The validity of clinical diagnoses of dementia in a group of consecutively autopsied memory clinic patients

Background: Epidemiological studies show that up to 10 % of individuals aged 65 years and older suffer from dementia, most commonly from dementia of the Alzheimer Type (DAT) [1]. Clinicopathological studies are critical to our understanding of this disease and improving the accuracy of clinical diagnoses.Objectives: Our objectives were to examine the validity of clinical diagnoses of DAT, to determine the prevalence of different forms of dementia in this sample, and to investigate the relationship between age at death and polymorbidity.Subjects and method: Clinical data were available from 221 patients who had been examined at the Basel Memory Clinic between 1986 and 1996. From this population, 34 % (75 patients) were autopsied in the Department of Pathology, University Hospital Basel, and neuropathological examinations were additionally performed on 62 (83 %) of these patients. Clinical and neuropathological data were retrospectively compared.Results: 67.8 % of the neuropathologically examined patients received a definitive diagnosis of AD (Alzheimer's disease), vascular dementia (VaD) or mixed dementia (AD and VaD). AD alone or with other histopathological hallmarks of dementia was the most prevalent neuropathological diagnosis (63 %). VaD was deemed the only cause of dementia in only 4.8 % of patients. The sensitivity for DAT was 75.9 %, the specificity 60.6 %. Increasing age was associated with an increasing number of clinical and neuropathological diagnoses.Conclusion: The sensitivity and specificity of the clinical diagnoses of DAT found in our study are similar to previous reports (2-5). Older patients had more etiologies of their dementia than younger patients. This study reaffirms the need for internationally accepted criteria for clinical and neuropathological diagnoses, as well as further clinical-neuropathological investigations to further refine the clinical diagnostic proces

Predictors of early postpartum mental distress in mothers with midwifery home care - results from a nested case-control study

PRINCIPLES: The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting. METHODS: Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis. RESULTS: Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth. CONCLUSION: The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers

Artificial Neural Network to predict mean monthly total ozone in Arosa, Switzerland

Present study deals with the mean monthly total ozone time series over Arosa, Switzerland. The study period is 1932-1971. First of all, the total ozone time series has been identified as a complex system and then Artificial Neural Networks models in the form of Multilayer Perceptron with back propagation learning have been developed. The models are Single-hidden-layer and Two-hidden-layer Perceptrons with sigmoid activation function. After sequential learning with learning rate 0.9 the peak total ozone period (February-May) concentrations of mean monthly total ozone have been predicted by the two neural net models. After training and validation, both of the models are found skillful. But, Two-hidden-layer Perceptron is found to be more adroit in predicting the mean monthly total ozone concentrations over the aforesaid period.Comment: 22 pages, 14 figure

Peroxy radicals in the summer free troposphere: seasonality and potential for heterogeneous loss

The sum of peroxy radicals (HO<sub>2</sub>+Σ<sub><i>i</i></sub>R<sub><i>i</i></sub>O<sub>2</sub>) and supporting trace gases were measured on the Jungfraujoch (3580 m a.s.l.) during the late summer of 2005. The period was marked by extended times of heavy snow which led to reduction in the observed peroxy radicals during the snowy periods that was greater than the concomitant reduction in <i>j</i>(O<sup>1</sup>D). In the limit a first order loss rate of 0.0063 s<sup>−1</sup> can be derived for the peroxy radical loss in the snowy conditions that could be potentially ascribed to a heterogenous loss process. On snow free days photolysis of HCHO is shown to be a significant peroxy radical source. The seasonal trends of the peroxy radical concentrations have been mapped from the winter to summer transition in line with previous experiments. Net ozone production in late summer at the Jungfraujoch was net neutral to marginally ozone destructive. A value of 28±4 pptv is calculated for the ozone compensation point for the snow free days

The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study.

More people than ever before are currently living with a diagnosis of cancer and the number of people concerned is likely to continue to rise. Cancer survivors are at risk of developing a second primary cancer (SPC). This study aims to investigate the risk of SPC in Switzerland. The study cohort included all patients with a first primary cancer recorded in 9 Swiss population-based cancer registries 1981-2009 who had a minimum survival of 6 months, and a potential follow-up until the end of 2014. We calculated standardized incidence ratios (SIR) to estimate relative risks (RR) of SPC in cancer survivors compared with the cancer risk of the general population. SIR were stratified by type of first cancer, sex, age and period of first diagnosis, survival period and site of SPC. A total of 33,793 SPC were observed in 310,113 cancer patients. Both male (SIR 1.18, 95%CI 1.16-1.19) and female (SIR 1.20, 95%CI 1.18-1.22) cancer survivors had an elevated risk of developing a SPC. Risk estimates varied substantially according to type of first cancer and were highest in patients initially diagnosed with cancer of the oral cavity and pharynx, Hodgkin lymphoma, laryngeal, oesophageal, or lung cancer. Age-stratified analyses revealed a tendency towards higher RR in patients first diagnosed at younger ages. Stratified by survival period, risk estimates showed a rising trend with increasing time from the initial diagnosis. We observed strong associations between particular types of first and SPC, i.e. cancer types sharing common risk factors such as smoking or alcohol consumption (e.g. repeated cancer of the oral cavity and pharynx (SIR <sub>males</sub> 20.12, 95%CI 17.91-22.33; SIR <sub>females</sub> 37.87, 95%CI 30.27-45.48). Swiss cancer survivors have an increased risk of developing a SPC compared to the general population, particularly patients first diagnosed before age 50 and those surviving more than 10 years. Cancer patients should remain under continued surveillance not only for recurrent cancers but also for new cancers. Some first and SPCs share lifestyle associated risk factors making it important to promote healthier lifestyles in both the general population and cancer survivors

Performance of the ground-based total ozone network assessed using satellite data

Dobson and Brewer spectrophotometer and filter ozonometer data available from the World Ozone and Ultraviolet Data Centre (WOUDC) were compared with satellite total ozone measurements from TOMS (onboard Nimbus 7, Meteor 3, and Earth Probe satellites), OMI (AURA satellite) and GOME (ERS-2 satellite) instruments. Five characteristics of the difference with satellite data were calculated for each site and instrument type: the mean difference, the standard deviation of daily differences, the standard deviation of monthly differences, the amplitude of the seasonal component of the difference, and the range of annual values. All these characteristics were calculated for five 5-year-long bins and for each site separately for direct sun (DS) and zenith sky (ZS) ozone measurements. The main percentiles were estimated for the five characteristics of the difference and then used to establish criteria for “suspect” or “outlier” sites for each characteristic. About 61% of Dobson, 46% of Brewer, and 28% of filter stations located between 60°S and 60°N have no “suspect” or “outlier” characteristics. In nearly 90% of all cases, Dobson and Brewer sites demonstrated 5-year mean differences with satellites to be within ±3% (for DS observations). The seasonal median difference between all Brewer DS measurements at 25°–60°N and GOME and OMI overpasses remained within ±0.5% over a period of more than 10 years (...

Long-term changes in lower tropospheric baseline ozone concentrations at northern mid-latitudes

Changes in baseline (here understood as representative of continental to hemispheric scales) tropospheric O<sub>3</sub> concentrations that have occurred at northern mid-latitudes over the past six decades are quantified from available measurement records with the goal of providing benchmarks to which retrospective model calculations of the global O<sub>3</sub> distribution can be compared. Eleven data sets (ten ground-based and one airborne) including six European (beginning in the 1950's and before), three North American (beginning in 1984) and two Asian (beginning in 1991) are analyzed. When the full time periods of the data records are considered a consistent picture emerges; O<sub>3</sub> has increased at all sites in all seasons at approximately 1% yr<sup>−1</sup> relative to the site's 2000 yr mixing ratio in each season. For perspective, this rate of increase sustained from 1950 to 2000 corresponds to an approximate doubling. There is little if any evidence for statistically significant differences in average rates of increase among the sites, regardless of varying length of data records. At most sites (most definitively at the European sites) the rate of increase has slowed over the last decade (possibly longer), to the extent that at present O<sub>3</sub> is decreasing at some sites in some seasons, particularly in summer. The average rate of increase before 2000 shows significant seasonal differences (1.08 ± 0.09, 0.89 ± 0.10, 0.85 ± 0.11 and 1.21 ± 0.12% yr<sup>−1</sup> in spring, summer, autumn and winter, respectively, over North America and Europe)

An evaluation of the performance of chemistry transport models by comparison with research aircraft observations. Part 1: Concepts and overall model performance

A rigorous evaluation of five global Chemistry-Transport and two Chemistry-Climate Models operated by several different groups in Europe, was performed. Comparisons were made of the models with trace gas observations from a number of research aircraft measurement campaigns during the four-year period 1995-1998. Whenever possible the models were run over the same four-year period and at each simulation time step the instantaneous tracer fields were interpolated to all coinciding observation points. This approach allows for a very close comparison with observations and fully accounts for the specific meteorological conditions during the measurement flights. This is important considering the often limited availability and representativity of such trace gas measurements. A new extensive database including all major research and commercial aircraft measurements between 1995 and 1998, as well as ozone soundings, was established specifically to support this type of direct comparison. Quantitative methods were applied to judge model performance including the calculation of average concentration biases and the visualization of correlations and RMS errors in the form of so-called Taylor diagrams. We present the general concepts applied, the structure and content of the database, and an overall analysis of model skills over four distinct regions. These regions were selected to represent various atmospheric conditions and to cover large geographical domains such that sufficient observations are available for comparison. The comparison of model results with the observations revealed specific problems for each individual model. This study suggests the further improvements needed and serves as a benchmark for re-evaluations of such improvements. In general all models show deficiencies with respect to both mean concentrations and vertical gradients of important trace gases. These include ozone, CO and NOx at the tropopause. Too strong two-way mixing across the tropopause is suggested to be the main reason for differences between simulated and observed CO and ozone values. The generally poor correlations between simulated and measured NOx values suggest that in particular the NOx input by lightning and the convective transport from the polluted boundary layer are still not well described by current parameterizations, which may lead to significant differences in the spatial and seasonal distribution of NOx in the models. Simulated OH concentrations, on the other hand, were found to be in surprisingly good agreement with measured values