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

Classifying Alzheimer's disease and frontotemporal dementia using machine learning with cross-sectional and longitudinal magnetic resonance imaging data

Alzheimer's disease (AD) and frontotemporal dementia (FTD) are common causes of dementia with partly overlapping, symptoms and brain signatures. There is a need to establish an accurate diagnosis and to obtain markers for disease tracking. We combined unsupervised and supervised machine learning to discriminate between AD and FTD using brain magnetic resonance imaging (MRI). We included baseline 3T-T1 MRI data from 339 subjects: 99 healthy controls (CTR), 153 AD and 87 FTD patients; and 2-year follow-up data from 114 subjects. We obtained subcortical gray matter volumes and cortical thickness measures using FreeSurfer. We used dimensionality reduction to obtain a single feature that was later used in a support vector machine for classification. Discrimination patterns were obtained with the contribution of each region to the single feature. Our algorithm differentiated CTR versus AD and CTR versus FTD at the cross-sectional level with 83.3% and 82.1% of accuracy. These increased up to 90.0% and 88.0% with longitudinal data. When we studied the classification between AD versus FTD we obtained an accuracy of 63.3% at the cross-sectional level and 75.0% for longitudinal data. The AD versus FTD versus CTR classification has reached an accuracy of 60.7%, and 71.3% for cross-sectional and longitudinal data respectively. Disease discrimination brain maps are in concordance with previous results obtained with classical approaches. By using a single feature, we were capable to classify CTR, AD, and FTD with good accuracy, considering the inherent overlap between diseases. Importantly, the algorithm can be used with cross-sectional and longitudinal data.© 2023 The Authors. Human Brain Mapping published by Wiley Periodicals LLC

Cortical thickness modeling and variability in Alzheimer's disease and frontotemporal dementia

Alzheimer's disease (AD) and frontotemporal dementia (FTD) show different patterns of cortical thickness (CTh) loss compared with healthy controls (HC), even though there is relevant heterogeneity between individuals suffering from each of these diseases. Thus, we developed CTh models to study individual variability in AD, FTD, and HC.We used the baseline CTh measures of 379 participants obtained from the structural MRI processed with FreeSurfer. A total of 169 AD patients (63 ± 9 years, 65 men), 88 FTD patients (64 ± 9 years, 43 men), and 122 HC (62 ± 10 years, 47 men) were studied. We fitted region-wise temporal models of CTh using Support Vector Regression. Then, we studied associations of individual deviations from the model with cerebrospinal fluid levels of neurofilament light chain (NfL) and 14-3-3 protein and Mini-Mental State Examination (MMSE). Furthermore, we used real longitudinal data from 144 participants to test model predictivity.We defined CTh spatiotemporal models for each group with a reliable fit. Individual deviation correlated with MMSE for AD and with NfL for FTD. AD patients with higher deviations from the trend presented higher MMSE values. In FTD, lower NfL levels were associated with higher deviations from the CTh prediction. For AD and HC, we could predict longitudinal visits with the presented model trained with baseline data. For FTD, the longitudinal visits had more variability.We highlight the value of CTh models for studying AD and FTD longitudinal changes and variability and their relationships with cognitive features and biomarkers.© 2023. The Author(s)

Early-onset Alzheimer's disease shows a distinct neuropsychological profile and more aggressive trajectories of cognitive decline than late-onset

Early- and late-onset Alzheimer's disease (EOAD and LOAD) share the same neuropathological traits but show distinct cognitive features. We aimed to explore baseline and longitudinal outcomes of global and domain-specific cognitive function in a well characterized cohort of patients with a biomarker-based diagnosis.In this retrospective cohort study, 195 participants were included and classified according to their age, clinical status, and CSF AD biomarker profile: 89 EOAD, 37 LOAD, 46 young healthy controls (age???65?years), and 23 old healthy controls (>65?years). All subjects underwent clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture.We found distinct neuropsychological profiles between EOAD and LOAD at the time of diagnosis. Both groups showed similar performances on memory and language domains, but the EOAD patients displayed worsened deficits in visual perception, praxis, and executive tasks (p?<?0.05). Longitudinally, cognitive decline in EOAD was more pronounced than LOAD in the global outcomes at the expense of these non-amnestic domains. We found that years of education significantly influenced the decline in most of the neuropsychological tests. Besides, the APOE ?4 status showed a significant effect on the decline of memory-related tasks within the EOAD cohort (p?<?0.05).Age of onset is a main factor shaping the cognitive trajectories in AD patients, with younger age driving to a steeper decline of the non-memory domains. Years of education are related to a transversal decline in all cognitive domains and APOE ?4 status to a specific decline in memory performance in EOAD.© 2022 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association

Frequency and clinical impact of CDKN2A/ARF/CDKN2B gene deletions as assessed by in-depth genetic analyses in adult T cell acute lymphoblastic leukemia

Altres ajuts: This project was supported by the Asociación Española Contra el Cáncer, AECC (project ref.: GC16173697BIGA), Obra Social "La Caixa" and by Celgene Spain. A. Gonzalez-Perez is supported by a Ramon y Cajal fellowship (RYC-2013-14554) of the Educational Ministry (Madrid, Spain). This work was also partially supported by FEDER funds from CIBERONC (CB16/12/00284 and CB16/12/00400), Madrid, Spain).Recurrent deletions of the CDKN2A/ARF/CDKN2B genes encoded at chromosome 9p21 have been described in both pediatric and adult acute lymphoblastic leukemia (ALL), but their prognostic value remains controversial, with limited data on adult T-ALL. Here, we investigated the presence of homozygous and heterozygous deletions of the CDKN2A/ARF and CDKN2B genes in 64 adult T-ALL patients enrolled in two consecutive trials from the Spanish PETHEMA group. Alterations in CDKN2A/ARF/CDKN2B were detected in 35/64 patients (55%). Most of them consisted of 9p21 losses involving homozygous deletions of the CDKNA/ARF gene (26/64), as confirmed by single nucleotide polymorphism (SNP) arrays and interphase fluorescence in situ hybridization (iFISH). Deletions involving the CDKN2A/ARF/CDKN2B locus correlated with a higher frequency of cortical T cell phenotype and a better clearance of minimal residual disease (MRD) after induction therapy. Moreover, the combination of an altered copy-number-value (CNV) involving the CDKN2A/ARF/CDKN2B gene locus and undetectable MRD (≤ 0.01%) values allowed the identification of a subset of T-ALL with better overall survival in the absence of hematopoietic stem cell transplantation

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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