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To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
Stress elicits adaptive responses from the brain, but it can also lead to maladaptive consequences. For example, stress can precipitate mental illness, including depression. Prolonged stress also causes damage to neurons in the hippocampus. Antidepressant drugs must be evaluated, not only for their ability to potentiate adaptive responses, but also to inhibit maladaptive consequences of stress. Ongoing research in our laboratory has compared the atypical tricyclic antidepressant, tianeptine, with the typical tricyclics, desipramine and imipramine, with respect to the effects of isolation and repeated restraint stress. Tianeptine and desipramine similarly attenuated isolation stress-induced increases in locus coeruleus and midbrain tyrosine hydroxylase mRNA levels and isolation-stress induced decreases in preproenkephalin mRNA levels in striatum and nucleus accumbens. However, tianeptine and imipramine differed in their effects in the cerebral cortex and hippocampus on 5HT2, and 5HT1A receptor levels but, surprisingly, produced similar effects on levels of the serotonin transporter labelled with [3H] paroxetine. Tianeptine also prevented stress-induced reductions in the length and number of branchpoints of dendrites of CA3 pyramidal neurons in hippocampus; comparison with effects of typical tricyclics are ongoing. Tianeptine also blocked effects of corticosterone treatment to reduce branching and length of CA3 dendrites. These actions of tianeptine may be due to interactions between 5HT and excitatory amino acids in the mossy fiber terminals on CA3 pyramidal neurons. Taken together, these results indicate that tianeptine has unique properties compared to some other antidepressant drugs, but shares in common with those drugs the ability to attenuate stress effects on tyrosine hydroxylase gene expression and on the serotonin transporter. It remains to be seen whether these actions are the basis of a common antidepressant action.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.
Identifying benthic substrates is important to researchers studying aquatic organisms in fresh and salt water systems. Benthic substrates are often not visible from the surface making it necessary to find another method to gather these data. Previous research has demonstrated that low cost side-scan sonar is a reliable way to identify hard substrates, such as rock and gravel, in a small, freshwater stream. In this study, the reliability of the side-scan sonar to accurately identify softer substrates such as grass and mud was tested in a large, brackish lagoon system. A total area of 11.55 km2 was surveyed with the sonar. Videos and pictures were taken at various points to groundtruth the sonar images and provide a measure of accuracy. Five substrate types were identified: dense seagrass, sparse seagrass, mangrove soil, mangrove soil with rock, and silt. Unidentifiable substrates were classified as unknown. A manually zoned benthic substrate map was created from the sonar recordings. Dense seagrass was most accurately identified. Sparse seagrass was the least accurately identified. A bathymetric map was also created from the sonar recordings.
A novel method to perform small-scale laboratory experiments that reproduce concrete–bentonite and concrete–groundwater interactions has been developed. Such interfaces will prevail in engineered barrier systems used for isolation of nuclear waste. With the goal of optimizing the experimental method, this work has analysed the geochemical interaction of distilled water, low-pH cement mortar and FEBEX-bentonite for 75 days. Limited but evident reactivity between the materials was observed, mainly decalcification in cement mortar, carbonation at the interface with bentonite and Mg enrichment in bentonite. These results are consistent with the state-of-the-art literature and were used to validate this small-scale pilot laboratory experiment to establish the basis for further studies comparing the behaviour of different buffer and cement materials.
A novel laboratory experimental design is described that will investigate the processing of dust grains in astrophysical shocks. Dust is a ubiquitous ingredient in the interstellar medium (ISM) of galaxies; however, its evolutionary cycle is still poorly understood. Especially shrouded in mystery is the efficiency of grain destruction by astrophysical shocks generated by expanding supernova remnants. While the evolution of these remnants is fairly well understood, the grain destruction efficiency in these shocks is largely unknown. The experiments described herein will fill this knowledge gap by studying the dust destruction efficiencies for shock velocities in the range
), at which most of the grain destruction and processing in the ISM takes place. The experiments focus on the study of grain–grain collisions by accelerating small (
) dust particles into a large (
diameter) population; this simulates the astrophysical system well in that the more numerous, small grains impact and collide with the large population. Facilities that combine the versatility of high-power optical lasers with the diagnostic capabilities of X-ray free-electron lasers, e.g., the Matter in Extreme Conditions instrument at the SLAC National Accelerator Laboratory, provide an ideal laboratory environment to create and diagnose dust destruction by astrophysically relevant shocks at the micron scale.
A simple model to describe the fundamental absorption of amorphous hydrogenated silicon carbide thin films based on band fluctuations is presented. It provides a general equation describing both the Urbach and Tauc regions in the absorption spectrum. In principle, our model is applicable to any amorphous material and it allows the determination of the bandgap. Here we focus on the bandgap engineering of amorphous hydrogenated silicon carbide layers. Emphasis is given on the role of hydrogen dilution during the deposition process and post deposition annealing treatments. Using the conventional Urbach and Tauc equations, it was found that an increase/decrease of the Urbach energy produces a shrink/enhancement of the Tauc-gap. On the contrary, the here proposed model provides a bandgap energy which behaves independently of the Urbach energy.
Eleven widely used crop simulation models (APSIM, CERES, CROPSYST, COUP, DAISY, EPIC, FASSET, HERMES, MONICA, STICS and WOFOST) were tested using spring barley (Hordeum vulgare L.) data set under varying nitrogen (N) fertilizer rates from three experimental years in the boreal climate of Jokioinen, Finland. This is the largest standardized crop model inter-comparison under different levels of N supply to date. The models were calibrated using data from 2002 and 2008, of which 2008 included six N rates ranging from 0 to 150 kg N/ha. Calibration data consisted of weather, soil, phenology, leaf area index (LAI) and yield observations. The models were then tested against new data for 2009 and their performance was assessed and compared with both the two calibration years and the test year. For the calibration period, root mean square error between measurements and simulated grain dry matter yields ranged from 170 to 870 kg/ha. During the test year 2009, most models failed to accurately reproduce the observed low yield without N fertilizer as well as the steep yield response to N applications. The multi-model predictions were closer to observations than most single-model predictions, but multi-model mean could not correct systematic errors in model simulations. Variation in soil N mineralization and LAI development due to differences in weather not captured by the models most likely was the main reason for their unsatisfactory performance. This suggests the need for model improvement in soil N mineralization as a function of soil temperature and moisture. Furthermore, specific weather event impacts such as low temperatures after emergence in 2009, tending to enhance tillering, and a high precipitation event just before harvest in 2008, causing possible yield penalties, were not captured by any of the models compared in the current study.
In 2008, nationwide investigations of a Salmonella serotype Saintpaul outbreak led first to consumer warnings for Roma and red round tomatoes, then later for jalapeño and serrano peppers. In New Mexico, where there were a large number of cases but no restaurant-based clusters, the NM Department of Health and the Indian Health Service participated with CDC in individual-level and household-level case-control studies of infections in New Mexico and the Navajo Nation. No food item was associated in the individual-level study. In the household-level study, households with an ill member were more likely to have had jalapeño peppers present during the exposure period and to have reported ever having serrano peppers in the household. This report illustrates the complexity of this investigation, the limitations of traditional individual-level case-control studies when vehicles of infection are ingredients or commonly eaten with other foods, and the added value of a household-level study.
The main aim of the present study was to examine the effects of long-term supplementing diets with saturated or unprotected polyunsaturated fatty acids from two different plant oils rich in either n-3 or n-6 fatty acids (FAs) plus docosahexaenoic acid (DHA)-rich algae on mammary gene expression and milk fat composition in lactating dairy cows. Gene expression was determined from mammary tissue and milk epithelial cells. Eighteen primiparous German Holstein dairy cows in mid-lactation were randomly assigned into three dietary treatments that consist of silage-based diets supplemented with rumen-stable fractionated palm fat (SAT; 3.1% of the basal diet dry matter, DM), or a mixture of linseed oil (2.7% of the basal diet DM) plus DHA-rich algae (LINA; 0.4% of the basal diet DM) or a mixture of sunflower oil (2.7% of the basal diet DM) plus DHA-rich algae (SUNA; 0.4% of the basal diet DM), for a period of 10 weeks. At the end of the experimental period, the cows were slaughtered and mammary tissues were collected to study the gene expression of lipogenic enzymes. During the last week, the milk yield and composition were determined, and milk was collected for FA measurements and the isolation of milk purified mammary epithelial cells (MECs). Supplementation with plant oils and DHA-rich algae resulted in milk fat depression (MFD; yield and percentage). The secretion of de novo FAs in the milk was reduced, whereas the secretion of trans-10,cis-12-CLA and DHA were increased. These changes in FA secretions were associated in mammary tissue with a joint down-regulation of mammary lipogenic enzyme gene expression (stearoyl-CoA desaturase, SCD1; FA synthase, FASN) and expression of the regulatory element binding transcription factor (SREBF1), whereas no effect was observed on lipoprotein lipase (LPL) and glycerol-3-phosphate acyltransferase 1, mitochondrial (GPAM). A positive relationship between mammary SCD1 and SREBF1 mRNA abundances was observed, suggesting a similar regulation for these genes. Such data on mammary gene expression in lactating cows presenting MFD contribute to strengthen the molecular mechanisms that govern milk fat synthesis in the mammary glands. In purified MEC, the dietary treatments had no effect on gene expressions. Differences between mammary tissue and milk purified MEC gene expression were attributed to the effect of lipid supplements on the number of milk purified MEC and its RNA quality, which are determinant factors for the analysis of gene expression using milk cells.
In this paper, we study the numerical approximation of a size-structured population model
whose dependency on the environment is managed by the evolution of a vital resource. We
show that this is a difficult task: some numerical methods are not suitable for a
long-time integration. We analyze the reasons for the failure.
Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10–50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.
Laboratory-based surveillance by OzFoodNet in Australia and FoodNet in the USA indicated that the incidence of Campylobacter infections in 2001 in Australia was about nine times higher than in the USA. We assessed whether this disparity could be explained by differences in the frequency of stool culturing. Using data from population surveys of diarrhoea and symptom profiles for Campylobacter from case-control studies, indices of healthcare behaviour taking into account the severity of Campylobacter infections were calculated. These suggest that culture-confirmed Campylobacter infections underestimate the incidence of community cases by similar ratios in the two countries. The incidence of Campylobacter infections in Australia was about 12 times higher than in the USA after consideration of healthcare system differences.
The mechanism of spread of an epidemic of variola minor (alastrim) occurring in 1956, in Vila Guarani, a semi-rural school district of the City of São Paulo, Brazil, is examined. Cases were grouped according to time and space relationships corresponding to either a household or a school class, as once variola minor was introduced into a household or a school class spread was independent of occurrences in neighbouring social units. The constant occurrence of a single introduction in school classes and households implied that the chance for transmission of the disease outside the homes or the school was very small. The secondary attack rate was higher in households than in school classes. Twenty households with cases had more pre-school children and school children and a lower vaccination level than twenty-two neighbouring households without cases but also including one or more persons who were known to have had personal contacts with patients.
Examination of the chain of contagion clearly shows that spread in the school was directly and indirectly responsible for the majority of cases in the epidemic, for the peak of the epidemic curve and for the extent of topographical spread of the epidemic. This predominant role of the school was accentuated by incomplete preventive measures (vaccination campaign and isolation of patients) applied late in the epidemic and it is attributed to the following facts, (a) There was a single school in the district, and school children were thus concentrated, (b) The school was the only place of the district where persons living in different neighbourhoods had regular, repeated contacts, (c) The great majority of school children had had no previous variola and many had no vaccination scar, (d) The social activities of school children gave them the highest potential as transmitters of variola minor.
A variola minor outbreak in a 36-bed hospital-ward comprised seven cases of overt variola after the first case. Clinical and epidemiological findings were typical, seven of the eight cases of overt variola being confirmed by virus isolation or antibody titrations. In addition, thirteen definite and seven possible instances of subclinical variola were deduced from complement-fixation or haemagglutination-inhibition tests. A discussion is made of the validity of serological criteria of variolous and vaccinial infections.
The co-ordinates of the dwellings where cases of variola minor (alastrim) occurred during a small epidemic were used in a worked example of contour mapping of disease spread. The contoured variable was the date of onset, relative to an arbitrary base date, of the case introducing the disease into each of twenty-two households. Three contour maps prepared with slightly different computer programmes or dates exhibited similar concentric loops whose centres were close to the first infected household. The average rate of spread of the disease was estimated by regression of the number of days to onset of the first case in the household on the average distance from an arbitrary origin to the relevant contour line. The calculated average rate of spread was 1.22 metres per day. An additional map was contoured using the cumulative number of cases as the contoured variable, relative to the onset of the example epidemic.
Household aggregation of cases, one possible characteristic of person-to-person transmitted disease, was formally tested in one epidemic of variola minor by using a pair statistic. A significant result was found for all households as well as for households grouped by the type of environment, or by the phase of the epidemic growth in time. Secondary attack rates, when related to household size (number of susceptibles) showed only a marginal trend in rural households but no trend in urban or semi-rural households.
Space-time interaction analysis was applied to data from 101 elementary school children who contracted variola minor during an epidemic in Bragança Paulista County, Brazil. One school had two and the other three shifts of students occupying the same classrooms each day. There was no evidence found for excessive numbers of cases to occur among unvaccinated students occupying the same desks or seated near the desks occupied by cases occurring during another shift. Only three cases occurred among the 31 unvaccinated students occupying desks of students with variola from other shifts. Only one of these three subsequent cases occurred at a time interval suggestive of transmission. For the three models tested there was no evidence of space-time interaction between time of onset of the disease and location of desk for pairs of students from different shifts.
Use of well persons as the comparison group for laboratory-confirmed cases of sporadic salmonellosis may introduce ascertainment bias into case-control studies. Data from the 1996–1997 FoodNet case-control study of laboratory-confirmed Salmonella serogroups B and D infection were used to estimate the effect of specific behaviours and foods on infection with Salmonella serotype Enteritidis (SE). Persons with laboratory-confirmed Salmonella of other serotypes acted as the comparison group. The analysis included 173 SE cases and 268 non-SE controls. SE was associated with international travel, consumption of chicken prepared outside the home, and consumption of undercooked eggs prepared outside the home in the 5 days prior to diarrhoea onset. SE phage type 4 was associated with international travel and consumption of undercooked eggs prepared outside the home. The use of ill controls can be a useful tool in identifying risk factors for sporadic cases of Salmonella.