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Terapia por Ejercicio , Fuerza de la Mano , Rango del Movimiento Articular , Esclerodermia Sistémica , Extremidad Superior , Humanos , Fuerza de la Mano/fisiología , Esclerodermia Sistémica/fisiopatología , Terapia por Ejercicio/métodos , Rango del Movimiento Articular/fisiología , Extremidad Superior/fisiopatología , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Ejercicio Físico , Equilibrio PosturalRESUMEN
OBJECTIVES: To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. METHODS: Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. RESULTS: Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48-3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35-10.25), nursing home care utilization 11.32 (95% CI, 3.88-33.02), hospitalizations 4.12 (95% CI, 2.88-5.90) and emergency room admissions 4.24 (95% CI, 3.04-5.91). DISCUSSION: Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.
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Americanos MexicanosRESUMEN
Abstract Objective: To quantify and compare respiratory functions and further screen the oral mucosa of tobacco and non-tobacco users. Material and Methods: First control group, non-tobacco users (n=55); Second group, smokers' group (n=168) who currently smoked cigarettes; Third group smokeless/chewing type, tobacco group (n=81); Fourth group, both smokeless and smoking type tobacco users (n=46). Fagerstrom Test for Nicotine Dependences (FTND) and Fagerström Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) instruments were used to assess nicotine dependence. Subsequently, spirometry and Toluidine Blue (TB) vital staining were performed. Chi-squared and one-way analysis of variance (ANOVA) were used for statistical analysis. Results: Fagerstrom test resulted in 48.8% of subjects with low dependency, followed by an increase in nicotine dependency from low to moderate (29.2%), moderate (15.6%), and highly dependent (6.4%) groups. All respiratory function tests and oral screening confirmed significant changes amongst tobacco and non-tobacco users. The forced vital capacity of non-smoker group was significantly different from other tobacco users' group (p<0.05). Conclusion: Early effects of tobacco use can lead to complications with the respiratory system and oral cavity. Such data can be used to delineate the harm of tobacco and should be used to urge individuals to evade the utilization of tobacco (AU).
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Humanos , Masculino , Adolescente , Adulto , Persona de Mediana Edad , Espirometría/métodos , Tabaquismo , Mediciones del Volumen Pulmonar/instrumentación , Mucosa Bucal/patología , Nicotina/efectos adversos , Distribución de Chi-Cuadrado , Estudios Transversales/métodos , Encuestas y Cuestionarios , Análisis de Varianza , India/epidemiologíaRESUMEN
OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.
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COVID-19/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Pobreza/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Factores de Edad , Anciano , COVID-19/terapia , Femenino , Humanos , Masculino , México/epidemiología , Servicios de Salud Rural/organización & administración , Servicios Urbanos de Salud/organización & administraciónRESUMEN
OBJECTIVES: The purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the US mainland. DESIGN: Medicare data from 2015 to 2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review. SETTING AND PARTICIPANTS: Post-acute care patients admitted to SNFs in Puerto Rico and the United States. METHODS: Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the United States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to an SNF (N = 15,197) following an acute hospital stay. We compared demographic, clinical, and facility-level characteristics among patients in Puerto Rico and the United States. We also described 2 quality indicators among these groups: (1) 30-day rehospitalization rates and (2) successful discharge from the facility to the community. RESULTS: Medicare patients in Puerto Rico were physically and cognitively healthier than patients in the United States. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community [17.6, 95% confidence interval (CI) 13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2, 95% CI 6.2-16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only. CONCLUSIONS AND IMPLICATIONS: SNFs in the United States and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients-even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the United States.
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Indicadores de Calidad de la Atención de Salud , Instituciones de Cuidados Especializados de Enfermería , Anciano , Planes de Aranceles por Servicios , Humanos , Puerto Rico , Atención Subaguda , Estados UnidosRESUMEN
Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.
RESUMEN
Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.
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Humanos , Masculino , Niño , Rabdomiosarcoma , Fibrosarcoma/patología , Neoplasias de Cabeza y Cuello , Neoplasias de los Tejidos Blandos/patología , Diagnóstico DiferencialRESUMEN
We have identified a precursor that differentiates into granulocytes in vitro and in vivo yet belongs to the monocytic lineage. We have termed these cells monocyte-like precursors of granulocytes (MLPGs). Under steady state conditions, MLPGs were absent in the spleen and barely detectable in the bone marrow (BM). In contrast, these cells significantly expanded in tumor-bearing mice and differentiated to polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs). Selective depletion of monocytic cells had no effect on the number of granulocytes in naive mice but decreased the population of PMN-MDSCs in tumor-bearing mice by 50%. The expansion of MLPGs was found to be controlled by the down-regulation of Rb1, but not IRF8, which is known to regulate the expansion of PMN-MDSCs from classic granulocyte precursors. In cancer patients, putative MLPGs were found within the population of CXCR1+CD15-CD14+HLA-DR-/lo monocytic cells. These findings describe a mechanism of abnormal myelopoiesis in cancer and suggest potential new approaches for selective targeting of MDSCs.
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Monocitos/patología , Células Supresoras de Origen Mieloide/patología , Neoplasias/patología , Neutrófilos/patología , Adulto , Anciano , Animales , Diferenciación Celular , Femenino , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Proteínas de Unión a Retinoblastoma/metabolismoRESUMEN
Highly photoresponsive semiconductor photocatalysis for energy and environmental applications require judicious choice and optimization of semiconductor interfaces for wide spectral capabilities. This work aims at rational designing of highly active SrTiO3/g-C3N4 junctions bridged with Ag/Fe3O4 nanoparticles for utilizing Z-scheme transfer and surface plasmon resonance effect of Ag augmented by iron oxide. The SrTiO3/(Ag/Fe3O4)/g-C3N4 (SFC) catalyst was employed for photocatalytic hydrogen production and photodegradation of levofloxacin (LFC; 20 mg/L) under UV, visible, near infra-red, and natural solar light exhibiting high performance. Under visible light (<780 nm), SFC-3 sample (30 wt % g-C3N4 and 3% Ag/Fe3O4) shows a H2 evolution of 2008 µmol g-1 h-1 which is â¼14 times that of bare g-C3N4. In addition, 99.3% removal of LFC was degraded in 90 min under visible light with retention of activity under sun. The inherent topological properties, complete, higher charge separation, and reduced recombination allowed this catalyst for a high photocatalytic response which was proved by UV-diffuse reflectance spectroscopy, photoluminescence, electrochemical impedance spectroscopy, and photocurrent response measurements. Scavenging experiments and electron spin resonance analysis reveal that the mechanism shifts from a dual charge transfer in case of binary junction to essential Z-scheme with incorporation of Ag/Fe3O4. Both â¢O2- and â¢OH are main active radicals in visible light, whereas â¢O2- majorly participate under UV. The synergistic effect of SrTiO3, g-C3N4, and plasmon resonance of Ag/Fe3O4 not only improves light response and reduce recombination but also enhances the redox-ability of charge carriers. A H2 production mechanism and LFC degradation pathway (degradation, defluorination, and hydrolysis) has been predicted. This work paves a way for development of photocatalysts working in practical conditions for pollution and energy issues.
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Compuestos Férricos/química , Hidrógeno/química , Levofloxacino/química , Luz , Nanopartículas/química , Óxidos/química , Plata/química , Estroncio/química , Titanio/química , Carbono/análisis , Catálisis , Electroquímica , Grafito/química , Concentración de Iones de Hidrógeno , Compuestos de Nitrógeno/química , Compuestos Orgánicos/análisis , Espectroscopía de Fotoelectrones , Factores de Tiempo , Difracción de Rayos XRESUMEN
BACKGROUND: Diagnosis of coronary artery disease and management strategies have relied solely on the presence of diameter stenosis ≥50%. We assessed whether direct quantification of plaque burden (PB) and plaque characteristics assessed by coronary computed tomography angiography could provide additional value in terms of predicting rapid plaque progression. METHODS AND RESULTS: From a 13-center, 7-country prospective observational registry, 1345 patients (60.4±9.4 years old; 57.1% male) who underwent repeated coronary computed tomography angiography >2 years apart were enrolled. For conventional angiographic analysis, the presence of stenosis ≥50%, number of vessel involved, segment involvement score, and the presence of high-risk plaque feature were determined. For quantitative analyses, PB and annual change in PB (â³PB/y) in the entire coronary tree were assessed. Clinical outcomes (cardiac death, nonfatal myocardial infarction, and coronary revascularization) were recorded. Rapid progressors, defined as a patient with ≥median value of â³PB/y (0.33%/y), were older, more frequently male, and had more clinical risk factors than nonrapid progressors (all P<0.05). After risk adjustment, addition of baseline PB improved prediction of rapid progression to each angiographic assessment of coronary artery disease, and the presence of high-risk plaque further improved the predictive performance (all P<0.001). For prediction of adverse outcomes, adding both baseline PB and â³PB/y showed best predictive performance (C statistics, 0.763; P<0.001). CONCLUSIONS: Direct quantification of atherosclerotic PB in addition to conventional angiographic assessment of coronary artery disease might be beneficial for improving risk stratification of coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02803411.
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Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Placa Aterosclerótica , Anciano , Brasil , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/cirugía , Estenosis Coronaria/mortalidad , Estenosis Coronaria/patología , Estenosis Coronaria/cirugía , Vasos Coronarios/patología , Vasos Coronarios/cirugía , Progresión de la Enfermedad , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Revascularización Miocárdica , América del Norte , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Sistema de Registros , República de Corea , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. BACKGROUND: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. METHODS: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. RESULTS: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. CONCLUSIONS: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).
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Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Estenosis Coronaria/tratamiento farmacológico , Vasos Coronarios/efectos de los fármacos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Placa Aterosclerótica , Anciano , Brasil , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/patología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/patología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Progresión de la Enfermedad , Europa (Continente) , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Masculino , Persona de Mediana Edad , América del Norte , Estudios Prospectivos , Sistema de Registros , República de Corea , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/patologíaRESUMEN
INTRODUCTION: Older Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations. METHODS: We analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3). RESULTS: Care recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34-2.94), self-care limitations (OR = 2.53; 95% CI, 1.70-3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28-3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26-2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05-5.24) than those with just arthritis and hypertension. CONCLUSION: MCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.
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Actividades Cotidianas , Americanos Mexicanos , Afecciones Crónicas Múltiples , Anciano , Anciano de 80 o más Años , Cuidadores , Evaluación de la Discapacidad , Personas con Discapacidad , Femenino , Humanos , Masculino , Oportunidad Relativa , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
The production of liquid fuels from crude oil requires water. There has been limited focus on the assessment of life cycle water demand footprints for crude oil production and refining. The overall aim of this paper is address this gap. The objective of this research is to develop water demand coefficients over the life cycle of fuels produced from crude oil pathways. Five crude oil fields were selected in the three North American countries to reflect the impact of different spatial locations and technologies on water demand. These include the Alaska North Slope, California's Kern County heavy oil, and Mars in the U.S.; Maya in Mexico; and Bow River heavy oil in Alberta, Canada. A boundary for an assessment of the life cycle water footprint was set to cover the unit operations related to exploration, drilling, extraction, and refining. The recovery technology used to extract crude oil is one of the key determining factors for water demand. The amount of produced water that is re-injected to recover the oil is essential in determining the amount of fresh water that will be required. During the complete life cycle of one barrel of conventional crude oil, 1.71-8.25 barrels of fresh water are consumed and 2.4-9.51 barrels of fresh water are withdrawn. The lowest coefficients are for Bow River heavy oil and the highest coefficients are for Maya crude oil. Of all the unit operations, exploration and drilling require the least fresh water (less than 0.015 barrel of water per barrel of oil produced). A sensitivity analysis was conducted and uncertainty in the estimates was determined.
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Petróleo , Alberta , Animales , Conservación de los Recursos Energéticos , México , Tecnología , Estados Unidos , AguaRESUMEN
OBJECTIVES: To examine the association between life-space mobility and cognitive decline over a five-year period among older Mexican Americans. DESIGN: Longitudinal study. SETTING: Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). PARTICIPANTS: Four hundred thirty-two Mexican Americans aged 75 and older with normal or high cognitive function at baseline. MEASUREMENTS: Socio-demographic factors, living arrangement, type of household, social support, financial strain, self-reported medical conditions, Mini-Mental State Examination (MMSE), depressive symptoms, activities of daily living (ADLs), and Short Physical Performance Battery. Life-space assessment (LSA) during the past 4 weeks was assessed during in-home interview. Scores ranged from 0 (daily restriction to the bedroom) to 120 (daily trips outside of their own town without assistance) and categorized as 0 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 120. Because of the small sample size in the category of 81 to 120, the two highest categories were combined into a single group. RESULTS: The mean LSA score and MMSE score of participants at baseline was 44.6 (Standard Deviation [SD], 20.7) and 25.7 (SD, 3.2), respectively. Mixed Model analyses showed that participants in the highest life-space category (≥61) experienced slower rates of cognitive decline over time compared to participants in the lowest category (0 to 20) (ß = 1.03, Standard Error [SE] = 0.29, P = 0.0004), after adjusting for all covariates. CONCLUSION: Greater life-space mobility at baseline was predictor of slower rates of cognitive decline over 5 years in older Mexican Americans.
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Actividades Cotidianas , Trastornos del Conocimiento/diagnóstico , Americanos Mexicanos/estadística & datos numéricos , Limitación de la Movilidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Cognición , Depresión/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Americanos Mexicanos/psicología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Factores Sexuales , Estados UnidosRESUMEN
OBJECTIVES: To create a risk index (Mexican American Dementia Nomogram (MADeN)) that predicts dementia over a 10-year period for Mexican Americans aged 65 and older. DESIGN: Retrospective cohort study with longitudinal analysis. SETTING: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) participants (n = 1,739). MEASUREMENTS: Dementia was defined as a decline of three or more points per year on the Mini-Mental State Examination and inability to perform one or more daily activities. Candidate risk factors included demographic characteristics, measures of social engagement, self-reported health conditions, ability to perform daily activities, and physical activity. RESULTS: The MADeN comprised the following risk factors: age, sex, education, not having friends to count on, not attending community events, diabetes mellitus, feeling the blues, pain, impairment in instrumental activities of daily living, and unable to walk a half-mile. The area under the receiver operating characteristic curve was 0.74 (95% confidence interval (CI) = 0.70-0.78) and a score of 16 points or higher had a sensitivity of 0.65 (95% CI = 0.59-0.72) and specificity of 0.70 (95% CI = 0.67-0.73) in predicting dementia. CONCLUSION: The MADeN was able to predict dementia in a population of older Mexican-American adults with moderate accuracy. It has the potential to identify older Mexican-American adults who may benefit from interventions to reduce dementia risk and to educate this population about risk factors for dementia.
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Demencia/diagnóstico , Evaluación Geriátrica/métodos , Americanos Mexicanos , Anciano , Anciano de 80 o más Años , Demencia/clasificación , Demencia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Nomogramas , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: To study the effect of undiagnosed diabetes on the relationship between self-reported diabetes and cognitive impairment. METHODS: Data were from 1033 participants aged ≥60 from Wave III (2012) of the Mexican Health and Aging Study. Participants were classified as nondiabetic (n = 589), undiagnosed diabetic (n = 201), and self-reported diabetic (n = 243). Multivariate logistic regression models were used to estimate the relationship between self-reported diabetes and severity of cognitive impairment (nonimpaired, moderate impaired, severe impaired). RESULTS: Self-reported diabetes was associated with significantly higher odds for severe, but not moderate, cognitive impairment (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.39-5.32). The association between self-reported diabetes and severe cognitive impairment decreased by 6.3% when undiagnosed diabetics were included in the nondiabetic category and by 30.4% when undiagnosed diabetics were included in the self-reported diabetes category. DISCUSSION: The association between self-reported diabetes and severe cognitive impairment is underestimated when undiagnosed diabetics are not differentiated from self-reported diabetics and nondiabetics.
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Envejecimiento , Disfunción Cognitiva/epidemiología , Diabetes Mellitus/epidemiología , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Autoinforme , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: The purpose of the study was to examine the prevalence and determinants of prediabetes, undiagnosed diabetes, and diabetes among Mexican adults from a subsample of the Mexican Health and Aging Study. METHODS: We examined 2012 participants from a subsample of the Mexican Health and Aging Study. Measures included sociodemographic characteristics, body mass index, central obesity, medical conditions, cholesterol, high-density lipoprotein cholesterol, hemoglobin A1c, and vitamin D. Logistic regression was performed to identify factors associated with prediabetes, undiagnosed diabetes, and self-reported diabetes. RESULTS: Prevalence of prediabetes, undiagnosed, and self-reported diabetes in this cohort was 44.2%, 18.0%, and 21.4%, respectively. Participants with high waist-hip ratio (1.61, 95% confidence interval [CI] = 1.05-2.45) and high cholesterol (1.85, 95% CI = 1.36-2.51) had higher odds of prediabetes. Overweight (1.68, 95% CI = 1.07-2.64), obesity (2.38, 95% CI = 1.41-4.02), and high waist circumference (1.60, 95% CI = 1.06-2.40) were significantly associated with higher odds of having undiagnosed diabetes. Those residing in a Mexican state with high U.S. migration had lower odds of prediabetes (0.61, 95% CI = 0.45-0.82) and undiagnosed diabetes (0.53, 95% CI = 0.41-0.70). Those engaged in regular physical activity had lower odds of undiagnosed diabetes (0.74, 95% CI = 0.57-0.97). CONCLUSIONS: There is a high prevalence of prediabetes and undiagnosed diabetes among Mexican adults in this subsample. Findings suggest the need for resources to prevent, identify, and treat persons with prediabetes and undiagnosed diabetes.