The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe.

AIMS: Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association. METHODS: We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome. RESULTS: High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results. CONCLUSIONS: Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.

Initial poor function in the age of old donors: prognostic factors.

INTRODUCTION: The current donor selection criteria have changed from the past years. Primary nonfunction is a serious complication after liver transplantation, but initial poor function (IPF), which occurs from 2% to 23%, also has an increased morbidity and mortality. We analyzed prognostic factors associated with IPF. MATERIALS AND METHOD: This retrospective study of 551 liver transplants performed from January 2000 to December 2005 excluded retransplantations and transplants by classic surgery. The study cohort was attentified according to the presence or the absence of IPF. The variables included were (1) donor age, gender, cause of death, length of stay in Critical Care Medicine, noradrenaline use, sodium levels, and cardiorespiratory arrest, (2) from the standpoint of surgery: we included ischemia time (IT), intervention time, units of packet red cells (PRC), volume of blood autotransfusion (VBA), postreperfusion syndrome (PRS), and vasoactive drugs within the surgery procedure (VAD); (3) from the recipient's: view we examined age, gender, etiology, functional state, and covermittant pathology; (4) During the postoperative period we noted the presence of postoperative hemorrhage. Statistical analysis used chi-square test, Student t test, multiple logistic regression with significance set at P < .05. RESULTS: Differences were found in IT (P = .001), VBA (P = .001), PRS (P = .012), VAD (P = .03), fulminant hepatic failure as the cause the transplantation (P = .002), and chronic obstructive pulmonary disease (P = .007). A regression model retained the following variables: IT, VBA, PRS, fulminant hepatic failure, and chronic obstructive pulmonary disease. CONCLUSIONS: The prognostic factors for IPF need to be modified together with donor selection criteria in liver transplantation.

High household infestation rates by synanthropic vectors of Chagas disease in southern Ecuador.

Entomological surveys were conducted in five rural communities (138 domiciliary units [DUs]) in the southern Andes of Ecuador. Adobe walls and ceramic tile roofs were predominant construction materials. A 35% house infestation rate with Panstrongylus chinai (Del Ponte, 1929) (0.7%), Panstrongylus rufotuberculatus (Champion, 1899) (0.7%), Rhodnius ecuadoriensis (Lent & León, 1958) (27%), and/or Triatoma carrioni (Larrousse, 1926) (7%) was found. Adults and nymphs of R. ecuadoriensis and T. carrioni were found in intradomiciliary and peridomiciliary areas. Breeding triatomine colonies were present in 85% of infested DUs, and the average insect crowding was 52+/-113 triatomine bugs per infested house. T. cruzi-like organisms were found by microscopic examination in the feces or hindgut but not the salivary glands of 4% of examined R. ecuadoriensis and 12% T. carrioni. Serological tests detected a general anti-T. cruzi antibody seroprevalence of 3.9% (n = 1136). Only 2% of individuals had heard of Chagas disease, and although triatomines were reported as a major nuisance by the population they were not considered vectors of disease. Additional baseline field research is needed for the design and implementation of a Chagas disease control program in the region.

[Pattern of antimicrobial susceptibility in uropathogen isolates from children]. / Patrón de sensibilidad a antimicrobianos en uropatógenos aislados en niños.

The bacteriological profile in children with culture-positive bacteriuria was analyzed during a 5-year period. Escherichia coli was the most common cause of urinary tract infections (57%), followed by Streptococcus faecalis (11%), Pseudomonas aeruginosa (8%), and Proteus mirabilis (6%). Results of antimicrobial susceptibility testing indicated that cephalosporins (first, second and third generation) and nitrofurantoin are the best empirical oral treatment for urinary infections in children. Fosfomycin is a valid option in some cases. In hospitalized children treatment must be initiated with a third-generation cephalosporin, and gentamicin can be added in severely ill inpatients. These treatments can be modified when microbiological results become available.