Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies.

OBJECTIVE: To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. METHOD: We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. RESULTS: Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). CONCLUSION: Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis.

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis.

BACKGROUND: Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS: We searched 6 databases until June 2015. INCLUSION CRITERIA: 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS: From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS: There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS: Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies.

OBJECTIVE: To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults. METHOD: We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775). RESULTS: From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07). CONCLUSION: Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.

A transiting giant planet with a temperature between 250 K and 430 K.

Of the over 400 known exoplanets, there are about 70 planets that transit their central star, a situation that permits the derivation of their basic parameters and facilitates investigations of their atmospheres. Some short-period planets, including the first terrestrial exoplanet (CoRoT-7b), have been discovered using a space mission designed to find smaller and more distant planets than can be seen from the ground. Here we report transit observations of CoRoT-9b, which orbits with a period of 95.274 days on a low eccentricity of 0.11 +/- 0.04 around a solar-like star. Its periastron distance of 0.36 astronomical units is by far the largest of all transiting planets, yielding a 'temperate' photospheric temperature estimated to be between 250 and 430 K. Unlike previously known transiting planets, the present size of CoRoT-9b should not have been affected by tidal heat dissipation processes. Indeed, the planet is found to be well described by standard evolution models with an inferred interior composition consistent with that of Jupiter and Saturn.

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study.

OBJECTIVE: The objective is to describe and characterize patterns of service use by out-patients with schizophrenia in Spain. METHOD: A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods. RESULTS: A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out-patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas. CONCLUSION: Development and organization of mental health services should take into account the combinations of services patients most frequently use.

Potent antileukemic interactions between flavopiridol and TRAIL/Apo2L involve flavopiridol-mediated XIAP downregulation.

Interactions between the cyclin-dependent kinase inhibitor flavopiridol (FP) and tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL/Apo2L), were examined in human leukemia cells (U937 and Jurkat). Coexposure of cells to marginally toxic concentrations of TRAIL and FP (24 h) synergistically increased mitochondrial injury (eg, cytochrome c, AIF, Smac/DIABLO release), cytoplasmic depletion of Bax, activation of Bid as well as caspase-8 and -3, PARP cleavage, and apoptosis. Coadministration of TRAIL markedly increased FP-induced apoptosis in leukemic cells ectopically expressing Bcl-2, Bcl-x(L), or a phosphorylation loop-deleted form of Bcl-2 (DeltaBcl-2), whereas lethality was substantially attenuated in cells ectopically expressing CrmA, dominant-negative-FADD, or dominant-negative-caspase-8. TRAIL/FP induced no discernible changes in FLIP, DR4, DR5, Mcl-1, or survivin expression, modest declines in levels of DcR2 and c-IAP, but resulted in the marked transcriptional downregulation of XIAP. Moreover, cells stably expressing an XIAP-antisense construct exhibited a pronounced increase in TRAIL sensitivity comparable to degrees of apoptosis achieved with TRAIL/FP. Conversely, enforced XIAP expression significantly attenuated caspase activation and TRAIL/FP lethality. Together, these findings suggest that simultaneous activation of the intrinsic and extrinsic apoptotic pathways by TRAIL and FP synergistically induces apoptosis in human leukemia cells through a mechanism that involves FP-mediated XIAP downregulation.

Intentos de suicidio y suicidios consumados por los ancianos de una residencia / Parasuicide and suicide among elderly residents of a long-term-care facility

OBJETIVO: Recoger y analizar de forma longitudinal retrospectiva todos los intentos de suicidio y los suicidios consumados entre los ancianos de una residencia. MÉTODOS: Se estudiaron los historiales clínicos de los 938 ancianos que ingresaron en el centro entre diciembre de 1984 y marzo de 2001. Se analizaron la frecuencia, los aspectos médicos y psiquiátricos y las circunstancias en las que se producen los suicidios y los intentos de suicidio en dicha población. RESULTADOS: La edad media de los residentes al final del estudio era de 80,9 años, y su estancia media de 1.716 días. Durante el período de estudio fallecieron 445 ancianos (47,4 por ciento). De ellos, 9 (5 varones y 4 mujeres) fallecieron por suicidio, lo que representa un 2 por ciento del total de fallecimientos y una tasa de 204,2 suicidios por 100.000 personas/año. Todos los suicidas tenían un diagnóstico psiquiátrico previo. El método elegido por la mayoría fue el de precipitación, y 4 de ellos habían efectuado intentos previos. En un caso se encontraron notas dirigidas al juez. Se detectaron intentos de suicidio no consumados en otros 5 residentes, de los que 4 padecían afecciones físicas incapacitantes. Uno de los residentes efectuó cuatro intentos, sin llegar a consumar el suicidio. CONCLUSIONES: El suicidio es causa relativamente frecuente de fallecimiento en residencias, alcanzando un alto grado de eficacia, sobre todo en aquellos residentes con diagnóstico psiquiátrico previo. La relación entre intentos y consumación de suicidios se encuentra cercana a 1:1. La prevención de los casos de suicidio debería ser considerada entre las labores del personal sanitario en estos centros (AU)

Synergistic induction of mitochondrial damage and apoptosis in human leukemia cells by flavopiridol and the histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA).

Interactions between the histone deacetylase inhibitor SAHA (suberoylanilide hydroxamic acid) and the cyclin-dependent kinase (CDK) inhibitor flavopiridol (FP) were examined in human leukemia cells. Simultaneous exposure (24 h) of myelomonocytic leukemia cells (U937) to SAHA (1 microM) and FP (100 nM), which were minimally toxic alone (1.5 +/- 0.5% and 16.3 +/- 0.5% apoptosis respectively), produced a dramatic increase in cell death (ie 63.2 +/- 1.9% apoptotic), reflected by morphology, procaspase-3 and -8 cleavage, Bid activation, diminished DeltaPsi(m), and enhanced cytochrome c release. FP blocked SAHA-mediated up-regulation of p21(CIP1) and CD11b expression, while inducing caspase-dependent Bcl-2 and pRb cleavage. Similar interactions were observed in HL-60 and Jurkat leukemic cells. Enhanced apoptosis in SAHA/FP-treated cells was accompanied by a marked reduction in clonogenic surivival. Ectopic expression of either dominant-negative caspase-8 (C8-DN) or CrmA partially attenuated SAHA/FP-mediated apoptosis (eg 45 +/- 1.5% and 38.2 +/- 2.0% apoptotic vs 78 +/- 1.5% in controls) and Bid cleavage. SAHA/FP induced-apoptosis was unaffected by the free radical scavenger L-N-acetyl cysteine or the PKC inhibitor GFX. Finally, ectopic Bcl-2 expression marginally attenuated SAHA/FP-related apoptosis/cytochrome c release, and failed to restore clonogenicity in cells exposed to these agents. Together, these findings indicate that SAHA and FP interact synergistically to induce mitochondrial damage and apoptosis in human leukemia cells, and suggest that this process may also involve engagement of the caspase-8-dependent apoptotic cascade.

Synergistic induction of apoptosis in human myeloid leukemia cells by phorbol 12-myristate 13-acetate and flavopiridol proceeds via activation of both the intrinsic and tumor necrosis factor-mediated extrinsic cell death pathways.

Previous studies have shown that coexposure to marginally toxic concentrations of phorbol 12-myristate 13-acetate (PMA; 10 nM) and the cyclin-dependent kinase inhibitor flavopiridol (FP; 100-200 nM) synergistically induces apoptosis in human myeloid leukemia cells U937 and HL-60 (i.e., >50% apoptotic at 24 h). Attempts have now been made to characterize the cell death pathway(s) involved in this phenomenon. In contrast to cytochrome c release and caspase-3 activation, which occur within 2.5 h of PMA/FP coexposure, caspase-8 activation and Bid cleavage appeared as later events. Such findings implicate the mitochondria-dependent pathway in the initial induction of apoptosis by PMA/FP. However, U937 cells ectopically expressing CrmA, dominant-negative caspase-8, or dominant-negative Fas-associated death domain that were highly resistant to tumor necrosis factor (TNF)/cycloheximide-induced lethality displayed significant, albeit incomplete, resistance to PMA/FP-induced apoptosis after 24 h. Furthermore, coadministration of TNF soluble receptor significantly attenuated PMA/FP-induced apoptosis in U937 (p < 0.02) and HL-60 (p < 0.03) cells at 24 h. PMA/FP coadministration also triggered substantial increases in TNFalpha mRNA and protein secretion compared with the effects of PMA administered alone. The protein kinase C (PKC) inhibitor bisindolylmaleimide (1 microM) completely blocked PMA/FP-induced TNFalpha secretion in U937 cells and attenuated apoptosis. Taken together, these results suggest that coadministration of PMA with FP in myeloid leukemia cells initially triggers mitochondrial damage, an event followed by the PKC-dependent induction and release of TNFalpha, supporting a model in which the synergistic induction of leukemic cell apoptosis by this drug combination proceeds via both mitochondrial- and TNF receptor-related apoptotic pathways.

A new death domain associated with gestational trophoblastic diseases induces apoptosis in distinct cell types.

Gestational trophoblastic diseases, like the complete hydatidiform mole (CHM), are a group of human interrelated neoplasms whose etiology and progression is poorly understood at the molecular level. We have previously reported the cloning and expression of a new tumor necrosis factor receptor (TNF-R) related transcript, named CHMS-1 that encodes a potential death domain. Here we show that ectopic expression of the putative CHMS-1 death domain specifically induced apoptosis in a dose-dependent manner, in trophoblastic (JEG-3) and non-trophoblastic (COS-7) cells. We also investigated the expression of apoptosis-related molecules such as Bcl-2 and p53 and demonstrated that Bcl-2 is repressed in CHM while p53 is overexpressed in CHM compared with persistent gestational trophoblastic tumors. Altogether, these data indicate that the CHMS-1 death domain is able to trigger apoptosis, thus suggesting that this new entity might be an important inducer of molar regression mechanisms in women.

Utilidad de las determinaciones analíticas al ingreso en una residencia / Usefulness of the analytic determinations on admission to a nursing home

OBJETIVO: Comprobar si existen variaciones de las magnitudes analíticas estudiadas en los ancianos con la edad, el sexo y la incapacidad funcional, para tenerlos en cuenta a la hora de realizar una valoración de su estado de salud al ingreso en una residencia. MATERIAL Y MÉTODO: Se recogieron los datos de los análisis hematológicos, bioquímicos y de orina, incluidos en el protocolo de ingreso de 194 sujetos mayores de 65 años, de los que 82 eran varones (44 asistidos) y 112 eran mujeres (91 asistidas). RESULTADOS: Se encontró una prevalencia de un 27,6 por ciento de diabetes y un 15,6 por ciento de dislipemias. Cabe destacar una disminución significativa en los asistidos de la hemoglobina, volumen corpuscular medio, hemoglobina corpuscular media, urato, proteínas totales, albúmina, hierro, calcio y fosfato y un aumento de la amplitud de la distribución eritrocitaria y del recuento de plaquetas. Aumentaban significativamente con la edad el recuento de leucocitos, y disminuían hemoglobina, colesterol, proteínas totales, albúmina y sideremia. Además, se encontraron en varones valores significativamente más elevados de volumen corpuscular medio y sideremia y más bajos de fosfato. La presencia de hallazgos patológicos en la orina se asoció significativamente con el sexo femenino y la condición de asistido. CONCLUSIONES: Las mayores alteraciones analíticas se observaron en los ancianos asistidos, revelando un déficit nutricional más o menos latente. Las determinaciones analíticas consideradas de mayor utilidad al ingreso son aquellas que sirven para detectar patologías graves y/o que se puedan tratar eficazmente: hemoglobina, albúmina, colesterol, triglicéridos, glucosa, creatinina, ferritina, TSH y sedimento urinario (AU)

[Anemia and functional incapacity at admission to a geriatric home]. / Anemia e incapacidad funcional al ingreso en una residencia geriátrica.

AIM: To ascertain the prevalence of anemia on admission to a nursing home, and to assess the relationship between the observed cases of anemia and the functional status of those subjects. METHODS: We studied 198 subjects: 82 men (41%) aged 75.8 +/- 8.8 years, and 116 women (59%) aged 78.2 +/- 8.3 years. Anemia was diagnosed according to the criteria of the World Health Organization. The classification as non-disabled, or physically or mentally disabled, was done according to the Scales of the Spanish Red Cross. RESULTS: Anemia was diagnosed in 36% of the males, being microcytic in 14%, normocytic in 83%, and macrocytic only in 3% of them. Among women there were 44% with anemia, which was microcytic in 16%, normocytic in 80%, and macrocytic in 4% of cases. The prevalence of anemia increased with age in both sexes. Among men, anemia was significantly associated (p = 0.013) with physical disability, whereas among women this association just fell off significance (p = 0.06). There was no association of anemia with mental disability. No association was found between serum concentrations of ferritin, vitamin B12, or folic acid, and the classification as non-disabled, or as physically or mentally disabled. CONCLUSIONS: Anemia is found in about 40% of the elderly on admission to our nursing home. Anemia is associated with older age and with physical disability, but not with mental disability. Whether anemia on admission entails a higher risk of disability onset during the stay in the nursing home remains to be elucidated.

¿Puede la anemia del anciano ser una manifestación del envejecimiento normal? / Can anemia in the elderly be a manifestation of normal aging?

Con la presente revisión pretendemos colocar en su contexto epidemiológico y clínico el problema de la definición y el estudio de la anemia en los ancianos. La anemia es tan frecuente en las personas de edad avanzada que se ha llegado a considerar como una consecuencia normal del proceso de envejecimiento. Recientes estudios que correlacionan la anemia con la capacidad funcional y con el riesgo subsiguiente de mortalidad han venido a confirmar que la anemia, aunque sea leve, trae consigo consecuencias deletéreas para el anciano (AU)

Anemia e incapacidad funcional al ingreso en una residencia geriátrica / Anemia and functional disability on admission to a geriatric nursing home

Objetivo: Establecer la prevalencia de anemia en ancianos al ingreso en una residencia, así como la relación de las anemias detectadas con el estado funcional de dichos sujetos. Método: Se estudiaron 198 sujetos: 82 varones (41 por ciento) con 75,8 ± 8,8 años y 116 mujeres (59 por ciento) con 78,2 ± 8,3 años. Se diagnosticó anemia según los criterios de la Organización Mundial de la Salud, y la clasificación en válidos o asistidos físicos o mentales se llevó a cabo mediante las Escalas de Incapacidad Física y Mental de Cruz Roja. Resultados: El 36 por ciento de los varones tenía anemia, que era microcítica en el 14 por ciento, normocítica en el 83 por ciento y macrocítica sólo en el 3 por ciento. Entre las mujeres había un 44 por ciento con anemia, que era microcítica en el 16 por ciento, normocítica en el 80 por ciento y macrocítica en el 4 por ciento de los casos. La prevalencia de anemia aumentó con la edad en ambos sexos. Entre los varones la anemia se asoció significativamente (P=0,013) a la incapacidad física, mientras que en las mujeres dicha asociación estuvo en el límite de la significación (P=0,06). La anemia no se asoció a la incapacidad mental en ninguno de los sexos. No hubo asociación entre las concentraciones séricas de ferritina, vitamina B12 o ácido fólico y la clasificación en válidos y asistidos físicos o mentales. Conclusiones: Alrededor del 40 por ciento de los ancianos que ingresan en nuestra residencia presentan anemia. La anemia se asocia a la mayor edad y a la incapacidad física, pero no a la incapacidad mental. Queda por determinar si la anemia al ingreso condiciona un mayor riesgo de incapacitación durante la estancia en la residencia. (AU)

Evolución de la incapacidad en los supervivientes de una cohorte de ancianos ingresados en una Residencia / Changes in disability among a cohort of elderly surviving residents of a nursing home

OBJETIVOS: Determinar los cambios en la incapacidad física o mental a lo largo del tiempo entre los ancianos ingresados en una Residencia, y los factores asociados a dichos cambios. MÉTODOS: Se obtuvieron datos de los 230 ingresados en una Residencia mixta en febrero de 1999, y se compararon con los mismos datos de esos mismos residentes obtenidos en el momento de su ingreso. La valoración física y mental se llevó a cabo mediante las Escalas de Incapacidad Física y Mental de Cruz Roja. RESULTADOS: Los 230 ancianos estudiados tenían un promedio de edad de 81,1 años y su estancia media era algo mayor de cinco años. La valoración física mejoró en tres residentes (1,3 por ciento), se mantuvo en 121 (54,0 por ciento) y empeoró en 100 (44,7 por ciento), no pudiendo ser valorada en seis casos. La valoración mental no mejoró en ningún caso, se mantuvo en 129 (61,7 por ciento) y empeoró en 80 (38,3 por ciento), no pudiéndose obtener una valoración pareada en 21 sujetos. Los 107 que ingresaron como válidos tenían un promedio de edad de 80,7 años y una estancia media de 7,5 años. De ellos hubo 43 (40,2 por ciento) que pasaron a ser asistidos, los cuales eran personas de mayor edad, con predominio del sexo femenino y con mayor tiempo de estancia en la Residencia que los que permanecieron siendo válidos. Su causa de incapacitación era una enfermedad física con mayor frecuencia que en los que ya ingresaron como asistidos. CONCLUSIONES: Alrededor el 60 por ciento de los ancianos válidos mantienen la capacidad física y mental que tenían al ingreso en la Residencia tras un promedio de siete años y medio de estancia en la misma (AU)

[Thyroid function in the aged admitted to a nursing home]. / Función tiroidea en ancianos al ingreso en una residencia.

BACKGROUND: Intrinsic thyroid diseases and so-called sick euthyroid syndrome are frequent among the elderly. Therefore, we set out to assess the usefulness of the measurement of thyroid hormones and TSH on admission to a public nursing home. METHODS: A medical history, physical examination, geriatric assessment and a venous sample were taken from 201 elderly subjects on admission to a nursing home. Thyroid hormones and TSH were measured in all cases. All subjects were classified as valid, mentally impaired, or physically impaired, according to the Spanish Red Cross Scales. RESULTS: Sixty non-disabled and 141 disabled elders were studied. Sixteen (7.9%) cases of primary hypothyroidism were found, of whom 7 (3.5%) were deemed deserving treatment with L-thyroxine, their mean daily dose being 114.3 mcg. Sick euthyroid syndrome was considered to be present in 28 (13.9%) cases, of whom 25 had a normal T4, three had a low T4, and none had a high T4. No cases of hyperthyroidism were detected. Thyroid hormone abnormalities were not statistically associated with age, gender, or physical or mental disability. CONCLUSIONS: On admission to the nursing home, nearly 8% of the elders have hypothyroidism, and an additional 14% have the sick euthyroid syndrome. Routine measurement of T4 and TSH in elders on admission to a nursing home has a favorable cost-utility ratio.

Función tiroidea en ancianos al ingreso en una residencia / Thyroid function in elderly subjects in admission to a nursing home

Fundamento: Las enfermedades tiroideas intrínsecas y el denominado síndrome del eutiroideo enfermo son frecuentes en los ancianos, por lo que nuestro objetivo ha sido valorar la utilidad de las determinaciones de hormonas tiroideas y TSH al ingreso en una residencia de ancianos de titularidad pública. Métodos: Se llevó a cabo anamnesis, exploración clínica, valoración geriátrica y obtención de sangre venosa de 201 ancianos a su ingreso en residencia, determinándose en todos los casos niveles de hormonas tiroideas y TSH. La clasificación como válidos, o como asistidos físicos o mentales, se efectuó de acuerdo con las Escalas de Cruz Roja. Resultados: Fueron estudiados 60 ancianos válidos y 141 asistidos diagnosticándose 16 casos (7,9 porciento) de hipotiroidismo primario, de los que 7 (3,5 porciento) fueron considerados susceptibles de tratamiento con L-tiroxina, siendo el promedio de dosis de 114,3 mcg/día. Se encontraron 28 casos (13,9 porciento) encuadrables como síndrome del eutiroideo enfermo, 25 con T4 normal, 3 con T4 baja y ninguno con T4 alta. No se encontró ningún caso de hipertiroidismo. Las alteraciones de las hormonas tiroideas no se asociaron estadísticamente ni con la edad, ni con el sexo, ni con la existencia de discapacidad física o mental. Conclusiones: Al ingreso en la residencia casi el 8 porciento de los ancianos padecen hipotiroidismo, y un 14 porciento adicional presenta el síndrome del eutiroideo enfermo. La determinación sistemática de T4 y TSH en ancianos al ingreso en residencias tiene una relación coste-utilidad favorable (AU)

[Healthy aging and functional disability among the elderly inhabitants of the Canary Islands (Spain)]. / Vejez saludable e incapacidad funcional en la población anciana de Canarias.

BACKGROUND: Among the elderly, health is usually measured in terms of ability for both the Basic and Instrumental Activities of Daily Living. The objective of this work is to estimate the percentage of healthy elderly among the population of the Canary Islands (Spain) and the factors associated with functional disability in this older population. METHODS: We randomly sampled 411 elderly from the whole population of the Canary Islands, of whom 97 had died or could not be located. Of the 314 people approached, 29 (9.2%) denied participation. The 285 participants were interviewed with the Spanish version of Pfeiffer's Functional Assessment Inventory previously adapted and validated in our habitat. RESULTS: Up to 53% of the elderly (61% of males and 47% of females) were disability-free. Greater disability was associated with higher age, lesser education, worse subjective health, worse subjective vision, and worse subjective hearing. No association of disability with female gender and cognitive deficit was found when including age and education in the logistic model. CONCLUSIONS: Health status among the elderly in the Canaries is similar to that in developed countries. In contrast with other studies, we found functional ability associated with poor hearing and dissociated from cognitive deficit.