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Ferreira-Hermosillo A, Toledo JO, Cordoba K. Evaluation of the risk of hypothyroidism and its clinical manifestations using the Zulewski scale. Front Endocrinol (Lausanne) 2024; 15:1416663. [PMID: 39220359 PMCID: PMC11362067 DOI: 10.3389/fendo.2024.1416663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Background Globally, clinical hypothyroidism affects an estimated 0.5 to 5% of the population, while subclinical hypothyroidism affects 5-20%. Limited data is available on the prevalence of thyroid disease within the Mexican population. The objective of this study was to describe the characteristics of people screened for hypothyroidism in Mexico during 2022 using the Zulewski scale. Methods A cross-sectional analysis was conducted using data obtained from a digital survey administered by an e-Health platform. This study included participants of all genders, aged 18 years and older (n = 31,449). Descriptive statistics (frequencies and percentages) were sued to describe the data. Differences between groups were assessed through the chi-square or Fischer's exact test. Information gathered was subjected to hierarchical segmentation analysis to explore trends and patterns. Statistical significance was set as <0.05. Results Among the participants, 87.7% were women, and 80% fell within the age group 18 and 44 years. According to the Zulewski scale, 27% of the participants had a low risk of hypothyroidism, 37.4% were classified as having an intermediate risk, and 35.6% were at a high risk. In people at high risk of hypothyroidism, the most common symptom was constipation (29.2%) whereas the most common sign was decreased speed of movement (26.2%). Inquiry of slow movements, dry skin, and facial edema allowed the identification of 90.2% of participants at high risk of hypothyroidism. Conclusions In Mexico, a significant portion of the population is at an intermediate or high risk of hypothyroidism, requiring confirmatory diagnostic tests.
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Affiliation(s)
- Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Karla Cordoba
- Medical Affairs México, MERCK, Naucalpan de Juárez, Mexico
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Sinha SH, Zietlow K, Papaleontiou M. Thyroid Function and Cognitive Decline: A Narrative Review. Endocr Pract 2024:S1530-891X(24)00643-8. [PMID: 39111592 DOI: 10.1016/j.eprac.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/30/2024]
Abstract
OBJECTIVE As the population of older adults in the United States continues to rise, understanding modifiable risk factors that contribute to cognitive decline and dementia becomes increasingly important. This narrative review summarizes existing literature on the association between thyroid function in the euthyroid range, hypothyroidism and hyperthyroidism, and cognitive outcomes in older adults. METHODS A comprehensive literature search of the PubMed and Ovid/Medline databases was conducted. Randomized controlled trials, systematic reviews, meta-analyses, and observational studies published in English between January 2000 and December 2023 were included. RESULTS Overall, existing studies yielded conflicting results, failing to delineate a concrete relationship between thyroid function and cognitive outcomes and/or dementia in older adults. There may be a possible association between higher thyroid stimulating hormone in the reference range and lower risk of incident dementia, which may be more pronounced in women. Majority of studies elucidated a possible association between low thyroid stimulating hormone and incident dementia, with suggestion that duration of hyperthyroidism may contribute to increasing dementia risk. Even though evidence on the association of hypothyroidism and cognitive decline are disparate, current data do not support treatment of subclinical hypothyroidism to improve cognitive outcomes in older adults. CONCLUSION Despite numerous studies, there is no conclusive evidence that supports a direct relationship between hyperthyroidism or hypothyroidism and cognitive decline. Study limitations include heterogeneity in study designs, measurement methodologies, and cognitive assessment tools. Future research is needed to better delineate whether an association exists and whether treatment of thyroid dysfunction ameliorates cognitive impairment.
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Affiliation(s)
- Sophia Hemmrich Sinha
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kahli Zietlow
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute of Gerontology, University of Michigan, Ann Arbor, Michigan.
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Venugopal A, Iyer M, Narayanasamy A, Ravimanickam T, Gopalakrishnan AV, Yadav MK, Kumar NS, Vellingiri B. Association of Biochemical Parameters and Screening for Mutations in the MCU Gene in Alzheimer's Disease Patients. Mol Neurobiol 2024; 61:4116-4128. [PMID: 38064106 DOI: 10.1007/s12035-023-03820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/08/2023] [Indexed: 01/23/2024]
Abstract
The most prevalent form of dementia, Alzheimer's disease (AD) is a chronic illness that is on the rise among the geriatric population. Even though research into its biochemical, genetic, and cytogenetic pathways has advanced, its aetiology is still unclear and complex. In this study, we recruited sixty-eight participants diagnosed with AD where the cytogenetic, biochemical parameters and genetic mutations were analysed. Our results revealed chromosomal aberrations such as aneuploidies in the peripheral blood of Alzheimer's disease patients. Biochemical parameters revealed no statistical significance in the study though a pattern could be observed in the serum levels. Further few novel mutations at the c.21 C > T, c.56G > A were observed in the MCU gene of mitochondrial calcium uniporter. All these findings reveal the need for a larger cohort study to gain a better and more detailed understanding of the aetiology of Alzheimer's disease.
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Affiliation(s)
- Anila Venugopal
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, 641 046, Coimbatore, Tamil Nadu, India
| | - Mahalaxmi Iyer
- Center for Neuroscience, Department of Biotechnology, Karpagam Academy of Higher Education, 641 021, Coimbatore, Tamil Nadu, India
- Department of Microbiology, School of Basic Sciences, Central University of Punjab, 151401, Bathinda, Punjab, India
| | - Arul Narayanasamy
- Disease Proteomics Laboratory, Department of Zoology, Bharathiar University, 641046, Coimbatore, Tamil Nadu, India
| | - T Ravimanickam
- Department of Zoology, School of Science, Tamil Nadu Open University, 600015, Chennai, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Tamil Nadu, 632014, Vellore, India
| | - Mukesh Kumar Yadav
- Department of Microbiology, School of Basic Sciences, Central University of Punjab, 151401, Bathinda, Punjab, India
| | | | - Balachandar Vellingiri
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, 641 046, Coimbatore, Tamil Nadu, India.
- Human Cytogenetics and Stem Cell Laboratory, Department of Zoology, School of Basic Sciences, Central University of Punjab, 151401, Bathinda, Punjab, India.
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Mirahmad M, Mansour A, Moodi M, Safkhani E, Haghpanah V, Asili P, Fakhrzadeh H, Payab M, Ebrahimpur M, Khorashadi M, Khodabakhshi H, Esmaeili AA, Sharifzadeh G, Zarban A, Sharifi F, Sajjadi-Jazi SM. Prevalence of thyroid dysfunction among Iranian older adults: a cross-sectional study. Sci Rep 2023; 13:21651. [PMID: 38066216 PMCID: PMC10709612 DOI: 10.1038/s41598-023-49085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
There is limited data on the prevalence of thyroid dysfunction in the older population. This study aimed to determine the prevalence of thyroid dysfunction among a sample of Iranian older adults. A cross-sectional analysis of older adults who aged 60 years and over was conducted. A total of 363 subjects were randomly selected from Birjand longitudinal aging study (BLAS) cohort study. Serum thyroid-stimulating hormone (TSH) level, total thyroxine (T4) and total triiodothyronine (T3) were measured by the enzyme-linked immunosorbent assay (ELISA). Based on thyroid function tests and history of taking medicines used to treat thyroid disorders, participants were classified into the following groups: euthyroid, overt/subclinical hypothyroidism, and overt/subclinical hyperthyroidism. Subsequently, the crude and World Health Organization (WHO) age-standardized prevalence were estimated for different thyroid function categories. A total of 171 men and 192 women, aged 60-94 years, were randomly selected. The crude prevalence of total hypothyroidism was 22.31% (subclinical [18.46%], overt [3.86%]), and that of hyperthyroidism was 1.66% (subclinical [1.38%], overt [0.28%]). The crude prevalence of total thyroid dysfunction was, therefore, 23.97%. A female preponderance was noticed in both total (P-value = 0.035) and overt (P-value = 0.035) hypothyroidism. An increasing trend with age was noticed in the prevalence of total hypothyroidism (P-value = 0.049). Age-standardized prevalence of total hypothyroidism and hyperthyroidism was 26.63% (95% confidence interval [CI] 20.58-33.69%) and 1.11% (95% CI 0.49-2.51%), respectively. A considerable proportion of our study population demonstrated evidence of thyroid dysfunction, particularly subclinical hypothyroidism. Our findings highlight the importance of further investigation of thyroid disorders among older Iranian adults.
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Affiliation(s)
- Maryam Mirahmad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Asieh Mansour
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Moodi
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Elaheh Safkhani
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Haghpanah
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooria Asili
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Non-Comunicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbube Ebrahimpur
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Khorashadi
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Huriye Khodabakhshi
- Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Iranian Research Center of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Akbar Esmaeili
- Department of Psychiatry, School of Medicine Medical Toxicology & Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Gholamreza Sharifzadeh
- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Asghar Zarban
- Department of Clinical Biochemistry, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sayed Mahmoud Sajjadi-Jazi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Martínez-Montoro JI, Doulatram-Gamgaram VK, Olveira G, Valdés S, Fernández-García JC. Management of thyroid dysfunction and thyroid nodules in the ageing patient. Eur J Intern Med 2023; 116:16-26. [PMID: 37394383 DOI: 10.1016/j.ejim.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10-15%. However, this rate is even higher in older adults, with an estimated prevalence of ≈25% in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Moreover, thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. On the other hand, thyroid nodules are also a prevalent condition in older adults, and its incidence increases with age. The assessment and management of thyroid nodules in the ageing patient should take into account several factors, as risk stratification, thyroid cancer biology, patient´s overall health, comorbidities, treatment preferences, and goals of care. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients and we also review how to identify and manage thyroid nodules in this population.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Viyey Kishore Doulatram-Gamgaram
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Sergio Valdés
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain.
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Pender K. Cracking open the eristic rhetoric of contralateral prophylactic mastectomy research or why surgeons should not be so certain about this controversial breast cancer treatment. MEDICAL HUMANITIES 2023; 49:378-389. [PMID: 36549858 DOI: 10.1136/medhum-2022-012460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Contralateral prophylactic mastectomy (CPM) is a controversial breast cancer treatment in which both breasts are removed when only one is affected by cancer. Rates of CPM have been rising since the late 1990s, despite surgeons' strong agreement that the procedure should not be performed for average-risk women. This essay analyses that agreement as it is demonstrated in the surgical literature on CPM, arguing that it forms a 'rhetoric of certainty' built on the stark epistemological divide between objective and subjective forms of knowledge that operates in some areas of medicine. Further, the essay argues that this rhetoric of certainty has the potential to function as a kind of eristic rhetoric in which the right conclusion is known prior to any rhetorical exchange. As a way to 'crack open' this certainty, the essay compares the rhetoric of the surgical literature on CPM to the rhetoric of uncertainty in the radiological literature on breast cancer screening for women with a personal history of the disease. The goal of this comparison is not to suggest surgeons should support all choices for CPM. Rather, the aim is to demonstrate that choices against the procedure are not as straightforward as the surgical literature indicates and that the uncertainty affecting women's preferences for CPM is not solely the result of patient misunderstanding and/or emotional instability.
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7
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Teng Z, Feng J, Lv P. Subclinical Hypothyroidism is Associated with Cognitive Impairment in Patients with Cerebral Small Vessel Disease. Neuropsychiatr Dis Treat 2023; 19:303-310. [PMID: 36761397 PMCID: PMC9904226 DOI: 10.2147/ndt.s401020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the association between subclinical hypothyroidism (SCH) and cognitive function in patients with cerebral small vessel disease (CSVD). METHODS We evaluated 528 patients with CSVD in this retrospective study. SCH was defined as elevated levels of thyroid stimulating hormone with normal concentrations of free thyroxine. Magnetic resonance imaging was performed to assess the total CSVD burden score and the Montreal Cognitive Assessment was used to measure the cognitive function. Participants were grouped based on cognitive function or total CSVD burden score. Multivariate logistic regression and mediation analysis models were used to estimate the association of SCH with cognitive function and CSVD burden. RESULTS SCH was an independent risk factor for cognitive impairment in patients with CSVD after adjustment for potential confounding factors (OR: 1.939; 95% CI: 1.170 to 3.213; P=0.010). Additionally, SCH was independently associated with severe CSVD burden after adjustment for potential confounding factors (OR: 1.668; 95% CI: 1.085 to 2.564; P=0.020). Mediation analysis found a significant moderating effect (P=0.021) of the severe CSVD burden on the relation between SCH and cognitive impairment after adjustment for potential confounding factors. A 30.1% of the total effect between this relation was attributable to the presence of severe CSVD burden. CONCLUSION SCH was associated with an increased risk of cognitive impairment in patients with CSVD. The mediating role of severe CSVD burden suggests that SCH may lead to cognitive impairment through the presence of severe CSVD burden. These findings may suggest strategies for screening for SCH in the context of cognitive impairment in patients with severe CSVD.
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Affiliation(s)
- Zhenjie Teng
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
| | - Jing Feng
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Peiyuan Lv
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
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Esan OT, Maswime S, Blaauw D. Organisational and individual readiness for change to respectful maternity care practice and associated factors in Ibadan, Nigeria: a cross-sectional survey. BMJ Open 2022; 12:e065517. [PMID: 36414287 PMCID: PMC9685001 DOI: 10.1136/bmjopen-2022-065517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study assessed health providers' organisational and individual readiness for change to respectful maternity care (RMC) practice and their associated factors in Ibadan Metropolis, Nigeria. DESIGN A cross-sectional survey using standardised structured instruments adapted from the literature. SETTING Nine public health facilities in Ibadan Metropolis, Nigeria, 1 December 2019-31 May 2020. PARTICIPANTS 212 health providers selected via a two-stage cluster sampling. OUTCOMES Organisational readiness for change to RMC (ORCRMC) and individual readiness for change to RMC (IRCRMC) scales had a maximum score of 5. Multiple linear regression was used to identify factors influencing IRCRMC and ORCRMC. We evaluated previously identified predictors of readiness for change (change valence, informational assessments on resource adequacy, core self-evaluation and job satisfaction) and proposed others (workplace characteristics, awareness of mistreatment during childbirth, perceptions of women's rights and resource availability to implement RMC). Data were adjusted for clustering and analysed using Stata V.15. RESULTS The providers' mean age was 44.0±9.9 years with 15.4±9.9 years of work experience. They scored high on awareness of women's mistreatment (3.9±0.5) and women's perceived rights during childbirth (3.9±0.5). They had high ORCRMC (4.1±0.9) and IRCRMC (4.2±0.6), both weakly but positively correlated (r=0.407, 95% CI: 0.288 to 0.514, p<0.001). Providers also had high change valence (4.5±0.8) but lower perceptions of resource availability (2.7±0.7) and adequacy for implementation (3.3±0.7). Higher provider change valence and informational assessments were associated with significantly increased IRCRMC (β=0.40, 95% CI: 0.11 to 0.70, p=0.015 and β=0.07, 95% CI: 0.01 to 0.13, p=0.032, respectively), and also with significantly increased ORCRMC (β=0.47, 95% CI: 0.21 to 0.74, p=0.004 and β=0.43, 95% CI: 0.22 to 0.63, p=0.002, respectively). Longer years of work experience (β=0.08, 95% CI: 0.01 to 0.2, p=0.024), providers' monthly income (β=0.08, 95% CI: 0.02 to 0.15, p=0.021) and the health facility of practice were associated with significantly increased ORCRMC. CONCLUSION The health providers studied valued a change to RMC and believed that both they and their facilities were ready for the change to RMC practice.
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Affiliation(s)
- Oluwaseun Taiwo Esan
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Ye Y, Wang Y, Li S, Guo J, Ding L, Liu M. Association of Hypothyroidism and the Risk of Cognitive Dysfunction: A Meta-Analysis. J Clin Med 2022; 11:jcm11226726. [PMID: 36431204 PMCID: PMC9694203 DOI: 10.3390/jcm11226726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The purpose of this meta-analysis was to assess whether there is an association between hypothyroidism and the risk of cognitive dysfunction. Methods: PubMed, Cochrane Library, and Embase were searched for relevant studies published from database inception to 4 May 2022, using medical subject headings (MeSHs) and keywords. Results: Eight studies involving 1,092,025 individuals were included, published between 2010 and 2021. The pooled analysis showed that there was no association between hypothyroidism and cognitive dysfunction (OR = 1.13, 95% CI = 0.84−1.51, p = 0.426), including both all-cause dementia (OR = 1.04, 95% CI = 0.76−1.43, p = 0.809) and cognitive impairment (OR = 1.50, 95% CI = 0.68−3.35, p = 0.318). Neither overt hypothyroidism (OR = 1.19, 95% CI = 0.70−2.02, p = 0.525) nor subclinical hypothyroidism (OR = 1.04, 95% CI = 0.73−1.48, p = 0.833) was associated with cognitive dysfunction. Neither prospective cohort (OR = 1.08, 95% CI = 0.77−1.51, p = 0.673) nor cross-sectional studies (OR = 1.23, 95% CI = 0.63−2.42, p = 0.545) had any effect on the association. Interestingly, the risk of cognitive dysfunction was significantly increased in the group not adjusted for vascular comorbidity (OR = 1.47, 95% CI = 1.07−2.01, p = 0.017), while it was reduced in the adjusted group (OR =0.82, 95% CI = 0.79−0.85, p < 0.001). Conclusions: This meta-analysis shows that hypothyroidism was associated with a reduced risk of cognitive dysfunction after adjustment for vascular-disease comorbidities. More prospective observational studies are needed in the future to investigate the relationship between hypothyroidism and cognitive dysfunction.
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Affiliation(s)
| | | | | | | | - Li Ding
- Correspondence: (L.D.); (M.L.)
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Hassen F, Enquselassie F, Ali A, Addissie A, Taye G, Tsegaye A, Assefa M. Association of risk factors and breast cancer among women treated at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a case-control study. BMJ Open 2022; 12:e060636. [PMID: 36137617 PMCID: PMC9511528 DOI: 10.1136/bmjopen-2021-060636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Many factors known to increase the risk of breast cancer, such as age, family history, early menarche and late menopause are not modifiable. Modifiable factors include obesity, use of menopausal hormones and breast feeding. This study aimed to assess risk factors associated with breast cancer among women at Tikur Anbessa Specialized Hospital. DESIGN Facility based case-control study. METHODS Case-control study was conducted from May 2018 to June 2019. A total of 230 cases and 230 controls participated in the study. Data were analysed using SPSS software. Multivariable logistic model based analysis was conducted to control the effect of potential confounding factors. ORs and 95% CI for the likelihood of developing breast cancer were calculated. RESULTS The odds of breast cancer was higher among women between 40 and 49 years (adjusted OR (AOR): 3.29, 95% CI 1.39 to 7.77), and being unemployed (AOR: 4.28, 95% CI 2.00 to 9.16). Regarding life style risk factors, women consuming solid oil and using wood or animal dung as source of fuel had significantly higher odds of breast cancer. In addition, the odds of breast cancer was significantly higher among postmenopausal women, women who had previous benign surgery and women with early menarche (<12 years). On the other hand, the odd of breast cancer was significantly lower among women who had moderate physical activities. CONCLUSION This study showed that occupational status, consumption of solid oil, and using wood or animal dung as source of fuel, early menarche, menopausal status and previous benign breast surgery were associated with breast cancer. On the other hand, physical activity was protective factor. Therefore, there is a need to design appropriate intervention to educate women about life style change or behaviour modification to decrease their breast cancer risk.
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Affiliation(s)
- Fatuma Hassen
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikre Enquselassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Taye
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Okyere J, Aboagye RG, Seidu AA, Asare BYA, Mwamba B, Ahinkorah BO. Towards a cervical cancer-free future: women's healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa. BMJ Open 2022; 12:e058026. [PMID: 35906053 PMCID: PMC9345091 DOI: 10.1136/bmjopen-2021-058026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We investigated the association between women's healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa. DESIGN Secondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling. SETTING Sub-Saharan Africa. PARTICIPANTS Women aged 15-49 years in Benin (n=5282), Côte d'Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006). PRIMARY OUTCOME MEASURES Cervical cancer screening uptake. RESULTS The overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts. CONCLUSION Women who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Western Region, Ghana
| | - Bernard Yeboah-Asiamah Asare
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Bupe Mwamba
- Centre for Midwifery, Family and Child Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Zhou S, Wang Q, Zhang J, Wang Q, Hou F, Han X, Hu S, Shen G, Zhang Y. Depressive Symptoms and Cognitive Decline Among Chinese Rural Elderly Individuals: A Longitudinal Study With 2-Year Follow-Up. Front Public Health 2022; 10:939150. [PMID: 35910927 PMCID: PMC9326072 DOI: 10.3389/fpubh.2022.939150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDepressive symptoms and mild cognitive impairment (MCI) are highly prevalent in rural China. The study aimed to investigate the longitudinal associations between changes in depressive symptoms and cognitive decline and MCI incidence among Chinese rural elderly individuals.MethodsA 2-year follow-up study was conducted among 1,477 participants from the Anhui Healthy Longevity Survey (AHLS). Depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9), and cognitive status was evaluated by the Mini Mental State Examination (MMSE). Multivariable linear regression and logistic regression were employed.ResultsEvery 1-unit PHQ-9 score increase was significantly associated with more cognitive decline (β = 0.157, 95% CI: 0.092, 0.221, p < 0.001) and a higher risk of MCI incidence (OR = 1.063, 95% CI: 1.025, 1.103, p = 0.001). The participants who experienced worsening of depression symptoms had a larger decline in the 2-year MMSE score (β = 0.650, 95% CI: 0.039, 1.261, p = 0.037) and elevated risks of incident MCI (OR = 1.573, 95% CI: 1.113, 2.223, p = 0.010).LimitationsScreening tools rather than standard diagnostic procedures were used in the study. Moreover, the long-term associations still need further exploration since the follow-up time was short.ConclusionsIncreased depressive symptoms were associated with more cognitive decline and higher risks of incident MCI among Chinese rural residents.
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Affiliation(s)
- Shuai Zhou
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Qiong Wang
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Jingya Zhang
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Qing Wang
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Fangfang Hou
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Xiao Han
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
| | - Shilian Hu
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Anhui Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei, China
- *Correspondence: Shilian Hu
| | - Guodong Shen
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Anhui Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei, China
- Guodong Shen
| | - Yan Zhang
- Department of Health Service Management, School of Health Service Management, Anhui Medical University, Hefei, China
- Yan Zhang
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Ang KW, Koh YLE, Wang XF, Yusoff AM, Tan AM, Poh XYC, Zhang N, Tan NC. Pilot cross-sectional study of foreign domestic workers supporting the basic healthcare needs of older persons in the community. BMJ Open 2022; 12:e051877. [PMID: 35351699 PMCID: PMC8961118 DOI: 10.1136/bmjopen-2021-051877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This pilot study aimed to determine the proportions, level of knowledge, anxiety and confidence of foreign domestic workers (FDWs) who were involved in supporting the healthcare needs of older persons with long-term non-communicable diseases. DESIGN The pilot study used a cross-sectional and descriptive design.FDWs who accompanied the older adults attending a primary healthcare setting in Singapore. 100 eligible FDWs' demographic data, knowledge and confidence level of caregiving in food preparation, medication supervision, exercise, blood pressure (BP), blood glucose (BG) monitoring and anxiety level assessed by the Generalised Anxiety Disorder-7 scale were recorded. Descriptive statistics were performed and presented. Items on confidence were regrouped into two groups of 'very' versus 'no/a little/moderate'. Knowledge scores and caregiving tasks were assessed with items on confidence using Mann-Whitney U test and χ2 test, respectively. RESULTS The FDWs were from Indonesia (60%), Philippines (23%) and Myanmar (14%). Their mean age was 33 years with an average of 5.8 years working experience; 62% self-reported previous caregiver training for elderly. The mean age of care-recipients was 81 years. Knowledge of FDWs on BP and BG monitoring was low (<50% answered correctly). Among the 55 FDWs who were required to perform BP monitoring, 45.5% lack confidence. Similarly, 40% of the 30 FDWs were not confident in performing BG monitoring. Those with very high confidence levels had higher knowledge on BP and BG monitoring. Of those who were involved in medication supervision (n=86), 36% lacked confidence. The majority of the FDWs (96%) were not affected by anxiety in managing these healthcare tasks for older persons. CONCLUSION More than half of the FDWs supported healthcare needs of older persons but they had inadequate knowledge and lacked confidence in performing the healthcare-related tasks.
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Affiliation(s)
- Kim Wai Ang
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Programme, Singapore
| | | | | | | | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Programme, Singapore
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14
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Kim JH, Lee HS, Kim YH, Kwon MJ, Kim JH, Min CY, Yoo DM, Choi HG. The Association Between Thyroid Diseases and Alzheimer's Disease in a National Health Screening Cohort in Korea. Front Endocrinol (Lausanne) 2022; 13:815063. [PMID: 35321339 PMCID: PMC8936176 DOI: 10.3389/fendo.2022.815063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Thyroid dysfunction is linked to an increased risk of cognitive impairment. However, studies on the relationships between thyroid diseases and Alzheimer's disease (AD) have reported conflicting results. We investigated the associations between several thyroid diseases and AD in a nested case-control study. Methods A total of 1,977 participants with AD were identified by claims data from 2002-2015 among a random sample of half a million people in the Korean National Health Insurance database. We recruited 16,473 age- and sex-matched (1:4 ratio) control participants and applied conditional logistic regression to estimate the relationships between thyroid diseases and AD, with adjustments for potential confounders, such as basic demographics, lifestyle factors, and various medical conditions or comorbidities. Results The prevalence rates of hypothyroidism (odds ratio [OR]=1.14, 95% confidence interval [CI]=1.00-1.30), thyroiditis (OR=1.22, 95% CI=1.05-1.40), and hyperthyroidism (OR=1.13, 95% CI=1.01-1.28) were significantly higher in participants with AD than in control participants after adjustment for confounders. Conclusion In this large national sample, we found significant relationships between several thyroid diseases and AD. Despite of the need for further investigation, these findings could better support to appreciate the pathophysiology of AD.
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Affiliation(s)
- Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, South Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, South Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, South Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University College of Medicine, Anyang, South Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Chan Yang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
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15
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Ferrara SJ, Chaudhary P, DeBell MJ, Marracci G, Miller H, Calkins E, Pocius E, Napier BA, Emery B, Bourdette D, Scanlan TS. TREM2 is thyroid hormone regulated making the TREM2 pathway druggable with ligands for thyroid hormone receptor. Cell Chem Biol 2022; 29:239-248.e4. [PMID: 34375614 PMCID: PMC8818810 DOI: 10.1016/j.chembiol.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/03/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022]
Abstract
Triggering receptor expressed on myeloid cells-2 (TREM2) is a cell surface receptor on macrophages and microglia that senses and responds to disease-associated signals to regulate the phenotype of these innate immune cells. The TREM2 signaling pathway has been implicated in a variety of diseases ranging from neurodegeneration in the central nervous system to metabolic disease in the periphery. Here, we report that TREM2 is a thyroid hormone-regulated gene and its expression in macrophages and microglia is stimulated by thyroid hormone and synthetic thyroid hormone agonists (thyromimetics). Our findings report the endocrine regulation of TREM2 by thyroid hormone, and provide a unique opportunity to drug the TREM2 signaling pathway with orally active small-molecule therapeutic agents.
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MESH Headings
- Acetates/chemical synthesis
- Acetates/pharmacology
- Animals
- Binding Sites
- Brain/drug effects
- Brain/immunology
- Brain/pathology
- Encephalomyelitis, Autoimmune, Experimental/drug therapy
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Gene Expression Regulation
- Humans
- Immunity, Innate
- Macrophages/drug effects
- Macrophages/immunology
- Macrophages/pathology
- Membrane Glycoproteins/antagonists & inhibitors
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/immunology
- Mice
- Mice, Inbred C57BL
- Microglia/drug effects
- Microglia/immunology
- Microglia/pathology
- Models, Molecular
- Phenols/chemical synthesis
- Phenols/pharmacology
- Phenoxyacetates/pharmacology
- Promoter Regions, Genetic
- Protein Binding
- Protein Conformation, alpha-Helical
- Protein Conformation, beta-Strand
- Protein Interaction Domains and Motifs
- RNA, Messenger/antagonists & inhibitors
- RNA, Messenger/genetics
- RNA, Messenger/immunology
- Receptors, Immunologic/antagonists & inhibitors
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Response Elements
- Retinoid X Receptors/chemistry
- Retinoid X Receptors/genetics
- Retinoid X Receptors/metabolism
- Signal Transduction
- Thyroid Hormones/pharmacology
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Affiliation(s)
- Skylar J Ferrara
- Department of Chemical Physiology and Biochemistry and Program in Chemical Biology, Oregon Health & Science University, L334, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Priya Chaudhary
- VA Portland Health Care System, Portland, OR 97239, USA; Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Margaret J DeBell
- Department of Chemical Physiology and Biochemistry and Program in Chemical Biology, Oregon Health & Science University, L334, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Gail Marracci
- VA Portland Health Care System, Portland, OR 97239, USA; Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Hannah Miller
- Department of Chemical Physiology and Biochemistry and Program in Chemical Biology, Oregon Health & Science University, L334, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Evan Calkins
- VA Portland Health Care System, Portland, OR 97239, USA; Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Edvinas Pocius
- VA Portland Health Care System, Portland, OR 97239, USA; Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Brooke A Napier
- Department of Biology, Portland State University, OR 97201, USA
| | - Ben Emery
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dennis Bourdette
- VA Portland Health Care System, Portland, OR 97239, USA; Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas S Scanlan
- Department of Chemical Physiology and Biochemistry and Program in Chemical Biology, Oregon Health & Science University, L334, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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16
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Szlejf C, Suemoto CK, Janovsky CCPS, Bertola L, Barreto SM, Lotufo PA, Benseñor IM. Subtle Thyroid Dysfunction Is Not Associated with Cognitive Decline: Results from the ELSA-Brasil. J Alzheimers Dis 2021; 81:1529-1540. [PMID: 33967048 DOI: 10.3233/jad-210018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Subtle thyroid alterations have a controversial role in cognition. OBJECTIVE We investigated the longitudinal association of baseline thyroid function, thyrotropin (TSH), and thyroxine (FT4) levels with cognitive performance after 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. METHODS We included 4,473 individuals, age≥55 years at the second study wave, without overt thyroid dysfunction at baseline. Individuals were divided according to thyroid function and TSH and FT4 tertiles. Cognition was assessed at baseline and after 4 years of follow-up by the word recall (DWR), semantic verbal fluency (SVF), and trail making (TMT) tests. The longitudinal association of thyroid function and TSH and FT4 tertiles with cognitive performance was investigated using generalized estimating equations adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors and depression. RESULTS There was no longitudinal association of thyroid function and TSH and FT4 baseline levels with performance on the cognitive tests. However, there was a baseline cross-sectional U-shaped association of FT4 tertiles with poorer performance in the SVF (first FT4 tertile: β= -0.11, 95% CI = -0.17; -0.04; third FT4 tertile: β= -0.10, 95% CI = -0.17; -0.04) and of the third FT4 tertile with poorer performance in the DWR (β= -0.09, 95% CI = -0.16; -0.02). CONCLUSION Thyroid function and hormone levels were not associated with cognitive decline during 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. Future studies with longer follow-up could clarify the implications of subtle thyroid alterations in cognition.
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Affiliation(s)
- Claudia Szlejf
- Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil
| | - Claudia Kimie Suemoto
- Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.,Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Laiss Bertola
- Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.,Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.,Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Alem AZ, Agegnehu CD. Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2021; 11:e044060. [PMID: 33837100 PMCID: PMC8043003 DOI: 10.1136/bmjopen-2020-044060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia. DESIGN Cross-sectional study. SETTING Ethiopia. PARTICIPANTS Reproductive age group women. PRIMARY OUTCOME Unmet need for family planning. METHODS This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables. RESULTS The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning. CONCLUSION Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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18
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Eslami-Amirabadi M, Sajjadi SA. The relation between thyroid dysregulation and impaired cognition/behaviour: An integrative review. J Neuroendocrinol 2021; 33:e12948. [PMID: 33655583 PMCID: PMC8087167 DOI: 10.1111/jne.12948] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
Despite decades of research on the relation between thyroid diseases and cognition, the nature of this relationship remains elusive. An increasing prevalence of cognitive impairment and thyroid dysfunction has been consistently observed with ageing. Also, there appears to be an association between thyroid disorders and cognitive decline. Given the increasing global burden of dementia, elucidating the relationship between thyroid disorders as a potentially modifiable risk factor of cognitive impairment was the main goal of this review. We summarise the current literature examining the relationship between thyroid hormonal dysregulation and cognition or behaviour. We present the available imaging and pathological findings related to structural and functional brain changes related to thyroid hormonal dysregulation. We also propose potential mechanisms of interaction between thyroid hormones, autoantibodies and cognition/behaviour. Effects of gender, ethnicity and environmental factors are also briefly discussed. This review highlights the need for long-term prospective studies to capture the course of brain functional changes associated with the incidence and progression of thyroid dysregulations along with the confounding effects of non-modifiable risk factors such as gender and ethnicity. Moreover, double-blind controlled clinical trials are necessary to devise appropriate treatment plans to prevent cognitive consequences of over or undertreatment of thyroid disorders.
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19
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Ferrara SJ, Chaudhary P, DeBell MJ, Marracci G, Miller H, Calkins E, Pocius E, Napier BA, Emery B, Bourdette D, Scanlan TS. TREM2 is thyroid hormone regulated making the TREM2 pathway druggable with ligands for thyroid hormone receptor. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021. [PMID: 33532772 DOI: 10.1101/2021.01.25.428149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Triggering receptor expressed on myeloid cells-2 (TREM2) is a cell surface receptor on macrophages and microglia that senses and responds to disease associated signals to regulate the phenotype of these innate immune cells. The TREM2 signaling pathway has been implicated in a variety of diseases ranging from neurodegeneration in the central nervous system to metabolic disease in the periphery. We report here that TREM2 is a thyroid hormone regulated gene and its expression in macrophages and microglia is stimulated by thyroid hormone. Both endogenous thyroid hormone and sobetirome, a synthetic thyroid hormone agonist drug, suppress pro-inflammatory cytokine production from myeloid cells including macrophages that have been treated with the SARS-CoV-2 spike protein which produces a strong, pro-inflammatory phenotype. Thyroid hormone agonism was also found to induce phagocytic behavior in microglia, a phenotype consistent with activation of the TREM2 pathway. The thyroid hormone antagonist NH-3 blocks the anti-inflammatory effects of thyroid hormone agonists and suppresses microglia phagocytosis. Finally, in a murine experimental autoimmune encephalomyelitis (EAE) multiple sclerosis model, treatment with Sob-AM2, a CNS-penetrating sobetirome prodrug, results in increased Trem2 expression in disease lesion resident myeloid cells which correlates with therapeutic benefit in the EAE clinical score and reduced damage to myelin. Our findings represent the first report of endocrine regulation of TREM2 and provide a unique opportunity to drug the TREM2 signaling pathway with orally active small molecule therapeutic agents.
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20
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Salvo G, Gonzalez Martin A, Gonzales NR, Frumovitz M. Updates and management algorithm for neuroendocrine tumors of the uterine cervix. Int J Gynecol Cancer 2020; 29:986-995. [PMID: 31263021 DOI: 10.1136/ijgc-2019-000504] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/03/2022] Open
Abstract
Neuroendocrine carcinomas of the cervix account for less than 2% of all invasive cervical cancers and are classified as low-grade (carcinoid, atypical carcinoid tumor) or high-grade (known as small- and large-cell) neuroendocrine carcinomas. There are increasing data showing that cervical neuroendocrine carcinomas may be associated with the human papillomavirus (HPV), especially HPV18, and most will stain positive for p16. Immunohistochemistry markers such as synaptophysin and CD56 are the most sensitive markers. Although there are no commonly associated mutations, PIK3CA, KRAS, and TP53 are the most frequently found mutations in neuroendocrine tumors. Neuroendocrine cervical carcinomas are exceedingly aggressive tumors with a high tendency for nodal involvement and distant metastases. Age, lymph node metastases, smoking, pure small-cell histology, and tumor size are independent prognostic factors. Overall, the 5-year survival rate is 36% and the median overall survival ranges between 22 and 25 months. Treatment options are often extrapolated from small-cell lung cancer and limited retrospective studies. The preferred treatment is a multimodal approach of surgery, chemoradiation, and systemic chemotherapy. The most common chemotherapy regimen used as initial therapy is a combination of cisplatin and etoposide. In the setting of recurrent disease, a combination of topotecan, paclitaxel, and bevacizumab has demonstrated favorable outcomes. Multicenter tumor registries, such as the Neuroendocrine Cervical Tumor Registry (NeCTuR), are an opportunity to evaluate patterns of disease treatment and oncologic outcomes.
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Affiliation(s)
- Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Naomi R Gonzales
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Akseer N, Wright J, Tasic H, Everett K, Scudder E, Amsalu R, Boerma T, Bendavid E, Kamali M, Barros AJD, da Silva ICM, Bhutta ZA. Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival. BMJ Glob Health 2020; 5:e002214. [PMID: 32133179 PMCID: PMC7042600 DOI: 10.1136/bmjgh-2019-002214] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs). Methods We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15-49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1-59 months) and school-aged children and adolescents (5-14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0-5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea. Results Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries. Conclusions Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Wright
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karl Everett
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Scudder
- Save the Children USA, Washington, District of Columbia, USA
| | - Ribka Amsalu
- Save the Children USA, Washington, District of Columbia, USA
| | - Ties Boerma
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Eran Bendavid
- Centers for Health Policy, Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aluisio J D Barros
- International Centre for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Accorroni A, Rutigliano G, Sabatini M, Frascarelli S, Borsò M, Novelli E, Bandini L, Ghelardoni S, Saba A, Zucchi R, Origlia N. Exogenous 3-Iodothyronamine Rescues the Entorhinal Cortex from β-Amyloid Toxicity. Thyroid 2020; 30:147-160. [PMID: 31709926 DOI: 10.1089/thy.2019.0255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: A novel form of thyroid hormone (TH) signaling is represented by 3-iodothyronamine (T1AM), an endogenous TH derivative that interacts with specific molecular targets, including trace amine-associated receptor 1 (TAAR1), and induces pro-learning and anti-amnestic effects in mice. Dysregulation of TH signaling has long been hypothesized to play a role in Alzheimer's disease (AD). In the present investigation, we explored the neuroprotective role of T1AM in beta amyloid (Aβ)-induced synaptic and behavioral impairment, focusing on the entorhinal cortex (EC), an area that is affected early by AD pathology. Methods: Field potentials were evoked in EC layer II, and long-term potentiation (LTP) was elicited by high frequency stimulation (HFS). T1AM (5 μM) and/or Aβ(1-42) (200 nM), were administered for 10 minutes, starting 5 minutes before HFS. Selective TAAR1 agonist RO5166017 (250 nM) and TAAR1 antagonist EPPTB (5 nM) were also used. The electrophysiological experiments were repeated in EC-slices taken from a mouse model of AD (mutant human amyloid precursor protein [mhAPP], J20 line). We also assessed the in vivo effects of T1AM on EC-dependent associative memory deficits, which were detected in mhAPP mice by behavioral evaluations based on the novel-object recognition paradigm. TAAR1 expression was determined by Western blot, whereas T1AM and its metabolite 3-iodothyroacetic acid (TA1) were assayed by high-performance liquid chromatography coupled to mass spectrometry. Results: We demonstrate the presence of endogenous T1AM and TAAR1 in the EC of wild-type and mhAPP mice. Exposure to Aβ(1-42) inhibited LTP, and T1AM perfusion (at a concentration of 5 μM, leading to an actual concentration in the perfusion buffer ranging from 44 to 298 nM) restored it, whereas equimolar amounts of 3,5,3'-triiodo-L-thyronine (T3) and TA1 were ineffective. The response to T1AM was abolished by the TAAR1 antagonist EPPTB, whereas it was mimicked by the TAAR1 agonist RO5166017. In the EC of APPJ20 mice, LTP could not be elicited, but it was rescued by T1AM. The intra-cerebro-ventricular administration of T1AM (0.89 μg/kg) also restored recognition memory that was impaired in mhAPP mice. Conclusions: Our results suggest that T1AM and TAAR1 are part of an endogenous system that can be modulated to prevent synaptic and behavioral deficits associated with Aβ-related toxicity.
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Affiliation(s)
- Alice Accorroni
- Scuola Superiore di Studi Universitari e di Perfezionamento Sant'Anna, Pisa, Italy
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Grazia Rutigliano
- Scuola Superiore di Studi Universitari e di Perfezionamento Sant'Anna, Pisa, Italy
| | | | | | - Marco Borsò
- Department of Pathology, University of Pisa, Pisa, Italy
| | - Elena Novelli
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | | | | | | | | | - Nicola Origlia
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
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23
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Diab N, Daya NR, Juraschek SP, Martin SS, McEvoy JW, Schultheiß UT, Köttgen A, Selvin E. Prevalence and Risk Factors of Thyroid Dysfunction in Older Adults in the Community. Sci Rep 2019; 9:13156. [PMID: 31511587 PMCID: PMC6739389 DOI: 10.1038/s41598-019-49540-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Prevalence estimates and evidence informing treatment targets for thyroid dysfunction largely come from studies of middle-aged adults. We conducted a cross-sectional analysis to determine the prevalence of thyroid dysfunction and risk factors for abnormal thyroid tests in participants aged ≥65 in the Atherosclerosis Risk in Communities (ARIC) study (N = 5,392). We measured serum concentrations of triiodothyronine (T3), free thyroxine (FT4), thyroid peroxidase antibody (Anti-TPO), and thyroid stimulating hormone (TSH). In this population (58% women, 22% black), 17% reported medication use for thyroid dysfunction. Among those not on treatment, the prevalence of overt and subclinical hypothyroidism was 0.82% and 6.06%, respectively. Overt and subclinical hyperthyroidism affected 0.26% and 0.78%, respectively. Multivariable adjusted TSH, FT4 and T3 levels were 25%, 1.3% and 3.9% lower in blacks compared to whites, respectively. Men were less likely to be anti-TPO positive compared to women (p < 0.001). Former and never smoking were associated with lower T3 and FT4 levels compared to current smoking. The prevalence of thyroid dysfunction in older adults is nearly 25%. Multiple illnesses can interact to contribute to declines in health. Additional attention to thyroid dysfunction and screening in this age group is recommended.
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Affiliation(s)
- Nermin Diab
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Natalie R Daya
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, MA, USA
| | - Seth S Martin
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John W McEvoy
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, National University of Ireland, Galway Campus, Ireland
- National Institute for Preventive Cardiology, Galway, Ireland
| | - Ulla T Schultheiß
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg and Faculty of Medicine, Freiburg, Germany
- Renal Division, Department of Medicine IV, Medical Center - University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Anna Köttgen
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg and Faculty of Medicine, Freiburg, Germany
| | - Elizabeth Selvin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
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Rosenfarb J, Sforza N, Rujelman R, Morosan Allo Y, Parisi C, Blanc E, Frigerio C, Fossati P, Caruso D, Faingold C, Meroño T, Brenta G. Relevance of TSH evaluation in elderly in-patients with non-thyroidal illness. J Endocrinol Invest 2019; 42:667-671. [PMID: 30367433 DOI: 10.1007/s40618-018-0967-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/13/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-thyroidal illness (NTI) is frequent in hospitalized patients. Its recovery is characterized by a raise in TSH levels. However, the clinical significance of high TSH levels at admission in hospitalized elderly patients with NTI remains uncertain. AIM To explore the relevance of baseline TSH evaluation in hospitalized elderly patients with NTI. METHODS We examined the participants with NTI (n = 123) from our previous study (Sforza, 2017). NTI was defined as: low T3 (< 80 ng/dL) and normal or low total T4 in the presence of TSH values between 0.1 and 6.0 mU/L. Thyroid function tests were performed on day 1 and day 8 of the hospital stay. Positive TSH changes (+ ΔTSH) were considered when the day-8 TSH value increased more than the reference change value for TSH (+ 78%). Multiple logistic regression was used to evaluate the independent association of baseline TSH, sex, clinical comorbidities (by ACE-27) and medications with + ΔTSH. RESULTS Out of 123 patients (77 ± 8 years, 52% female), 34 showed a + ΔTSH. These patients had a lower TSH at admission (p < 0.001) and intra-hospital mortality (p = 0.003) than the others. In multiple logistic regression, TSH > 2.11 mU/L at baseline was associated with reduced odds to show + ΔTSH [odds ratio (95 CI) 0.29 (0.11-0.75); p = 0.011] in a model adjusted by age, sex and ACE-27. DISCUSSION Inappropriately higher TSH levels at admission in hospitalized elderly patients were associated with a reduced ability to raise their TSH levels later on. The present results confront the idea that TSH levels at admission are irrelevant in this clinical context.
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Affiliation(s)
- J Rosenfarb
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - N Sforza
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - R Rujelman
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - Y Morosan Allo
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Parisi
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - E Blanc
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Frigerio
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - P Fossati
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - D Caruso
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Faingold
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - T Meroño
- Depto. de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Brenta
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina.
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25
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Cremer M, Alfaro K, Garai J, Salinas M, Maza M, Zevallos A, Taxa L, Diaz AC, Castle P, Alonzo TA, Masch R, Soler M, Conzuelo-Rodriguez G, Gage JC, Felix JC. Evaluation of two alternative ablation treatments for cervical pre-cancer against standard gas-based cryotherapy: a randomized non-inferiority study. Int J Gynecol Cancer 2019; 29:ijgc-2018-000148. [PMID: 31055452 PMCID: PMC9884482 DOI: 10.1136/ijgc-2018-000148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Gas-based cryotherapy is the conventional ablative treatment for cervical pre-cancer in low-income settings, but the use of gas poses significant challenges. We compared the depth of necrosis induced by gas-based cryotherapy with two gas-free alternatives: cryotherapy using CryoPen,and thermoablation. METHODS We conducted a five-arm randomized non-inferiority trial: double-freeze carbon dioxide (CO2) cryotherapy (referent), single-freeze CO2 cryotherapy, double-freeze CryoPen, single-freeze CryoPen, and thermoablation. Subjects were 130 women scheduled for hysterectomy for indications other than cervical pathology, and thus with healthy cervical tissue available for histological evaluation of depth of necrosis post-surgery. The null hypothesis was rejected (ie, conclude non-inferiority) if the upper bound of the 90% confidence interval (90% CI) for the difference in mean depth of necrosis (referent minus each experimental method) was <1.14 mm. Patient pain during treatment was reported on a scale of 0 (no pain) to 10 (worst pain). RESULTS A total of 133 patients were enrolled in the study. The slides from three women were deemed unreadable. One patient was excluded because her hysterectomy was postponed for reasons unrelated to the study, and two patients were excluded because treatment application did not follow the established protocol. For the remaining 127 women, mean depth of necrosis for double-freeze CO2 (referent) was 6.0±1.6 mm. Differences between this and other methods were: single-freeze CO2 = 0.4 mm (90% CI -0.4 to 1.2 mm), double-freeze CryoPen= 0.7 mm (90% CI 0.04 to 1.4 mm), single-freeze CryoPen= 0.5 mm (90% CI -0.2 to 1.2 mm), and thermoablation = 2.6 mm (90% CI 2.0 to 3.1 mm). Mean pain levels were 2.2±1.0 (double-freeze CO2 cryotherapy), 1.8±0.8 (single-freeze CO2 cryotherapy), 2.5±1.4 (double-freeze CryoPen), 2.6±1.4 (single-freeze CryoPen), and 4.1±2.3 (thermoablation). DISCUSSION Compared with the referent, non-inferiority could not be concluded for other methods. Mean pain scores were low for all treatments. Depth of necrosis is a surrogate for treatment efficacy, but a randomized clinical trial is necessary to establish true cure rates.
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Affiliation(s)
- Miriam Cremer
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Basic Health International, San Salvador, El Salvador
- Basic Health International, New York City, New York, USA
| | - Karla Alfaro
- Basic Health International, San Salvador, El Salvador
| | - Jillian Garai
- Basic Health International, New York City, New York, USA
| | - Manuel Salinas
- Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | | | - Luis Taxa
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Ana C Diaz
- Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Philip Castle
- Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Todd A Alonzo
- University of Southern California, Los Angeles, California, USA
| | - Rachel Masch
- Basic Health International, New York City, New York, USA
| | - Montserrat Soler
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Basic Health International, New York City, New York, USA
| | | | - Julia C Gage
- National Cancer Institute, Bethesda, Maryland, USA
| | - Juan C Felix
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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26
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Bensenor I. Thyroid disorders in Brazil: the contribution of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res 2019; 52:e8417. [PMID: 30785482 PMCID: PMC6376318 DOI: 10.1590/1414-431x20198417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
Thyroid disorders are common diseases, both in Brazil and worldwide. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study that investigates cardiovascular diseases, diabetes, and associated factors, including non-classical cardiovascular risk factors such as thyroid function. Thyroid function was classified according to thyrotropin stimulating hormone (TSH), free thyroxine (FT4), and use of medication to treat thyroid disorders, after excluding participants who reported use of any medication that could alter the results of the TSH and FT4 tests. All analyses included in this review are cross-sectional using baseline data (2008 to 2010). The results showed an association of subclinical thyroid disorders with biomarkers of subclinical atherosclerosis, measured by carotid intima-media thickness and coronary artery calcium, insulin resistance, metabolic syndrome, and some psychiatric disorders. No association was found with the biomarker of inflammation high-sensitivity C-reactive protein, or changes in pulse wave velocity or heart rate variability.
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Affiliation(s)
- I.M. Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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27
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Delitala AP, Manzocco M, Sinibaldi FG, Fanciulli G. Thyroid function in elderly people: The role of subclinical thyroid disorders in cognitive function and mood alterations. Int J Clin Pract 2018; 72:e13254. [PMID: 30216651 DOI: 10.1111/ijcp.13254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alessandro P Delitala
- U.O.C. di Medicina Interna 2 (Clinica Medica), Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Marta Manzocco
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Federico G Sinibaldi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giuseppe Fanciulli
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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28
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Dew R, King K, Okosieme OE, Pearce SH, Donovan G, Taylor PN, Hickey J, Dayan CM, Leese G, Razvi S, Wilkes S. Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study. BMJ Open 2018; 8:e019970. [PMID: 29467136 PMCID: PMC5855452 DOI: 10.1136/bmjopen-2017-019970] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/12/2017] [Accepted: 01/16/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice. DESIGN A qualitative interview study using semistructured interviews. PARTICIPANTS Sixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner. SETTING General practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stockton-on-Tees and North Cumbria, North of England, UK. METHOD A grounded-theory approach was used to generate themes from interviews, which were underpinned by the theory of planned behaviour to give explanation to the data. RESULTS Although health professionals felt that hypothyroidism was easy to manage, GPs and nurses generally revealed inadequate knowledge of medication interactions and levothyroxine pharmacokinetics. Pharmacists felt limited in the advice that they provide to patients due to lack of access to patient records. Most GPs and nurses followed local guidelines, and relied on blood tests over clinical symptoms to adjust levothyroxine dose. The information exchanged between professional and patient was usually restricted by time and often centred on symptoms rather than patient education. Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned. Enablers perceived by health professionals to improve the management of hypothyroidism included continuity of care, blood test reminders, system alerts for interfering medications and prescription renewal, and accessible blood tests and levothyroxine prescriptions for patients. CONCLUSION There is a significant health professional behavioural component to the management of hypothyroidism. Addressing the differences in patient and professional knowledge and perceptions could reduce the barriers to optimal treatment, while continuity of care and increased involvement of pharmacists and practice nurses would help to promote optimal thyroid replacement.
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Affiliation(s)
- Rosie Dew
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Kathryn King
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Simon H Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Donovan
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Peter N Taylor
- Institute of Molecular Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Colin M Dayan
- Institute of Molecular Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Graham Leese
- School of Medicine, University of Dundee, Dundee, UK
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Endocrinology, Queen Elizabeth Hospital, Gateshead, UK
| | - Scott Wilkes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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29
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Mouse Thyroid Gland Changes in Aging: Implication of Galectin-3 and Sphingomyelinase. Mediators Inflamm 2018; 2017:8102170. [PMID: 29375200 PMCID: PMC5742507 DOI: 10.1155/2017/8102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/12/2017] [Indexed: 11/27/2022] Open
Abstract
Prevalence of thyroid dysfunction and its impact on cognition in older people has been demonstrated, but many points remain unclarified. In order to study the effect of aging on the thyroid gland, we compared the thyroid gland of very old mice with that of younger ones. We have first investigated the changes of thyroid microstructure and the possibility that molecules involved in thyroid function might be associated with structural changes. Results from this study indicate changes in the height of the thyrocytes and in the amplitude of interfollicular spaces, anomalous expression/localization of thyrotropin, thyrotropin receptor, and thyroglobulin aging. Thyrotropin and thyrotropin receptor are upregulated and are distributed inside the colloid while thyroglobulin fills the interfollicular spaces. In an approach aimed at defining the behavior of molecules that change in different physiopathological conditions of thyroid, such as galectin-3 and sphingomyelinase, we then wondered what was their behavior in the thyroid gland in aging. Importantly, in comparison with the thyroid of young animals, we have found a higher expression of galectin-3 and a delocalization of neutral sphingomyelinase in the thyroid of old animals. A possible relationship between galectin-3, neutral sphingomyelinase, and aging has been discussed.
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30
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Szlejf C, Suemoto CK, Santos IS, Lotufo PA, Haueisen Sander Diniz MDF, Barreto SM, Benseñor IM. Thyrotropin level and cognitive performance: Baseline results from the ELSA-Brasil Study. Psychoneuroendocrinology 2018; 87:152-158. [PMID: 29096222 DOI: 10.1016/j.psyneuen.2017.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The role of subtle thyroid alterations, such as subclinical thyroid disease and low/high serum thyrotropin (TSH) within the normal range, on cognitive decline is controversial. The aim of this study was to evaluate the association of serum TSH and subclinical thyroid dysfunction with performance on cognitive tests in a large sample of Brazilian middle-aged adults without overt thyroid disease. METHODS In this cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health, we excluded individuals aged 65 years and older, with overt thyroid dysfunction, prevalent stroke, in use of medications that affect thyroid function or that indicate neurologic diseases, and from Asian or indigenous ethnicity. Thyroid status was assessed by serum TSH and free thyroxine (only when the TSH was altered). Individuals were divided according to TSH tertiles and classified according to thyroid function as euthyroidism, subclinical hypothyroidism, or subclinical hyperthyroidism. Cognition was evaluated using delayed word recall test, semantic verbal fluency test, and trail making test version B. The associations of cognitive tests performance with TSH tertiles (using the middle tertile as reference) and thyroid function were investigated using linear regression models, adjusted for an extensive set of possible confounders (sociodemographic characteristics, cardiovascular risk factors, and depression). RESULTS The mean age of the 10,362 participants was 49.5±7.4years, 52.3% women. After adjustment for confounders, the first TSH tertile was associate with worse performance on the trail making test (β=-0.05, 95% CI=-0.09; -0.01, p=0.017). When restricting the analysis to the 9769 individuals with TSH within the normal range, the association between TSH and performance on the trail making test remained significant (β=-0.05, 95% CI=-0.09; -0.01, p=0.020) on multiple linear regression. Subclinical thyroid disease was not associated with performance on cognitive tests. CONCLUSION Low TSH is associated with poorer performance on an executive function test in middle-aged adults without overt thyroid dysfunction.
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Affiliation(s)
- Claudia Szlejf
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Instituto Nacional de Geriatría, Mexico City, Mexico.
| | - Claudia K Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Itamar S Santos
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Isabela M Benseñor
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
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