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

Medication incidents in primary care medicine: protocol of a study by the Swiss Federal Sentinel Reporting System.

BACKGROUND/RATIONALE: Patient safety is a major concern in healthcare systems worldwide. Although most safety research has been conducted in the inpatient setting, evidence indicates that medical errors and adverse events are a threat to patients in the primary care setting as well. Since information about the frequency and outcomes of safety incidents in primary care is required, the goals of this study are to describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Label="METHODS AND ANALYSIS" ="METHODS"/> <AbstractText STUDY DESIGN AND SETTING: We will conduct a prospective surveillance study to identify cases of medication incidents among primary care patients in Switzerland over the course of the year 2015. PARTICIPANTS: Patients undergoing drug treatment by 167 general practitioners or paediatricians reporting to the Swiss Federal Sentinel Reporting System. INCLUSION CRITERIA: Any erroneous event, as defined by the physician, related to the medication process and interfering with normal treatment course. EXCLUSION CRITERIA: Lack of treatment effect, adverse drug reactions or drug-drug or drug-disease interactions without detectable treatment error. PRIMARY OUTCOME: Medication incidents. RISK FACTORS: Age, gender, polymedication, morbidity, care dependency, hospitalisation. STATISTICAL ANALYSIS: Descriptive statistics to assess type, frequency, seasonal and regional distribution of medication incidents and logistic regression to assess their association with potential risk factors. Estimated sample size: 500 medication incidents. LIMITATIONS: We will take into account under-reporting and selective reporting among others as potential sources of bias or imprecision when interpreting the results. ETHICS AND DISSEMINATION: No formal request was necessary because of fully anonymised data. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT0229537

Trends and variability of midlatitude stratospheric water vapour deduced from the re-evaluated Boulder balloon series and HALOE

This paper presents an updated trend analysis of water vapour in the lower midlatitude stratosphere from the Boulder balloon-borne NOAA frostpoint hygrometer measurements and from the Halogen Occulation Experiment (HALOE). Two corrections for instrumental bias are applied to homogenise the frostpoint data series, and a quality assessment of all soundings after 1991 is presented. Linear trend estimates based on the corrected data for the period 1980–2000 are up to 40% lower than previously reported. Vertically resolved trends and variability are calculated with a multi regression analysis including the quasi-biennal oscillation and equivalent latitude as explanatory variables. In the range of 380 to 640 K potential temperature (≈14 to 25 km), the frostpoint data from 1981 to 2006 show positive linear trends between 0.3±0.3 and 0.7±0.1%/yr. The same dataset shows trends between −0.2±0.3 and 1.0±0.3%/yr for the period 1992 to 2005. HALOE data over the same time period suggest negative trends ranging from −1.1±0.2 to −0.1±0.1%/yr. In the lower stratosphere, a rapid drop of water vapour is observed in 2000/2001 with little change since. At higher altitudes, the transition is more gradual, with slowly decreasing concentrations between 2001 and 2007. This pattern is consistent with a change induced by a drop of water concentrations at entry into the stratosphere. Previously noted differences in trends and variability between frostpoint and HALOE remain for the homogenised data. Due to uncertainties in reanalysis temperatures and stratospheric transport combined with uncertainties in observations, no quantitative inference about changes of water entering the stratosphere in the tropics could be made with the mid latitude measurements analysed here

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

Volatile Organic Compounds in the Po Basin. Part A: Anthropogenic VOCs

Measurements of volatile organic compounds (VOCs) were performed in the Po Basin, northern Italy in early summer 1998 within the PIPAPO project as well as in summer 2002 and autumn 2003 within the FORMAT project. During the three campaigns, trace gases and meteorological parameters were measured at a semi-rural station, around 35 km north of the city center of Milan. Low toluene and benzene concentrations and lower toluene to benzene ratios on weekends, on Sundays, and in August enabled the identification of a ‘weekend' and a ‘vacation' effect when anthropogenic emissions were lower due to less traffic and reduced industrial activities, respectively. Recurrent nighttime cyclohexane peaks suggested a periodical short-term release of cyclohexane close to the semi-rural sampling site. A multivariate receptor model analysis resulted in the distinction of different characteristic concentration profiles attributed to natural gas, biogenic impact, vehicle exhaust, industrial activities, and a single cyclohexane sourc

Quantification of the impact in mid-latitudes of chemical ozone depletion in the 1999/2000 Arctic polar vortex prior to the vortex breakup

International audienceFor the winter 1999/2000 transport of air masses out of the vortex to mid-latitudes and ozone destruction inside and outside the northern polar vortex is studied to quantify the impact of earlier winter (before March) polar ozone destruction on mid-latitude ozone. Nearly 112 000 trajectories are started on 1 December 1999 on 6 different potential temperature levels between 500?600 K and for a subset of these trajectories photo-chemical box-model calculations are performed. We linked a decline of ?0.9% of mid-latitude ozone in this layer occurring in January and February 2000 to ozone destruction inside the vortex and successive transport of these air masses to mid-latitudes. Further, the impact of denitrification, PSC-occurrence and anthropogenic chlorine loading on future stratospheric ozone is determined by applying various scenarios. Lower stratospheric temperatures and denitrification were found to play the most important role in the future evolution of polar ozone depletion

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

Volatile Organic Compounds in the Po Basin. Part B: Biogenic VOCs

Measurements of volatile organic compounds (VOCs) were performed in the Po Basin, northern Italy in early summer 1998, summer 2002, and autumn 2003. During the three campaigns, trace gases and meteorological parameters were measured at a semi-rural station, around 35 km north of the city center of Milan. Bimodal diurnal cycles of isoprene with highest concentrations in the morning and evening were found and could be explained by the interaction of emissions, chemical reactions, and vertical mixing. The diurnal cycle could be qualitatively reproduced by a three-dimensional Eulerian model. The nighttime decay of isoprene could be attributed mostly to reactions with NO3, while the decay of the isoprene oxidation products could not be explained with the considered chemical reactions. Methanol reached very high mixing ratios, up to 150 ppb. High concentrations with considerable variability occurred during nights with high relative humidities and low wind speeds. The origin of these nighttime methanol concentrations is most likely local and biogenic but the specific source could not be identifie