Vascular risk and depression in outpatients at Groote Schuur Hospital memory clinic

Includes bibliographical references (leaves 59-67).Background and Objective: Depression in the elderly has been linked with stroke, and with white matter lesions, particularly in frontal-subcortical regions responsible for mood regulation. Such evidence of vascular disease has in turn been associated with vascular risk factors such as diabetes, hypertension, smoking, high cholesterol and heart disease. The vascular depression hypothesis (Alexopoulos et al., 1997) proposes that individuals with late-onset depression and vascular risk factors have more apathy, fewer ideational symptoms, and more functional and cognitive impairment. Recent studies offer only limited support for this proposal, perhaps due to lack of comparability of studies, lack of control for factors such as age, medical co-morbidity and functional impairment, and exclusion of patients with cognitive impairment. The current study aimed to test the vascular depression hypothesis in a non-Western sample by examining (a) whether a specific depression symptom profile exists in patients with vascular risk factors, and (b) the relationship between vascular risk, depression and cognitive and functional ability. Method: Retrospective data were gathered from 184 individuals (age>= 55, MMSE >= 17) who had been evaluated at the Groote Schuur Hospital Memory Clinic. Correlational and multiple regression analyses tested relationships between a cumulative vascular risk index, scores on the Cornell Scale for Depression and the Bristol Activities of Daily Living Scale, physical evidence of heart disease and 4 executive function tests (Trail Making Test, category fluency, CLOX I, and an initiation/perseveration index). Results: Vascular risk and depression were significantly related, even after controlling for age and functional impairment. However, using a vascular risk model of vascular depression, the data provided no further support for the vascular depression hypothesis either in terms of (a) a specific depression profile, or (b) the impact of vascular risk and depression on cognitive and functional impairment. There were, however, significant relationships between heart disease and executive function measures, and between all cognitive measures and ADL functioning. Conclusion: The current findings imply there may be a threshold of severity of vascular burden before clinically significant symptoms become apparent. However, the findings may also be explained by a common underlying mechanism (either biological or psychosocial) linking vascular disease and depression. Prospective longitudinal studies are required to clarify causal mechanisms

On Interaction Classification

Further classification is made of Lindquist's dichotomy of inter action effects. The extension hopefully reduces errors of inter pretation and provides a simple, accurate means of summarizing in teractions obtained.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67338/2/10.1177_001316448004000405.pd

Using a task-based approach in evaluating the usability of BoBIs in an e-book environment

This paper reports on a usability evaluation of BoBIs (Back-of-the-book Indexes) as searching and browsing tools in an e-book environment. This study employed a task-based approach and within-subject design. The retrieval performance of a BoBI was compared with a ToC and Full-Text Search tool in terms of their respective effectiveness and efficiency for finding information in e-books. The results demonstrated that a BoBI was significantly more efficient (faster) and useful compared to a ToC or Full-Text Search tool for finding information in an e-book environment

Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax

INTRODUCTION: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP

Tuberculosis research in South Africa over the past 30 years: From bench to bedside

The South African Medical Research Council Centre for Tuberculosis Research has a rich history of high-impact research that has influenced our understating of this hyper-epidemic which is further exacerbated by the emergence and spread of drug-resistant forms of the disease. This review aims to summarise the past 30 years of research conducted in the Centre which has influenced the way that tuberculosis (TB) is diagnosed and treated. The review includes the development of new technologies for rapid screening of people with probable TB and the repurposing of human diagnostics for wildlife conservation