OBJECTIVE -To determine the effect of thiazolidinedione treatment on subclinical atherosclerosis progression in insulin-requiring patients with clinical characteristics suggesting type 2 diabetes.RESEARCH DESIGN AND METHODS -Eligible participants (n ϭ 299) were randomized within strata of baseline common carotid artery (CCA) intima-media thickness (IMT) (Ͻ0.8 mm, Ն0.8 mm) to 400 mg troglitazone daily or placebo for 2 years. A general linear mixed-effects model was used to compare the rate of change in CCA-IMT between treatment groups.RESULTS -Overall, average rates of CCA-IMT change were not significantly different between troglitazone-and placebo-treated subjects (0.0030 Ϯ 0.021 vs. 0.0066 Ϯ 0.021 mm/year; P ϭ 0.17). In the stratum of subjects with CCA-IMT Ն0.8 mm, troglitazone significantly reduced the progression of CCA-IMT relative to placebo (0.0013 Ϯ 0.022 vs. 0.0084 Ϯ 0.023 mm/year; P ϭ 0.03). Fasting glucose, insulin, and HbA 1c were significantly lower in troglitazone-versus placebo-treated subjects (P Ͻ 0.01). Whereas blood pressure significantly differed between treatment groups in the Ն0.8-mm stratum, there was no difference between treatment groups in the Ͻ0.8-mm stratum.CONCLUSIONS -Insulin sensitization and reduction in blood pressure may be contributory mechanisms by which troglitazone reduced subclinical atherosclerosis progression in this cohort of well-controlled insulin-dependent patients with clinical characteristics suggesting type 2 diabetes. Diabetes Care 29:1545-1553, 2006T ype 2 diabetic patients have a 2-to 4-times-greater risk for cardiovascular events than people without diabetes (1). People with type 2 diabetes also have increased carotid arterial wall thickness, a marker of subclinical atherosclerosis (2). Although the mechanisms by which diabetes accelerates atherosclerosis and promotes clinical events are unclear, the etiology appears to be multifactorial and includes abnormalities of glucose, blood pressure, and lipoproteins (3).Thiazolidinedione (TZD) drugs activate nuclear peroxisome proliferatoractivated receptor (PPAR)␥. TZDs reduce insulin resistance and lower serum insulin levels in diabetic and nondiabetic individuals. They also lower exogenous insulin requirements in insulin-treated type 2 diabetic patients (4). TZDs also have beneficial effects on lipid levels (5), lower peripheral vascular resistance (6), and increase arterial compliance and lower blood pressure (7). TZDs also have direct arterial effects that limit proliferation of vascular endothelial and smooth muscle cells in vitro (8) and have reduced carotid artery intima-media thickness (IMT) in short-term studies (9,10). These findings suggest that TZDs may have antiatherogenic properties. The Troglitazone Atherosclerosis Regression Trial was conducted to determine whether management of insulin-treated patients with clinical characteristics suggesting type 2 diabetes with a TZD could reduce subclinical atherosclerosis progression. RESEARCH DESIGN AND METHODS -The Troglitazone Atherosclerosis Regression Trial wa...

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Adolescentes y jóvenes que pertenecen a bandas juveniles con frecuencia son omitidos de las encuestas nacionales sobre consumo de alcohol y drogas. El objetivo del estudio fue conocer los trastornos por consumo de alcohol, y analizar el efecto de factores personales sobre estos, en 125 adolescentes y jóvenes margínales de bandas juveniles de Monterrey, NL. México. Los resultados indicaron que 70% mostró consumo excesivo, 62% se clasificó con consumo perjudicial y el 50% con dependencia. Los factores que más contribuyeron en la predicción del consumo excesivo fueron la edad, sexo y el bajo nivel educativo, para el consumo perjudicial fueron la edad y problemas de salud mental, y para el consumo dependiente fueron la edad, los años de escolaridad y los problemas de salud mental. Estos resultados posibilitarán la reflexión de la necesidad de diseñar programas adecuados dirigidos a la prevención en este grupo de jóvenes marginales.

NN. Self-esteem, perceived self-efficacy, consumption of tobacco and alcohol in secondary students from urban and rural areas of Monterrey, Nuevo León, México. Rev Latino-am Enfermagem 2008 maio-junho; 16(especial):614-20 This study aimed to know the differences, if any, in the consumption of tobacco and alcohol among adolescents from urban and rural areas, and if self-esteem and self-efficacy are related to the consumption in these two groups of adolescents from secondary schools in urban and rural areas of Nuevo León México, from January to June in 2006. The study was based on the theoretical concepts of self-esteem, perceived selfefficacy and consumption of alcohol and tobacco. The design was descriptive and correlational with a sample of 359 students. A substantial difference was found in the consumption of tobacco among secondary students from urban and rural areas (U= 7513.50, p = .03). The average consumption in urban area was higher (χ = .35) than in the rural area (χ = .14). A negative and significant relation was found between the quantity of drinks consumed on a typical day and self-esteem (r s = -.23, p <.001), as well as for the quantity of cigarettes consumed on a typical day (r s = -.20, p <.001).DESCRIPTORS: self-concept; efficacy; tobacco; alcohol drinking; education primary and secondary AUTOESTIMA, AUTOEFICACIA PERCIBIDA, CONSUMO DE TABACO Y ALCOHOL EN ESTUDIANTES DE EDUCACIÓN SECUNDARIA DE ÁREA URBANA Y RURAL DE MONTERREY, NUEVO LEÓN, MÉXICOEl propósito del estudio fue conocer si existen diferencias en el consumo de tabaco y alcohol en adolescentes del área urbana y rural y si la autoestima y la autoeficacia se relacionan con el consumo en estos dos grupos de adolescentes que estudian en la educación secundaria en el área urbana y rural de Nuevo León México, entre enero y junio de 2006. El estudio se realizó bajo los conceptos teóricos de autoestima, autoeficacia percibida y consumo de alcohol y tabaco. El diseño fue descriptivo y correlacional. La muestra fue de 359 estudiantes. Se encontró diferencia significativa de consumo de tabaco en estudiantes de secundaria urbana y rural (U= 7513.50, p=.03) siendo más alta la media de consumo en área urbana (χ=.35) que en la rural (χ=.14). Se encontró relación negativa y significativa de cantidad de bebidas consumidas en un día típico y la autoestima (r s =-.23, p<.001), así mismo de la cantidad de cigarrillos consumidos en un día típico (r s =-.20, p< .001).DESCRIPTORES: autoimagen; eficacia; tabaco; consumo de bebidas alcólicas; educación primaria y secundaria AUTO-ESTIMA, AUTO-EFICÁCIA PERCEBIDA, CONSUMO DE TABACO E ÁLCOOL ENTRE ESTUDANTES DO ENSINO FUNDAMENTAL, DAS ÁREAS URBANA E RURAL, DE MONTERREY, NUEVO LEÓN, MÉXICOO propósito deste estudo foi verificar diferenças no consumo de tabaco e álcool entre adolescentes das áreas urbana e rural, e se a auto-estima e auto-eficácia se relacionam com o consumo nestes dois grupos de adolescentes do ensino fundamental nas áreas urbana e rural de Nuevo León México, entre janeiro e junho de 2006. Este est...

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