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By C. Osmund. Avila College.

Sometimes anxious patients who have had a squint since childhood begin to notice their double vision Superior rectus again generic malegra fxt 140mg without prescription, having suppressed one image for many Superior oblique years buy malegra fxt 140mg with amex. Lateral rectus Inferior rectus Medial Optic nerva Sixth Cranial Nerve Palsy rectus The affected eye is converged because of a weak- Superior rectus ness of the lateral rectus muscle discount 140 mg malegra fxt free shipping. It occurs most commonly as an isolated microvascular episode in hypertensive elderly patients and heals spon- taneously in three to six months. In young patients,the possibility of mul- of the inferior recti in particular becomes tiple sclerosis or even raised intracranial pres- impaired and diplopia on upward gaze is a sure must be borne in mind. When the inammation has settled, the inltrating cells are replaced by brous tissue, further restricting muscle action. Fourth Cranial Nerve Palsy The eye fails to look down when it is turned in Myasthenia Gravis and might be turned slightly up when the other eye is looking straight ahead. Trauma (a blow This disease presents sometimes with diplopia over the head) is an important cause in younger with or preceded by ptosis,which becomes worse patients but a full investigation for an intra- as the day goes by. The symp- toms and signs show a transient improvement seconds after the intravenous injection of edro- Third Cranial Nerve Palsy phonium chloride (Tensilon). Diagnosis can be The eye is turned out and slightly down, the conrmed by high serum titres of acetylcho- pupil is dilated and ptosis is usually severe line receptor antibodies. Trauma is an important cases are associated with a thymoma, which can cause in young people but a posterior com- become malignant. A chest X-ray is, therefore, municating aneurysm should also be consid- mandatory in any patient suspected of having ered, particularly if it is associated with pain. Treatment is with an anti- Other causes include demyelination, diabetes, cholinesterase such as pyridostigmine. Recovery of nerve function particu- Blow-out Fracture of the Orbit larly after compressive lesions can lead to a phe- nomenon known as aberrant regeneration. This A special cause of double vision following injury can manifest as atypical pupil or lid responses is the trapping of extraocular muscles,usually the on attempted eye movement. The patient experiences double vision on looking upwards and the limitation of movement is evident. Surgical Patients with this condition develop double intervention to repair the orbital wall defect vision because the extraocular muscles become might be required if the patient suffers from inltrated with inammatory cells. Patients Work usually starts by nding and classifying might also consult with a view to prenatal the disease in question in a large family or series testing, particularly if the disease leads to of families. The discovery and the unravell- narrowed down (by the use of linkage analysis ing of the role of numerous ocular disease genes followed by chromosome walking). This usually has also helped in our understanding of normal produces a region of the chromosome on which eye development and functioning. Once chromosome, the abnormal gene s position on the sequence of the gene is known, this can be the chromosome and its nucleotide sequence. The potential of the latter many disorders, we also now know the role the has been greatly improved by the project to abnormal gene plays in the pathogenesis of sequence the entire human genome. If different, one can exert an overriding Basic Genetic Mechanisms inuence and is said to be dominant. In order to be able to give advice about the Genetic disorders can be divided into three appearance of inherited disease in future gen- broad groups: erations,it is essential to have a basic knowledge of the mechanism of genetic transmission. The abnormalities of individual genes, which twenty-third pair comprises the sex chromo- are transmitted to offspring somes (the remainder being known as auto- abnormalities involving the interplay of somes). Pathological genes can carry abnormalities, In a woman, the sex chromosomes are the same which are transmitted to the offspring in the length but in a man, one is shorter than the same way as (other) normal characteristics. The shorter one is known as the Y In a given individual, the abnormal gene can chromosome and the longer one, which is the be recessive and masked by the other one of same as the female sex chromosome, is the X the pair. Genetic the disease, while expressivity refers to the clin- material is thus equally provided from each ical spectrum of severity of a particular genetic parent. The four important patterns of along the length of a chromosome and each one inheritance are: is known to bear special inuence on the devel- autosomal recessive opment of one or more individual characteris- tics. The two genes of the pair can be sex-linked recessive similar (homozygous) or different (heterozy- mitochondrial inheritance. When a Autosomal Recessive carrier marries a normal individual, 50% of the Inheritance offspring are carriers. Common dis- another abnormal one on the opposite chromo- eases inherited in this manner include sickle- some, it will have an effect, but if the opposite cell disease and cystic brosis. Recessive disease in clinical practice usually results from the mating of heterozygous Autosomal Dominant carriers. If the abnormal gene is represented by a, the disease will appear in the individual Inheritance with genetic conguration aa (homozygote) and not with the conguration aA (heterozy- When a gene bearing a defect or disease gives gote). When two heterozygotes mate, the likely rise to the disease even though the other one of offspring can be considered as in the diagram the pair is normal, it is said to be dominant. If a patient has recessively inher- affected heterozygote can, therefore, have 50% ited disease, his or her parents are likely to be of affected children when married to a normal normal but there might be brothers or sisters spouse. It is important to enquire abnormal dominant gene, all the offspring will whether the parents are blood relatives because be affected. Dominant inheritance can only be this greatly increases the likelihood of trans- shown with certainty if three successive genera- mission. If an individual with recessive disease tions show the disease and if about 5% of indiv- marries someone with the same recessive iduals are affected. Sex-linked Recessive X chromosome and the pattern of inheritance is termed X-linked recessive. Examples of this Inheritance type of inheritance are seen in ocular albinism and colour blindness. Retinitis pigmentosa It has been mentioned already that males have can also show this pattern in some families. Because of the affected and there is no father-to-son transmis- unpaired nature of much of the male sex sion of the disease. Genetics and the Eye 193 that it is possible to predict the likely disease moment of fertilisation. It should also be realised by changes in numbers or structure of chromo- that such predictions can only be based on somes. In most large with Down s syndrome have an additional centres, there are now genetic clinics in which chromosome, which is indistinguishable from time is devoted specically to the investigation chromosome 21. Brusheld s spots are sometimes seen in otherwise normal Mitochondria are the only organelles of the cell individuals. This leads to variable phenotypic Microscopic studies of the chromosomes them- expression. Examples include diabetes mellitus, selves have revealed that abnormal numbers of some malignancies and perhaps age-related chromosomes can be produced by a fault at the macular degeneration. In this way,a high local concentration can posterior segment is to give it systemically. This treatment drops cannot be discounted, particularly in sus- method has the drawback of systemic side ceptible individuals. This can be reduced by delivering the can precipitate asthma and slow the pulse rate drug to the posterior segment by local injection in elderly patients, and pilocarpine drops can either directly into the vitreous, along the cause sweating and nausea. The action of local orbital oor, within the sub-Tenon s space or in medications can be prolonged by incorporating the subconjunctival space.

Airborne dispersal may explain the low level of ende- mism seen for some fungi 140 mg malegra fxt otc, but the situation for those that do not have a signiWcant airborne stage is less clear purchase malegra fxt 140 mg without a prescription. There is very little evidence for co-evolution between fungi and their hosts in the Antarctic purchase 140 mg malegra fxt visa, and all of the fungi so far recovered from endemic Antarctic nema- todes have been identiWed as cosmopolitan species (Duddington et al. This may be the case with the Antarctic Neozygites, as although Alaskozetes is restricted to Southern latitudes (Convey 1998), the apparent host shift for Neozygites from prostigmatid mites to the oribatid species may be the result of a cosmopol- itan fungus being able to adapt in the absence of its usual host and under a diVerent compe- tition regime. This possibility could also explain other apparent host or environmental shifts seen with Antarctic fungi such as Lecanicillium lecanii and Rhizoscyphus ericae (Hughes and Lawley 2003; Upson et al. In particular the availability of liquid water may be more important to biological activity than increased temperature in Antarctic habitats (Kennedy 1993). These environ- mental changes may aVect the current interactions between the Antarctic mites and fungi, and a number of possible scenarios might occur. Increased temperatures and moisture with a longer summer season could allow a greater proportion of the mite life cycle to be undertaken in a year. It is however, unclear as to what level of change in population structure and environmental conditions would be necessary to change the existing interaction and lead to epizootics. Major changes in the population structure in the Antarctic are unlikely, but population structures on some sub-Antarctic islands and those further north could be aVected. However, there have been no targeted surveys for entomopathogens in these areas, and so the current range of occurrence and frequency of Neozygites sp. At least seven of the 40+ fungal species that include pathogens of Acari have been reported from the Antarctic environment (Table 1), where they have largely been isolated as viable cultures from soil or vegetation. These fungi may have the potential to infect the existing mite populations under less extreme environmental conditions, and they could provide future sources of infections in Antarctic arthropods as conditions change. Aerial studies have shown opportunities for colonisation by new fungal species, but it is likely that new colonisation is currently limited by low winter temperatures and a lack of available water together with limited opportunities for dispersal (Convey 2001). A third scenario is that climate change and increasing human activity (such as tourism) could increase the likelihood of colonisation and this could result in the introduction and estab- lishment of more aggressive mite pathogens. Changes in the radiation climate have already occurred with the regular formation of the Ozone hole over large areas of the Antarctic. Although there are no recorded eVects of increased ultraviolet radiation on terrestrial arthropods, the growth of fungi, cyanobacteria, algae and cryptograms is known to be aVected (Wynn-Williams 1994; Hughes et al. Conversely the conidia are relatively short-lived and so would have short exposure times. This adds a further uncertainty to any predictions regarding future Antarctic fungal-invertebrate interactions. The presence of the Neozygites and other potential mite pathogens provides a starting point for future changes, but the large number of environmental and functional uncertainties prevent any clear models being developed until more baseline data, particularly on the range and occurrence of the fungus in the population is available. Institute of Botany, Krakow Baiazy S, Wisniewski J (1982) Two species of entomopathogenic fungi on the myrmecophylic mite Trachy- uropoda coccinea (Michael, 1981) (Acari: Uropodina). Bull Pol Acad Sci, Ser Biol Sci 30:1 12 Diseases of Mites and Ticks 51 Baiazy S, Wisniewski J (1984) Records on some lower fungi occurring in mites (Acarina) from Poland. Acta Oecologia 15:43 53 Convey P (1998) Latitudinal variation in allocation to reproduction by the Antarctic oribatid mite, Alaskoze- tes antarcticus. Sydowia 44:39 122 Keller S (1997) The genus Neozygites (Zygomycete, Entomophthorales) with special reference to species found in tropical regions. Sydowia 49:118 146 Keller S (2006) Validation of the combination Apterivorax acaricida (Petch) S. Sydowia 58:75 Keller S, Petrini O (2005) Keys to the identiWcation of the arthropod pathogenic genera of the families Entomophthoraceae and Neozygitaceae (Zygomycetes), with descriptions of three new subfamilies and a new genus. Environ Entomol 20:731 735 Lawley B, Ripley S, Bridge P, Convey P (2004) Molecular analysis of geographic patterns of eukaryotic diversity in Antarctic soils. Xoridana (Zygo- mycetes: Entomophthorales) in mummiWed cassava green mites and the viability of its primary conidia. Mycotaxon 44:445 451 Onofri S, Zucconi L, Tosi S (2007) Continental Antarctic Fungi. J Invertebr Pathol 69:285 288 Steenberg T, Eilenberg J, Bresciani J (1996) First record of a Neozygites species (Zygomycetes: Entomoph- thorales) infecting springtails (Insecta: Collembola). Bull Br Mycol Soc 16:113 143 Wuczkowski M, Prillinger H (2004) Molecular identiWcation of yeasts from soils of the alluvial forest nation- al park along the river Danube downstream of Vienna, Austria ( Nationalpark Donauauen ). Biodivers Conserv 5:1271 1293 Diversity of acaropathogenic fungi in Poland and other European countries Stanisaw Baazy Ryszard Mietkiewski Cezary Tkaczuk Rudolf Wegensteiner Marta Wrzosek Originally published in the journal Experimental and Applied Acarology, Volume 46, Nos 1 4, 53 70. From among 33 species of fungi affecting mites only ve species of Entomophthorales were separated and the most numerous were Neozygites oridana mostly on Tetranychus urticae, N. The most frequent mite pathogens occurring in mite communities on plants and in wood infested by insects were of the genus Hirsutella. Until now 13 of their form-species have been recognized in these habitats, but only H. Tkaczuk (&) University of Podlasie, Prusa 14, 08-110 Siedlce, Poland e-mail: tkaczuk@ap. Wrzosek Department of Plant Systematics and Phytogeography, Warsaw University, Al. Although fungi affecting mites and insects generally belong to the same taxonomical entities, only little more than 50 species show acaropathogenic capabilities, compared to [1,000 actu- ally known insect pathogenic species excluding Laboulbeniales (Baazy 2000; Van der Geest et al. The rst cases of mite mycoses were described about 70 years after the recognition of the infective character of insect mycoses and this delay remained until the 1970s, except for a few subtropical and tropical institutes, where mycoses of mites had been included into some research, but usually on a very limited scale (e. In Poland the rst records on mite mycoses appeared in the 1970s, but during the last three decades they have been developed and widened continuously (Mietkiewski et al. The political and economical changes of the turn of the 1980s made it possible not only to accelerate these studies in Poland but also to enter into international cooperation and to stimulate acaropathogenic research in other European countries (a. Data on mite pathogens are scarce, hence recent investigations on mycoses of the two groups of host mites widens our knowledge about the diversity of fungal pathogens as well as their taxonomical afnity and host selectivity. Most material included here has been collected or identied in 2003 2007, and this paper is supplementary to three previous publications (Mietkiewski and Baazy 2003; Mietkiewski et al. Materials and methods Bark and wood samples were preliminarily investigated and selected in local laboratories. Further rearing and periodical checking for the appearance of mycosed arthropod indi- viduals, and subsequent analytical processing (isolation and identication of disease agents, their frequency, duration and succession) were performed in the Research Centre for Agricultural and Forest Environment of the Polish Academy of Sciences in Poznan. Quantitative estimations of the fungal pathogens share in mite mortality were done only in high prevalence cases. Fungi were preserved alive, but in cases of epizootics only representative strains were retained. For details on sampling methods and further Diseases of Mites and Ticks 55 treatment of collected material we refer to previous publications (Mietkiewski et al. In recent years attempts have been made to verify the patho- genicity of particular strains by articial infection of experimental host mites or other invertebrates (Baazy et al. On a small scale this research has also concerned mites from forest litter, moss and lichens covering tree logs and trunks, decayed tree hollows and occasionally abandoned bird nests. In the Siedlce area systematic collections were continued in 2003 2007 on different plants, mostly grasses, weeds and fruit trees.

Although these rates of skipped at a much higher rate that year order 140mg malegra fxt otc, making its catheter and ostomy use are not dramatic purchase generic malegra fxt from india, they are results diffcult to interpret (Table 17) 140mg malegra fxt with amex. The rates of indwelling catheter and ostomy use Direct Costs in male nursing home residents have remained stable Urinary tract infections in men are associated at 11. Men with pyelonephritis also missed health care expenditures for men and women with more total time from work than did women (11. Fluoroquinolones accounted for a large portion each ambulatory care visit or hospitalization for of these expenditures, in terms of both costs and orchitis, men missed an average of 3. Including expenditures on these excluded medications would increase total outpatient drug spending for urinary tract infections by Diabetes may also be associated with a component approximately 52%, to $146 million. Expenditures for male urinary tract infection (in millions of $) and share of costs, by site of service Year 1994 1996 1998 2000 Totala 811. However, the mean time personal costs for both individual patients and the lost from work by men is somewhat greater. Expenditures for male Medicare benefciaries for the treatment of urinary tract infection (in millions of $), by site of service, 1998 Site of Service Total Annual Expenditures Age < 65 Age 65+ Inpatient 70. Expenditures for male Medicare benefciaries age 65 and over for treatment of urinary tract infection (in millions of $) Year 1992 1995 1998 Total 436. How can health care delivery be optimized to provide high-quality care while simultaneously decreasing costs and complications? Additional research on health services, outcomes, economic impacts, and epidemiological factors is needed to answer these challenging questions. More care is rendered to when irritative urinary tract symptoms occur girls than to boys, at a ratio of 3 4 to 1. Because other factors can cause care increased during the 1990s despite shorter lengths similar symptoms, the presence of symptoms in the of stay. Likewise, the fnancial burden is probably much higher because it presence of leukocytes in the urine is not proof of includes costs for outpatient services, imaging, other infection. Diagnostic methods in which there is a comorbidity that predisposes a vary markedly and depend on presentation, clinical child either to infection or to greater morbidity due suspicion, medical history, and local practice patterns. In the young child, there can years of age), older children (3 to 10), and adolescents be signifcant overlap in the clinical presentations (11 to 17). The rest of the cases are distributed Alternatively, urine can be obtained by sterile primarily among Proteus mirabilis, Klebsiella catheterization or suprapubic needle aspiration. Less common However, both of these techniques are invasive and infectious agents include gram-positive cocci, such as frequently met with parental disapproval. Viral infections are under-recognized because obtained, urine is examined with a reagent dipstick of diffculties with culture and identifcation, but for the presence of nitrates and leukocyte esterase. The course is typically is used to evaluate for the presence of obstruction characterized by discomfort and irritative voiding or stones, which can greatly increase the severity symptoms with rapid resolution following the and sequelae of infection. The primary appearance of the kidney can also be altered by the risk is that of recurrence or persistence. Ultrasound can assist constipation or voiding dysfunction are particularly in localizing the site of infection in the presence of prone to recurrence; 10% of these children develop renal abscess, parenchymal edema (lobar nephronia), a rapid recurrence following the completion of a or pyonephrosis. Renal scarring can lead confrming acute pyelonephritis and later for assessing to renal insuffciency and subsequent hypertension. Bacterial virulence it is nearly universally recommended for identifying factors include adhesins, K-antigen, hemosysins, vesicoureteral refux or other anatomic abnormalities and colicin. Bacterial colonization of the perineum that may contribute to future infection risk. Adhesins are specialized structures that enable the bacteria to adhere to specifc receptors on the uroepithelium. Such attachment leads to ascension into the urinary tract and promotes tissue invasion, 216 217 Urologic Diseases in America Urinary Tract Infection in Children infammation, and tissue injury. Adhesins may also The exact mechanism by which constipation exerts help promote intestinal carriage of more virulent its infuence on voiding is unclear, but it frequently bacteria, leading to perineal colonization. The relatively short length of the female urethra Successful host defense depends on the proper has traditionally been blamed for the increased risk of functioning of the urinary system. In the past, there was concern that a tight of the urinary tract is the frequent and complete ring narrowed the urethra, often prompting urethral emptying of urine in a low-pressure environment. Current evidence indicates This effectively fushes out bacteria prior to their that urethral constriction is not a reproducible establishment of clinical infection. It is anatomy (the short urethra in females and the prepuce clear that male infants with an intact prepuce are at in males). Colonization of bacteria on the inner children presenting with febrile infections. Present preputial mucosa occurs, but it is not clear whether in approximately 1% of the asymptomatic population this is the etiology of infection (8). Refux also bypasses one of the host defense risk of urinary infection during their frst 6 months mechanisms against upper tract invasion by allowing compared with circumcised boys, in addition to a less virulent strains of bacteria to reach the kidney. A fuller discussion but important host risk factor that can contribute of this controversial subject is beyond the scope of this to increased morbidity, persistence, and recurrence. Dysfunctional infection is based on symptoms, positive culture, or voiding refers to a learned pattern of behavior both; how accurate the method of specimen collection surrounding voiding that frequently begins with is; how accurate the history is, especially in young voluntary holding. Alternatively, it can present as an atonic associated with fever; and what the baseline rate of bladder with infrequent voiding and high post-void circumcision is in the population. Frequently, dysfunctional year of life (boys and girls), cumulative incidence at voiding can be compounded by chronic constipation. Age differences were most prominent among Girls have an increased risk of febrile infection patients requiring hospitalization. The rate of in the frst year of life, then the risk steadily declines inpatient hospital stays was 6. Their risk of nonfebrile commercially insured infants than the rate among infections is higher during childhood than during older children, and 11 times higher than the rate infancy. It also refects more aggressive treatment patterns in the very young that Inpatient Care tend to include parental antimicrobials. Despite recent support for outpatient treatment centers contributed minimally, especially in the of pediatric pyelonephritis (13), these data indicate Medicaid population. From 1996 onward, the hospitalization rate centers more often than did children with commercial was at least 2. The female-to-male That children with Medicaid visited emergency ratio was at least 5:1 for each year analyzed. Urinary tract infections listed as primary diagnosis among children having commercial health insurance (left) and Medicaid (right) by visit setting and gender. The female-to- counts were low for this diagnosis in children, these male ratio for physicians offce visits by commercially counts and rates were derived by frst collapsing data insured children rose from 4. Circumcision is not a covered diagnosis in children, these counts and rates were service, and families insured through Medicaid may derived by frst collapsing data from the even years in not be able to afford to pay for it out-of-pocket; the 1994 2000 and then dividing by 4. In the offce setting, adolescents Isolated orchitis is extremely rare in the had lower visit rates than did either infants or older prepubertal male and in most cases is due to the children, regardless of insurance status (Tables 4 and extension of acute epididymitis into epididymo- 5). Most cases occur in adolescents and present 222 223 Urologic Diseases in America Urinary Tract Infection in Children Table 6. The primary differential diagnosis is usage in adolescents may represent an appropriate torsion of the testis or appendix testis.

No updated data on observed total prevalent cases are available for comparison in all European countries discount malegra fxt 140mg. It is realistic to state that trends similar to those in Italian data are present in the majority of European countries malegra fxt 140mg online. The relation in women might be caused by a higher exposure to risk factors in rich countries and also by the 4 recent implementation of an organised breast cancer screening programme (breast cancer being the main female cancer) cheap malegra fxt 140 mg on line. In conclusion, in countries with low health investments, showing similar incidence but low survival than rich countries, men die more than in richer countries. Eastern European countries have to promote actions against tobacco following the experience of other European countries and put attention to increasing trends in male cancer mortality. Hence: - the needs of cancer patients and prevalent cancer patients (especially elderly patients) are increasing. For this reason it is necessary to have full knowledge of the variation of health services demand as a function of cancer type, patient age and rehabilitation requirements. Once the demand for services is accurately assessed, services can be provided rationally according to available resources [14] - the demand for resources to follow-up cancer patients and identify and treat cancer recurrences is increasing. While this is happening, new knowledge is being acquired by genetic research and the reality of cancer is changing. A list of few major killer diseases changed into to a long list of deferent rare diseases, each requiring a specific treatment. These are the problems that an integrated and effective cancer control policy for Europe has to face. Experts from various fields of expertise contributed to the preparation of the recommendations of the Portuguese Presidency to the European Council and the Slovenian Presidency of 2008. Recommendations for cancer covered the three priority fields of Cancer Plans, Cancer Registries and Cancer Screening Programmes. Cancer screening Nation-wide screening programmes should be implemented for: breast cancer in women aged 50 and over (2- to 3 yrs intervals), cervical cancer in women aged 30 and over (5-year interval), colorectal cancer in persons aged 50 and over Nation-wide screening should not be implemented for other cancers unless and until 5 the evidence is strong Before implementing of a screening programme, predict the public health effects and the costs After implementation of screening maintain continuous evaluation of mortality and of screening processes (intermediate outcomes). European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer. Couffignal (Centre de Recherche Public Sant), Guy Berchem (Hmato-Cancrologie-Centre Hospitalier du Luxembourg); Malta: M. It is not actually a disease but rather a syndrome (a pattern of symptoms) which may be caused by an almost infinite number of cerebral and extracerebral diseases. Neuro-degenerative diseases and small vessel cerebro- vascular diseases account for most cases of dementia (Kurz, 2002). In this report, we will use the term dementia unless referring to a specific form of dementia such as Alzheimer s disease (which is the most common form) or vascular dementia etc. A great deal of research is being carried out all over Europe into the mechanisms involved in the development of dementia, risk factors/protective factors and possible future treatments. At this moment in time, there is no curative treatment for dementia although there are a few drugs which treat the symptoms of the disease and temporarily slow down the rate of cognitive decline. It affects about one person in 20 over 65, one in five over 80 and one in three over 90. According to Alzheimer Scotland (2006), as dementia is more common in older people, delaying the onset of the disease by five years would halve the number of people with dementia. This is extremely important in the light of predicted increases in the number of elderly people in the next few decades. It is therefore not possible to provide full details of all existing information in this report. We will then briefly examine the results of a prospective analysis of risk factors carried out in Canada by Lindsay et al. This is typically rich in vegetables, fruit, cereals and unsaturated fatty acids with a low intake of saturated fatty acids and moderate fish consumption. Nevertheless, it does clearly play a role in the development of cardiovascular disease and stroke. For these risk factors, no modification of risk was found by age, sex or ApoE4 allele status. Factors which were found to increase the risk of Alzheimer s disease were increasing age, few years of education and the ApoE4 allele. However, it is still unclear whether fewer years of education actually increases the risk or more years of education provide a kind of brain reserve which makes the symptoms less obvious with the result that the disease may go undetected for some time. Individual studies have reported gender differences linked to certain health determinants/risk factors. For example, Whitmer (2007) found that the increased risk of dementia associated with being overweight or obese was greater for women than for men. On the other hand, women who drank 3 or more cups of coffee per day were found to perform better on verbal and viso-spatial memory tasks than those who did not. Whilst this beneficial effect did not affect the incidence of dementia, the researchers (Ritchie et al, 2007) do not rule out the possibility that it might prolong the period of mild cognitive decline in women already in the process of developing dementia. Finally, an interesting study was carried out by Kivipelto et al (2006) which aimed to devise a simple technique to predict the risk of dementia in later life on the basis of risk factors which were present in middle age. With regard to the above-mentioned health determinants/risk factors, it is clear that there may be differences between Member States linked to different lifestyles. For example, in some countries the percentage of people who are obese, smoke, consume various amounts of alcohol or have a Mediterranean diet may differ. Nevertheless, we are unaware of any investigations regarding Member State differences in lifestyles and the incidence of dementia. However, the rates do not usually differentiate between different forms of dementia or different stages of the disease. Their work resulted in prevalence rates for men and women combined in 5 year age groups from 60 to 84 and for 85+. Their rates also differed depending on which region each country was classified as belonging to. The region Euro A covered countries in Western Europe, Euro B included countries in Eastern Europe with a low adult mortality rate and Euro C, countries in Eastern Europe with a high adult mortality rate. In terms of the actual number of new dementia cases per year for 2001, Ferri et al. However, 93 estimates vary considerably and whilst incidence seems to increase with age, actual estimates vary depending on which cases are included. Some exclude people with no diagnosis of dementia and some do not cover very mild dementia. Hospital admission is usually avoided if at all possible to provide care in another way. The reason for this is that hospital stays can be very stressful for people with dementia and can have a detrimental effect on their dementia e. Consequently, in most countries, people with dementia are not cared for in hospital. However, people with dementia may be admitted to hospital for observation, tests or other medical conditions or in the final stages of the disease.

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