The economic status of older people’s households in urban and rural settings in Peru, Mexico and China: a 10/66 INDEP study cross-sectional survey

Few data are available from middle income countries regarding economic circumstances of households in which older people live. Many such settings have experienced rapid demographic, social and economic change, alongside increasing pension coverage. Population-based household surveys in rural and urban catchment areas in Peru, Mexico and China. Participating households were selected from all households with older residents. Descriptive analyses were weighted back for sampling fractions and non-response. Household income and consumption were estimated from a household key informant interview. 877 Household interviews (3177 residents). Response rate 68 %. Household income and consumption correlated plausibly with other economic wellbeing indicators. Household Incomes varied considerably within and between sites. While multigenerational households were the norm, older resident’s incomes accounted for a high proportion of household income, and older people were particularly likely to pool income. Differences in the coverage and value of pensions were a major source of variation in household income among sites. There was a small, consistent inverse association between household pension income and labour force participation of younger adult co-residents. The effect of pension income on older adults’ labour force participation was less clear-cut. Historical linkage of social protection to formal employment may have contributed to profound late-life socioeconomic inequalities. Strategies to formalise the informal economy, alongside increases in the coverage and value of non-contributory pensions and transfers would help to address this problem

Prediction of dementia risk in low-income and middle-income countries (the 10/66 Study): an independent external validation of existing models

BackgroundTo date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This study investigated whether dementia prediction models developed in HICs are applicable to LMICs.MethodsData were from the 10/66 Study. Individuals aged 65 years or older and without dementia at baseline were selected from China, Cuba, the Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. Dementia incidence was assessed over 3–5 years, with diagnosis according to the 10/66 Study diagnostic algorithm. Discrimination and calibration were tested for five models: the Cardiovascular Risk Factors, Aging and Dementia risk score (CAIDE); the Study on Aging, Cognition and Dementia (AgeCoDe) model; the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI); the Brief Dementia Screening Indicator (BDSI); and the Rotterdam Study Basic Dementia Risk Model (BDRM). Models were tested with use of Cox regression. The discriminative accuracy of each model was assessed using Harrell's concordance (c)-statistic, with a value of 0·70 or higher considered to indicate acceptable discriminative ability. Calibration (model fit) was assessed statistically using the Grønnesby and Borgan test.Findings11 143 individuals without baseline dementia and with available follow-up data were included in the analysis. During follow-up (mean 3·8 years [SD 1·3]), 1069 people progressed to dementia across all sites (incidence rate 24·9 cases per 1000 person-years). Performance of the models varied. Across countries, the discriminative ability of the CAIDE (0·52≤c≤0·63) and AgeCoDe (0·57≤c≤0·74) models was poor. By contrast, the ANU-ADRI (0·66≤c≤0·78), BDSI (0·62≤c≤0·78), and BDRM (0·66≤c≤0·78) models showed similar levels of discriminative ability to those of the development cohorts. All models showed good calibration, especially at low and intermediate levels of predicted risk. The models validated best in Peru and poorest in the Dominican Republic and China.InterpretationNot all dementia prediction models developed in HICs can be simply extrapolated to LMICs. Further work defining what number and which combination of risk variables works best for predicting risk of dementia in LMICs is needed. However, models that transport well could be used immediately for dementia prevention research and targeted risk reduction in LMICs

Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas congénito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos Mes (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizo, clasifico y organizo en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital», «prevention and control», «diagnosis», «therapeutics» and «pregnancy». Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study

Cleusa Ferri and colleagues studied mortality rates in over 12,000 people aged 65 years and over in Latin America, India, and China and showed that chronic diseases are the main causes of death and that education has an important effect on mortality

A cohort study of the effects of older adult care dependence upon household economic functioning, in Peru, Mexico and China

BACKGROUND: While links between disability and poverty are well established, there have been few longitudinal studies to clarify direction of causality, particularly among older adults in low and middle income countries. We aimed to study the effect of care dependence among older adult residents on the economic functioning of their households, in catchment area survey sites in Peru, Mexico and China. METHODS: Households were classified from the evolution of the needs for care of older residents, over two previous community surveys, as 'incident care', 'chronic care' or 'no care', and followed up three years later to ascertain economic outcomes (household income, consumption, economic strain, satisfaction with economic circumstances, healthcare expenditure and residents giving up work or education to care). RESULTS: Household income did not differ between household groups. However, income from paid work (Pooled Count Ratio pCR 0.88, 95% CI 0.78-1.00) and government transfers (pCR 0.80, 95% CI 0.69-0.93) were lower in care households. Consumption was 12% lower in chronic care households (pCR 0.88, 95% CI 0.77-0.99). Household healthcare expenditure was higher (pCR 1.55, 95% CI 1.26-1.90), and catastrophic healthcare spending more common (pRR 1.64, 95% CI 1.64-2.22) in care households. CONCLUSIONS: While endogeneity cannot be confidently excluded as an explanation for the findings, this study indicates that older people's needs for care have a discernable impact on household economics, controlling for baseline indicators of long-term economic status. Although living, typically, in multigenerational family units, older people have not featured prominently in global health and development agendas. Population ageing will rapidly increase the number of households where older people live, and their societal significance. Building sustainable long-term care systems for the future will require some combination of improved income security in old age; incentivisation of informal care through compensation for direct and opportunity costs; and development of community care services to support, and, where necessary, supplement or substitute the central role of informal caregivers

Prevalence of stroke and related burden among older people living in Latin America, India and China

Objectives Despite the growing importance of stroke in developing countries, little is known of stroke burden in survivors. the authors investigated the prevalence of self-reported stroke, stroke-related disability, dependence and care-giver strain in Latin America (LA), China and India.Methods Cross-sectional surveys were conducted on individuals aged 65+ (n=15 022) living in specified catchment areas. Self-reported stroke diagnosis, disability, care needs and care giver burden were assessed using a standardised protocol. for those reporting stroke, the correlates of disability, dependence and care-giver burden were estimated at each site using Poisson or linear regression, and combined meta-analytically.Results the prevalence of self-reported stroke ranged between 6% and 9% across most LA sites and urban China, but was much lower in urban India (1.9%), and in rural sites in India (1.1%), China (1.6%) and Peru (2.7%). the proportion of stroke survivors needing care varied between 20% and 39% in LA sites but was higher in rural China (44%), urban China (54%) and rural India (73%). Comorbid dementia and depression were the main correlates of disability and dependence.Conclusion the prevalence of stroke in urban LA and Chinese sites is nearly as high as in industrialised countries. High levels of disability and dependence in the other mainly rural and less-developed sites suggest underascertainment of less severe cases as one likely explanation for the lower prevalence in those settings. As the health transition proceeds, a further increase in numbers of older stroke survivors is to be anticipated. in addition to prevention, stroke rehabilitation and long-term care needs should be addressed.Wellcome TrustWorld Health Organization (India, Dominican Republic and China)US Alzheimer's AssociationFONACIT/ CDCH/ UCV (Venezuela)Kings Coll London, Inst Psychiat, Epidemiol Sect, Hlth Serv, London SE5 8AF, EnglandKings Coll London, Inst Psychiat, Clin Neurosci Div, London SE5 8AF, EnglandUniv Nacl Pedro Henriquez Urena, Geriatr Sect, Santo Domingo, Dominican RepUniv Peruana Cayetano Heredia, Lima, PeruPeking Univ, Inst Mental Hlth, Div Social Psychiat & Behav Med, Beijing 100871, Peoples R ChinaChristian Med Coll & Hosp, Vellore, Tamil Nadu, IndiaMed Univ Havana, Dept Clin Sci, Havana, CubaCaracas Univ Hosp, Dept Med, Caracas, VenezuelaNatl Inst Neurol & Neurosurg Mexico, Mexico City, DF, MexicoVHS, Dept Community Hlth, Chennai, Tamil Nadu, IndiaUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilUniv Ciencias Med Matanzas, Dept Internal Med, Matanzas, CubaKings Coll London, Inst Psychiat, Epidemiol Sect, Populat Res Dept, London SE5 8AF, EnglandUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilWellcome Trust: GR066133Wellcome Trust: GR08002US Alzheimer's Association: IIRG-04-1286Web of Scienc

Whose Development? How Women Living Near the Yanacocha Mine, Peru, Envision Potential Futures

Among women opposing expansion of mining operations in Cajamarca, Peru, narratives of preferred alternatives diverge: from sustainable mining, to alternative economic development, to more radical alternatives to ‘development’. In these accounts, both their relative powerlessness and agency become apparent. This article critically explores women’s views of development and their imaginings of their region with or without mining. I argue that those who opposed mining show a continuing engagement with questions of development in the aftermath of conflict over natural resource extraction, highlighting a common thread of desires for bottom-up initiatives embracing local knowledge, practice and history

Anosognosia in Amnestic Mild Cognitive Impairment is Related to Diminished Hippocampal Volume Comparable to Alzheimer's Disease Dementia:Preliminary MRI Findings

Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer’s disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest (hippocampus and cingulum cortex gray matter, cingulum bundle white matter): aMCI subjects with anosognosia (n = 6), aMCI subjects without anosognosia (n = 12), AD subjects with anosognosia (n = 6), and AD subjects without anosognosia (n = 9). aMCI subjects with anosognosia displayed a significantly lower gray matter density (GMD) in the bilateral hippocampus than aMCI subjects without anosognosia, which was accounted for by bilateral hippocampal differences. Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology

Durabilidad del Concreto en Ambiente Urbanos y Urnbano/Marinos de México y España

Trabajo presentado en el III Congreso Nacional ALCONPAT (Asociación Latinoamericana de Control de Calidad, Patología y Recuperación de la Construcción), celebrado en Caracas (Venezuela), en noviembre de 200

XI CIDU. La transformación digital de la universidad Congreso Iberoamericano de Docencia Universitaria

Nesta comunicação apresenta-se uma experiência de gamificação realizada numa turma online, numa Universidade Virtual. Foram utilizados como elementos de jogo pontos, badges, leadboard, avatares e desafios. Do ponto de vista do desenho da unidade curricular, foi proposto um desafio global, sob a forma de roleplaying, que percorreu todo o semestre. Para este desafio global contribuíram três outros desafios, nos quais os estudantes deveriam dinamizar discussões, sendo atribuídos pontos e badges em função da sua prestação. No que se refere à metodologia, tratou-se de uma investigação exploratória, com carácter qualitativo. Como técnicas de recolha de dados, privilegiou-se a observação, realizada durante toda a unidade curricular, complementada por um questionário aos estudantes no final do semestre. Constatou-se que a estratégia adotada incentivou a participação ativa dos estudantes, tendo estes gostado da experiência. Verificaram-se, contudo, algumas limitações, pelo facto de os estudantes desta amostra serem adultos trabalhadores a frequentar uma licenciatura online, com outros compromissos profissionais e familiares. Com efeito, verificou-se que vários deles mencionaram ter dificuldade na gestão do tempo, limitando a possibilidade de adesão a um percurso exigente em termos de participação ativa.In this paper, we present a gamification experiment that took place in an online class at a virtual university. The game elements were points, badges, leaderboard, avatars and challenges. Taking into account the curricular unit design, a global challenge was proposed, in the form of roleplaying, and took place along the whole semester. Three other challenges contributed to this global challenge: the students had to dynamize debates, and received points and badges, according to their performance. In terms of methodology, it consisted in an exploratory research of a qualitative character. Observation, complemented by a questionnaire made available to the students at the end of the semester, were the chosen techniques for data collection. It was observed that the adopted strategy motivated the students’ active participation, who really enjoyed the experience. However, some limitations were also observed, once these students, attending an online First Cycle Degree, are adults who have professional and family responsibilities and commitments. Actually, several of them mentioned that the difficulty in organizing their time did limit the possibility of participating in the challenge, which was indeed demanding in terms of active participation.info:eu-repo/semantics/publishedVersio