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Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest.
Aims
To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI.
Method
Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11.
Results
Alternative second-line strategies led to higher response (28.2% v. 14.3%, odds ratio = 2.36 [95% CI 1.0–5.6], p = 0.05) and remission (16.9% v. 12.2%, odds ratio = 1.46, [95% CI 0.57–3.71], p = 0.27) rates, with greater HDRS-17 score reductions (−2.6 [95% CI −4.9 to −0.4], p = 0.021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2.53 [95% CI 0.94–6.80], p = 0.067; HDRS-17 difference: −2.7 [95% CI −5.5 to 0.0], p = 0.054) and for SSRI+PST (odds ratio = 2.46 [95% CI 0.92 to 6.62], p = 0.074; HDRS-17 difference: −3.1 [95% CI −5.8 to −0.3], p = 0.032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28.1% v. 75%; p < 0.01), largely mild.
Conclusions
Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.
Climate change profoundly affects plant phenology. An important parameter in research on plant dynamics is the plastochrone interval (PI), which is define as the time interval between the formation of successive leaves. The PI has been used to evaluate seagrass demography and as a direct measure of shoot growth and age. Variations in PI determine the growth rates, maintenance, and success of seagrass beds. Global warming could affect the PI dynamics of Zostera marina and, consequently, alter the dynamics of seagrass beds. Using Bayesian linear regression with a time series composed of 316 biweekly sampling dates from 1998 to 2018, we evaluated PI dynamics in the Punta Banda Estuary in Baja California, Mexico. We found that the tendency of the series was linear with parameter values of β0 = 1.65 (SD ±0.19) and β1 = −0.012 (SD ±0. 001). The Bayesian analysis of variance showed strong evidence of differences in the PI among years, given probabilities from 3.2 to 1.88 × 106 times higher of differences than no differences. The largest differences were detected between cold and hot years. The climatology of the time series PI values showed changes in seasonality over time. Summer and autumn were found to be the most perturbed seasons. Finally, by linking the PI estimates with the sea surface temperature anomalies for the complete series, a good inverse correspondence was observed between hot years and high PI, as well as cold years and low PI values, suggesting that climate change has affected PI among years and seasons.
The objective of this study is to describe the prevalence of benzodiazepine in a sample of patients (≥65 years) attended by liaison psychiatry units (LPU) in Spain and its possible relation to falls.
Methods:
This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.
Results:
We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home. 65,45% of patients had prescribed at least one psychotropic drug before LPU intervention; mainly (50,9%) benzodiazepines (60%women/40%men). 70,9% of these group of patients had more than one psychotropic drug prescribed before LPU. After LPU intervention in 39,39% at least one drug was withdrawn (in 50,81 % of cases benzodiazepines). Falls in the past 6 months were reported in 24.8% of total patients. Patients under benzodiazepine treatment had fallen in 29% of cases. After LPU intervention benzodiazepines were withdrawn in 56,25% % of them.
Conclusions:
Benzodiazepines are widely used in our sample and frequently is associated with polypharmacy. LPU intervention might be a useful tool to reduce the use of them, specially for those who reported falls.
Longitudinal studies might be carried out to study these factors and their possible relationship with falls, given that Benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Ppropriate prescription of medications such as BZDs is an important public health issue.
In any conservation programme, a variety of actors participate and interact in its different phases. They commonly have different perspectives and priorities regarding conservation, and diversity in the ensuing perspectives constitutes a barrier to effective conservation. In this paper, we analyse the different perspectives around the Programa de Conservación de Maíz Criollo (Programme for the Conservation of Native Maize in Mexico; PROMAC) in order to understand the possible causes that resulted in the programme not fulfilling its objectives. We used Q methodology and semi-structured interviews with farmers from a natural protected area to analyse the perspectives of the key actors who conceptualized, designed and implemented the programme and of the target population. Our research identified two different perspectives: (1) native maize can only be conserved with the support of community processes; and (2) the government, and not farmers, is responsible for the conservation of native maize. For farmers, native maize is key to their subsistence livelihoods, and they participated in the programme because of government monetary incentives. These differences contributed to dissimilar interpretations throughout the programme’s implementation phase, which, in turn, likely contributed to PROMAC failing to meet its objectives.
The aim of this study was to investigate if Mexican-Mestizo individuals with obesity, with or without binge eating disorder (BED), exhibited mutations or other type of genetic variants in the sequence of ANKK1.
Subjects and methods:
Fifty unrelated individuals (21–53 years of age) with obesity, of Mexican-Mestizo ethnic origin were included; 25 of them had BED and 25 presented obesity without BED. The diagnosis of BED was based on criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Besides, we also analyzed 100 individuals with normal body mass index. DNA from blood leukocytes was amplified by the polymerase chain reaction and all exons of ANKK1 were sequenced.
Results:
After ANKK1 sequencing we did not find any mutations; however, we observed various polymorphisms. One polymorphism, rs4938013 in exon 2 showed an association with obesity, whilst rs1800497 (also known as Taq1A) in exon 8, showed an association with BED (P = 0.020). Remarkable, for this study, the number of individuals for both polymorphisms for and additive model was sufficient to derive strong statistical power (80%, with a P < 0.05).
Conclusions:
To our knowledge, this constitutes the first report where the complete sequences of ANKK1 has been analyzed in individuals with obesity, with or without BED. No mutations were found; however, one polymorphism was associated with obesity, with or without BED, and another one was associated with BED.
Race has long been a contentious issue in the study of Latin American politics. During the mid-twentieth century, contemporaries often viewed nationalist mass movements as testing existing racial hierarchies – challenges often welcomed by supporters and derided by opponents, which lent an added intensity to the era's political antagonisms. Typically, mid-century nationalist reforms were not framed explicitly as programs for racial uplift; their advocates preferred, instead, to emphasize ideals of modernization, social peace, and collective justice. Nevertheless, these movements promised, and in some cases delivered, improvements demanded by laboring majorities that included racially stigmatized sectors. At the same time, many of these movements embraced, to various degrees and with varying motivations, cultural nationalisms that valorized African and/or indigenous folkways and acknowledged the virtues of multiracialism and mestizaje. It is common in retrospect to associate this generation of nationalist movements – many of which were subsequently labeled “populist” – with paradigms of “racial democracy,” a concept coined by commentators toward the end of Brazil's nationalist government under Getúlio Vargas (1930–45), and which later worked its way into the conceptual toolkit of Latin American studies. The status of populist leaders as racial democrats has, however, stoked debate. If contemporary critics assailed these actors as dangerous demagogues, revisionists have focused on their limitations, arguing that ideas of racial harmony were illusory and acted as barriers to deeper change. By contrast, a more recent wave of post-revisionist scholarship is reappraising the social resonance of mid-century racial discourses.
The place of Peronism – Argentina's mid-century political movement first led by Juan D. Perón and Eva Duarte de Perón – in these discussions is unclear, despite its standing as one of Latin America's most famed expressions of “populist nationalism.” This isolation derives from the reasonable inclination to study Peronism within the framework of Argentine history, but also from entrenched ideas of racial exceptionalism that encourage viewing Argentina as a regional outlier. The conventional wisdom among historians has long maintained that race was of marginal importance to Peronist rule, especially compared to the centrality of class in articulating “the people” as a political subject. Researchers, however, are now subjecting these views to greater empirical scrutiny as part of a broader reconsideration of the history of race and nation in Argentina.
Argentina suffers from what marketing experts would call an “image problem.” The country rarely fares well in the global media spotlight, where it is frequently trotted out as an example of spectacular political or economic failure. But seldom are the results of this scrutiny so unflattering as when issues of race and national identity come to the fore. As we write this Introduction, the 2014 World Cup provides the latest occasion for commentary. In a piece titled “Why So Many World Cup Fans Dislike Argentina,” The New York Times informed readers that “across Latin America, Argentina has the most people rooting against it” – not just because of the country's past successes on the field against its regional rivals but, more pointedly, because of “how some Argentines projected their perceptions of economic and cultural superiority in the region.” For the article's authors, the ugliest aspect of this ethnocentrism lies in “the ways in which some Argentines have traditionally viewed their nation, which received millions of European immigrants in the nineteenth and twentieth centuries: as a dominion of racial pre-eminence in the region.” A piece in the Huffington Post took a similar angle, asking “Why Are There No Black Men on Argentina's Roster?” Unlike other Latin American “rainbow nations […] conceived by the blend of American-Indians, Spaniards, and enslaved Africans,” Argentina's seemingly all-white roster confirmed, for the author of this piece, the country's exceptionally violent history of “purg[ing] their African roots from their socio-historical landscape and conscience,” and even of “ethnic cleansing” and “genocide,” in its eagerness to become “South America's whitest country.”
These journalistic assessments are all too familiar. The image of Argentina as a racial outlier in Latin America has become deeply engrained in popular and even academic discourses over the last century, and it shows few signs of fading. Whether celebrating the country's white and European character or condemning the discrimination and violence that sustained this image, commentators in Argentina and abroad have largely agreed in placing Argentina well outside of the narratives of racially mixed nationhood that characterize much of modern Latin America. The image of Argentina as a racial outlier makes for a good story, whether in the world of sports, in journalism, or in the classroom: it rings true and, as the World Cup coverage demonstrates, it often carries an important moral critique of racism and ethnocentrism.
This book is the outcome of many years of conversation among the editors, contributors, and various audiences and readers. Most of the chapters first took shape in a series of panel presentations delivered at the Latin American Studies Association conferences in Toronto (2010), San Francisco (2012), and Washington, D.C. (2013). The volume's authors have also shared their research with colleagues in venues across Argentina as well as with students, activists, and wider publics there and elsewhere. Along the way, we encountered a spectrum of reactions to our project: from enthusiasm and encouragement, to thoughtful critiques, to skepticism and even hostility. Indeed, the range and intensity of these responses not only helped us sharpen our arguments and reframe our assumptions, but they also strengthened our conviction that questions of race and nation in twentieth- and twenty-first-century Argentina merit rethinking.
If the subjects treated in this volume touch a nerve for some readers, it is surely because the chapters reconsider the conventional wisdom about Argentine politics, culture, and society held by many commentators in Argentina and abroad. Raising questions about the racial dimensions of inequality, identity, and power in Argentina is itself controversial. And even among those who agree that those are crucial questions, disagreements persist over how best to pose and answer them. To pick one telling example, the very title of this book, Rethinking Race in Modern Argentina, may provoke some unease. In the United States, references to race as a social dilemma or as an academic area of inquiry are commonplace. Yet in contemporary Argentina, the term raza carries a strongly negative connotation and is thus far less frequently invoked: indeed, it is common for raza to be placed within quotation marks even in the writings of researchers who use the concept to expose problems of discrimination. This circumspect treatment of raza is intended to emphasize its socially constructed, rather than essential or biological, character (despite the fact that other social constructs like género [gender] and clase do not require this kind of treatment), or to signal the concept's status as archaic and somehow foreign to Argentina. The pages that follow devote considerable attention to unraveling the many languages of race in Argentina employed since the early twentieth century and assessing their political implications.