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BACKGROUND AND PURPOSE: Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)-as a surrogate of choroid plexus dysfunction-and severity and progression of putative markers of glymphatic dysfunction, including white matter hyperintensities (WMH) of presumed vascular origin and abnormally enlarged basal ganglia perivascular spaces (BG-PVS). METHODS: This study recruited community-dwellers aged ≥40 years living in neighboring Ecuadorian villages. Participants who had baseline head CTs and brain MRIs were included in cross-sectional analyses and those who additional had follow-up MRIs (after a mean of 6.4 ± 1.5 years) were included in longitudinal analyses. Logistic and Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess associations between CPCs and WMH and enlarged BG-PVS severity and progression. RESULTS: A total of 590 individuals were included in the cross-sectional component of the study, and 215 in the longitudinal component. At baseline, 25% of participants had moderate-to-severe WMH and 27% had abnormally enlarged BG-PVS. At follow-up, 36% and 20% of participants had WMH and enlarged BG-PVS progression, respectively. Logistic regression models showed no significant differences between CPCs volumes stratified in quartiles and severity of WMH and enlarged BG-PVS. Poisson regression models showed no association between the exposure and WMH and enlarged BG-PVS progression. Baseline age remained significant in these models. CONCLUSIONS: Choroid plexus calcifications are not associated with putative markers of glymphatic system dysfunction.
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Calcinose , Plexo Corióideo , Sistema Glinfático , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Plexo Corióideo/diagnóstico por imagem , Plexo Corióideo/patologia , Pessoa de Meia-Idade , Sistema Glinfático/diagnóstico por imagem , Estudos Transversais , Imageamento por Ressonância Magnética/métodos , Idoso , Calcinose/diagnóstico por imagem , Estudos Longitudinais , Equador , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adulto , Tomografia Computadorizada por Raios X , BiomarcadoresRESUMO
STUDY OBJECTIVES: Changing the clocks seasonally is potentially harmful because it interferes with normal daytime activities. Studies aimed at quantifying this association are scant. The objective of this study was to determine the effects of 1 year's worth of changing the clocks (fall and spring transitions) on healthy young men located in the Southern Hemisphere in South America. METHODS: We performed an observational prospective study. Thirty healthy male university students were evaluated from 2 weeks before to 2 weeks after both the fall and spring transitions. We administered an overall sleep questionnaire, assessed quality of life, recorded 7-day wrist actigraphy, and had participants perform a psychomotor vigilance task. We defined the 1-hour clock change as the primary exposure and the change in psychomotor vigilance task lapses of 500 milliseconds or more in response time as our primary outcome. Changes were evaluated by the Wilcoxon rank test (significance: P < .05). RESULTS: After the fall transition, we found a significant worsening in psychomotor vigilance task performance (median [interquartile range], 9.9 [6.0-14.3] lapses of ≥ 500 milliseconds in response time at baseline vs 16.8 [8.2-28.0] after transition; P < .002). Additionally, we found a median loss of about 1 hour of total sleep time and time in bed after the fall transition. Furthermore, participants presented with insomnia. Performance on the psychomotor vigilance task was also affected after the spring transition (16.7 [10-23] vs 23 [12.2-32.2]; P < .001). CONCLUSIONS: A decrease in performance in neurocognitive tests was found after both time transitions. The transition led to insomnia and a significant worsening of sleep variables. CITATION: Labarca G, Henriquez-Beltrán M, Sanhueza R, et al. Impact on health outcomes associated with changing the clock 1 hour during fall and spring transitions in the Southern Hemisphere. J Clin Sleep Med. 2024;20(6):887-893.
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Desempenho Psicomotor , Estações do Ano , Humanos , Masculino , Estudos Prospectivos , Desempenho Psicomotor/fisiologia , Adulto Jovem , Actigrafia/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários , América do Sul , Adulto , Sono/fisiologiaAssuntos
Vida Independente , Síndrome da Mioclonia Noturna , Humanos , Idoso , Sono , Movimento , Atrofia , HipocampoRESUMO
STUDY OBJECTIVES: This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community dwellers enrolled in the Atahualpa Project. METHODS: Atahualpa residents aged ≥40 years were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) 9 months before the pandemic and a lateral flow-based test for identification of SARS-CoV-2 antibodies during the peak of the pandemic. Six months later, individuals completed a follow-up PSQI. The independent relationship between SARS-CoV-2 infection and deterioration in sleep quality was assessed by fitting logistic mixed models for longitudinal data. RESULTS: Of 639 participants (mean age at baseline: 59 ± 12.8 years), 325 (51%) had SARS-CoV-2 antibodies. A total of 185 (29%) individuals at baseline and 311 (49%) at follow-up were poor sleepers (p < 0.001). Mixed logistic regression models demonstrated a significant increase in poor sleepers at follow-up (odds ratio [OR]: 2.85; 95% CI: 2.16 to 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% CI: 2.48 to 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% CI: 50.9% to 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% CI: 35.3% to 46.1%) in their seronegative counterparts (p < 0.001). Likewise, progression from a good to a poor sleeper status was higher among seropositive individuals than in their seronegative counterparts (38.1% vs 22.3%; p < 0.001), after adjusting for relevant covariates. CONCLUSIONS: This study shows a deleterious effect of SARS-CoV-2 in sleep quality. An effect of SARS-CoV-2 in disrupting sleep-related pathways cannot be ruled out. TRIAL REGISTRATION: The Atahualpa Project has been registered at ClinicalTrials.gov; the identifier number is NCT01627600, and the date was: 10/02/2012 (https://clinicaltrials.gov/ct2/show/NCT01627600?cond=Atahualpa&draw=2&rank=1). The Sleep Disorders substudy has been registered at ClinicalTrials.gov; the identifier number is NCT01877616, and the date was: 06/13/2013 (https://clinicaltrials.gov/ct2/show/NCT01877616?cond=Atahualpa&draw=2&rank=4).
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COVID-19 , SARS-CoV-2 , Idoso , Equador/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , SonoRESUMO
BACKGROUND: Inability to encircle the neck by hands (neck grasp) has been proposed as an indicator of obstructive sleep apnea (OSA) that would be useful for recognition of candidates for polysomnography (PSG). We assessed the value of neck grasp for predicting OSA in community-dwelling older adults of Amerindian ancestry. METHODS: Neck grasp was evaluated in individuals aged ≥60 years undergoing PSG. The association between neck grasp and OSA was assessed by logistic regression models adjusted for relevant covariates. Mediation analysis was used to establish the proportion of the effect of the association between neck grasp and OSA, which is mediated by the neck circumference (a well-known OSA biomarker). Receiver operator characteristics curve analysis was used to estimate diagnostic accuracy of neck grasp for predicting OSA. RESULTS: Of 201 individuals undergoing PSG, 167 (83%) had the neck grasp test. The remaining 34 could not perform the test because of different factors. Neck grasp was positive in 127 (76%) cases, and 114 (68%) individuals had OSA (apnea-hypopnea index ≥5). Multivariate logistic regression models disclosed a significant association between neck grasp and OSA. The neck circumference was the single covariate remaining independently significant in these models. Neck grasp was not efficient at predicting OSA (sensitivity: 83.3%, specificity: 39.6%, positive predictive value: 0.75 and negative predictive value: 0.53). The area under the curve disclosed only a moderate predictive capability (61.5%) of neck grasp. CONCLUSION: Results do not support the use of neck grasp as an independent predictor of OSA in the study population.
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Vida Independente , Apneia Obstrutiva do Sono , Idoso , Feminino , Força da Mão , Humanos , Masculino , Polissonografia , Valor Preditivo dos Testes , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
BACKGROUND/OBJECTIVES: The relationship between physical activity and sleep quality has been reported in specific conditions or in selected individuals. To better understand this association at the population level, we aimed to assess the association between physical activity and sleep quality in community-dwellers residing in three neighboring rural villages of Coastal Ecuador. METHODS: A total of 1438 individuals aged ≥40 years were included. Data collection focused on the levels of physical activity and sleep quality. Multivariate models were fitted to assess independent associations between adequate physical activity and good sleep quality, after adjusting for relevant covariates. RESULTS: Physical activity was categorized as ideal in 676 (47%) individuals, intermediate in 644 (45%), and poor in 118 (8%). According to the Pittsburgh Sleep Quality Index (PSQI), 880 (61%) individuals had a good sleep quality. In univariate analysis, the percentage of individuals with a good sleep quality was lower among individuals with poor and intermediate physical activity when compared to those with ideal physical activity. Using individuals with poor physical activity as the referent category, a logistic regression model showed that a good sleep quality was significantly associated with intermediate (odds ratio, OR: 1.54; 95% confidence interval, CI: 1.03-2.30; p = 0.036) and ideal (OR: 1.78; 95% C.I.: 1.18-2.69; p = 0.006) physical activity, after adjusting for relevant covariates. CONCLUSIONS: This population-based study provides robust epidemiological evidence favoring an association between adequate levels of physical activity and good sleep quality in middle-aged and older adults living in rural settings.
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Exercício Físico , População Rural , Sono , Idoso , Equador/epidemiologia , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Information on the relationship between the diameters of the abdominal aorta (AA) and the basilar artery (BA) is limited. Using the Atahualpa Project cohort, we aimed to assess this association in Atahualpa residents aged ≥ 60 years. MATERIALS AND METHODS: Atahualpa residents aged ≥ 60 years underwent abdominal ultrasound and MRA of intracranial vessels. The independent association between both arterial diameters was estimated in a generalized linear model adjusted for demographics, cardiovascular risk factors, the presence of a fetal-type Circle of Willis, and severity of white matter hyperintensities. Fractional polynomials were fitted to model the relationship between AA and BA diameters. RESULTS: The mean age of 277 participants was 69.5 ± 7.7 years (61% women). The mean AA diameter was 19.8 ± 3.3 mm, and the mean BA diameter was 3.1 ± 0.7 mm. The mean diameters of both arteries were significantly higher in men than in women. Locally weighted scatterplot smoothing showed a non-linear relationship between both arterial diameters. Fractional polynomial models showed that AA and BA diameters had a significant non-linear association in men (p = 0.005), but not in women (p = 0.315). When sex was excluded from a generalized linear model, the relationship between both arterial diameters became significant (p = 0.017). CONCLUSION: In this population of community-dwelling older adults, the relationship between AA and BA diameters was confined to men. The finding of a large AA diameter in men should prompt the investigation of the intracranial vasculature because of the possibility of BA ectasia.
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Aorta Abdominal/anatomia & histologia , Artéria Basilar/anatomia & histologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Equador , Etnicidade , Feminino , Humanos , Modelos Lineares , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Neuroimagem/métodos , Fatores de Risco , Caracteres Sexuais , UltrassonografiaRESUMO
BACKGROUND: Evidence of the relationship between periodic limb movements during sleep (PLMS) and cerebral small vessel disease (cSVD) is limited and inconsistent. Here, we aimed to assess the independent association between PLMS and the different neuroimaging signatures of cSVD. METHODS: Atahualpa residents aged more than or equal to 60 years enrolled in the Atahualpa Project undergoing polysomnography and MRI with time intervals less than or equal to 6 months were included. MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and more than 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Data from single-night polysomnograms were interpreted according to recommendations of the American Academy of Sleep Medicine. Associations between the PLMS index and neuroimaging signatures of cSVD (as dependent variables) were assessed by means of logistic regression models, adjusted for relevant confounders. RESULTS: A total of 146 individuals (mean age: 71.4 ± 7.5 years; 64% women) were included. A PLMS index more than or equal to 15 per hour were noted in 48 (33%) participants. Moderate-to-severe WMH were present in 33 individuals (23%), deep CMB in 9 (6%), silent LI in 16 (11%), and more than 10 BG-PVS in 44 (30%). In univariate analyses, silent LI (P = .035) and the presence of more than 10 enlarged BG-PVS (P = .034) were significantly higher among participants with a PLMS index more than or equal to 15 per hour. However, fully-adjusted multivariate models showed no significant association between PLMS index more than or equal to 15 per hour and any of the neuroimaging signatures of cSVD. CONCLUSIONS: This study shows no independent association between the PLMS index and neuroimaging signatures of cSVD in stroke-free community-dwelling older adults.
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Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Vida Independente , Extremidade Inferior/inervação , Imageamento por Ressonância Magnética , Movimento , Neuroimagem/métodos , Síndrome da Mioclonia Noturna/fisiopatologia , Sono , Idoso , Idoso de 80 Anos ou mais , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Mioclonia Noturna/diagnóstico , Síndrome da Mioclonia Noturna/epidemiologia , Polissonografia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Saúde da População RuralRESUMO
STUDY OBJECTIVES: Evidence of an association between atherosclerosis and sleep quality is limited and has not been studied in remote rural settings, where living conditions are different than in urban centers. We aimed to assess the relationship between the aortic pulse wave velocity (PWV) and sleep quality in older adults living in rural Ecuador. METHODS: Atahualpa residents aged 60 years or older identified during door-to-door surveys, who consented to participate, underwent face-to-face interviews with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Aortic PWV determinations were performed for arterial stiffness estimation (as a surrogate of atherosclerosis). RESULTS: A total of 303 individuals were included (mean age: 70.3 ± 7.8 years; 59% women). Univariate logistic regression showed a significant association between the aortic PWV and poor sleep quality (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.07-1.39; P = .003). A multivariate logistic regression model, adjusted for demographics, cardiovascular risk factors, oily fish intake and psychological distress showed a significant association between increased PWV and poor sleep quality (OR 1.59; 95% CI 1.12-2.25; P = .009). Similar significance was noted when the model was adjusted for neuroimaging signatures of cerebral small-vessel disease and stroke (OR 1.47; 95% CI 1.07-2.03; P = .019). CONCLUSIONS: This study shows a significant independent association between the aortic PWV and poor sleep quality in older adults living in rural Ecuador. Results provide more insights into the relevance of the impact of sleep disorders on cardiovascular diseases. CLINICAL TRIAL REGISTRATION: The Atahualpa Project has been registered at ClinicalTrials.gov. The identifier number is NCT01627600, and the date was: 10/02/2012. CITATION: Del Brutto OH, Mera RM, Peñaherrera E, Costa AF, Peñaherrera R, Castillo PR. On the association between sleep quality and arterial stiffness: a population study in community-dwelling older adults living in rural ecuador (the atahualpa project). J Clin Sleep Med. 2019;15(8):1101-1106.
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Sono/fisiologia , Rigidez Vascular , Idoso , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Equador/epidemiologia , Feminino , Humanos , Vida Independente/estatística & dados numéricos , Modelos Logísticos , Masculino , Fatores de Risco , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
The earlobe crease (ELC) has been linked to coronary artery disease, but there is limited information on the association between ELC and extracranial atherosclerosis. Using the Atahualpa Project cohort, we aimed to assess the association between ELC and increased carotid intima-media thickness (cIMT). Atahualpa residents aged ≥40 years underwent visual inspection of both earlobes to evaluate ELC presence, and ultrasound examinations of carotid arteries to calculate the cIMT. The association between both variables was assessed by logistic regression and predictive models, after adjusting for relevant confounders. Mean age of 570 enrolled individuals was 61.5 ± 12.4 years (58% women). ELC was present in 221 (39%) participants. The mean cIMT was 0.85 ± 0.19 mm, with 81 individuals (14%) having an increased cIMT (>1 mm). Univariate logistic regression showed a significant association between ELC presence and increased cIMT (OR: 1.67; 95% C.I.: 1.04-2.69), which disappeared when age (OR: 1.09; 95% C.I.: 0.65-1.85) and other covariables (OR: 1.06; 95% C.I.: 0.62-1.84) were added to the model. Predictive cIMT margins did not differ according to ELC presence or absence, with participants stratified in quartiles of age. This study shows that the effect of the increase in cIMT in subjects with ELC is related to aging.
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ABSTRACT Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman's tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians. Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador. Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI. Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 - 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 - 1.31; p=0.357). Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).
RESUMEN Antecedentes: Se desconoce la prevalencia de la apnea obstructiva del sueño (AOS) en entornos rurales. En esas regiones, los equipos necesarios para el diagnóstico de AOS no están disponibles, y la detección de AOS con instrumentos de campo puede ser complicada debido a factores interculturales y analfabetismo. La asociación entre la posición de la lengua de Friedman (FTP) y AOS se ha evaluado en personas de diferentes grupos étnicos, pero no en Amerindios. Objetivo: Evaluar si al tipo IV de FTP está asociado con la severidad de la AOS y con el índice de apnea-hipopnea (IAH) en adultos mayores que viven en una comunidad de ascendencia Amerindia en zonas rurales de Ecuador. Métodos: Se incluyeron 201 residentes de Atahualpa de edad ≥60 años, que fueron sometidos a evaluación de la posición de la lengua, resonancia magnética cerebral y polisomnografía. Después de ajustar por factores de confusión relevantes, modelos de regresión logística ordinal evaluaron la probable asociación entre la presencia de un FTP tipo IV y las categorías AOS (ninguna, leve y moderada a grave), y se ajustaron modelos lineales generalizados con un enlace gaussiano para evaluar la asociación entre la presencia de un FTP tipo IV y el IAH continuo. Resultados: Se identificó un tipo IV de FTP en 153 (76%) individuos, el IAH promedio por hora fue de 11.9 ± 12.4 y 49 (24%) individuos tenían AOS de moderada a grave, 88 (44%) tenían AOS leve. y los 64 restantes (32%) no tenían AOS. Los modelos lineales generalizados, ajustados por confusores, no mostraron una asociación independiente entre la exposición investigada y el IAH (β: 0.09; 95% C.I.: -1.56 - 1.76; p = 0.909). Del mismo modo, los modelos de regresión logística ordinal no mostraron una asociación independiente entre la exposición investigada y las categorías de AOS (β: 0,42; 95% C.I.: -0,47 - 1.31; p = 0,357). Conclusión: El tipo IV de FTP no está asociado con el IAH o la gravedad de la AOS en esta población de Amerindios. Esta falta de asociación podría estar relacionada con las características fenotípicas de las personas de este grupo étnico (principalmente su paladar óseo de tipo elíptico).
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BACKGROUND/OBJECTIVES: Evidence of an association between sleep disorders and extracranial atherosclerosis is limited and has not been studied in remote rural settings, where living conditions and cardiovascular risk factors are different than in urban centers. We assessed the relationship between the carotid intima-media thickness (cIMT) and sleep quality in stroke-free individuals aged ≥40 years living in rural Ecuador. METHODS: Applying a population-based study design, participants underwent face-to-face interviews using the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and sonographic examinations for measurement of the carotid intima-media thickness (cIMT). The association between the cIMT and sleep quality (as the dependent variable) was assessed by means of generalized linear models, adjusted for relevant confounders. RESULTS: The mean age of 561 participants was 60.4 ± 12.6 years (58% women). The mean PSQI was 4.6 ± 2.2 points. Of those, 79 (14%) individuals had an increased cIMT (>1 mm). A model adjusted for demographics showed a significant association between increased cIMT and the PSQI score (ß: 0.602; 95% C.I.: 0.027-1.177; p = 0.040). This relationship was reduced when cardiovascular risk factors were added to the model (ß: 0.514; 95% C.I.: -0.072 - 1.101; p = 0.086). When the model was adjusted for demographics and psychological distress, the association between increased cIMT and the PSQI score became significant (ß: 0.573; 95% C.I.: 0.013-1.133; p = 0.045). In addition, both symptoms of depression (p = 0.032) and anxiety (p < 0.001) remained independently significant. CONCLUSIONS: This study shows an association between increased cIMT and the PSQI score, which is, at least, partly mediated by manifestations of psychological distress.
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Espessura Intima-Media Carotídea/psicologia , Vida Independente/psicologia , População Rural , Transtornos do Sono-Vigília/psicologia , Sono/fisiologia , Acidente Vascular Cerebral , Adulto , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Aterosclerose/psicologia , Espessura Intima-Media Carotídea/efeitos adversos , Espessura Intima-Media Carotídea/tendências , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Vida Independente/tendências , Masculino , Pessoa de Meia-Idade , População Rural/tendências , Transtornos do Sono-Vigília/diagnóstico por imagem , Transtornos do Sono-Vigília/epidemiologiaRESUMO
BACKGROUND: No information is available on the distribution of cervicocephalic atherosclerosis in Amerindians. We aimed to assess the distribution of these lesions and their correlation with cardiovascular risk factors in Amerindians living in rural Ecuador. METHODS: Atahualpa residents aged ≥40years underwent head CT for assessment of carotid siphon calcifications (CSC) and sonographic examination for measurement of the carotid intima media thickness (cIMT). CSC were used as a surrogate of intracranial atherosclerosis and the cIMT as a surrogate of extracranial atherosclerosis. Linear regression and multinomial logistic regression models were fitted to assess the association between cIMT and CSC, and to evaluate differences in risk factors across individuals with atherosclerosis involving both arterial beds when compared with those with extra- or intracranial atherosclerosis alone, or no atherosclerosis. RESULTS: Of 590 participants, 145 had high calcium content in the carotid siphons and 87 had a cIMT >1mm (25% versus 15%, P < .001). Thirty-eight (7%) individuals had atherosclerosis at both vascular beds, 107 (18%) had intracranial atherosclerosis, and 49 (8%) had extracranial atherosclerosis alone. The cIMT and CSC were independently associated (P = .008). When compared with participants without atherosclerosis, those with atherosclerosis at both vascular beds were older, more often male, hypertensive and diabetic. Subjects with intracranial atherosclerosis alone were older, and those with extracranial atherosclerosis alone reported less physical activity than those without atherosclerosis. CONCLUSION: Intracranial atherosclerosis is more common than extracranial atherosclerosis in Amerindians. Traditional risk factors only explain a minority of cases of cervicocephalic atherosclerosis in this population.
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Doenças das Artérias Carótidas/etnologia , Indígenas Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Saúde da População Rural/etnologia , Idoso , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Distribuição de Qui-Quadrado , Equador/epidemiologia , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Análise Multivariada , Razão de Chances , Placa Aterosclerótica , Fatores de Risco , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etnologiaRESUMO
Researchers developed a restless legs syndrome questionnaire using diagnostic criteria to assess its prevalence among veterans with spinal cord injuries and disorders.
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There is limited information on participants' adherence and reasons for declining consent in observational cohort studies conducted in remote rural communities. We aimed at sharing lessons learned during the Atahualpa Project, a population-based cohort study conducted in a rural Ecuadorian village. Atahualpa residents aged ≥40 years identified during door-to-door surveys who signed a consent form were enrolled. Annual surveys were conducted to assess the number of participants who moved out of the village, as well as those who died, declined consent, and newly entered the study. Reasons for declining consent were tabulated. Abstracted data included age, sex, education, disability, time between enrollment and declining consent, and reasons for withdrawal. We also counted participants who, despite expressing their willingness to continue in the study, refused specific procedures. After five years of follow-up, 54 (6.3%) of 863 enrolled individuals declined consent. Increasing age and disability had no impact on declining consent. In contrast, refusal was higher among relatives or neighbors of a given participant declining consent. Most people who declined consent did so after one or two years of enrollment. Less than 20% of enrolled individuals refused certain procedures. "Fear of the needle" was the most frequent reason for refusing blood tests, and common reasons for declining complimentary exams were lack of interest and time constraints. Cohort retention in the Atahualpa Project is high. Main reasons for this adherence include adequate selection of the village, detailed planning of procedures, assurance of sponsorship, and field personnel who continuously engage with study participants. This trial is registered with NCT01627600.
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Consentimento Livre e Esclarecido/psicologia , População Rural/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Equador , Feminino , Humanos , Consentimento Livre e Esclarecido/estatística & dados numéricos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: There is no information on the prevalence of symptoms related to neurotoxicity among carpenters working in underserved populations. To assess the magnitude of the problem, we conducted a population-based study in Atahualpa, a rural Ecuadorian village, where most men work as carpenters under poor safety conditions. METHODS: All men aged 40-75 years living in Atahualpa were identified during a door-to-door survey and evaluated with a general demographic questionnaire, the Q16 questionnaire, the depression axis of the Depression Anxiety Stress Scale-21, and the Montreal Cognitive Assessment (MoCA). RESULTS: Among 230 participants, 63% were carpenters. Seventy participants (30%) had a positive Q16 questionnaire (≥6 points), which suggested neurotoxicity. In a logistic regression model adjusted for age, education, alcohol intake, symptoms of depression, and MoCA score, the proportion of Q16 positive persons was 39.1% for carpenters and 15.9% for noncarpenters (odds ratio: 3.53, 95% confidence interval: 1.75-7.15, P < 0.0001). In a generalized linear model, adjusted mean scores in the Q16 questionnaire were 4.9 for carpenters and 3.6 for noncarpenters (ß: 1.285, standard error: 0.347, P < 0.0001). There was no correlation between scores in the Q16 questionnaire and the MoCA (Pearson correlation coefficient = -0.02), and the only significant covariate in the multivariate linear model was age, with every 10 years of age difference contributing 0.64 points in the Q16 questionnaire. CONCLUSION: This study shows a high prevalence of symptoms associated with neurotoxicity among carpenters after adjusting for a number of confounders. Long-term exposure to toxic solvents is the most likely explanation to this finding.
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More information is needed to better understand the effect of caffeine on sleep quality at the community level. In a population-based, cross-sectional study design, we aimed to assess the effect of caffeine intake on sleep quality by the use of a multivariate exposure-effect model, adjusted for relevant confounders. All Atahualpa residents aged ≥40 years were identified during a door-to-door survey and interviewed with the Pittsburgh Sleep Quality Index (PSQI) and a structured instrument designed to estimate the daily amount of caffeine intake. An exposure-effect model was built using augmented inverse probability weighting taking into account variables that were associated with exposure (using a probit model) and variables that were associated with outcome (in a linear model). Out of 779 eligible individuals, 716 (92%) were included. Consumption of <100 mg/day of caffeine was recorded in 320 (45%) participants, from 100 to 200 mg/day in 299 (42%), and >200 mg/day in 97 (13%). Mean score in the PSQI was 4.5±2.2 points, with 203 (28%) individuals classified as poor sleepers (≥6 points). The exposure-effect model, adjusted for variables associated with the exposure (symptoms of depression, total cholesterol blood levels and smoking) and the outcome (age, symptoms of depression, physical activity and fasting glucose levels), revealed no effect of caffeine intake in sleep quality (average exposure effect: 0.027, 95% C.I.: -0.284 to 0.338, p=0.866). This population-based study shows that caffeine intake has no effect on sleep quality in community-dwelling adults living in a rural village of Ecuador.