RESUMO
INTRODUCTION: Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. METHODS: We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0 IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3 IU/l and FT4 >23 pmol/l; (3) Overt hypothyroidism: TSH >4.8 IU/l, FT4 <13 pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3 IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8 IU/l, FT4: 13-23 pmol/l. RESULTS: The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). CONCLUSIONS: The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.
Assuntos
Envelhecimento/psicologia , Cognição/fisiologia , Demência/epidemiologia , Demência/psicologia , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/sangue , Escalas de Graduação Psiquiátrica Breve , Transtornos Cognitivos/sangue , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Demência/sangue , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Doenças da Glândula Tireoide/sangue , Glândula Tireoide/metabolismoRESUMO
OBJECTIVE: The aim of this survey was to assess the correlation between leptin and insulin sensitivity (IS) in cases of diffuse toxic goiter. DESIGN, PATIENTS, MEASUREMENTS: This is a descriptive study on patients with diffuse toxic goiter (DTG) assessing their body mass index (BMI), serum leptin concentrations, circulating insulin (area under the curve (AuC) of insulin), average insulin level, thyroid hormones, thyroid stimulating hormone (TSH), glycemia and IS (using a hyperinsulinemic-euglycemic clamp and the homeostasis model for assessment of insulin resistance (HOMA-IR) before and after euthyroidism induced with metimazol. RESULTS: The average patient age was 35 years old (range 31-40 years), height was 157 cm (range 151-160 cm), glycemia was 4.3 +/- 0.3 mmol/L and TSH 0.1 +/- 0.1 microU/mL. Average leptin level was 11.3 +/- 2.8 ng/dL, the average insulin level was 10.13 +/- 3.7 mIU/mL and the AuC for insulin was 50.6 +/- 18 microIU x min/mL. No correlation was found between leptin and BMI, thyroid hormones and glycemia. While controlling for the BMI effect, a correlation was found between leptin and TSH (r = -0.77, p = 0.042), as well as between leptin and insulinemia (r = 0.93, r2 = 0.86, p = 0.001) independently from the state of thyroid function. There was a tendency for a high correlation between leptin and the insulin AuC (hyperthyroidism: r = 0.89, p = 0.056; euthyroidism: r = 0.99, p = 0.056). A negative correlation was found between IS and the insulin AuC (rho = -0.58, p = 0.18). There was a high tendency for correlation between leptin and IS when the BMI effect (HOMA-IR: r = 0.70, p = 0.12; PHE: r = -0.55, p = 0.26) was taken into consideration. CONCLUSIONS: There is a high tendency for a negative correlation between leptin and IS when the BMI effect is controlled. There is a high tendency for a positive correlation between leptin and insulin and TSH.
Assuntos
Bócio/sangue , Resistência à Insulina , Leptina/sangue , Adulto , Glicemia/metabolismo , Composição Corporal , Índice de Massa Corporal , Humanos , Insulina/sangue , Hormônios Tireóideos/sangue , Tireotropina/sangueRESUMO
A cross-sectional survey of the seroprevalence of hepatitis B virus (HBV) markers among healthy people was conducted in San Juanito, a rural community in the northern state of Chihuahua, Mexico. The overall prevalence in 970 people was 6.6% for antibody to hepatitis B core antigen. There was an age effect on the prevalence of HBV infection, and a gradual increase in prevalence was observed in patients up to the age of 40 years. Those subjects with a history of dental procedures had a 2-fold higher risk for HBV infection (odds ratio [OR], 2.4; 95% confidence intervals [CI], 1.01-5.86), and there was a 74% increased risk for each blood product transfusion (OR, 1.74; 95% CI, 1.09-2.77). Horizontal transmission seems to be the major source of endemicity in San Juanito because no woman was a chronic carrier. To lower HBV transmission rate, an adequate active screening program for blood donors should be implemented, together with a universal infant immunization program.
Assuntos
Antígenos do Núcleo do Vírus da Hepatite B/sangue , Hepatite B/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Transmissão de Doença Infecciosa , Feminino , Hepatite B/transmissão , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Saúde da População Rural , Estudos Soroepidemiológicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Silent myocardial ischemia is a growing world health problem. It has been related to factors that promote an increase in myocardial oxygen demand or affect coronary vasomotor tone. Coronary artery disease has shown an increasing trend in Mexico in this century. HYPOTHESIS: The aim of the study was to estimate the strength of the association between some risk factors and the occurrence of silent myocardial ischemia. METHODS: A cross-sectional study was conducted and 249 individuals were screened by 24-h Holter electrocardiogram. Silent myocardial ischemia was diagnosed in patients with painless transient ST-segment depression. All subjects were interviewed for coronary risk factors and total serum cholesterol was measured. RESULTS: Silent ischemia was diagnosed in 115 patients (46%), who were older (59 +/- 9 vs. 57 +/- 11 years; p = 0.01). In a logistic regression analysis, a lower risk for silent ischemia was found in patients with thrombolysis [odds ratio (OR) 0.28; 95% confidence interval (CI 95%) 0.14-0.53], or those who followed their medical treatment (OR 0.16; CI 95% 0.04-0.68). The major risk factors were hypercholesterolemia (OR 1.6; CI 95% 0.9-2.9) and more severe coronary artery disease (OR 2.5; CI 95% 1.1-5.7). CONCLUSIONS: Some coronary risk factors are related to silent ischemia. It is still important to diagnose this entity, but modification of its related risk factors should be kept in mind to diminish its occurrence and its severe consequences.
Assuntos
Isquemia Miocárdica/epidemiologia , Colesterol/sangue , Angiografia Coronária , Estudos Transversais , Eletrocardiografia Ambulatorial , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Razão de Chances , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To analyze the association of hypertension and upper body fat distribution on the occurrence of non-insulin-dependent diabetes mellitus in Mexicans. MATERIAL AND METHODS: It was a population-based cross-sectional study in Cuajimalpa, a district of Mexico City. A total of 1066 subjects were home interviewed, and attended our clinic for fasting plasma glucose sampling, blood pressure and anthropometric measurements. Diabetes was defined according to the World Health Organization criteria, and hypertension as a blood pressure equal to or greater than 140/90. The ratio of upper to lower body skinfolds was used to estimate body fat distribution. RESULTS: The prevalence of diabetes was 12.0%. There was a significant positive trend in the age and sex adjusted prevalence of diabetes according to the magnitude of hypertension (p = 0.0006) and upper body fat distribution (p = 0.007). The age and sex adjusted prevalence in normotensive subjects with lower body fat distribution was 7.1% (95% confidence interval 5.9-8.2) whereas it was 19.9% (CI 17.0-22.8) in those with hypertension and upper body fat distribution. The prevalence of diabetes in Mexicans was high and it may be related to a genetic susceptibility for an insulin resistance syndrome. CONCLUSIONS: These results indicate that there is a dose response effect in the association of hypertension and upper body fat distribution with diabetes in Mexicans, and that there may be an interaction in the effect of hypertension and body fat distribution in this syndrome.
Assuntos
Tecido Adiposo/anatomia & histologia , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Somatotipos , Adulto , Idoso , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/genética , Feminino , Humanos , Hipertensão/genética , Resistência à Insulina , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Dobras Cutâneas , SíndromeRESUMO
OBJECTIVE: To determine the prevalence of tobacco consumption among the active insured population of the Mexican Social Security Institute. MATERIAL AND METHODS: A cross-sectional study in which the active insured population from the 36 political delegations was interviewed by means of a structured and self-applicable questionnaire on tobacco consumption, age of initiation, amount of cigarettes consumed and suspension. RESULTS: The sample consisted of 45 117 subjects, of which approximately half were men and half women. Smoking prevalence in men was 40% and in women, 17.6%. Prevalence was highest in the north of the country. There is an effect of age on tobacco consumption and more than half started smoking during adolescence. CONCLUSIONS: Smoking prevalence was found to be high, however, the average number of cigarettes is low. Suspension index is low. Public health measures are necessary to diminish this addiction.
Assuntos
Fumar/epidemiologia , Previdência Social , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Abandono do Hábito de Fumar/estatística & dados numéricos , Previdência Social/estatística & dados numéricos , Inquéritos e QuestionáriosAssuntos
Portador Sadio/parasitologia , Entamoeba histolytica/fisiologia , Entamebíase/epidemiologia , Abscesso Hepático Amebiano/epidemiologia , Animais , Entamebíase/mortalidade , Interações Hospedeiro-Parasita , Humanos , Incidência , Abscesso Hepático Amebiano/mortalidade , México/epidemiologia , PrevalênciaAssuntos
Anticorpos Antiprotozoários/análise , Entamoeba histolytica/imunologia , Entamebíase/epidemiologia , Imunoglobulina A/análise , Proteínas e Peptídeos Salivares/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Estudos Transversais , Entamebíase/diagnóstico , Entamebíase/imunologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Saúde da População RuralRESUMO
Prognosis after an acute myocardial infarction is closely related to the severity of coronary obstruction, and the residual functionality of left ventricle, which may be evaluated by the ejection fraction. To evaluate the utility of the ejection fraction and some cardiovascular risk factors, as predictors of a second myocardial infarction and delayed death, in those patients with a first acute myocardial infarction, 161 hospitalized patients were included in the study. The occurrence of a second myocardial infarction or death after the first month was evaluated. All patients were followed for 1 to 51 months, and the ejection fraction through a transthoracic echocardiogram was measured. 119 men and 42 women were included in the study, with a total of 3802 person-months of follow-up. The incidence rate for a second myocardial infarction was 0.01052 month,-1 and the mortality rate was 0.00342 month-1. In a Cox survival analysis model, ejection fraction was a major prognostic index and those subjects with an ejection fraction below 40% had a seven fold higher risk for a second myocardial infarction. Diabetes mellitus and hypertension were major predictors of a delayed death after a first myocardial infarction. Ejection fraction is the most related variable to the occurrence of a second myocardial infarction, and together with a history of diabetes and hypertension are good predictors of a delayed death after a first myocardial infarction. The identification of subjects with a poor prognosis may allow to establish specific preventive measures. Ejection fraction is useful to categorize patients according to their prognosis.
Assuntos
Doença das Coronárias/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Doença Aguda , Adulto , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Complicações do Diabetes , Ecocardiografia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Prognóstico , Fatores de Risco , Volume Sistólico , Análise de SobrevidaRESUMO
The occurrence non-insulin dependent diabetes mellitus has increased during the second half of this century in Mexico as well as in other countries. American Indians have one of the highest prevalences in the world, but there are few studies that have estimated the occurrence of diabetes in Mexican Indians. The authors conducted a cross-sectional study in Huautla, Oaxaca, Mexico, to estimate the prevalence of diabetes in Mexican Mazatecos Indians, as well as its related risk factors. A total of 798 subjects were interviewed, and 16 diabetics were found, the prevalence of diabetes was 2.01%. The prevalence increased with age, but declined in those 65 years of age or older, mainly in women. The prevalence was slightly higher in women (2.2%) than in men (1.6%). There was a relation of diabetes with obesity, central body fat distribution, a family history of diabetes and hypertension. The prevalence is low if compared with the notified prevalence in the country, but there are certain age groups where its occurrence is similar to those living in an urban area. There is a need of intervention measures to prevent an epidemic such as the one seen nowadays among American Indians.