A soft systems approach of asthma management in children based on therapeutic education and e-learning.

One of the most common respiratory chronic diseases is asthma, with 5-16 % of world prevalence. In chronic disease, prevention, diagnosis, management, and palliation are the strategies for a care model; the patient-self management is fundamental with the so-called therapeutic education (TE) to train the patient in the necessary skills. The challenge of TE grows when the patient is a child or a person with special needs, even more in public health care in low- and middle-income countries. This is a problematic human situation, that needs soft system thinking. In this research, the analytic hierarchy process was used to determine the perceived importance of the factors that affect children's asthma health care in a public health institution in Mexico. The soft systems methodology (SSM) was applied to learn about the disease self-management, in order to obtain activities models and an action plan. According to AHP, human resources and education were percived as the most important among the factors that affect children health care within the institution. The perceived importance of two main subfactors (human resources training and TE) was around 34 %, which emphasizes the need to generate strategies for the improvement of the education of patients and health care providers. In MSS, the rich vision, the CATWOE, the root definition, and an activities model were proposed, including the application of an instructional design methodology (ADDIE) for the development of learning objects of asthma for children. Desirable and feasible actions and recommendations include the update of the national clinical practice guides, the use of control measures such as the Asthma Control Test, and a daily asthma diary to register the daily status of the breathing capacity, the drug administration, and the potential trigger events. The proposed model can be used as part of a systemic patient-and-family centered approach for chronic care model (CCM), particularly in diseases unsuitable for prevention interventions.

Características de replicación y supervivencia del virus de viremia primaveral de la carpa (SVCV) aislado en México / Replication and survival traits of spring viremia of carp virus (SVCV) isolated in Mexico

RESUMEN Objetivo. Realizar el aislamiento del virus de la viremia primaveral de la carpa (SVCV) en ejemplares de carpa común (Cyprinus carpió), evaluar su crecimiento en diferentes tipos de células, así como la supervivencia viral a diferentes temperaturas. Materiales y métodos. Diez carpas de entre 400 500 gramos de una laguna del centro de México fueron procesadas para el diagnóstico de SVCV mediante aislamiento en cultivo de células y RT-PCR semianidado. El virus obtenido se inoculó en células EPC, BF-2, CHSE-214 y RTG-2 para determinar diferencias de crecimiento de SVCV. Además, se evaluó la supervivencia del virus conservado a temperatura ambiente (TA 20-25°C), refrigeración (REF 4°C) y congelación (CONG -80°C) hasta once meses. Los órganos internos se procesaron para análisis histológico. Resultados. Los peces analizados no presentaron signos externos sugestivos de enfermedad, pero interna e histopatológicamente se observaron lesiones sugestivas de infección sistémica. SVCV fue aislado en células EPC y BF-2 y confirmado por RT-PCR semianidado. SVCV únicamente indujo CPE en células EPC y BF-2 y fue negativo en RTG-2 y CHSE-214. El virus conservado a TA perdió viabilidad después de cuatro meses post infección (mpi), siendo total a seis mpi; mientras REF y CONG fueron estables durante los once meses de estudio. Conclusiones. La infección subclínica por SVCV fue confirmada en carpas que presentaron lesiones histológicas asociadas a esta infección. SVCV únicamente causó CPE en células EPC y BF-2 y el virus conservó su viabilidad a 4°C y -80°C hasta once meses; mientras que a TA se perdió en seis meses.

ABSTRACT Objective. To perform the isolation of spring viremia of carp virus (SVCV) in common carp (Cyprinus carpió) and evaluate its growth in different cell types and viral survival at different temperatures. Materials and methods. Ten carps of between 400-500 grams of a lagoon in central Mexico were processed for diagnosis of SVCV by isolation in cell culture and by RT-PCR. The virus obtained was inoculated into EPC, BF-2, CHSE-214 and RTG-2 cells to determine differences in virus growth; the survival of virus stored at room temperature (TA 20-25°C), refrigeration (REF 4°C) and freezing (CONG -80°C) up to eleven months was also evaluated. Internal organ samples were processed for histological analysis. Results. The fish analyzed did not show external signs suggestive of disease but internally and histopathologically lesions suggestive of systemic infection were observed. SVCV was isolated in EPC and BF-2 cells and confirmed by semi-nested RT-PCR. SVCV only induced CPE in EPC and BF-2 cells and was negative in RTG-2 and CHSE-214. The virus conserved at TA lost viability after four months post-infection (mpi), being total at six mpi; while REF and CONG were stable during the eleven months. Conclusions. Subclinical SVCV infection was confirmed in carp that presented histological lesions associated with this infection; SVCV only caused CPE in EPC and BF-2 cells; and the virus kept in refrigeration and at -80°C retained its viability up to eleven months; while TA was lost in six months.

Therapeutic Patient Education with Learning Objects Improves Asthma Control in Mexican Children.

One of the most common chronic diseases that causes missed school days and workdays is pediatric asthma, producing education, health and economic delays in low and middle-income countries. A patient-centered remarkable therapeutic strategy in the prevention and treatment of chronic diseases is the Therapeutic Patient Education (TPE) which denotes an outstanding difference in the outcomes, from the awareness, to the personal treatment adaption to prevent crises. In this paper, an intervention of TPE with learning objects (LOs) of a pediatric asthma course, designed to train the uncontrolled patient and the caregiver as a team on the specific knowledge to self-control the disease, was carried out at a health facility in Mexico. The Asthma Control Test (ACT) was used and the learning performance was evaluated with formative quizzes. A randomized controlled trial was designed, with pairs of children patients and caregivers during 60 days; the control group was trained with the usual approach, receiving general information about the disease. ACT measures showed statistical significance for the TPE group after the use of the LOs, achieving a controlled state, while the control group did not show difference. Also, the intervention group obtained a higher score in learning performance assessment. The users learned how to avoid risks, the personal triggers of the patient, how to correctly use the different treatments and accessories, consequently, they learned how to self-manage the disease. Our study also confirmed that control of asthma is not only a matter of knowledge, but financial issues to afford the treatment.

Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study.

PURPOSE: The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS: A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS: There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS: The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.

Milk fatty acid profile from cows fed with mixed rations and different access time to pastureland during early lactation.

Milk fatty acid (FA) profiles were determined in Holstein cows (n = 27) fed total mixed rations (TMR) ad libitum (G0) or diet composed by TMR (50% dry matter [DM] offered) plus grazing of pasture with 6 hr of access time to paddock in one session (G1) or 9 hr in two sessions (G2) at 45 days in milk (DIM). Moreover, milk FA was determined at 65 DIM when G0 cows turned out to G1 diet without adaptation period (Post-G0), G1 remained as controls. Milk FA was quantified using gas chromatography and mass spectrometry. Preformed FA at 45 DIM was greater (+27%) for G2 than G0 cows (p < .05). Stearic acid (C18:0) was 30% greater for G2 cows (p < .05). De novo FA was lowest for G2 cows (p < .05). Conjugated linoleic acid (CLA) did not differ (p < .12), while vaccenic acid (C18:1trans) was twofold greater for grazing treatments (p < .01). Linolenic acid [C18:3(n-3)] was greatest for G2 and lowest for G0 cows (p < .01). Omega 6 FA was greater for G0 than grazing cows, mainly due to linoleic acid [18:2cis(n-6); p < .05]. These results determined that n-6/n-3 ratio was almost threefold greater for G0 than grazing cows (p < .001). When diet of G0 cows changed to include pasture (Post-G0), preformed FA increased (p < .05), explained mainly by the increase (p < .05) of stearic (C18:0) and C18:1trans, while de novo FA tended to decrease (p < .1). Moreover, the amount of CLA and C18:3(n-3) tended to increase (p < .1) in Post-G0 cows. Offering 50% of dietary DM from pasture modified milk FA profile in early lactation potentially beneficial for human health. When TMR-fed cows were turned out to 50% pasture, milk FA profile reflected dietary change without need of an adaptation period.

Health status and behaviors among adults residing in rural Dominican Republic.

INTRODUCTION: The rapidly increasing burden of chronic diseases linked to adequacy of healthcare services and individual health behaviors is a key determinant of global public health. Given demographic aging and the accompanying health transition, chronic diseases in low and middle income communities of the Dominican Republic are likely to increase significantly. The objective of this article was to report on efforts in surveillance of health conditions and behaviors in underserved rural Dominican communities. METHODS: A modified 30 item, language-sensitive health survey was randomly administered to 117 adult participants (18 years and older) during a health fair held at three rural villages from March to April 2009 in the rural San Cristobál region of the Dominican Republic. Descriptive analyses of select health conditions and behavior variables from all completed surveys were tabulated. RESULTS: Adult participant ages ranged from 18 to 79 years (mean ± standard deviation; 34.0 ± 2.1), height from 1.4 to 2.0 m (1.7 ± 0.1), weight from 41.8 to 100.0 kg (66.2 ± 1.7) and BMI from 15.2 to 46.2 (24.2 ± 0.7). Overall, 69.2% of the sample self-reported their general health status to be fair to poor. The top three chronic diseases included: high blood pressure (35.8%), diabetes (15.0%), and asthma (14.2%). In all, 33.4% reported current smoker status and 61.7% were classified as heavy alcohol drinkers. CONCLUSION: Considerable variation was found in the self-report of health conditions and behavioral characteristics among those individuals that attended the health fair. Documenting these important health indicators in the rural communities has the potential to inform the development of surveillance activities and prevention efforts for future health education interventions.

Timing of patent ductus arteriosus treatment and respiratory outcome in premature infants: a double-blind randomized controlled trial.

OBJECTIVE: To determine whether "early" ibuprofen treatment, at the onset of subtle patent ductus arteriosus (PDA) symptoms, would improve respiratory outcome in premature infants compared with "expectant" management, with ibuprofen treatment only when the PDA becomes hemodynamically significant (HS). STUDY DESIGN: We conducted a randomized double-blind controlled trial of infants with gestational ages 23 to 32 weeks and birth weights 500 to 1250 g who had echocardiography for subtle PDA symptoms (metabolic acidosis, murmur, bounding pulses). Infants were then randomized to "early" treatment (blinded ibuprofen; n = 54) or "expectant management" (blinded placebo, n = 51). If the PDA became HS (pulmonary hemorrhage, hypotension, respiratory deterioration), infants received open label ibuprofen. Infants with HS PDA at enrollment were excluded from the study. Respiratory outcomes and mortality and major morbidities were determined. RESULTS: "Early" treatment infants received ibuprofen at median age of 3 days; infants in the "expectant group" in whom HS symptoms developed (20%) received ibuprofen at median of 11 days. A total of 49% of "expectant" infants never required ibuprofen or ligation. No significant differences were found in the primary outcome (days on oxygen [O(2)] during the first 28 days), death, O(2) at 36 weeks, death or O(2) at 36 weeks, intestinal perforation, surgical necrotizing enterocolitis, grades III and IV intracranial hemorrhage, periventricular leukomalacia, sepsis or retinopathy of prematurity. CONCLUSION: Infants with mild signs of PDA do not benefit from early PDA treatment compared with delayed treatment.

Influencias de la actividad humana sobre la costa de la ciudad de Comodoro Rivadavia, prov. de Chubut, Argentina

Se analizan las variaciones inducidas por la actividades humanas en la costa de la ciudad de Comodoro Rivadavia, prov. de Chubut. Comparando las fotografías aéreas de la zona portuaria de la ciudad, surge un ritmo de erosión de 1,2 m/año para el intervalo 1983-1995. El artículo analiza las causas de esta erosión y concluye que la principal causante, es la falta de provisión de sedimentos

Influencias de la actividad humana sobre la costa de la ciudad de Comodoro Rivadavia, prov. de Chubut, Argentina

Se analizan las variaciones inducidas por la actividades humanas en la costa de la ciudad de Comodoro Rivadavia, prov. de Chubut. Comparando las fotografías aéreas de la zona portuaria de la ciudad, surge un ritmo de erosión de 1,2 m/año para el intervalo 1983-1995. El artículo analiza las causas de esta erosión y concluye que la principal causante, es la falta de provisión de sedimentos

Contenido en algunos nutrientes del alga marina comestible Monostroma undulatum Wittrock de la costa patagónica argentina / Chemical composition and seasonal fluctuations of the edible green seaweed, Monostroma undulatum, Wittrock, from the Southern Argentina coast

The chemical composition of green seaweed, Monostroma undulatum, Wittrock, growing in the Southern Argentina coast, was studied. Samples were collected in Puerto Deseado, province of Santa Cruz (47 degrees 45'L.S., 65 degrees 55'L.W.), from October to December 1999 and 2000. It has been analyzed six sample during this period. Algae were washed with sea water and dried at room temperature for 24 hs. Moisture, nitrogen, lipids and ashes were determined according to AOAC; fiber (total, soluble and insoluble), according to Lahaye. After mineralization with nitric acid, sodium and potassium were determined by flame photometry, calcium by complexometric method, and phosphorus by Gomori's method. The ranges expressed per 100 g dry algae were: protein (Nx6.25): 12.89-21.85; ashes (g): 33.92-40.05; lipid (g): 0.32-1.47; total fiber (g): 14.36-19.6; digestible carbohydrates (calculated by difference) (g): 20.86-32.48; sodium (g): 7.39-13.11; potassium (g): 1.38-3.18; calcium (mg): 149-226; phosphorus (mg): 190-447; Vitamin C (mg): 159-455. These results show that this green seaweed is an important source for protein, fiber, macronutrients minerals and vitamin C, during the macroscopic period. There was an important fluctuation that must be taken into account to consider the commercial collection to use it in human nutrition.

Comparison of the def index with Nyvad's caries diagnostic criteria in 3- and 4-year-old Colombian children.

PURPOSE: The aims of this research were to determine the epidemiological profile of dental caries in 3- and 4-year-old preschool children living in Bogotá, Colombia, and to compare two different caries indices--the standard def and Nyvad's new caries diagnostic criteria. METHODS: The children were screened by two calibrated examiners who first brushed the children's teeth and air dried them for 5 seconds before they were examined. The diagnostic criteria used were the standard def-t and def-s and the def-t and def-s of the new caries diagnostic system proposed by Nyvad. The chi-square test2 was used with a significance level of 5%. RESULTS: Prevalence of caries was 70% using the standard def-t criteria and 97% with the criteria proposed by Nyvad. The standard def-t and def-s were 3.3 and 5.7, respectively, and the def-t and def-s with the Nyvad citeria were 8.7 and 14.3, respectively. CONCLUSIONS: Prevalence of caries was high, indicating that the population studied had a high disease rate. The results obtained with the more detailed Nyvad new caries diagnostic criteria were higher than the ones obtained with the standard def-t index, both for teeth and surfaces.

[Contraception knowledge and practices in pregnant adolescents]. / Conocimientos y prácticas anticonceptivas en adolescentes embarazadas.

The purpose of this article is to describe the knowledge and the background in the use of contraceptive methods in 100 pregnant adolescents in the prenatal care of the Hospital General "Dr. Manuel Gea González". In our study it was showed a lack of knowledge regarding the methods during the first sexual intercourse in the half of cases. At the time of the interview, only one-third of the adolescents had a suitable knowledge on at least one constraceptive method. It is very important for pregnant adolescents to have access to sex education including the use of contraceptive methods. This in turn, should impact positively to postpone the next pregnancy.

Gonadotropins at menopause: the influence of obesity, insulin resistance, and estrogens.

UNLABELLED: Obese, postmenopausal women have lower FSH levels. To determine whether this is due to higher estrogen exposure, we compared feedback gonadotropin sensitivity and its relation to insulin resistance in four groups of obese and lean, postmenopausal women. Group one was treated with 400 mg troglitazone (TG) daily for two weeks; 150 clomiphene citrate (CC) was added daily for the second week. Group two received 150 mg CC daily for a week. Group three received 1000 mg metformin (MET) daily for two weeks, with 120 mg raloxifene (RAL) added during the second week. Group four received 120 mg RAL for a week. Before and after each period, a serum pool was obtained from samples taken every minute during a 10 ml interval. The women recruited for this study were categorized as obese or lean based on BMI >/= 29 or BMI < 29, respectively. Obese, menopausal women had lower FSH (45.5 IU/l) and LH (16.2 IU/l) values than those of lean (64.1 IU/l and 23.0 IU/l), but the obese menopausal women had higher leptin, DHEAS, glucose, insulin, and HOMA-IR levels. Log [FSH] was associated with BMI (r = -0.53, P < 0.000001) and number of pregnancies (r = -0.37, P = 0.0009). TG treatment did not change HOMA-IR or gonadotropin levels, but DHEAS and androstenedione levels decreased significantly. CC alone or together with TG, diminished FSH (-7.9 and -9.2) and LH (-2.5 and -3.6) concentrations, with a greater reduction in lean women. MET reduced glucose and the HOMA-IR index without affecting gonadotropin or steroid levels. CONCLUSIONS: obese, menopausal women have lower FSH levels due to greater estrogen exposure, by mechanisms unrelated to insulin resistance.

[Sociodemographic factors associated with depression in pregnant adolescents]. / Factores sociodemográficos asociados a depresión en adolescentes embarazadas.

The objective of this study is to determine the frequency of depression among pregnant adolescents and explore the potential risk factors associated to the depression. The sample comprised 59 pregnant teenagers recruited from the Program for Pregnant Adolescents in the Hospital General "Dr. Manuel Gea Gonzalez". All subjects completed the Beck Depression Inventory (BDI) and a sociodemographic and medical questionnaire. The frequency of depression was 39%. Sociodemographic correlates of depression were not identified using ratios and 95% confidence limits. Results indicate that the depression is common among pregnant teenagers. Adequate prenatal cares including screening for depression symptoms and development of treatment programs for affected pregnant adolescents are of particular importance for young mothers. In further studies is necessary to explore the impact of family environment.

[Obstetric characteristics of adolescent pregnancy]. / Características obstétricas de la adolescente embarazada.

Obstetrical characteristics of pregnant adolescents. The aim of the present study was to determine the obstetrical characteristics of pregnant adolescents and to evaluate if the high risk comes from biological factors associate to their age or not. The obstetrical complications and the perinatal results were not different in relation from other groups, with exception of the minors of fifteen years in which the age constitutes an important risk. Nevertheless, the adolescent has other risks to the health such as the risk of acquiring sexual transmission diseases including HIV/AIDS. The child of a teen mother are also more likely to die in infancy, between the first month and the first year of life. Adolescents need information and services to protect their sexual and reproductive health.

[Contents of various nutrients, minerals and seasonal fluctuations in Porphyra columbina, an edible marine algae from the Argentine Patagonian++ coast]. / Contenido de algunos nutrientes, minerales y variaciones estacionales en Porphyra columbina, alga comestible de la Costa Patagónica argentina.

Porphyra columbina (Rodophyta Bangiales), one of the most important edible seaweeds, grows abundantly in the southern Argentine coast. Their mineral content and seasonal fluctuations were determined because there is no national data about their nutritional value. Samples were collected from April 1993 to February 1994 from Golfo San Jorge (30 Km South of Comodoro Rivadavia). Algae were washed with sea water and dried at room temperature (20-2 degrees C) for 24 hs, following the local processing procedure. Moisture and ashes were determined according to A.O.A.C. After mineralization with nitric acid sodium and potassium were determined by flame photometry; calcium, magnesium and iron by atomic absorption spectrophotometry (AAS); and phosphorus by Gomori's method. The results, expressed per 100 g dry algae showed the following values: moisture content: 7.03 to 11.00 g/100 g; ashes: 16.18 to 22.70 g/100 g; sodium: 3.18 to 6.41 g/100 g; potassium 1.24 to 1.96 g/100 g; magnesium: 600 to 836 mg/100 g; phosphorus: 78 to 276 mg/100 g; calcium: 63 to 108 mg/100 g and iron: 3.9 to 26.4 mg/100 g. The results of composition of algae as manufactured in the region showed important seasonal differences, with the highest values of ashes, sodium, potassium and magnesium in winter season (June and July).

Infection Studies of Mycosphaerella fijiensis on Banana and the Control of Black Sigatoka with Chlorothalonil.

Infection studies with Mycosphaerella fijiensis, causal agent of black Sigatoka disease of banana (Musa AAA), demonstrated that the abaxial leaf surface is the primary infection site. Inoculation of banana plants with M. fijiensis ascospores on the abaxial surface of young leaves resulted in disease symptoms in 100% of the leaves inoculated within 18 to 30 days; whereas only 5% of the leaves inoculated on the adaxial surface showed black Sigatoka symptoms within 10 weeks. Disease symptoms appeared more rapidly on the new, emerging leaves than on the first and second fully expanded leaves. Application of chlorothalonil (1.08 kg a.i. ha-1) to the abaxial surface of emerging leaves resulted in 99 to 100% disease control in the treated area. When the emerging leaf was not sprayed until fully expanded, disease control was reduced to 76 to 80%. Application of chlorothalonil to the adaxial surface of banana leaves had little or no impact on disease control. Chlorothalonil arrested hyphal growth when applied to banana leaves after ascospores had already germinated and reduced the rate of lesion expansion when applied to the abaxial leaf surface after symptom appearance. Chlorothalonil was less effective than systemic fungicides in reducing production of M. fijiensis pseudothecia in infected tissue. When systemic and protectant fungicides were applied to infected leaf tissue, none of the fungicides affected the viability of ascospores that were discharged from pseudothecia produced in that tissue. For successful control of black Sigatoka with chlorothalonil, deposition of the fungicide on the abaxial leaf surface is essential.

Detection of Chlorothalonil in Dew Water Following Aerial Spray Application and Its Role in the Control of Black Sigatoka in Banana.

A standardized bioassay measuring the growth inhibition of Aspergillus niger in vitro allowed the detection of small concentrations (0.1 to 20 µg/ml) of chlorothalonil present in dew water on both the adaxial and abaxial surface of banana leaves in a commercial plantation receiving aerial sprays. Chlorothalonil concentrations detected in dew water on the banana leaf surface were within the range of concentrations required to prevent Mycosphaerella fijiensis (causal agent of black Sigatoka) ascospore germination in laboratory bioassays. When 9-cm-diameter banana leaf disks inoculated with M. fijiensis ascospores were immersed for 4 h in water containing 0.1 to 0.6 µg of chlorothalonil per ml, ascospore germination was inhibited by 96.9%. The EC50 values for inhibition of ascospore germination were between 0.01 and 0.03 µg/ml for chlorothalonil and between 3.2 and 3.7 µg/ml for mancozeb. Following a 4-h exposure to chlorothalonil and mancozeb, and subsequent removal of the fungicides by a washing step, ascospores failed to germinate, indicating that both fungicides are fungicidal to M. fijiensis, not fungistatic. Recovery analysis of chlorothalonil spray droplet deposits and active ingredient on deposition cards in the field during aerial spray applications indicated that detectable fungicide deposition on the abaxial leaf surface occurs only when the banana leaf-target is vertical or nearly so. The significance of this observation in relation to the control of black Sigatoka with protectant fungicides is discussed.

Menopause in normal and uncomplicated NIDDM women: physical and emotional symptoms and hormone profile.

OBJECTIVE: To compare the physical characteristics, emotional symptoms and metabolic conditions of menopausal women with and without non insulin dependent diabetes mellitus (NIDDM). METHODS: We studied 100 menopausal women 45-72 years of age, 51 with and 49 without NIDDM, in a cross-sectional design. Biological characteristics were collected and emotional symptoms were assessed with a modified Hamilton and Bech-Rafaelsen scale, scoring depression, anxiety, non specific symptoms of depression (NSSD) and the empty nest syndrome (ENS). Weight, body mass index (BMI), waist/hip and abdomen/hip ratios and percent of body fat were registered. The sulfoconjugated form of the dehydroepiandrosterone (DHEAS), follicle stimulating hormone (FSH), cortisol and fasting, as well as postprandial insulin/glucose ratios, were measured in blood. RESULTS: Women with NIDDM had earlier mean age for menopause, more central obesity and less peripheral fat; they had also more prevalent emotional symptoms than non diabetic menopausal women. In women with NIDDM, symptoms were associated with years since diagnosis and with BMI. In non diabetic menopausal women schooling and attitudes to sexuality were associated with symptoms. FSH was inversely associated with BMI in both diabetic and non diabetic women; postprandial insulin/glucose ratio was correlated with central obesity in the group without NIDDM and cortisol with sitting systolic blood pressure (SBP) in the group with NIDDM. CONCLUSION: The diagnosis of NIDDM and its metabolic conditions were associated with an increased frequency of some symptoms in menopausal women.

High-frequency FSH and LH pulses in obese menopausal women.

We studied the pulsatile luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretory patterns, at early or intermediate years of menopause in seven normal women with different degrees of obesity, taking blood samples every minute for 40 min to 2 h. The hormones were assayed with an immunoradiometric assay (IRMA) system, analyzing with the cluster pulse algorithm. All women showed hormone pulses every 8-10 min. In five of them were found periods of discrete pulses with oscillations of high amplitude alternating with periods of pulses of low amplitude. In two cases, the high-frequency oscillatory pattern with low amplitude was found around low mean levels of 22.8 and 25.7 IU/L. The LH oscillatory pattern also had a high frequency, but at a lower level, giving a high FSH/LH ratio. The coincidence index of FSH with LH peaks was 76.6%. We concluded that at menopause, the frequency of FSH and LH secretion increases with a high FSH/LH ratio. Obese menopausal women may have the same high-frequency oscillatory patterns, but at low levels.