[Health status and wellness among older adult beneficiaries of the ISSSTE and IMSS in Southwest Mexico City]. / Estado de salud y bienestar en adultos mayores derechohabientes usuarios del ISSSTE e IMSS del suroeste de la Ciudad de México.

OBJECTIVE: To explore the conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS of the Southwest Mexico City. MATERIAL AND METHODS: Cross-sectional study samples of users to health services in primary care ISSSTE (n = 161) and IMSS (n = 176) in Southwest Mexico City. Were determined chronic health conditions, cognitive function, depressive symptoms, use of health services, nutritional status, functioning and disability and quality of life related to health. RESULTS: It is observed that there is a difference between samples ISSSTE vs. IMSS in comorbidity conditions (ISSSTE 53.4% vs. IMSS 57.9%), nutritional status (malnutrition risk ISSSTE 25.8% us. IMSS 36.4%; overweight ISSSTE 23.3% vs. IMSS 11.6%) (p < 0.05). There were no differences between samples IMSS us. ISSSTE in cognitive function, depression, use of health services, abdominal obesity, functioning and disability, and quality of life related to health. CONCLUSIONS: The conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS users are similar, with meaning in comorbidity conditions, nutritional status.

The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.

BACKGROUND: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. METHODS: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. RESULTS: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. CONCLUSION: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population.

OBJECTIVES: To evaluate the psychometric properties of the Geriatric/General Oral Health Assessment Index, Spanish version (GOHAI-Sp) and their relationship with the dentition status of an elderly Mexican population as a discriminatory validation. METHODS: A cross-sectional study was conducted among persons over 60 years of age. A Spanish version the GOHAI-Sp validated in Spain in institutionalized geriatric patients was used. Clinical evaluation was done in order to determine experience with coronal and root caries. RESULTS: Measurement of internal consistency of the GOHAI gave a Cronbach alpha coefficient of 0.77 for the 12 items. In factorial analysis, one factor alone was capable of explaining 30.6 percent of the total variance. The factor that was most apparent in the factorial analysis of the GOHAI had coefficients > 0.30 for the 12 items. The Kaiser-Meyer-Olkin measure of simple adequacy was 0.81 and the Bartlett's sphericity test was 1,748.55 with 66 degrees of freedom (P < 0.001). There was a statistically significant difference in the GOHAI scores between the responses to self-perception of oral and general health (P < 0.001). Also, there was a statistically significant low correlation coefficient between the missing and filled components of the DMFT index and the number of healthy and functional teeth (P < 0.05). CONCLUSIONS: The GOHAI has acceptable psychometric properties, discriminates between self-perception of oral health and self-perception of general health, and correlates with past caries experience measured by the DMFT index.

Direct costs associated with the appropriateness of hospital stay in elderly population.

BACKGROUND: Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. METHODS: Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. RESULTS: The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9-5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6-2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2-US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7-US$6,198.3), (p < 0.001). CONCLUSION: Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

Depressive symptoms among older adults in Mexico City.

BACKGROUND: Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries. OBJECTIVE: To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider. DESIGN: Cross-sectional, multistage community survey. PARTICIPANTS: A total of 7,449 persons aged 60 years and older. MEASUREMENTS: Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire. MAIN RESULTS: The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2). CONCLUSIONS: According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care.

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5% of the total variance and nine factors that explained 57.9% in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82% and a specificity of 49.2%; GDS reported 53.8% sensitivity and 78.9% specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

The Effect of Agave tequilana Weber Inulin on Postprandial Ghrelin Concentration in Obese Patients.

This study was performed to investigate the effect of Agave tequilana Weber inulin on postprandial ghrelin levels in obese patients. A randomized, double-blind, cross-over design was performed. A total of 14 patients were allocated into two groups: one group received a drink that contained 500 mL lemon water, 24 g of A. tequilana Weber inulin, and 75 g glucose and the other group received a placebo drink with 500 mL lemon drink and 75 g of glucose. After a 7-day washout period, the groups were crossed. The primary outcome measure was postprandial ghrelin levels between minute 240 and minute 270. A. tequilana Weber inulin did not change postprandial ghrelin concentration in obese patients.

Late-life depressive symptoms: prediction models of change.

BACKGROUND: Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS: Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS: A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS: New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS: The study has not included clinical evaluations and nutritional assessments.

Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial.

OBJECTIVE: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. DESIGN: Unblinded, randomized, controlled trial. SETTING: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico. PARTICIPANTS: Patients were aged over 60 years with a frailty index score higher than 0.14. INTERVENTION: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups. MEASUREMENTS: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered. RESULTS: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group. CONCLUSION: An intervention based on NV+AB seems to have a positive effect on frailty scores.

A prediction model for root caries in an elderly population.

OBJECTIVES: To identify factors associated with root caries development in a 12- month period, in an elderly Mexican population, so as to develop a prediction model for the occurrence of root caries. METHODS: A case-cohort study was carried out with 698 randomly selected beneficiaries of the Mexican Institute of Social Security (IMSS), residing in the southeast of Mexico City. Initially, base line (t0) data regarding sociodemographic variables, general health, general and oral healthy habits, salivary conditions, cariogenic microorganisms and oral health clinical indicators were collected. Twelve months from the date of the first clinical evaluation (t1), a new examination was carried out to determine the root caries increment. Variables that showed a significant association (P ≤ 0.05) with the root caries increment were included in the prediction model. RESULTS: Six hundred and ninety-eight elderly subjects were included in the cohort (t0), with 76.1% (n = 531) of the elderly patients followed up at 12 months (t1). Incidence of root caries was 21.7% (n = 115), a mean root caries increase of 0.4 (1.0) surfaces. The variables, DLBA limitations (Yes), smoking (Yes), mouthwash (No), Mutans streptococci (≥105 CFU/ml), healthy root surfaces (≥6) and Root Caries Index (≥8%), showed a statistically significant association (P < 0.05). This model showed a correct classification in 80.0% (n = 425) and an area under the Receiver Operating Characteristic curve of 0.75. CONCLUSIONS: This is a good prediction model for the 12 months root caries increment in this population of elderly Mexicans.

Critical analysis of deaths due to atypical pneumonia during the onset of the influenza A (H1N1) virus epidemic.

BACKGROUND: The ongoing influenza A (H1N1) pandemic stroked Mexico and posed a huge challenge to the medical care and public health systems. This report analyzes the clinical course and process of care of patients who died due to atypical pneumonia and fulfilled the clinical criteria of suspected case of novel influenza A (H1N1) virus infection. METHODS: We conducted a retrospective analysis of a series of 38 patients who died between April 7 and April 28, 2009 at Instituto Mexicano del Seguro Social (IMSS) hospitals due to severe pneumonia and respiratory distress. These cases coincided with the beginning of the outbreak, so patients did not undergo laboratory testing to diagnose influenza. According to IMSS and CDC criteria, post-hoc analysis allowed considering the presumptive diagnosis of S-OIV infection. A multidisciplinary group analyzed the information from the clinical charts, laboratory tests, radiographic studies and death certificates, using descriptive statistics. RESULTS: Most cases were middle-aged (mean 33 years, range: 4-62 years) and previously healthy; 18.4% had an underlying chronic disease, 23.7% were obese and 7.9% were current smokers. None had received the seasonal influenza vaccine; they had cough (92%), fever (86.8%), and malaise (73.7%). The median time from disease onset to hospital admission was 6 days (range 0-8 days). All were admitted to the intensive care unit with pneumonia and/or respiratory distress. Average time from disease onset to death was 8 days (range 4-18 days). CONCLUSIONS: An increased number of severe cases of atypical pneumonia in previously healthy adults highlight the importance of the availability of a timely surveillance system able to identify sudden increases in the number of cases or presentation of apparently known diseases.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care / Utilidad de dos instrumentos para valorar depresión entre adultos mayores de México en estudios poblacionales y para la atención en el primer nivel de salud

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5 percent of the total variance and nine factors that explained 57.9 percent in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82 percent and a specificity of 49.2 percent; GDS reported 53.8 percent sensitivity and 78.9 percent specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5 por ciento de la varianza, comparado con nueve del CESDR que explicaron 57.9 por ciento. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82 por ciento y una especificidad de 49.2 por ciento comparado con 53.8 por ciento y 78.9 por ciento, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad.