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1.
Artigo em Inglês | MEDLINE | ID: mdl-32394534

RESUMO

BACKGROUND: The concept of European psychologization of depression versus somatisation in non-European populations has been the basis of several studies of cultural psychopathology in the general population. Little is currently known about cross-cultural differences and similarities in late-life depression symptom reporting. We cross-culturally compared symptom reporting in the context of Major Depressive Disorder (MDD) among community-dwelling older adults from Spain and Nigeria. METHODS: We relied on data from two household multistage probability samples comprising 3,715 persons aged 65 years or older in the Spanish and Nigerian populations. All participants underwent assessments for MDD using the World Mental Health Survey version of the Composite International Diagnostic Interview. Cross-cultural comparison of broad somatic and psychological categories as well as relationship and influence of individual symptoms were analysed using the Symptom Network Analysis approach. RESULTS: Current MDD was diagnosed in 232 and 195 older persons from Spain and Nigeria, respectively. The symptom network of the two samples were invariant in terms of global strength, S(GSPAIN , GNIGERIA ) = 7.56, p = .06, with psychological and somatic symptoms demonstrating centrality in both countries. However, country-specific relationships and influence of individual symptoms were found in the network structure of both samples, M(GSPAIN , GNIGERIA ) = 2.95, p < .01. CONCLUSION: Broad somatic and psychological symptoms categories contributed to the structural network of older Africans and their peers from the Spanish population. Variations in the relationship and influence of individual symptoms suggests that the functional and 'communicative' role of individual symptoms may be differentiated by context specific imperatives.

4.
Rev Esp Enferm Dig ; 1122020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32054280

RESUMO

We present abdominal computed tomography and enteroscopy images of a 48-year-old male patient with a previous melanoma who presented with epigastric pain. The pain was not controlled with medical management. Abdominal computed tomography and a histological study of biopsies form enteroscopy confirmed the diagnosis of metastatic melanoma. The gastrointestinal involvement of melanoma is usually metastatic. Symptomatic gastrointestinal involvement occurs in less than 5% of melanomas, although postmortem analyses have reported up to 70%. The clinical presentation is variable and usually presents as abdominal pain. The diagnosis of small intestinal involvement of melanoma is a challenge due to its poor accessibility. The enteroscopy has a fundamental role as it allows a direct visualization and biopsies to be taken for histological study.

5.
Clin Nutr ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32075745

RESUMO

BACKGROUND & AIMS: Some previous evidence have linked dairy products with greater muscle mass, bone mineral density and lower risk of osteoporosis. However, there is also evidence of a detrimental effect of milk on the risk of hip fracture. The aim of this study was to assess the prospective association between dairy consumption and risk of falls in older adults. METHODS: We used data from 2 cohorts of community-dwellers aged ≥60y: the Seniors-ENRICA cohort with 2981 individuals, and the UK Biobank cohort with 8927 participants. In the Seniors-ENRICA, dairy consumption was assessed with a validated diet history in 2008-10, and falls were ascertained up to 2015. In the UK Biobank study, dairy consumption was obtained with 3-5 multiple-pass 24-h food records in 2006-10, and falls were assessed up to 2016. RESULTS: A total of 801 individuals in the Seniors-ENRICA and 201 in the UK Biobank experienced ≥1 fall. After adjustment for potential confounders, dairy products were not associated with risk of falls in the Seniors-ENRICA [hazard ratio (95% confidence interval) per 1-serving increment in total dairy consumption: 1.02 (0.93-1.11), milk: 0.93 (0.85-1.01), yogurt: 1.05 (0.96-1.15), and cheese: 0.96 (0.88-1.05)]. Corresponding figures in the UK Biobank were: total dairy: 1.19 (1.00-1.41), milk: 1.53 (1.13-2.08), yogurt: 1.10 (0.90-1.31), and cheese: 1.02 (0.87-1.22). CONCLUSIONS: These results suggest a null association between habitual dairy consumption and the risk of falling in older adults. Whether milk consumption may increase the risk of falls, as observed in the UK Biobank cohort, merits further study.

6.
Rev Esp Enferm Dig ; 112(4): 332, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32054273

RESUMO

A 72-year-old female presented with abdominal pain and constipation and intestinal dilation was found. Abdominal computed tomography showed two areas of thickening and stenosis in the proximal jejunum and preterminal ileum, with an unknown etiology. Exploratory laparotomy was proposed but the patient suffered a sudden and progressive decrease in consciousness. Cranial computed tomography showed an ischemic area and a midline shift. Brain biopsies suggested infection by Aspergillus Fumigatus. Despite antifungal drugs, the patient had a progressive clinical deterioration and died. The autopsy concluded a systemic infection due to Aspergillus Fumigatus. Invasive aspergillosis is a serious fungal infection and usually occurs in immunocompromised patients. It mainly affects the lungs, followed by the gastrointestinal tract. The most frequent location in gastrointestinal involvement is the small bowel. Gastrointestinal involvement is more frequent in invasive disease. Although, there are case reports of isolated gastrointestinal aspergillosis, even in immunocompetent patients without risk factors. The prognosis is poor.

7.
Rev Esp Enferm Dig ; 112(4): 325-326, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32054283

RESUMO

We present the case of a 59-year-old patient with malabsorption syndrome which started with polyneuropathy. Capsule endoscopy and enteroscopy show villous denudation. Histological study confirms diaphragm disease of the small bowel. Diaphragm disease is a rare disease characterized by the presence of multiple thin diaphragms, such as septa, that narrow the intestinal lumen. The clinical features can be iron deficiency anemia, intestinal obstruction, change in bowel habits or acute abdomen secondary to perforation. It is usually generally with sustained use of high doses of non-steroidal anti-inflammatory drugs. The diagnosis usually requires the use of a capsule endoscopy or enteroscopy with biopsies.

8.
J Affect Disord ; 266: 424-428, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32056909

RESUMO

BACKGROUND: Literature has shown that the effect of depression on all-cause mortality is stronger in men. However, it is less clear whether depression affects older and younger people equally. The present study is aimed to analyze whether depression is associated to all-cause mortality in different age and gender groups. METHODS: We analyzed a nationally representative sample of the Spanish adult population that was followed-up on for a period of 6 years (n = 4583). Unadjusted and adjusted cox proportional hazard regression models were conducted to test whether baseline depression was associated to all-cause mortality in the total sample and in the different gender and age specific groups, separately. RESULTS: Unadjusted analyses revealed that depression was associated with higher likelihood of having a shorter survival and dying, in the total sample and in both groups of men (18-64 and 65+ years). However, adjusted analyses stratified by age groups and gender revealed that depression was only a significant factor for all-cause mortality in 18-64 aged men (HR: 6.11; 95%CI= 2.16,17.23). LIMITATIONS: Cause-specific mortality was not examined. Young adults and middle-aged participants were not analyzed separately. CONCLUSIONS: The depression and all-cause mortality relationship was only found among young and middle-aged men. Further studies should consider whether the significant association between depression and all-cause mortality in young and middle-aged men is due to a behavior of seeking help less, the way depression is shaped in adult men, or to other clinical or health-system related factors.

10.
Rev Esp Enferm Dig ; 112(1): 77-78, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31909633

RESUMO

We present a family with several cases of eosinophilic esophagitis. Some cases of eosinophilic esophagitis in the same family have been previously described. Patients with eosinophilic esophagitis present frequently atopy, and atopy has a strong family association due to complex interactions between genetic and environment. However, eosinophilic esophagitis has a stronger genetic component than other atopic diseases. Eosinophilic esophagitis has been linked to variations in genes like eotaxin-3, TSLP and its receptor and CAPN14, although the inheritance pattern has not yet well defined.

11.
Psychol Health ; 35(2): 177-195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31237442

RESUMO

Objective: Loneliness is associated with worse health status outcomes. Yet, the present study is one of the first to identify how patterns of loneliness (transient and chronic) are associated with health over time. Design: A total of 2,390 individuals were interviewed in 2011-2012 and 2014-2015 in a follow-up study conducted over a nationally representative sample of Spain. After confirming a longitudinal relationship between loneliness and health status, a growth curve mixture modeling was used to examine health trajectories. Main outcome measures: The three-item UCLA Loneliness Scale was used to assess loneliness. Health status was measured with self-reported questions regarding ten domains (vision, mobility, and self-care, among others), and seven measured tests (including grip strength, walking speed and immediate and delayed verbal recall). Results: A quarter of participants were lonely at baseline. Both the group of transient and chronic loneliness showed a negative significant relationship with health status at follow-up, (ß = -0.063 and ß = -0.075 respectively, p < 0.001). Nevertheless, the health status did not change across time in any group. Conclusion: People experiencing chronic loneliness had the worst health status. Different patterns of loneliness could benefit from the appropriate interventions.

12.
BMC Med Res Methodol ; 19(1): 226, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31801473

RESUMO

BACKGROUND: Our population is ageing and in 2050 more than one out of five people will be 60 years or older; 80% of whom will be living in a low-and-middle income country. Living longer does not entail living healthier; however, there is not a widely accepted measure of healthy ageing hampering policy and research. The World Health Organization defines healthy ageing as the process of developing and maintaining functional ability that will enable well-being in older age. We aimed to create a healthy ageing index (HAI) in a subset of six low-and-middle income countries, part of the 10/66 study, by using items of functional ability and intrinsic capacity. METHODS: The study sample included residents 65-years old and over (n = 12,865) from catchment area sites in Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico. Items were collected by interviewing participants or key informants between 2003 and 2010. Two-stage factor analysis was employed and we compared one-factor, second-order and bifactor models. The psychometric properties of the index, including reliability, replicability, unidimensionality and concurrent convergent validity as well as measurement invariance per ethnic group and gender were further examined in the best fit model. RESULTS: The bifactor model displayed superior model fit statistics supporting that a general factor underlies the various items but other subdomain factors are also needed. The HAI indicated excellent reliability (ω = 0.96, ωΗ = 0.84), replicability (H = 0.96), some support for unidimensionality (Explained Common Variance = 0.65) and some concurrent convergent validity with self-rated health. Scalar measurement invariance per ethnic group and gender was supported. CONCLUSIONS: A HAI with excellent psychometric properties was created by using items of functional ability and intrinsic capacity in a subset of six low-and-middle income countries. Further research is needed to explore sub-population differences and to validate this index to other cultural settings.

13.
Int J Epidemiol ; 48(6): 1906-1913, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31873752

RESUMO

BACKGROUND: Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA. METHODS: The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment. RESULTS: Similar ageing trends were found in ELSA (ß = -0.311; p < 0.001) and HRS (ß = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (ß = -0.082; p < 0.05) and HRS (ß = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (ß = 0.125; p < 0.001) and HRS (ß = 0.170; p < 0.001). CONCLUSIONS: Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society.

14.
Mayo Clin Proc ; 94(9): 1707-1717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31486377

RESUMO

OBJECTIVES: To identify the factors associated with the excess risk of pain observed among older women compared with men. PATIENTS AND METHODS: We used information from a cohort of 851 women and men age 63 years and older who were free of pain during 2012 and were followed up to December 31, 2015. Sociodemographic variables, health behaviors, psychosocial factors, morbidity, and functional limitations were assessed in 2012 during home visits. Incident pain in 2015 was classified according to its frequency, intensity, and number of localizations into lowest, middle, and highest categories. RESULTS: During a mean follow-up of 2.8 years, the incidence of middle and highest pain was 12.5% and 22.6% in women and 12.4% and 12.6% in men, respectively. The age-adjusted relative risk ratios and 95% CIs of middle and highest pain in women versus men were 1.20 (0.79-1.83) and 2.03 (1.40-2.94), respectively. In a mediation analysis, a higher frequency in women than men of osteomuscular disease, impaired mobility, and impaired agility accounted, respectively, for 31.1%, 46.6%, and 32.0% of the excess risk of highest pain in women compared with men. Other relevant mediators were psychological distress (25.2%), depression (8.7%), poor sleep quality (10.7%), and lower recreational physical activity (12.6%). CONCLUSION: A greater frequency of some chronic diseases, worse functional status, psychological distress, and lower physical activity can mediate the excess risk of pain in older women compared with men. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02804672.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Avaliação Geriátrica , Medição da Dor , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Espanha
16.
Sci Rep ; 9(1): 11041, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31363117

RESUMO

Projections show that the number of people above 60 years old will triple by 2050 in Mexico. Nevertheless, ageing is characterised by great variability in the health status. In this study, we aimed to identify trajectories of health and their associations with lifestyle factors in a national representative cohort study of older Mexicans. We used secondary data of 14,143 adults from the Mexican Health and Aging Study (MHAS). A metric of health, based on the conceptual framework of functional ability, was mapped onto four waves (2001, 2003, 2012, 2015) and created by applying Bayesian multilevel Item Response Theory (IRT). Conditional Growth Mixture Modelling (GMM) was used to identify latent classes of individuals with similar trajectories and examine the impact of physical activity, smoking and alcohol on those. Conditional on sociodemographic and lifestyle behaviour four latent classes were suggested: high-stable, moderate-stable, low-stable and decliners. Participants who did not engage in physical activity, were current or previous smokers and did not consume alcohol at baseline were more likely to be in the trajectory with the highest deterioration (i.e. decliners). This study confirms ageing heterogeneity and the positive influence of a healthy lifestyle. These results provide the ground for new policies.

18.
Int J Geriatr Psychiatry ; 34(11): 1613-1622, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31304639

RESUMO

OBJECTIVE: This study aimed to examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults. METHODS: Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow-up. Adjusted generalized estimating equations models were performed. RESULTS: Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = -0.14 to B = -3.16; P < .05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = -0.06 to B = -0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression. CONCLUSIONS: Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

20.
Gerontologist ; 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31115438

RESUMO

BACKGROUND AND OBJECTIVES: There is a link between sensory and cognitive functioning across old age. However, there are no integrative measures for assessing common determinants of sensory-cognitive functioning. This study aims to develop a combined measure of sensory-cognitive functioning, and to identify heterogeneous trajectories and associated risk factors. RESEARCH DESIGN AND METHODS: Two thousand two hundred and fifty-five individuals aged 60 years and over selected from the first six waves (2002-2012) of the English Longitudinal Study of Ageing completed a set of five self-reported visual and hearing functioning items and four cognitive items. Several health-related outcomes were also collected. RESULTS: The common cause model presented longitudinal factorial invariance (Tucker-Lewis index [TLI] = 0.989; Comparative Fit Index [CFI] = 0.991; Root Mean Square Error of Approximation [RMSEA] = 0.026). A common factor explained 32%, 36%, and 26% of the visual, hearing, and cognitive difficulties, respectively. The developed sensory-cognitive measure predicted incident dementia over 10 years (area under the curve = .80; 95% confidence interval [CI] = .75, .86). A three-trajectory model was proved to fit better, according to growth mixture modeling. Low levels of education and household wealth, disability, diabetes, high blood pressure, depressive symptoms, and low levels of physical activity were risk factors associated with the classes showing trajectories with a steeper increase of sensory-cognitive difficulties. DISCUSSION AND IMPLICATIONS: A time-invariant factor explains both sensory and cognitive functioning over 8 years. The sensory-cognitive measure derived from this factor showed a good performance for predicting dementia 10 years later. Several easily identifiable socioeconomic and health-related risk factors could be used as early markers of subsequent sensory-cognitive decline. Therefore, the proposed latent measure could be useful as a cost-effective indicator of sensory-cognitive functioning.

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