RESUMEN
OBJECTIVE: To determine the prevalence of 21-hydroxylase (21-OH)-deficient nonclassic adrenal hyperplasia (NCAH) and insulin resistance in hirsute women from Puerto Rico. DESIGN: Cross-sectional prospective study. SETTING: Clinical research center. PATIENT(S): 100 consecutive untreated hirsute women. MAIN OUTCOME MEASURE(S): Fasting total T, free T, DHEAS, insulin, and glucose were measured, and a 60-minute acute ACTH-(1-24) stimulation for 17-hydroxyprogesterone (17-HP) was performed. A diagnosis of 21-OH-deficient NCAH was considered when the stimulated 17-HP level was >30.3 nmol/L. The glucose/insulin ratio was calculated as a measure of insulin resistance (normal value, > or =4.5). RESULT(S): Patients had a mean (+/-SD) age of 26.8+/-6.6 years; 82 were oligomenorrheic. Overall, 12%, 8%, and 60% of patients had elevated levels of DHEAS, total T, or free T, respectively. One patient was identified as having 21-OH-deficient NCAH. Eight women, none of whom had NCAH, were found to be hyperglycemic; four of these women had type 2 diabetes mellitus. Excluding hyperglycemic patients, a glucose/insulin ratio of <4.5, consistent with IR, was found in 51.7%. CONCLUSION(S): The prevalence of 21-OH-deficient NCAH among patients from Puerto Rico does not differ significantly from that reported for other non-Jewish, non-Hispanic white populations.
Asunto(s)
Hiperplasia Suprarrenal Congénita , Hiperplasia Suprarrenal Congénita/complicaciones , Hirsutismo/complicaciones , Resistencia a la Insulina , Síndrome del Ovario Poliquístico/epidemiología , Hiperplasia Suprarrenal Congénita/enzimología , Adulto , Sulfato de Deshidroepiandrosterona/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Prueba de Tolerancia a la Glucosa , Hirsutismo/enzimología , Humanos , Síndrome del Ovario Poliquístico/complicaciones , Puerto Rico/epidemiología , Testosterona/sangreRESUMEN
PIP: This prospective study on breastfeeding practices sought to identify if factors that intervene or determine breastfeeding practices are those influenced by women themselves, promoted by institutions such as hospitals or is a combination of both factors. The methodology included 582 women who did not attend prenatal consultations and only attended the 3 hospitals included in the study to deliver their babies. Hospital A studied 252 women, supported breastfeeding practices and gave patients milk samples; hospital B studied 80 women, did not support breastfeeding and gave milk samples; and hospital C interviewed 250 women, did not support breastfeeding and did not give women milk samples. Invitations to attend the study explained that 12 hours postpartum a questionnaire would be given and 15 days postpartum a session would be held to verify if they were breastfeeding. The independent variables were: place of birth, residence of the new mothers and that their own mothers age, educational level, status of relationship with the father of the baby, number of pregnancies, number of live children, background and number of previous stillbirths, were they living with the father of the baby and was he supporting her, was the pregnancy planned, previous problems with breastfeeding, was previous baby breastfed number of previous babies breastfed, reasons for not breastfeeding, and prior to the study what were other sources of information on breastfeeding. Results demonstrated that the sociocultural and demographic differences between each of the 3 populations attending the 3 hospitals were found to have stronger effects on breastfeeding practices than hospital policies.^ieng