Plusieurs études ont montré que la perturbation des fonctions du système cardiovasculaire constitue un risque majeur de développement du trouble dépressif chez l'homme. De plus, suite à un infarctus du myocarde, 15-30% de la population développe la dépression majeure dans les 6 à 8 mois suivant cet événement suggérant un lien entre les maladies cardiovasculaires et la dépression. Cette dépression est caractérisée par une série de troubles du sommeil. Approximativement 80% des patients hospitalisés et 70% des malades en consultation externe avec une dépression majeure rapportent des difficultés d’initiation et de maintient du sommeil. Les travaux effectués dans les laboratoires de Roger Godbout et Guy Rousseau ont montré que suite à un infarctus aigu du myocarde chez le rat, on observait de l'anhédonie, de la détresse comportementale et de la mort cellulaire par apoptose dans le système limbique. Cette apoptose suivait un décours spatial et temporel et avait été prévenue par l’administration d’antidépresseurs. De plus, le facteur de nécrose tumorale alpha (TNF-α) serait un composant majeur dans l’activation de la voie extrinsèque conduisant à la mort cellulaire observée dans le système limbique. Les résultats de cette thèse montrent que les rats ayant subi un infarctus du myocarde (IM) présentaient à la fois des troubles du sommeil, de l'anhédonie et de la détresse comportementale comparables à ceux des autres modèles animaux de dépression. Les symptômes de dépression ont été prévenus par l'administration à la fois d'un antidépresseur (escitalopram) et d'un inhibiteur de la synthèse des cytokines proinflammatoires (pentoxifylline). Les troubles du sommeil et l'apoptose avaient aussi été prévenus par l'admistration respective de l'escitalopram et de la pentoxifylline. De plus, les animaux ayant subi un IM présentaient une diminution du nombre de cellules cholinergiques dans le générateur du sommeil paradoxal expliquant en partie la réduction de la durée du sommeil paradoxal observée dans cette thèse. Les animaux ayant subi un IM montraient une augmentation systémique du TNF-α, l'interleukine-1 (IL-1β), et la prostaglandine E2 (PGE2). Le traitement par l'escitalopram bloquait l'augmentation des niveaux plasmatiques du TNF-α, de l'IL-1β, et de la PGE2 sans affecter celui de la corticostérone et de l'IL-6. Finalement, pour la première fois, nous avons mis évidence qu'un traitement autre qu'un antidépresseur (pentoxifylline) pouvait réduire le comportement dépressif dans la dépression post-infarctus du myocarde lorsqu'il est administré quelques minutes avant la période ischémique. Il apparait donc important d’intervenir rapidement chez les patients à la suite d'un IM et ce dès les premiers jours et avant même l’apparition des premiers signes d’insomnie et de dépression. Une combinaison de traitements pharmacologique et comportemental serait une voie intéressante à considérer dans la prise en charge de ces patients. / Several studies have shown that disruption of the cardiovascular system functions is a major risk of developing depressive disorder in humans. In addition, following a myocardial infarction, 15-30% of the population develops major depression within 6 to 8 months after this event suggesting a link between cardiovascular disease and depression. The depression is characterized by a series of symptoms including sleep disorders. Approximately 80% of hospitalized patients and 70% of patients with major depression reported difficulties initiating and maintaining sleep. Work in the laboratories of Roger Godbout and Guy Rousseau showed that following an acute myocardial infarction, the rats displayed anhedonia, behavioral dispair and cell death by apoptosis in the limbic system. This apoptosis follows a spatial and temporal time course and could be prevented by administration of antidepressants. Moreover, tumor necrosis factor alpha (TNF-α) is a major component in the activation of the extrinsic pathway leading to cell death observed in the limbic system. The results of this thesis show that acute myocardial infarction (MI) is accompanied, within 2 weeks, by paradoxical sleep specific insomnia. Moreover, the myocardial infarcted rats have shown a decrease in the number of cholinergic neurons in the paradoxical sleep generator in the central nervous system. The post MI syndrome is accompanied by increase systemic levels of TNF-α, interleukin-1 (IL-1β), prostaglandin E2 and circulating corticosterone. The SSRI antidepressant escitalopram blocks the post MI behavioural syndrome without affecting sleep while it decreased TNF-α, IL-1β, and PGE2 levels but not corticosterone nor IL-6. Finally, the administration of pentoxifylline, a non selective cytokine synthesis inhibitor before the ischemic period attenuates the post-MI depressive behavior. This is the first evidence that a non-antidepressant may reduce the depressive behavior in a post-MI behavioural syndrome. Therefore, it appears important to intervene quickly in patients following a MI and in the earliest days and even before the first signs of insomnia and depression. A combination of pharmacological and behavioral treatments would be an interesting way in the management of these patients.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Background: In 2007 the population density for the Gauteng Province was 614 persons per km2 and in the Northern Cape Province it was 2.9 persons per km2 . High population density leads to an increase in crime. This was evident in the percentage distribution of total crime reported from 2000 to 2003 of 27.4% in Gauteng Province, while the percentage distribution of total crime reported in the Northern Cape for the same period of time was 2,8%. Stress and insomnia can be caused by crime which is influenced by population density. Crime and high population density, may cause stress and fear, which may lead to insomnia and anxiety, which in turn may lead to an increase in benzodiazepine usage. Objective: The general objective of this study was to investigate the benzodiazepine usage in the private health care sector in South Africa based on age, sex, geographical areas, prescriber type and days between refills. Methods: The data were obtained from a medicine claims database of a pharmacy benefit management company covering the periods from 1 January 2006 to 31 December 2006 and 1 January 2008 to 31 December 2008. The statistical analysis was performed by making use of the Statistical Analysis System®. A drug utilisation review was performed. Results: Patients claiming benzodiazepines represented about 7.25% of all patients in total database in 2006 and 7.97% in 2008. Female patients claimed more benzodiazepines than male patients in both Gauteng (67.24% in 2006 & 67.36% in 2008 respectively) and Northern Cape Province (67.77% in 2006 & 67.70% in 2008 respectively). Patients aged 40 years to 65 years claimed the highest number of benzodiazepine items, while patients younger than 12 years claimed the lowest number of benzodiazepine items. The number of patients that claimed benzodiazepines in the Northern Cape was lower than those in Gauteng. The percentage of patients that claimed benzodiazepines in 2006 was 7.91% in Gauteng versus 8.96% in Northern Cape. In 2008 the percentage of patients that claimed benzodiazepines was 8.47% in Gauteng versus 9.51% in Northern Cape. The percentage of benzodiazepine prescriptions claimed in Gauteng was 4.79% in 2006 and 5.10% in 2008. In the Northern Cape the percentages of benzodiazepine prescriptions claimed in 2006 and 2008 were 4.62% and 4.30% respectively. General medical practitioners prescribed most of the benzodiazepine prescriptions in both Northern Cape and Gauteng Province. Trade name products that were mostly prescribed in the Gauteng was Adco–Alzam® 0.5 mg and in the Northern Cape it was Brazepam® 3 mg for both 2006 and 2008. Conclusion: The difference in the prescribing patterns of benzodiazepines in Gauteng and the Northern Cape was not statistically significant. Recommendations for future research were made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Background: In 2007 the population density for the Gauteng Province was 614 persons per km2 and in the Northern Cape Province it was 2.9 persons per km2 . High population density leads to an increase in crime. This was evident in the percentage distribution of total crime reported from 2000 to 2003 of 27.4% in Gauteng Province, while the percentage distribution of total crime reported in the Northern Cape for the same period of time was 2,8%. Stress and insomnia can be caused by crime which is influenced by population density. Crime and high population density, may cause stress and fear, which may lead to insomnia and anxiety, which in turn may lead to an increase in benzodiazepine usage. Objective: The general objective of this study was to investigate the benzodiazepine usage in the private health care sector in South Africa based on age, sex, geographical areas, prescriber type and days between refills. Methods: The data were obtained from a medicine claims database of a pharmacy benefit management company covering the periods from 1 January 2006 to 31 December 2006 and 1 January 2008 to 31 December 2008. The statistical analysis was performed by making use of the Statistical Analysis System®. A drug utilisation review was performed. Results: Patients claiming benzodiazepines represented about 7.25% of all patients in total database in 2006 and 7.97% in 2008. Female patients claimed more benzodiazepines than male patients in both Gauteng (67.24% in 2006 & 67.36% in 2008 respectively) and Northern Cape Province (67.77% in 2006 & 67.70% in 2008 respectively). Patients aged 40 years to 65 years claimed the highest number of benzodiazepine items, while patients younger than 12 years claimed the lowest number of benzodiazepine items. The number of patients that claimed benzodiazepines in the Northern Cape was lower than those in Gauteng. The percentage of patients that claimed benzodiazepines in 2006 was 7.91% in Gauteng versus 8.96% in Northern Cape. In 2008 the percentage of patients that claimed benzodiazepines was 8.47% in Gauteng versus 9.51% in Northern Cape. The percentage of benzodiazepine prescriptions claimed in Gauteng was 4.79% in 2006 and 5.10% in 2008. In the Northern Cape the percentages of benzodiazepine prescriptions claimed in 2006 and 2008 were 4.62% and 4.30% respectively. General medical practitioners prescribed most of the benzodiazepine prescriptions in both Northern Cape and Gauteng Province. Trade name products that were mostly prescribed in the Gauteng was Adco–Alzam® 0.5 mg and in the Northern Cape it was Brazepam® 3 mg for both 2006 and 2008. Conclusion: The difference in the prescribing patterns of benzodiazepines in Gauteng and the Northern Cape was not statistically significant. Recommendations for future research were made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Sömnsvårigheter inklusive insomni är ett utbrett problem för stora delar av befolkningen. Personer med insomni tenderar att oroa sig över sin sömn och har dysfunktionella antaganden kring sömnbristens konsekvenser. Studiens huvudsakliga syfte var att undersöka om skillnader i utfall mellan två behandlingsmetoder för insomni kunde tillräknas en exponeringseffekt. Studiens hypoteser var: 1a) Patienter som deltar i sömnrestriktion kommer få en större reducering av oro över sin sömn. 1b) Det finns ett samband mellan hög följsamhet till behandlingsmetoden och minskad oro över sömnen. 2) En kraftigare exponering medför lägre följsamhet till behandlingsmetoden. 3) Det finns ett samband mellan minskad oro över sömnen och minskade insomnisymptom. Data användes där 185 deltagare randomiserats till någon av KBT-behandlingarna för insomni sömnkomprimering (n=93) och sömnrestriktion (n=92). Oron hade minskat för studiedeltagarna fem veckor efter behandlingsstart men inga signifikanta skillnader påträffades mellan grupperna. Ett signifikant samband observerades mellan minskning av insomnisymptom och oro över sömnbrist. Slutsatser från uppsatsen är det redan etablerade sambandet mellan oro och insomni bekräftas. Studien kunde inte bekräfta hypotesen att exponering leder till minskad oro. Vidare forskning rekommenderas för att avgöra hur exponering kan användas för patienter med insomni för att möjliggöra effektivare behandlingsmetoder. / Sleep impairments including insomnia is a widespread problem affecting a large quantity of the population. Insomnia patients tend to worry about their sleep and having dysfunctional beliefs about sleep deficit consequences. The main purpose of this study was to examine if differences in results between two treatment methods could be attributed to effects of exposure. The hypotheses in the study were: 1a) Patients who participate in sleep restriction will have a greater reduction of sleep-related worry. 1b) There is a correlation between high compliance to the treatment methods and reduced sleep-related worry. 2) A greater exposure induces lower compliance to the treatment methods. 3a) There is a correlation between reduction of sleep-related worry and reduction of insomnia symptoms. Data consisted of 185 participants who was randomised into the CBT-treatments for insomnia sleep compression (n=93) or sleep restriction (n=92). A hypothesis was that sleep restriction implicate more exposure than sleep compression. Worry had decreased among participants after five weeks of treatment but no significant differences occurred between the groups. A significant correlation occurred between reduction of insomnia symptoms and reduction of worries regarding sleep deficit. Conclusions is that the already established correlation between worry and insomnia is confirmed. This study failed to confirm that exposure leads to reduced worry. Further research is advised to determine how exposure can be used for insomnia patients to enable more efficient treatment methods. / ClinicalTrials.gov Identifier: NCT02743338, CompRest - a Comparison Between Sleep Compression and Sleep Restriction for Treating Insomnia

No description available.

O avanço econômico, científico e tecnológico, vem levando a um aumento da expectativa de vida e consequente envelhecimento da população. Assim, o idoso requer atenção especial pela maior incidência de doenças crônicas e degenerativas e pelo aumento concomitante no uso de fármacos, podendo ocasionar complicações pela sua maior vulnerabilidade à eventos adversos (EAs), uso inapropriado e abusivo, exposição à interações medicamentosas sérias, e casos de iatrogenias. Acrescenta-se o fato particular de um aumento abusivo no uso de benzodiazepínicos (BDZs). O objetivo deste trabalho foi rever e sintetizar as evidências geradas por ensaios clínicos controlados e randomizados sobre a incidência de EAs relacionados ao uso de BDZs em idosos com ansiedade ou insônia em comparação àqueles que, sob as mesmas condições clínicas, não o utilizaram. Desenvolveu-se a recuperação de artigos em cinco bases de dados eletrônicas na área da saúde (PubMed, SCOPUS, Web of Science, Cochrane Central, e LILACS), para posterior análise combinada (metanálise) dos resultados evidenciados. / The economic, scientific and technological progresses have provided an increase in life expectancy and the consequent process of aging. Thus, the elderly requires special attention due to the higher incidence of chronic and degenerative diseases and the higher concomitant increase in the drugs use that may cause complications by increasing ulnerability for adverse events (AEs); nappropriate and abusive use; exposition to serious drug interactions, and iatrogenic cases. Add to these the particular abusive increase in benzodiazepine (BDZ) use. The objective of this study was to review and synthesize the evidence generated by randomized controlled trials on the incidence of AEs related to therapy with BDZs in elderly with anxiety or insomnia compared to those under the same clinical conditions, not medicated. The articles were recovered in five healthcare electronic databases (PubMed, SCOPUS, Web of Science, Cochrane Central, and LILACS), for subsequent combined analysis (meta-analysis) of the results.

Submitted by Fabiano Vassallo (fabianovassallo2127@gmail.com) on 2017-04-27T18:32:06Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) [Tese] Texto integral (DEFINITIVA).pdf: 138158192 bytes, checksum: 4e855488221b4162d21dee52418fab4f (MD5) / Approved for entry into archive by Josimara Dias Brumatti (bcgdigital@ndc.uff.br) on 2017-05-08T17:06:32Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) [Tese] Texto integral (DEFINITIVA).pdf: 138158192 bytes, checksum: 4e855488221b4162d21dee52418fab4f (MD5) / Made available in DSpace on 2017-05-08T17:06:32Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) [Tese] Texto integral (DEFINITIVA).pdf: 138158192 bytes, checksum: 4e855488221b4162d21dee52418fab4f (MD5) / Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro / A literatura de Graciliano Ramos sofre expressiva guinada estética, a partir de 1937, depois de passar dez meses na prisão. Embora quase todos os seus livros tenham partido de um conto, apenas depois de sua liberdade, o escritor alagoano passou a se dedicar à narrativa curta, em sua concepção, organização e crítica. Os contos produzidos nesse período foram reunidos em Insônia (1947), mas alguns deles foram também publicados em Dois dedos (1945) e Histórias incompletas (1946), cada um destes dois como esboço de uma proposta estética que tomaria consistência apenas no livro posterior. A estrutura do conto passa a orientar, então, a atividade criativa de Graciliano, que abandona o gênero romanesco e busca a forma mais “razoável” para expressar criticamente as tensões entre indivíduo e sociedade. Além disso, o escritor incorpora organicamente alguns procedimentos de tendências artísticas herdadas das vanguardas históricas, não de modo conciliado, mas por meio de apropriações críticas e diferenciais. Com isso, Graciliano elabora estratégias estético-narrativas na concepção de Insônia, que se tornam fundamentais para a escrita de Memórias do cárcere (1953), cujos capítulos apresentam, em sua maioria, aspectos congruentes a alguns contos de Insônia, especialmente os aqui denominados “Noturnos”. As categorias simbólicas de “noturnidade” e “insonolência” tornam-se também fundamentais para o desenvolvimento do conceito de memória em Graciliano Ramos, um dos componentes decisivos para a construção do livro sobre a cadeia. Portanto, a tese busca comprovar a importância de Insônia na concepção de Memórias do cárcere, bem como das articulações do substrato do vivido na reconfiguração estética do projeto literário do escritor e na produção de sua contística / From 1937 on, the literature of Graciliano Ramos has a significant esthetic turn, after ten months in prison. Though almost all of his books have been created from a short story, after his release, the writer has begun to produce, organize and criticize short stories. The texts produced during that period were gathered in Insônia (Insomnia), 1947, although some of them have also been published in Dois dedos (Two Fingers), 1945, and in Histórias incompletas (Incomplete Stories), 1946, each having an esthetic proposal that would only become more consistent in his later book. Then, the structure of the short story serves as a guideline to Graciliano’s creative activity, which leads him to leave the novel and to seek a reasonable form to critically express the tensions between man and society. Furthermore, the writer organically embodies some procedures of artistic tendencies inherited from the historic vanguards, not in a conciliatory way, but through critical and differential appropriations instead. Thereby, Graciliano elaborates esthetic-narrative strategies to create Insônia, which becomes fundamental to the writing of Memórias do cárcere, considering the aspects of some chapters and the short stories called here “Noturnos” (Nocturnes). The symbolic categories of “nocturnity” and “insomnolence” also become important to develop the concept of memory in Graciliano Ramos, one of the most decisive components to build the book of the prison. Therefore, the thesis aims at proving the importance of Insônia to the creation of Memórias do cárcere, and the articulation of the living substrate with the esthetic reconfiguration of Graciliano Ramos’ literary project and his short story production

Slow-wave sleep plays an important role in consolidation of declarative memory. From electrophysiological point of view, this process is dependent on a common occurrence and mutual integration of neocortical slow oscillations (< 1 Hz), hippocampal sharp-wave ripples (150-250 Hz) and thalamo-cortical sleep spindles (10-15 Hz). Previous studies demonstrated that periodic acoustic stimulation by pink noise pulses applied at frequency of sleep slow oscillation during slow wave sleep leads to prolongation of slow wave sleep and to enhancement in declarative memory performance in normal sleepers. Our study investigated this kind of periodic acoustic stimulation in its relation to sleep architecture and declarative memory of people suffering from insomnia due to which there often comes to a reduction in slow wave sleep which positively correlates with worsening of declarative memory performance. Our aim was to investigate if this kind of comparatively non-invasive brain stimulation has a potential to increase a total length of slow wave sleep and enhance declarative memory performance in insomnia. Our study revealed acoustic stimulation neither improved declarative memory performance nor it increased total length of slow-wave sleep. No positive association was found between level of declarative memory...

Tato práce je vícevrstevným zamyšlením nad tématem prázdnoty. Její prvotní inspirací jsou Bondyho úvahy na toto téma. Nejde o to, ukazovat na neukazatelné, či popisovat nepopsatelné, to by byla spíše filosofická statistika; prázdnota je tu primárně chápána spíše na způsob krajního horizontu, jehož bytostné připuštění zakládá možnost pravého setkání podobném smyslu uvažuje nad souvislostí prázdnoty a milosti a otevírá možnost chápat prázdnotu nikoliv jako axiologickou neurčenost, ale právě jako horizont zvláštního setkání se světem. Takto nahlížená prázdnota otevírá bytostnou plnost a zároveň braných souvislostí těchto myšlenek o mezích ontologie - Plótínovou koncepcí emanační ontologie, či se substanční ontologií ze Spinozovy Protože se v průběhu tohoto rozboru dostává do popředí problém statického a předsudečného chápání ontologické substance (která takové vlastnosti nemůže mít, vyjdeme jako krajního ontologického horizontu), otevírá se otázka původu tohoto problému; v Myšlení vnějšku) a Berďajevem následuje hodnocení možnosti ontologii, což je přeneseně otevření otázky vztahu moci a ontologie či prolínání mocenského hlediska do ontologické úvahy (prázdnota by v yslu představovala zřeknutí se moci). Druhá kapitola práce se návazně zabývá formami zřeknutí se tohoto mocenského hlediska, coby praktikovaného...