[The effect of age and sex on factors associated with dementia]. / Efecto de la edad y el sexo en los factores asociados a la demencia.

INTRODUCTION: There is currently no cure for dementia and its prevention is considered to be crucial. The aim is to analyse the association between risk factors and dementia, and how this varies according to age and sex. PATIENTS AND METHODS: This cross-sectional study includes 1,048,956 people aged 65 and over. Data were obtained from the SIDIAP pseudonymised clinical database. The response variable was dementia and cases were identified using a validated algorithm. Exposure to the following risk factors was assessed: smoking, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, alcoholism, high blood pressure, hyperlipidaemia, diabetes, hyperthyroidism, Parkinson's disease, depressive disorder and rurality. Logistic regression models were estimated to assess the association between risk factors and dementia, and they were stratified by age, sex and both jointly. RESULTS: The association between a medical history of cerebrovascular disease, Parkinson, depressive disorder or hyperthyroidism and dementia was more pronounced in men. The inverse association between coronary heart disease, heart failure or smoking and dementia was significant only in women. A stronger association was observed in younger age groups for most risk factors, but hypertension, coronary heart disease, heart failure or smoking were negatively associated among the older age groups. CONCLUSION: Sex and age both condition the association between risk factors and dementia. We recommend promoting effective control of cardiovascular risk factors in order to prevent dementia.

TITLE: Efecto de la edad y el sexo en los factores asociados a la demencia.Introducción. Actualmente no existe ningún tratamiento curativo para la demencia por lo que se considera que su prevención es clave. El objetivo es analizar la asociación entre los factores de riesgo y la demencia, y su variación según la edad y el sexo. Pacientes y métodos. Este estudio transversal incluye a 1.048.956 personas de 65 años o más. Los datos se obtuvieron de la base de datos clínicos pseudoanonimizados SIDIAP. La variable respuesta fue la demencia y se identificaron los casos mediante un algoritmo validado. Se evaluó la exposición a los siguientes factores de riesgo: tabaquismo, enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardíaca, arteriopatía periférica, alcoholismo, hipertensión arterial, hiperlipidemia, diabetes, hipertiroidismo, Parkinson, trastorno depresivo y ruralidad. Se calcularon modelos de regresión logística para evaluar la asociación de los factores de riesgo y la demencia, y se estratificó por edad, sexo y ambos conjuntamente. Resultados. La asociación entre los antecedentes de enfermedad cerebrovascular, el Parkinson, el trastorno depresivo o el hipertiroidismo y la demencia fue más pronunciada en los hombres. La asociación inversa entre la enfermedad coronaria, la insuficiencia cardíaca o el tabaquismo con la demencia fue significativa sólo en las mujeres. Se observó una mayor asociación en los grupos de menor edad en la mayoría de los factores de riesgo. Conclusión. El sexo y la edad condicionan la asociación de los factores de riesgo y la demencia. Recomendamos promover el control eficaz de los factores de riesgo cardiovascular para prevenir la demencia.

Efecto de la edad y el sexo en los factores asociados a la demencia / The effect of age and sex on factors associated with dementia

Introducción: Actualmente no existe ningún tratamiento curativo para la demencia por lo que se considera que su prevención es clave. El objetivo es analizar la asociación entre los factores de riesgo y la demencia, y su variación según la edad y el sexo. Pacientes y métodos: Este estudio transversal incluye a 1.048.956 personas de 65 años o más. Los datos se obtuvieron de la base de datos clínicos pseudoanonimizados SIDIAP. La variable respuesta fue la demencia y se identificaron los casos mediante un algoritmo validado. Se evaluó la exposición a los siguientes factores de riesgo: tabaquismo, enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardíaca, arteriopatía periférica, alcoholismo, hipertensión arterial, hiperlipidemia, diabetes, hipertiroidismo, Parkinson, trastorno depresivo y ruralidad. Se calcularon modelos de regresión logística para evaluar la asociación de los factores de riesgo y la demencia, y se estratificó por edad, sexo y ambos conjuntamente. Resultados: La asociación entre los antecedentes de enfermedad cerebrovascular, el Parkinson, el trastorno depresivo o el hipertiroidismo y la demencia fue más pronunciada en los hombres. La asociación inversa entre la enfermedad coronaria, la insuficiencia cardíaca o el tabaquismo con la demencia fue significativa sólo en las mujeres. Se observó una mayor asociación en los grupos de menor edad en la mayoría de los factores de riesgo. Conclusión: El sexo y la edad condicionan la asociación de los factores de riesgo y la demencia. Recomendamos promover el control eficaz de los factores de riesgo cardiovascular para prevenir la demencia.(AU)

Introduction: There is currently no cure for dementia and its prevention is considered to be crucial. The aim is to analyse the association between risk factors and dementia, and how this varies according to age and sex. Patients and methods: This cross-sectional study includes 1,048,956 people aged 65 and over. Data were obtained from the SIDIAP pseudonymised clinical database. The response variable was dementia and cases were identified using a validated algorithm. Exposure to the following risk factors was assessed: smoking, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, alcoholism, high blood pressure, hyperlipidaemia, diabetes, hyperthyroidism, Parkinson’s disease, depressive disorder and rurality. Logistic regression models were estimated to assess the association between risk factors and dementia, and they were stratified by age, sex and both jointly. Results: The association between a medical history of cerebrovascular disease, Parkinson, depressive disorder or hyperthyroidism and dementia was more pronounced in men. The inverse association between coronary heart disease, heart failure or smoking and dementia was significant only in women. A stronger association was observed in younger age groups for most risk factors, but hypertension, coronary heart disease, heart failure or smoking were negatively associated among the older age groups. Conclusion: Sex and age both condition the association between risk factors and dementia. We recommend promoting effective control of cardiovascular risk factors in order to prevent dementia.(AU)

Salutogenic health promotion program for migrant women at risk of social exclusion.

BACKGROUND: Migrant women at risk of social exclusion often experience health inequities based on gender, country of origin or socioeconomic status. Traditional health promotion programs designed for this population have focused on covering their basic needs or modifying lifestyle behaviors. The salutogenic model of health could offer a new perspective enabling health promotion programs to reduce the impact of health inequities. This study evaluated the effectiveness of a salutogenic health promotion program focused on the empowerment of migrant women at risk of social exclusion. METHODS: A four-session salutogenic health promotion program was conducted over a period of 6 months. In a quasi-experimental pre-test post-test design, an ad hoc questionnaire was administered to 26 women to collect sociodemographic data, together with 5 validated instruments: Antonovsky's Sense of Coherence (SOC-13), Duke-UNC-11 (perceived social support), Quality of Life Short Form-36 (SF-36), Rosenberg's Self-Esteem Scale, and the Cohen et al. Perceived Stress Scale (PSS-10). Descriptive analysis and multiple linear regression models were performed. Statistical tests were considered significant with a two-tailed p value < 0.05. RESULTS: Participants had a low initial SOC-13 score (60.36; SD 8.16), which did not show significant change after the health promotion program. Perceived social support (37.07; SD 6.28) and mental quality of life also remained unchanged, while physical quality of life increased from 50.84 (SD 4.60) to 53.08 (SD 5.31) (p = 0.049). Self-esteem showed an increasing trend from 30.14 (SD 4.21) to 31.92 (SD 4.38) (p = 0.120). Perceived stress decreased from 20.57 (SD 2.91) to 18.38 (SD 3.78) (p = 0.016). A greater effect was observed at the end of the program in women with lower initial scores for SOC-13 and quality of life and higher initial scores of perceived stress. CONCLUSIONS: The health promotion program reduced perceived stress, increased physical quality of life and showed a trend toward increased self-esteem, especially among migrant women with multiple vulnerability factors. The salutogenic model of health should be considered as a good practice to apply in health promotion programs and to be included in national policies to reduce health inequity in migrant populations.

Derivation and validation of BOREAS, a risk score identifying candidates to develop cold-induced hypertension.

INTRODUCTION: Blood pressure increases in cold periods, but its implications on prevalence of hypertension and on individual progression to hypertension remain unclear. Our aim was to develop a pre-screening test for identifying candidates to suffer hypertension only in cold months among non-hypertensive subjects. METHODS: We included 95,277 subjects registered on a primary care database from Girona (Catalonia, Spain), with ≥ 3 blood pressure measures recorded between 2003 and 2009 and distributed in both cold (October-March) and warm (April-September) periods. We defined four blood pressure patterns depending on the presence of hypertension through these periods. A Cox model determined the risk to develop vascular events associated with blood pressure patterns. A logistic regression distinguished those nonhypertensive individuals who are more prone to suffer cold-induced hypertension. Validity was assessed on the basis of calibration (using Brier score) and discrimination (using the area under the receiver operating characteristics). RESULTS: In cold months, the mean systolic blood pressure increased by 3.3 ± 0.1 mmHg and prevalence of hypertension increased by 8.2%. Cold-induced hypertension patients were at higher vascular events risk (Hazard ratio=1.44 [95% Confidence interval 1.15-1.81]), than nonhypertensive individuals. We identified age, diabetes, body mass index and prehypertension as the major contributing factors to cold-induced hypertension onset. DISCUSSION: Hypertension follows a seasonal pattern in some individuals. We recommend screening for hypertension during the cold months, at least in those nonhypertensive individuals identified as cold-induced hypertensive by this assessment tool.

Protection from inflammatory disease in insulin resistance: the role of mannan-binding lectin.

AIMS/HYPOTHESIS: Decreased sensing of the innate immune system may lead to chronic activation of the inflammatory cascade. We hypothesised that mannan-binding lectin (MBL) deficiency may confer risk of obesity and insulin resistance. MATERIALS AND METHODS: We performed a cross-sectional study of MBL protein concentration (n=434) and MBL2 gene mutations (exon 1) (n=759) in association with obesity, markers of inflammation and insulin action (euglycaemic clamp, n=113), and a longitudinal study of MBL protein before and after weight loss in obese patients (n=10). We also studied the effects of MBL in vitro in muscle cells and circulating MBL-A (mouse equivalent of human MBL) in a mouse model. RESULTS: Among 434 consecutive non-diabetic men, the age-adjusted serum MBL concentration was lower in obese subjects than in lean subjects (median: 959 microg/ml [interquartile range: 116.8-2,044 microg/ml] vs 1,365 [467-2,513] microg/ml; p=0.01) and was accompanied by increased serum inflammatory markers. Insulin action correlated significantly with serum MBL (r=0.49, p<0.0001). Serum MBL concentration increased by a median of 110.2% after weight loss. The change in serum concentration of MBL was positively associated with the increase in insulin sensitivity (r=0.713, p=0.021). At least one MBL2 gene mutation was present in 48.2% of obese vs 39.3% of non-obese subjects (p=0.037). The plasma concentration of MBL-A was lower in insulin-resistant obese ob/ob mice, as was the glucose/insulin ratio. Incubation of rat soleus muscle with human MBL markedly increased fatty acid oxidation. CONCLUSIONS/INTERPRETATION: These findings suggest that MBL, previously thought only to be involved in inflammation and immune system function, affects metabolic pathways.

[Social welfare and health services in the Fraylesca Region in Chiapas: the use of prenatal care services]. / Bienestar social y servicios de salud en la Región Fraylesca de Chiapas: el uso de servicios de atención prenatal.

OBJECTIVE: To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. MATERIAL AND METHODS: In 1994, a health survey was performed on a random sample of 1,100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n = 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. RESULTS: Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (Cl 95% 1.12-5.44). CONCLUSIONS: Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.