To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The aetiology of dementia is not yet fully understood. Stress can have a damaging effect on brain health. The prognostic effect of anxiety is still unclear regarding Alzheimer's disease as well as vascular dementia.
To explore the association between anxiety and future dementia.
Medline, PsycINFO, CINAHL, Web of Science and ALOIS were searched for publications up to 12 January 2018. Longitudinal studies with a follow-up of at least 2 years were included, if the trait or state anxiety had been assessed at baseline. Studies with cognitive impairment at baseline were not included. We used a random effects model to calculate the pooled time to Alzheimer's disease and incidence of vascular dementia.
Anxiety predicts risk of Alzheimer's disease (n = 26 193 out of seven studies, hazard ratio1.53, 95% CI 1.16–2.01, P < 0.01) and vascular dementia (n = 4916 out of two studies, odds ratio1.88, 95% CI 1.05–3.36, P < 0.01). The pooled hazard ratio regarding risk of Alzheimer's disease was still significant when excluding studies with critical risk of bias (n = 14 110 out of six studies, hazard ratio 1.35, 95% CI 1.08–1.70, P < 0.01).
Anxiety is a risk factor for both types of dementia. The temporal and functional relation between anxiety and dementia needs investigation in future studies. The protective value of treating anxiety should be explored further.
To assess the representativeness of the data in the Krankenhaus Infektions Surveillance System (KISS), which is a nosocomial infections surveillance system for intensive care units (ICUs) in Germany.
Prospective and retrospective surveillance study.
Medical-surgical ICUs in Germany.
A sample of medical-surgical ICUs from all over Germany, stratified according to hospital size, was randomly selected. Surveillance personnel from the hospitals were trained in surveillance of nosocomial infections, and they subsequently conducted a 2-month surveillance in their ICUs. Data were compared with KISS data for medical-surgical ICUs.
During the period from 2004 through 2005, a total of 50 medical-surgical ICUs agreed to participate in our study: 21,832 patient-days were surveyed, and 262 cases of nosocomial infection were registered, 176 of which were cases of device-associated nosocomial infection (100 cases of lower respiratory tract infection, 47 cases of urinary tract infection, and 29 cases of bloodstream infection). The overall incidence density of all types of nosocomial infections was estimated to be 10.65 cases per 1,000 patient-days. Device utilization rates in the study ICUs and in the KISS medical-surgical ICUs were similar. The pooled mean device-associated infection rates were higher in the study ICUs than in the KISS medical-surgical ICUs (10.2 vs 5.1 cases of pneumonia; 2.0 vs 1.2 cases of bloodstream infection; and 2.7 vs 1.2 cases of urinary tract infection), but the pooled mean device-associated infection rates in the study ICUs were comparable to those of the KISS ICUs during their first year of participation in KISS. The incidence density for nosocomial infections in the study ICUs varied according hospital size, with ICUs in larger hospitals having a higher incidence density than those in smaller hospitals.
KISS ICUs started with nosocomial infection rates comparable to those found in our study ICUs. Over the years of participation, however, a decrease in nosocomial infections is seen. Thus, rates of nosocomial infection from KISS should be used as benchmarks, but estimations for Germany that are based on KISS data may underestimate the real burden of nosocomial infections.
Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.
To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder.
A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability.
Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness.
The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
Email your librarian or administrator to recommend adding this to your organisation's collection.