Estado de salud y género en Cataluña. Una aproximación a través de las fuentes de información disponibles

ResumenObjetivoPresentar las diferencias en el estado de salud de varones y mujeres en Cataluña a través de las principales fuentes de información disponibles.MétodosSe presentan las principales fuentes de información sanitaria institucionales referidas al ámbito catalán. Se hace una aproximación a la morbimortalidad según género.ResultadosLos varones mueren antes que las mujeres y presentan con mayor frecuencia patologías que requieren ingreso hospitalario. Las conductas poco saludables son más frecuentes en los varones que en las mujeres. Éstas, en general, cualquiera que sea la clase social a la que pertenecen, presentan más enfermedades crónicas y discapacidades y declaran peor percepción del estado de salud que los varones de la misma clase social.ConclusionesLas fuentes de información institucionales en Cataluña permiten caracterizar el estado de salud según género, si bien deberían incorporar variables que facilitaran el análisis de la información desde la perspectiva de género.SummaryObjectiveTo present health status differences between men and women in Catalonia across the main available data sources.MethodsThe main institutional health data sources of the Catalan population are presented. Mortality and morbidity differences by gender are studied.ResultsMen die before than women and present more frequently pathologies that require hospitalary care. Unhealthy behaviours are more frequent in men than in women. Women in general, in all social classes, present more frequently chronic disorders and disabilities and declare worse perception of health status than men of the same social class.ConclusionsInstitutional sources of data available in Catalonia allow the description of gender differences in health, nevertheless new variables should be included to improve gender perspective analyse

Percepción del estado de salud en varones y mujeres en las últimas etapas de la vida

ResumenObjetivoAnalizar las diferencias en la percepción del estado de salud de los varones y mujeres en las últimas etapas de la vida y explorar su relación con variables sociodemográficas y de salud.MétodosDatos procedentes de la Encuesta de Salud de Cataluña de 1994, de 1.459 varones y 1.993 mujeres de 60 y más años. Se realizó un análisis de la autovaloración del estado de salud según la edad, el sexo, la clase social, la declaración de enfermedades crónicas y la discapacidades y se aplicó un modelo de análisis multivariable de regresión logística teniendo en cuenta el diseño muestral.ResultadosEl 57,3% de las mujeres de 60 y más años declaraba no tener buena salud, frente al 43,6% de los varones. También fue superior la proporción de mujeres que padecía una o más discapacidades (41,2%) respecto a los varones (28,7%), así como la de enfermedades crónicas, el 92,2% de las mujeres y el 85,6% de los varones. En el modelo de regresión logística multivariable continúa manteniéndose una percepción de mala salud superior en las mujeres y aparecen como factores explicativos el número de enfermedades crónicas, padecer discapacidades y pertenecer a las clases sociales más desfavorecidas. La edad en interacción con las enfermedades crónicas amortigua el efecto de éstas en la valoración del estado de salud.ConclusionesEntre la población anciana, la percepción de mala salud fue superior en las mujeres incluso ajustando por otras variables explicativas significativas (clase social, edad, discapacidades y enfermedades crónicas). Padecer enfermedades crónicas y/o discapacidades constituyen los factores explicativos más importantes en la percepción del estado de salud. El impacto del padecimiento de enfermedades crónicas en relación con la percepción de mala salud disminuye a medida que los grupos son de mayor edad.SummaryObjectivesTo analyze the differences in health self-perception between men and women in the later stages of life and to assess their association with sociodemographic and health variables.MethodsData on 1,459 men and 1,993 women aged 60 or older from the 1994 Catalan Health Survey, were collected and an analysis of health self-perception according to age, gender, social class, reporting of chronic disease and handicaps was performed. Multivariate logistic regression analysis was used, taking into account the survey design.ResultsOf the women aged 60 and older, 57.3% reported poor health compared with 43.6% of men of the same age. The proportion of women with one or more handicaps was also greater (41.2%) than that of the men (28.7%), as was the case with chronic disease (92.2% inwomen and 85.6% in men). The multivariate model also revealed that health self-peerception was poorer among women than among men. Other explanatory factors were the number of chronic diseases, having handicaps, and being a member of a lower social class. Age interacted with the number of chronic diseases to mitigate the effect of chronic diseases on perceived health status.ConclusionsIn the elderly population, poor health self-perception was greater among women, even when other significant explanatory variable (social class, age, handicaps and chronic disease) were adjusted for. The most important explanatory factors in health self-perception were having chronic disease and/or handicaps. The impact of chronic disease on poor health self-perception decreased in older age groups

Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Background Health surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing. Methods Cross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data. Results We analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR. Conclusions Prevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.Ministry of Science and Innovation through the Instituto Carlos IIIISCiii-RETICSInstitut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol

Ghrelin causes a decline in GABA release by reducing fatty acid oxidation in cortex

Lipid metabolism, specifically fatty acid oxidation (FAO) mediated by carnitine palmitoyltransferase (CPT) 1A, has been described to be an important actor of ghrelin action in hypothalamus. However, it is not known whether CPT1A and FAO mediate the effect of ghrelin on the cortex. Here, we show that ghrelin produces a differential effect on CPT1 activity and γ-aminobutyric acid (GABA) metabolism in the hypothalamus and cortex of mice. In the hypothalamus, ghrelin enhances CPT1A activity while GABA transaminase (GABAT) activity, a key enzyme in GABA shunt metabolism, is unaltered. However, in cortex CPT1A activity and GABAT activity are reduced after ghrelin treatment. Furthermore, in primary cortical neurons, ghrelin reduces GABA release through a CPT1A reduction. By using CPT1A floxed mice, we have observed that genetic ablation of CPT1A recapitulates the effect of ghrelin on GABA release in cortical neurons, inducing reductions in mitochondrial oxygen consumption, cell content of citrate and α-ketoglutarate, and GABA shunt enzyme activity. Taken together, these observations indicate that ghrelin-induced changes in CPT1A activity modulate mitochondrial function, yielding changes in GABA metabolism. This evidence suggests that the action of ghrelin on GABA release is region specific within the brain, providing a basis for differential effects of ghrelin in the central nervous system. Keywords: Ghrelin, GABA, Fatty acid oxidation, CPT1A, Cortical neuron

Perivascular spaces are associated with tau pathophysiology and synaptic dysfunction in early Alzheimer’s continuum

Background: Perivascular spaces (PVS) have an important role in the elimination of metabolic waste from the brain. It has been hypothesized that the enlargement of PVS (ePVS) could be affected by pathophysiological mechanisms involved in Alzheimer’s disease (AD), such as abnormal levels of CSF biomarkers. However, the relationship between ePVS and these pathophysiological mechanisms remains unknown. Objective: We aimed to investigate the association between ePVS and CSF biomarkers of several pathophysiological mechanisms for AD. We hypothesized that ePVS will be associated to CSF biomarkers early in the AD continuum (i.e., amyloid positive cognitively unimpaired individuals). Besides, we explored associations between ePVS and demographic and cardiovascular risk factors. Methods: The study included 322 middle-aged cognitively unimpaired participants from the ALFA + study, many within the Alzheimer’s continuum. NeuroToolKit and Elecsys® immunoassays were used to measure CSF Aβ42, Aβ40, p-tau and t-tau, NfL, neurogranin, TREM2, YKL40, GFAP, IL6, S100, and α-synuclein. PVS in the basal ganglia (BG) and centrum semiovale (CS) were assessed based on a validated 4-point visual rating scale. Odds ratios were calculated for associations of cardiovascular and AD risk factors with ePVS using logistic and multinomial models adjusted for relevant confounders. Models were stratified by Aβ status (positivity defined as Aβ42/40 < 0.071). Results: The degree of PVS significantly increased with age in both, BG and CS regions independently of cardiovascular risk factors. Higher levels of p-tau, t-tau, and neurogranin were significantly associated with ePVS in the CS of Aβ positive individuals, after accounting for relevant confounders. No associations were detected in the BG neither in Aβ negative participants. Conclusions: Our results support that ePVS in the CS are specifically associated with tau pathophysiology, neurodegeneration, and synaptic dysfunction in asymptomatic stages of the Alzheimer’s continuum

Spatial patterns of white matter hyperintensities associated with Alzheimer's disease risk factors in a cognitively healthy middle-aged cohort

Background White matter hyperintensities (WMH) of presumed vascular origin have been associated with an increased risk of Alzheimer’s disease (AD). This study aims to describe the patterns of WMH associated with dementia risk estimates and individual risk factors in a cohort of middle-aged/late middle-aged individuals (mean 58 (interquartile range 51–64) years old). Methods Magnetic resonance imaging and AD risk factors were collected from 575 cognitively unimpaired participants. WMH load was automatically calculated in each brain lobe and in four equidistant layers from the ventricular surface to the cortical interface. Global volumes and regional patterns of WMH load were analyzed as a function of the Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE) dementia risk score, as well as family history of AD and Apolipoprotein E (APOE) genotype. Additional analyses were performed after correcting for the effect of age and hypertension. Results The studied cohort showed very low WMH burden (median 1.94 cm3) and 20-year dementia risk estimates (median 1.47 %). Even so, higher CAIDE scores were significantly associated with increased global WMH load. The main drivers of this association were age and hypertension, with hypercholesterolemia and body mass index also displaying a minor, albeit significant, influence. Regionally, CAIDE scores were positively associated with WMH in anterior areas, mostly in the frontal lobe. Age and hypertension showed significant association with WMH in almost all regions analyzed. The APOE-ε2 allele showed a protective effect over global WMH with a pattern that comprised juxtacortical temporo-occipital and fronto-parietal deep white matter regions. Participants with maternal family history of AD had higher WMH load than those without, especially in temporal and occipital lobes. Conclusions WMH load is associated with AD risk factors even in cognitively unimpaired subjects with very low WMH burden and dementia risk estimates. Our results suggest that tight control of modifiable risk factors in middle-age/late middle-age could have a significant impact on late-life dementia

La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000

ObjetivoConocer la detección y el control de los factores de riesgo cardiovascular (FRCV) en las áreas básicas de salud (ABS) en el año 2000 y compararlos con resultados de 1995.Diseño y sujetosEstudio descriptivo, transversal, de una muestra de 5.875 historias clínicas (HC) de la población de 15 y más años atendida en las ABS de Cataluña con más de 3 años de funcionamiento.Mediciones y resultados principalesSe estudia el registro en la HC de los valores, diagnóstico y control en relación con: tensión arterial, colesteremia, glucemia, talla, peso, hábito tabáquico y consumo de alcohol. Se comparan los resultados con los obtenidos en el estudio de 1995, realizado con la misma metodología. Las variables clínicas más anotadas son colesteremia (57,3%), tensión arterial (52,9%) y glucemia (51,3%). Los obesos diabéticos y los hipertensos son los pacientes más estudiados, con una media de 3,6 anotaciones en la HC sobre otros factores de riesgo. El tabaquismo (41,7%) y la hipertensión arterial (32,9%) son los diagnósticos más frecuentes. Se observa un control óptimo y aceptable en un 32,3% y 42,9% de los hipertensos, respectivamente. El 31,2% de los hipercolesterémicos y un 34,1% de los diabéticos se encuentran en situación de control. Respecto a 1995 se observa un aumento de la anotación de los valores de colesterolemia y glucemia y un descenso del resto, y es especialmente relevante el del cribado del hábito de fumar y consumo de alcohol.También se constata un descenso en el diagnóstico de diabetes y obesidad y un aumento del de tabaquismo y consumo excesivo de alcohol. Se mantienen las diferencias en el cribado según grupo de edad y sexo.ConclusionesLos resultados sugieren que puede estar produciéndose un cambio en la práctica de la detección de FRCV y cabe plantearse los factores que pueden influir en él.ObjectivesTo know if much the detection and control of cardiovascular risk factors (FRCV) have been incorporated in primary care settings (PCS) on 2000 and compare them with 1995 results.Design and participantsA descriptive crosssectional study of a random sample of 5,875 of clinical histories (CH) of patients aged 15 and over attended during 2000 in PCS, which had been in operation for over three years.Measurements and main resultsWhether were recorded values, levels, diagnoses and control related to: blood pressure, cholesterol, glucose, weight, size, tobacco and alcohol consumption, in order to compare 1995 and 2000 results obtained with the same methodology. Cholesterol levels (57.3%), blood pressure values (52.9%) and glucose levels (51.3%) are the most recorded variables in CH.Obese diabetics and high blood pressure patients are the most studied with a mean of 3.6 records in the CH related others CRF. Smoking (41.7%) and hypertension (32.9%) are the most frequents diagnoses. The 32.3% of the high blood pressure patients have optimum control and 42.9% acceptable control. The 31.2% hyperlipaemia and the 34.1% diabetic patients are controlled. Compared with 1995, the main variations observed are: an increase of the records of cholesterol levels and glucose levels and a decrease of the others, especially in tobacco and alcohol consumption screening. Diabetes and obesity diagnosis decrease and smoking and excessive alcohol consumption increase have been also observed. Screening age and sex group differences are maintained.ConclusionsThe results suggest that may be a change in CRF screening performance is happening and the influencial factors would be study