Depression with melancholic features is associated with higher long-term risk for dementia

BACKGROUND: Depression has been reported to increase the risk of subsequently developing dementia, but the nature of this relation remains to be elucidated. Depression can be a prodrome/manifestation of dementia or an early risk factor, and the effect may differ according to depression subtypes. Our aim was to study the association between early-onset depression and different depression subtypes, and the later occurrence of dementia. METHODS: We conducted a cohort study including 322 subjects with depression, recruited between 1977 and 1984. A comparison cohort (non-exposed) was recruited retrospectively, to include 322 subjects admitted at the same hospital for routine surgery (appendicectomy or cholecystectomy), at the same period as the depressed cohort. Subjects were contacted again between 2009 and 2014, to assess their dementia status. We computed the risk for dementia in subjects with early onset depression and quantified the association between different depression subtypes (namely melancholic, anxious, and psychotic) and dementia. RESULTS: The odds of dementia were increased by 2.90 times (95% C.I. 1.61-5.21; p<0.0001) for the depressed cohort when compared to the surgical cohort. When the analysis was restricted to patients younger than 45 years old at baseline, the odds for dementia in the depressed cohort were also significantly higher when compared to the surgical cohort (8.53; 95% C.I. 2.40-30.16). In the multivariate Cox analysis, subjects having depression with melancholic features had an increased risk for developing dementia compared to those without melancholic features (HR=3.64; 95% C.I. 1.78-11.26; p=0.025). LIMITATIONS: About 59% of the participants with depression and 53% of those non-exposed were lost during follow up. The inclusion of biological biomarkers would strengthen the results. The sample included a low number of bipolar patients. CONCLUSIONS: These results support depression as an early risk factor for dementia. Depression with melancholic features was found as an important risk factor for dementia, playing a main role in the relation between these disorders

Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients

Objectives: to identify the prevalence of the Nursing Diagnosis (ND) Risk for falls in the hospitalizations of adult patients in clinical and surgical units, to characterize the clinical profile and to identify the risk factors of the patients with this ND. Method: a cross-sectional study with 174 patients. The data was collected from the computerized nursing care prescriptions system and on-line hospital records, and analyzed statistically. Results: the prevalence of the ND Risk for falls was 4%. The patients’ profile indicated older adults, males (57%), those hospitalized in the clinical units (63.2%), with a median length of hospitalization of 20 (10-24) days, with neurological illnesses (26%), cardio-vascular illnesses (74.1%) and various co-morbidities (3±1.8). The prevalent risk factors were neurological alterations (43.1%), impaired mobility (35.6%) and extremes of age (10.3%). Conclusion: the findings contributed to evidencing the profile of the patients with a risk of falling hospitalized in clinical and surgical wards, which favors the planning of interventions for preventing this adverse event

Paving (through) Amazonia: Neoliberal Urbanism and the Reperipheralization of Roraima

This paper examines the neoliberal reshaping of infrastructure provision in Brazil's extreme north since the mid-1990s, when roadway investments resulted in unprecedented regional connectivity. The BR-174 upgrade, the era's most important project, marked a transition from resource-based developmentalism to free-market transnationalism. Primarily concerned with urban competitiveness, the federal government funded the trunk roadway's paving to facilitate manufacturing exports from Manaus. While an effort was made to minimize deforestation, planners sidelined development implications in adjacent Roraima. The state's urban system has thus experienced reperipheralization and intensified primacy. Market-led growth now compounds the inheritance of hierarchical centralism and ongoing governmental neglect. Our study shows a vast territory dependent on primate cities for basic goods and services. Travelling with Roraimans from bypassed towns, we detected long-distance passenger transportation and surface logistics with selective routes. Heterogeneous Roraiman (im)mobilities comprise middle-class tourism and heightened consumerism as well as informal mobility tactics and transnational circulations of precarious labor. The paper exhorts neoliberal urbanism research to look beyond both Euro America's metropoles and their Global South counterparts. Urbanization dynamics in Brazil's extreme north demonstrate that market-disciplined investments to globalize cities produce far-reaching spatial effects. These are felt even by functionally-articulated-yet-marginalized peripheries in ostensibly remote locations

Pulse wave velocity and coronary risk stratification.

Introdução: A compliance arterial ou distensibilidade é uma determinante fundamental nas doenças cardiovasculares, apresentando grande interesse a sua medição não invasiva. A velocidade da onda de pulso (VOP) é usada, actualmente, como um índice de distensibilidade arterial. Objectivos: Avaliar se a VOP constitui um factor de risco, independente, para doença das artérias coronárias (DAC). Investigar se a determinação da mesma pode constituir uma ferramenta útil, na estratificação do risco cardiovascular, tanto nos indivíduos assintomáticos, como nos doentes com DAC População e Métodos: 811 indivíduos, 301 consecutivos com DAC, confirmada por coronário-angiografia, média de idade 53,7±10,0 anos e 510 assintomáticos, seleccionados das listas eleitorais, média de idade 46,1±10,0 anos. Os indivíduos assíntomáticos formavam o grupo A e eram subdivididos em A1 (grupo sem HTA, dislipidémia e ou diabetes) e A2 (grupo com HTA, dislipidémia, e ou diabetes). Os doentes coronários constituiam o grupo B, também sub dividido em B1 sem HTA, dislipidémia e ou diabetes e B2 com HTA, dislipidemia e ou diabetes. Os dados foram expressos em média ± desvio padrão (DP). O teste t de Student foi usado para comparar as variáveis contínuas e o c2 para comparar as variáveis categóricas. A força da correlação independente entre as variáveis contínuas foi avaliada segundo Pearson. Finalmente, foi efectuado um modelo de regressão logística (step by step) para avaliar quais as variáveis que se relacionavam de forma significativa e independente com a DAC. A análise estatística foi efectuada através do software SPSS for Windows, sendo o valor de p <0,05 considerado significativo. Resultados: Comparando os dois grupos, A1 e A2, no primeiro, a média da VOP foi significantemente mais baixa em relação ao A2. Comparando o grupo B1 e B2, também no grupo B1 a média da VOP é mais baixa. No grupo A1 a VOP correlacionou-se, segundo Pearson, com a idade, pressão arterial sistólica (PAS), diastólica e média, IMC, glicémia, colesterol total, LDL, relação CT/HDL, ApoB, triglicerídeos, ingestão de álcool, relação cintura/anca (C/A), e proteína C reactiva(as). A correlação foi inversa com o colesterol HDL. No grupo A2 a correlação da VOP foi positiva com a idade, PAS, PAM, PAD, glicémia, CT/ HDL e pressão do pulso (PP). No grupo B1 a correlação foi positiva e significante com a idade, PAS, PAM, PAD e PP. Foi inversa com a fracção de ejecção do VE. No grupo B2, foi positiva e significante com a idade, PAS, PAM, relação C/A, PP e homocisteína. Conclusão: A VOP foi sempre, quer nos indivíduos assintomáticos quer nos doentes coronários, mais elevada nos grupos com maior número de factores de risco. Esta constatação sugere influência cumulativa dos factores de risco, no processo de rigidez arterial. Correlacionou-se de forma positiva e significativa, com alguns dos factores de risco clássicos e alguns dos novos marcadores bioquímicos de risco. Após análise de regressão logística, manteve-se na equação de forma significativa, mostrando ser um factor de risco independente para DAC. Assim, a avaliação da distensibilidade arterial, através da medição da VOP, poderá representar um método simples, rápido e não invasivo, capaz de estratificar o risco de DAC, tanto nos indivíduos assintomáticos com nos doentes coronários.BACKGROUND: Arterial compliance or stiffness is an important determinant of cardiovascular disease and there is considerable interest in its noninvasive measurement. Pulse wave velocity (PWV) is widely used as an index of arterial stiffness. AIM: To determine whether PWV is useful for risk stratification in both healthy individuals and coronary patients. METHODS: Control subjects, n=510, aged 46.1 +/- 11 years, with no history of coronary disease, were selected from electoral rolls, and coronary patients, n=301, aged 53.7 +/- 10 years, were selected from hospital patients with a history of coronary artery disease (CAD) confirmed by coronary angiogram (at least 75% obstruction of one of the main coronary vessels). The asymptomatic subjects without CAD formed Group A, and were subdivided into A1 (without hypertension, dyslipidemia and/or diabetes) and A2 (with hypertension, dyslipidemia and/or diabetes). The coronary patients formed Group B, who were also subdivided into B1, without these classic risk factors, and B2 with hypertension, dyslipidemia and/or diabetes. We used the Student's t test to compare continuous variables and the chi-square test to compare categorical data. The strength of correlation between continuous variables was tested by Pearson's linear correlation. Independent variables predictive of CAD were determined by backward logistic regression analysis. The statistical analysis was performed using SPSS for Windows version 11.0 and data were expressed as means +/- SD; a p value of 0.05 was considered significant. RESULTS: Comparing the two groups A1 and A2, mean PWV was significantly lower in group A1. Comparing B1 and B2, mean PWV was also significantly lower in group B1. In group A1, PWV was significantly and positively correlated with age, body mass index, waist-to-hip ratio, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean blood pressure (BP), blood glucose, apo B, triglycerides, and high-sensitivity C-reactive protein, unlike HDL which was inversely correlated (Pearson's coefficient). In group A2, PWV was significantly and positively correlated with age, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean BP, blood glucose and pulse pressure (PP), but not HDL, which was inversely correlated with PWV. In group B1, PWV was only significantly and positively correlated with age, systolic, mean, and diastolic BP and PP, and presented a significant inverse correlation with ejection fraction. However, in the high-risk coronary population (group B2), there was a positive correlation with age, waist-to-hip ratio, systolic and mean BP, PP and homocysteine. After stepwise logistic regression, PWV remained in the model and proved to be a significant and independent risk factor for CAD. CONCLUSION: The results of our study show that PWV is higher in high-risk groups and significantly correlated with many classic and new CAD risk markers, suggesting that there is a cumulative influence of risk factors in the development of arterial stiffness. We believe that PWV is a useful index of vascular status and hence cardiovascular risk and that it may be useful for risk stratification in both asymptomatic and coronary patients.info:eu-repo/semantics/publishedVersio