Age, menopause and hormone replacement therapy influences on cardiovascular risk factors in a cohort of middle-aged Chilean women.

OBJECTIVE: To determine the prevalence of obesity and other cardiovascular risk factors (RF) in middle-aged women, to correlate them with each other, and to describe the prevalence of such a RF and their changes with aging, menopause and Hormone Replacement Therapy (HRT) in a cohort of Chilean workers. MATERIAL AND METHOD: In 1991-1992 cardiovascular RFs were assessed in 467 women between 40 and 59 who were not taking HRT at that time. Five years later these women were re-evaluated. RESULTS: Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the more prevalent RF. These RF become more prevalent with age. In the second control, 5 years later, hypertension (20.9%), obesity (27.3%), smoking (20.8%) and diabetes (5.9%) were observed increased. Dyslipidemia did not changed, although triglyceride levels rose from 125.9+/-56.4 to 136.8+/-63.5 mg/dl (P<0.01). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5-years follow-up from 3.8 to 35%, and related to its use a decrease in LDL-cholesterol and an increase in HDL-cholesterol levels were detected. CONCLUSION: Middle-aged women included in this cohort have a high prevalence of RF; these deteriorate with age, but no with menopause. HRT improves the lipid profile.

Factores de riesgo cardiovascular en una cohorte de mujeres de edad media / Cardiovascular risk factors in a cohort of middle-age women

Background: It is generally accepted that menopause significantly modifies cardiovascular risk. The effects of hormone replacement therapy (HRT) on this risk remain controversial. Aim: To study the prevalence of cardiovascular risk factors (RF) in middle-aged women and their changes with aging, menopause and hormone replacement therapy (HRT). Material and methods: cardiovascular risk factors were assessed in 576 women aged 40 to 59 years in 1991-92. Five years later, 467 of these women were reassessed. Results: Sedentarism (87.2 percent), dyslipidemias (71.5 percent), high blood pressure (13.5 percent), obesity (13.1 percent), smoking (12.4 percent) and diabetes (2.8 percent) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9 percent, the prevalence of obesity increased to 27.3 percent, smoking increased to 20.8 percent and diabetes to 5.9 percent. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9Ý56.4 to 136.8Ý63.5 mg/dl (p <0.001). Sedentarism dropped to 58.8 percent. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8 percent to 35 percent. Women on HRT experienced 3 percent decrease in LDL-cholesterol and 9 percent increase in HDL-cholesterol levels. Conclusions: Middle aged women included in this cohort have a high prevalence of RF. There is a deterioration with age, but not with menopause. HRT improves the lipid profile

Do women using hormone replacement treatment have less pre-existing cardiovascular risk.

BACKGROUND: Several studies have suggested that women who choose to use hormone replacement therapy (HRT) already, before starting this therapy, have a better cardiovascular risk profile than those who do not use it. Some of these studies contain factors of confusion and biases, such as HRT users' greater educational achievement or physical activity, which could have led to wrong conclusions. AIM: To study a cohort, without confounding factors in order to analyse whether the cardiovascular risk profile is different in women who choose to use HRT. MATERIAL AND METHODS: Coronary risk factors of 387 women between 45 and 64 were studied. This study was carried out at the Unit for the Preventive Medical Examination of the South Metropolitan Health Service in Santiago (Chile) during the annual check-up. The first evaluation was in 1991-1992; with a second evaluation 5 years later. Of all the women, 174 (45%) never received hormones (Group A), 124 (32%) were HRT users at the time (Group B), and 89 (23%) were former-users (Group C). RESULTS: No differences were found between the three groups for age, body mass index (BMI), educational background, alcohol consumption, smoking or physical activity. Blood pressure was similar in the three groups. No significant differences were found in total cholesterol (A, 221.7+/-42.2; B, 228.2+/-47.0; and C, 227.3+/-44.9 mg/dl); high density lipoprotein (HDL, A, 53.5+/-13.2; B, 51.8+/-12.8; and C, 54.0+/-12.4 mg/dl); low density lipoprotein (LDL, A, 141.7+/-38.9; B, 148.5+/-43.1 and C, 148.3+/-43.8 mg/dl); triglycerides (A, 134.5+/-67.9; B, 141.0+/-66.1; and C, 127.3+/-68.5 mg/dl) and glucose plasma levels (A, 90.5+/-32.2; B, 87.7+/-15.3; and C, 85.0+/-8.8 mg/dl). CONCLUSIONS: Our results suggest that women who choose to use HRT have a cardiovascular risk profile, before starting the therapy, similar to those who do not use it.

Progressive deterioration of central components of auditory brainstem responses during postnatal development of the myelin mutant taiep rat.

Auditory brainstem responses (ABRs) were evaluated during the postnatal development (P10-P180) of taiep rats, neurological mutants characterized by early abnormal myelin development and subsequent demyelination of the CNS. The disorder is produced by an autosomal recessive mutation trait that affects the oligodendrocytes but not the Schwann cells. After onset of ABRs (P12-P14), taiep rats and their nonaffected heterozygous littermates that served as controls showed a similar pattern of maturation for wave I. The central waves (In-IV) showed significantly longer latencies in the mutants. By P60-P180, the later waves (III and IV) were frequently difficult to discern. From the onset of ABRs, the interpeak latency I-IV, corresponding to the central conduction time (CCT) of the auditory pathway, showed in taiep rats significantly longer values than controls. After an initial reduction, proportional to that of control rats, the CCT value increased progressively during the second month of the mutants' lives. The electrophysiological results of the present study strongly support the hypothesis that mutation in the taiep rat impairs neuromaturation of the central auditory pathway in the brainstem by affecting the myelination process in the CNS.

Dysmyelination, demyelination and reactive astrogliosis in the optic nerve of the taiep rat.

Taiep is an autosomal recessive mutant rat that shows a highly hypomyelinated central nervous system (CNS). Oligodendrocytes accumulate microtubules (MTs) in association with endoplasmic reticulum (ER) membranes forming MT-ER complexes. The microtubular defect in oligodendrocytes, the abnormal formation of CNS myelin and the astrocytic reaction were characterized by immunocytochemical and ultrastructural methods during the first year of life. Optic nerves of both control and taiep rats were processed by the immunoperoxidase method using antibodies against tubulin, myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP). Taiep oligodendrocytes are strongly immunoreactive against tubulin, indicative of a significant accumulation of microtubules. Early differentiated oligodendrocytes observed with electron microscopy show that MT-ER complexes are mainly present in the cell body. This defect increases during the first year of life; oligodendrocytes show large MT-ER complexes projected within oligodendrocyte processes. Using anti-MBP, there was a progressive reduction of immunolabeling in the myelin sheaths as taiep rats grew older. Ultrastructural analysis revealed severely dysmyelinated axons with a frequently collapsed periaxonal collar. However, through age the myelin sheath became gradually infiltrated by MTs, suggesting their contribution to premature loss of myelin in the taiep rat. Axons of one-year-old taiep rats were severely demyelinated. Modifications in astrocytes revealed by the GFAP antibody showed a strong hypertrophy with increased immunostaining in their processes. As demyelination of axons progressed, taiep rats developed a strong astrogliosis. The present findings suggest that in taiep rats the early abnormal myelination of axons affects the adequate maintenance of myelin, leading to a progressive loss of myelin components and severe astrogliosis, features that should be considered in the pathogenesis of dysmyelinating diseases.

Evidence of altered central nervous system development in infants with iron deficiency anemia at 6 mo: delayed maturation of auditory brainstem responses.

Iron deficiency anemia has long been thought to have effects on the central nervous system (CNS). Finding direct evidence of this in human infants, however, has been challenging. Auditory brainstem responses (ABRs) provide a noninvasive means of examining an aspect of the CNS that is rapidly maturing during the age period when iron deficiency is most common. ABRs represent the progressive activation of the auditory pathway from the acoustic nerve (wave I) to the lateral lemniscus (wave V). The central conduction time (CCT, or wave I-V interpeak latency) is considered an index of CNS development because myelination of nerve fibers and maturation of synaptic relays lead to an exponential reduction in the CCT from birth to 24 mo. In 55 otherwise healthy, 6-mo-old Chilean infants (29 with iron deficiency anemia and 26 nonanemic control infants), the CCT was longer in those who had been anemic at 6 mo, with differences becoming more pronounced at 12- and 18-mo follow-ups despite effective iron therapy. The pattern of results--differences in latencies but not amplitudes, more effects on the late ABR components (waves III and V), and longer CCTs (as an overall measure of nerve conduction velocity)--suggested altered myelination as a promising explanation, consistent with recent laboratory work documenting iron's essential role in myelin formation and maintenance. This study shows that iron deficiency anemia in 6-mo-old infants is associated with adverse effects on at least one aspect of CNS development and suggests the fruitfulness of studying other processes that are rapidly myelinating during the first 2 y of life.

[Patterns of sexual behavior in Chilean women]. / Patrones de conducta sexual en mujeres chilenas.

BACKGROUND: Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. AM: To assess the sexual behavior of a group of Chilean women. SUBJECTS AND METHODS: A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service. RESULTS: Seventy seven percent of women were sexually active. These figures ranged from 80% of women aged 40-44 years old to 40% of women over 60. Sixty percent of women living together, 53.7% of single women, 65.6% of divorced women, 94.2% of married women and 100% of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 +/- 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms. CONCLUSIONS: Age and legal status of women are related to their sexual behavior and less educated women have a less satisfactory sexual life.

Patrones de conducta sexual en mujeres chilenas / Sexual behavior patterns in chilean women

Background: Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. Aim: To assess the sexual behavior of a group of Chilean women. Subjects and methods: A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service. Results: Seventy seven percent of women are sexually active. These figures ranged from 80 percent of women aged 40-44 years old to 40 percent of women over 60. Sixty percent of women living together, 53.7 percent of single women, 65.6 percent of divorced women. 94.2 percent of married women and 100 percent of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 ± 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms. Conclusions: Age and legal status of women are related lo their sexual behavior and less educated women have a less satisfactory sexual life

Binding of microtubules to transitional elements in oligodendrocytes of the myelin mutant taiep rat.

The presence of microtubules physically bound to smooth endoplasmic reticulum profiles of oligodendrocytes constitutes the most conspicuous feature observed in the myelin mutant taiep rat. The endoplasmic reticulum membranes associated with microtubules were morphologically characterized as transitional elements that constitute the intermediate compartment according to their topographic location close to the cis-Golgi apparatus. The development of this surprising microtubular defect appears to be associated with the early events of myelination. Transitional elements associated with microtubules operate in protein transport from endoplasmic reticulum to cis-Golgi. This microtubular defect could explain the dysmyelination and neurologic alterations observed in taiep rats. Moreover, these findings allow us to propose that there is a blockage of protein traffic at the intermediate compartment of taiep oligodendrocytes, a situation that could explain the hypomyelinated axons observed in this myelin mutant. The binding of microtubules to membranous organelles promotes the stabilization of microtubules, a feature that has important implications regarding its accumulation within the cytoplasm of oligodendrocytes during the temporal evolution of this neurologic disorder. The taiep rat is a myelin mutant with a long survival and could be a useful model for understanding dysmyelinating diseases in which the intracellular transport of myelin components is affected.

Prevalencia de síntomas psiquicos y vasomotores en diferentes periodos del climaterio / Prevalence of vasomotor and psychic symptoms in different periods of the climateric

Las mujeres climatéricas presentan una amplia gama de síntomas vasomotores y psíquicos, sin embargo los estudios psiquiátricos muestran resultados contradictorios sobre los efectos de la menopausia en la sintomatología psíquica. Para conocerlos, estudiamos la prevalencia de síntomas, evaluados según BlattKupperman, en 1167 mujeres de 40 a 59 años de edad en su examen de Medicina Preventiva. Cuarenta y dos por ciento de estas mujeres habían presentado ya su menopausia, siendo la mediana de edad de presentación de ella, 48,3 años. En relación con los síntomas climatéricos, se observa que su prevalencia no cambia significativamente al acercarse la edad de la menopausia; sólo los bochornos y los dolores osteoarticulares aumentan después de los 50 años. La mayoría de los síntomas psíquicos no aumentan con la edad e incluso algunos, como la irritabilidad y el llanto fácil disminuyen en las mujeres mayores. En cambio, al analizar la prevalencia de los síntomas según la etapa del climaterio en que se, encontraban las mujeres, se observa que la mayoría de los síntomas se incrementan en el período perimenopáusico y posteriormente decrecen. Conclusión: la mujer en la postmenopausia tiene menos síntomas psíquicos y vasomotores que en la perimenopausia, período este último, de gran sintomatología y deterioro de la calidad de vida

[Decrease of labor absenteeism associated with hormone replacement therapy in postmenopausal women]. / Disminución del ausentismo laboral asociado a la terapia de reemplazo hormonal en mujeres postmenopáusicas.

Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climacteric symptoms may reduce their work capacity working at a public hospital in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8% of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days/year for premenopausal and 17.8 days/year for postmenopausal women (NS). Among the latter, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3% and psychiatric diseases for 18.1% of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women.

Disminución del ausentismo laboral asociado a la terapia de reemplazo hormonal en mujeres postmenopáusicas / Dicrease of work absenteeism related to hormone replacement therapy in postmenopausal women

Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climateric symptoms may reduce their work capacity. We studied absenteeism rates due to medical causes in 444 women of 40 years old or more, working at a public hospitalñ in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8 percent of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days-year for premenopausal and 17.8 days/year for the postmenopausal women (NS). Among the later, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3 percent and psychiatric diseases for 18.1 percent of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women

Short-term homeostasis of active sleep and the architecture of sleep in the rat.

1. Sixteen rats were recorded continuously for 3 days using an automated system that detected, quantified, and stored the incidence of cortical delta waves, cortical sigma spindles, hippocampal theta rhythm, and electromyographic activity. A time series then was constructed wherein 15-s epochs were ascribed to one behavioral state: wakefulness (W), quiet sleep (QS), or active sleep (AS, a state also referred to as REM sleep). From those series, AS episodes and non-AS intervals could be determined. Episodes and intervals were defined as lasting at least two epochs and the one-epoch episodes and intervals were incorporated to the ongoing state. 2. Having established the length of each AS episode and non-AS interval, pairings were made, on the one hand between episodes and their preceding intervals, and on the other, between episodes and the intervals that followed. 3. Highly significant correlations were found between the length of AS episodes and the length of the non-AS intervals that followed. Correlations were also significant when calculated separately versus the amount of QS and of W within the following interval. Correlations improved when they were performed against the log of the interval and when only intervals with a predominance of QS were selected. 4. No significant correlation was found between the length of AS episodes and the length of the preceding non-AS intervals, except for a negative one that was present only when the statistical analysis was performed in the unsmoothed array where the one-epoch episodes and intervals were preserved. 5. These results suggest that there is a short-term homeostasis operating within the spontaneous architecture of sleep in rats. This homeostatic mechanism is not manifested by the regulation of the length of AS episodes. Instead, there is a forward regulatory mechanism that, given the duration of an AS episode, permissively controls the interval that the animal may abstain from AS, and hence the timing of the triggering of a new AS episode.

Measures of location and dispersion of sleep state distributions within the circular frame of a 12:12 light: dark schedule in the rat.

Distributions within a 12:12 light:dark schedule of wakefulness (W), active sleep (AS), quiet sleep (QS) and of QS rich in delta (QSD) and in spindle (QSS) activities were evaluated for 52 days from 15 rats. Angular statistics were applied for each state by equating their hourly incidence to data distributed around a circle. Measures of location (mean angle, median angle, mode angle, maximum semicircle), dispersion (mean vector, standard deviation, quartile deviation), skewness and kurtosis were computed and their intra- and interindividual variabilities were compared. Mean angles (in hours and after lights-on) averaged 5.5 for QS, 8.6 for AS, 18.4 for W, 1.9 for QSD and 10.6 for QSS. Length of vectors, representing concentration around the mean angle, averaged 0.22 for QS, 0.36 for AS, 0.22 for W, 0.38 for QSD and 0.23 for QSS. Distributions of QS and W were closely related to the light-dark step function. QSD had a leptokurtic distribution, sharply rising at the beginning of the sleep-predominant phase, whereas AS and QSS had smoother distributions reaching maxima in its second half. In rodents as in humans, QSS and AS have opposite distributions to QSD. QSS may contribute to maintain sleep through the resting phase of the light-dark schedule after restorative function associated with delta activity has been fulfilled.

[Double-blind method of the effect of menopause symptoms, lipid profile, and endometrial thickness of continuous therapy with estradiol valerate and medroxyprogesterone acetate]. / Estudio doble ciego del effecto sobre la sintomatología menopáusica, el perfil lipídico y el grosor endometrial de una terapia continua de valerato de estradiol más acetato de medroxiprogesterona.

Continuous combined therapy (CCT) using estrogens and progestagens has appeared as an alternative to avoid vaginal bleeding, which is characteristic of sequential hormone therapy, and the main reason for the stopping treatment. Irregular vaginal bleeding can occur at the beginning of treatment, but it has been observed that after a few months patients are in amenorrhea. Fifty postmenopausal women were studied in order to evaluate the clinical outcome. Half of them were treated with a product containing 2 mg estradiol valerate and 2.5 mg medroxiprogesterone acetate, while the other half received a placebo. Menopause symptomatology was recorded as described by Blatt-Kupperman, depression was evaluated with the use of Hamilton's test, lipid profile by enzymatic methods and endometrial thickness by transvaginal ultrasonography. Patients were evaluated at the beginning, third and sixth month of the study, following a double blind methodology. Symptomatology diminished both in patients under CCT and using placebo, although improvement was significantly greater in patient under CCT. Thus in the hormone treated group the Blatt-Kupperman score fell from 12.1 to 6.4 and 3.2 in the third and sixth month respectively, while in the group receiving placebo the score fell from 11.5 to 6.3 in the third month and raised to 7.4 in the sixth month. Hamilton's test showed a significant improvement of depression only in patients under hormone therapy. Nineteen out of twenty five women using CCT had vaginal bleeding, showing no changes in the endometrial thickness during the study. Finally, HDL-cholesterol was raised in 14.5% while LDL-cholesterol was lowered in 18.7% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Auditory brainstem responses of children with developmental language disorders.

Brainstem auditory evoked potentials (BAEPs) were recorded from 48 children with language disorders (aged four to nine years old, IQs normal to borderline, normal audiometric thresholds and attending special school) and 20 healthy children (four to eight years old, with normal IQs, audiometry and school-level). The language-disabled group showed significantly lower absolute latency values of the BAEPs than controls. There were no significant differences in the central conduction time of the auditory pathway (I-V interval). Therefore, the only significant difference corresponded to a minor value for the first wave (auditory nerve discharge) of the BAEP. A reduction in the control mechanisms of the sensory inputs at the peripheral level, or a disturbance in the inhibitory mechanisms of cortico-subcortical modulation, might explain these findings.

Estudio doble ciego del efecto sobre la sintomatología menopáusica, el perfil lipídico y el grosor endometrial de una terapia continua de valerato de estradiol mas acetato de medroxiprogesterona / Double blind study of the effect on menopausic symptomatology, the lipid profile and endometrial thickness, of a continous therapy of stradiol valerate plus medroxyprogesterone acetate

La terapia combinada continua (TCC) de estrógenos y progestágenos ha surgido como una alternativa para evitar el sangramiento vaginal, característico de la hormonoterapia secuencial y principal causal de abandono del tratamiento. Al inicio del tratamiento pueden presentarse sangramientos irregulares, pero después de algunos meses las pacientes caen en amenorrea. Para evaluar sus resultados clínicos se estudiaron 50 mujeres postmenopáusicas, a la mitad de las cuales se les indicó, un producto que contenía 2 mg. valerato de estradiol más 2,5 mg de acetato de medroxiprogesterona; y a la otra mitad, placebo. Se midió la sintomatología menopáusica según Blatt Kupperman, la depresión con test de Hamilton, el perfil lipídico por métodos enzimáticos y el grosor endometrial por ultrasonografía transvaginal. Las pacientes fueron evaluadas en forma doble ciego al inicio, al tercero y al sexto mes de tratamiento. Tanto con el preparado hormonal como con el placebo, la sintomatología disminuyó, aunque la magnitud de la mejoría fue significativamente mayor con la TCC. Así, con esta última en índice de Blatt Kupperman cayó de 12,1 a 6,4 y 3,2 al tercero y sexto mes respectivamente, mientras que en el grupo con placebo, este índice, que había caído de 11,5 a 6,3 al tercer mes, subió a 7,4 al sexto. El test de Hamilton mostró una significativa mejoría de la depresión sólo con la hormonoterapia. Por otra parte, 19 de 25 mujeres con TCC mostraron sangramientos vaginales, no observándose en ellas cambios del grosor endometrial durante el estudio. Finalmente, el HDL-colesterol se incrementó en 14,5 por ciento y el LDL-colesterol declinó en 18,7 por ciento (p<0,01). Concluímos que la TCC es eficiente para controlar la sintomatología menopáusica y mejorar el perfil lipídico. La mayoría de las mujeres con este esquema terapéutico presentarán sangramientos vaginales durante los primeros seis meses

Time course of rat sleep variables assessed by a microcomputer-generated data base.

A microcomputer-based system is described that detects, counts and stores cortical delta and sigma waves, hippocampal theta waves and electromyographic activities in the rat by building matrices with the incidence of those four variables (columns) in 15-second bins (rows). Data tables are submitted to statistical, graphics and spread-sheet software to assess internal organization of sleep episodes and 24-hour distribution of sleep variables. Within sleep episodes, cross-correlograms reveal a delta-sigma-theta sequence, while autocorrelograms quantify clustering and periodicity of variables. Sleep accumulates in the lights-on phase, with high concentration of delta at the beginning of this sleep-predominant phase and of sigma and theta in its second half. These are notable similarities with human sleep architecture. Simple procedures for data reduction into standard behavioral state diagnosis are demonstrated. The low cost of personal computers and data acquisition interfaces facilitates the automation of complex paradigms by ad hoc on-line programs that produce as output a data base that can be processed by standard software, providing a fluid pathway of automated acquisition, analysis and presentation of data.