Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.

Spraying ozonated water on Bobal grapevines: Effect on grape quality.

Ozone is a powerful oxidant that is increasingly used as sanitizing agent in the wine industry and even in the vineyard to control grapevine diseases. In this study, we evaluated the effect on grape enological quality of ozonated water spraying treatments carried out in Bobal grapevines during two consecutive harvest seasons. In the first season, ozonated water was applied once during the ripening period on grapevines trained on the traditional gobelet system (S1). In the second season, ozonated water was applied three times between the fruit set and harvest on grapevines grown on a vertical trellis system (S2). Grape quality on harvest day was evaluated through several enological and chromatic parameters, the phenolic maturity, the Varietal Aroma Potential Index (IPAv) and the phenolic and volatile composition. The S1 treatment had a positive effect on the technological maturity, the chromatic parameters, the seed maturity and the content of glycosylated aroma precursors, phenolic compounds and free terpenoids of grapes. The S2 treatment also improved the technological maturity and the content of total anthocyanins (pH 1.0) and free terpenoids, but had a negative impact on the chromatic parameters, the anthocyanin extractability and the content of glycosylated aroma precursors and phenolic compounds. Therefore, ozonated water sprayed on Bobal grapevines affected the quality of grapes, but the effect seemed to depend on the number of applications.

Degree of cognitive impairment and mortality: a 17-year follow-up in a community study.

BACKGROUND: To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment. METHOD: A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages. RESULTS: Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%. CONCLUSIONS: A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

Incidence and lifetime risk of dementia and Alzheimer's disease in a Southern European population.

OBJECTIVE: To calculate both the incidence rates and the lifetime risk (LTR) of dementia and Alzheimer's disease (AD). METHODS: A two-phase case-finding procedure was implemented in a cohort of 4057 cognitively intact individuals 55+ years of age living in Zaragoza, Spain, and followed-up at 2.5 and 4.5 years. Age- and sex-specific incidence rates were calculated. A mortality-adjusted, multivariate model was used to document LTRs. RESULTS: The incidence rate of dementia continued to rise after the age of 90 years, but was slightly lower than in North and West European studies. Only a tendency for an increased LTR with age was observed. Thus, LTR was 19.7% for a 65-year-old woman and 20.4% at the age of 85 years, the corresponding figures for AD being 16.7% and 17.6%. The LTR of AD was higher in women and was about twice as high among illiterate individuals when compared with individuals with higher educational levels. CONCLUSIONS: The incidence rate of dementia in this Southern European city was slightly lower than in previous studies in North-West Europe. LTR of dementia and AD seems to be slightly increased with age. The association of illiteracy with higher LTR of AD is intriguing.

Complejidad de pacientes médico-quirúrgicos hospitalizados: Depresión, parámetros biológicos y Enfermedad Física / No disponible

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Hipocondriasis y Síntomas depresivos en Medicina Interna: Estudio FA-MIDEP / No disponible

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Transferencia de datos de investigación epidemiológica a la práctica clínica en psiquiatría geriátrica / No disponible

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Mortalidad asociada a la depresión en pacientes hospitalizados en medicina interna y seguidos en atención primaria: factores etiopatogénicos y “autopsia biopsicosocial” / No disponible

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Hacia modelos asistenciales más eficientes para pacientes con morbilidad psíquica y somática / No disponible

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Transferencia de datos de investigación epidemiológica a la practica clínica en psiquiatría psicosomática y psiquiatría de enlace / No disponible

No disponible

Transferencia de datos de investigación epidemiológica a la práctica clínica en psiquiatría geriátrica / No disponible

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Somatic and psychiatric co-morbidity in Primary Care patients in Spain

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Background: There is limited information on the subject of co-morbidity of general medical conditions (GMCs) and general psychiatric disturbance in primary care (PC). Methods: A representative sample (n = 1559) of adult PC patients was examined in a two-phase screening. Standardized screening instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI). ICD-10 research criteria were used for psychiatric diagnosis, and ICPC-2 for medical diagnosis. Results: Most co-morbidity cases had depressive (120 cases, 28.1%) or anxiety/neurotic disorders (217 cases, 50.9%). In support of the working hypothesis, the proportion of patients with several medical diagnoses was significantly higher among the cases, and logistic regression showed that the probability of being a psychiatric case increased with each medical diagnosis done by the primary care physician (OR = 2.46; IC 1.66-3.66, p < 0.001). Moderate/severe cases were significantly more frequent among the depressed group (91 cases, 75.9%), but were also common in the anxiety/neurosis group (52 cases,24%), the between groups differences in disability being non-significant. The distribution of both affective and neurotic disorders by specific ICPC-2 categories suggests preferential associations. Conclusion: In PC, the probability of having a co-morbid psychiatric diagnosis doubles with each medical diagnosis. Anxiety/neurotic disorders, and not only depressive disorders, are relevant co-morbid psychiatric categories in this setting (AU)

[Severe self-limiting hypersensitivity reaction after immunotherapy with intravesical BCG]. / Severa reacción de hipersensibilidad autolimitada tras inmunoterapia con BCG intravesical.

We present the case of a 67-years-old patient diagnosed of superficial vesical transitional carcinoma which, under immunotherapy with intravesical BCG, developed a severe hypersensitivity reaction with spontaneous resolution. We describe several adverse reactions after the administration of intravesical BCG, as well as its diagnostic and therapeutic problems, especially in the cases of hypersensitivity.

[Porphyria cutanea tarda and human immunodeficiency virus infection]. / Porfiria cutánea tarda e infección por el virus de la inmunodeficiencia humana.

Recently, cases of porphyria cutanea tarda (PCT) have been reported associated with infection due to human immunodeficiency virus (HIV). We presented the cases of three males, former ethanol users, and which have had previously a contact with the Hepatitis B virus. In one of the patients symptomatology appeared after treatment with zidovudine was begun. We suggest that HIV infection associated with other toxic or viral factors could contribute to the early development of a PCT latent until that moment.