Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave.

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

The recovery and resilience plan on the long-term care system. Towards a deinstitutionalization?

Introduction: After the crisis caused by Covid-19, among other socioeconomic problems, the fragility of the organizations that make up the Spanish Long-Term Care System was revealed. These events prompted the Recovery and Resilience Plan (RRP). The aim of this study is to estimate the socioeconomic impact on Long-Term Care (LTC) of the investment delivered by the RRP. In addition, to fulfil our main aim, a secondary and necessary aim was to calculate the most current social accounting matrix (SAM) of the Spanish economy. Methods: We analyse the components of the demand linked to the RRP investment allocated to LTC, and subsequently, based on Input-Output methodology, we calculate a social accounting matrix (SAM) of the Spanish economy to estimate the overall economic return. Results: The results obtained using the SAM model proposed herein evidence the multiplier effect of the RRP invested in LTC. Every euro allocated to the RRP generates 4 euros in income for Households, Firms and the External Sector, 3.4 euros in industrial output, and returns 0.6 euros in taxes and social contributions to the Government. This also entails creating 26,410 direct and indirect jobs as well as 10,059 induced ones. Discussion: Given the severe recession scenario triggered by the consequences of COVID-19, the results of this study highlight the significant multiplier effect that RRP investment may generate to alleviate the downturn in the Spanish economy and, more specifically, in the Spanish LTC System.

Impact of implementation of the Dependency Act on the Spanish economy: an analysis after the 2008 financial crisis.

The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries' copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input-output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input-Output Table at current prices was extracted from the WIOD Database's 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services.

Socioeconomic and Lifestyle Factors Related to Cost and Frequency of Hospitalization in European Older Adults.

Individuals' lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the Survey of Health, Aging, and Retirement in Europe. Generalized regression models for panel data were developed and adjusted hospitalization costs derived from the length of hospital stay were also estimated. The average adjusted cost of hospitalization was I$ 9901.50 and the analyses showed that performing weekly physical activity significantly reduces the probability of hospitalization (OR: 0.624) and its costs (I$ 2594.5 less per person per year than subjects who never performed physical activity). Muscle strength plays an important role in this relationship and eating habits are not of great significance. Furthermore, we found interesting differences in the frequency and costs of hospitalization between subjects by country.

Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain.

BACKGROUND: A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. METHODS: The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. RESULTS: 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. CONCLUSIONS: This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State.

[Costs of health services associated with fruit and vegetable consumption habits]. / Costes de los servicios sanitarios asociados a los hábitos de consumo de frutas y verduras.

INTRODUCTION: healthy eating habits, such as the consumption of fruits and vegetables, allow better health and, consequently, reduce the consumption of health resources. It is important to establish a relationship between fruit and vegetable consumption and the use of health services in the Spanish population to consider the need to intervene. METHODS: the European Health Survey in Spain for 2014 was used, and the possible existence of differences in access and visit frequency to the family physician, specialist physician and emergency services depending on fruits and vegetables consumption habits was assessed through Hurdle models. Subsequently, two groups were generated through the propensity score matching technique in order to compare the differences in the frequenting of services depending on the consumption of fruits and/or vegetables and other adjustment covariates. Finally, the cost generated by such differences was estimated according to consumption groups. RESULTS: there are differences in access to the emergency services, both in subjects who never consume fruit and in subjects who never consume vegetables. In the first case, there is an increase of 420 visits per year for every 1,000 persons with attributable costs of €75,000, whereas in the second case, an increase of 780 visits per year for every 1,000 persons, with a cost of €139,000, is observed. CONCLUSIONS: certain eating habits of the Spanish population, such as never consuming fruits or vegetables, produce important avoidable expenses in the health system. It would be of interest to implement prevention policies to reduce such costs and use resources appropriately.

Introducción: los buenos hábitos de alimentación, como el consumo de frutas y verduras, permiten tener una mejor salud y, consecuentemente, minorar el consumo de recursos sanitarios. Es importante establecer una asociación entre consumo de frutas y verduras y el uso de los servicios sanitarios en la población española para considerar la necesidad de intervenir.Métodos: se empleó la Encuesta Europea de Salud en España del año 2014 y, mediante la utilización de modelos Hurdle, se valoró si existían diferencias en el acceso y la frecuentación al médico de familia, especialista y urgencias, dependiendo de los hábitos de consumo de frutas y verduras. Posteriormente, mediante la técnica propensity score matching se generaron dos grupos con los que poder comparar las diferencias en la frecuentación de los servicios sanitarios dependiendo del consumo de frutas y/o verduras y otras covariables de ajuste. Finalmente, se estima el coste de dichas diferencias por grupos de consumo.Resultados: se revela la existencia de diferencias en el acceso al servicio de urgencias, tanto por los sujetos que no consumen nunca fruta como por parte de los sujetos que no consumen nunca verdura. En el primer caso hay un incremento de 420 visitas al año por cada 1.000 personas con un coste atribuible de 75.000 €, mientras que en el segundo caso se observa un incremento de 780 visitas al año por cada 1.000 personas, con un coste equivalente de 139.000 €.Conclusiones: determinados hábitos de alimentación de la población española como no consumir nunca fruta o verdura producen importantes gastos evitables en el sistema sanitario. Es de gran interés implementar políticas de prevención para minorar dichos gastos y emplear los recursos de forma adecuada.

Validity and reliability of the Spanish sign language version of the KIDSCREEN-27 health-related quality of life questionnaire for use in deaf children and adolescents.

OBJECTIVE: The aim of this paper was to test the validity and reliability of a Spanish sign language (SSL) adaptation of KIDSCREEN-27, a health-related quality of life (HRQoL) questionnaire for use in deaf children and adolescents. METHODS: We performed an observational cross-sectional study of 114 deaf children and adolescents aged 8 to 18 years old. The Spanish version of the KIDSCREEN-27 was adapted to SSL through the translation-back translation technique. The adapted questionnaire was then administered using a web tool to ensure complete access to study participants. Floor and ceiling effects were calculated. Structural and cultural validity were tested using exploratory and confirmatory factor analysis. Cronbach's α was used to assess internal consistency. The questionnaire was administered for a second time to the entire sample after 2 to 4 weeks (test-retest reliability). RESULTS: In the SSL version of the KIDSCREEN-27, as in the original Spanish scale, five dimensions explained 59% of the variance. None of the participants obtained the minimum or maximum scores on the scale (floor and ceiling effect, respectively). Confirmatory factor analysis showed the goodness-of-fit of the factor solution with five dimensions of the SSL version. The Cronbach's α of both the total scale and of each of the distinct dimensions was above 0.75. The intra-class correlation coefficient of the test-retest scale was considered acceptable in all the dimensions. CONCLUSIONS: The reliability and validity of the SSL version of the KIDSCREEN-27 are similar to those of the original Spanish version, providing a new tool for measuring HRQoL in deaf children and adolescents.

Health-related quality of life, obesity, and fitness in schoolchildren: the Cuenca study.

PURPOSE: The purpose of this study was to analyze the association of weight status and physical fitness with health-related quality of life (HRQoL) and to examine the independent association of body mass index (BMI), cardiorespiratory fitness (CRF) and musculoskeletal fitness (MF) with HRQoL in schoolchildren. METHODS: Cross-sectional study of 1,158 schoolchildren, 8-11 years, from 20 schools in the Cuenca province, Spain. We measured weight, height, and physical fitness, measured by CRF (20-m shuttle run test) and MF index by summing the age-sex z scores of handgrip strength test/weight + standing broad jump test. Self-reported HRQoL was measured by KIDSCREEN-52 questionnaire. RESULTS: Normal weight boys scored better in physical well-being, mood and emotions, autonomy, and social support and peers dimensions than overweight/obese boys. The mean in self-perception dimensions was lower in obese girls compared to normal weight or overweight girls. Higher levels of CRF and MF were associated with better physical well-being in both genders. Multiple linear regression models showed that the influence of MF in boys and CRF in girls on HRQoL was greater than that of overweight. CONCLUSIONS: This is one of the first studies that assess the association of CRF and MF with HRQoL while controlling for BMI. CRF and MF are closely related to HRQoL, in particular to physical well-being. Improving fitness could be a strategy of particular interest for improving the HRQoL of schoolchildren.

Protocol of a randomized cluster trial to assess the effectiveness of the MOVI-2 program on overweight prevention in schoolchildren.

INTRODUCTION AND OBJECTIVES: The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain. METHODS: Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, body fat percentage, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept. CONCLUSIONS: This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224).

[The role of informal care in individualized care plan delivery: a conditional choice for dependent people]. / El papel del apoyo informal en las prestaciones del Plan Individualizado de Atención: una elección condicionada para las personas dependientes.

OBJECTIVES: To analyze the relationship between sociodemographic and health variables (including informal care) and the healthcare service delivery assigned in the individualized care plan. METHODS: An observational cross-sectional study was conducted in a representative sample of the dependent population in Cuenca (Spain) in February, 2009. Information was obtained on people with level II and III dependency. Four different logistic regression models were used to identify the factors associated with the care service delivery assigned in the individualized care plan. Independent variables consisted of age, gender, marital status, annual income, place of residence, health conditions, medical treatment, and perception of informal care. RESULTS: A total of 83.7% of the sample was assigned economic benefits and 15.3% were assigned services. Eighty percent of the sample received informal care in addition to dependency benefits. People who received informal care were 3239 times more likely to be assigned economic benefits than persons not receiving informal care. CONCLUSION: For the period analyzed (the first phase of the implementation of the Dependency Act), the variables associated with receiving economic benefits (versus services) were being married, having a high annual income, the place of residence (rural areas versus urban area), and receiving hygiene-dietary treatment and informal care.

[Validity of a single-factor model underlying the metabolic syndrome in young adults: confirmatory factor analysis]. / Validez de un modelo con un único factor en el síndrome metabólico en adultos jóvenes: análisis factorial confirmatorio.

INTRODUCTION AND OBJECTIVES: To determine by confirmatory factor analysis whether a model of the metabolic syndrome including waist circumference-to-height ratio, as a measure of adiposity, has better goodness of fit than that based on waist circumference alone and, on the basis of the data of the best-fit model, to develop an index of global cardiometabolic risk in young adults. METHODS: Cross-sectional observational study involving 683 university students aged 18 to 30 years, in their first year at the University of Castilla-La Mancha in Spain, during the 2009-10 academic year. We compared the best fit of 2 models of the metabolic syndrome, both of which included the triglyceride-to-high-density lipoprotein cholesterol ratio, HOMA-IR index, and mean arterial blood pressure, but differed in that one of them used waist circumference, whereas the other used the waist circumference-to-height ratio. A metabolic syndrome index (MSI) was constructed and its association with aerobic capacity, daily physical activity and muscle strength was estimated. RESULTS: The single-factor model that included waist circumference was a better indicator of goodness of fit. The MSI was inversely associated with aerobic capacity and muscle strength. CONCLUSIONS: This study confirms that a single factor underlies the concept of metabolic syndrome; including the waist circumference-to-height ratio does not result in improvements over the model in which waist circumference alone is considered, and the development of a quantitative MSI may be useful for the quantification of cardiometabolic risk in clinical practice.

[Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study]. / Coste-efectividad de un programa de actividad física de tiempo libre para prevenir el sobrepeso y la obesidad en niños de 9-10 años.

OBJECTIVE: To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. METHODS: Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group. RESULTS: The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P<.001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (-0.59%; 95% CI: -1.03 to -0.67; P<.001), and those with a BMI>P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P<.001), and percentage of body fat (-0.67%; 95%CI: -1.32 to -0.01; P<.05). CONCLUSIONS: This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.

[Pharmaceutical expenditure among primary care physicians in the province of Cuenca (Spain)]. / Gasto farmacéutico de médicos de atención primaria del área de salud de Cuenca.

OBJECTIVE: To determine the factors related to pharmaceutical expenditure per primary care physician in the province of Cuenca, which could allow public health authorities to take decisions to curb expenditure. Determining these factors could also be of interest to primary care physicians, specialists, health authorities, health economists, and health management researchers. METHODS: We performed a multiple linear regression analysis with three dependent variables to determine which factors explain variability in generic drug prescription, the referral rate, and pharmaceutical expenditure among primary care physicians. RESULTS: Not being a resident physician, practicing in a town with more than 10,000 people and having a large patient list had a negative impact on the percentage of generic drugs prescribed. Physicians using electronic medical records and with a high referral rate to specialized care prescribed fewer generic drugs. The two most important factors explaining pharmaceutical expenditure were having a large patient list and a high percentage of patients aged more than 65 years old. Expenditure was reduced by greater prescription of generic drugs and was increased by a larger proportion of elderly patients on the patient list. CONCLUSIONS: After controlling for the size of the patient list, the proportion of elderly patients and other factors, the percentage of generic drugs prescribed was one of the most important factors explaining pharmaceutical expenditure in primary care physicians.

[Costs associated to informal caregiving hours for older people living in rural communities [Spain]]. / Costes asociados a las horas de cuidado informal de los mayores dependientes en un ámbito rural.

OBJECTIVES: To determine the costs associated with the variables that best predict hours of informal care among people living at home with some level of dependency for activities of daily living (ADL). METHODS: We performed a crosssectional observational study of 241 men and women aged more than 64 years old living in rural communities (men 37.8%, women 62.2%). The mean (standard deviation) age was 81.07 (7.07) years. Through the Resident Assessment Instrument Home Care (RAI-HC) questionnaire, sociodemographic variables, ADL dependencies and caregiving hours were assessed. Multiple linear regression analysis was applied. RESULTS: The predictive variables in the multiple linear regression model were living alone and requiring assistance for eating, meal preparation, bed mobility, and outdoor mobility. These predictive variables explained 46.3% of the total variation in caregiving hours. Standardized b coefficients were obtained from needing help to eat (0.272) and prepare meals (0.205). Needing help to eat represented an increment of 275 annual caregiving hours and its associated cost was 2,406.15 euro/year. Becoming dependent for meal preparation represented an increment of 307.2 h and a cost of 2688.18 euro/year. Dependency had a cost of between 4,972.72 and 21,479.15 euro/year, depending on ADL limitations. CONCLUSIONS: Almost 50% of the costs related to the care giving hours that may be required by an elderly person with some degree of dependency can be attributed to the fact of living alone and to some ADL that can be easily evaluated, such as eating, cooking, bed mobility, and outdoor mobility.

Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study.

BACKGROUND: In developed countries, there is abundant information on the epidemic of childhood obesity, but only a few studies on trends in the dual burden of body weight (overweight and thinness). OBJECTIVE: To examine trends in overweight and thinness among 9-10-year-old Spanish children in the last decade. METHODS: Data were taken from cross-sectional studies on schoolchildren in Cuenca (Spain), conducted in 1992, 1996, 1998 and 2004 with similar methods. Weight and height were measured by trained personnel with standardized procedures. Overweight (including obesity) and thinness were defined according with the International Obesity Taskforce BMI cut-offs. RESULTS: The overall prevalence of overweight increased from 24.4% in 1992 to 30.9% in 2004 (P = 0.07), rising from 21.2% in 1992 to 32.0% in 2004 (P = 0.03) among boys and from 27.7% to 29.8% (P = 0.67) among girls. The overall prevalence of thinness was 2.7% in 1992 and 9.2% in 2004 (P < 0.001); in the same period, thinness prevalence rose from 1.9% to 9.0% (P = 0.10) among boys and from 3.7% to 9.5% (P < 0.01) among girls. CONCLUSIONS: The dual burden of body weight has increased among children in Cuenca in the last decade. Population-based policies addressing childhood obesity, which is the most frequent problem, should not increase the risk of thinness.