An evaluation of depression, self-efficacy, satisfaction with life and perceived access to medical care across stages of HIV infection

This survey was designed to identify the incidence and scope of depression, satisfaction with life, self-efficacy and perceived access to medical care for those who are infected with the HIV virus. It also determined whether or not factors such as sexual orientation, ethnicity and socioeconomic status are intervening variables with respect to mental health issues. Subjects were recruited through a purposive sample from South Florida. A total of 871 surveys were used in the analysis. The overall response rate was nearly 90%. The incidence of depression was found to be higher than 75% across all stages of HIV infection. Furthermore, the incidence of depression increased as HIV disease progressed. Satisfaction with life and for the most part, self efficacy were found to decrease slightly as HIV disease progressed. Significant variance in depression, life satisfaction and self efficacy were found across stages of HIV infection. No significant differences between groups that were HIV infected were found for depression, life satisfaction and self efficacy. The severity of depression was found to vary significantly with self efficacy, life satisfaction and access to medical care but not with socioeconomic status. Life satisfaction was found to vary significantly with socioeconomic status, depression and self efficacy but not with access to medical care. Self-efficacy was found to vary significantly with socioeconomic status, depression and life satisfaction but not with access to medical care. Gender and ethnicity were not found to be significant precedent variables in depression for HIV infected individuals. Sexual orientation was found to be a significant precedent variable for depression, life satisfaction and self efficacy.

On the eigenvalues of the spatial sign covariance matrix in more than two dimensions

Acknowledgments Alexander Dürre was supported in part by the Collaborative Research Grant 823 of the German Research Foundation. David E. Tyler was supported in part by the National Science Foundation grant DMS-1407751. A visit of Daniel Vogel to David E. Tyler was supported by a travel grant from the Scottish Universities Physics Alliance. The authors are grateful to the editors and referees for their constructive comments.

Numerical detection of the Gardner transition in a mean-field glass former.

Recent theoretical advances predict the existence, deep into the glass phase, of a novel phase transition, the so-called Gardner transition. This transition is associated with the emergence of a complex free energy landscape composed of many marginally stable sub-basins within a glass metabasin. In this study, we explore several methods to detect numerically the Gardner transition in a simple structural glass former, the infinite-range Mari-Kurchan model. The transition point is robustly located from three independent approaches: (i) the divergence of the characteristic relaxation time, (ii) the divergence of the caging susceptibility, and (iii) the abnormal tail in the probability distribution function of cage order parameters. We show that the numerical results are fully consistent with the theoretical expectation. The methods we propose may also be generalized to more realistic numerical models as well as to experimental systems.

The Role of Perceived Social Support, Resilience, and Depression on Communicative Participation in Head and Neck Cancer Survivors

Thesis (Master's)--University of Washington, 2016-08

Adolescent depression in schools: + Contigo Project

epidemiological data. It involves a high degree of mortality, namely by suicide, which is the third leading cause of death in the 15-24 age group. Objectives: To assess the presence and severity of depressive symptoms in a non-clinical population of adolescents. Methodology: This is a quantitative, descriptive and cross-sectional study, using the Portuguese version of the Beck Depression Inventory (BDI-II). The sample was composed of 741 adolescents. Results: The results show that 31.2% of the adolescents have depression and, of these, 17.7% have moderate to severe depressive symptoms. Girls have higher levels of depression (p=.00). The total mean score in the BDI-II was 12. Conclusion: Given the adolescents' high vulnerability to depression and suicide, it is essential to implement prevention programs in schools to promote the early detection of depression and suicidal behaviors, and the referral to mental health services.

Développement et pré-test d’un plan de soins de suivi pour des femmes atteintes du cancer de l’endomètre avec traitements adjuvants lors de la transition de la fin du traitement actif vers la survie au cancer

La fin du traitement actif et le début de la phase de survie correspondent à une période de transition qui présente de nombreux défis pour la personne survivante au cancer, les soignants et le système de santé. La phase de survie au cancer est une phase distincte mais négligée du continuum de soins. Pour faciliter la transition de la fin du traitement actif vers la survie et optimiser la coordination des soins de suivi, la mise en place d’un plan de soins de suivi (PSS) est proposée. Le but de cette recherche est de développer, de mettre en place et d’évaluer si un plan de soins de suivi (PSS) permet de répondre aux besoins globaux, de diminuer la détresse émotionnelle et de favoriser les comportements d’autogestion de santé de femmes atteintes du cancer de l’endomètre (FACE) lors de la transition de la fin du traitement actif vers la survie au cancer. Elle comprend deux phases distinctes. La première phase visait d’abord le développement d’un plan de soins de suivi (PSS) pour des femmes atteintes du cancer de l’endomètre avec traitements adjuvants. La sélection du contenu du PSS a été faite à partir de la recension des écrits et des données recueillies lors d’entrevues individuelles avec 19 FACE, 24 professionnels de la santé travaillant avec cette clientèle et quatre gestionnaires de proximité en oncologie. Cette première phase avait également pour but la validation du contenu du PSS auprès de dix professionnels de la santé impliqués dans l’étude. La seconde phase consistait à évaluer la faisabilité, l’acceptabilité du PSS et à en pré-tester l’utilité à répondre aux besoins globaux, à diminuer la détresse émotionnelle (peur de la récidive) et à favoriser l’autogestion de santé auprès d’un groupe de 18 femmes atteintes du cancer de l’endomètre avec traitements adjuvants à la fin du traitement actif vers la survie. Sur le plan de la faisabilité, les résultats suggèrent que la mise en place du PSS comporte des défis en termes de temps, de ressources et de coordination pour l’infirmière pivot en oncologie (IPO). Concernant l’acceptabilité du PSS, les FACE le perçoivent comme un outil d’information utile qui favorise la communication avec le médecin de famille ou d’autres professionnels de la santé. Les IPO soutiennent sa valeur ajoutée à la fin du traitement et soulignent que la discussion du contenu du PSS fait ressortir des éléments de surveillance et de suivi essentiels à prendre en compte pour la phase de survie et permet de mettre l’emphase sur l’autogestion de sa santé. Pour les médecins de famille, le PSS est un outil d’information pour les survivantes qui favorise la réassurance, la communication et la continuité des soins entre professionnels de la santé. Enfin, pour ce qui est de l’utilité du PSS à répondre aux besoins globaux, les résultats suggèrent que l’ensemble des besoins sont plus satisfaits trois mois après la fin des traitements pour le groupe ayant reçu un PSS. Bien que la peur de récidive du cancer (PRC) s’améliore au suivi de trois mois pour le groupe exposé au PSS, 55% des FACE conservent un score cliniquement significatif de 13 à la sous-échelle de sévérité de peur de récidive à la fin du traitement et 42% au suivi de trois mois. Les comportements d’autogestion de santé s’améliorent entre la fin du traitement et le suivi de trois mois pour le groupe exposé un PSS. Considérant ces résultats, la démarche soutient la pertinence de mettre en place un PSS à la fin du traitement actif pour les FACE pour répondre à des besoins d’information, favoriser la communication et la continuité des soins avec les professionnels de la santé et les comportements d’autogestion de santé dans la phase de survie. Cependant, des contraintes de temps, de ressources et de coordination doivent être prises en compte pour sa mise en place dans le milieu clinique. Mots-clés : Transition, fin du traitement actif, besoins, survie au cancer, plan de soins de suivi.

Childhood Attention Problems and the Development of Comorbid Symptoms at the Transition to High School: The Mediating Role of Parent and Peer Relationships

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for the development of depression and delinquent behavior. Children and adolescents with ADHD also experience difficulty creating/maintaining high quality friendships and parent-child relationships, and these difficulties may contribute to the development of co-morbid internalizing and externalizing symptoms in adolescence. However, there is limited research examining whether high quality friendships and parent-child relationships mediate the relation between ADHD and the emergence of these co-morbid symptoms at the transition to high school. This study examines the mediating role of relationship quality in the association between ADHD and depressive symptoms/delinquent behaviors at this developmentally significant transition point. Results revealed significant indirect effects of grade 6 attention problems on grade 9 depressive symptoms through friendship quality and quality of the mother-child relationship in grade 8. Interventions targeting parent and peer relationships may be valuable for youth with ADHD to promote successful transitions to high school.

Exploring the potential role of allostatic load biomarkers in risk assessment of patients presenting with depressive symptoms

Background: Depression is a major health problem worldwide and the majority of patients presenting with depressive symptoms are managed in primary care. Current approaches for assessing depressive symptoms in primary care are not accurate in predicting future clinical outcomes, which may potentially lead to over or under treatment. The Allostatic Load (AL) theory suggests that by measuring multi-system biomarker levels as a proxy of measuring multi-system physiological dysregulation, it is possible to identify individuals at risk of having adverse health outcomes at a prodromal stage. Allostatic Index (AI) score, calculated by applying statistical formulations to different multi-system biomarkers, have been associated with depressive symptoms. Aims and Objectives: To test the hypothesis, that a combination of allostatic load (AL) biomarkers will form a predictive algorithm in defining clinically meaningful outcomes in a population of patients presenting with depressive symptoms. The key objectives were: 1. To explore the relationship between various allostatic load biomarkers and prevalence of depressive symptoms in patients, especially in patients diagnosed with three common cardiometabolic diseases (Coronary Heart Disease (CHD), Diabetes and Stroke). 2 To explore whether allostatic load biomarkers predict clinical outcomes in patients with depressive symptoms, especially in patients with three common cardiometabolic diseases (CHD, Diabetes and Stroke). 3 To develop a predictive tool to identify individuals with depressive symptoms at highest risk of adverse clinical outcomes. Methods: Datasets used: ‘DepChron’ was a dataset of 35,537 patients with existing cardiometabolic disease collected as a part of routine clinical practice. ‘Psobid’ was a research data source containing health related information from 666 participants recruited from the general population. The clinical outcomes for 3 both datasets were studied using electronic data linkage to hospital and mortality health records, undertaken by Information Services Division, Scotland. Cross-sectional associations between allostatic load biomarkers calculated at baseline, with clinical severity of depression assessed by a symptom score, were assessed using logistic and linear regression models in both datasets. Cox’s proportional hazards survival analysis models were used to assess the relationship of allostatic load biomarkers at baseline and the risk of adverse physical health outcomes at follow-up, in patients with depressive symptoms. The possibility of interaction between depressive symptoms and allostatic load biomarkers in risk prediction of adverse clinical outcomes was studied using the analysis of variance (ANOVA) test. Finally, the value of constructing a risk scoring scale using patient demographics and allostatic load biomarkers for predicting adverse outcomes in depressed patients was investigated using clinical risk prediction modelling and Area Under Curve (AUC) statistics. Key Results: Literature Review Findings. The literature review showed that twelve blood based peripheral biomarkers were statistically significant in predicting six different clinical outcomes in participants with depressive symptoms. Outcomes related to both mental health (depressive symptoms) and physical health were statistically associated with pre-treatment levels of peripheral biomarkers; however only two studies investigated outcomes related to physical health. Cross-sectional Analysis Findings: In DepChron, dysregulation of individual allostatic biomarkers (mainly cardiometabolic) were found to have a non-linear association with increased probability of co-morbid depressive symptoms (as assessed by Hospital Anxiety and Depression Score HADS-D≥8). A composite AI score constructed using five biomarkers did not lead to any improvement in the observed strength of the association. In Psobid, BMI was found to have a significant cross-sectional association with the probability of depressive symptoms (assessed by General Health Questionnaire GHQ-28≥5). BMI, triglycerides, highly sensitive C - reactive 4 protein (CRP) and High Density Lipoprotein-HDL cholesterol were found to have a significant cross-sectional relationship with the continuous measure of GHQ-28. A composite AI score constructed using 12 biomarkers did not show a significant association with depressive symptoms among Psobid participants. Longitudinal Analysis Findings: In DepChron, three clinical outcomes were studied over four years: all-cause death, all-cause hospital admissions and composite major adverse cardiovascular outcome-MACE (cardiovascular death or admission due to MI/stroke/HF). Presence of depressive symptoms and composite AI score calculated using mainly peripheral cardiometabolic biomarkers was found to have a significant association with all three clinical outcomes over the following four years in DepChron patients. There was no evidence of an interaction between AI score and presence of depressive symptoms in risk prediction of any of the three clinical outcomes. There was a statistically significant interaction noted between SBP and depressive symptoms in risk prediction of major adverse cardiovascular outcome, and also between HbA1c and depressive symptoms in risk prediction of all-cause mortality for patients with diabetes. In Psobid, depressive symptoms (assessed by GHQ-28≥5) did not have a statistically significant association with any of the four outcomes under study at seven years: all cause death, all cause hospital admission, MACE and incidence of new cancer. A composite AI score at baseline had a significant association with the risk of MACE at seven years, after adjusting for confounders. A continuous measure of IL-6 observed at baseline had a significant association with the risk of three clinical outcomes- all-cause mortality, all-cause hospital admissions and major adverse cardiovascular event. Raised total cholesterol at baseline was associated with lower risk of all-cause death at seven years while raised waist hip ratio- WHR at baseline was associated with higher risk of MACE at seven years among Psobid participants. There was no significant interaction between depressive symptoms and peripheral biomarkers (individual or combined) in risk prediction of any of the four clinical outcomes under consideration. Risk Scoring System Development: In the DepChron cohort, a scoring system was constructed based on eight baseline demographic and clinical variables to predict the risk of MACE over four years. The AUC value for the risk scoring system was modest at 56.7% (95% CI 55.6 to 57.5%). In Psobid, it was not possible to perform this analysis due to the low event rate observed for the clinical outcomes. Conclusion: Individual peripheral biomarkers were found to have a cross-sectional association with depressive symptoms both in patients with cardiometabolic disease and middle-aged participants recruited from the general population. AI score calculated with different statistical formulations was of no greater benefit in predicting concurrent depressive symptoms or clinical outcomes at follow-up, over and above its individual constituent biomarkers, in either patient cohort. SBP had a significant interaction with depressive symptoms in predicting cardiovascular events in patients with cardiometabolic disease; HbA1c had a significant interaction with depressive symptoms in predicting all-cause mortality in patients with diabetes. Peripheral biomarkers may have a role in predicting clinical outcomes in patients with depressive symptoms, especially for those with existing cardiometabolic disease, and this merits further investigation.

Prevalence, severity and risk factors of allergic disorders among people in south India.

Background: Allergic disorders are not usually life-threatening conditions but they impair the person’s ability to function. It thus adversely affects the psychological wellbeing and quality of life. These implications of allergic disorders can be minimized if strategies are planned for its early identification followed by appropriate interventions. Objectives: To find out the prevalence and risk factors of allergic disorders. Methods: Data was collected by house to house survey among participants aged 18 years and above using a standardized allergy assessment questionnaire. Results: Mean age of the 400 participants was 42.8±14.7 years. Majority 105(26.2%) were in the age group 36 to 45 years. Majority were females 287(71.7%) and were house wives 217(54.2%). Majority of participants were of upper socio economic class 98(44.7%) out of 219 and majority were from urban areas 326(81.5%). The prevalence of allergy among participants was found to be 115(28.7%). Out of these 115, 37(32.2%) had possibility of allergy, 60(52.2%) had probability of allergy and the rest 18(15.6%) had very high likelihood for allergy. People residing in semi urban areas had increased risk of allergy (p=0.024) than those from urban areas. The prevalence of asthma was 30(7.5%) and skin allergy was 23(5.8%). Most common precipitating factors for allergy were dust exposure 103(25.8%) followed by seasonal changes 71(17.8%). Family history of allergy was associated with allergy among participants (p<0.001). Usage of firewood was associated with symptoms of respiratory allergy among participants (p=0.01). Conclusion: The study revealed some important determinants of allergic disorders which have important implications to frame appropriate prevention and health educational strategies.

Nonlinear development of matrix-converter instabilities

Matrix converters convert a three-phase alternating-current power supply to a power supply of a different peak voltage and frequency, and are an emerging technology in a wide variety of applications. However, they are susceptible to an instability, whose behaviour is examined herein. The desired “steady-state” mode of operation of the matrix converter becomes unstable in a Hopf bifurcation as the output/input voltage transfer ratio, q, is increased through some threshold value, qc. Through weakly nonlinear analysis and direct numerical simulation of an averaged model, we show that this bifurcation is subcritical for typical parameter values, leading to hysteresis in the transition to the oscillatory state: there may thus be undesirable large-amplitude oscillations in the output voltages even when q is below the linear stability threshold value qc.

Structural brain connectivity and cognitive ability differences: A multivariate distance matrix regression analysis

Neuroimaging research involves analyses of huge amounts of biological data that might or might not be related with cognition. This relationship is usually approached using univariate methods, and, therefore, correction methods are mandatory for reducing false positives. Nevertheless, the probability of false negatives is also increased. Multivariate frameworks have been proposed for helping to alleviate this balance. Here we apply multivariate distance matrix regression for the simultaneous analysis of biological and cognitive data, namely, structural connections among 82 brain regions and several latent factors estimating cognitive performance. We tested whether cognitive differences predict distances among individuals regarding their connectivity pattern. Beginning with 3,321 connections among regions, the 36 edges better predicted by the individuals' cognitive scores were selected. Cognitive scores were related to connectivity distances in both the full (3,321) and reduced (36) connectivity patterns. The selected edges connect regions distributed across the entire brain and the network defined by these edges supports high-order cognitive processes such as (a) (fluid) executive control, (b) (crystallized) recognition, learning, and language processing, and (c) visuospatial processing. This multivariate study suggests that one widespread, but limited number, of regions in the human brain, supports high-level cognitive ability differences. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.

Determination of subclinical metabolic disorders in transition dairy cows

Das Gesundheitsmanagement von Milchkühen hat in den vergangenen Jahren auf den landwirtschaftlichen Betrieben an Bedeutung gewonnen. Neben Präventionsmaßnahmen zur Gesunderhaltung der Tiere ist die frühzeitige und systematische Erkennung von Erkrankungen hierbei der Hauptbestandteil. Es zeigt sich vermehrt, dass vor allem Transitkühe verstärkt an Stoffwechselerkrankungen in sowohl klinischer als auch subklinischer Form erkranken. Letztere stellen ein hohes Risiko dar, zum einen weil subklinische Erkrankungen oftmals nur schwer oder gar nicht erkannt werden und zum anderen, weil sie in vielen Fällen die Grundlage für meist schwerwiegendere Folgeerkrankungen sind. In der vorliegenden Studie wird das Thema der Früherkennung von subklinischen Ketosen und der subakuten Pansenazidose behandelt. Verschiedene Methoden wurden unter praktischen Versuchsbedingungen auf ihre Tauglichkeit zur Krankheitserkennung hin geprüft. In einer ersten Studie wurde auf einem konventionellen Milchviehbetrieb ein Ketose-Monitoring bei frischlaktierenden Kühen ab Tag 3 postpartum durchgeführt. Insgesamt 15 Tiere waren an einer subklinischen Ketose erkrankt, was eine Aufkommensrate von 26% in den untersuchten Tieren bedeutete. Die Blutproben von insgesamt 24 Tieren wurden auf ihren IL-6-Gehalt untersucht. Von den untersuchten Tieren waren 14 Tiere erkrankt, 10 Tiere bildeten die gesunde Kontrollgruppe. Interleukin-6 wurde bestimmt, da dem Zytokin IL-6 in anderen Studien in Bezug auf Ketosen eine Rolle zugesprochen wurde. Die erwartete Erhöhung von IL-6 bei erkrankten Tieren konnte nicht festgestellt werden; die erkrankten Kühe zeigten vielmehr die niedrigsten IL-6 Werte der Studiengruppe. Insgesamt waren die IL-6 Konzentrationen auf einem niedrigen Niveau mit 27.2 pg/m l± 10.2. Es zeigte sich, dass die IL-6 Bestimmung im Blut hinsichtlich der Erkennung von subklinischen Ketosen nur eingeschränkt nutzbar ist. Es konnte ausschließlich eine schwache negative Korrelation zwischen Beta- Hydroxybutyrat (BHBA, Goldstandard für den Nachweis einer Ketose) und IL-6 detektiert werden. Zusätzlich zu den Blutanalysen wurde ebenfalls die tägliche Wiederkauaktivität mit dem „DairyCheck“ System bestimmt, welches kontinuierlich die charakteristischen Kaumuskelkontraktionen aufzeichnet und somit die Dauer des Wiederkäuens bestimmt werden kann. Es wurde geprüft, ob sich ketotische Tiere von nicht ketotischen Tieren hinsichtlich der täglichen Wiederkäuzeit unterscheiden. Milchkühe mit einer Ketose kauten im Schnitt 475 min/d ± 56 wieder, nach Genesung 497 min/d ± 48. Sie befanden sich somit im Durchschnitt immer unterhalb der gesunden Kontrollgruppe, welche 521 min/d ± 76 wiederkaute. Eine Korrelation zwischen der Wiederkauzeit und dem BHBA- Gehalt im Blut war nur sehr schwach ausgeprägt, nicht zuletzt da die Tiere generell eine hohe Variabilität in der Wiederkauaktivität zeigten. Bei einer weiteren Studie, ebenfalls auf einem Praxisbetrieb durchgeführt, wurde auf die Erkennung der subakuten Pansensazidose (SARA) fokussiert. Hierbei kam ein drahtloses, kommerziell verfügbares Bolussystem zum Einsatz, welches den pH Wert kontinuierlich im Retikulorumen misst. Es macht die Erkennung einer SARA auch unter Praxisbedingungen ohne invasive Methoden wie der Punktion möglich. Das Bolussystem wurde 24 Milchkühen kurz vor der Abkalbung oral eingegeben, um den pH-Wert während der gesamten Transitphase messen und überwachen zu können. Während in der Trockenstehphase nur vereinzelte SARA Fälle auftraten, erlitt ein Großteil der untersuchten Tiere in der Frühlaktation eine SARA. Auf Grundlage von pH-Werten von laktierenden Milchkühen, wurde zusätzlich eine Sensitivitätsanalyse von verschieden, bereits eingesetzten Nachweismethoden durchgeführt, um die Tauglichkeit für die SARA-Diagnostik zu untersuchen. Es handelte sich hierbei zum einen um einen SARA-Nachweis unter Heranziehung von Einzelwerten, Fress- und Wiederkäuzeiten, sowie ausgewählten Milchinhaltsstoffen und der Milchmenge. Die Analyse ergab, dass nahezu alle Nachweismethoden im Vergleich zur Langzeitmessung nur eingeschränkt zur SARA-Diagnostik nutzbar sind. In einem weiteren Teil der Studie wurde eine Kotfraktionierung bei den gleichen Tieren durchgeführt, um damit SARA-Tiere auch mittels der Kotanalyse erkennen kann. Es konnte gezeigt werden, dass zum einen die Ration einen Einfluss auf die Kotzusammensetzung hat (Trockensteherration versus Ration für Laktierende) zum anderen aber auch, dass eine SARA die Zusammensetzung des Kotes verändert. Hierfür wurden Kotproben ausschließlich von laktierenden Kühen untersucht, sodass der Einfluss der Ration ausgeschlossen werden konnte. Erhöhte Faseranteile im Kot von SARA - Kühen gaben Hinweis auf eine verminderte Verdaulichkeit. Dabei erwies sich vor allem die Hemizellulose als guter Parameter, um auf eine SARA schließen zu können. Die Versuchsbedingungen ließen es ebenfalls zu, die pH-Verläufe der Tiere in der Frühlaktation zu untersuchen. Eine Clusteranalyse von pH-Werten der ersten 12 Tage postpartum zeigte, dass die untersuchten Tiere trotz gleicher Haltungs- und Fütterungsbedingungen unterschiedliche pH-Wert Verläufe entwickelten. So gab es eine Gruppe von Milchkühen, die den pH-Wert stabil halten konnte, während die restlichen pH-Abfälle in verschiedenen Verläufen und Intensitäten aufzeigten. Es konnte ebenfalls aufgezeigt werden, dass Tiere innerhalb der Testherde unterschiedliche Schweregrade der SARA entwickelten. Auch in dieser Studie wurde deutlich, dass Tiere scheinbar unterschiedliche Möglichkeiten haben, auf ihre Umwelt zu reagieren, bzw. suboptimalen Bedingungen entgegenwirken zu können. Zusammengefasst wurden verschiedene Methoden zur Ketose- und SARA- Erkennung geprüft, von denen nur einzelne für die Praxis zu empfehlen sind. Die Variabilität der Tiere, sowohl bei der Ausprägung der Erkrankungen als auch bei den gemessenen Parametern verdeutlicht die Notwendigkeit, diese im Herden- und Gesundheitsmanagement in Zukunft stärker zu berücksichtigen.

Sex differences in coronary artery disease severity and mortality: the impact of conventional cardiovascular risk factors

It is still unknown whether traditional risk factors may have a sex specific impact on the severity of coronary artery disease (CAD) and subsequent mortality in acute coronary syndromes (ACS). We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS-TC (NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between conventional risk factors and severity of CAD and its relationship with 30-day mortality. Risk ratios (RRs) and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Severity of disease was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD, specifically Ischemia and No Obstructive Coronary Artery disease (INOCA) and Myocardial Infarction with Non obstructive Coronary Arteries (MINOCA). The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49(95%CI,0.41–0.60) and among those with diabetes mellitus was 0.89(95% CI,0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95%CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex-related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30-day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with INOCA/MINOCA. In conclusion, obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions.

Analysis of heat-related phenomena and their interactions at different spatio-temporal scales

This thesis analyzes the impact of heat extremes in urban and rural environments, considering processes related to severely high temperatures and unusual dryness. The first part deals with the influence of large-scale heatwave events on the local-scale urban heat island (UHI) effect. The temperatures recorded over a 20-year summer period by meteorological stations in 37 European cities are examined to evaluate the variations of UHI during heatwaves with respect to non-heatwave days. A statistical analysis reveals a negligible impact of large-scale extreme temperatures on the local daytime urban climate, while a notable exacerbation of UHI effect at night. A comparison with the UrbClim model outputs confirms the UHI strengthening during heatwave episodes, with an intensity independent of the climate zone. The investigation of the relationship between large-scale temperature anomalies and UHI highlights a smooth and continuous dependence, but with a strong variability. The lack of a threshold behavior in this relationship suggests that large-scale temperature variability can affect the local-scale UHI even in different conditions than during extreme events. The second part examines the transition from meteorological to agricultural drought, being the first stage of the drought propagation process. A multi-year reanalysis dataset involving numerous drought events over the Iberian Peninsula is considered. The behavior of different non-parametric standardized drought indices in drought detection is evaluated. A statistical approach based on run theory is employed, analyzing the main characteristics of drought propagation. The propagation from meteorological to agricultural drought events is found to develop in about 1-2 months. The duration of agricultural drought appears shorter than that of meteorological drought, but the onset is delayed. The propagation probability increases with the severity of the originating meteorological drought. A new combined agricultural drought index is developed to be a useful tool for balancing the characteristics of other adopted indices.