RESUMEN
El embarazo ectópico es la implantación de un óvulo fecundado fuera de la cavidad uterina, el cual tiene un abordaje quirúrgico y otro médico, que en ocasiones puede generar inseguridad o temor en los médicos tratantes optar por este último; pero ya existen criterios establecidos para este, los cuales incluye: tamaño de saco gestacional ectópico, concentración sérica de B-hCG y estabilidad hemodinámica; representando un menor costo hospitalario. El Metotrexato es un antagonista del ácido fólico que inhibe síntesis de Novo de purinas y pirimidinas, también interfiere con síntesis de ADN y proliferación celular
Asunto(s)
Embarazo Ectópico , Perfil de Salud , Costos de Hospital , GinecologíaRESUMEN
El embarazo ectópico es la implantación de un óvulo fecundado fuera de la cavidad uterina, el cual tiene un abordaje quirúrgico y otro médico, que en ocasiones puede generar inseguridad o temor en los médicos tratantes optar por este último; pero ya existen criterios establecidos para este, los cuales incluye: tamaño de saco gestacional ectópico, concentración sérica de B-hCG y estabilidad hemodinámica; representando un menor costo hospitalario. El Metotrexato es un antagonista del ácido fólico que inhibe síntesis de Novo de purinas y pirimidinas, también interfiere con síntesis de ADN y proliferación celular
Asunto(s)
Embarazo Ectópico , Perfil de Salud , Costos de Hospital , GinecologíaRESUMEN
El embarazo ectópico es la implantación de un óvulo fecundado fuera de la cavidad uterina, el cual tiene un abordaje quirúrgico y otro médico, que en ocasiones puede generar inseguridad o temor en los médicos tratantes optar por este último; pero ya existen criterios establecidos para este, los cuales incluye: tamaño de saco gestacional ectópico, concentración sérica de B-hCG y estabilidad hemodinámica; representando un menor costo hospitalario. El Metotrexato es un antagonista del ácido fólico que inhibe síntesis de Novo de purinas y pirimidinas, también interfiere con síntesis de ADN y proliferación celular
Asunto(s)
Embarazo Ectópico , Perfil de Salud , Costos de Hospital , GinecologíaRESUMEN
PURPOSE: Higher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established. METHODS: Acculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II. We conducted a cross-sectional analysis of the association of acculturation with prevalence of CV risk factors among 1789 elderly men and women from the Sacramento Area Latino Study on Aging using multivariate linear and logistic regression. We tested for the interaction of acculturation with risk factors by nativity status. RESULTS: Median age was 69.8 years. Higher acculturation was associated with lower systolic blood pressure, lower low-density lipoprotein, higher high-density lipoprotein, and lower prevalence of CV disease after age and sex adjustment. Higher acculturation remained associated with lower level of low-density lipoprotein and higher level of high-density lipoprotein after full adjustment. Nativity status did not affect these results. CONCLUSIONS: Contrary to other reports in middle-aged persons, higher levels of acculturation were associated with better lipid profiles and no significant differences in other CV risk factors by acculturation level in elderly Latinos.
Asunto(s)
Aculturación , Enfermedades Cardiovasculares/etnología , Americanos Mexicanos/estadística & datos numéricos , Anciano , Índice de Masa Corporal , California/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Humanos , Entrevistas como Asunto , Masculino , México/etnología , Persona de Mediana Edad , Análisis Multivariante , Examen Físico , Prevalencia , Factores de Riesgo , Factores SocioeconómicosRESUMEN
BACKGROUND: The purpose of this study was to examine the associations of cardiovascular disease (CVD) risk with cognitive decline and incidence of dementia and cognitive impairment but not dementia (CIND) and the role of education as a modifier of these effects. METHODS AND RESULTS: One thousand one hundred sixteen Mexican American elderly were followed annually in the Sacramento Area Latino Study on Aging. Our sex-specific 10-year CVD risk score included baseline age, systolic blood pressure, total cholesterol, high-density lipoprotein, smoking, body mass index, and diabetes. From adjusted linear mixed models, errors on the Modified Mini-Mental State Exam (3MSE) were annually 0.41% lower for women at the 25th percentile of CVD risk, 0.11% higher at the 50th percentile, and 0.83% higher at the 75th percentile (P value of CVDrisk×time <0.01). In men, 3MSE errors were annually 1.76% lower at the 25th percentile of CVD risk, 0.96% lower at the 50th percentile, and 0.12% higher at the 75th percentile (P value of CVDrisk×time <0.01). From adjusted linear mixed models, the annual decrease in the Spanish and English Verbal Learning Test score was 0.09 points for women at the 25th percentile of CVD risk, 0.10 points at the 50th percentile, and 0.12 points at the 75th percentile (P value of CVDrisk×time=0.02). From adjusted Cox models in women, compared with having <6 years of education, having 12+ years of education was associated with a 76% lower hazard of dementia/CIND (95% CI, 0.08 to 0.71) at the 25th percentile of CVD risk and with a 45% lower hazard (95% CI, 0.28 to 1.07) at the 75th percentile (P value of CVDrisk×education=0.05). CONCLUSIONS: CVD risk score may provide a useful tool for identifying individuals at risk for cognitive decline and dementia.
Asunto(s)
Enfermedades Cardiovasculares/etnología , Trastornos del Conocimiento/etnología , Demencia/etnología , Americanos Mexicanos , Anciano , Anciano de 80 o más Años , Envejecimiento , Estudios de Cohortes , Escolaridad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Clase Social , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Creatinine, the current clinical standard to detect chronic kidney disease (CKD), is biased by muscle mass, age and race. The authors sought to determine whether cystatin C, an alternative marker of kidney function less biased by these factors, can identify elderly Mexican Americans with CKD who are at high risk for death and cardiovascular disease. DESIGN: Longitudinal, with mean follow-up of 6.8 years. SETTING: Sacramento Area Latino Study of Aging (SALSA). PARTICIPANTS: One thousand four hundred and thirty five Mexican Americans aged 60 to 101. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m(2)) was determined according to creatinine (eGFRcreat) and cystatin C (eGFRcys), and participants were classified into four mutually exclusive categories: CKD neither (eGFRcreat ≥60 mL/min per 1.73 m(2); eGFRcys ≥60 mL/min per 1.73 m(2)), CKD creatinine only (eGFRcreat <60 mL/min per 1.73 m(2); eGFRcys ≥60 mL/min per 1.73 m(2)), CKD cystatin only (eGFRcreat ≥60 mL/min per 1.73 m(2); eGFRcys <60), and CKD both (eGFRcreat <60 mL/min per 1.73 m(2); GFRcys <60 mL/min per 1.73 m(2)). The associations between each CKD classification and all-cause death and cardiovascular (CV) death were studied using Cox regression. RESULTS: At baseline, mean age was 71 ± 7; 481 (34%) had diabetes mellitus, and 980 (68%) had hypertension. Persons with CKD both had higher risk for all-cause (HR = 2.30, 95% confidence interval (CI) = 1.78-2.98) and CV disease (CVD) (HR = 2.75, 95% CI = 1.96-3.86) death than CKD neither after full adjustment. Persons with CKD cystatin C only were also at greater risk of all-cause (HR = 1.91, 95% CI = 1.37-2.67) and CV (HR = 2.56, 95% CI = 1.64-3.99) death than CKD neither. In contrast, persons with CKD creatinine only were not at greater risk for CV death (HR = 1.39, 95% CI = 0.71-2.72) but were at higher risk for all-cause death (HR = 1.95, 95% CI = 1.27-2.98). CONCLUSION: Cystatin C may be a useful alternative to creatinine for detecting high risk of death and CVD in elderly Mexican Americans with CKD.
Asunto(s)
Envejecimiento/etnología , Enfermedades Cardiovasculares/etnología , Creatinina/sangre , Cistatina C/sangre , Americanos Mexicanos , Insuficiencia Renal Crónica/diagnóstico , Anciano , Anciano de 80 o más Años , Envejecimiento/sangre , California/epidemiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
BACKGROUND: Hispanics are the fasting growing population in the U.S. and disproportionately suffer from chronic diseases such as hypertension and diabetes. Little is known about the complex interplay between acculturation and chronic disease prevalence in the growing and increasingly diverse Hispanic population. We explored the association between diabetes and hypertension prevalence among distinct U.S. Hispanic subgroups by country of origin and by degree of acculturation. METHODS: We examined the adult participants in the 2001, 2003, 2005, and 2007 California Health Interview Survey (CHIS). Using weighted logistic regression stratified by nativity, we measured the association between country of origin and self-reported hypertension and diabetes adjusting for participants' demographics, insurance status, socio-economic status and degree of acculturation measured by citizenship, English language proficiency and the number of years of residence in the U.S. RESULTS: There were 33,633 self-identified Hispanics (foreign-born: 19,988; U.S.-born: 13,645). After multivariable adjustment, we found significant heterogeneity in self-reported hypertension and diabetes prevalence among Hispanic subgroups. Increasing years of U.S. residence was associated with increased disease prevalence. Among all foreign-born subgroups, only Mexicans reported lower odds of hypertension after adjustment for socioeconomic and acculturation factors. Both U.S.-born and foreign-born Mexicans had higher rates of diabetes as compared to non-Hispanic whites. CONCLUSIONS: We found significant heterogeneity among Hispanics in self-reported rates of hypertension and diabetes by acculturation and country of origin. Our findings highlight the importance of disaggregation of Hispanics by country of origin and acculturation factors whenever possible.