Sex Hormones and Diabetes in 45- to 74-year-old Men and Postmenopausal Women: The Hispanic Community Health Study.

Previous studies demonstrated associations of endogenous sex hormones with diabetes. Less is known about their dynamic relationship with diabetes progression through different stages of the disease, independence of associations, and role of the hypothalamic-pituitary gonadal axis. The purpose of this analysis was to examine relationships of endogenous sex hormones with incident diabetes, prediabetes, and diabetes traits in 693 postmenopausal women and 1015 men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos and followed for 6 years. Baseline hormones included estradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and, in men, testosterone and bioavailable testosterone. Associations were analyzed using multivariable Poisson and linear regressions. In men, testosterone was inversely associated with conversion from prediabetes to diabetes (incidence rate ratio [IRR] for 1 SD increase in testosterone: 0.821; 95% CI, 0.676, 0.997; P = 0.046), but not conversion from normoglycemia to prediabetes. Estradiol was positively associated with increase in fasting insulin and homeostatic model assessment of insulin resistance. In women, SHBG was inversely associated with change in glycosylated hemoglobin, postload glucose, and conversion from prediabetes to diabetes (IRR = 0.62; 95% CI, 0.44, 0.86, P = 0.005) but not from normoglycemia to prediabetes. Relationships with other hormones varied across glycemic measures. Stronger associations of testosterone and SHBG with transition from prediabetes to diabetes than from normoglycemic to prediabetes suggest they are operative at later stages of diabetes development. Biologic pathways by which sex hormones affect glucose homeostasis await future studies.

A Cross-sectional Study of Depressive Symptoms and Diabetes Self-care in African Americans and Hispanics/Latinos With Diabetes: The Role of Self-efficacy.

PURPOSE: The purpose of this study is to examine the relationship between depressive symptoms and diabetes self-care in African American and Hispanic/Latino patients with type 2 diabetes and whether the association, if any, is mediated by diabetes-related self-efficacy. METHODS: The sample included self-report baseline data of African American and Hispanic/Latino patients with type 2 diabetes who were aged ≥18 years and enrolled in a diabetes self-management intervention study. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire. The Summary of Diabetes Self-care Activities measured engagement in healthy eating, physical activity, blood glucose checking, foot care, and smoking. The Diabetes Empowerment Scale-Short Form assessed diabetes-related psychosocial self-efficacy. Indirect effects were examined with the Baron and Kenny regression technique and Sobel testing. RESULTS: Sample characteristics (n = 250) were as follows: mean age of 53 years, 68% women, 54% African American, and 74% with income <$20 000. Depressive symptoms showed a significant inverse association with the self-care domains of general diet, specific diet, physical activity, and glucose monitoring in the African American group. In Hispanics/Latinos, depression was inversely associated with specific diet. Self-efficacy served a significant mediational role in the relation between depression and foot care among African Americans. CONCLUSIONS: Self-efficacy mediated the relationship between depression and foot care in the African American group but was not found to be a mediator of any self-care areas within the Hispanic/Latino group. In clinical practice, alleviation of depressive symptoms may improve self-care behavior adherence. Diabetes education may consider inclusion of components to build self-efficacy related to diabetes self-care, especially among African American patients.

Nativity and serum concentrations of antioxidants in Mexican American children: a cross-sectional study.

There is limited research on the effect of immigration on biological markers of nutrition among children of Mexican origin in the United States. The purpose of this cross-sectional study was to examine data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994), on a national and representative sample of 1559 Mexican American children, 4-16 years of age, and assess the associations of country of birth with serum concentrations of carotenoids, vitamin A, and vitamin E. In multiple regression analyses, Mexico-born Mexican American children had significantly higher serum concentrations of α-carotene, ß-carotene, ß-cryptoxanthin, lutein/zeaxanthin, vitamin A, and vitamin E than their counterparts who were born in the United States after adjustment for age, sex, poverty income ratio, level of education of family reference person, body mass index, total serum cholesterol, serum cotinine, total energy intake, and vitamin/mineral consumption. Our findings confirm evidence for a negative effect of immigration/acculturation on dietary quality in this population. These findings also suggest that immigrant Mexican families should be encouraged to maintain their consumption of fruits and vegetables. Prospective studies are needed to further assess the effects of immigration/acculturation on diet and other health outcomes in children of Mexican origin and immigrants.

Correlates of self-care in low-income African American and Latino patients with diabetes.

OBJECTIVE: This study aimed to examine diabetes self-care (DSC) patterns in low-income African American and Latino patients with Type 2 diabetes, and identify patient-related, biomedical/disease-related, and psychosocial correlates of DSC. METHOD: We performed cross-sectional analysis of survey data from African Americans and Latinos aged ≥18 years with Type 2 diabetes (n = 250) participating in a diabetes self-management intervention at 4 primary care clinics. The Summary of Diabetes Self-Care Activities captured the subcomponents of healthy eating, physical activity, blood sugar testing, foot care, and smoking. Correlates included patient-related attributes, biomedical/disease-related factors, and psychosocial constructs, with their multivariable influence assessed with a 3-step model building procedure using regression techniques. RESULTS: Baseline characteristics were as follows: mean age of 53 years (SD = 12.4); 69% female; 53% African American; 74% with incomes below $20,000; and 60% with less than a high school education. DSC performance levels were highest for foot care (4.5/7 days) and lowest for physical activity (2.5/7 days). Across racial/ethnic subgroups, diabetes-related distress was the strongest correlate for DSC when measured as a composite score. Psychosocial factors accounted for 14% to 33% of variance in self-care areas for both racial/ethnic groups. Patient characteristics were more salient correlates in Hispanic/Latinos when examining the self-care subscales, particularly those requiring monetary resources. CONCLUSIONS: Important information is provided on specific DSC patterns in a sample of ethnic/racial minorities with Type 2 diabetes. Significant correlates found may help with identification and intervention of patients who may benefit from strategies to increase self-care adherence.

The effects of acculturation on healthy lifestyle characteristics among Hispanic fourth-grade children in Texas public schools, 2004-2005.

BACKGROUND: Childhood obesity is a national epidemic that disproportionately affects Hispanic children. Evidence suggests that increased acculturation among this population adversely affects diet and other healthy lifestyle characteristics, leading to higher rates of overweight and obesity. Healthy lifestyle characteristics must be understood in order to prevent or decrease overweight and obesity among Hispanic children. METHODS: Using the School Physical Activity and Nutrition (SPAN) study, we examined cross-sectional data on healthy lifestyle characteristics collected in Texas public schools from Hispanic fourth-grade children in 2004-2005. We calculated adjusted odds ratios and associated confidence intervals using multivariate logistic regression analyses to analyze the association between acculturation and healthy lifestyle characteristics among Spanish-speaking Hispanic children compared to English-speaking Hispanic children. RESULTS: Spanish-speaking Hispanic boys consumed more milk and fruit than English-speaking Hispanic boys (milk: adjusted odds ratio [AOR]: 1.7, p = .02; fruit: AOR: 2.5, p = .0001). The likelihood that Spanish-speaking Hispanic boys and girls did not know that there is a relationship between overweight and health problems were 2 times greater (boys: AOR: 1.7, p = .03; girls: AOR: 2.2, p = .006) than their English-speaking Hispanic counterparts. Likelihood of weight loss attempts was greater among Spanish-speaking Hispanic boys than English-speaking Hispanic boys (AOR: 1.9, p = .04). CONCLUSIONS: Results are mixed. Lower levels of acculturation appear to be associated with both positive and negative healthy lifestyle characteristics, depending on sex. These findings have important implications for school health policies and programs and should be distributed to school administrators.

The effect of low-cost modification of the home environment on the development of respiratory symptoms in the first year of life.

BACKGROUND: Previous studies have suggested that environmental exposures may be related to the development of respiratory symptoms in early life. Intervention studies, however, have not produced consistent findings. OBJECTIVE: The Peer Education in Pregnancy Study examined the effect of home environment intervention with pregnant women at risk for having children with asthma on the development of respiratory symptoms in their infants. METHODS: A total of 383 pregnant women whose unborn child had a first-degree relative with an allergic history were randomized to 1 of 2 intervention groups, both of whom received general health education, smoking cessation advice, and encouragement to breastfeed. In addition, the intensive education group received 3 home visits focused on home environment modification. Home assessment was performed at baseline and after 1 year of follow-up. Respiratory symptoms were identified during the first year of life. RESULTS: Families in both intervention groups showed significant changes in several environmental factors, with significant differences between the 2 groups in insects other than cockroaches, use of mattress covers, and washing in hot water. Children in the intensive education group had slightly lower incidence rates of respiratory symptoms, but few differences were statistically significant. CONCLUSIONS: The results of this study do not provide strong support for a primary intervention focused on general modification of the home environment during pregnancy for high-risk children. It does not address the effects of more aggressive approaches or of interventions targeting individual environmental factors.

Prenatal exposure to acetaminophen and respiratory symptoms in the first year of life.

BACKGROUND: Prevalence of asthma in developed countries increased between the 1970s and the 1990s. One factor that might contribute to the trends in asthma is the increased use of acetaminophen vs aspirin in children and pregnant women. OBJECTIVE: To examine relationships between in utero exposure to acetaminophen and incidence of respiratory symptoms in the first year of life. METHODS: A total of 345 women were recruited in the first trimester of pregnancy and followed up with their children through the first year of life. Use of acetaminophen in pregnancy was determined by questionnaire and related to incidence of respiratory symptoms. RESULTS: Use of acetaminophen in middle to late but not early pregnancy was significantly related to wheezing (odd ratio, 1.8; 95% confidence interval, 1.1-3.0) and to wheezing that disturbed sleep (odds ratio, 2.1; 95% confidence interval, 1.1-3.8) in the first year of life after control for potential confounders. CONCLUSION: This study suggests that use of acetaminophen in middle to late but not early pregnancy may be related to respiratory symptoms in the first year of life. Additional follow-up will examine relationships of maternal and early childhood use of acetaminophen with incidence of asthma at ages 3 to 5 years, when asthma diagnosis is more firmly established.

Dietary differences among women of Polish descent by country of birth and duration of residency in the United States.

OBJECTIVES: Changes in breast and gastric cancers and coronary artery disease among people of Polish descent after migration to the United States suggest there may be potentially modifiable factors affecting incidence of these diseases. We examined relationships of dietary factors associated with these diseases with stage of migration among Polish women in Chicago. DESIGN: Women of Polish descent (N = 396) were selected from Polish women's social organizations. Women completed a modified Health Habits and History Questionnaire. SETTING: The questionnaire was completed either at the participant's home or at a Polish social organization. PARTICIPANTS: Participants ranged in age from 17-81 years, and included women born in Poland or the United States, who had at least one parent of Polish. INTERVENTIONS: Participants were stratified by country of birth and migration period (1935-1979, 1980-1989, 1990-1997). MAIN OUTCOME MEASURES: The average daily intake of food groups and nutrients was assessed using multiple linear regression. RESULTS: We found statistically significant differences by birth country for 19 of 34 nutrients, 4 of 7 food groups, and for 21 nutrients, and 5 food groups among the different migration tertiles. CONCLUSIONS: Women from Poland and more recent migrants had generally more nutritious intakes, compared to US-born women, or earlier migrants. APPLICATIONS/CONCLUSIONS: There are significant dietary differences among women of Polish descent that vary by duration of US residency and birth country. Women with dietary intakes which place them at higher risk for cancers and cardiovascular disease could be targeted for interventions to lower their disease risk.

Experiencia en hernioplastía inguinal con anestesia local / Inguinal hernioplasty experience using local anesthesia

Objetivo: Evaluar la utilidad de la cirugía ambulatoria con anestesia local en pacientes con patología herniaria inguinal. Material y métodos: Se realizó un estudio descriptivo tipo serie de casos, entre abril de 1996 y marzo de 1999, en el Servicio de Cirugía de la Clínica Fiori. Se intervinieron 1,167 pacientes por patología de pared abdominal de las cuales 432 correspondieron a pacientes intervenidos por patología herniaria inguinal, de ellos 372 fueron operados con anestesia local, los cuales fueron incluidos en el estudio. Las técnicas quirúrgicas empleadas fueron las de Bassini y McVay, con un tiempo operatorio promedio de 30 minutos y un control a los 3 días post-cirugía. Resultados: El 72.9 por ciento de la patología herniaria inguinal se presentó en los pacientes entre los 31 y 70 años de edad. Solo el 2.6 por ciento (10 pacientes) presentaron complicaciones post-operatorias, 6 con recidivas de hernia inguinal, 2 con infección de herida operatoria, 1 con seroma y 1 con hematoma, ninguno resultó ser de gravedad; y 97.4 por ciento (362) no presentaron ninguna complicación. No hubo complicaciones anestésicas. Conclusiones: La hernioplastia inguinal con anestesia local es efectiva, segura y económica.

Korean American Men's Perceptions about Smoking-Related Symptomatology: Implications for Intervention.

This study examines what midlife and older (age 45 to 74) Korean American men who are current or former cigarette smokers think cause symptoms or health problems that may be related to smoking cigarettes. The study also examines how those perceptions influence attitudes and behaviors regarding smoking cessation. Separate focus groups were conducted with seven current smokers and nine former smokers in the Korean language in a Korean American. Current smokers experienced few symptoms or health problems that they attribute to smoking, and they generally do not regard smoking as a cause of symptoms or health problems. Former smokers generally quit smoking in response to experiencing a wide range of symptoms or health problems that they attribute to smoking or that they believe smoking exacerbates. A pervasive theme among both groups is that health is a function of a person's physical constitution. The perception is that those born with a strong or special physical constitution are able to smoke and be healthy; persons with a weak physical constitution or who are predisposed to be ill should not smoke or should quit smoking. Smoking-cessation interventions for midlife and older Korean American men should take these findings into account.

Experiencia en hemorroidectomías aplicado en la Clínica Fiori / Experience in haemmorrhoidectomy at the clinica Fiori

Objetivo: Evaluar la utilidad de la cirugía ambulatoria con anestesia local en pacientes con patología hemorroidal. Material y métodos: Se realizó un estudio prospectivo, transversal, entre abril de 1996 y marzo de 1999, en el servicio de cirugía de la Clínica Fiori. Se intervinieron 260 pacientes por patología hemorroidal, de ellos 229 pacientes fueron sometidos a hemorroidectomía con anestesia local, los que fueron incluidos en el estudio. La técnica quirúrgica utilizada fue la de Milligan y Morgan con un tiempo operatorio de 20 minutos; y control a los 3 días. resultados: El 69.4 por ciento de patología hemorroidal se observó entre los 31-60 años de edad. Sólo el 1.7 por ciento (4 pacientes) presentaron complicaciones post-operatorias, 2 pacientes con sangrado leve y 2 con hemorroides residuales, ninguno resultó ser de gravedad; y el 98.3 por ciento (225 pacientes) no presentaron ningún tipo de complicaciones. No hubo accidentes anestésicos. Conclusión: La hemorroidectomía con anestesia local es efectiva y segura.

Mortalidad en los Servicios de Cirugía General del Hospital Nacional "Guillermo Almenara Irigoyen" IPSS / Mortality at General Surgery Services at National Hospital \"Guillermo Almenara Irigoyen\"

Entre octubre '86-agosto '88, hubo 177 defunciones en el servicio de Cirugía General del HNGAI (IPSS), sobre un total de 6,007 ingresos, dando una mortalidad de 2.95 por ciento. Los pacientes varones predominan sobre las mujeres en relación 3:1. La edades más afectadas estuvieron sobre los 50 años. La mayoría de pacientes procedían del mismo servicio, un tercio tenía antecedentes quirúrgico previo, 31 murieron sin ser operados, las neoplasias fueron el 47 por ciento de las causas de muerte (Cáncer gástrico, pancreático, vesícula y vías biliares en orden de frecuencia), luego la patología inflamatoria con 21 por ciento (colecistopatías y pancreatitis). Las operaciones de urgencia fueron el 35 por ciento y las Programadas el 65 por ciento. Las condiciones preoperatorias más observadas fueron Anemia, deshidratación con desequilibrio hidro-electrolítico e hipertensión arterial. Las complicaciones intraoperatorias fueron paro cardiorrespiratorio, hipotensión y lesiones de vísceras intrabdominales; entre las post-operatorias el disbalance ácido-base, insuficiencia renal y sepsis, 27 pacientes fueron reintervenidos por dehiscencia de anastomosis, abceso residual y perforación intestinal. El tiempo entre Ingreso-Operación y Operación-Fallecimiento varió entre 1-84 días y 3 horas 67 días, respectivamente. Hubo baja incidencia de necropsias (2.50 por ciento).

Aspectos anatomopatológicos del Leiomioma uterino en el Hospital "Guillermo Almenara Irigoyen" I.P.S.S / Anatomopathological Approach to uterine Leiomioma in the Hospital \"Guillermo Almenara Irigoyen\" I.P.S.S

En el Servicio de Patología del Hospital "Guillermo Almenara Irigoyen", se recibieron desde mayo de 1981 a setiembre de 1982, 314 especímenes quirúrgicos (que tuvieron al utero como órgano principal) procedentes del servicio de ginecología del mismo hospital. En ellos se estudió la presencia de leiomiomas uterinos, observándose que cada 2 especímenes uno correspondió a dicho tumor. Las edades fluctuaron entre los 36 a 50 años. De los 139 especímenes que histológicamente no tenían leiomiomas, 44 venían con diagnóstico clínico pre-operatorio de tal. En tanto, en los 175 especímenes que si tenían leiomioma uterino confirmado, 21% no venía con dicho diagnóstico. La localización topográfica del leiomioma en el utero fue predominantemente intramural (61%), seguido de submucoso y subseroso. El cambio patológico secundario más frecuente fue calcificación distrófica (6 casos), encontrándose asimismo 2 casos de degeneración sarcomatosa. Dentro de la patología asociada con más frecuencia al tumor, encontramos cervicitis crónica (100%), salpingitis crónica inespecífica (45.34%) y adenomiosis (18.3%). Creemos que es muy alta la asociación con salpingitis crónica inespecífica, lo cual merece un estudio posterior