Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community based study.

Background. Poor physical health has long been recognized to be one of the most important risk factors for depression in older adults. Since many aspects of physical health can be targeted for improvement in primary care, it is important to know whether physical health problems predict the onset and/or the persistence of depression. Methods. The study is based on a sample which at the outset consisted of 327 depressed and 325 non-depressed older adults (55-85) drawn from a larger random community-based sample in the Netherlands. Depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves. Results. From all incident episodes, the majority (57%) was short-lived. These short episodes could generally not be predicted by physical health problems. The remaining incident episodes (43%) were not short-lived and could be predicted by poor physical health. Chronicity (34%) was also predicted by physical health problems. Conclusions. The study design with its frequent measurements recognized more incident cases than previous studies; these cases however did have a better prognosis than is often assumed. The prognosis of prevalent cases was rather poor. Physical health problems were demonstrated to be a predictor of both the onset and the persistence of depression. This may well have implications for prevention and intervention

On the applicability of local softness and hardness

9 pages, 5 figures, 3 schemes, 2 tables.-- PMID: 20094672 [PubMed].Global hardness and softness and the associated hard/soft acid/base (HSAB) principle have been used to explain many experimental observed reactivity patterns and these concepts can be found in textbooks of general, inorganic, and organic chemistry. In addition, local versions of these reactivity indices and principles have been defined to describe the regioselectivity of systems. In a very recent article (Chem.–Eur. J. 2008, 14, 8652), the present authors have shown that the picture of these well-known descriptors is incomplete and that the understanding of these reactivity indices must be reinterpreted. In fact, the local softness and hardness contain the same potential information and they should be interpreted as the local abundance or concentration of their corresponding global properties. In this contribution, we analyze the implications of this new point of view for the applicability of these well-known descriptors when comparing two sites in three situations: two sites within one molecule, two sites in two different, but noninteracting molecules, and two sites in two different, but interacting, molecules. The implications on the HSAB principle are highlighted, leading to the discussion of the role of the electrostatic interaction.M. T. thanks the European Community for financial help through the postdoctoral grant MEIF-CT-2006-025362. P. G. and F. D. P are indebted to the Fund for Scientific Research—Flanders (FWO) and to the Free University of Brussels for continuous support to their group. P. W. A. thanks NSERC, the Canada Research Chairs, and Sharcnet for research support.Peer reviewe

Prognostic factors for important clinical outcomes in patients with a severe infection

Patients who are admitted with a suspicion of a severe infection usually enter the hospital through the emergency department (ED). The recognition of prognostic factors in an early stage affects further treatment and might improve clinical outcomes. WE EXAMINED POSSIBLE PROGNOSTIC FACTORS FOR FOUR IMPORTANT OUTCOMES: intensive care unit (ICU) admission, positive blood cultures, mortality and re-admission. All adult patients arriving at the ED with a suspected infection for whom admittance and intravenous (iv) antibiotics were indicated were included between March and December 2006. Possible prognostic variables were obtained from medical history, physical examination and laboratory results during the ED presentation. Data were analysed using logistic regression analysis. A total of 295 ED patients were evaluated, of whom 27 were referred to the ICU, 62 had a positive blood culture, 16 died and 48 were re-admitted. In multivariate analysis, patients with a respiration rate of >25/min were at higher risk for ICU admission. Patients with a positive blood culture had a higher heart rate and a higher percentage of segmented neutrophils. Patients who died during admission were more likely to be older, confused and had lower blood pressure. Patients who were re-admitted within 30 days were more likely to be male, younger and less likely to have a positive blood culture. Routine clinical and biochemical information can be used to predict ICU admission, the presence of bacteraemia, mortality and re-admission (within 30 days) and should be taken into consideration for treatment decision

A new approach to local hardness

The applicability of the local hardness as defined by the derivative of the chemical potential with respect to the electron density is undermined by an essential ambiguity arising from this definition. Further, the local quantity defined in this way does not integrate to the (global) hardness - in contrast with the local softness, which integrates to the softness. It has also been shown recently that with the conventional formulae, the largest values of local hardness do not necessarily correspond to the hardest regions of a molecule. Here, in an attempt to fix these drawbacks, we propose a new approach to define and evaluate the local hardness. We define a local chemical potential, utilizing the fact that the chemical potential emerges as the additive constant term in the number-conserving functional derivative of the energy density functional. Then, differentiation of this local chemical potential with respect to the number of electrons leads to a local hardness that integrates to the hardness, and possesses a favourable property; namely, within any given electron system, it is in a local inverse relation with the Fukui function, which is known to be a proper indicator of local softness in the case of soft systems. Numerical tests for a few selected molecules and a detailed analysis, comparing the new definition of local hardness with the previous ones, show promising results.Comment: 30 pages (including 6 figures, 1 table

Asymptotic tunneling conductance in Luttinger liquids

Conductance through weak constrictions in Luttinger liquids is shown to vanish with frequency $\omega$ as $c_1 \omega^2 + c_2 \omega^{2/g - 2}$, where $g$ is a dimensionless parameter characterizing the Luttinger liquid phase, and $c_1$ and $c_2$ are nonuniversal constants. The first term arises from the ^^ Coulomb blockade' effect and dominates for $g < 1/2$, whereas the second results from eliminating high-energy modes and dominates for $g > 1/2$.Comment: Latex file + one appended postcript figur

Rehabilitation of young adults during renal replacement therapy in Europe: The presence of disabilities

The aim of this study was to analyse rehabilitation during RRT in 617 young adults from different European countries who started dialysis or transplantation before the age of 15 years. The data were derived from the EDTA Registry patient data files and a special questionnaire that was sent to centres reporting to the EDTA Registry. The duration of RRT was more than 10 years in 63% of patients. Fifty-four percent were living with a functioning graft and 46% were on dialysis. The prevalence and severity of motor, hearing, sight, and mental disabilities were analysed retrospectively. They were found to vary according to primary renal disease and method oftreatment. One-third of patients had one or more disabilities at the start of RRT. Although disability status had changed in many patients by 31 December 1986, some disability remained in one-third of the patients available for study. Disabilities were recorded as mild in the majority of patients. Both improvement and worsening of motor and mental disability occurred more often than changes of hearing capacity and sight. It is concluded that prevention and treatment of disabilities need special attention in children and young adults on RRT in order to improve rehabilitatio

Demography of Dialysis and Transplantation in Children in Europe, 1985: Report from the European Dialysis and Transplant Association Registry

At the end of 1985 there were 5482 patients known to the Registry who started renal replacement therapy (RRT) between the ages of 6 months and 15 years. Of these, approximately 25% had died, 30% were still aged less than 15 years, and the other 45% were older. The acceptance rate of new patients over the last 10 years has slowly but steadily increased; six new paediatric patients per million child population probably represents the likely needs of the near future. Hospital haemodialysis remained the main form of renal replacement therapy in new patients, while 3 years after start of RRT, transplantation became the most frequently used replacement therapy; CAPD appeared to be used mainly in children with a short waiting time for transplantation. Out of the 384 grafts reported in 1985, only 16% were from living related donors; among 321 cadaver grafts, 24% were second and only 3% were third grafts. Glomerulonephritis and pyelonephritis accounted for 50% of all primary renal diseases. During the last 5 years, the proportion with glomerulonephritis seems to have decreased slightly. Hyperkalaemia and fluid overload have still to be considered the main causes of death. Only in 17% of all cases was the cause of death reported as unknown or undetermine

Factors influencing anaemia in dialysis patients. A special survey by the EDTA-ERA Registry

The European Dialysis and Transplantation Association—European Renal Association (EDTA-ERA) Registry conducted a special study on anaemia in dialysis patients because it seemed important to elucidate the various factors that influence the degree of anaemia and the use of regular transfusions in dialysis patients before the introduction of recombinant human erythropoietin (rHuEpo) for larger groups of patients. In a 20% sample of all patients recorded to have been dialysed throughout 1987, statistically significant associations could be found by multifactorial analysis between haemoglobin (Hb) concentration and age, sex, primary renal disease, type of treatment, hours of dialysis per week, and number of years on renal replacement therapy. The type of dialyser membrane did not seem to play a role (although there was weak evidence of an effect of the dialyser). Mean Hb concentration for dialysis patients differed between countries as did the transfusion policy. In view of the high costs of the rHuEpo treatment and potential side-effects, factors such as method of dialysis and hours of haemodialysis per week should be taken into consideration in the treatment of anaemia in dialysis patient