Introduction: Historical Development and Progression of Clinical Research on Ageing.

Research on ageing has developed since Greek times. It had a very slow advance during the Middle Ages and a big increase in the Renaissance. Darwin contributed somehow to the understanding of the ageing process and initiated a cumulus of ageing explications under the name of Evolutionary Theories. Subsequently, science discovered a great number of genes, molecules, and cell processes that intervened in ageing. This led to the beginning of trials in animals to retard or avoid the ageing process. Alongside this, improvements, geriatric clinical investigations (with the evidence-based medicine tools) started to consolidate as a discipline and commenced to show the challenges and deficiencies of actual clinical trials in ageing; the COVID-19 outbreak revealed some of them. The history of clinical research in ageing has already begun and is essential to affront the challenges that the world will face with the increasing ageing population.

Advancements in dementia research, diagnostics, and care in Latin America: Highlights from the 2023 Alzheimer's Association International conference satellite symposium in Mexico City.

INTRODUCTION: While Latin America (LatAm) is facing an increasing burden of dementia due to the rapid aging of the population, it remains underrepresented in dementia research, diagnostics, and care. METHODS: In 2023, the Alzheimer's Association hosted its eighth satellite symposium in Mexico, highlighting emerging dementia research, priorities, and challenges within LatAm. RESULTS: Significant initiatives in the region, including intracountry support, showcased their efforts in fostering national and international collaborations; genetic studies unveiled the unique genetic admixture in LatAm; researchers conducting emerging clinical trials discussed ongoing culturally specific interventions; and the urgent need to harmonize practices and studies, improve diagnosis and care, and use affordable biomarkers in the region was highlighted. DISCUSSION: The myriad of topics discussed at the 2023 AAIC satellite symposium highlighted the growing research efforts in LatAm, providing valuable insights into dementia biology, genetics, epidemiology, treatment, and care.

Morquio A Syndrome: Identification of Differential Patterns of Molecular Pathway Interactions in Bone Lesions.

Mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome) is a rare autosomal recessive lysosomal storage disease (LSD) caused by deficiency of a hydrolase enzyme, N-acetylgalactosamine-6-sulfate sulfatase, and characterized clinically by mainly musculoskeletal manifestations. The mechanisms underlying bone involvement in humans are typically explored using invasive techniques such as bone biopsy, which complicates analysis in humans. We compared bone proteomes using DDA and SWATH-MS in wild-type and MPS IVA knockout mice (UNT) to obtain mechanistic information about the disease. Our findings reveal over 1000 dysregulated proteins in knockout mice, including those implicated in oxidative phosphorylation, oxidative stress (reactive oxygen species), DNA damage, and iron transport, and suggest that lactate dehydrogenase may constitute a useful prognostic and follow-up biomarker. Identifying biomarkers that reflect MPS IVA clinical course, severity, and progression have important implications for disease management.

Estimation of vaccination coverage and associated factors in older Mexican adults.

National vaccination programmes recommend the influenza vaccine for older adults, but this population group has the greatest morbidity and mortality from other preventable vaccine diseases. The aim of this article is to estimate the vaccine coverage in adults aged 65 years and older and to analyse the factors that could increase or decrease vaccination uptake probability for the three listed vaccines in the national vaccination programme (influenza, tetanus and diphtheria, and pneumococcus) and the full scheme in Mexico. We conducted an analytical cross-sectional study with 2012, 2018, and 2021 rounds from the National Health and Nutrition Survey, in which we calculated the vaccine coverage estimations and performed multivariable logistic regression models to analyse the factors related to vaccine uptake. Tetanus and diphtheria vaccines had the greatest coverage estimation in all years (59-71%), whereas the pneumococcus vaccine had the lowest (32-53%). Full scheme vaccine coverage decreased from 37.80% to 24.77% in 2012 and 2021, respectively. The National Health Card property, morbidity, being a beneficiary of any health system institution, and use of preventive services increased the probability of vaccine uptake. In conclusion, vaccine coverage in older Mexican adults decreased over time, and the Mexican health system plays a strategic role in immunisation.

Psychometric properties of ability to contribute measurements as a domain of functional ability of older persons: a COSMIN systematic review.

BACKGROUND: Older person's ability to contribute covers contributions divided into five subdomains: assisting friends and neighbours, mentoring peers and younger people, caring for family, engaging in the workforce and voluntary activity. OBJECTIVE: To evaluate the psychometric properties of ability to contribute measurements as a domain of functional ability of older persons using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic reviews. METHODS: A systematic search was performed in PubMed, Embase and PsycINFO databases, for observational studies published within the last 10 years. The measurement properties of these ability measures were evaluated against the COSMIN taxonomy. Risk-of-bias assessment was performed using the COSMIN Risk of Bias checklist. RESULTS: Of the 32,665 studies identified, we selected 19, of which the main purpose was to develop or validate an instrument or have related items that measure at least one of the subdomains. None of the instruments contained items that were fully related to the five subdomains, 60% (n = 12) were related to voluntary activities and 15% (n = 3) to mentoring peers and younger people. As for psychometric properties, two studies assessed content validity. Factor analysis was used to evaluate structural validity in 10 studies. Internal consistency was evaluated in 63% of the instruments and Cronbach's alpha ranges from 0.63 to 0.92. No study reported predictive validity. A very limited overview of their scope and limitations for their application was observed. CONCLUSIONS: We found no single instrument measuring all subdomains of ability to contribute. We found several instruments containing items that could indirectly measure some of the subdomains of the ability to contribute.

Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study.

BACKGROUND: Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive. OBJECTIVE: Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico. METHODS: A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up. RESULTS: From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality. CONCLUSION: Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.

Impact of the COVID-19 lockdown on routine childhood vaccination coverage rates in Catalonia (Spain): a public health register-based study.

OBJECTIVE: The aim of this study was to determine the impact of the lockdown measures adopted during the COVID-19 pandemic on routine childhood vaccination coverage rates in Catalonia (Spain) and to estimate its recovery once the progressive return to 'normalcy' had begun. STUDY DESIGN: We conducted a public health register-based study. METHODS: Routine childhood vaccination coverage rates were analysed in three periods: a first pre-lockdown period (from January 2019 to February 2020), a second lockdown period with full restrictions (from March 2020 to June 2020), and, finally, a third post-lockdown period with partial restrictions (from July 2020 to December 2021). RESULTS: During the lockdown period, most of the coverage rates remained stable, concerning the pre-lockdown period; however, when comparing the vaccination coverage rates in the post-lockdown period to the pre-lockdown period, we observed decreases in all types of vaccines and doses analysed, except for coverage with the PCV13 vaccine in 2-year-olds, which experienced an increase. The most relevant reductions were observed in measles-mumps-rubella and diphtheria-tetanus-acellular pertussis vaccination coverage rates. CONCLUSIONS: Since the beginning of the COVID-19 pandemic, there has been an overall decline in routine childhood vaccine coverage rates, and the pre-pandemic rates have not yet been recovered. Immediate and long-term support strategies must be maintained and strengthened to restore and sustain routine childhood vaccination.

20 years of the Mexican Health and Aging Study.

The Mexican Health and Aging Study (MHAS) is a longitudinal study using a national sample of approximately 15,000 community-dwelling adults aged 50 years old and older in Mexico. Spanning over 20 years (2001-2021), six waves of data collection establish the MHAS as the leading data platform for the study of aging in Latin America.

Association between the changes in socialsecurity continuity condition and mortality: MHAS 2001-2018 analysis.

OBJECTIVE: To analyze the association of changes in social security (SS) continuity and mortality, using the Mexican Health and Aging Study (MHAS) in people aged 60 years and more. MATERIALS AND METHODS: Retrospective cohort. We analyzed the SS continuity condition -classified as stable, unstable with SS, unstable without SS, and without SS- and its relation with mortality; a probit regression model was utilized to obtain marginal effects, taking into consideration covariates related to mortality. RESULTS: Unstable continuity with and without SS and multimorbidity (two or more diseases) increased the probability of dying by 52.9% (p = 0.000, 95%CI: 0.508,0.551), 50.3% (p = 0.000, 95%CI: 0.474,0.531) and 13.3% (p = 0.000, 95%CI: 0.108,0.159), respectively. Meanwhile, being woman, at least one year of formal education, and marriage reduced it in 8.8% (p = 0.000, 95%CI: -0.106,-0.071), 7% (p = 0.000, 95%CI: -0.091,-0.050) and 7.8% (p = 0.000, 95%CI: -0.096,-0.061), respectively. CONCLUSION: Belonging to SS was associated with higher mortality, compared to other social health determinants, like education.

La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores que viven en la comunidad.

OBJETIVO: Determinar la asociación entre mala autopercepción de salud oral y fragilidad en personas mayores. Material y métodos. Estudio transversal en personas mayores de la Ciudad de México. La autopercepción de salud oral se midió con el Geriatric/General Oral Health Assessment Index (GOHAI) y la fragilidad con el fenotipo de Fried y colaboradores. RESULTADOS: 1 173 personas mayores, media de edad de 66.0 (5.7) años, mujeres 46.1% (n=541). La media (IC95%) de GOHAI-Sp fue de 49.2 (48.9-49.6). El 9.2% (n=108) presentaron fragilidad, 59.9% (n=703) prefrágil y 30.9% (n=362) no frágiles. La fuerza de asociación (RM) para mala autopercepción de salud oral y frágil fue RM 2.4 (IC95% 1.5,3.7) y RM ajustada RM 1.7 (IC95% 1.1,2.8), referencia no frágil. No existe asociación significativa para la mala autopercepción de salud oral y prefrágil. Conclusión. La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores.

Insomnia Impairs Both the Pro-BDNF and the BDNF Levels Similarly to Older Adults with Cognitive Decline: An Exploratory Study.

Sleep disorders, including insomnia, are common during aging, and these conditions have been associated with cognitive decline in older adults. Moreover, during the aging process, neurotransmitters, neurohormones, and neurotrophins decrease significantly, leading to the impairment of cognitive functions. In this sense, BDNF, the most abundant neurotrophic factor in the human brain, has been suggested as a potential target for the prevention and improvement of cognitive decline during aging; however, the current evidence demonstrates that the exogenous administration of BDNF does not improve cognitive function. Hence, in the present study, we quantified pro-BDNF (inactive) and BDNF (active) concentrations in serum samples derived from older individuals with insomnia and/or cognitive decline. We used linear regression to analyze whether clinical or sociodemographic variables impacted the levels of BNDF concentration. We observed that insomnia, rather than cognitive decline, is significantly associated with BDNF concentration, and these effects are independent of other variables. To our knowledge, this is the first study that points to the impact of insomnia on improving the levels of BDNF during aging and suggests that opportune treatment of insomnia may be more beneficial to prevent cognitive decline during aging.

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia.

BACKGROUND: The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020. METHODS: Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category. RESULTS: Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p = < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216). CONCLUSIONS: The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Variability in case fatality rate risk due to Covid-19 according to health services provider in Mexico City hospitals.

OBJECTIVE: To describe differences in Case Fatality Rate (CFR) for Covid-19 among healthcare subsystems in Mexico City between March and December 2020. MATERIALS AND METHODS: This is a retrospective secondary data analysis from the National Epidemiological Surveillance System data of Covid-19 cases. Information about health provider institutions was retrieved from the Catalogue of Health Establishments (CLUES). Logistic regressions were fitted to determine the association between health subsystems and mortality associated to Covid-19. The analyses were divided between hospitalized and ambulatory patients. RESULTS: The probability of dying from Covid-19 was higher among those treated at Instituto Mexicano del Seguro Social (IMSS) (Hospitalized:OR=5.11, Ambulatory:OR=36.57), Instituto de Se-guridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Hospitalized:OR=2.10, Ambulatory:OR=9.19), Secretaría de Salud (SS) (Hospitalized:OR=1.94, Ambulatory:OR=5.29) or other public institutions (Hospitalized: OR=1.70, Ambulatory:OR=9.56) than in those treated in private in-stitutions. CONCLUSIONS: Differences in healthcare quality and access between health subsystems are profound. It is imperative to increase the capacity and quality of the different health subsystems to improve health outcomes.

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Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial.

BACKGROUND: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

Understanding adherence of hypertensive patients in Mexico to an exercise-referral scheme for increasing physical activity.

Among the strategies developed thus far for promoting physical activity (PA), exercise-referral schemes (ERs) have gained in popularity as an effective means of preventing secondary health conditions such as hypertension. However, information on the factors affecting adherence to these programs is limited. Using a mixed-methods approach, we undertook the present study to determine the factors associated with adherence to a specific ER aimed at increasing PA among the hypertensive patients in a Social Security institution in Mexico. Data were obtained through semi-structured questionnaires and interviews as well as from the clinical records of participants. For the quantitative component, multinomial regression analysis estimated the factors behind the varying levels of adherence. For the qualitative component, we performed a content analysis based on the health belief model. According to our findings, 80% of participants who began the ER exhibited high levels of adherence. Older age and being female were the key demographic characteristics of those showing increased adherence. Meanwhile, financial issues, the investment of time required, low perception of the benefits of PA, lack of confidence in being able to achieve changes in lifestyle, and a reluctance to acknowledge the seriousness of their health condition were the principal factors among those who did not join the program or exhibited low levels of adherence. Our findings can serve as a basis for designing PA interventions that take into account individual, cultural and administrative elements in their efforts to improve adherence to PA programs for those suffering from chronic conditions such as hypertension.

Transitions of disability according to health insurance enrollment among older adults in Mexico / Transiciones de la discapacidad según afiliación a instituciones de salud en adultos mayores en México

Objective: To study the transitions of disability according to health insurance in the population of adults over 50 in Mexico, as well as the set of socioeconomic and health variables associated with these transitions. Materials and methods: Data comes from the Mexican Health and Aging Study (MHAS). Twenty regression models were fitted for the transitions of disability measured through activities of daily living in the period 2012-15, using socioeconomic and health as explanatory variables. Results: Enrollees with Seguro Popular had the highest frequency of transition to disability with 13.26%. Health insurance was not found to be related to any of the four transitions studied. Diseases associated with the development of disability vary according to health insurance. Conclusions: The socioeconomic and health factors associated with disability transitions are different between health insurance enrollees.

[Opportunity cost approximation of underage caregivers in Mexico]. / Aproximación al costo de oportunidad de los cuidadores menores de edad en México.

OBJECTIVE: To calculate the cost assumed by society for having underaged individuals who do not study and provide care to dependent older adults. MATERIALS AND METHODS: The Mexican Health and Ageing Study (MHAS) 2015 was used to calculate the number of underage caregivers who do not attend school. The Household Income and Expenditure Survey (ENIGH) 2018 was used to estimate wage differences between populations of working age with complete elementary and complete high school education. Those differences were then converted to present value, added, and multiplied by the number of underage caregivers. RESULTS: The total annual cost of having underage caregivers who drop out of school adds to 1 112 179 210 pesos. CONCLUSIONS: The topic concerning underage caregivers has not received enough attention from specialized literature, and there is still a large research gap in this area.

Oral health condition and development of frailty over a 12-month period in community-dwelling older adults.

BACKGROUND: To determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults. METHODS: Population-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t0), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t1) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services. RESULTS: 663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t0, a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t1, 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health. CONCLUSION: Older adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period.

Impact of social disadvantages in the presence of diabetes at old age.

BACKGROUND: Social disadvantages that start during childhood and continue into the later stages in life may be linked to the presence of diabetes during adulthood. OBJECTIVE: To analyze whether the presence of social disadvantages in childhood and in the present affects the presence of diabetes in older adults. METHODS: The present study was based on longitudinal data from the third and fourth Mexican Health and Aging Study (MHAS) waves (2012 and 2015). Data on diabetes diagnosis, past (e.g. "no shoes during childhood") and present (e.g. self-perception of economic status) social disparities, and other covariables were analyzed. RESULTS: From 8,848 older adults, 21.5% (n = 1903) were classified as prevalent cases (PG), 5.2% (n = 459) as incident cases (IG) and 77.4% (n = 6,486) were free of disease (NDG). The predictor variable "no shoes during childhood" was statistically significant in the model incident versus no diabetes group. Hypertension and body mass index (BMI) were the most relevant covariates as they were statistically significant in the three groups (PG, IG and NDG). CONCLUSIONS: Not having shoes during childhood, an indicator of social disadvantages, is associated with the incidence and prevalence of diabetes in older adults. This suggests that social disadvantages can be a determinant for the presence of chronic diseases in adulthood.