Estado de saúde percebido em idosos: desigualdades regionais e sociodemográficas na Espanha

OBJECTIVE: To assess regional and sociodemographic differences in self-perceived health status among older adults. METHODS: A face-to-face quality of life survey was conducted in a representative sample of the Spanish population comprising 1,106 non-institutionalized elderly aged 60 or more in 2008. Logistic regression models were used to explain self-perceived health status according to the EuroQol Group Visual Analogue Scale (EQ-VAS). Independent variables included sociodemographic and health characteristics as well as the nomenclature of territorial units for statistics level 1 (NUTS1: group of autonomous regions) and level 2 (NUTS 2: autonomous regions). RESULTS: Younger and better off respondents were more likely to have a positive self-perceived health status. Having no chronic conditions, independence in performing daily living activities and lower level of depression were also associated with positive self-perceived health status. People living in the south of Spain showed a more negative self-perceived health status than those living in other regions. CONCLUSION: The study results point to health inequality among Spanish older adults of lower socioeconomic condition and living in the south of Spain. The analysis by geographic units allows for international cross-regional comparisons.OBJETIVO: Analisar as diferenças regionais e sociodemográficas no estado de saúde percebido por adultos mais velhos. MÉTODOS: Realizou-se um inquérito de qualidade de vida mediante entrevista pessoal com amostra representativa da população espanhola de 1.106 pessoas com 60 e mais anos não institucionalizadas, em 2008. Aplicaram-se modelos de regressão logística para explicar a saúde percebida segundo a escala visual analógica do EuroQol Group (EQ-VAS). As variáveis independentes incluíram características sociodemográficas e de saúde, assim como unidades territoriais estatísticas de nível 1 (grupo de comunidades autônomas) e nível 2 (comunidades autônomas). RESULTADOS: Os participantes dos grupos mais jovens e os que tinham uma melhor situação econômica mostraram maior probabilidade de ter uma percepção positiva da sua saúde. A ausência de problemas crônicos de saúde, a independência para realizar atividades da vida diária e menor nível de depressão também se associaram positivamente à saúde percebida como boa. Os idosos que viviam no sul mostraram uma percepção mais negativa da saúde do que as que vivem noutras regiões. CONCLUSÕES: Os resultados indicam uma desigualdade relativa no estado de saúde dos adultos mais velhos de níveis socioeconômicos inferiores e dos habitantes do sul do país. A análise por unidades territoriais estatísticas permite estabelecer comparações entre regiões em nível internacional.OBJETIVO: Analizar las diferencias regionales y sociodemográficas en el estado de salud percibido por ancianos. MÉTODOS: Se realizó una encuesta de calidad de vida mediante entrevista personal en una muestra representativa de la población española de 1.106 personas con 60 y más años no institucionalizadas en 2008. Se aplicaron modelos de regresión logística para explicar la salud percibida de acuerdo con la escala visual analógica del EuroQol Group (EQ-VAS). Las variables independientes incluyeron características sociodemográficas y de salud, así como unidades territoriales estadísticas de nivel 1 (NUTS1: grupos de comunidades autónomas), y nivel 2 (NUTS2: comunidades autónomas). RESULTADOS: Los participantes de ambos grupos, el de los más jóvenes y los que tenían una mejor situación económica, mostraron mayor probabilidad de tener una percepción positiva de la salud. La ausencia de problemas crónicos de salud, la independencia para desarrollar actividades de la vida diaria y un menor nivel de depresión también se asociaron positivamente a la salud percibida como buena. Los ancianos que vivían en el sur mostraron una percepción más negativa de su salud que aquellos que vivían en otras regiones. CONCLUSIONES: Los resultados muestran desigualdad relativa en el estado de salud de los ancianos de niveles socioeconómicos inferiores y en los habitantes del sur del país. El análisis estadístico por unidades territoriales permite establecer comparaciones entre regiones en nivel internacional

Micellar Iron Oxide Nanoparticles Coated with Anti-Tumor Glycosides

The synthesis procedure of nanoparticles based on thermal degradation produces organic solvent dispersible iron oxide nanoparticles (OA-IONP) with oleic acid coating and unique physicochemical properties of the core. Some glycosides with hydrophilic sugar moieties bound to oleyl hydrophobic chains have antimitotic activity on cancer cells but reduced in vivo applications because of the intrinsic low solubility in physiological media, and are prone to enzymatic hydrolysis. In this manuscript, we have synthetized and characterized OA-IONP-based micelles encapsulated within amphiphilic bioactive glycosides. The glycoside-coated IONP micelles were tested as Magnetic Resonance Imaging (MRI) contrast agents as well as antimitotics on rat glioma (C6) and human lung carcinoma (A549) cell lines. Micelle antimitotic activity was compared with the activity of the corresponding free glycosides. In general, all OA-IONP-based micellar formulations of these glycosides maintained their anti-tumor effects, and, in one case, showed an unusual therapeutic improvement. Finally, the micelles presented optimal relaxometric properties for their use as T2-weighed MRI contrast agents. Our results suggest that these bioactive hydrophilic nano-formulations are theranostic agents with synergistic properties obtained from two entities, which separately are not ready for in vivo applications, and strengthen the possibility of using biomolecules as both a coating for OA-IONP micellar stabilization and as drugs for therapy.This research was funded by FP7 Marie Curie Pulmonary imaging network (PINET) and Ministerio de Economia y Competitividad MAT2015-65184-C2-2-R; SAF2016-79593-P; SAF2017-84494-C2-1-R). This work was partially funded by Instituto de Salud Carlos III (DTS16/00059), CNIC (Centro Nacional de Investigaciones Cardiovasculares), and Comunidad de Madrid (B2017-BMD3731 and B2017-BMD3875). We thank Ligue contre le cancer, comite Charentes Maritimes which allows to free up some time to complete the redaction of this manuscript during a grant-not dedicated on this work-agreed to LIENSs, UMR CNRS 7266, La Rochelle.S

Change and predictors of quality of life in institutionalized older adults with dementia

PURPOSE: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period. METHODS: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline. RESULTS: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures. CONCLUSIONS: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.This study was funded by the CIEN Foundation, Carlos III Institute of Health (Ref. PI 017/09). We would like to thank the help provided by V Blaya-Novakova in language editing. The Spanish Research Group on Quality of Life and Aging is formed by: M. J. Forjaz, ENS-ISCIII; P. Martinez-Martin, CNE-ISCIII; F. Rojo-Perez, CCHS-CSIC; G. Fernandez-Mayoralas, CCHS-CSIC; B. Frades, Fundación CIEN-ISCIII; B. Leon-Salas, Fundación CIEN-ISCIII; Marina Avila, Fundación CIEN-ISCIII; M. E. Prieto-Flores, UNED; S. Martin, EULEN; I. Martinez, EULEN; C. Rodriguez-Blazquez, CNE-ISCIII; A. Ayala, ENS-ISCIII

Measurement properties of the Community Wellbeing Index in older adults

PURPOSE: The international wellbeing index (IWI) consists of two scales, the personal (PWI) and national (NWI) wellbeing indices. The community wellbeing index (CWI) is a new measure of the individual's level of satisfaction with the local place of residence. The main goal of this paper is to validate the CWI in a sample of older adults. METHODS: The IWI was satisfactorily applied to survey the global quality of life of a community sample of 1,106 people aged 60 years and over residing in Spain. The CWI psychometric properties were studied using Rasch analysis. Classic psychometric parameters were also analyzed. RESULTS: Tests of unidimensionality, and exploratory and confirmatory factor analyses, revealed the presence of three subscales: community services, community attachment, and physical and social environment. To achieve adequate model fit of the three subscales to the Rasch model, one item (distribution of wealth) of the initial 11 was removed and item response categories were rescored. The person separation index was 0.82-0.85, indicating a good reliability. All items were free from gender bias. The three subscales displayed satisfactory convergent validity with the PWI and NWI and were able to discriminate between groups with high and low satisfaction with local place of residence. CONCLUSION: The CWI, made up of three subscales, is a valid and reliable measure of subjective wellbeing related to the community as assessed by older adults. Further research with this promising measure should focus on cross-national comparisons.This research was supported by the Spanish Ministry of Science and Innovation (National R&D&I Plan: ref. SEJ2006-15122-C02-00). Prieto-Flores’ position is supported by the Juan de la Cierva program for postdoctoral research, of the Spanish Ministry of Science and Innovation. The Carlos III Institute of Health team is a member of the Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED). The Spanish Research Group on Quality of Life and Aging is made up as follows: (1) at the Carlos III Institute of Health by M. Joao Forjaz, Pablo Martinez-Martin, Maria-Eugenia Prieto-Flores, Belen Frades-Payo, Carmen Rodriguez-Blazquez and Concepcion Delgado-Sanz; and, (2) at the Spanish National Research Council by Gloria Fernandez-Mayoralas, Fermina Rojo-Perez, Karim Ahmed-Mohamed and Raul Lardies-Bosque

Impact of the coronavirus pandemic on maxillofacial trauma:a retrospective study in southern Spain

The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns

Población mayor, Calidad de Vida y redes de apoyo: demanda y prestación de cuidados en el seno familiar

Esta investigación ha recibido el 2º Premio Caja Madrid de Investigación Social - Edición 2008El trabajo se enfoca desde la doble complementariedad de metodologías cuantitativa y cualitativa, al usar, respectivamente, datos de la encuesta sobre Calidad de Vida de los mayores no institucionalizados en la Comunidad de Madrid –CadeViMa- (diseñada y elaborada por el equipo de investigación en el año 2005), así como Entrevistas en Profundidad a mayores dependientes y Grupos de Discusión a familiares cuidadores (realizados en abril-mayo de 2007)

ドイツ企業買収法をめぐる最近の動向と実務からの提案 (ドイツM&A弁護士との対話3)

OBJECTIVE: To assess the psychometric quality of an instrument designed to measure functional independence (Functional Independence Scale [FIS]) in several activities of daily living domains and to be applied by trained non-health-related interviewers. The study was carried out in the autonomous region of Madrid in community-dwelling elders. METHODS: We performed a cross-sectional validation study. In addition to the FIS, Pfeiffer's questionnaire, the Depression Subscale of the Hospital Anxiety and Depression Scale, the Comorbidity Index, the Barthel Index, and EQ-5D were used. These measures were cross-sectionally applied to community-dwelling elders (n=500) and outpatients in a general hospital (n=100) aged 65 years. The following FIS psychometric attributes were analyzed: acceptability, scaling assumptions, internal consistency, construct validity, and precision. RESULTS: A fully computable FIS total score was obtained in 94.3% of the subjects. A ceiling effect (60.65%), but no floor effect (0.22%) was evident in the community-dwelling elders. No floor or ceiling effects were detected in the hospital sample. Scaling assumptions and internal consistency were satisfactory (item-total correlations: 0.57-0.91; Cronbach's alpha: 0.94). Factor analysis identified three factors that explained 74.3% of the variance. Indexes of convergent, internal, and known-groups validity were satisfactory. The scale's precision, determined by the standard error of measurement (2.49; 95%CI=4.88), was also satisfactory. CONCLUSION: The FIS is an easy-to-use instrument with appropriate metric attributes. This scale can be usefully applied in broad samples of non-institutionalized elders by non-health related personnel.Estudio financiado por la Dirección General de Universidades e Investigación de la Comunidad de Madrid (PlanRegionalI+D+I. Ref.06/HSE/0417/2004) y por el Plan Nacional I+D+I del Ministerio de CienciayTecnología (Ref.BSO2003-00401).S

Gender differences in the utilization of health-care services among the older adult population of Spain

BACKGROUND: Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. METHODS: Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. RESULTS: As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07–1.44), received home medical visits (OR: 1.67; 95% CL: 1.34–2.10) and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45). After adjustment for HRQL, the OR was 1.03 (0.89–1.21) for visits to medical practitioners, 1.24 (0.98–1.58) for home medical visits, 0.71 (0.58–0.87) for hospitalization, and 1.14 (0.97–1.33) for intake of ≥3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56–0.84). CONCLUSION: The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women