Evidence-based programs for older persons in the Americas.

In the current context of the aging of populations and the increase in multiple chronic conditions and dependence, it is important that health systems provide opportunities to improve capacities of older adults to enable healthy aging. Opportunities to enhance older adults' abilities, including self-management, can be offered through evidence-based programs. Such programs have been proven effective in improving individuals' symptoms and quality of life, often lowering health-care costs. Self-management evidence-based programs can foster the development of personal skills, increase confidence and motivation on self-care, and help individuals to make better decisions about their own health. This special report describes the implementation history of a self-management program in the Region of the Americas, and the barriers to and facilitators of implementation that can serve as examples for evidence-based program dissemination in the Region.

En el contexto actual de envejecimiento poblacional y aumento de la dependencia y de diversas enfermedades crónicas, es importante que los sistemas de salud brinden oportunidades para mejorar las capacidades de las personas mayores para propiciar un envejecimiento saludable. Las oportunidades de mejorar las capacidades de las personas mayores, incluido el autocuidado, se pueden ofrecer mediante programas basados en la evidencia. Estos programas han resultado eficaces para mejorar y la calidad de vida y los síntomas de las personas y, a menudo, para reducir los costos de salud. Los programas de autocuidado basados en la evidencia pueden fomentar el desarrollo de aptitudes personales, aumentar la confianza y la motivación sobre el autocuidado y ayudar a las personas a tomar mejores decisiones sobre su propia salud. En este informe especial se describe el proceso de ejecución de un programa de autocuidado en la Región de las Américas, y los factores facilitadores y los obstáculos para la ejecución que pueden servir de ejemplo para la difusión de los programas basados en la evidencia en la Región.

No contexto atual de envelhecimento populacional e o consequente aumento de diversas doenças crônicas e da dependência, é importante que os sistemas de saúde criem oportunidades para a melhora da capacidade funcional da pessoa idosa visando ao envelhecimento saudável. Programas desenvolvidos com base em evidências científicas podem ser oferecidos porque comprovadamente ajudam a melhorar os sintomas e a qualidade de vida da pessoa idosa, reduzindo os custos em saúde. Os programas com enfoque no autocuidado estimulam o desenvolvimento de habilidades pessoais, aumentam a confiança e a motivação das pessoas idosas no próprio cuidado e contribuem para que elas tomem melhores decisões sobre a própria saúde. Este informe especial apresenta um programa de autocuidado implementado na Região das Américas, com a descrição do processo de implementação, das barreiras e dos facilitadores ­ uma experiência que pode servir de exemplo para difundir programas com base em evidências científicas na região.

Returning to School: Separation Problems and Anxiety in the Age of Pandemics.

The shift to the postpandemic school environment will cause dramatic changes and is likely to increase separation problems. In this article, we look at the anxiety problems that some parents and their children might experience when school reopens after the COVID-19 lockdown. Using a behavioral theory of development, we provide suggestions for how to handle the departure and separation problems that may emerge as parents drop their children off at school. Many parents are unsure about how to handle anxiety or fear as their children return to school or have to visit other environments outside their homes. Social distancing has caused families to develop stronger dependencies at home and to create new routines that vary, in many instances greatly, from their prepandemic routines. Families are adjusting to the new "normal." They are keeping their children busy with schoolwork as best they can. In particular, families have likely developed close attachment relationships. Families have been struggling with an unprecedented lockdown, and for many parents and their children, this extended period of family confinement and severe restrictions has been especially stressful, and the timing for returning to school is uncertain. We emphasize here that parents can be responsive to their children's needs, plan ahead, provide reassurance, and depart firmly without vacillating, and we provide other tips to avoid inadvertently shaping children's negative or anxiety behaviors as they go back to school. We offer some specific advice for parents and teachers to follow to prevent the departure and separation problems that typically develop during challenging behavioral interactions in school settings.

Increasing Vocalizations and Echoics in Infants at Risk of Autism Spectrum Disorder.

Infant siblings of children with an autism spectrum disorder (ASD) diagnosis (i.e., infants at risk of ASD) are excellent candidates for early interventions based on the principles of applied behavior analysis. This study replicates and extends behavioral research using contingent social reinforcement procedures (i.e., vocal imitation and motherese speech) to increase both vocalizations and echoics among 3 infants at risk of ASD with their mothers in the natural environment. Results confirmed earlier findings that contingent reinforcement, specifically vocal imitation, reliably produces high rates of vocalizations, echoic approximations, and emerging pure echoic repertoires in at risk infants.

Development of Communication in Infants: Implications for Stimulus Relations Research.

Early forms of stimulus-response relations are learned by infants to communicate with caregivers. The infant communication abilities begin with the learning of eye gazing, joint attention, social referencing, and naming, among others. Learning to engage in these early communication skills facilitates the development of more advanced phenomena seen in equivalence class formations and derived relational responding research. This article discusses evidence of early communication skills that are often required for the emergence of other, more complex forms of stimulus-stimulus relations. We emphasize the importance of establishing these types of operants early in infancy and their implications for developmental research on stimulus relations.

Social referencing in infants of mothers with symptoms of depression.

The present study examined the acquisition of social referencing skills in infants of mothers with symptoms of depression (n = 44). We aimed to determine if a short discrimination training could facilitate infants' social referencing. Mothers were instructed to pose either joyful or fearful facial expressions to cue infants' approach/avoidance responses toward an ambiguous object. Maternal expressions were correlated with pleasant or unpleasant events occurring after the infant's response. The results showed that after the intervention, infants looked at their mothers more frequently and reached or avoided the ambiguous object based on the preceding maternal expression. The results suggest that discrimination training procedures can establish social referencing in infants of mothers with symptoms of depression.

Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project.

BACKGROUND: There is no consensus regarding the definition of frailty for clinical uses. METHODS: A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted. RESULTS: Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis. CONCLUSIONS: There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established.

Acquisition of social referencing via discrimination training in infants.

This experiment investigated social referencing as a form of discriminative learning in which maternal facial expressions signaled the consequences of the infant's behavior in an ambiguous context. Eleven 4- and 5-month-old infants and their mothers participated in a discrimination-training procedure using an ABAB design. Different consequences followed infants' reaching toward an unfamiliar object depending on the particular maternal facial expression. During the training phases, a joyful facial expression signaled positive reinforcement for the infant reaching for an ambiguous object, whereas a fearful expression signaled aversive stimulation for the same response. Baseline and extinction conditions were implemented as controls. Mothers' expressions acquired control over infants' approach behavior for all participants. All participants ceased to show discriminated responding during the extinction phase. The results suggest that 4- and 5-month-old infants can learn social referencing via discrimination training.

Reinforcement of vocalizations through contingent vocal imitation.

Maternal vocal imitation of infant vocalizations is highly prevalent during face-to-face interactions of infants and their caregivers. Although maternal vocal imitation has been associated with later verbal development, its potentially reinforcing effect on infant vocalizations has not been explored experimentally. This study examined the reinforcing effect of maternal vocal imitation of infant vocalizations using a reversal probe BAB design. Eleven 3- to 8-month-old infants at high risk for developmental delays experienced contingent maternal vocal imitation during reinforcement conditions. Differential reinforcement of other behavior served as the control condition. The behavior of 10 infants showed evidence of a reinforcement effect. Results indicated that vocal imitations can serve to reinforce early infant vocalizations.

Breakup distress in university students.

A sample of 192 university students who had experienced a recent breakup of a romantic relationship was divided into high versus low score groups based on the Breakup Distress Scale. Females had higher Breakup Distress Scale scores. The group who had high Breakup Distress Scale scores reported having less time since the breakup occurred, did not initiate the breakup, reported that the breakup was sudden and unexpected, felt rejected and betrayed, and had not yet found a new relationship. They also scored higher on the Intrusive Thoughts Scale, on the Difficulty Controlling Intrusive Thoughts Scale, on The Sleep Disturbance Scale, and on the depression (CES-D) and anxiety scales (STAI). In a regression analysis, the most important predictors of the Breakup Distress scores were the depression score (CES-D), the feeling of being betrayed by the breakup, shorter time since the breakup occurred, and a higher rating of the relationship prior to the breakup. This explained as much as 37% of the variance, suggesting that these factors are important contributors to relationship breakup distress.

Religiosity and self-rated health among Latin American and Caribbean elders.

OBJECTIVE: To describe religious affiliation, importance of religion, and the relationship between religion and self-rated health in persons aged 60 or older living in Latin America or the Caribbean. METHOD: We used data from seven cities (n = 10,587). Multivariate models were used to analyze the associations between religious affiliation and importance of religion with sociodemographic or health factors and self-rated health. RESULTS: Overall, 92% of the total study population had a religious affiliation; among those who are religious, 80% considered religion to be important in their lives. Half of the population (51%) reported fair or poor health. In multivariate models, older age increased odds of having a religious affiliation and religion being important. Women were about four times more likely to have a religious affiliation and over twice as likely as men to indicate that religion was important. Although religious affiliation was associated with poor health, this association was no longer significant after controlling for functional status. Older adults who considered religion as very important were less likely to report fair or poor health compared to those who were less religious (somewhat important, not very important). CONCLUSIONS: These older adults have a high prevalence of religious affiliation and most of them consider religion to be important. Better self-rated health was associated with higher self-rated religiosity.

Survey data for the study of aging in Latin America and the Caribbean: selected studies.

The article summarizes three of the data collection studies that can assist researchers in examining population aging processes in the Latin America and Caribbean region with an emphasis on cross-national comparisons, including the population of Mexican immigrants in the United States. These are the Survey on Health and Wellbeing of Elders conducted in seven urban centers of the region, the national Mexican Health and Aging Study, and the Hispanic Established Populations for Epidemiologic Studies of the Elderly in the United States. The article describes the studies and marks them as informative, comprehensive, and still underanalyzed in particular for the purpose of cross-national analyses of aging among Latin American and Caribbean populations.

The tide to come: elderly health in Latin America and the Caribbean.

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status' connection to early conditions has some merit.

The prevalence of diagnosed diabetes among the elderly of seven cities in Latin America and the Caribbean: The Health Wellbeing and Aging (SABE) Project.

OBJECTIVE: To examine the relation of diagnosed diabetes mellitus (DM) to the level of education and body mass index (BMI) among the elderly of seven cities using data from SABE. METHODS: The SABE survey was based on a probabilistic sample of the elderly population. RESULTS: Results: The prevalence of diagnosed diabetes among the elderly was 15.7% (95% CI 14.7-16.8), with the highest prevalence reported in Bridgetown and the lowest in Buenos Aires. DISCUSSION: There was a high prevalence of diagnosed DM among the elderly of the seven cities. The prevalence of diagnosed DM was strongly associated with BMI and low education. The inclusion of these factors in policies and programs aiming to reduce the prevalence of diabetes among the elderly is recommended.

Mammography use among older women of seven Latin American and Caribbean cities.

BACKGROUND: To describe the prevalence of mammography use, and to estimate its association with sociodemographics. METHODS: A sample of 6207 women aged 60 and older from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE) in seven cities (Buenos Aires, Bridgetown, Havana, Mexico, Montevideo, Santiago, and Sao Paulo). The outcome was reporting a mammogram within the last 2 years. RESULTS: Prevalence of mammography use ranged from 9.8% in Havana to 34.4% in Sao Paulo. Independent predictors of mammography use across cities were older age (lowest odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.89-0.95), higher education (highest OR = 1.14, 95% CI 1.08-1.20), public health insurance (lowest OR = 0.28, 95% CI 0.11-0.76), or no insurance (lowest OR = 0.08, 95% CI 0.02-0.34) compared with private insurance. In a combined sample of six cities, higher education was associated with higher mammography use, but older age and insurance (public: OR = 0.54, 95% CI 0.45-0.65; no insurance: OR = 0.30, 95% CI 0.23-0.40; compared with private insurance) were associated with lower mammography use. CONCLUSIONS: Prevalence of mammography use across cities was lower than that reported for Hispanic populations in the US. In the overall sample, mammography use was increased in highly educated people and decreased in people without insurance.

Cross-national comparison of disability in Latin American and Caribbean persons aged 75 and older.

The objectives of this study were to compare rates of instrumental activity of daily living (IADL) and activity of daily living (ADL) difficulties and examine sociodemographic and health correlates of IADL and ADL difficulties. Data were extracted from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (abbreviated from Spanish name as: SABE = salud, bienestar y envejecimiento en America Latina y el Caribe). This analysis included 3225 subjects aged 75 and older living in seven capital cities during 1999-2000. Reporting either IADL or ADL difficulties were the outcomes. Bivariate and multiple logistic regression analyses were used to examine the associations between IADL or ADL difficulties and sociodemographics, and health characteristics. The highest prevalence of IADL difficulties was reported in Sao Paulo (33.8%) and the lowest in Montevideo (12.0%). The highest prevalence of ADL difficulties was reported in Santiago (34.7%) and the lowest in Bridgetown (16.9%). In a combined analysis across cities, increased age, fewer years of education, lower body mass index (BMI) (<20), and high number of medical conditions were independently significantly associated with IADL and ADL difficulties. In conclusion, about a third of persons aged 75 and older reported difficulty in at least one IADL or ADL. There was a wide variation on disability rates and correlates across cities.