RESUMO
OBJECTIVE: Few Latin American studies have described menopausal symptoms in detail by means of a standardized assessment tool. The objective of this study was to assess the prevalence and severity of menopausal symptoms and their impact over quality of life among mid-aged Latin American women. METHOD: In this cross-sectional study, 8373 otherwise healthy women aged 40-59 years from 12 Latin American countries were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire containing personal sociodemographic data. Menopause status (pre-, peri- and postmenopausal) was defined according to the criteria of the Stages of Reproductive Aging Workshop. RESULTS: Of all the studied women, 90.9% had at least one menopausal symptom (complaint) that they rated. Muscle and joint discomfort, physical and mental exhaustion and depressive mood were highly prevalent and rated as severe-very severe (scores of 3 and 4), at a higher rate than vasomotor symptoms (15.6%, 13.8% and 13.7% vs. 9.6%, respectively). Of premenopausal women (40-44 years), 77.0% reported at least one rated complaint, with 12.9% displaying MRS scores defined as severe (> 16). The latter rate increased to 26.4% in perimenopausal, 31.6% in early postmenopausal and 29.9% among late postmenopausal women. As measured with the MRS, the presence of hot flushes increased the risk of impairment of overall quality of life in both premenopausal (odds ratio 12.67; 95% confidence interval 9.53-16.83) and peri/postmenopausal women (odds ratio 9.37; 95% confidence interval 7.85-11.19). CONCLUSION: In this large, mid-aged, female Latin American series, muscle/joint discomfort and psychological symptoms were the most prevalent and severely rated menopausal symptoms. The symptoms appear early in the premenopause, significantly impair quality of life and persist 5 years beyond the menopause.
Assuntos
Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Pré-Menopausa/fisiologia , Avaliação de Sintomas , Adulto , Artralgia , Sintomas Comportamentais/epidemiologia , Estudos Transversais , Depressão , Feminino , Fogachos/epidemiologia , Humanos , América Latina/epidemiologia , Pessoa de Meia-Idade , Músculos , Dor , Qualidade de Vida , Inquéritos e Questionários , Sudorese , Doenças da Bexiga Urinária/epidemiologia , Doenças Vaginais/epidemiologiaRESUMO
BACKGROUND: Latin American women present more severe menopausal symptoms when compared to those from other regions of the world. Since this population is an ethnic blend of Caucasian and indigenous people, we sought to test the hypothesis that severe menopausal symptoms in Latin American women are associated with an indigenous origin. OBJECTIVE: To assess menopausal symptoms among two specific indigenous Latin American populations. METHOD: A total of 573 natural postmenopausal indigenous women aged 45-59 years (288 Quechua (Peru) and 285 Zenú (Colombia)) living in isolated communities were surveyed with a general questionnaire and the Menopause Rating Scale (MRS). RESULTS: The total MRS score was significantly higher among Quechua women as compared to Zenú ones (22.7 ± 5.7 vs. 14.7 ± 2.5, p < 0.0001); both figures were higher than those described for Hispanic or European populations. Quechua women presented more intense somatic and psychological symptoms as compared to Zenú (8.8 ± 2.3 vs. 5.3 ± 1.8; and 7.8 ± 2.4 vs. 3.2 ± 1.7, p < 0.0001); however, both indigenous groups presented similar intense urogenital symptoms (6.1 ± 1.6 vs. 6.2 ± 1.4, not significant). These differences persisted after adjusting for age, years since menopause onset and parity. The percentage of women presenting severe somatic and psychological symptoms significantly increased with aging among Quechua. This was not the case for Zenú women. More than 90% of indigenous women (Quechua and Zenú) at all age intervals presented severe urogenital scores, a percentage that is much higher than that described in the world literature. CONCLUSION: Severe menopausal symptoms found among Latin American women could be the result of their indigenous ethnic origin; the urogenital domain is the most affected.
Assuntos
Etnicidade , Pós-Menopausa/etnologia , Pós-Menopausa/psicologia , Índice de Gravidade de Doença , Fatores Etários , Ansiedade/etnologia , Artralgia/etnologia , Colômbia/epidemiologia , Estudos Transversais , Depressão/etnologia , Fadiga/etnologia , Feminino , Fogachos/etnologia , Humanos , Humor Irritável , Pessoa de Meia-Idade , Peru/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/etnologia , Inquéritos e QuestionáriosRESUMO
La enfermedad de Alzheimer es la más común de las causas de demencia, con el 50 a 70 por ciento de los casos, caracterizada por un deterioro continuo y progresivo de la función cognitiva, pensar, recordar y razonar, que puede llegar a ser tan severa que interfiera con las funciones individuales y sociales de la persona. Generalmente la enfermedad de Alzheimer aparece después de los 65 años de edad y es mucho más frecuente en mujeres que en varones. El estudio de las monjas ha realizado importantes aportes al conocimiento del comportamiento de la entidad. Aunque se conoce mucho sobre la manera en que los estrógenos actúan en el sistema nervioso central y de la importancia de existir dos tipos de receptores estrogénicos en este sistema, continúa siendo controversial, por la ausencia de ensayos clínicos adecuadamente diseñados, el papel de los estrógenos en la prevención y en el retardo en el progreso de la enfermedad de Alzheimer. No obstante, los estudios observacionales permiten concluir que la terapia de suplencia hormonal es una valiosa estrategia terapéutica que debe ser involucrada en el cuidado de mujeres post menopáusicas con factores de riesgo o cuadro de Alzheimer en fase de establecimiento
Assuntos
Doença de Alzheimer , Terapia de Reposição HormonalRESUMO
El Palenque de San Basilio (Bolívar), es un asentamiento humano de raza negra, descendiente de negros que en la época de la colonia se ocultaron en la región de los Montes de María, huyendo de la condición de esclavos a que estaban sometidos. Han conservado muchas de sus tradiciones culturales y poseen una baja incidencia de mezcla con otras razas. Las mujeres se dedican especialmente a la venta ambulante de productos frutales propios de la región, actividad que desempeñan desde corta hasta avanzada edad. Se encuestaron 129 mujeres mayores de 40 años de edad, naturales de San Basilio de Palenque, con edad promedio 57.8 años de edad. El 73.7 por ciento Postmenopáusicas y el 26.3 por ciento premenopáusicas. Edad promedio de menopausia: 49.4 años. El 69 por ciento se dedicaban a ventas ambulantes en las ciudades de Cartagena, Barranquilla y poblaciones vecinas. 71 mujeres (55 por ciento ) informaron tener algún grado de conocimiento sobre menopausia, y de ellas el 69 por ciento comunicaron haberla obtenido a través de las amigas y un 26.8 por ciento en conversaciones familiares. El 36.6 por ciento consideró a la educación impartida por el Médico, la fuente del conocimiento. Los medios masivos de comunicación (televisión, radio, prensa) obtuvieron una calificación ínfima, medios que estas mujeres no utilizan. Aunque el nivel educativo es muy bajo, 81 mujeres (62 por ciento ) definieron correctamente menopausia, no obstante 62 (48 por ciento ) no sabían la edad en la cual se presenta y el 72 por ciento no sabían la causa de dicho evento. 71 mujeres (55 por ciento ) creen que la menopausia es una enfermedad. 53 (41 por ciento ) informaron no saber si debe darse tratamiento en la menopausia. La mitad de las mujeres manifestó no tener temores sobre la menopausia, 41(31 por ciento >) informaron creer que la menopausia disminuye la libido y 71 mujeres (55 por ciento ) comunicaron seguir con actividad coital activa. Existe interés en este grupo poblacional sobre la menopausia, no se presentan barreras sociales o culturales y deben adelantarse programas de educación. La capacitación de lideres comunitarios puede ser una estrategia valiosa para multiplicar la información
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Menopausa , MulheresRESUMO
OBJECTIVE: Little is known about the role of lifestyle factors in non-insulin-dependent diabetes mellitus (NIDDM) incidence among Mexican-Americans. Therefore, we examined whether baseline lifestyle factors predictive of 8-year NIDDM incidence differ in Mexican-American men and women. RESEARCH DESIGN AND METHODS: We studied 353 Mexican-American men and 491 Mexican-American women free of diabetes at baseline who participated in the San Antonio Heart Study follow-up. Lifestyle factors examined were body mass index (BMI), energy intake (total calories/kg), grams of alcohol consumed per week, efforts to control weight by dieting and exercise, leisure physical activity, sugar avoidance, saturated fat/cholesterol avoidance, and 24-h dietary recall assessment of total calories and percentage of calories from total carbohydrate, sucrose, and starch and from total, saturated, monounsaturated, and polyunsaturated fat. Incidence of NIDDM was regressed on lifestyle factors separately for men and women using a backward elimination procedure. RESULTS: Lifestyle factors significantly associated with NIDDM incidence differed for the two sexes. In men, leisure physical activity, was inversely associated and alcohol consumption, weight control by dieting, and BMI were positively associated with NIDDM. In women, BMI was positively associated with NIDDM and was the strongest lifestyle predictor. Sugar avoidance and leisure physical activity were also associated with increased NIDDM risk, while weight control by dieting was associated with decreased NIDDM risk. Saturated fat/cholesterol avoidance, grams of alcohol consumed per week, and energy intake were also negatively and indirectly associated with NIDDM in women by means of their direct effects on BMI. CONCLUSIONS: It may be important to tailor interventions designed to prevent NIDDM in Mexican-Americans to address sex differences in lifestyle precursors of this disease
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Estilo de Vida/etnologia , Americanos Mexicanos , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/etnologia , Peso Corporal/etnologia , Diabetes Mellitus Tipo 2/etiologia , Dieta , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores Sexuais , Texas/epidemiologiaRESUMO
To study demographic, anthropometric and metabolic determinants of weight change, we divided a random sample of 1493 Mexican Americans and non-Hispanic whites into two groups: weight gainers and weight losers. This classification was based on the weight change during the eight-year follow-up of participants of the San Antonio Heart Study, a population-based longitudinal study of diabetes and cardiovascular disease. Men gained significantly less weight and lost more weight than women. The average gains for weight gainers were 6.1 kg and 6.8 kg for men and women respectively; and the average losses for weight losers were 4.4 and 3.4 kg for men and women respectively. There was no ethnic difference in either category of weight change. Weight gainers were significantly younger and leaner than weight losers. Fasting insulin was the only independent metabolic predictor of weight change and only among the most obese tertile of the population: the higher the baseline levels of fasting insulin, the less the likelihood of gaining and the greater the likelihood of losing weight. Our results support the hypothesis that insulin resistance is part of a negative feedback mechanism that attenuates further weight gain among the obese.
Assuntos
Peso Corporal , Adulto , Antropometria , Índice de Massa Corporal , Demografia , Feminino , Hispânico ou Latino , Humanos , Insulina/sangue , Masculino , Metabolismo , México/etnologia , Pessoa de Meia-Idade , Obesidade , Análise de Regressão , Texas , População BrancaRESUMO
Microalbuminuria is associated with increased cardiovascular mortality in both diabetic and non-diabetic subjects. A number of studies have indicated that insulin resistance, increased blood pressure and dyslipidaemia precede the onset of clinical diabetes. We examined various correlates of microalbuminuria in 1,298 non-diabetic subjects who participated in the Mexico City Diabetes Study, a population-based study of diabetes and cardiovascular risk factors. Both parental history of diabetes and impaired glucose tolerance were significantly associated with microalbuminuria. These results were not explained by differences in age or blood pressure between subjects with or without a parental history of diabetes or impaired glucose tolerance. In addition, subjects with microalbuminuria had increased 2-h insulin and triglyceride concentrations, a higher prevalence of hypertension, and decreased high density lipoprotein cholesterol concentrations relative to subjects without microalbuminuria. These results that microalbuminuria may be a feature of the prediabetic state.
Assuntos
Albuminúria , Diabetes Mellitus Tipo 2/urina , Estado Pré-Diabético/urina , Proteinúria , Análise de Variância , Glicemia/metabolismo , Pressão Sanguínea , Estudos de Casos e Controles , Colesterol/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Hiperlipidemias/fisiopatologia , Hipertensão/fisiopatologia , Resistência à Insulina , México/epidemiologia , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/fisiopatologia , Fatores de Risco , Triglicerídeos/sangueRESUMO
We developed predictive models for type II diabetes using stepwise multiple logistic regression analyses of a cohort of 844 Mexican Americans and 641 non-Hispanic whites who were nondiabetic at baseline and who were then followed for 8 yr. Models were developed for the overall population and separately for each sex and ethnic group. For optimal models, the multiple logistic regression program selected potential risk factors from a panel of 5 categorical and 14 continuous demographic, anthropometric, metabolic, and hemodynamic variables. For reduced models, the list of candidate variables was restricted to those commonly used in ordinary clinical practice, i.e., skinfolds, and serum insulin and postural glucose load variables were excluded. For all models, the stepwise process selected a mixture of anthropometric, glucose, lipid, and hemodynamic variables. The top 15% of the risk continuum for each model was defined as high risk to compare the performance of the models with the performance of impaired glucose tolerance (15% prevalence) as a predictor of diabetes. The relative risk of being high risk ranged from 12.16 to 35.29, whereas the relative risk of having impaired glucose tolerance ranged from 7.11 to 10.0. The sensitivity of the multiple logistic regression models ranged from 67.7 to 83.3% compared with 56.5 to 62.1% for impaired glucose tolerance. The results indicate that multivariate predictive models perform at least as well, if not better than impaired glucose tolerance in predicting type II diabetes but need not require an oral glucose load. Moreover, the models highlight the complex metabolic and hemodynamic syndrome that precedes diabetes.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Teste de Tolerância a Glucose , Adulto , Pressão Sanguínea , Colesterol/sangue , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Frequência Cardíaca , Hispânico ou Latino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Análise de Regressão , Fatores de Risco , Texas/epidemiologia , População BrancaRESUMO
En 20 mujeres sin trastornos menstruales y con evidencia ultrasonográfica de ovulación, se cuantificaron los niveles de progesterona durante la mañana (9:00-11:00) y la tarde (2:00-4:00) de un día correspondiente a las fases lútea temprana, mediana y tardía. Los niveles de progesterona obtenidos en la mañana no fueron estadísticamente diferentes de los valores obtenidos en la tarde en ninguno de los días estudiados. Las fluctuaciones en los niveles de progesterona observadas durante las fases lútea temprana, media y tardía fueron relativamente pequeñas y durante la fase lútea media en ninguna de las mujeres estudiadas se obtuvieron valores de progesterona inferiores a 5 ng/ml. Por lo tanto, concluimos que una sola determinación de progesterona, realizada en la fase lútea media del ciclo y durante el intervalo comprendido entre las 9:00 a.m y las 4:00 p.m, es suficientemente para evaluar adecuadamente la función del cuerpo lúteo