Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies?

OBJECTIVES: To test the hypothesis that an inverse association exists between socio-economic position and all-cause mortality in a developing country in Latin America. STUDY DESIGN: Prospective cohort study carried out in Chile using data from a simple random sample of 920 apparently healthy subjects (weighted population 11,600 aged 30-89 years) followed for 8 years. METHODS: Education level (0-8 years, 9-12 years and > or = 13 years) and income quartiles were established at the outset of the study, along with behavioural and biological risk factors for chronic diseases: smoking, alcohol use, obesity, diabetes, hypertension, lipids and family history of death by cardiovascular disease. Relative risks of all-cause mortality were estimated using age-adjusted Cox regression models. RESULTS: During the follow-up period, 46 deaths were observed. Adjusting for age, gender, and behavioural and biological risk factors, the mortality risk for increasing categories of education after controlling for income was 1.0, 0.76 and 0.33 (P for trend<0.01). In contrast, the relative risk for increasing levels of income after controlling for education was 1.0, 0.98, 1.33 and 1.17 (P for trend=0.07). CONCLUSION: While education level had a protective effect on mortality risk of Chilean adults, income had a slightly unfavourable effect on survival. This finding is described as suggestive of a 'pauper-rich paradox', since the higher income quantiles in this study correspond with the lower income levels in most developed countries. Nevertheless, due to the small number of deaths, additional research is required to assess the validity of these findings.

Impact of parity on anthropometric measures of obesity controlling by multiple confounders: a cross-sectional study in Chilean women.

AIM: To find out whether there is an association between parity and obesity, evaluated through body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Chilean women after controlling for sociodemographic characteristics, health risk and gynaeco-obstetric factors. DESIGN: Cross-sectional study, using baseline data of the San Francisco Project. SETTING: San Francisco de Mostazal, located in the central region of Chile, 6512 Chilean-Hispanic women (Spanish heritage with a variable indigenous component). METHODS: A weighted random sample of 508 women who had their first pregnancy inside the primary child-bearing ages. Data were collected between 1997 and 1999. Statistical associations between parity and different anthropometric measurements of adiposity in multiple linear (MLnR) and logistic regression models (MLtR) were evaluated. RESULTS: In MLnR a modest parity-related increment in BMI and practically null increment in WC, WHR and WHtR was observed. Covariates that showed a statistically significant association with anthropometric measures of adiposity were age, low education, marital status, employment, smoking, smoking cessation, hypertension, diabetes, dyslipidaemia, parent's obesity, menarche and fetal macrosomia. Crude odds ratio (OR) showed a strong association between parity and anthropometric markers of obesity. Nevertheless, after adjustments in MLtR models, the association remained only for BMI. All the measures of abdominal obesity related to parous women showed OR smaller than 1 (95% confidence intervals 0.57 to 0.96). CONCLUSIONS: Parity modestly influences BMI, but does not seem to be related to WC, WHR and WHtR after controlling by confounders. Parity can increase adiposity but not necessarily following an abdominal pattern.

Cistitis crónica fibrótica telangectásica por ciclofosfamida / Fibrous chronic cystitis telangectasia for ciclofosfamide

Enfoque de estudio y manejo de pacientes pediátricos hematúricos, con antecedente de tratamiento previo con ciclofosfamida.Paciente femenino de 8 años, con antecedente de linfoma no Hodgkin diagnosticado a los 4 años, que es tratado durante un año en centro extranjero con quimioterapia que incluía ciclofosfamida, sin registro de protección vesical. Presenta también un síndrome atáxico de etiología desconocida. Tres años después consulta por disuria, hematuria recurrente micro y macroscópica con coágulos, presentando función renal normal. Estudio por imágenes (ecografía, pielografía y TAC), muestra imagen de defecto de llene de 4 cm a nivel del trígono vesical, sugerente de coágulo. Se descartan malformaciones vasculares y tumorales.Cistoscopía demostró una cistitis hemorrágica con telangectasias. Histología mostró cistitis crónicahemorrágica fibrosa G° III.Pacientes sometidos a terapias con ciclofosfamida o sus derivados deben recibir protección vesical con Ledoxina, para reducir al máximo este tipo de complicación. Este paciente es candidato a reemplazo vesical total, aún no operado por encontrarse en su centro de origen en el extranjero. Se discute la indicación quirúrgica y la técnica quirúrgica en este caso particular.

Riñón en herradura: sintomático / Horseshoe kidney: symptomatic

Presentamos un estudio retrospectivo de pacientes portadores de Riñon en Herradura (R:H:), en un período de 10 años. Encontramos 12 casos, todos estudiados con Ecografía, Pielografía, Uretrocistografía y DMSA. Cinco de 12 pacientes presentaron Reflujo Vesico-ureteral, 2 Obstrucción Pielo-ureteral. La sintomatología más frecuente fue Infección Urinaria. El manejo de las patologías asociadas a R.H., fue el mismo utilizado cuando éstas se presentan aisladas. La incidencia de R.H. en nuestra área geográfica es muy inferior a la descrita en la literatura

[Medical student traits associated with future success as physicians]. / Características del estudiante de medicina asociadas al éxito ulterior como médico.

OBJECTIVE: To identify the individual and family factors present during medical studies which are associated to success as a physician. RESEARCH DESIGN: Prolective case-control study. SETTING: Mexico City metropolitan area. STUDY UNITS: 120 physicians considered to be successful and 245 physicians who according to an established criteria were considered to be non-successful. MAIN MEASUREMENTS: A success-achieving index was constructed on the opinion of 134 physicians from different health-care institutions private and public. The index was composed by criteria such as being a member of prestiged academic associations; having a practice in third level institutions; having done postgraduate studies; being a professor with teaching and research activities; having obtained directive medical positions; and a high income at the moment of the interview. RESULTS: The main factors associated to success were: frequent attendance to cultural activities by the family of the subjects (OR = 5.2, IC 95% = 3.15-8.60, p = 0.00000001); the global score obtained during their medical studies, i.e. higher than 8.5 over 10 (OR = 4.43, IC 95% = 2.64-7.49, p = 0.00000001); and having been awarded recognitions, prizes or scholarships during their medical studies (OR = 4.3, IC 95% = 2.64-7.03, p = 0.00000001). A logistic regression model selected the cultural activities of the family, global score during medical studies and earning of recognitions, prizes and scholarships as independent variables associated to success achievement (p = 0.00001). CONCLUSIONS: Frequent cultural activities by the family and academic behavior were the factors present during medical studies which were associated to ulterior success as a physician.

Differential expression of extracellular matrix molecules and the alpha 6-integrins in the normal and neoplastic prostate.

The epithelial basal lamina composition and integrin expression profile of normal and neoplastic human prostate was characterized using immunohistochemical analysis of frozen samples. The major components of the basal lamina surrounding normal acini were laminin, type IV collagen, entactin, and type VII collagen with variable amounts of tenascin. The basal lamina of neoplastic acini had a similar composition, except for the loss of type VII collagen, which was observed in all grades of carcinoma. The basal cells of the normal prostate express the alpha 6-, beta 1-, and beta 4-integrin subunits, suggesting that both the alpha 6 beta 1- and alpha 6 beta 4-integrin complexes are formed. In prostate carcinoma there is a complete loss of beta 4 expression and the alpha 6- and beta 1-integrin subunits, which are restricted to the basal and basal lateral surfaces of basal cells, are distributed diffusely throughout the cytoplasmic membrane. The differential expression of type VII collagen and beta 4 are discussed in relationship to their possible role in tumor progression.