseases: diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and vaccine-preventable diseases (polio, diphtheria, tetanus, whooping cough, and measles). Men and women from 20 to 59 years of age were included in the study. The proportion of preventable causes among hospital admissions was higher for women than for men. From 1995 to 2004 there was a decrease in preventable hospitalization rates. Even after direct standardization, analysis showed that admission rates in Pelotas were lower than for the State of Rio Grande do Sul as a whole. Preventable hospitalization costs decreased in parallel with the drop in hospital admission rates. The decrease in hospitalizations is consistent with improvement in primary health care. However, the findings may result from the system's financial model. Reimbursement for hospital procedures is low, which could induce the hospitals to curtail admissions.

Qualidade da atenção básica mediante internações evitáveis no Sul do Brasil / Quality of primary care as measured by preventable hospitalizations in the South of Brazil

Realizou-se estudo para avaliar mediante taxa de internações hospitalares evitáveis a qualidade dos cuidados oferecidos pela rede básica de saúde em Pelotas, Rio Grande do Sul, Brasil, no período entre 1995 a 2004. Foram consideradas como internações evitáveis: diabetes mellitus, insuficiência cardíaca, hipertensão arterial sistêmica, doença pulmonar obstrutiva crônica e doenças imunopreveníveis (poliomielite, difteria, tétano, coqueluche, sarampo). Foram incluídos homens e mulheres de 20 a 59 anos. Os percentuais entre as mulheres foram superiores aos encontrados nos homens. Foi observada uma diminuição dos percentuais de internações tanto nos homens como nas mulheres no decorrer do período. Mesmo após a padronização direta revelou-se que as taxas de internação de Pelotas foram inferiores às do Rio Grande do Sul. Os custos das hospitalizações evitáveis acompanharam a queda observada nas taxas de internações. Aparentemente, a diminuição verificada nas taxas de internações evitáveis pode estar relacionada à qualificação dos serviços de atenção básica. Contudo, os resultados podem ser conseqüências do financiamento do sistema de saúde. Os valores de pagamento desses procedimentos são baixos e podem estar direcionando os hospitais a uma diminuição da oferta de leitos.

This study assessed the quality of primary care in Pelotas, Rio Grande do Sul, Brazil, through preventable hospitalization rates (1995-2004). Preventable hospitalizations were defined as those related to the following diseases: diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and vaccine-preventable diseases (polio, diphtheria, tetanus, whooping cough, and measles). Men and women from 20 to 59 years of age were included in the study. The proportion of preventable causes among hospital admissions was higher for women than for men. From 1995 to 2004 there was a decrease in preventable hospitalization rates. Even after direct standardization, analysis showed that admission rates in Pelotas were lower than for the State of Rio Grande do Sul as a whole. Preventable hospitalization costs decreased in parallel with the drop in hospital admission rates. The decrease in hospitalizations is consistent with improvement in primary health care. However, the findings may result from the system's financial model. Reimbursement for hospital procedures is low, which could induce the hospitals to curtail admissions.

Insatisfação corporal em freqüentadores de academia / Body dissatisfaction among gym customers

A imagem corporal consiste numa variável multidimensional composta por representações sobre o tamanho e a aparência do corpo. A auto percepção do peso corporal é um aspecto importante da imagem corporal. Provavelmente reflete a satisfação e as preocupações sobre o peso corporal e pode ser influenciada por normas e padrões sociais da cultura dominante. Objetivo: O presente estudo objetivou identificar a prevalência de insatisfação corporal entre freqüentadores de academias, verificando possíveis fatores associados a essa morbidade. Metodologia: Foi utilizado um delineamento transversal para estudar indivíduos de 15 anos ou mais, freqüentadores de academias de ginástica da cidade de Pelotas-RS, durante o período de agosto a dezembro de 2002. A coleta foi realizada através de questionário que incluía questões sócio-demográficas, comportamentais e nutricionais. Foram estudados 315 indivíduos em 13 academias de ginástica da cidade. O estudo foi aprovado pelo comitê de ética e pesquisa da Universidade Federal de Pelotas e o sigilo individual foi mantido. Resultados: Praticamente metade dos entrevistados (48,3%) relatou estar insatisfeito com o próprio corpo. As variáveis sexo, idade e índice de massa corporal (IMC) mostraram-se associadas a insatisfação corporal apos controle para fatores de confusão. Indivíduos do sexo feminino e a categoria de idade até 19 anos foram as que apresentaram maiores riscos de insatisfação corporal. O IMC encontrou-se diretamente associado a insatisfação com o corpo, sendo que a categoria obeso apresentou um risco 2,3 vezes maior quando comparada aos indivíduos desnutridos. Conclusão: O estudo apontou que a prevalência de insatisfação corporal encontrada entre os frequentadores de academias de ginastica é importante, principalmente quando consideramos os transtornos nutricionais e psicológicos a que essa pode levar.

introduction: The body image consists of a multidimensional variable composed of statistics for the size and appearance of the body. Self-perception of the weight of the body is an important aspect of the body image. The self-perception probably reflects the satisfaction and worries about the weight of the body and can be influenced by social rules and norms from the dominant culture. Objective: This study aimed at identifying the prevalence of body dissatisfaction among gym customers by verifying possible factors associated to this morbidity. Methodology: Cross-sectional study, with individuals aged 15 or older who frequented different gyms in the city of Pelotas – RS from August to December 2002. Data collection was achieved through questionnaires including socio-demographic, behavioral and nutritional issues. 315 individuals from 13 different gyms in Pelotas were studied. The study was approved by the commission of Ethics and Research of the Federal University of Pelotas and the individual data secrecy was maintained. Results: Practically half of the people interviewed (48,3%) reported that they were dissatisfied with their own body. The sex, age and body mass index variables (BMI) showed to be associated to corporal dissatisfaction after confusing factors control. Female individuals and the group aged until nineteen years old were the ones who showed the highest risks of body dissatisfaction. The BMI was directly associated to body dissatisfaction having the obese group presenting a risk 2,3 times bigger when compared to the malnourished individuals.