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BACKGROUND: We aimed to identify the association among nutritional status, Oral Health-Related Quality of Life (OHRQoL) and frailty, and to estimate the mediation effect of these conditions between age and frailty in a group of Mexico City nursing home residents. METHODS: We conducted a cross-sectional study. Fried's phenotype criteria, Full Mini Nutritional Assessment, and General Oral Health Assessment Index was applied. RESULTS: The participants (n = 286) mean age was 82.4 (± 9.2) years. The prevalence of frailty was 58%, and the prevalence of malnutrition and the risk of malnutrition were 22.7% and 59.5%, respectively. A higher risk of frailty was associated with older age (p = 0.015), sex (women) (p = 0.041), poor nutritional status (p <0.001) and compromised OHRQoL (p <0.001). Approximately 40% of the effect of age on frailty was mediated by nutritional status and OHRQoL (p <0.05). CONCLUSION: A strong association between nutritional status and frailty was observed. Additionally, OHRQoL was associated with frailty. The effect of age on frailty was mediated by OHRQoL and nutritional status. Interventions targeted to improve nutritional status and oral health may contribute to preventing or delaying the onset of frailty.
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Fragilidade , Desnutrição , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional , Fragilidade/epidemiologia , Fragilidade/complicações , Qualidade de Vida , Estudos Transversais , México/epidemiologia , Avaliação Geriátrica , Desnutrição/epidemiologia , Avaliação Nutricional , Casas de SaúdeRESUMO
BACKGROUND: Frailty is a clinical state defined as an increase in an individual's vulnerability to developing adverse health-related outcomes. OBJECTIVES: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. DESIGN: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. SETTING: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. PARTICIPANTS: A total of 6,087 individuals 50-year or older were included. MEASUREMENTS: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. RESULTS: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). CONCLUSIONS: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.
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Fragilidade/epidemiologia , Comportamentos Relacionados com a Saúde , Estilo de Vida , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
In this communication the prediction of a two-dimensional carbon nitride allotrope (CN) featuring a 1 : 1 stoichiometry is considered. Calculations were carried out under ambient conditions of pressure and temperature (1 atm, 300 K), to prove its dynamic (phonon) and thermal stability. The novel CN structure contains pentagonal rings (c-C3N2) linked by nitrogen atoms, and separated by holes, whereas the sp3-like C atoms are bonded to isocyano (C[triple bond, length as m-dash]N-) groups projecting out of its surface and resembling spine-like formations. The predicted structure has a calculated indirect bandgap of approximately 2.78 eV (hybrid HSE06 approximation), that is in the range of visible light, and this it might increase its use in the field of photocatalysis.
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Frailty is an age-associated condition, characterized by an inappropriate response to stress that results in a higher frequency of adverse outcomes (e.g., mortality, institutionalization and disability). Some light has been shed over its genetic background, but this is still a matter of debate. In the present study, we used network biology to analyze the interactome of frailty-related genes at different levels to relate them with pathways, clinical deficits and drugs with potential therapeutic implications. Significant pathways involved in frailty: apoptosis, proteolysis, muscle proliferation, and inflammation; genes as FN1, APP, CREBBP, EGFR playing a role as hubs and bottlenecks in the interactome network and epigenetic factors as HIST1H3 cluster and miR200 family were also involved. When connecting clinical deficits and genes, we identified five clusters that give insights into the biology of frailty: cancer, glucocorticoid receptor, TNF-α, myostatin, angiotensin converter enzyme, ApoE, interleukine-12 and -18. Finally, when performing network pharmacology analysis of the target nodes, some compounds were identified as potentially therapeutic (e.g., epigallocatechin gallate and antirheumatic agents); while some other substances appeared to be toxicants that may be involved in the development of this condition.
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Epigênese Genética/efeitos dos fármacos , Fragilidade/genética , Envelhecimento/efeitos dos fármacos , Envelhecimento/genética , Apoptose/efeitos dos fármacos , Apoptose/genética , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/genética , Fragilidade/tratamento farmacológico , Genes/efeitos dos fármacos , Genes/genética , Humanos , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiologia , Farmacologia/métodos , Proteólise/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Biologia de Sistemas/métodosRESUMO
BACKGROUND AND OBJECTIVE: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. METHODS: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. RESULTS: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 - 3.33) and low gait speed (OR: 2.76; CI 1.83 - 4.15) in the adjusted model. CONCLUSION: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship.
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Disfunção Cognitiva , Força da Mão , Testes de Estado Mental e Demência , Debilidade Muscular , Velocidade de Caminhada , Idoso , Idoso de 80 Anos ou mais , Causalidade , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/fisiopatologia , Colômbia/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Debilidade Muscular/diagnóstico , Debilidade Muscular/epidemiologia , Debilidade Muscular/etiologia , Debilidade Muscular/psicologia , Estatística como Assunto , Fatores de TempoRESUMO
OBJECTIVE: The main objective was to test the validity of height estimated by knee height in Mexican older adults, as a surrogate for standing height. DESIGN: Cohort study. SETTING: Data were drawn from the first and third waves of the Mexican Health and Aging Study. PARTICIPANTS: Included participants were community-dwelling 50-year or older adults with measured height at baseline and in follow-up. Subjects with a lower limb fracture in the follow-up were excluded. MEASUREMENTS: Main measurements were baseline standing height and 11-year follow-up and knee-estimated height in follow-up. Population specific equations were used to estimate standing height from knee height. Comparisons between baseline standing height and knee-derived height were done with simple correlations, limits of agreement (Bland-Altman plot) and Deming regressions. RESULTS: A total of 136 50-year or older adults were followed-up for eleven years, with a mean age of 60. There was a positive correlation between knee-estimated height and baseline standing height of 0.895 (p<0.001) for men and of 0.845 (p<0.001) for women. Limits of agreement for men were from -6.95cm to 7.09cm and for women from -6.58cm to 8.44cm. CONCLUSION: According to our results, knee-estimated height could be used interchangeably with standing height in Mexican older adults, and these results might apply also to other populations.
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Antropometria/métodos , Estatura/fisiologia , Joelho/fisiologia , Perna (Membro)/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Estudos de Coortes , Feminino , Humanos , Masculino , Americanos Mexicanos , México , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Calf circumference is a surrogate measurement of muscle mass. However, there is scarce evidence on its validity in predicting adverse outcomes such as mobility disability. The aim of this report is to determine if calf circumference could predict incident mobility disability in Mexican 60-year or older adults. METHODS: This is a secondary analysis of the Mexican Health and Aging Study and in particular of its two first waves. Sixty-year or older adults without mobility disability in the first assessment were included and followed-up for two years. Calf circumference quartile groups were compared to test the difference of incident mobility disability. Logistic regression models were fitted to test the independent association when including confounding variables. RESULTS: A total of 745 older adults were assessed, from which 24.4% of the older adults developed mobility disability at follow-up. A calf circumference > 38 cm was associated with a higher risk of developing mobility disability, even after adjustment in the multivariate model, with an odds ratio 0.55 (95% confidence interval 0.31-0.99, P = 0.049). CONCLUSIONS: High calf circumference in Mexican older adults is independently associated with incident mobility disability. This could reflect the impact of adverse health conditions such as obesity (with high fat tissue) or edema. Further research should aim at testing these results in different populations.
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BACKGROUND: The implementation of an aging biomarker into clinical practice is under debate. The Frailty Index is a model of deficit accumulation and has shown to accurately capture frailty in older adults, thus bridging biological with clinical practice. OBJECTIVES: To describe the association of socio-demographic characteristics and the Frailty Index in different age groups (from 20 to over one hundred years) in a representative sample of Mexican subjects. DESIGN: Cross-sectional analysis. SETTING: Nationwide and population-representative survey. PARTICIPANTS: Adults 20-years and older interviewed during the last Mexican National Health and Nutrition Survey (2012). MEASUREMENTS: A 30-item Frailty Index following standard construction was developed. Multi-level regression models were performed to test the associations of the Frailty Index with multiple socio-demographic characteristics across age groups. RESULTS: A total of 29,504 subjects was analyzed. The 30-item Frailty Index showed the highest scores in the older age groups, especially in women. No sociodemographic variable was associated with the Frailty Index in all the studied age groups. However, employment, economic income, and smoking status were more consistently found across age groups. CONCLUSIONS: To our knowledge, this is the first report describing the Frailty Index in a representative large sample of a Latin American country. Increasing age and gender were closely associated with a higher score.
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Envelhecimento , Idoso Fragilizado , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores Sexuais , Fatores SocioeconômicosRESUMO
OBJECTIVE: To estimate the prevalence of sarcopenia in Mexican older adults using simple measurements and tailored cutoff values for the components of the European Working Group on Sarcopenia in Older People algorithm. MATERIAL AND METHODS: This study used cross-sectional data from the third wave (2012) of the Mexican Health and Aging Study. Gait speed and handgrip strength cutoff values were tailored for Mexican older adults. Muscle mass was estimated by a formula, which uses simple anthropometry and demographic characteristics. RESULTS: From the total of 1,238 older adults included in our study, sarcopenia prevalence was 11% (n = 137). When categorizing sarcopenia, 39.1% (n = 484) had pre-sarcopenia, 8.3% (n = 103) moderate sarcopenia, and 2.75% (n = 34) had severe sarcopenia. CONCLUSIONS: Sarcopenia is a common problem in Mexican older adults, and its frequency along with its severity increases with age. Tailored cutoff values could help in identifying those subjects that could have benefited from intervention.
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El proceso de envejecimiento no es sinónimo de disminución en la función del cuerpo humano -o de cualquier otro organismo vivo- sin embargo, sí lleva consigo el incremento en la frecuencia de enfermedades crónicas como la diabetes mellitus y la hipertensión arterial sistémica. Hoy por hoy, uno de los grandes retos de la investigación en salud de este grupo de edad es el conocer cómo es envejecer con una enfermedad crónica, cuáles son los efectos de las complicaciones de la misma, qué impacto tiene el uso prolongado de medicamentos, cuál es el papel de las enfermedades crónicas en la pérdida de la funcionalidad; entre otros muchos temas en los que aún no se tiene la suficiente información que pudieran llevar a la formulación de planes de acción concretos. La salida más común en los últimos años ha sido llevar a cabo las mismas acciones que se utilizan en adultos más jóvenes, una estrategia que no ha sido efectiva y afortunadamente se está abandonando por el personal de salud. Existen algunos ejemplos en adultos mayores mexicanos, en donde se ha evidenciado que implementar una estrategia de atención específica para ellos puede mejorar su estado de salud.
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. OBJECTIVES: To determine risk factors associated with slowness in Mexican older adults. DESIGN: A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study. SETTING PARTICIPANTS: One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). MEASUREMENTS: A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. RESULTS: In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. CONCLUSIONS: Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.
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Physical performance tests are associated with different adverse outcomes in older people. The objective of this study was to test the association between handgrip strength and gait speed with incident disability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability was defined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133 participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associations of handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR 0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reduced the statistical significance of the associations without substantially modifying the magnitude of them. Handgrip strength and gait speed are independently associated with incident disability in Mexican older adults.
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BACKGROUND: Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS: A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS: Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION: Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.
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Síndrome de Down/epidemiologia , Hipersensibilidade/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Modelos Logísticos , Masculino , México/epidemiologiaRESUMO
Sarcopenia has an important impact in elderly. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the loss of muscle mass plus low muscle strength or low physical performance. Lack of clinical sounding outcomes (ie external validity), is one of the flaws of this algorithm. The aim of our study was to determine the association of sarcopenia and mortality in a group of Mexican elderly. A total of 345 elderly were recruited in Mexico City, and followed up for three years. The EWGSOP algorithm was integrated by: gait speed, grip strength and calf circumference. Other covariates were assessed in order to test the independent association of sarcopenia with mortality. Of the 345 subjects, 53.3% were women; with a mean age of 78.5 (SD 7) years. During the three year follow-up a total of 43 (12.4%) subjects died. Age, cognition, ADL, IADL, health self-perception, ischemic heart disease and sarcopenia were associated in the bivariate analysis with survival. Negative predictive value for sarcopenia regarding mortality was of 90%. Kaplan-Meier curves along with their respective log-rank test were significant for sarcopenia. The components of the final Cox-regression multivariate model were age, ischemic heart disease, ADL and sarcopenia. Adjusted HR for age was 3.24 (CI 95% 1.55-6.78 p 0.002), IHD 5.07 (CI 95% 1.89-13.59 p 0.001), health self-perception 5.07 (CI 95% 1.9-13.6 p 0.001), ADL 0.75 (CI 95% 0.56-0.99 p 0.048) and sarcopenia 2.39 (CI 95% 1.05-5.43 p 0.037).
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Sarcopenia/diagnóstico , Sarcopenia/mortalidade , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Antropometria , Cognição/fisiologia , Estudos de Coortes , Feminino , Seguimentos , Avaliação Geriátrica , Humanos , Estimativa de Kaplan-Meier , Masculino , México , Atividade Motora , Análise Multivariada , Força Muscular , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Sarcopenia/complicações , Autoimagem , Fatores SocioeconômicosRESUMO
BACKGROUND: "Frailty" has emerged as a condition associated with an increased risk of functional decline among the elderly, which may be differentiated from aging, disability, and co-morbidities. OBJECTIVE: The Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly has emerged to help answer many questions about frailty among the older adults. This report presents the design of the study and baseline data of its participants. DESIGN: The "Coyoacan cohort" is a longitudinal observational study developed in Mexico City. PARTICIPANTS: A representative sample of 1,294 non-institutionalized men and women aged 70 years and older were randomly recruited to undergo a face-to-face interview and a comprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009. MEASUREMENTS: Data collected included socio-demographic and economic characteristics, medical history, oral health, drug use, cognitive function and mood, nutritional status, physical performance and functional status, physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 of the following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentional weight loss. RESULTS: A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years, and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 blood samples were collected. The baseline prevalence of frailty was 14.1%. CONCLUSIONS: Understanding the medical, biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the current research in the field.
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BACKGROUND: For a child to develop acute leukaemia (AL), environmental exposure may not be sufficient: interaction with a susceptibility factor to the disease, such as Down syndrome (DS), may also be necessary. We assessed whether breastfeeding and early infection were associated with the risk of developing AL in children with DS. METHODS: Children with DS in Mexico City, and either with or without AL, were the cases (N=57) and controls (N=218), respectively. Population was divided in children with AL and with acute lymphoblastic leukaemia (ALL) and also in children < or = 6 and >6 years old. RESULTS: Breastfeeding and early infections showed moderate (but not significant) association for AL, whereas hospitalisation by infection during the first year of life increased the risk: odds ratios (confidence interval 95%) were 0.84 (0.43-1.61), 1.70 (0.82-3.52); and 3.57 (1.59-8.05), respectively. A similar result was obtained when only ALL was analysed. CONCLUSION: We found that breastfeeding was a protective factor for developing AL and ALL, and during the first year of life, infections requiring hospitalisation were related to a risk for developing the disease in those children with DS >6 years of age. These data do not support the Greaves's hypothesis of early infection being protective for developing ALL.
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Aleitamento Materno/efeitos adversos , Síndrome de Down/complicações , Infecções/complicações , Infecções/epidemiologia , Leucemia Mieloide/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Doença Aguda , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide/complicações , Leucemia Mieloide/diagnóstico , Masculino , Razão de Chances , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
El presente trabajo es una revisión de la literatura sobre los factores de riesgo para la aparición del Síndrome de Burnout en el personal de Enfermería. Este síndrome caracterizado por agotamiento mental, estrés laboral, estrés emocional y desgaste profesional , aparece según los estudios revisados como resultado de múltiples factores personales y organizacionales entre los que destacan el estado civil, el género, la edad, la antigüedad laboral, el coeficiente enfermera-paciente y el ambiente físico y organizacional del trabajo. Así también se incluye algunas recomendaciones para que las organizaciones de salud y los profesionales de Enfermería puedan identificar oportunamente el Síndrome de Burnout, prevenir su aparición y definir acciones en consecuencia.
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Humanos , Masculino , Feminino , Enfermagem , Esgotamento Profissional , Estresse PsicológicoRESUMO
El corazón es una bomba contráctil regulada por estímulos mecánicos y neurohumorales encargado de mantener un flujo sanguíneo acorde con las demandas metabólicas de nuestro organismo. Los cardiomiocitos y sus sarcómeros son las unidades básicas responsables del proceso de contracción miocárdica. Dado que los cardiomiocitos no proliferan después del nacimiento, estas células experimentan hipertrofia, aumentando la cantidad de sarcómeros, con objeto de aumentar el trabajo cardíaco en situaciones de estrés. En este trabajo se hace una revisión crítica de las señales y mecanismos de transducción responsables del desarrollo de la hipertrofia cardíaca fisiológica y patológica. Además se abordan las implicancias clínicas y bases genéticas asociadas a la cardiomiopatía hipertrófica. El conocimiento de estas vías transduccionales permite comprender las bases biológicas de esta patología y proyectar futuras intervenciones terapéuticas.