Asma y salud mental en mujeres: estudio en centros de atención primaria / Association of asthma control with psychological factors in women

Background: Asthma is a chronic multifactorial disease with a fast-growing global prevalence. Its association with psychological factors is not completely elucidated. Aim: To analyze features associated with not well-controlled asthma and to test the association of psychological factors with asthma control criteria. Patients and Methods: Cross-sectional study that analyzed data from clinical records of asthmatic women under care in the Adult Respiratory Diseases Programs (ERA, in Spanish) and the Mental Health Program of Family Care Health Centers in the city of Arica. According to the asthma control score, patients were classified as having adequate control or not. Results: A total of 60 women were analyzed and 62% had a not well-controlled asthma. Factors associated with not well-controlled asthma were moderate depression (Odds ratio (OR) = 6.84;p < 0.01), emotional lability (OR = 0.14; p = 0.02) and domestic violence (OR = 5.75; p = 0.05). The psychological factors associated with asthma control criteria were fear, emotional instability, domestic violence, sleep disorders, mixed anxiety-depressive disorders, and moderate depression. Conclusions: Psychological factors and violence exposure were consistently associated with asthma control.

Idade da menopausa em mulheres idosas do município de São Paulo: fatores associados e análise de sobrevida / Age at menopause among elderly women in the São Paulo municipality associated factors and survival analysis

Introdução: O crescimento do número de idosos no Brasil tem aumentado o interesse em identificar os determinantes da sua sobrevida e da incidência de doenças crônicas. A menopausa é definida como a cessação permanente da menstruação e está associada à diminuição da secreção de estrógenos por perda da função folicular, marcando o fim da fase reprodutiva na vida feminina. A idade da menopausa tem sido associada em alguns estudos internacionais com a mortalidade e algumas causas de morbidade, mas faltam estudos sobre o tema no Brasil. Esta tese será apresentada por meio de 3 artigos. O primeiro analisou os fatores associados à idade da menopausa natural em mulheres do estudo SABE (Saúde, Bem-estar e Envelhecimento). O tabagismo e a escolaridade estiveram estatisticamente associados com uma menopausa mais cedo nas três coortes analisadas: 2000, 2006 e 2010. Mulheres fumantes atuais tiveram 35% maior risco de ter menopausa precoce (HR=1.35, 95% CI: 1.12, 1.62) e as ex-fumantes 27% maior risco (HR=1.27, 95% CI: 1.09, 1.50), em comparação com as mulheres que nunca fumaram. Em relação à escolaridade, as mulheres com 8 anos ou mais de estudos tiveram 33% menor risco de menopausa precoce (HR=0.67, 95% CI: 0.50, 0.89) comparadas às mulheres sem escolaridade. Estado civil e número de filhos estiveram associados a uma menopausa mais tardia na coorte 2006. No segundo artigo, foi realizada uma análise de sobrevida segundo a idade da menopausa natural das mulheres pertencentes à coorte 2000. Foram identificados 444 óbitos de mulheres até 2016. Mulheres com menopausa precoce tiveram 48% de maior risco de mortalidade geral (HR=1.48, 95% IC: 1.03, 2.14) comparadas às mulheres com idade de menopausa entre os 50 e 54 anos (referência). Em relação à mortalidade específica, mulheres entre 41 e 49 anos apresentaram o dobro de risco de mortalidade por neoplasias em comparação com o grupo de referência. No terceiro artigo, foi realizada uma revisão sistemática e meta-análise dos fatores reprodutivos associados à menopausa natural. Os três fatores estudados apresentaram uma associação com a menopausa tardia. As mulheres com uso de anticoncepcionais orais em relação àquelas que não relataram uso de anticoncepcionais orais (HR=0.86, CI=0.79, 0.92), as com idade da menarca >=13 anos comparadas àquelas com idade da menarca

Introduction: The increase of the elderly population in Brazil has raised concerns about their care and the determinants of survival and incidence of chronic diseases. Menopause is defined as the permanent end of a woman's menstruation and is associated with the decline of the release of estrogens due to loss of follicular function, indicating the end of the reproductive phase of a woman's life. Age at menopause has been linked with mortality and morbidity in international studies. The first article of this thesis analyzed the factors associated with age at natural menopause among women of the SABE study cohort (Health, Well-Being, Aging). Smoking and education were associated with earlier menopause for the three waves analyzed: 2000, 2006 and 2010. Current smokers had 35% higher risk of earlier natural menopause (HR=1.35, 95% CI: 1.12, 1.62) and former smokers had 27% higher risk of earlier natural menopause (HR=1.27, 95% CI: 1.09, 1.50), in comparison with never smokers. Regarding education, women with 8 years or more of formal education had 33% lower risk of earlier natural menopause (HR=0.67, 95% CI: 0.50, 0.89) than women with no education. Marital status and parity were associated with later age at natural menopause only in 2006. In the second article, a survival analysis was performed according to age at natural menopause in women from SABE 2000. We found a total of 444 deaths from 2000 to 2016. Women with earlier menopause had 48% increased risk of all-cause mortality (HR=1.48, 95% IC: 1.03, 2.14) compared to women with age at menopause between 50 and 54 years (reference group). Regarding cause-specific mortality, women with ages at natural menopause between 41 and 49 had twice the risk of cancer mortality compared to the reference group. In the third article, we performed a systematic review and meta-analysis of the reproductive factors associated with natural menopause. The three factors analyzed were statistically associated with later menopause: women with use of oral contraceptives before menopause compared to women with no use of oral contraceptive (HR=0.86, CI=0.79, 0.92), women with age at menarche >=13 compared to women with age at menarche