Influencia del síndrome metabólico, y los hábitos de vida en la fragilidad, la discapacidad y la calidad de vida en adultos mayores

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva, Salud Pública y Microbiología. Fecha de lectura: 14-09-201

Combined healthy behaviors and healthcare services use in older adults

Data on the combined impact of healthy behaviors on healthcare use in older adults are limited. Methods Study with community-dwelling individuals aged ≥60 years from the Spanish Seniors-ENRICA cohort, recruited in 2008–2010, followed through 2012–2013, and analyzed in 2016 (N=2,021). At baseline, the following healthy behaviors were self-reported: three traditional (never smoking, being physically active, having a healthy diet) and three emerging (sleeping 7–8 hours/day, sitting < 8 hours/day, not living alone). Outcomes were self-reported polypharmacy (five or more drugs per day), primary care physician visits (one or more per month), medical specialist visits (more than one per year), and hospitalization (one or more in the last year). The associations between baseline healthy behaviors and healthcare services used in 2012–2013 were summarized with ORs and 95% CIs from multiple logistic regression, adjusting for demographics, lifestyles, comorbidities, and baseline health services used. Results Most single healthy behaviors were associated with lower use of most health services. Compared with participants with zero or one healthy behavior, those with five or six healthy behaviors showed lower risk of polypharmacy (OR=0.46, 95% CI=0.24, 0.85, p-trend=0.001), visits to the primary care physician (OR=0.50, 95% CI=0.26, 0.96, p-trend=0.013), and hospitalization (OR=0.50, 95% CI=0.24, 1.01, p-trend=0.016). No association was found with visits to the medical specialist. Conclusions The combination of five to six healthy behaviors in older adults is associated with half the risk of polypharmacy and using several healthcare services. In an era of constrained resources in most countries, this information may help inform health policy to control healthcare spending in the futureSpecific funding for this study was obtained from Fondo de Investigación Sanitaria (FIS) grant PI13/02321 and PI16/ 01460 (Instituto de Salud Carlos III and FEDER/FSE). RFP-T was supported by the National Government of Ecuador through the National Institution of Higher Education, Science, Technology and Innovation (SENESCYT

Socioeconomic determinants of sarcopenic obesity and frail obesity in community-dwelling older adults: The Seniors-ENRICA Study

Information on the association between socioeconomic status (SES) throughout life and sarcopenic obesity is scarce, whereas no study has been focused on the association between SES and frail obesity. This analysis estimated the prevalence of sarcopenic obesity and frail obesity, and their associations with SES in older adults. Data were collected in 2012 from 1,765 non-institutionalized individuals aged ≥65 participating in the Seniors-ENRICA study in Spain, by using standardized techniques and equipment. SES throughout life was evaluated with the father's occupation, participant's educational level, former own occupation, and current poor housing condition. Overall, 17.2% of participants had sarcopenic obesity, and 4.0% frail obesity. No association was found between SES and sarcopenic obesity. In contrast, the prevalence of frail obesity was higher in those with lower education, having worked in manual job, and currently having poor housing condition. Having ≥1 social disadvantages throughout life was associated with higher prevalence of frail obesity. The prevalence of this disorder increased by 1.49 (95% CI: 1.21-1.85) times for each social disadvantage added. The OR (95% CI) of frail obesity was 3.13 (1.71-5.7) for those having 3 or 4 vs. 0 or 1 social disadvantages, implying a more complex process beginning early in life.Data collection was funded by the following grants: PI13/0288; PI14/0009; PI16/01460; PI16/01512; and PI16/00609 (State Secretary of R+D and FEDER/FSE). BM-F was supported by a CIBERCV contract, RFP-T was supported by the National Government of Ecuador through the National Institution of Higher Education, Science, Technology and Innovation-SENESCYT, and ML research activity is funded by Agencia Aragonesa para la Investigación y el Desarrollo (ARAID

Chocolate and health-related quality of life: A prospective study

Background Chocolate consumption has been associated with a short-term reduction in blood pressure and cholesterol, and improvement of insulin sensitivity; however, participants could not be aware of presenting hypertension or hypercholesterolemia. Moreover, the effect of chocolate on mental health is uncertain. This study assessed the association of regular chocolate consumption with the physical (PCS) and mental (MCS) components of health-related quality of life (HRQL). Materials and methods We analyzed data from a cohort of 4599 individuals recruited in 2008–2010 and followed-up once prospectively to January 2013 (follow-up mean: 3.5 years). Regular chocolate consumption was assessed at baseline with a validated diet history. HRQL was assessed with the SF-12 v.2 at baseline and at follow-up. Analyses were performed with linear regression and adjusted for the main confounders, including HRQL at baseline. Results At baseline, 72% of the study participants did not consume chocolate, 11% consumed 10 g/day and 17% >10 g/day. Chocolate consumption at baseline did not show an association with PCS and MCS of the SF-12 measured three years later. Compared to those who did not consume chocolate, the PCS scores were similar in those who consumed 10g/day (beta: -0.07; 95% confidence interval (95% CI): -0.94 to 0.80) and in those who consumed >10g/day (beta: 0.02; 95% CI:-0.71 to 0.75); corresponding figures for the MCS were 0.29; 95% CI: -0.67 to 1.26, and -0.57; 95%CI: -1.37 to 0.23. Similar results were found for sex, regardless of obesity, hypertension, hypercholesterolemia, diabetes or depression Conclusions No evidence was found of an association between chocolate intake and the physical or mental components of HRQLBaseline data collection (ENRICA study) was funded by Sanofi-Aventis. Data collection during follow-up was funded by FIS grant 09/162 (Ministry of Health of Spain). Funding specific for this analysis was obtained from FIS grants PI11/01379 and PI12/ 1166 (Ministry of Health of Spain), and from the "Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular

Physical activity and exercise: Strategies to manage frailty

Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.pre-print2.493 K

Cesárea ¿Alternativa al parto vaginal? Consideraciones éticas

In recent years, cesarean births have increased globally, even in the absence of clear therapeutic indications. This increase is due to a number of circumstances, among which are the greater access to health interventions, the level of education or culture of mothers and greater economic returns to health workers. The health professional who decides to perform an intervention at the request of the patient must face several ethical considerations and clinical, social and economic judgment.En los últimos años los nacimientos por cesárea se han incrementado de manera global, incluso en ausencia de indicaciones terapéuticas claras. Este aumento se debe a un sin número de circunstancias entre las que se destacan el mayor acceso a intervenciones en salud, el nivel de educación o cultural de las madres y mayores réditos económicos al personal sanitario. El profesional de la salud que decide realizar una intervención por petición de la paciente se debe enfrentar a varias consideraciones éticas y de juicio clínico, social y económico

Histoplasmosis Diseminada en paciente Inmunocompetentes

Histoplasmosis is a fungal infection that is acquired by inhalation causing lung disease in its primary form. It can spread to other organs, especially in immunosuppressed patients in whom it reaches high mortality. It is endemic in certain areas, especially temperate and tropical ones. The clinical manifestations vary according to the person's spread and immune status. The diagnosis is made by histopathological identification, culture and serology. African-American young adult female patient with no clinical history presenting a one-year history characterized by involuntary weight loss, alopecia, hyperpigmented skin lesions, diarrhea and cervical lymphadenopathies whose histopathological study was compatible with histoplasmosis. Extension studies suggested, but did not confirm, an associated autoimmune pathology. In Ecuador there is no record of cases of histoplasmosis despite being considered an endemic mycosis in the area. The immunocompetence study in the present case was suggestive of systemic lupus erythematosus with overlapping manifestations. Systemic lupus erythematosus patients are susceptible to opportunistic fungal infections due to intrinsic immune defects with impaired cellular immunity. Histoplasmosis is an endemic disease in our environment, underdiagnosed by the diversity of the clinical picture and its association with other pathologies.La histoplasmosis es una infección micótica que se adquiere por inhalación causando enfermedad pulmonar en su forma primaria. Puede diseminarse a otros órganos sobre todo en pacientes inmunodeprimidos en quienes alcanza una alta mortalidad. Es endémica en ciertas zonas, en especial las templadas y tropicales. Las manifestaciones clínicas varían según la diseminación y estado inmunológico de la persona. El diagnóstico se lo realiza por la identificación histopatológica, cultivo y serología. Paciente femenina adulta joven afroamericana sin antecedentes clínicos que presenta cuadro de un año de evolución caracterizado por pérdida involuntaria de peso, alopecia, lesiones dérmicas hiperpigmentadas, diarrea y adenopatías cervicales cuyo estudio histopatológico fue compatible con histoplasmosis. Estudios de extensión sugirieron, pero no confirmaron, una patología autoinmune asociada. En Ecuador no existe registro de casos de histoplasmosis a pesar de ser considerada una micosis endémica en la zona. El estudio de inmunocompetencia en el caso presente fue sugestivo de un lupus eritematoso sistémico con manifestaciones solapadas. Los pacientes con Lupus Eritematoso Sistémico son susceptibles a infecciones oportunistas por hongos dado a defectos inmunológicos intrínsecos con alteración de la inmunidad celular. La histoplasmosis es una enfermedad endémica en nuestro medio, infradiagnosticada por la diversidad del cuadro clínico y su asociación con otras patologías

Mediterranean Diet and Health-Related Quality of Life in Two Cohorts of Community-Dwelling Older Adults.

INTRODUCTION:In older adults, the Mediterranean diet is associated with lower risk of chronic diseases, but its association with health-related quality of life (HRQL) is still uncertain. This study assessed the association between the Mediterranean diet and HRQL in 2 prospective cohorts of individuals aged ≥60 years in Spain. METHODS:The UAM-cohort (n = 2376) was selected in 2000/2001 and followed-up through 2003. At baseline, diet was collected with a food frequency questionnaire, which was used to develop an 8-item index of Mediterranean diet (UAM-MDP). The Seniors-ENRICA cohort (n = 1911) was recruited in 2008/2010 and followed-up through 2012. At baseline, a diet history was used to obtain food consumption. Mediterranean diet adherence was measured with the PREDIMED score and the Trichopoulou's Mediterranean Diet Score (MSD). HRQL was assessed, at baseline and at the end of follow-up, with the physical and mental component summaries (PCS and MCS) of the SF-36 questionnaire in the UAM-cohort, and the SF-12v.2 questionnaire in the Seniors-ENRICA cohort. Analyses were conducted with linear regression, and adjusted for the main confounders including baseline HRQL. RESULTS:In the UAM-cohort, no significant associations between the UAM-MDP and the PCS or the MCS were found. In the Seniors-ENRICA cohort, a higher PREDIMED score was associated with a slightly better PCS; when compared with the lowest tertile of PREDIMED score, the beta coefficient (95% confidence interval) for PCS was 0.55 (-0.48 to 1.59) in the second tertile, and 1.34 (0.21 to 2.47) in the highest tertile. However, the PREDIMED score was non-significantly associated with a better MCS score. The MSD did not show an association with either the PCS or the MCS. CONCLUSIONS:No clinically relevant association was found between the Mediterranean diet and HRQL in older adults in Spain