Fundamento y generalidades de la construcción de modelos estadísticos multinivel en el ámbito de la investigación en salud / Construction of multilevel statistical models in health research: Foundations and generalities

Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

Mortality due to traffic accidents in Colombia: Profiles of pedestrians and cyclists, 1998-2019.

Background: Traffic accidents are an important issue for public health and a threat for sustainable development, with pedestrians and cyclists having been recognized as the most vulnerable actors on the streets. The objective of this study was to analyze the profiles of pedestrians and cyclists who died as a result of traffic accidents in Colombia during the 1998-2019 period. Methods: An observational and descriptive study, with the deaths due to traffic accidents in Colombia between 1998 and 2019 as data source. Secondary data were taken from the Vital statistics of Colombia (EEVV), published by Departamento Administrativo Nacional de Estadística (DANE). A trend analysis of the number of deaths during the period under study was performed, and such number was examined against sex to identify potential differences. Multiple correspondence analysis was employed to elaborate the profile of pedestrians and cyclists who die due to traffic accidents. Three profiles were prepared for each road actor: a global profile, one for 1998, and another for 2019. Results: The mortality profiles are different for pedestrians and cyclists, and, in turn, there are also demographic, geographic, and socioeconomic conditions in each type of road actor, which determine higher mortality risks. High population density, younger age group in the cyclists and adults among the pedestrians, low schooling levels and absence of health insurance are suggested as key factors in these profiles. Related to sex, for men is not possible to establish a profile. Women's cases are commonly related to health insurance, age, and population density. Conclusions: Several contextual and demographic characteristics in pedestrians and cyclists allow delimiting mortality profiles. The profiles that were identified suggest the need to articulate road safety policies with other social and development policies in order to coordinate and integrate intersectoral actions that reduce mortality in these road actors.

[Social inequalities related to road traffic mortality]. / Desigualdades sociales relacionadas con la mortalidad por accidentes de tráfico.

OBJECTIVE: To synthesize the social inequalities related to mortality from traffic accidents reported in scientific publications. METHOD: A scoping review following the PRISMA-ScR guide was carried out. Using the MesH vocabulary, we systematically searched for articles in English, Portuguese and Spanish published in the EBSCO, Scielo, Scopus, Ovid, and PubMed databases. RESULTS: We identified 47,790 records in the initial search, of which 35 articles met the selection criteria. Nine out ten publications are in high-income countries; there is a greater interest in analyzing mortality in occupants and drivers of vehicles and motorcyclists. Half of the publications use race-ethnicity and geolocation as socioeconomic position variables. The articles included in this review indicate that groups of people with low socioeconomic positions have higher mortality due to traffic accidents. CONCLUSIONS: The highest mortality from traffic accidents occurs in people with low socioeconomic positions which suggests the development of road safety actions from a comprehensive, integrative perspective and linked to other political agendas to reduce their incidence by 2030. Although road traffic fatalities are higher in low and middle-income countries, few publications are available in these countries. It is necessary to strengthen the research capacities in these countries.

Exposición a material particulado y su relación con el cáncer de mama. Mecanismos fisiopatológicos / Exposure to particulate matter and its association to breast cancer. Pathophysiological mechanisms

Introducción. El cáncer de mama es el tipo de cáncer que genera más muertes en mujeres en el mundo. Aunque se reconoce el aporte de factores genéticos, hormonales y de estilos de vida como sus principales causas, las hipótesis que señalan que la contaminación del ambiente juega un papel importante en su desarrollo, han tomado mucha fuerza en los últimos años. Estas hipótesis surgen debido a que el aumento en la incidencia del cáncer de mama coincide con procesos de industrialización, además de mayor presencia en regiones urbanas y con altos niveles de contaminación. El objetivo de este artículo fue consolidar información sobre los mecanismos fisiopatológicos que puedan explicar la relación entre cáncer de mama y la contaminación por material particulado. Metodología. Se realizó una búsqueda de literatura en PubMed, Google Académico y Epistemonikos para documentos publicados sobre el tema desde enero de 2016 hasta el 3 de agosto de 2022. Resultados. Se encontró que algunos de los mecanismos que podrían explicar dicha relación incluyen: alteraciones endocrinas que favorecen cambios hormonales, induciendo el crecimiento mamario; cambios en las características histológicas del tejido normal, como involución reducida de unidades lobulares ductales terminales; formación de aductos de hidrocarburos aromáticos policíclicos-ácido desoxirribonucleico (HAP-ADN), con mutación específica del gen TP53; activación de la proliferación en la línea celular MCF-7; y, alteraciones en la metilación del ADN. Conclusión. Si bien órganos distales como la mama no son la primera entrada de los contaminantes ambientales al cuerpo, estos sí pueden verse afectados tras la exposición a largo plazo, a través de diferentes mecanismos de disrupción endocrina y daño al ADN principalmente

Breast cancer is the type of cancer that causes the most deaths in women worldwide. Although the contribution of genetic, hormonal and lifestyle factors are recognized as its main causes, the hypotheses that indicate that environmental pollution has an important role in its development have taken on great strength during the last years. These hypotheses are based on the increase in the incidence of breast cancer that coincides with industrialization processes, in addition to its greater presence in urban regions with high levels of pollution. The aim of this study was to consolidate information on the pathophysiological mechanisms that can explain the relationship between breast cancer and air pollution by particulate matter. Methodology. A literature search was carried out in PubMed, Google Scholar and Epistemonikos for documents published on this topic from January 2016 until August 3rd 2022. Results. Some of the mechanisms that could explain this association include endocrine alterations that favor hormonal changes, inducing breast growth; changes in the histological characteristics of normal tissue such as reduced involution of terminal duct lobular units; formation of polycyclic aromatic hydrocarbons-deoxyribonucleic acid (PAH-DNA) adducts, with specific mutation of the TP53 gene; an increase in cell proliferation in the MCF-7 cell line; and alterations in DNA methylation. Conclusion. Although distal organs such as the breast are not the entry site of environmental pollutants into the body, they can be affected after prolonged exposure, mainly through different mechanisms of endocrine disruption and DNA damage

La antifragilidad: Una mirada positiva del envejecimiento

Este artículo pretende explorar el concepto de antifragilidad en el adulto mayor, dado el cambio demográfico en el mundo, con evidencia del aumento de personas mayores, que exige a los profesionales vinculados a su atención implementar modelos de intervención acordes con sus necesidades, relacionadas con su capacidad funcional y promoción de una cultura de antifragilidad. La construcción teórica de lo que significa ser adulto mayor antifrágil, en una sociedad que asimila el envejecimiento con fragilidad, enfermedad y discapacidad, es una oportunidad para presentar una mirada positiva de la salud en la vejez, a partir de las adaptaciones al estrés en diferentes dimensiones que influencian la vida de este grupo poblacional, en el que el capital físico, psicológico y social se integran e influencian, en un proceso que se relaciona con la antifragilidad y el envejecer como un continuo de la vida, con ganancias y pérdidas; el estudio de esta relación permitirá contar con políticas inclusivas adecuadas en cada etapa de la vida.

This article intends to explore the concept of anti-fragility in the elderly, given the demographic change in the world, with evidence of the increase in the number of elderly people, which requires professionals linked to their care, to implement intervention models in accordance with their needs, related to their functional capacity and promotion of a culture of antifragility. The theoretical construction of what it means to be an anti-fragile older adult, in a society that assimilates aging with frailty, illness and disability, is an opportunity to present a positive view of health in old age, based on the adaptations to stress in different dimensions that influence the life of this population group, in which physical, psychological and social capital are integrated and influenced, in a process that is related to anti-fragility and aging as a continuum of life, with gains and losses; the study of this relationship will make it possible to have appropriate inclusive policies at each stage of life.

Escalas de percepción subjetiva del esfuerzo y actividad física en tiempos de SARS-CoV-2/COVID-19 / Scales of subjective perception of effort and physical activity in times of SARS-CoV2/COVID 19

Sr. Editor; recientemente leímos con interés el artículo publicado en la Revista Universidad y Salud en su volumen 22, número 2, denominado "Recomendaciones prácticas para evitar el desacondicionamiento físico durante el confinamiento por pandemia asociada a COVID-19."(1). Felicitamos a los autores por el gran valor y alta pertinencia del artículo en general, cuyos resultados contribuyen a elevar el nivel de conocimiento respecto a recomendaciones prácticas para evitar el sedentarismo asociado a las medidas de confinamiento por SARS-CoV-2/COVID-19. Sin embargo, con el fin de aportar mayor e importante información nos gustaría exponer algunas reflexiones centradas en las recomendaciones de actividad física (AF).

Friends, physical activity, and sedentary behavior in university students: A social network analysis / Amigos, actividad física y comportamiento sedentario en estudiantes universitarios: un análisis de redes sociales

Abstract Introduction: Understanding the processes of socialization during youth and their association with healthy behaviors is crucial for university education. Objective: To explore the associations of the characteristics of friendship networks with being physically active and having a sedentary behavior in university students. Materials and methods: Cross-sectional study conducted in 475 university students and based on a social network analysis. Measurements included sociodemographic, physical activity, sedentary behavior, and friendship network variables. The associations between the characteristics of friendship networks and physical activity and sedentary behavior were explored using logistic regression models. Confidence intervals (95%) were estimated and a significance level of p<0.05 was considered. Results: In women, being part of at least a cluster of friends was significantly associated with being physically active (adjusted OR [aOR]: 2.3; 95%CI: 1.2-4.6), while being popular was significantly associated with a lower probability of being physically active (aOR: 0.3; 95%CI: 0.1-0.7). Also, a ten-percentage point increase in active friends was significantly associated with a higher probability of being physically active (aOR: 9.3; 95%CI: 3.5-24.6). Regarding sedentary behavior, a ten-percentage point increase in the number of sedentary friends was significantly associated with a higher probability of being sedentary (aOR: 5.5; 95%CI: 2.5-12.3). In men, none of the studied associations were statistically significant. Conclusion: Some characteristics of social network are relevant for female university students in relation to their physical activity levels and sedentary behaviors. These findings highlight the need to consider friendship network dynamics for designing initiatives aimed at physical activity promotion and sedentary behavior reduction.

Resumen Introducción. El entendimiento de los procesos de socialización durante la juventud y su relación con conductas saludables son cruciales para la educación universitaria. Objetivo. Explorar las asociaciones de las características de la red social de amigos con ser físicamente activo y con tener un comportamiento sedentario en estudiantes universitarios. Materiales y métodos. Estudio transversal, basado en un análisis de redes sociales, realizado en 475 estudiantes universitarios. Las mediciones realizadas incluyeron variables sociodemográficas, actividad física, conducta sedentaria y redes sociales de amigos. Las asociaciones entre las características de la red social de amigos con la actividad física y el comportamiento sedentario fueron exploradas mediante modelos de regresión logística. Se estimaron intervalos de confianza (95%) y se consideró un nivel de significancia de p<0.05. Resultados. En mujeres, ser parte de al menos un conglomerado de amigos se asoció significativamente con ser físicamente activa (OR ajustados: 2.3; IC95%: 1.2-4.6), mientras que ser popular se asoció significativamente con una menor probabilidad de ser físicamente activa (OR ajustados [aOR]: 0.3; IC95%: 0.1-0.7). Asimismo, un incremento de diez puntos porcentuales de amigos activos se asoció significativamente con una mayor probabilidad de ser físicamente activa (aOR: 9.3; IC95%: 3.5-24.6). En relación con el comportamiento sedentario, un incremento de diez puntos porcentuales de amigos sedentarios se asoció significativamente con una mayor probabilidad de ser sedentaria (aOR: 5.5; IC95%: 2.5-12.3). En hombres, ninguna de las asociaciones estudiadas fue estadísticamente significativa. Conclusión. Algunas características de las redes sociales de amigos fueron relevantes para las estudiantes universitarias en relación a sus niveles de actividad física y comportamiento sedentario. Estos hallazgos resaltan la necesidad de considerar las dinámicas de las redes sociales de amigos en el diseño de iniciativas orientadas a la promoción de la actividad física y la reducción de conductas sedentarias.

Reliability of the Gross Motor Function Measure-66 scale in the evaluation of children with cerebral palsy: validation for Colombia.

BACKGROUND: Infantile cerebral palsy is the leading cause of physical disability in childhood and generates different alterations in motor development that prevent the child's independence. The Gross Motor Function Measure (GMFM) scale is considered the gold standard for this measurement in children with infantile cerebral palsy. In Colombia, its use is delayed due to its original language (English) and no studies on its validity in this specific field. This study aimed to determine whether cultural equivalence allows maintaining the reliability characteristics of the instrument to favor its use in the clinical setting. METHODS: We conducted a cross-sectional study that included 330 children with infantile cerebral palsy from three departments of Colombia, to whom the GMFM-66 scale was applied. Reliability was evaluated from interobserver consistency by estimating intraclass correlation coefficients and internal consistency with the omega coefficient (w) or McDonald's test. RESULTS: The scale demonstrates consistency and stability in its measurements in terms of reliability. The internal consistency was satisfactory only for the first dimension, Lying and rolling (w = 0.91). For the other dimensions, the w-value was always > 0.95. Good agreement was found among the experts in 83.3% of the items and dimensions evaluated. CONCLUSIONS: The GMFM-66 scale in Spanish and for the Colombian context demonstrates good psychometric properties and provides a better understanding of the motor development of children with infantile cerebral palsy so that it can be recommended for use in the Colombian context.

INTRODUCCIÓN: La parálisis cerebral infantil es la principal causa de discapacidad física en la infancia y genera diferentes alteraciones en el desarrollo motor que impiden la independencia del niño. La escala de Medición de la Función Motora Gruesa (GMFM) se considera el método de referencia para esta medición en niños con parálisis cerebral. En Colombia, su uso está rezagado por el lenguaje original (inglés) y la carencia de estudios sobre su validez en este contexto. El objetivo de este estudio fue determinar si la equivalencia cultural permite mantener las características de confiabilidad del instrumento para favorecer su uso en el ámbito clínico. MÉTODOS: Se llevó a cabo un estudio transversal que incluyó 330 niños con parálisis cerebral infantil de tres Departamentos de Colombia, a quienes se aplicó la escala GMFM-66. Se evaluó la confiabilidad desde la consistencia interobservador mediante la estimación de coeficientes de correlación intraclase y la consistencia interna con el coeficiente omega (w) o prueba de McDonald. RESULTADOS: En términos de confiabilidad, la escala demuestra consistencia y estabilidad en sus mediciones. La consistencia interna fue satisfactoria únicamente para la primera dimensión, Decúbito y rolado (w = 0.91). Para las demás dimensiones, el valor de w siempre fue > 0.95. Se encontró un buen acuerdo entre los jueces en el 83.3% de los ítems y las dimensiones evaluadas. CONCLUSIONES: La GMFM-66 en español y para el contexto colombiano demuestra buenas propiedades psicométricas y proporciona una mejor comprensión del desarrollo motor de los niños con parálisis cerebral infantil, por lo que se puede recomendar su uso en el contexto colombiano.

Friendly Residential Environments That Generate Autonomy in Older Persons.

OBJECTIVE: This study aimed to explore the housing and residential environment conditions associated with functional autonomy in older persons. METHODS: A quantitative cross-sectional study was conducted, including 175 individuals over the age of 60. Participants were non-institutionalized urban residents of Medellín, Colombia, selected by random two-stage sampling (neighborhoods and blocks). Analysis was done according to functional autonomy of action (dependent variable); and demographic conditions, housing, and the physical and social environment suggested by the World Health Organization (WHO) in the strategy of age-friendly cities (independent variables). Univariate, bivariate, and multivariate analyses were performed with these variables, where the odds ratio (OR), association hypothesis test, and confidence intervals were estimated, using logistic regression models. RESULTS: 89.7% of older persons had moderate physical performance. The performance of intergenerational activities (OR = 5.28) and community actions (OR = 11.28) were part of social environments. The adaptations in public transport (OR = 90.33), sanitary services (OR = 4.1), and lighting in parks (OR = 19.9) of the physical environment were the associations found with functional autonomy. CONCLUSIONS: Exploring how the physical and social environments surrounding housing are associated with the functional performance of older persons can generate useful information to support public health and city infrastructure strategies that improve their physical performance and maintain autonomy.

Análisis Rasch de la escala APGAR-familiar en adultos mayores de Colombia / Rasch analysis of the APGAR-family scale in older adults in Colombia / Analise Rasch da escada APGAR-familiar em adultos maiores da Colômbia

Resumen El objetivo de este estudio fue analizar mediante el modelo Rasch las evidencias de validez de la medida de funcionalidad familiar obtenida a partir del APGAR-familiar en adultos mayores de Colombia. Se encuestaron 1.514 participantes residentes en Medellín, Barranquilla y Pasto. Se realizaron análisis Rasch de ajuste de categorías de respuesta, ajuste de los ítems y de las personas, funcionamiento diferencial de los ítems, dimensionalidad e independencia local de los ítems y confiabilidad. Los principales resultados indicaron que el formato de respuesta se ajusta a los requerimientos de optimización de función de Linacre, todos los ítems muestran medias cuadráticas Infit y Outfit en el rango esperado, la escala es unidimensional y la confiabilidad de Wright se estimó en 0,962. Se concluye que, en adultos mayores colombianos, el APGAR-familiar proporciona una medida de funcionalidad familiar unidimensional, a nivel de intervalo, confiable e insesgada por edad y sexo, que permite clasificar cinco niveles de funcionalidad familiar con fines de tamizaje.

Abstract The objective of this study was to analyze, using the Rasch model, the evidence of validity of the measure of family functionality obtained from the APGAR-family assessment in older adults in Colombia. A total of 1,514 participants residing in Medellín, Barranquilla and Pasto were surveyed. Rasch analysis of adjustment of response categories, adjustment of items and people, differential functioning of the items, dimensionality and local independence of the items and reliability were carried out. The main results indicated that the response format conforms to the Linacre function optimization requirements. All the items show Infit and Outfit means square in the expected range. The scale is one-dimensional and Wright's reliability was estimated at 0.962. It is concluded that the APGAR-family assessment in Colombian older adults provides a one-dimensional measure of family functionality at the interval level, reliable and unbiased by age and gender, which allows classifying five levels of family functionality for screening purposes.

Resumo O objetivo deste estudo foi analisar através do modelo Rasch as evidencias de validez da medida de funcionalidade familiar obtida a partir do APGAR-familiar em adultos maiores da Colômbia. Entrevistaram-se 1.514 participantes residentes em Medellín, Barranquilla e Pasto. Fizeram-se análises Rasch de ajuste de categorias de resposta, ajuste dos itens e das pessoas, funcionamento diferencial dos itens, dimensionalidade e independência local dos itens e confiabilidade. Os principais resultados indicaram que o formato de resposta se ajusta aos requerimentos de optimização de função de Linacre, todos os itens amostram medias quadráticas Infit e Outfit no rango esperado, a escada é unidimensional e a confiabilidade de Wright se estimou em 0,962. Conclui que, em adultos maiores colombianos, o APGAR-familiar proporciona uma medida de funcionalidade familiar unidimensional, a nível de intervalo, confiável e imparcial por idade e sexo, que permite classificar cinco níveis de funcionalidade familiar com fins de triagem.

Vulneración a la integridad física de personas mayores: prevalencia del maltrato y factores asociados / Violation of the Physical Integrity of the Elderly: Prevalence of Abuse and Related Factors

Resumen El envejecimiento poblacional que experimenta actualmente América Latina trae consigo retos para la sociedad, como la prevención de la vulneración a los derechos humanos y libertades de las personas mayores y la eliminación de todas las formas de maltrato. La prevalencia de maltrato físico a personas mayores fue de 4,1%. Se presentó principalmente en mujeres, personas sin pareja y con ingreso económico. Además, fue más prevalente en personas mayores con riesgo de depresión, ante cedentes de pensamientos suicidas, insatisfacción con la salud y que convivían con familias disfuncionales. Los hallazgos de esta investigación muestran como las re laciones familiares pueden ser un factor clave a la hora de abordar la problemática del maltrato; además, las graves repercusiones que generan estos hechos sobre la víctima, como afectaciones no solo a la salud física sino también mental.

Abstract The ageing population currently experienced by Latin America brings with it cha llenges for society, such as the prevention of human rights violation and freedoms of the elderly, and the elimination of all forms of abuse. The prevalence of physical abuse for the elderly was 4.1%. It was mainly presented in women, people without a partner, and with financial income. In addition, it was more prevalent in older people at risk of depression, a history of suicidal thoughts, dissatisfaction with health, and living with dysfunctional families. The findings of this research show how family re lationships can be a key factor in addressing the problem of abuse. In addition, the serious impact of these facts on the victim, such as affectations not only to physical health, but also to mental health.

Factors Associated With Suicidal Ideation in Older Adults From Three Cities in Colombia, 2016. / Factores asociados con la ideación suicida del adulto mayor en tres ciudades de Colombia, 2016.

INTRODUCTION: Suicidal ideation refers to thoughts that range from a vague idea of committing suicide to a specific suicide plan. OBJECTIVE: To explore factors such as demographic, social, family, abuse, risk of depression, habits and health conditions, which influence suicidal ideation in the elderly people in the cities of Medellín, Barranquilla, and Pasto (Colombia), with the intention to identify those associated factors that can be used in public health programs focused on this population. METHODS: Cross-sectional analytical study was conducted using a secondary source, demographic, social, clinical variables, social support, discrimination, abuse, happiness, depression, functional capacity, and as a dependent variable were asked the question: "Have you ever thought about committing suicide?" A descriptive, bivariate and multivariate analysis was performed. RESULTS: The median age was ≤ 69 [interquartile range, 11] years, and 58.2% were women. The prevalence of suicidal ideation was 6.4%, and of these, 28.7% had made plans to end their lives, and 66.7% had tried at least once. A statistical association was found with informal employment, cigarette consumption, alcohol and psychoactive substances, risk of depression, having a disability, dissatisfaction with their quality of life, with their health, with their economic situation, as well as feeling unhappy, bad treatment and bad relationships among family members, poor social support, sexual and economic abuse, and finally, discrimination. CONCLUSIONS: Suicidal ideation in older adults in three cities of Colombia is explained by the sexual and economic abuse that this population is suffering, as well as bad personal relationships between the members of the family of the older adult. The risk of depression increases the probability of having thoughts against one's life.

Factores asociados con la ideación suicida del adulto mayor en tres ciudades de Colombia, 2016 / Factors Associated With Suicidal Ideation in Older Adults From Three Cities in Colombia, 2016

RESUMEN Introducción: La ideación suicida se refiere a pensamientos que abarcan desde una vaga idea de suicidarse a un plan específico de suicidio. Objetivo: Explorar factores demográficos, sociales y familiares, maltrato, riesgo de depresión y hábitos y condiciones de salud que influyen en la ideación suicida del adulto mayor en las ciudades de Medellín, Barranquilla y Pasto, para identificar aquellos en los que se puede intervenir con programas de salud pública enfocados en esta población. Métodos: Estudio analítico transversal con fuente secundaria; se consideraron variables demográficas, sociales y clínicas, apoyo social, discriminación, maltrato, felicidad, depresión y capacidad funcional, y como variable dependiente, la pregunta: «¿ha pensado en atentar contra su vida?¼. Se realizaron análisis descriptivo, bivariable y multivariable. Resultados: La mediana de edad fue ≤ 69 (intervalo intercuartílico, 11) años; el 58,2% eran mujeres; la prevalencia de ideación suicida fue del 6,4%; el 28,7% de estos había hecho planes para terminar con su vida y el 66,7% lo había intentado al menos una vez. Se encontró asociación estadística con el empleo informal, el consumo de cigarrillos, alcohol y sustancias psicoactivas, el riesgo de depresión, tener discapacidad, la insatisfacción con la calidad de vida, la salud y la situación económica, sentirse infeliz, los maltratos y las malas relaciones entre los miembros de la familia, el escaso apoyo social, el maltrato sexual y económico y, por último, la discriminación. Conclusiones: La ideación suicida de los adultos mayores en 3 ciudades de Colombia se explica por el maltrato sexual y económico que sufre esta población; asimismo las malas relaciones personales entre los miembros de la familia del adulto mayor y el riesgo de depresión aumentan la probabilidad de que se presenten pensamientos contra la propia vida.

ABSTRACT Introduction: Suicidal ideation refers to thoughts that range from a vague idea of committing suicide to a specific suicide plan. Objective: To explore factors such as demographic, social, family, abuse, risk of depression, habits and health conditions, which influence suicidal ideation in the elderly people in the cities of Medellín, Barranquilla, and Pasto (Colombia), with the intention to identify those associated factors that can be used in public health programs focused on this population. Methods: Cross-sectional analytical study was conducted using a secondary source, demographic, social, clinical variables, social support, discrimination, abuse, happiness, depression, functional capacity, and as a dependent variable were asked the question: "Have you ever thought about committing suicide?" A descriptive, bivariate and multivariate analysis was performed. Results: The median age was ≤ 69 [interquartile range, 11] years, and 58.2% were women. The prevalence of suicidal ideation was 6.4%, and of these, 28.7% had made plans to end their lives, and 66.7% had tried at least once. A statistical association was found with informal employment, cigarette consumption, alcohol and psychoactive substances, risk of depression, having a disability, dissatisfaction with their quality of life, with their health, with their economic situation, as well as feeling unhappy, bad treatment and bad relationships among family members, poor social support, sexual and economic abuse, and finally, discrimination. Conclusions: Suicidal ideation in older adults in three cities of Colombia is explained by the sexual and economic abuse that this population is suffering, as well as bad personal relationships between the members of the family of the older adult. The risk of depression increases the probability of having thoughts against one's life.

Recomendaciones prácticas para evitar el desacondicionamiento físico durante el confinamiento por pandemia asociada a COVID-19 / Practical recommendations to avoid physical deconditioning during confinement due to pandemic associated with COVID-19

Introducción: El aislamiento social durante la pandemia por COVID-19 incluye el confinamiento en casa, que redunda en incremento de la inactividad física y de comportamientos sedentarios, favoreciendo el desacondicionamiento físico. Las personas desacondicionadas físicamente tienen alteraciones metabólicas y sistémicas por la falta de movimiento. Objetivo: Presentar recomendaciones prácticas, y de bajo costo sobre actividades basadas en la evidencia para evitar el desacondicionamiento físico durante el confinamiento en casa, que se pueden mantener a largo plazo, incluso después de la pandemia. Materiales y métodos: Revisión documental sobre estrategias para conducir estilos de vida saludable en casa que disminuyan los efectos negativos a nivel fisiológico producidos por el confinamiento derivado de la pandemia. Resultados: La evidencia señala que el confinamiento en casa incrementa los niveles de inactividad física y el comportamiento sedentario; la realización de actividad física bajo condiciones particulares puede entre otros, fortalecer el sistema respiratorio e inmunológico, mantener la condición física y generar efectos positivos sobre la salud mental. Conclusiones: Los hábitos relacionados con la práctica de actividad física en casa se deben mantener en el tiempo, se recomienda realizarla de manera programada, establecer horarios de descanso entre las actividades y durante la noche, y elegir aquellas que generen disfrute.

Introduction: Social isolation during the COVID-19 pandemic includes home confinement, which results in increased physical inactivity and sedentary behaviors, favoring physical deconditioning. Deconditioned people have metabolic and systemic disorders due to the lack of movement. Objective: To present practical, low-cost recommendations on evidence-based activities to avoid physical deconditioning during home confinement, which can be maintained over the long term, even after the pandemic. Materials and methods: Documentary review on strategies to support healthy lifestyles at home that decrease the negative effects at a physiological level produced by the confinement derived from the pandemic. Results: Evidence indicates that home confinement increases the levels of physical inactivity and sedentary behavior; executing physical activity under particular conditions, among other effects, can strengthen the respiratory and immune systems, maintain physical condition and generate positive effects on mental health. Conclusions: The habits related to the practice of physical activity at home should be maintained over time, it is recommended to do it on a scheduled basis, define rest times between activities and during the night, and choosing those that generate enjoyment.

Factores que explican el apoyo social del adulto mayor en tres ciudades de Colombia. 2016 / Factors that explain the social support of the elderly in three cities of Colombia. 2016

Resumen Objetivo: Identificar los factores asociados a las dimensiones del apoyo social del adulto mayor en tres ciudades de Colombia: Medellín, Barranquilla y Pasto. Método: Estudio cuantitativo, transversal analítico, de fuente de información primaria, obtenida a partir de encuestas realizadas a adultos mayores sobre aspectos demográficos, familiares y sociales, y escalas de medición validadas que permitieron evaluar aspectos como funcionamiento familiar, felicidad, maltrato, depresión, riesgo nutricional y discriminación. El apoyo social percibido se evaluó mediante el Cuestionario de Estudio de Desenlaces Médicos de Apoyo Social (Medical Outcomes Study- Social Support Survey (MOS)). La muestra fue de 1452 personas seleccionadas por muestreo probabilístico por conglomerado, bietápico, en las ciudades de Medellín, Barranquilla y Pasto (Colombia). Se realizó análisis univariado, bivariado y multivariado, se calcularon medidas estadísticas y epidemiológicas. Se consideraron asociaciones estadísticas aquellas con un valor p inferior a 5%. Resultados: Los adultos mayores participantes percibieron un apoyo social adecuado en sus diferentes dimensiones: 92% emocional, 93,5% instrumental, 92% interacción social positiva y 93% apoyo afectivo, y 91,9% en el índice global de apoyo. Percibir buen apoyo social fue una condición predominante en los adultos mayores: con pareja, sin riesgo de depresión, afiliados al Sistema General de Seguridad Social en Salud, que se sienten felices, que conviven con al menos dos familiares, que perciben un adecuado funcionamiento familiar, no reciben malos tratos al interior de su familia, tienen al menos cuatro amigos cercanos, no se sienten discriminados, que están acompañados y tienen alguien que los cuidan permanentemente.

Abstract Objective: Identify the factors that explain the social support components of the elderly. Methods: Quantitative, cross-sectional, analytical study of a source of primary information, obtained from surveys of older adults. The sample was 1452 people selected by probabilistic sampling by cluster, two-stage. In Medellín, Barranquilla and Pasto. To measure the perceived social support, the Medical. Results Study Social Support Survey was applied. Univariate, bivariate and multivariate analyzes were performed, statistical and epidemiological measures were calculated. Statistical associations considered with a p value of less than 5% were considered. Results: In relation to the social support components of the elderly, with an adequate condition: emotional support (92%); instrumental support (93.2%); positive social interaction (92.2%); affective support (93.2%) and in the total evaluation (91.9%). The city of Pasto was the one that selected the lowest percentages, in the different components. Perceiving good social support was a predominant condition in older adults: with a partner, without depression, affiliated with the General System of Social Security in Health, happy (through the Lima happiness scale), who live with at least two relatives, with proper family functioning, they do not perceive ill-treatment within their family, they have at least four close friends, they do not feel discriminated against, they do not leave them constantly alone and they have someone to take care of them permanently. Conclusion: Being from the city of Medellín, having a partner, feeling happy, not being alone, as well as not having depression, important factors in each of the components of social support.

La felicidad como predictor de funcionalidad familiar del adulto mayor en tres ciudades de colombia / Happiness as a predictor of family functionality of the elderly in three cities of colombia / Felicidade como indutor de funcionalidade familiar do idoso em três cidades de colômbia

Resumen Objetivo: Determinar la capacidad predictiva de la felicidad sobre el funcionamiento familiar del adulto mayor en tres ciudades de Colombia. Materiales y métodos: Estudio analítico, transversal, de fuente primaria, con 1514 encuestas aplicadas a personas de 60 años en adelante, en 2016, residentes en las ciudades de Medellín, Barranquilla y Pasto. Se indagó por la funcionalidad familiar a través del APGAR familiar; aunado a las características demográficas, sociales y del estado de salud físico, mental y funcional de la persona mayor. Se realizó análisis univariado, bivariado y multivariado con el fin de ajustar por las variables confusoras y se calculó un modelo predictivo con el método backward (Wald). Resultados: Las características asociadas al funcionamiento familiar fueron: ciudad de residencia; sexo femenino; tener pareja sentimental; alto nivel educativo; no padecer trastornos mentales; percepción de felicidad, sin riesgo de depresión; baja vulnerabilidad y contar con apoyo social. Las que aportan a su predicción fueron ser mujer, ser feliz, no tener depresión, no ser vulnerable, tener apoyo instrumental y social adecuado y no haber sido maltratado. La felicidad es el mayor predictor, según el modelo calculado, con sensibilidad del 92,6 % y especificidad del 40,8 %. Conclusión: Si se fortalece el bienestar subjetivo de la persona mayor se permitirá ver la vejez con una imagen positiva como facilitador de buenas relaciones familiares e integrante activo de la sociedad.

Abstract Objective: To determine the predictive capacity of happiness on the family functioning of the elderly in three cities of Colombia. Materials and methods: Analytical, cross sectional, primary source study with 1514 surveys applied to people aged 60 and older, residents in the cities of Medellín, Barranquilla and Pasto in 2016. Family functionality was explored with the family APGAR scale, along with demographic, social and the physical, mental, functional and health status of the elderly. Univariate, bivariate and multivariate analyzes were carried out to adjust the confounding variables and a predictive model was calculated with the backward method (Wald). Results: The characteristics associated to family functioning were: city of residence, female gender, having a sentimental partner, high educational level, not suffering from mental disorders, perception of happiness without risk of depression, low vulnerability, and having social support. The characteristics that contributed to this prediction were: being a woman, being happy, not having depression, not being vulnerable, having adequate instrumental and social support, and not having been mistreated. Happiness is the greatest predictor according to the calculated model with sensitivity of 92.6% and specificity of 40.8%. Conclusion: if the subjective well-being of the elder is strengthened, it will be possible to see old age with a positive image as a facilitator of good family relationships and an active member of society.

Resumo Objetivo: Determinar a capacidade preditiva da felicidade sobre o funcionamento familiar do adulto maior em três cidades de Colômbia. Materiais e métodos: Estudo analítico, transversal, de fonte primaria, com 1514 enquetes aplicadas a pessoas de 60 anos em adiante, em 2016, residentes nas cidades de Medellín, Barranquilla e Pasto. Pesquisou-se pela funcionalidade familiar a través do APGAR familiar; aunado às caraterísticas demográficas, sociais e do estado de saúde físico, mental e funcional dos idosos. Realizou-se analise uni variado, bivariado e multivariado com o fim de ajustar as variáveis confessoras e se calculou um modelo indutivo com o método backward (Wald). Resultados: As características associadas ao funcionamento familiar foram: cidade de residência; sexo feminino; ter casal sentimental; alto nível educativo; não padecer transtornos mentais; percepção da felicidade, sem risco de depressão; baixa vulnerabilidade e contar com apoio social. As que ajudam a sua predição foram ser mulher, ser feliz, não ter depressão, não ser vulnerável, ter apoio instrumental e social adequado e não ter sido maltratado. A felicidade é o maior indutor, segundo o modelo calculado, com sensibilidade do 92,6 % e especificidade do 40,8 %. Conclusão: Sim se fortalece o bem estar subjetivo do idoso se permitirá ver a velhice com uma imagem positiva como facilitador de boas relações familiares e integrante ativo da sociedade.

Características sociales y familiares asociadas al maltrato al adulto mayor de Pasto, Colombia 2016 / Social and family characteristics associated with elder abuse in Pasto, Colombia 2016

Resumen Objetivo: determinar la prevalencia de maltrato en el adulto mayor de la ciudad de Pasto (Colombia) y la asociación con factores sociodemográficos y familiares. Método: estudio transversal de fuente de información primaria obtenida a partir de encuestas. La muestra fue de 506 adultos mayores seleccionados por muestreo probabilístico, por conglomerado, bietápico. Para la detección del maltrato se utilizó la Escala Geriátrica de Maltrato. Se realizó análisis univariado para describir y análisis bivariado y multivariado por regresión logística binaria, para identificar factores asociados. Resultados: La prevalencia de maltrato al adulto mayor en la ciudad de Pasto para el año 2016 fue de 13,0%; la tipología más reportada fue el maltrato psicológico (5,4%). Los principales factores asociados fueron dependencia, disfuncionalidad severa del adulto mayor, malos tratos entre miembros de la familia y escaso apoyo social. Conclusión: La prevalencia de adultos mayores maltratados en Pasto es alta, considerando que corresponde a acciones que se presentan al interior de la familia; el deterioro en las relaciones sociales y familiares del adulto mayor son factores que incrementan el maltrato en la vejez, por lo cual deben fortalecerse vínculos y redes de apoyo en esta etapa.

Abstract Objective: To determine the prevalence of elder abuse in the city of Pasto, Colombia and its association with sociodemographic and family factors. Material and Methods: A cross-sectional study of primary information source obtained from surveys was conducted. The sample consisted of 506 elder adults selected by probabilistic sampling, by conglomerate, two-stage. The Geriatric Abuse Scale was used for the detection of abuse. Descriptive statistics were obtained by performing univariate analyses. Bivariate and multivariate analyses by binary logistic regression were conducted to identify associated factors. Results: The prevalence of abuse was 13% and the most reported typology was psychological (5.4%). The main factors associated with abuse were dependence, severe dysfunctionality, family member maltreatment and poor social support. Conclusion: Abuse of elderly adults is high due to specific behaviors that are present within families. The deterioration in social and family relationships of elder adults are factors that increase the abuse in old age. For this reason, support networks must be strengthened to support the elderly population.

Depression in the elderly: A study in three cities of Colombia / Depresión en el adulto mayor: Un estudio en tres ciudades de Colombia

Abstract Objective: To explore the demographic, health and functional factors associated with depression in the elderly in three cities from Colombia: Medellin, Barranquilla and Pasto. Materials and methods: An analytical cross-sectional study. The study population corresponded to a probabilistic sample of 1514 adult whose age is 60 years or over. A sample was selected by a probabilistic sampling, in two-stage, and conglomerate, according to the geographical and administrative distribution of each city. Results: The results support that the city of Pasto presents the highest number of elderly people with depression; conditions such as low educational level (PR = 4.11), hyperthyroidism / hypothyroidism (PR = 3.43), and dependence on activities of daily living such as using the telephone (PR = 3.80) increase the prevalence of the disease. Conclusion: Depression is present in an important part of the population of older adults and is associated with conditions not only of health but also demographic and functional capacity. It is necessary to address these components from the public health that promotes the prevention of this condition if you want to contribute to the goals of active, satisfactory and healthy aging in Colombia and a better quality of life for this population.

Resumen Objetivo: Explorar los factores demográficos, de salud y de funcionalidad asociados con la depresión en los adultos mayores en tres ciudades de Colombia: Medellín, Barranquilla y Pasto. Material y métodos: Estudio analítico transversal. La población del estudio correspondió a una muestra probabilística de 1514 adultos de 60 años y más. La muestra fue seleccionada mediante un muestreo probabilístico, por conglomerado, bietápico, según la distribución geográfica y administrativa de cada ciudad. Resultados: Los resultados muestran que la ciudad de Pasto presenta el mayor número de adultos mayores con depresión; condiciones como el bajo nivel educativo (RP=4,11), el hipertiroidismo/hipotiroidismo (RP=3,43), y la dependencia en actividades básicas de la vida diaria como usar el teléfono (RP=3,80) incrementan la prevalencia de la enfermedad. Conclusión: La depresión está presente en una parte importante de la población de adultos mayores y está asociada a condiciones no solo de salud sino también demográficas y de la capacidad funcional. Se hace necesario el abordaje de estos componentes desde la salud pública que promueva la prevención de esta condición si se quiere contribuir con las metas de envejecimiento activo, satisfactorio y saludable en Colombia y una mejor calidad de vida para esta población.

Factores asociados a la vulnerabilidad cognitiva de los adultos mayores en tres ciudades de Colombia / Factors Associated with the Cognitive Vulnerability of Older Adults in Three Colombian Cities / Fatores associados à vulnerabilidade cognitiva dos idosos em três cidades da Colômbia

RESUMEN Objetivo: identificar los factores asociados a la vulnerabilidad cognitiva de los adultos mayores en tres ciudades de Colombia en el año 2016. Materiales y método: se condujo un estudio cuantitativo, transversal analítico, con fuente de información primaria, encuestando a 1514 adultos mayores residentes en la zona urbana de Barranquilla, Medellín y Pasto, empleando muestreo probabilístico bietápico. La condición cognitiva se evaluó con el Mini Examen Cognoscitivo modificado. Se realizaron análisis univariados, bivariados y multivariados, cálculos estadísticos y epidemiológicos, intervalos de confianza y pruebas estadísticas menores del 5%. Resultados: el riesgo de deterioro cognitivo se presentó en un 5,1% en Medellín, un 2,7% en Pasto y un 1,7% en Barranquilla, predominantemente en hombres, con edades entre los 75 y 89 años, sin pareja y con bajos niveles de escolaridad. El 100% de quienes tenían deterioro cognitivo refieren no realizar actividad física, el 13% reportaron depresión y el 7,7% soporte social escaso. Conclusiones: los factores asociados a la vulnerabilidad cognitiva de los adultos mayores incluyen características demográficas, sociales y de estilos de vida. Es importante considerar estos resultados en las políticas de salud para la población de adultos mayores con el fin de reorientar la atención en la prevención de la vulnerabilidad cognitiva.

ABSTRACT Objective: Identify the factors associated with the cognitive vulnerability of older adults in three Colombian cities during 2016. Materials and methods: A quantitative, cross-sectional, analytical study was conducted with a primary source of information by surveying 1514 older adults living in the urban areas of Barranquilla, Medellín and Pasto. Two-stage probabilistic sampling was used. The cognitive condition of the adults in the sample was evaluated with the modified Mini Cognitive Exam. Univariate, bivariate and multivariate analyzes, statistical and epidemiological calculations, confidence intervals and statistical tests of less than 5% were performed. Results: The risk of cognitive deterioration was found in 5.1% of the sample in Medellín, 2.7% in Pasto and 1.7% in Barranquilla, predominantly among men between 75 and 89 years of age who are without a partner and have low levels of schooling. One hundred percent (100%) of those with cognitive impairment reported having no physical activity, 13% reported depression, and 7.7% indicated social support was scarce. Conclusions: The factors associated with cognitive vulnerability among older adults include demographic, social and lifestyle characteristics. It is important to consider these results when drafting health policies for the elderly population to redirect attention to the prevention of cognitive vulnerability.

RESUMO Objetivo: identificar os fatores associados à vulnerabilidade cognitiva dos idosos em três cidades da Colômbia em 2016. Materiais e método: estudo quantitativo, transversal analítico, com fonte de informação primária, que entrevistou 1514 idosos residentes na zona urbana de Barranquilla, Medellín e Pasto, empregando amostra probabilística bietápica. A condição cognitiva foi avaliada com o Miniexame Cognoscitivo Modificado. Foram realizadas análises univariadas, bivariadas e multivariadas, cálculos estatísticos e epidemiológicos, intervalos de confiabilidade e testes estatísticos menores de 5 %. Resultados: o risco de deterioração cognitiva foi apresentado em 5,1 % em Medellín; 2,7 % em Pasto e 1,7 % em Barranquilla, predominantemente em homens, com faixa etária entre 75 e 89 anos, sem companheiro(a) e com baixo nível de escolaridade. 100 % dos que apresentaram deterioração cognitiva referem não realizar atividade física; 13 % relataram depressão e 7,7 %, apoio social escasso. Conclusão: os fatores associados à vulnerabilidade cognitiva dos idosos incluem características demográficas, sociais e de estilos de vida. É importante considerar os resultados nas políticas de saúde para a população de idosos a fim de reorientar a atenção na prevenção da vulnerabilidade cognitiva.

Entornos y actividad física en enfermedades crónicas: Más allá de factores asociados / Environments and physical activity in chronic diseases: Beyond associated factors

Resumen Introducción: Las enfermedades crónicas no transmisibles son la mayor causa de morbimortalidad. La estrategia más costo-efectiva es la realización de actividad física pero hay una relación directa entre el incremento de estas enfermedades con la alta prevalencia de personas físicamente inactivas. Objetivo: Recoger los elementos esenciales de las enfermedades crónicas en términos del impacto y sus efectos negativos y mostrar, dentro de los factores de riesgo, a la inactividad física como uno de los determinantes clave en su aparición y el rol de los entornos construidos en esta conducta no saludable. Materiales y métodos: Estudio descriptivo mediante revisión documental sobre el papel de los entornos como factores determinantes entre la inactividad física y el desarrollo de las enfermedades crónicas no transmisibles. Resultados: Se describen los efectos negativos de las enfermedades crónicas, los factores que influyen en su aparición y se destaca a la inactividad física como uno de los determinantes de las enfermedades crónicas. La evidencia empírica sugiere que las características del entorno obran como determinantes en este comportamiento dentro de los estilos de vida. Conclusión: Los entornos en que habitan las personas se constituyen en factores asociados y determinantes en la realización o no de actividad física y deben ser considerados, más allá de los factores individuales, si se quiere tener éxito en la prevención y control de las enfermedades no transmisibles.

Abstract Introduction: Chronic noncommunicable diseases are the major cause of morbidity and mortality. The most cost-effective strategy is the practice of physical activity but there is a direct relationship between the increase of these diseases with the high prevalence of physically inactive people. Objective: To collect the essential elements of chronic diseases in terms of impact and their negative effects and to show, within risk factors, physical inactivity as one of the key determinants in their emergence and the role of environments built on this unhealthy behavior. Materials and methods: A descriptive study was conducted through documentary review on the role of environments as determinants between physical inactivity and the development of chronic noncommunicable diseases. Results: The negative effects of chronic diseases are described as well as the factors that influence their appearance. Physical inactivity is highlighted as one of the determinants of chronic diseases. The empirical evidence suggests that the characteristics of the environment work as determinants in this behavior within the lifestyles. Conclusion: The environments where people inhabit are associated factors and determinants in the practice or not of physical activity and should be considered, beyond the individual factors, if there is the need to succeed in the prevention and control of noncommunicable diseases.