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This study aimed to develop a new measure of sleep acceptance, the Sleep Acceptance Scale (SAS), and evaluate its psychometric properties. Participants were 1419 adults, with and without insomnia symptoms, who completed the SAS and several other questionnaires related to sleep, anxiety, and depression. Results from parallel analysis and exploratory factor analysis suggested that the SAS consisted of two latent factors: Avoidance and Distress. Confirmatory factor analysis found that the 2-factor model provided a good fit and had high factor loadings. The SAS had moderate to high internal consistency and showed construct validity by being positively correlated with measures of insomnia, anxiety, and depression and negatively correlated with a measure of sleep problem acceptance. Overall, the study provides preliminary evidence that the SAS is a valid tool for assessing the acceptance of sleep problems.

Sleep problems are common in childhood and can cause damage in children. There is a possible association between childhood sleep disorders and behavioral problems. The aim of this study was to evaluate the relationship between internalizing and externalizing problems and sleep problems in children of pre-school age, assessed by their mothers through the Child Behavior Checklist ( CBCL1 ½ -5 years) when seeking care at a clinic school psychology . The study included 83 mothers of children (and their children were: 58 boys and 25 girls) whose ages ranged between 2 and 5 years. Analysis indicated that 29 % of children had sleep problems among which the most frequent were “not wanting to sleep alone” and “resist the bed”. The data also suggested an association between sleep problems and internalizing (PR = 1,4; p < 0,05) and externalizing (PR = 1,4; p < 0,05) behaviors. Keywords: insomnia; externalizing behavior; internalizing behavior; children; Child Behavior Checklist.

Sleep problems are common in childhood and are associated with behavioral problems. The aim of this study was to evaluate the effect of a multicomponent treatment for childhood insomnia on children’s patterns, routine and sleep habits. 57 children with behavioral problems related to sleep and their mothers participated. The mothers were educated on their child’s sleep, received guidance on the establishment of sleeping schedules and routines and on the use of extinction and positive reinforcement techniques. The data were evaluated before and after the intervention by sleep diaries and by the Escala UNESP de Habitos e Higiene do Sono – Versao Criancas. Our results showed that children with sleep problems mostly present inadequate habits and routines before bedtime and that an intervention that focused on changing these habits, added to extinction strategies for inappropriate behaviors and positive reinforcement for adequate behaviors at bedtime may have contributed to improved sleep. It is hoped that this work can stimulate the production of national research on the subject, serving as an incentive for the development of preventive and interventional measures for childhood sleep problems.

O objetivo da presente pesquisa foi determinar a prevalência do uso de drogas psicoativas e investigar a sua associação com as redes de apoio social entre universitários. Os dados foram coletados por meio da aplicação de um questionário multidimensional em 227 universitários. Os resultados indicam que embora mais da metade já tenham consumido algum tipo de substância ilícita na vida, os índices de apoio social se mantiveram altos em todas as dimensões. Contudo, aqueles que estão expostos ao baixo apoio afetivo estão mais propensos ao uso moderado/alto de álcool e maconha, assim como aqueles que não possuem parentes com quem conversar possuem mais chances de usar álcool ou usar maconha. Outro dado importante consiste no fato de que estudantes que não possuem ou não praticam sua religião possuem mais chances de fazer uso de álcool.

The aim of the present study was to analyze the impact suffered by 40 people when discovering that one of their family members was diagnosed with cancer, to analyze their coping strategies and expectations towards the patient's illness and future. The study made use of the Coping Strategies Inventory by Folkman and Lazarus. Results show that most of the patients' caregivers are their married children, with an average age of 45.7 (dp=12.67), and gainfully employed. These family members reported the negative impact of the diagnosis, with the predominant feelings of sadness and fear of loss, even though they had a positive perspective about the future, expecting the patient's recovery. As to the functional coping strategies, the most used were the resolution of problems, followed by social support; the least used was positive revaluation. As to the dysfunctional strategies, the most used ones were escape and avoidance and the least used was taking the responsibility for the illness. Conclusions are that despite suffering with the negative impact of the disease, the family members are optimistic about the patient's future and seek to use strategies that solve the problem effectively, without blaming themselves for the patient's illness.

O presente artigo tem como objetivo determinar e analisar a prevalência do uso de álcool entre estudantes universitários e possíveis problemas relacionados a esse consumo. Trata-se de estudo transversal com a utilização de amostra representativa de estudantes universitários. Para colher as informações foram utilizados o Questionário multidimensional, fechado, de autopreenchimento sobre o uso de álcool e o Rutgers Alcohol Problem Index (RAPI). Os dados foram analisados por meio de medidas descritivas e comparações entre médias. Foi detectado um consumo de álcool cada vez mais precoce entre a população universitária e um significativo percentual de jovens expostos a diversos riscos como acidentes de trânsito, intoxicação, abuso sexual e atos de violência sob influência do álcool. Torna-se imprescindível que haja uma maior promoção da saúde entre a população universitária concomitantemente a uma incisiva aproximação com o contexto universitário, visando a elaboração de programas de prevenção direcionados a essa população.

OBJECTIVES: Our aims were to investigate the pituitary volume in patients with seasonal winter depression and healthy volunteers in winter and summer, and to assess the effects of phototherapy in these patients. METHOD: The pituitary volume of 12 patients with winter depression and 12 healthy controls, paired according gender, age and menstrual cycle, were obtained from magnetic resonance imaging in winter and summer. Eight patients were submitted to phototherapy (10000 vs. 2500 lux) in a double-blind crossover fashion during the winter, and reassessed (symptoms and magnetic resonance imaging) after treatment. RESULTS: There were no significant differences in pituitary volume between controls and patients in winter or summer. Exposure to phototherapy (10000 lux) decreased the depressive symptoms (p = 0.004), but the glandular volume did not change (p = 0.5). However, the pituitary volume in winter showed a positive correlation with the severity of depression in these patients (r = 0.69, p = 0.04). CONCLUSIONS: The results suggest that neither winter depression nor the change of seasons is associated with significant change in the pituitary volume. Despite the fact that this study was performed in a tropical area, phototherapy with 10000 lux showed to be an efficient treatment in this SAD patients sample. OBJETIVOS: Nossos objetivos foram investigar o volume da pituitária em pacientes com depressão sazonal de inverno e controles sadios, no inverno e verão, e avaliar os efeitos da fototerapia nesses pacientes. MÉTODO: O volume da pituitária de 12 pacientes com depressão de inverno e 12 controles sadios, pareados quanto ao gênero, idade e fase do ciclo menstrual, foi examinado por meio de imagem por ressonância magnética no inverno e verão. Oito pacientes foram submetidos à fototerapia (10.000 vs 2.500 lux) de forma duplo-cega e cruzada durante o inverno e reavaliados (sintomas e imagem por ressonância magnética) após o tratamento. RESULTADOS: Não houve diferença significativa no volume da pituitária entre controles e pacientes, no inverno e verão. A fototerapia (10.000 lux) reduziu os sintomas depressivos (p = 0,004), mas não alterou o volume glandular (p = 0,5). Contudo, o volume da pituitária, no inverno, mostrou uma correlação positiva com a gravidade da depressão nesses pacientes (r = 0,69, p = 0,04). CONCLUSÕES: Os resultados sugerem que nem a depressão de inverno, nem a mudança das estações estão associadas com a mudança significativa do volume da pituitária. Apesar do fato deste estudo ter sido realizado em uma região tropical, a fototerapia com 10.000 lux mostrou-se um tratamento eficaz nesta amostra.

Most of what is known about the seasonal variation in suicide rate originates from studies conducted in the northern hemisphere; very few studies have been done in the southern hemisphere. The purpose of the present study was to explore the possibility that in Brazil, the seasonal variation of suicides is a function of photoperiod. This was accomplished by analyzing monthly suicide data for a 12 yr period (1979 to 1990), within latitudes ranging from 2 degrees N to 33 degrees S. Single cosinor analyses with periods of 12 or 6 months were applied to time series of monthly total and suicidal deaths, separated by gender and state. Significant spring or early summer peaks of suicide were found only in the south of Brazil for both men and women, except for the latter in one state. These peaks did not coincide with those found for total deaths, which occurred in the autumn or winter in all areas. No significant six-month period was found. In the present study, the chance of a suicide was typically 10-17% higher during the peak period than during the other months of the year. Although this moderate seasonal effect might not be sufficient to justify planning large scale prophylactic interventions, those dealing with patients who have suicide ideation should be aware of this high risk time.

This study was undertaken to evaluate the acute effects of single low doses of melatonin given to healthy volunteers in the evening. Six healthy male volunteers (age range 22-24 years) participated in this study, after signing an informed consent form. They received in a double-blind fashion placebo or 0.3 or 1.0 mg melatonin at three fixed times: 18:00, 20:00, and 21:00 hr. Polysomnographic recordings began immediately thereafter, with their being allowed to sleep. Prior to each experimental session and in the following morning, subjects completed a sleep quality questionnaire, the Profile of Mood States, the Stanford Sleepiness Scale, and underwent a visual reaction test. Significant decrease on sleep latencies was found following melatonin treatment at 18:00 and 20:00 hr. In addition, melatonin tended to improve sleep efficiency and to reduce intermittent wakefulness. However, at 21:00 hr, 0.3 mg melatonin increased latency to sleep onset and 1.0 mg melatonin had no effect on sleep variables. Furthermore, melatonin given at different times did not alter subjective sleepiness, mood, and reaction time in the following morning. The results from the present study support the notion that administration of low doses of melatonin, mimicking the nocturnal physiological concentration of this hormone may exert immediate sleep-inducing effects.

Previous studies have shown that pretreatment with naloxone (Nlx), an opiate antagonist, attenuates the stimulating effect of ethanol. the purpose of the present study was to determine the influence of Nix on the development and expression of the sensitization to ethanol. Initially, effects of different doses of Nix on the response to a low dose of ethanol (2.0 g/kg) were assessed. Nix (1.0 and 3.0 mg/kg i.p.) decreased the stimulating effect of ethanol. Groups of mice were treated with saline or Nix (1.0 mg/kg i.p.) plus saline or ethanol (2.0 g/kg if) during 21 d. On day 25 of treatment all animals received an ethanol challenge (2.0 g/kg i.p.). It significantly increased the locomotor activity of mice that had received chronic ethanol (2.0 g/kg) once daily as compared to those that had received saline. Chronic administration of Nlx (1.0 mg/kg i.p.), during the same period of time, did not change the locomotor activity of the mice. However, the group concomitantly treated with Nix + ethanol did not develop sensitization to the locomotor-activating effect of ethanol. Another experiment was carried out to determine the effects of Nix on the expression of sensitization to ethanol. Acute pretreatment with Nix did not change the response of the mice that had developed sensitization to ethanol. These data show Nix's prevention of the development of ethanol-induced sensitization but not of its expression, suggesting an important role of the opioid neurotransmitter systems modulating the development of sensitization to the locomotor-activating effect of ethanol. Universidade Federal de São Paulo, Escola Paulista Med, Dept Psychobiol, BR-04023062 São Paulo, Brazil Univ Calif San Francisco, Dept Neurol, San Francisco, CA 94143 USA Univ Calif San Francisco, Gallo Ctr, San Francisco, CA 94143 USA Oregon Hlth Sci Univ, Portland, OR 97201 USA Universidade Federal de São Paulo, Escola Paulista Med, Dept Psychobiol, BR-04023062 São Paulo, Brazil Web of Science

The Premenstrual Assessment Form (PAF) is a retrospective self-report questionnaire, yielding classification into syndromal categories and severity assessment (unipolar summary scales) of behavioral, psychological and physical premenstrual changes. However, the PAF has been criticized due to an overlap of its syndromal categories and the unipolar summary scores from symptomatic and asymptomatic women. PAF data from women seeking treatment for premenstrual symptoms and meeting a provisional diagnosis of premenstrual dysphoric disorder (PMDD; n=30) were compared to a control group (n=16). Results showed that 97% of the symptomatic group met the PAF depressive premenstrual syndrome criteria vs. only 12% of the control subjects (chi(2)=29.9, P

The aim of this study was to compare the prevalence of sleep habits and complaints and to estimate the secular trends through three population-based surveys carried out in 1987, 1995, and 2007 in the general adult population of the city of Sao Paulo, Brazil.Surveys were performed using the same three-stage cluster-sampling technique in three consecutive decades to obtain representative samples of the inhabitants of Sao Paulo with respect to gender, age (20-80 years), and socio-economic status. Sample sizes were 1000 volunteers in 1987 and 1995 surveys and 1101 in a 2007 survey. In each survey, the UNIFESP Sleep Questionnaire was administered face-to-face in each household selected.For 1987, 1995, and 2007, respectively, difficulty initiating sleep (weighted frequency %; 95% CI) [(13.9; 11.9-16.2), (19.15; 16.8-21.6), and (25.0; 22.5-27.8)], difficulty maintaining sleep [(15.8; 13.7-18.2), (27.6; 24.9-30.4), and (36.5; 33.5-39.5)], and early morning awakening [(10.6; 8.8-12.7), (14.2; 12.2-16.5), and (26.7; 24-29.6)] increased in the general population over time, mostly in women. Habitual snoring was the most commonly reported complaint across decades and was more prevalent in men. There was no statistically significant difference in snoring complaints between 1987 (21.5; 19.1-24.2) and 1995 (19.0; 16.7-21.6), but a significant increase was noted in 2007 (41.7; 38.6-44.8). Nightmares, bruxism, leg cramps, and somnambulism complaints were significantly higher in 2007 compared to 1987 and 1995. All were more frequent in women.This is the first study comparing sleep complaints in probabilistic population-based samples from the same metropolitan area, using the same methodology across three consecutive decades. Clear trends of increasing sleep complaints were observed, which increased faster between 1995 and 2007 than from 1987 to 1995. These secular trends should be considered a relevant public health issue and support the need for development of health care and educational strategies to supply the population's increased need for information on sleep disorders and their consequences.

The literature widely recognizes that shift workers have more health complaints than the general population. The objective of this study was to describe the prevalence of sleep complaints and verify the polysomnographic (PSG) variables of shift workers in two Brazilian nuclear power plants. We carried out a subjective evaluation with a sleep questionnaire. Based on these results, the interviewees that reported sleeprelated complaints were referred for polysomnographic evaluation. Of the 327 volunteers initially evaluated by the sleep questionnaire, 113 (35%) reported sleep complaints; they were significantly older, had higher body mass index (BMI), and worked more years on shifts than those without sleep complaints. Of these 113, 90 met criteria for various sleep disorders: 30 (9%) showed obstructive sleep apnea (OSA), 18 (5.5%) showed limb movement, and 42 (13%) evidenced both sleep problems and had a significantly higher proportion of sleep stage 1 and arousals compared with the 23 shift workers that had no indices of sleep problems. The present study found that 90 (27.5%) of the evaluated participants met the PSG criteria of some type of clinical sleep disorder. This high proportion should be investigated for associations with other aspects of work, such as working hours, working schedule, years performing shift work, and access to health services. Due to the strong association between sleep disorders and the incidence of fatigue and sleepiness, the evaluation of the sleep patterns and complaints of shift workers is essential and should be considered to be one of the basic strategies of industry to prevent accidents. (Author correspondence: tmello@psicobio.epm.br)

Sleepiness is a physiological function, and can be defined as increased propension to fall asleep. However, excessive sleepiness (ES) or hypersomnia refer to an abnormal increase in the probability to fall asleep, to take involuntary naps, or to have sleep atacks, when sleep is not desired. The main causes of excessive sleepiness is chronic sleep deprivation, sleep apnea syndrome, narcolepsy, movement disorders during sleep, circadian sleep disorders, use of drugs and medications, or idiopathic hypersomnia. Social, familial, work, and cognitive impairment are among the consequences of hypersomnia. Moreover, it has also been reported increased risk of accidents. The treatment of excessive sleepiness includes treating the primary cause, whenever identified. Sleep hygiene for sleep deprivation, positive pressure (CPAP) for sleep apnea, dopaminergic agents and exercises for sleep-related movement disorders, phototherapy and/or melatonin for circadian disorders, and use of stimulants are the treatment modalities of first choice.

Shift work has potentially adverse effects on health, particularly on sleep. The purpose of the present study was to assess sleep parameters among personnel working in oil and gas offshore installations in the Campos Basin, Rio de Janeiro, Brazil. One hundred and seventy-nine subjects were asked to complete a sleep questionnaire with multiple-choice answers. Offshore workers were divided into two groups according to their work schedule: (1) fixed daytime workers (n = 86; age: 35.8+/-9.6 yrs) and (2) shift (n = 87) or night (n = 6) workers (total n = 93; age: 37.7+/-9.7 yrs). Shift/night workers reported poor sleep more frequently than the daytime workers (20.4% vs. 1.2%, p0.01), as well as habitual difficulty in falling asleep (15.1% vs. 4.7%, p0.01), long latency of sleep onset (28% vs. 7%, p0.01), fragmented sleep (45.2% vs. 16.3%, p0.01), short sleep episodes (44.1% vs. 16.3%, p0.01), irregular bedtimes (29.0% vs. 12.8%, p0.01), and feeling tired upon awakening (15.1% vs. 3.5%, p0.01). Habitual napping and loud snoring were reported twice as often in shift/night than in day workers (p0.01). Nightmares, somnambulism, and unpleasant feeling in the legs were equality reported by both groups (p0.05). Few offshore workers had sought medical help for their sleep problems. A higher number of shift/night workers reported feelings of sadness compared with day workers (26.9% vs. 9.3%, p0.01). The findings of this study show that subjective reports of sleep-related problems are quite common among Brazilian offshore shift workers. Reliance on self-reported sleep problems and a cross-sectional design are the main limitations of our study.

Study objectives Actigraphy is generally compared to polysomnography (PSG), which has been considered the gold standard for sleep studies. The objective of the present study was to evaluate the concordance between PSG and two previously proposed algorithms (Cole et al, 1992; Sadeh et al, 1994) to analyze actigraphic recordings. The minute-by-minute agreement rate was evaluated through calculation of sensitivity, specificity, and accuracy. Regarding the sleep parameters, the concordance was performed through the Bland and Altman technique. Design A night of adaptation to the sleep laboratory followed by simultaneous polysomnographic and actigraphic recordings throughout the night. Participants 21 healthy volunteers. Setting A sleep laboratory Interventions None. Results Ninety-one percent of all PSG epochs were correctly identified by both algorithms, and this accuracy is reasonably satisfactory. The actigraphy was a sensitive method, with values of 99% and 97% for Cole's and Sadeh's algorithms, respectively. However, actigraphy had a low specificity: 34% and 44% for Cole's and Sadeh's algorithms, respectively. The Bland and Altman technique showed that actigraphy systematically overestimated Sleep Latency, Total Sleep Time and Sleep Efficiency while it underestimated Intermittent Awakenings. Conclusions The results of this study show the utility of actigraphy as a useful method for assessment of sleep, despite its limitations regarding identification of waking epochs during sleep. The Bland and Altman concordance technique was revealed to be a powerful tool to evaluate how well actigraphy agreed with polysomnography. This technique, combined with calculations of sensitivity and specificity, appears to be the most adequate procedure for the assessment of concordance.

Previous studies suggest that organic solvents show anticonvulsant and convulsant effects, respectively at low and high doses. In the present study the first experiment was designed to determine low and high doses of injected acute n-hexane, ethyl acetate and toluene in mice through LD50 estimations. In the second experiment, high doses (around LD50) were employed to evaluate the convulsant effects. Finally, the third experiment evaluated the ability of low doses to prevent electroshock- and PTZ-induced convulsions. Results showed that n-hexane increased the severity of the electroshock-induced seizures only at low doses and had no anticonvulsant effects. Ethyl acetate produced generalized clonic seizures and deaths at high doses and was ineffective to prevent electroshock- and PTZ-induced seizures at low doses. Toluene induced forelimb clonus at high doses and protected against electroshock-induced seizures at low doses. Therefore, the biphasic property on convulsant activity seems to be a feature not shared among organic solvents.

The trauma questionnaire proposed as a brief and non-intimidating instrument to identify alcohol abuse was applied in a Brazilian group of 109 known alcoholics and 109 non-alcoholics. Although the sensitivity (66%) and specificity (81%) values found were similar to figures previously reported, it was found that sensitivity is influenced by the respondents socioeconomic background. The finding that the only direct item on drinking was the one that most contributed to the sensitivity of the test was discussed.

Drinking habits was studied in a sample of 3114 students from a low socioeconomic level and aging from 9 to 18 years. Males and females were equally represented in the sample. The survey showed that 27% were non-drinkers, 54% experimental drinkers, 14% moderate regular drinkers and 5% excessive regular drinkers. The excessive regular drinkers reported a higher proportion of heavy alcohol consumption among close relatives, mainly fathers. Sex and age-related differences were found in the drinking pattern. Males as well as oldest students were over represented among the drinkers excepted for excessive regular drinkers where no age difference was detected. This finding (same proportion of excessive regular drinkers in all age groups) was discussed taking into account the possibility that the high drop out rates in Brazilian schools could be introducing a bias in the figures found for the oldest adolescent groups. Beliefs about drinking consequences and location where most drinking occurs were also studied.

The effects of 3, 6 and 48 mg/kg of the benzodiazepine receptor antagonist Ro 15-1788 on the ethanol-induced depressant action were evaluated in mice. These results support and extend previous findings in experimental animals and show that Ro 15-1788 in doses devoid of intrinsic effects, does not antagonize the motor impairment, hypnotic effect or lethality induced by ethanol.

The influence of pretreatment with 5.0 or 10.0 mg/kg of indomethacin, a prostaglandin synthetase inhibitor, on the alterations in body temperature produced by 3.0 and 4.0 g/kg of ethanol, was studied in food-deprived and free-feeding rats. A partial antagonism of ethanol's hypothermic effect resulted from indomethacin pretreatments and this effect was found to be ethanol dose-dependent. This result could account for the conflicting reports in the literature on the effectiveness of indomethacin in antagonizing ethanol-induced hypothermia. Indomethacin (5.0 mg/kg) also antagonized ethanol-induced hypoglycemia in 48 hr starved rats. The relationship between two effects of ethanol, hypothermia and hypoglycemia, is discussed.

Flight safety is one of the most important and frequently discussed issues in aviation. Recent accident inquiries have raised questions as to how the work of flight crews is organized and the extent to which these conditions may have been contributing factors to accidents. Fatigue is based on physiologic limitations, which are reflected in performance deficits. The purpose of the present study was to provide an analysis of the periods of the day in which pilots working for a commercial airline presented major errors. Errors made by 515 captains and 472 co-pilots were analyzed using data from flight operation quality assurance systems. To analyze the times of day (shifts) during which incidents occurred, we divided the light-dark cycle (24:00) in four periods: morning, afternoon, night, and early morning. The differences of risk during the day were reported as the ratio of morning to afternoon, morning to night and morning to early morning error rates. For the purposes of this research, level 3 events alone were taken into account, since these were the most serious in which company operational limits were exceeded or when established procedures were not followed. According to airline flight schedules, 35% of flights take place in the morning period, 32% in the afternoon, 26% at night, and 7% in the early morning. Data showed that the risk of errors increased by almost 50% in the early morning relative to the morning period (ratio of 1:1.46). For the period of the afternoon, the ratio was 1:1.04 and for the night a ratio of 1:1.05 was found. These results showed that the period of the early morning represented a greater risk of attention problems and fatigue.

Problemas no momento de dormir e frequentes despertares noturnos são comuns em crianças, afetando 20% a 30% da população infantil. Tais dificuldades com o sono podem afetar aspectos comportamentais da criança, além de prejudicar o sono, o humor e a funcionalidade diurna de seus cuidadores. Apesar da importância do sono para a saúde infantil, há uma carência de estudos sobre o tema no cenário nacional. Esta pesquisa teve como objetivo avaliar a eficácia de uma intervenção comportamental para insônia infantil por meio de um programa dirigido aos pais. Participaram 62 pais de crianças de um a cinco anos de idade que apresentavam problemas de ordem comportamental relacionados ao sono. Os participantes foram randomizados em bloco de oito para os grupos de intervenção e controle. O programa de intervenção foi composto por cinco sessões nas quais os pais receberam educação sobre o sono da criança, orientações sobre o estabelecimento de horários e rotina para dormir e quanto ao uso de técnicas (extinção e reforço positivo) para a melhoria do momento de dormir e redução de despertares noturnos. Os participantes foram avaliados em quatro etapas pré-­intervenção, pós-­intervenção, seguimento de um e seis meses por meio dos instrumentos Escala UNESP de Hábitos e Higiene do Sono -­ Versão Crianças, Escala de Distúrbios do Sono para Crianças e Adolescentes, Inventário de Comportamentos para Crianças entre 1½ a 5 anos (CBCL), Inventário de Autoavaliação para adultos de 18 a 59 anos (ASR), Diário de Sono, Diário de Comportamento e Actigrafia. Os resultados deste estudo demonstraram que depois da intervenção houve melhora (p