Efficacy of sertraline in a 12-week trial for generalized anxiety disorder

Objective: Sertraline's efficacy and tolerability in treating generalized anxiety disorder were evaluated. Method: Adult outpatients with DSM-IV generalized anxiety disorder and a total score of 18 or higher on the Hamilton Anxiety Rating Scale were eligible. After a 1-week single-blind placebo lead-in, patients were randomly assigned to 12 weeks of double-blind treatment with placebo (N=188, mean baseline anxiety score=25) or flexible doses (50-150 mg/day) of sertraline (N=182, mean anxiety score=25). The primary outcome measure was baseline-to-endpoint change in the Hamilton anxiety scale total score. A secondary efficacy measure was the Clinical Global Impression (CGI) improvement score; response was defined as a score of 2 or less. Results: Sertraline patients had significantly greater improvement than placebo patients on all efficacy measures at week 4. Analysis of covariance of the intent-to-treat group at endpoint (with the last observation carried forward) showed a significant difference in the decrease from baseline of the least-square mean total score on the Hamilton anxiety scale between sertraline (mean=11.7) and placebo (mean=8.0). Significantly greater endpoint improvement with sertraline than placebo was obtained for mean scores on the Hamilton anxiety scale psychic factor (6.7 versus 4.1) and somatic factor (5.0 versus 3.9). The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). Sertraline was well tolerated; 8% of patients versus 10% for placebo dropped out because of adverse events. Conclusions: Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder.

Investigating information requirements for evaluating effectiveness of marine protected areas - Indonesian case studies

Identifying the information needs of managers and other stakeholders is an important first step in designing an evaluation of management effectiveness for marine protected areas (MPAs) that will be relevant to local circumstances and useful for improving management practices. Information requirements for evaluating effectiveness were investigated at two MPAs in Indonesia. Results show that, despite similar management objectives, information needs for evaluation differ between sites and those differences reflect the unique context within which management operates in each case. The scope of information needs at each site covers a broad range of issues including context, planning, resources, processes, outputs, and outcomes. Relevant components of a variety of different evaluation tools will need to be used to satisfy information needs at these sites. Evaluation tools that are based primarily on stated management objectives or the expressed views of a few key stakeholders are unlikely to be very useful for improving management in these cases.