Teresa Juárez-Cedillo

Frailty among community-dwelling elderly Mexican people: Prevalence and association with sociodemographic characteristics, health state and the use of health services

To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community‐dwelling elderly in Mexico City.

Genetic admixture and diversity estimations in the Mexican Mestizo population from Mexico City using 15 STR polymorphic markers

The 15 AmpFlSTR Identifiler loci D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA were analyzed in a sample of 378 unrelated individuals from Mexico City, Mexico. Significant deviations from HW equilibrium in 14/15 STR loci alleles were not detected. The D18S51 locus had the highest power of discrimination (0.970). Genetic admixture estimations revealed a 69% of Amerindian, 26% of European and 5% of African contribution. Comparative analyses between Mexicans and other neighboring populations reveal significant differences in genetic diversity. Our results are important for future comparative genetic studies in different Latin American ethnic groups, particularly Mexican Mestizos and Amerindians. They should also be helpful in genetics, population evolution, forensic and paternity testing.

The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.

BACKGROUND The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. METHODS MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. RESULTS Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. CONCLUSION Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population

OBJECTIVES To evaluate the psychometric properties of the Geriatric/General Oral Health Assessment Index, Spanish version (GOHAI-Sp) and their relationship with the dentition status of an elderly Mexican population as a discriminatory validation. METHODS A cross-sectional study was conducted among persons over 60 years of age. A Spanish version the GOHAI-Sp validated in Spain in institutionalized geriatric patients was used. Clinical evaluation was done in order to determine experience with coronal and root caries. RESULTS Measurement of internal consistency of the GOHAI gave a Cronbach alpha coefficient of 0.77 for the 12 items. In factorial analysis, one factor alone was capable of explaining 30.6 percent of the total variance. The factor that was most apparent in the factorial analysis of the GOHAI had coefficients > 0.30 for the 12 items. The Kaiser-Meyer-Olkin measure of simple adequacy was 0.81 and the Bartletts sphericity test was 1,748.55 with 66 degrees of freedom (P < 0.001). There was a statistically significant difference in the GOHAI scores between the responses to self-perception of oral and general health (P < 0.001). Also, there was a statistically significant low correlation coefficient between the missing and filled components of the DMFT index and the number of healthy and functional teeth (P < 0.05). CONCLUSIONS The GOHAI has acceptable psychometric properties, discriminates between self-perception of oral health and self-perception of general health, and correlates with past caries experience measured by the DMFT index.

Angiotensin-Converting Enzyme Gene (ACE) Insertion/Deletion Polymorphism in Mexican Populations

The angiotensin-converting enzyme gene (ACE) insertion/deletion polymorphism was determined in 211 Mexican healthy individuals belonging to different Mexican ethnic groups (98 Mestizos, 64 Teenek, and 49 Nahuas). ACE polymorphism differed among Mexicans with a high frequency of the D allele and the D/D genotype in Mexican Mestizos. The D/D genotype was absent in Teenek and present in only one Nahua individual (2.0%). When comparisons were made, we observed that Caucasian, African, and Asian populations presented the highest frequencies of the D allele, whereas Amerindian (Teenek and Pima) and Australian Aboriginals showed the highest frequencies of the I allele. The distribution of I/D genotype was heterogeneous in all populations: Australian Aboriginals presented the lowest frequency (4.9%), whereas Nahuas presented the highest (73.4%). The present study shows the frequencies of a polymorphism not analyzed previously in Mexican populations and establishes that this polymorphism distinguishes the Amerindian populations of other groups. On the other hand, since ACE alleles have been associated with genetic susceptibility to developing cardiovascular diseases and hypertension, knowledge of the distribution of these alleles could help to define the true significance of ACE polymorphism as a genetic susceptibility marker in the Amerindian populations.

Health care utilization in the elderly Mexican population: Expenditures and determinants

BackgroundWorldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual).ObjectiveTo analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly.MethodsA secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age.ResultsHigher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were

Estado de la dentición y sus efectos en la capacidad de los ancianos para desempeñar sus actividades habituales

240.6 am dlls, whereas in households exclusively with elderly the expenditure was

Prevalence of Mild Cognitive Impairment and Its Subtypes in the Mexican Population

308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization.ConclusionsThe conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this group requires immediate attention.

Late-life depressive symptoms: Prediction models of change

OBJECTIVE: The aim of this study was to evaluate the effect of dental state on the capacity of elderly individuals to carry out their daily activities during the previous six months. MATERIAL AND METHODS: A transversal study was conducted in the Mexican Institute of Social Security (IMSS) with insured elderly persons residing in southwestern Mexico City. Home interviews were conducted to gather sociodemographic data, data on the use of oral health services, problems in carrying out daily activities, and their relationship with the state of dentition over the past six months, utilizing the Oral Impacts on Daily Performance (OIDP) index. Later, three oral health professionals trained in determining the state of dentition according to World Health Organization (WHO) criteria performed a clinical examination on each elderly subject. RESULTS: A total of 540 elderly individuals were studied. The prevalence of elderly persons with problems in carrying out their daily activities was 21.5%. The main problems in daily activities were eating (14.4%), speaking (8.7%), not becoming irritated (5.4%), brushing their teeth(5%), and inability to enjoy contact with people (4.4%). There is a positive OIDP correlation between number of teeth lost and the decayed, missing, filled teeth(DMFT) index (p<0.05) and a negative correlation with the number of functional and filled teeth. CONCLUSIONS: The state of dentition in the elderly has repercussions on the capacity to carry out daily activities, with quality of life most seriously affected with regard to eating and enjoying food, as well as with respect to correct pronunciation.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care

Background/Aim: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes, taking into account education and health status. Methods: This is the first report of our Study on Aging and Dementia in Mexico. This study included 2,944 elderly individuals 60 years old or more with in-home assessment for cognitive impairment. The prevalence of MCI was based on Petersen criteria. MCI was classified as amnestic of single domain (a-MCI-s) or multiple domain (a-MCI-md) or nonamnestic of single domain (na-MCI-s) or multiple domain (na-MCI-md). In addition to a battery of neuropsychological measures, a self-report depression measure and a medical history including history of stroke, heart disease and other health conditions were recorded. Results: The global estimated prevalence of MCI in the Mexican population was 6.45%. Of these subjects, 2.41% met criteria for a-MCI-s, 2.56% for a-MCI-md, 1.18% for na-MCI-s and 0.30% for na-MCl-md. Women showed a higher prevalence of MCI than men (63.7 vs. 36.3%, respectively). The analysis showed that heart disease [odds ratio (OR) 1.5], stroke (OR 1.2) and depression (OR 2.1) were associated with an increased risk of MCI. Conclusions: The prevalence of MCI in Mexico is similar to that in other countries. The results suggest that stroke, heart disease and depression may have an important role in the etiology of MCI.