Anxiety, depression, and alcohol use disorder in dermatologists: relationship with burnout and associated risk factors.

Burnout syndrome is a mental health condition related to chronic occupational stress; its prevalence, as well as its relationship with other mental health disorders in physicians, has become a topic of growing interest. However, no studies with large sample sizes evaluate this association in dermatologists. With this background, a cross-sectional study was designed, which included 420 Spanish dermatologists; the mean age was 44.5 years (12.39), and 62% (260/420) were women. Eleven percent (45/420) of the participants presented a moderate risk of burnout, more than half of the sample had at least one of the burnout symptoms, 47% (198/420) had some degree of anxiety, and 20.3% (85/420) presented some degree of depression. Less than 1% (4/420) demonstrated a high risk of alcohol use disorder. Being female was associated with a higher risk of depression and anxiety. Meanwhile, men and residents showed an increasedrisk of alcohol use disorder. Burnout and its domains showed a significative association with depression and anxiety, while no relationship with alcohol abuse was observed.

La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores que viven en la comunidad.

OBJETIVO: Determinar la asociación entre mala autopercepción de salud oral y fragilidad en personas mayores. Material y métodos. Estudio transversal en personas mayores de la Ciudad de México. La autopercepción de salud oral se midió con el Geriatric/General Oral Health Assessment Index (GOHAI) y la fragilidad con el fenotipo de Fried y colaboradores. RESULTADOS: 1 173 personas mayores, media de edad de 66.0 (5.7) años, mujeres 46.1% (n=541). La media (IC95%) de GOHAI-Sp fue de 49.2 (48.9-49.6). El 9.2% (n=108) presentaron fragilidad, 59.9% (n=703) prefrágil y 30.9% (n=362) no frágiles. La fuerza de asociación (RM) para mala autopercepción de salud oral y frágil fue RM 2.4 (IC95% 1.5,3.7) y RM ajustada RM 1.7 (IC95% 1.1,2.8), referencia no frágil. No existe asociación significativa para la mala autopercepción de salud oral y prefrágil. Conclusión. La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores.

[Answer to "Comment on article "Sleep disorders in older people. How do older people in Mexico City sleep?""]. / Respuesta a "Comentario al artículo: "Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?"".

The response of the authors of the article "Sleep disorders in older people. How do older people in Mexico City sleep?" is presented, in which they carry out pertinent clarifications.

Se presenta la respuesta de los autores del artículo "Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?" en la que llevan a cabo aclaraciones pertinentes.

[Sleep disorders in older people. How do older people from Mexico City sleep?] / Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?

Background: Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by communitydwelling older people. Objective: To describe the prevalence of sleep disorders and their relationship with medical conditions in communitydwelling older people. Material and methods: Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions. Results: Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system. Conclusions: This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Introducción: el buen sueño es esencial para la salud física y mental a lo largo de la vida. Sin embargo, existen pocos reportes sobre los problemas del sueño que enferentan las personas mayores que viven en la comunidad. Objetivo: describir la prevalencia de los principales problemas de sueño y su relación con condiciones médicas en las personas mayores que viven en la comunidad. Material y métodos: estudio transversal descriptivo con 1678 personas de 60 años y más, derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. Se evaluó la duración del sueño, la calidad del sueño, la somnolencia diurna, el insomnio y el riesgo de apnea obstructiva de sueño, junto con algunas variables sociodemográficas y condiciones médicas. Resultados: las personas mayores reportaron dormir, en promedio, 6.04 (± 1.5) horas por noche; el 49.1% tenía baja calidad del sueño y el 19.1% experimentaba somnolencia diurna; el 30.8% presentó insomnio y el 27.5% tenía riesgo de apnea obstructiva del sueño. Se observó un patrón de mayor prevalencia de problemas de sueño en las personas mayores con depresión, deterioro cognitivo, dificultades para realizar actividades básicas de la vida diaria y en quienes consumían medicamentos para el sistema nervioso. Conclusiones: este estudio mostró que las personas mayores duermen pocas horas, tienen baja calidad de sueño y prevalencia alta de trastornos del sueño. La identificación y el tratamiento de los problemas del sueño en las personas mayores debe ser una prioridad en el IMSS.

Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México? / Sleep disorders in older people. How do older people from Mexico City sleep?

Introducción: el buen sueño es esencial para la salud física y mental a lo largo de la vida. Sin embargo, existen pocos reportes sobre los problemas del sueño que enferentan las personas mayores que viven en la comunidad. Objetivo: describir la prevalencia de los principales problemas de sueño y su relación con condiciones médicas en las personas mayores que viven en la comunidad. Material y métodos: estudio transversal descriptivo con 1678 personas de 60 años y más, derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. Se evaluó la duración del sueño, la calidad del sueño, la somnolencia diurna, el insomnio y el riesgo de apnea obstructiva de sueño, junto con algunas variables sociodemográficas y condiciones médicas. Resultados: las personas mayores reportaron dormir, en promedio, 6.04 (± 1.5) horas por noche; el 49.1% tenía baja calidad del sueño y el 19.1% experimentaba somnolencia diurna; el 30.8% presentó insomnio y el 27.5% tenía riesgo de apnea obstructiva del sueño. Se observó un patrón de mayor prevalencia de problemas de sueño en las personas mayores con depresión, deterioro cognitivo, dificultades para realizar actividades básicas de la vida diaria y en quienes consumían medicamentos para el sistema nervioso. Conclusiones: este estudio mostró que las personas mayores duermen pocas horas, tienen baja calidad de sueño y prevalencia alta de trastornos del sueño. La identificación y el tratamiento de los problemas del sueño en las personas mayores debe ser una prioridad en el IMSS.

Background: Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by community-dwelling older people. Objective: To describe the prevalence of sleep disorders and their relationship with medical conditions in community-dwelling older people. Methods: Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions. Results: Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system. Conclusions: This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Ixekizumab for Patients with Plaque Psoriasis Affected by Multiple Sclerosis: Case report.

Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system that shares similar immunopathogenic mechanisms with chronic plaque psoriasis, such as the overexpression of the Th17 pathway. We report a 50-year-old male patient with MS and severe chronic plaque psoriasis who presented to Hospital Virgen de la Victoria, Málaga, Spain, in 2019. He was successfully treated with ixekizumab (anti-interleukin [IL]-17A and IL-17A/F monoclonal antibody). The treatment achieved complete skin clearance (i.e. a Psoriasis Area Severity Index 100 response) with no adverse event and no evidence of progression of the neurological disease either.

Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults.

PURPOSE: To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults. PATIENTS AND METHODS: Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex. RESULTS: This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty. CONCLUSION: In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.

Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort.

PURPOSE: To identify factors associated with recovered functionality after a hip fracture in a sample of older adult patients. PATIENTS AND METHODS: Nested case-control study in a cohort. Older adults (60 years or older) with a hip fracture were recruited between May 2017 and October 2018. The Barthel scale was used to measure performance in activities of daily living (ADL). A questionnaire was applied to collect information about demographic, clinic, psychological and social variables, and anthropometric measurements were taken. A logistic regression model was built to analyze various factors related to recovered functionality. RESULTS: A total of 346 older adults with a hip fracture were studied (n=173 cases and n=173 controls); 69.4% (n=240) women and 30.6% (n=140) men. Mean age was 79.4 years (±8.7) overall; for cases, 77.4 (±7.9) years and for controls, 81.4 (±9.0). Mean schooling was 6.3 (± 4.3) years. Recovered functionality was associated with normal nutritional status (OR 4.81, 95% CI = 2.54-9.12), absence of heart disease (OR 4.08, 95% CI = 1.48-11.20), self-efficacy for ADL (OR 4.07, 95% CI = 2.15-7.72), absence of depressive symptoms (OR 2.99, 95% CI = 1.69-5.28), prior functionality (OR 2.83, 95% CI = 1.51-5.31), high socioeconomic level (OR 2.41, 95% CI = 1.24-4.65) and transcervical fracture (OR 2.34, 95% CI = 1.05-5.22). CONCLUSION: In older adults who have suffered a hip fracture, clinical, psychological, and demographic characteristics are associated with recovered functionality. These factors should be considered as a priority in the care of older adults who have experienced hip fractures.

Social isolation undermines quality of life in older adults.

OBJECTIVE: Several studies have documented associations between social isolation and poor physical health or well-being. However, little is known of the importance of social support among older adults on specific topics about their quality of life. The purpose of the present study was to determine the relationship between social isolation and quality of life among older adults. DESIGN: A cross-sectional study. SETTING: Mexico City. PARTICIPANTS: 1,252 subjects aged ≥ 60 years living at home. MEASUREMENTS: We used the Abbreviated Version of the Lubben Social Network Scale (LSNS-6) to assess social isolation and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old) to assess quality of life. Socio-demographic and health factors were collected through face-to-face interviews. A series of linear regression analyses were used to investigate relationship between social isolation and quality of life. The statistical models were controlled for socio-demographic and health factors. RESULTS: A total of 750 women (60%) and 502 men (40%) participated in the study. According to their LSNS-6 scores, 426 participants (34.0%) were classified into the highest group of isolation (range 0-10 points). Older adults with higher scores of social isolation exhibited lower quality of life. Regression analyses indicated that social isolation correlated with lower levels of global quality of life, autonomy, intimacy, and past, present, and future activities. CONCLUSIONS: Coping with life from a socially isolated situation entails serious difficulties concerning quality of life. Interventions that foster environments where older adults can forge social bonds might improve their quality of life.

Allele Frequency of ACE2 Intron Variants and Its Association with Blood Pressure.

Angiotensin-converting enzyme 2 (ACE2) is known as the counter-regulator of the renin-angiotensin system, it cleaves angiotensin II to render Ag 1-7, a potent vasodilator with multiple roles in cardiovascular protection. A few studies have pinpointed ACE2 polymorphisms and their relationship with heart function and hypertension in a sex-dependent manner. These observations still lack replication mostly for admixed populations. This study aimed to report minor allele frequencies of four ACE2 intron variants, rs2285666, rs2048683, rs2106809, and rs4240157, derived from previous research using the GSA, v1.0, microarray in 1231 hypertensive and nonhypertensive patients. Logistic and multiple linear regression models were developed to identify potential associations with hypertension status and systolic and diastolic blood pressure (SBP and DBP). Allele frequency differences were identified for ACE2 rs2048683 and rs4240157 in populations with European ancestry and people of the Americas. Regression analyses identified a significant association of ACE2 rs2048683 and rs4240157 with SBP/DBP in males or females. Our observations confirm sex differences in ACE2 genetic associations with SBP and DBP and contribute to the collection of genetic variation in ACE2 for admixed populations.

Quality of Life of Cohabitants of People Living with Acne.

The aim of this study was to analyse the levels of anxiety, depression, and quality of life of individuals living with acne patients (cohabitants). The study included patients, cohabitants, and controls; a total of 204 participants. Patients' health-related quality of life was measured with the Dermatology Life Quality Index (DLQI), while cohabitants' quality of life was measured with the Family Dermatology Life Quality Index (FDLQI). The psychological state of all participants was measured with the Hospital Anxiety and Depression Scale (HADS). Presence of acne impaired the quality of life of 89.4% of the cohabitants. The FDLQI scores of cohabitants were significantly associated with the DLQI scores of the patients (rp = 0.294; p = 0.044). Anxiety and depression levels in cohabitants were significantly higher than in controls (p < 0.01). In conclusion, acne may have a negative impact on quality of life and psychological well-being of patients and their cohabitants.

Ixekizumab vs ustekinumab for skin clearance in patients with moderate to severe psoriasis after a year of treatment: Real-world practice.

There is a lack of real practice studies comparing ustekinumab and ixekizumab effectiveness and safety. The main aim of this study was to compare the effectiveness and safety of both drugs used to treat moderate-to-severe psoriasis patients over 52 weeks. The secondary objective was to identify which clinical variables could have an impact on its effectiveness. A retrospective observational study was carried out, comparing the first 28 patients treated with ustekinumab after its commercialization was compared to the first 35 patients treated with ixekizumab. Although a higher level of skin clearance was achieved with ixekizumab with a PASI 90 and 100 response of 54.3% and 40% compared to 42.9% and 25% for ustekinumab, these differences were not statistically significant. Ixekizumab achieved a higher PASI 90 response in those patients with BMI > 27 (slightly overweight), which was statistically significant (P = .024). Ustekinumab had a greater survival at 52 weeks than ixekizumab, with a trend towards statistical significance (P = .052). Ixekizumab achieved higher skin clearance rates (PASI 90 and 100 response) than ustekinumab, with no statistically significant differences. However, ixekizumab should be specially considered in overweight patients.

Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women.

OBJECTIVE: To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults. SUBJECTS & METHODS: Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty. RESULTS: Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men. CONCLUSION: In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.

Comparative study of the efficacy and safety of secukinumab vs ixekizumab in moderate-to-severe psoriasis after 1 year of treatment: Real-world practice.

There are no studies which directly compare efficacy in Psoriasis Area and Severity Index (PASI) response of secukinumab and ixekizumab. The main aim of this study was to compare the efficacy and safety of both drugs used to treat moderate-to-severe psoriasis patients over 52 weeks. Secondary objectives were to identify which factors related to prior biologic treatment influenced their efficacy and analyze data obtained at 12 weeks. A retrospective observational study was carried out, in which a group of the first 59 patients treated with secukinumab after its commercialization, was compared with another group of the first 29 patients treated with ixekizumab. The PASI 75, 90, and 100 response obtained at 52 weeks was 64.4%, 49.2%, and 41.4% for secukinumab and 75.9%, 62.1%, and 41.4% for ixekizumab, respectively, with no statistically significant differences. Regarding previous biological treatment, both treatments showed a decrease in efficacy as the number of prior biologics increases. No differences were found between secukinumab and ixekizumab in bio-naïve or bio-experienced patients, with the exception of a higher PASI 75 response at week 52 for ixekizumab in those patients with two or more previous biologics (P = .039) Secukinumab and ixekizumab have demonstrated high efficacy and safety, with no statistically significant differences.

Exploring Patients' Insight, Concerns, and Expectations at Dermatology Clinic: An Observational Study in 2 Centers in Scotland and Spain.

BACKGROUND: Effective doctor-patient communication is of great importance in order to optimize medical consultation outcomes. However, it can be difficult to address all patients' concerns and expectations in clinic. OBJECTIVE: To identify how much patients know about their medical condition, their fears and concerns, and their expectations, as well as evaluate the benefits of using a preconsultation questionnaire routinely. METHODS: This study included consecutive patients attending dermatology outpatients from Dundee (Scotland) and Granada (Spain) who completed a simple preconsultation 3-part questionnaire. Answers to this questionnaire were discussed during clinic visits. RESULTS: Two hundred patients participated in the study. Of all, 111 (55.5%) patients already knew their diagnosis or were able to describe their symptoms and/or feelings quite accurately at their visit to Dermatology. Most patients (85%) had fears regarding their dermatological problem. A majority of patients (97%) came to clinic with specific expectations, and many (41.5%) had multiple expectations. A high proportion of patients (74%) found the questionnaire useful. CONCLUSION: Patients attend clinic with different levels of knowledge, fears, and expectations. We recommend using a brief and easy to use preconsultation questionnaire as a cost-effective way of enhancing doctor-patient communication.

Decreased Autonomy In Community-Dwelling Older Adults.

PURPOSE: The present study aims to explore characteristics associated with low perception of autonomy among community-dwelling older adults. PATIENTS AND METHODS: This original research was derived from a cross-sectional study based on the study COSFOMA with information from 1,252 (60 years and older) community-dwelling older adults whose data was obtained through a questionnaire that included sociodemographic characteristics, as well as different scales of geriatric assessment. The perception of autonomy was evaluated with the autonomy sub-scale of the Quality of Life Scale of Older Adults from the World Health Organization (World Health Organization Quality of Life of Older Adults, WHOQOL-OLD). RESULTS: The mean (SD) age of the 1,252 community-dwelling older adults participating in the study was 68.5 (7.2) years. The average perception of autonomy was 65.3 (18.2) points out of 100. In the final logistic regression model, schooling <6 years (Odds Ratio, OR = 2.1, 95% Confidence Interval, CI = 1.5-2.9), low social support (OR = 1.6, 1.2-2.2), low spirituality (OR = 2.6, 95% CI = 1.9-3.4), presence of cognitive impairment (OR = 1.9, 95% CI = 1.4-2.5), anxiety (OR = 1.7, 95% CI = 1.2-2.5), and limitation in activities of daily living (ADL) (OR = 1.6, 95% CI = 1.1-2.2) were statistically associated with the presence of low autonomy in older adults. CONCLUSION: The perception of autonomy among community-dwelling older adults is moderate. Social support and spirituality, as well as cognitive impairment, anxiety, and limitations in ADL, play a significant role for degree of perceived autonomy in this population. Health professionals can use this information to promote participation in decision-making processes through programs that improve quality of life.

Oxidative stress in the elderly with diabetes mellitus or hypertension / Estrés oxidativo en adultos mayores con diabetes mellitus o hipertensión arterial

Background: Mexico City has the highest aging rate in the country, as well as a high prevalence of diabetes mellitus (DM) and hypertension (HT). It is known that each one of these conditions increase oxidative stress (OS) independently. Methods: With this study we described changes in OS of 18 patients without DM or HT (controls), 12 with DM, 23 with HT, and 18 with DM and HT, all of them members of the COSFAMM (Cohorte de Obesidad, Sarcopenia y Fragilidad en Adultos Mayores de México). OS was measured by the quantification of reactive oxygen species (ROS), by the oxidation of diclorofluorosceine, and by determination of lipid peroxidation by product malondialdehyde (MDA). Results: HT patients showed increased ROS levels, as did men with HT compared with the respective DM and HT groups. Also, women of control group showed higher levels of ROS compared with men. Conclusions: Generally, HT turned out to be the most influential factor for the increase of oxidative stress in the elderly while DM has no effect whatsoever.

Introducción: la Ciudad de México tiene el mayor índice de envejecimiento del país, así como una alta prevalencia de diabetes mellitus (DM) e hipertensión arterial (HTA). Se sabe que cada una de estas condiciones incrementa el estrés oxidativo (EO) de forma independiente. Métodos: en este estudio describimos los cambios en el EO de 18 pacientes sin DM ni HTA (controles), 12 con DM, 23 con HTA y 18 con DM y HTA, todos miembros de la Cohorte de Obesidad, Sarcopenia y Fragilidad en Adultos Mayores de México (COSFAMM). El EO fue medido por la cuantificación de especies reactivas de oxígeno (ERO) por la oxidación de la diclorofluorosceína (DCFH) y por determinación de peroxidación de lípidos por producto malondialdehído (MDA). Resultados: los pacientes con HTA mostraron niveles de ERO elevados, así como los hombres con HTA, comparados con los grupos correspondientes de DM y HTA. Asimismo, las mujeres del grupo control mostraron mayor cantidad de ERO que los hombres. Conclusiones: en general, la HTA en el adulto mayor resultó ser el factor que mayor contribución tiene en el incremento del estrés oxidativo, mientras que la DM no tiene efecto alguno.

Sleep disturbances are associated with frailty in older adults / Las dificultades del sueño se asocian con fragilidad en adultos mayores

Background: Sleep plays a vital role in good health. Since sleep disturbances have been linked to a series of adverse physical health outcomes, the objective was to analyze the association between sleep disturbances and the frailty criteria in Mexican older adults from Mexico City. Methods: The study design was cross-sectional. A total of 1252 people aged 60 years or older were assessed according to Fried criteria for defining frailty. Sleep disturbances (sleeping without rest, sleeping more than usual and having trouble sleeping) were collected by self-report through a face to face questionnaire. The association between sleep disturbances and frailty was estimated with ordinal logistic regression controlled by covariates. Results: It was found that 6.9% of older people reported sleeping more than usual, 18.9% slept without rest and 16.3% had trouble sleeping. There was a statistically significant association between sleeping more than usual (OR = 1.96, 95% CI: 1.23-3.12) and having trouble sleeping (OR = 1.53, 95%CI: 1.09-2.17) with frailty. Conclusion: Sleeping more than usual or having trouble sleeping contribute to increase frailty in older people from Mexico City.

Introducción: el sueño es importante para una buena salud. Las dificultades como dormir mal, de manera insuficiente o excesiva, entre otras, traen consigo diversos desenlaces adversos para la salud. El objetivo fue analizar la asociación entre las dificultades del sueño y la presencia de fragilidad de adultos mayores de la Ciudad de México. Métodos: el diseño del estudio fue transversal. Se evaluaron 1252 personas de 60 años o más con base en los criterios de Fried para definir fragilidad. Las dificultades del sueño (dormir sin descansar, dormir más de lo habitual y dificultad para dormir) se recolectaron mediante un cuestionario de entrevista directa. La asociación entre dificultades del sueño y fragilidad se estimó con regresión logística ordinal controlada por covariables. Resultados: se encontró que 6.9% de personas mayores reportaron que dormían más de lo habitual, 18.9% dormía sin descansar y a 16.3% le costaba mucho dormir. Se observó una asociación estadísticamente significativa entre dormir más de lo habitual (RM = 1.96; IC95%: 1.23-3.12) y la dificultad para dormir (RM = 1.53; IC 95%: 1.09-2.17) con la fragilidad. Conclusiones: dormir más de lo habitual o presentar dificultad para dormir están asociadas con la presencia de fragilidad en los adultos mayores.

Photoletter to the editor: Response of linear porokeratosis to photodynamic therapy in an 11-year-old girl.

Porokeratoses are a group of different entities that belong to the skin keratinization disorders. From the histological point of view the main and common characteristic of these disorders is the presence of compact parakeratotic columns known as cornoid lamellae. All varieties should be carefully treated and followed-up because of the risk of developing malignant epithelial tumors. We report the successful response to photodynamic therapy (PDT) in a pediatric patient diagnosed with linear porokeratosis.