The association between air pollution and the daily number of deaths: findings from the Slovak Republic contribution to the APHEA project.

STUDY OBJECTIVE: To analyse the short term relation between daily air pollutant values and the daily number of deaths in Bratislava, Slovak Republic, during the study period 1987-91. DESIGN: This follows the APHEA protocol. The association between the daily number of total and cause specific deaths and daily variations in ambient air levels of sulphur dioxide (SO2) and total suspended particulates (TSP) were analysed using Poisson regression that allowed control for meterological data and variables that handle temporal and autoregressive patterns. SETTING: Bratislava is the capital town of Slovakia, the total population was 442,999 according to 1991 census data. The dominant sources of industrial air pollution are the chemical industry and oil refinery. MAIN RESULTS AND CONCLUSIONS: After adjustment for season, temperature and relative humidity, days of week and holidays, secular trends, and autoregressive patterns no significant associations were found between the daily variations in the air pollutants, SO2-24 h and TSP-24 h, and total mortality (RR 0.978, 95% CI 0.96, 0.99; RR 1.008, 95% CI 0.96, 0.99) and cause specific mortality in Bratislava during the study period.

Assessing diagnostic approaches to depression in medically ill older adults: how reliably can mental health professionals make judgments about the cause of symptoms?

OBJECTIVE: To evaluate the reliability of the DSM-IV approach and five other schemes for counting symptoms toward the diagnosis of depression in hospitalized medically ill older patients and to examine whether mental health professionals can reliably make judgments about the etiology (medical or psychological) of depressive symptoms. METHOD: A sample of 38 patients aged 60 years or older admitted to the general medicine, cardiology, or neurology services at Duke University Medical Center were evaluated for depression using a structured psychiatric interview and the Hamilton Depression Scale. Interrater reliability for the diagnostic schemes, for unstructured clinical diagnoses, and for determinations of the causes of individual depressive symptoms was assessed by three pairs of mental health professionals. RESULTS: Agreement between raters for structured diagnoses was high regardless of diagnostic strategy, with the DSM-IV approach being only slightly less reliable than the strict inclusive approach (Kappa 0.88 vs Kappa 1.0, respectively). For all diagnostic approaches, there was perfect agreement between raters for eight cases of major depression. Agreement for unstructured clinical diagnoses of depression (K = 0.50) was much lower than for the structured diagnoses. Agreement between raters on the etiology of individual depression criterion symptoms assessed by structured interview was greater than 80% for 14 of 19 symptoms. Correlation between raters' depression severity ratings on the Hamilton Scale using the DSM-IV etiologic approach was equivalent to that using the strict inclusive approach (0.98 vs 0.95, respectively). CONCLUSIONS: Mental health professionals can be trained to make judgments reliably about the cause (medical or psychological) of symptoms in hospitalized older medical patients. The "strict inclusive" and other diagnostic schemes for counting symptoms toward the diagnosis of depression have only marginal, if any, benefit compared with the current DSM-IV approach.

A statistical analysis of the classification of depression in a mixed community and clinical sample.

Depressive symptoms in three samples are assessed using grade-of-membership analysis to clarify the distribution of depressive symptoms across traditional affective diagnoses. The technique is used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders cluster into recognizable syndromes or pure types that parallel current operational diagnoses. Three hundred and ninety subjects were studied to address the question: among a mixed population with a range of depressive symptoms, will syndromes resembling endogenous depression and demoralization emerge from the range of presentation of depressive symptoms? A single pure type is nearly identical to the DSM-III classification of major depression with melancholia. No such pure type emerged that resembled demoralization.

Beam monitoring system for simultaneous measurement of near and far field patterns in high repetition rate KrF lasers.

A computer-controlled beam monitoring system for KrF excimer lasers was developed for simultaneous measurement of near and far field patterns and pointing stability of the laser beam at a 250 Hz repetition rate. The system and results obtained are described.

Major depression with melancholia: a comparison of middle-aged and elderly adults.

Patients admitted to an inpatient psychiatric service were screened to identify middle-aged (35 to 50 years of age) and elderly (60 years of age and over) patients suffering from a major depressive episode with melancholia. Thirty-seven subjects (18 middle-aged and 19 elderly) were identified. Criteria symptoms for depression and symptoms specifically associated with melancholic or endogenous depression did not differ across age groups, with few exceptions. Major depression with melancholia in this hospitalized population was symptomatically similar in the middle-aged and elderly. The syndrome is therefore relatively common on this inpatient service and should be easily recognized.

Suicide in late life. Review and commentary.

Increasing attention has been directed to recent increases in suicide rates for children, adolescents, and young adults. Nevertheless, persons 65 years and older continue to commit suicide at a higher rate than any other age group in the United States. In this paper various aspects of suicide are examined by analyzing recent trends among young and elderly populations, cohort suicide rates, and future projection of the number of suicides in late life. Data are derived from US death certificates. Consideration of the epidemiologic data and projections may be helpful both to those interested in public policy and to clinicians serving the elderly.