Autonomia funcional em idosos : caracterização multidimensional em idosos utentes de um centro de saúde urbano

RESUMO: Tivemos como objectivo do presente trabalho avaliar a capacidade funcional, e factores eventualmente a ela associados, numa amostra de 152 idosos ambulatórios, sem doenças agudas ou graves, utentes de um centro de saúde urbano. Cada avaliação consistiu numa entrevista, mediante um inquérito sobre capacidade funcional, morbilidade, estado mental e aspectos sociais, e no estudo da composição corporal. As perguntas referentes às variáveis estudadas foram por nós desenvolvidas e estruturadas com base em escalas internacionais validadas e de utilização comum na avaliação de idosos, excepto para as variáveis em que não encontrámos escalas com essas características. Os seus quesitos foram incluídos como perguntas e respostas estruturadas e pré-codificadas, permitindo a atribuição de uma pontuação a cada variável e a sua posterior divisão dicotómica. Aplicámos as escalas de Katz e de Lawton para a avaliação das actividades de autonomia física e instrumental da vida diária, a escala de Grimby para a avaliação da actividade física, a escala de Hamilton e o teste de Folstein para a avaliação do estado mental nas vertentes afectiva e cognitiva e a escala de Graffar para caracterizar a classe social, e perguntas sobre locomoção, autoavaliação da saúde, queixas de saúde presentes e rede social. Fizemos o registo da morbilidade segundo a International Classification of Primary Care - ICPC. A avaliação antropométrica constou da medição do peso, da altura, dos perímetros do braço, da cintura, da anca e proximal da coxa, e das pregas bicipital, tricipital, sub-escapular e supra-ilíaca. Foi também feita a estimativa da composição corporal por cálculos derivados de índices antropométricos e de bioimpedância eléctrica corporal total, o doseamento de algumas proteínas plasmáticas e a quantificação da força de preensão. Analisámos os resultados obtidos por grupos quanto ao sexo e à idade, dividida nos escalões etários 65 a 74 anos e mais do que 74 anos. Por regressão linear múltipla, foi testado o efeito do sexo e da idade sobre os valores medidos, para cada uma das variáveis e cada uma das suas pontuações parciais, sendo considerado como evidência de um efeito estaticamente significativo um valor “p” inferior a 0,05.Resumimos do seguinte modo os dados obtidos e a sua comparação com os dos estudos que seleccionámos como referência: A média de idades da amostra foi de 74 anos, sendo um terço destes do sexo masculino. Na sua maioria eram independentes em locomoção e funcionalidade, praticavam alguma actividade física, classificavam a sua saúde como razoável ou boa, apresentavam sintomatologia activa, não tinham depressão ou demência, tinham quem os acompanhasse embora cerca de metade apresentasse algum grau de isolamento, eram de baixa classe social, tinham excesso de peso, valores elevados de massa gorda, parâmetros plasmáticos proteicos compatíveis com ausência de doenças agudas ou graves e considerável força muscular de preensão. Na análise descritiva por grupos quanto ao sexo e/ou à idade, verificou-se que as mulheres e os mais idosos apresentavam maior isolamento social e os valores mais baixos de massa magra, hemoglobina e força de preensão. As mulheres tinham maior prevalência de dependência em autonomia física, depressão e valores mais baixos de transferrina. Os mais idosos apresentavam maior dependência em funcionalidade, menor actividade física, maior prevalência de demência, índice de massa corporal menos elevado, e valores mais baixos de albumina. Não se verificou prevalência de piores resultados dicotómicos nos homens nem no escalão etário menos idoso. Não teve relação com o sexo ou a idade o compromisso em autonomia instrumental, a presença de morbilidade ou a baixa classe social, assim como a não perturbação da locomoção e dos níveis de somatomedina-C. A análise comparativa com estudos multidimensionais em idosos portugueses e europeus ambulatórios revelou que a nossa amostra apresentava muitas características semelhantes às desses idosos. Assim, tinham elevada independência em locomoção, considerável independência em autonomia física e menor independência em autonomia instrumental; prática de actividade física ligeira, as mulheres dentro e os homens fora de casa; maior prevalência de morbilidade a nível dos aparelhos locomotor e cardiocirculatório, nos nossos idosos com pouca flutuação na autoavaliação de saúde; pequena prevalência de depressão e de demência; maior isolamento social nas mulheres e nas mais idosas; factores de classe social de baixo nível, diferindo apenas em relação aos idosos do norte da Europa que apresentavam elevada escolaridade e profissões mais diferenciadas; características biométricas sobreponíveis às dos idosos portugueses e às dos do sul da Europa, com tendência para o excesso de peso e proporção elevada de massa gorda; e doseamentos plasmáticos proteicos e força muscular de preensão compatíveis com ausência de doenças agudas ou crónicas graves. A comparação com os referidos estudos em relação ao risco de dependência, revelou semelhanças na associação entre dependência funcional e idade avançada, morbilidade, alteração do estado mental e isolamento social. Na amostra que estudámos não obtivemos associação entre dependência e o sexo feminino, facto que se verificou no estudo nacional de Almeida et al. e nos estudos multicêntricos europeus, ou o grau de escolaridade, como no estudo francês. Podemos concluir que, com o instrumento de avaliação que utilizámos, foi possível detectar e caracterizar perturbações numa amostra de idosos ambulatórios, a maioria funcionalmente independentes, sem alterações do estado mental, mas apresentando morbilidade activa, tendência para a obesidade, e actividade física ligeira. Nos que apresentaram alterações, estas foram mais frequentes no sexo feminino e nos indivíduos com mais de 74 anos. A escala de funcionalidade desenvolvida foi sensível aos efeitos da idade e permitiu o cálculo do risco de dependência em relação às outras variáveis estudadas, sendo mais marcante a associação com baixa actividade física, presença de queixas de saúde, demência e índice de massa corporal elevado. Consideramos que a metodologia que empregámos poderá contribuir para a avaliação de capacidades, cujo conhecimento sistemático nos idosos se impõe. ------------- ABSTRACT: The main objective of the present work was to evaluate functional capacity and related factors, in a sample of 152 ambulatory elderly, free from acute or serious disease, attending an urban health centre. Each evaluation included an interview, with a questionnaire about functional capacity, morbidity, mental health and social aspects, and the study of body composition. The questions were developed and structured in accordance with international validated scales usually applied in the evaluation of the elderly, whenever there were scales for that purpose. Their items were included as structured pre-coded questions and answers, so that each variable could have its own quotation and be dichotomised. We employed Katz and Lawton scales for basic and instrumental activities of daily living, Grimby scale for physical activity, Hamilton scale for depression, Folstein’s Mini Mental State Examination for cognitive ability and Graffar scale for social class, and questions about walking, health perception, active complaints and social network. The symptoms register was done according to the International Classification of Primary Care - ICPC. The anthropometric exam involved the determination of height and weight, arm, waist, hip and proximal thigh circumferences, and biceps, triceps, subscapular and suprailiac skinfolds. For the body composition calculation we employed equations derived from anthropometric indices, and from measurement of total body bioelectric impedance. We also measured some plasma proteins and handgrip strength. The analysis of results was done by sex and age groups, separating those with 65 to 74 years from those older than 74 years. The effects of sex and age were tested by linear multiple regression, for each variable and its components. Presented "p" values being considered statistically significative if less than 0,05. The results we obtained and their comparison with the studies we choose as reference can be summarised as follows: Mean age of the sample was 74 years and about one third were men. Most of them were independent in gait and functionality, practised some physical activity, rate their health as fair or good, had physical complaints, had not depression or dementia, had some companionship although almost half of them with stigmas of isolation, belonged to low social class, were in the range of overweight, had raised values of fat mass, plasma proteins in accordance with no acute or serious disease, and considerable handgrip strength. The analysis of groups by sex and age revealed that women and the eldest had the greater social isolation and the lowest values of free fat mass, haemoglobin and handgrip strength. Women had the higher dependence in basic activities of daily living, more depression and lower levels of transferrin. The eldest were more dependent in functionality, had greater prevalence of dementia, less physical activity, less raised body mass index and lower levels of albumin. Men alone and the age range of 65 to 74 did not show any prevalence of the worse dichotomised results. There was no relationship between sex or age and instrumental activities of daily living, morbidity or low social class, and unaffected gait or somatomedin-C levels. The comparison of results with multidimensional studies in portuguese and european ambulatory elderly showed that our sample had many similarities with theirs. They were independent in gait and activities of daily living; practiced light physical activity, women indoors and men outdoors; had greater morbidity at locomotor and cardiovascular systems, with small latitude in health evaluation; low prevalence of depression and dementia; social isolation predominantly in older women; and low social class factors, witch is only different from those of north Europe who had higher education levels and professional carriers; biometric characteristics similar to other portuguese and south Europe elders, with tendency for overweight and high proportion of fat mass; and plasma protein levels and handgrip strength in accordance with no acute or chronic serious disease. The comparison to the referred studies in relation to dependency risk, showed similarities in the association of dependency and age, morbidity,altered mental state and social isolation. We did not find association between dependency and sex, as it was found in the portuguese study of Almeida et al. and the european multicentric studies, or the education level, as in the french study. We conclude that, with the evaluation battery we employed, it was possible to detect and characterise alterations in a sample of ambulatory elderly, most of whom were functionally independent and had no alterations in mental state, but had active morbidity, tendency to obesity, and only light physical activity. Those that had some alteration, were more frequently women and the eldest. The functionality scale we developed showed to be sensitive to age effects and suitable for the calculation of risk of dependency, being more important the association with low physical activity, active complaints, dementia and high body mass index. We consider that the methodology we applied can contribute to the evaluation of capabilities that should be systematically sought for in the elderly.

Assessing cardiorespiratory capacity in older adults with major depression and Alzheimer disease

ABSTRACT Objective To assess cardiorespiratory capacity through subjective and objective tests in older adults diagnosed with major depression (MDD), Alzheimer disease (AD) and healthy older adults. Methods Fifty seven subjects (72 ± 7.9 years) were divided into three groups: MDD (n = 20), AD (n = 17) and Healthy (n = 20). The subjects answered Hamilton Scale (HAM-D), Mini-Mental State Examination (MMSE), Veterans Specific Activity Questionnaire (VSAQ) and 2-minute Step test. Results MDD and AD showed lower scores than healthy group for Nomogram VSAQ (p < 0.001) and 2-minute Step (p = 0.009; p = 0.008, respectively). Adjusted for age and educational level, no differences among groups were observed for Step (MDD, p = 0.097; AD, p = 0.102). AD group did not present differences to healthy group for Step, when adjusting for MMSE (p = 0.261). Conclusions Despite the lower cardiorespiratory fitness of elderly patients with DM and DA have been found in both evaluations, the results should be viewed with caution, since the tests showed low correlation and different risk classifications of functional loss. In addition, age, level educational and cognitive performance are variables that can influence the performance objective evaluation.

Traitement de la dépression résistante par l'association citalopram-lithium. Méthodologie d'une étude multicentrique en double aveugle et résultats préliminaires [Treatment of resistant depression with the citalopram-lithium combination. Methodology of a double-blind multicenter study and preliminary results].

Citalopram, a new bicyclic antidepressant, is the most selective serotonin reuptake inhibitor. In a number of double-blind controlled studies, citalopram was compared to placebo and to known tricyclic antidepressants. These studies have shown their efficacy and good safety. The inefficacy of a psychotropic treatment in at least 20% of depressives has led a number of authors to propose original drug combinations and associations, like antidepressant/lithium (Li), antidepressant/sleep deprivation (agrypnia), antidepressant/ECT, or antidepressant/LT3. The aim of this investigation is to evaluate the clinical effectiveness and safety of a combined citalopram/lithium treatment in therapy-resistant patients, taking account of serotonergic functions, as tested by the fenfluramine/prolactin test, and of drug pharmacokinetics and pharmacogenetics of metabolism. DESIGN OF THE STUDY: A washout period of 3 days before initiating the treatment is included. After an open treatment phase of 28 days (D) with citalopram (20 mg D1-D3; 40 mg D4-D14; 40 or 60 mg D15-D28; concomitant medication allowed: chloral, chlorazepate), the nonresponding patients [less than 50% improvement in the total score on the 21 item-Hamilton Depression Rating Scale (HDRS)] are selected and treated with or without Li (randomized in double-blind conditions: citalopram/Li or citalopram/placebo) during the treatment (D29-D35). Thereafter, all patients included in the double-blind phase subsequently receive an open treatment with citalopram/Li for 7 days (D36-D42). The hypothesis of a relationship between serotoninergic functions in patients using the fenfluramine/prolactin test (D1) and the clinical response to citalopram (and Li) is assessed. Moreover, it is evaluated whether the pharmacogenetic status of the patients, as determined by the mephenytoin/dextromethorphan test (D0-D28), is related to the metabolism of fenfluramine and citalopram, and also to the clinical response. CLINICAL ASSESSMENT: Patients with a diagnosis of major depressive disorders according to DSM III are submitted to a clinical assessment of D1, D7, D14, D28, D35, D42: HDRS, CGI (clinical global impression), VAS (visual analog scales for self-rating of depression), HDRS (Hamilton depression rating scale, 21 items), UKU (side effects scale), and to clinical laboratory examens, as well as ECG, control of weight, pulse, blood pressure at D1, D28, D35. Fenfluramine/prolactin test: A butterfly needle is inserted in a forearm vein at 7 h 45 and is kept patent with liquemine. Samples for plasma prolactin, and d- and l-fenfluramine determinations are drawn at 8 h 15 (base line). Patients are given 60 mg fenfluramine (as a racemate) at 8 h 30. Kinetic points are determined at 9 h 30, 10 h 30, 11 h 30, 12 h 30, 13 h 30. Plasma levels of d- and l-fenfluramine are determined by gas chromatography and prolactin by IRNA. Mephenytoin/dextromethorphan test: Patients empty their bladders before the test; they are then given 25 mg dextropethorphan and 100 mg mephenytoin (as a racemate) at 8 h 00. They collect all urines during the following 8 hours. The metabolic ratio is determined by gas chromatography (metabolic ratio dextromethorphan/dextrorphan greater than 0.3 = PM (poor metabolizer); mephenytoin/4-OH-mephenytoin greater than 5.6, or mephenytoin S/R greater than 0.8 = PM). Citalopram plasma levels: Plasma levels of citalopram, desmethylcitalopram and didesmethylcitalopram are determined by gas chromatography--mass spectrometry. RESULTS OF THE PILOT STUDY. The investigation has been preceded by a pilot study including 14 patients, using the abovementioned protocol, except that all nonresponders were medicated with citalopram/Li on D28 to D42. The mean total score (n = 14) on the 21 item Hamilton scale was significantly reduced after the treatment, ie from 26.93 +/- 5.80 on D1 to 8.57 +/- 6.90 on D35 (p less than 0.001). A similar patCitalopram, a new bicyclic antidepressant, is the most selective serotonin reu

Late-life depression, heart failure and frontal white matter hyperintensity: a structural magnetic resonance imaging study

The relevance of the relationship between cardiac disease and depressive symptoms is well established. White matter hyperintensity, a bright signal area in the brain on T2-weighted magnetic resonance imaging scans, has been separately associated with cardiovascular risk factors, cardiac disease and late-life depression. However, no study has directly investigated the association between heart failure, major depressive symptoms and the presence of hyperintensities. Using a visual assessment scale, we have investigated the frequency and severity of white matter hyperintensities identified by magnetic resonance imaging in eight patients with late-life depression and heart failure, ten patients with heart failure without depression, and fourteen healthy elderly volunteers. Since the frontal lobe has been the proposed site for the preferential location of white matter hyperintensities in patients with late-life depression, we focused our investigation specifically on this brain region. Although there were no significant group differences in white matter hyperintensities in the frontal region, a significant direct correlation emerged between the severity of frontal periventricular white matter hyperintensity and scores on the Hamilton scale for depression in the group with heart failure and depression (P = 0.016, controlled for the confounding influence of age). There were no significant findings in any other areas of the brain. This pattern of results adds support to a relationship between cardiovascular risk factors and depressive symptoms, and provides preliminary evidence that the presence of white matter hyperintensities specifically in frontal regions may contribute to the severity of depressive symptoms in cardiac disease.

Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis

Resumen Introducción Una posible opción de tratamiento para el manejo del trastorno depresivo mayor (TDM) es la estimulación magnética transcraneal (EMT) que ha mostrado propiedades antidepresivas superiores al placebo con un buen perfil de seguridad. El objetivo del presente trabajo es determinar la reducción en la severidad del TDM y la proporción de eventos adversos (EA) en pacientes con TDM refractario y no refractario, posterior al uso de EMT administrada en monoterapia o tratamiento coadyuvante comparado con terapia farmacológica. Metodología Se planteó una pregunta PICOT de la cual se realizó una búsqueda sistemática de estudios clínicos en las bases de datos Medline, EMBASE y Cochrane. Dos investigadores en forma independiente realizaron la selección de artículos, evaluación de calidad con la herramienta de la colaboración Cochrane y extracción de datos. Se extrajeron datos de eficacia como tasa de respuesta, porcentaje de remisión, calidad de vida, diminución sintomática del trastorno depresivo mayor en la escala de Hamilton y capacidad funcional. Igualmente, proporción de pacientes con EA. Se realizó un meta-análisis de estas variables teniendo en cuenta la heterogeneidad. Resultados La presente revisión sistemática incluyó 26 estudios clínicos aleatorizados de baja calidad metodológica mostrando que la EMT presentó una eficacia superior cuando es usada como coadyuvante a las terapias con que venían siendo tratados los pacientes con TDM refractario y no refractario en los desenlaces de tasa de respuesta y porcentaje de remisión. En el caso de intervenciones farmacológicas específicas, la EMT presento eficacia similar, tanto en terapia coadyuvante como en monoterapia comparado con las intervenciones farmacológicas. En cuanto a seguridad, la EMT presenta un buen perfil de seguridad debido a que en todos los escenarios estudiados los EA fueron no serios y baja frecuencia Conclusiones La evidencia disponible sugiere que la EMT mostró ser efectivo y seguro para el manejo del TDM refractario y no refractario. Sin embargo, la evidencia es débil por lo tanto se necesita mayor investigación clínica que soporte su uso.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: Estudo multicêntrico brasileiro

Introduction: To evaluate the efficacy, safety, and tolerability of sertraline for the treatment of Brazilian patients with mild to moderate major depression. Patients and methods: Patients were 18 years old or older treated on an out-patient basis. Previous medications were stopped for a 2-week washout period. Afterwards, patients received sertraline, initial dose of 50 mg/day up to the 4 th week. The dose could then be increased up to 200 mg/day according to the efficacy and tolerability. Therapeutic efficacy was evaluated with the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton scale for depression (HAM-D), and Clinical Global Impression (CGI). Results: 51 patients (42 women) were evaluated regarding efficacy and safety. Treatment with sertraline significantly decreased scores of MADRS, HAM-D e ICGfrom 15.7 ± 6.1; 12.2 ± 3.9 e 3.5 ± 0.6 to 6.2 ± 6.5; 5.4 ± 4.7 e 2.3 ± 1.0 (P < 0.0001), respectively. Sertraline was well tolerated. Gastro-intestinal upset (N=14; 24.6%), headache (N=7; 12.3%), sleep alterations (H-7; 12.3%), dizziness (N-4; 7.0%), and anorexia (N=4; 7.0%) were the most common adverse events. Six patients discontinued the treatment due to adverse events. Conclusion: Sertraline is efficient and presents a favorable safety and tolerability profile for the treatment of Brazilian patients with mild to moderate major depression. © Copyright Moreira Jr. Editora.

Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinson

Introduction. Complex relations between brain and psychopathology have attracted the interest of researchers, aiming to clarify the neurobiological mechanisms of depression in Parkinson's disease, obviously in addiction to mental features. Aims. The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigating relationships between the severity of depressive symptoms and motor characteristics of Parkinson's disease. Patients and methods. Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson's disease in initial clinic stages were studied. The Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mental condition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson's correlation and multiple regression analysis. Results. A significant correlation of severity of depression symptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found. Conclusion. There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson's disease. © 2007, Revista de Neurología.

Drug dependence, mental impairment and education

This study aimed to evaluate the mental conditions of cocaine-dependent individuals and school commitment/attachment. We evaluated 50 patients referred to the psychiatry emergency room due to mental disorders from chemical dependence. After clinical diagnosis, clinical interview, Hospital Anxiety and Depression Scale, Hamilton Scale for Depression and Brief Psychiatric Rating Scale were applied. The Spearman and Mann-Whitney nonparametric tests, as well as the t-Student test were utilized for statistical analysis.. The accepted significance value was 0.05. All subjects had used cocaine or crack and other substances. Only 13 (26%) did not drop out of school (group 1). Regarding the other 37 (74%), irregular class attendance , successive failures and definitive school drop out rates (group 2) were verified. These subjects presented an early substance use when compared with those which did not drop out of school (p=0.0001). Patients with an early substance use presented higher school dropout rates than those with a later initiation to substance use. Psychopathological phenomena were frequent in both groups.

Measuring motor activity in major depression: the association between the Hamilton Depression Rating Scale and actigraphy

Despite the use of actigraphy in depression research, the association of depression ratings and quantitative motor activity remains controversial. In addition, the impact of recurring episodes on motor activity is uncertain. In 76 medicated inpatients with major depression (27 with a first episode, 49 with recurrent episodes), continuous wrist actigraphy for 24h and scores on the Hamilton Depression Rating Scale (HAMD) were obtained. In addition, 10 subjects of the sample wore the actigraph over a period of 5 days, in order to assess the reliability of a 1-day measurement. Activity levels were stable over 5 consecutive days. Actigraphic parameters did not differ between patients with a first or a recurrent episode, and quantitative motor activity failed to correlate with the HAMD total score. However, of the motor-related single items of the HAMD, the item activities was associated with motor activity parameters, while the items agitation and retardation were not. Actigraphy is consistent with clinical observation for the item activities. Expert raters may not correctly rate the motor aspects of retardation and agitation in major depression.

Validity of a Brazilian version of the Zung self-rating depression scale for screening of depression in patients with Parkinson`s disease

Introduction: Parkinson`s disease (PD) is a neurodegenerative disorder with prominent motor manifestations and many other non-motor symptoms that significantly decrease quality-of-life and are frequently under-recognized, for example depression. Objective: To study the validity of a Brazilian version of the Zung Self-rating Depression Scale (SDS) for the diagnosis of depression in patients with PD. Methods: We evaluated 78 consecutive non demented patients over the age of 40 with diagnosis of PD at a Movement Disorders Outpatient Clinic, who could read and understand questionnaires. They completed the SIDS and the Geriatric Depression Scale with 15 items (GDS-15). The diagnosis of depression was made after a structured clinical interview based on DSM-IV criteria for the diagnosis of major depression (SCID-CV). Results: The prevalence of major depression was 23.1%. Cronbach`s alpha was 0.73 and the area under the ROC curve was 0.93 for the SDS. The score index of 55 had a sensitivity of 88.9% and a specificity of 83.3% for the diagnosis of depression. The total scores of the SDS and GDS-15 were highly correlated (0.652, p < 0.0001) and correlated weakly with the scores of a motor scale. Discussion: The SIDS is a valid too] for screening depression in patients with PD since the specific SDS index of 55 is adopted. Two shortened versions could be used with good results. (C) 2009 Published by Elsevier Ltd.

Flow-R, a model for susceptibility mapping of debris flows and other gravitational hazards at a regional scale: some case studies

Every year, debris flows cause huge damage in mountainous areas. Due to population pressure in hazardous zones, the socio-economic impact is much higher than in the past. Therefore, the development of indicative susceptibility hazard maps is of primary importance, particularly in developing countries. However, the complexity of the phenomenon and the variability of local controlling factors limit the use of processbased models for a first assessment. A debris flow model has been developed for regional susceptibility assessments using digital elevation model (DEM) with a GIS-based approach.. The automatic identification of source areas and the estimation of debris flow spreading, based on GIS tools, provide a substantial basis for a preliminary susceptibility assessment at a regional scale. One of the main advantages of this model is its workability. In fact, everything is open to the user, from the data choice to the selection of the algorithms and their parameters. The Flow-R model was tested in three different contexts: two in Switzerland and one in Pakistan, for indicative susceptibility hazard mapping. It was shown that the quality of the DEM is the most important parameter to obtain reliable results for propagation, but also to identify the potential debris flows sources.

Regional-scale debris-flow risk assessment for an alpine valley

In this paper, we perform a societal and economic risk assessment for debris flows at the regional scale, for lower Valtellina, Northern Italy. We apply a simple empirical debris-flow model, FLOW-R, which couples a probabilistic flow routing algorithm with an energy line approach, providing the relative probability of transit, and the maximum kinetic energy, for each cell. By assessing a vulnerability to people and to other exposed elements (buildings, public facilities, crops, woods, communication lines), and their economic value, we calculated the expected annual losses both in terms of lives (societal risk) and goods (direct economic risk). For societal risk assessment, we distinguish for the day and night scenarios. The distribution of people at different moments of the day was considered, accounting for the occupational and recreational activities, to provide a more realistic assessment of risk. Market studies were performed in order to assess a realistic economic value to goods, structures, and lifelines. As terrain unit, a 20 m x 20 m cell was used, in accordance with data availability and the spatial resolution requested for a risk assessment at this scale. Societal risk the whole area amounts to 1.98 and 4.22 deaths/year for the day and the night scenarios, respectively, with a maximum of 0.013 deaths/year/cell. Economic risk for goods amounts to 1,760,291 ?/year, with a maximum of 13,814 ?/year/cell.

Méthodes rapides et efficaces pour la résolution numérique d'équations de type Hamilton-Jacobi avec application à la simulation de feux de forêt

Cette thèse est divisée en trois chapitres. Le premier explique comment utiliser la méthode «level-set» de manière rigoureuse pour faire la simulation de feux de forêt en utilisant comme modèle physique pour la propagation le modèle de l'ellipse de Richards. Le second présente un nouveau schéma semi-implicite avec une preuve de convergence pour la solution d'une équation de type Hamilton-Jacobi anisotrope. L'avantage principal de cette méthode est qu'elle permet de réutiliser des solutions à des problèmes «proches» pour accélérer le calcul. Une autre application de ce schéma est l'homogénéisation. Le troisième chapitre montre comment utiliser les méthodes numériques des deux premiers chapitres pour étudier l'influence de variations à petites échelles dans la vitesse du vent sur la propagation d'un feu de forêt à l'aide de la théorie de l'homogénéisation.

Scale bridging concepts in molecular simulation : coarse-graining and thermodynamic coupling

In dieser Arbeit wurden Simulation von Flüssigkeiten auf molekularer Ebene durchgeführt, wobei unterschiedliche Multi-Skalen Techniken verwendet wurden. Diese erlauben eine effektive Beschreibung der Flüssigkeit, die weniger Rechenzeit im Computer benötigt und somit Phänomene auf längeren Zeit- und Längenskalen beschreiben kann.rnrnEin wesentlicher Aspekt ist dabei ein vereinfachtes (“coarse-grained”) Modell, welches in einem systematischen Verfahren aus Simulationen des detaillierten Modells gewonnen wird. Dabei werden ausgewählte Eigenschaften des detaillierten Modells (z.B. Paar-Korrelationsfunktion, Druck, etc) reproduziert.rnrnEs wurden Algorithmen untersucht, die eine gleichzeitige Kopplung von detaillierten und vereinfachten Modell erlauben (“Adaptive Resolution Scheme”, AdResS). Dabei wird das detaillierte Modell in einem vordefinierten Teilvolumen der Flüssigkeit (z.B. nahe einer Oberfläche) verwendet, während der Rest mithilfe des vereinfachten Modells beschrieben wird.rnrnHierzu wurde eine Methode (“Thermodynamische Kraft”) entwickelt um die Kopplung auch dann zu ermöglichen, wenn die Modelle in verschiedenen thermodynamischen Zuständen befinden. Zudem wurde ein neuartiger Algorithmus der Kopplung beschrieben (H-AdResS) der die Kopplung mittels einer Hamilton-Funktion beschreibt. In diesem Algorithmus ist eine zur Thermodynamischen Kraft analoge Korrektur mit weniger Rechenaufwand möglich.rnrnAls Anwendung dieser grundlegenden Techniken wurden Pfadintegral Molekulardynamik (MD) Simulationen von Wasser untersucht. Mithilfe dieser Methode ist es möglich, quantenmechanische Effekte der Kerne (Delokalisation, Nullpunktsenergie) in die Simulation einzubeziehen. Hierbei wurde zuerst eine Multi-Skalen Technik (“Force-matching”) verwendet um eine effektive Wechselwirkung aus einer detaillierten Simulation auf Basis der Dichtefunktionaltheorie zu extrahieren. Die Pfadintegral MD Simulation verbessert die Beschreibung der intra-molekularen Struktur im Vergleich mit experimentellen Daten. Das Modell eignet sich auch zur gleichzeitigen Kopplung in einer Simulation, wobei ein Wassermolekül (beschrieben durch 48 Punktteilchen im Pfadintegral-MD Modell) mit einem vereinfachten Modell (ein Punktteilchen) gekoppelt wird. Auf diese Weise konnte eine Wasser-Vakuum Grenzfläche simuliert werden, wobei nur die Oberfläche im Pfadintegral Modell und der Rest im vereinfachten Modell beschrieben wird.