Valoraciones sobre el proceso de prevención de enfermedades profesionales, a propósito de dos novedades editoriales / Appraisals about the Process for Preventing Professional Diseases. A Propose of two Editorial Updates

En el volumen 37 del último número de la Revista Cubana de Medicina General Integral perteneciente al año 2021, se identifican entre las novedades editoriales dos valiosos trabajos1,2 que motivan una valoración sobre la significación del proceso de prevención de enfermedades profesionales (PPEP), en las condiciones actuales del desarrollo socioeconómico del país. La baja tasa de natalidad y el envejecimiento poblacional, unido a la generación de nuevas formas de gestión económica que incluyen a trabajadores por cuenta propia, usufructuarios de tierras, pequeñas y medianas empresas, en ocasiones carentes de los tradicionales sistemas de seguridad y salud en el trabajo, operados por profesionales especializados, elevan la significación del mandato previsto en el artículo 69 de la Carta Magna, en términos de adopción de medidas adecuadas para la prevención de accidentes y enfermedades profesionales.3 En ese sentido, López y otros2) revelan, mediante revisión científica, las implicaciones del especialista en Medicina General Integral que se desempeña como médico de familia, con el diseño y ejecución de las medidas preventivas referidas en la cita anterior. Estos autores realizan un análisis integrador del Programa del Médico y Enfermera de la Familia y el Programa Nacional de Salud de los Trabajadores, con énfasis en las actividades de salud ocupacional, cuyo resultado constituye, en opinión de la remitente, un referente para reflexionar de manera creadora sobre el mejoramiento del...(AU)

Instrumento para identificar barreras ambientales percibidas por personas mayores en el contexto cubano / An Instrument for Identifying Environmental Barriers Perceived by Elderly People in the Cuban Context

Introducción: El envejecimiento de la población cubana trae aparejado un aumento de la discapacidad. En este sentido la Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud recomienda el diseño de instrumentos de medición que identifiquen los factores ambientales que afectan la funcionalidad. Objetivo: Describir las propiedades psicométricas de un instrumento de medición diseñado para identificar barreras ambientales percibidas por las personas mayores en el contexto cubano en cuanto a la validez de apariencia, de contenido y constructo. Métodos: Se realizó un estudio de desarrollo tecnológico. Se consultó a un grupo de expertos para la validación de apariencia y contenido, y se calculó el coeficiente de validez de contenido insesgado y corregido. Para la validez de constructo se calculó el análisis factorial de los componentes principales. Resultados: El coeficiente de validez de contenido insesgado y el corregido mostraron cifras superiores a 0,80, considerado como bueno. El análisis factorial arrojó siete factores que explican las dimensiones exploradas en la definición que se pretende medir. Conclusiones: El instrumento diseñado mostró un alto acuerdo entre los expertos en cuanto a la validez de apariencia y contenido. Los indicadores evidenciaron que el instrumento tiene una estructura multidimensional que se corresponde con el constructo que se pretende medir(AU)

Introduction: The aging of the Cuban population brings about an increase in disability. In this sense, the International Classification of Functioning, Disability and Health recommends the design of measurement instruments to identify environmental factors affecting functionality. Objective: To describe, in terms of face, content and construct validity, the psychometric properties of a measurement instrument designed to identify environmental barriers perceived by elderly people in the Cuban context. Methods: A technological development study was carried out. A group of experts was consulted for the face and content validation, while the unbiased and corrected content validity coefficient was calculated. For construct validity, principal component factor analysis was calculated. Results: The unbiased and corrected content validity coefficient showed figures above 0.80, considered as good. Factor analysis yielded seven factors that explain the dimensions explored in the definition intended to be measured. Conclusions: The designed instrument showed high agreement among the experts in terms of face and content validity. The indicators showed that the instrument has a multidimensional structure that corresponds to the construct that it is intended to measure(AU)

Well beyond the 60s? The impact of a pandemic on the growth of the older population / Muito além dos 60? Impacto de uma pandemia na dinâmica de crescimento da população idosa

Contrary to expectations that the first decades of the 21st century would experience an increase in lived time, the 2020s cast doubts on the future of old age. The Brazilian population is expected to increase until 2030, when it will reach its maximum, with a total of approximately 215 million inhabitants. A trend of population decline was already in progress and had already been documented, but the pandemic accelerated this process. This study describes a set of projections for the older Brazilian population. The projections were elaborated using the main components method, whose advantages are the possibility of separately projecting the behavior of the three demographic variables (fertility, mortality, and migrations) and obtaining results disaggregated by sex and age groups. Birth data for 2018, 2019, and 2020 suggest a 3.51 and 5.28% decrease in total births between 2018 and 2019 and 2019 and 2020, respectively. Preliminary data for 2021, which indicate the continuation of this trend between 2020­2021, show a 2.32% reduction in the number of births. The hypotheses raised for the mortality patterns, if proven to be accurate, suggest a life expectancy of 72.8 years for men and 76.2 years for women at the final period of the projection, resulting in gains of 4.6 and 2.0 years, respectively. Despite these gains, the levels obtained in 2019, pre-pandemic, would be reached by the male population only between 2035 and 2040.

Contrariando expectativas de que as primeiras décadas do século XXI seriam um tempo de expansão do tempo vivido, os anos 2020 apontam dúvidas com relação ao futuro da velhice. A população brasileira deverá crescer até 2030, quando se projeta que atingirá o seu máximo, com um total de aproximadamente 215 milhões de habitantes. Uma tendência de redução populacional já era documentada e estava em curso, mas a pandemia acelerou o seu movimento. Este artigo apresenta um conjunto de projeções para a população brasileira e idosa. Para a sua elaboração, utilizamos o método das componentes, cujas vantagens são: (a) projetar, isoladamente, o comportamento de cada uma das três variáveis demográficas ­ fecundidade, mortalidade e migrações ­ e (b) obter resultados desagregados por sexo e grupos de idade. Os dados de nascimentos para 2018, 2019 e 2020 apontam para uma diminuição deste total de 3,51% entre 2018 e 2019 e de 5,28% entre 2019 e 2020. Os dados preliminares de 2021, que apontam para uma continuação dessa tendência entre 2020 e 2021 demonstram redução de 2,32% no número de nascimentos. As hipóteses feitas para os padrões de mortalidade, se verificadas, apontam para uma expectativa de vida de 72,8 e 76,2 anos no final do período da projeção, o que resultaria em ganhos de 4,6 e 2,0 anos, para homens e mulheres, respectivamente. Apesar desses ganhos, os níveis obtidos em 2019, pré-pandemia, seriam alcançados pelos homens entre 2035 e 2040.

Apoyo social y uso de espacios de vida en la persona mayor en el contexto rural / Social Support and the Use of Life Spaces by Older Adults in the Rural Context

Introducción: El uso de espacios de vida cobra interés investigativo sobre el envejecimiento, por ser una medida de movilidad y participación social, pues refleja factores físicos, psicosociales y ambientales necesarios para el funcionamiento independiente. Objetivo: Identificar los factores asociados con el apoyo social y uso de los espacios de vida en el contexto rural. Métodos: Estudio descriptivo, con 193 adultos mayores de 60 años, del municipio de Samaniego, departamento de Nariño. Se describió el comportamiento del uso del espacio de vida y su relación con variables demográficas, cognitivas, emocionales y psicosociales mediante modelos de regresión lineal y logística. Resultados: La escala LSA presentó una media de 21,68 (DE = 18,6), se observó correlación con la variable edad (Rho = -0,15, p = 0,042) y género (d = -0,05; IC 95 por ciento -0,35 a 0,23). Hubo relación directamente proporcional pero baja con el Test Minimental (Rho = 0,04, p = 0,580) y Yesavage (Rho = -0,13, p = 0,064). Con la escala apoyo social, hubo correlaciones bajas en apoyo emocional (Rho = 0,19, p = 0,009), instrumental (Rho = 0,13, p = 0,062), interacción social positiva (Rho = 0,23, p = 0,001) y apoyo afectivo (Rho = 0,16, p = 0,027). Conclusión: Las características psicosociales y demográficas influyeron en la utilización que el adulto mayor rural hace de su espacio vital(AU)

Introduction: The use of life spaces is gaining research interest regarding aging, as it is a measure of mobility and social participation, insofar it reflects physical, psychosocial and environmental factors necessary for independent functioning. Objective: To identify the factors associated with social support and the use of life spaces in the rural context. Methods: Descriptive study carried out with 193 adults aged over 60 years, from the Samaniego Municipality, Nariño Department. The behavior of the use of life spaces and its relationship with demographic, cognitive, emotional and psychosocial variables were described using linear and logistic regression models. Results: The LSA scale presented a mean of 21.68 (SD=18.6). A correlation was observed with the variable age (Rho=-0.15, P=0.042) and gender (d=-0.05; CI 95 percent: -0.35 to 0.23). There was a directly proportional but low relationship with the Minimental test (Rho=0.04, P=0.580) and Yesavage (Rho=-0.13, P=0.064). With the social support scale, there were low correlations in emotional support (Rho=0.19, P=0.009), instrumental support (Rho=0.13, P=0.062), positive social interaction (Rho=0.23, P=0.001), and affective support (Rho=0.16, P=0.027). Conclusion: The psychosocial and demographic characteristics influenced on how rural older adults make use of their life spaces(AU)

Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries.

BACKGROUND: Since 2013, Hong Kong has sustained the world's highest life expectancy at birth-a key indicator of population health. The reasons behind this achievement remain poorly understood but are of great relevance to both rapidly developing and high-income regions. Here, we aim to compare factors behind Hong Kong's survival advantage over long-living, high-income countries. METHODS: Life expectancy data from 1960-2020 were obtained for 18 high-income countries in the Organisation for Economic Co-operation and Development from the Human Mortality Database and for Hong Kong from Hong Kong's Census and Statistics Department. Causes of death data from 1950-2016 were obtained from WHO's Mortality Database. We used truncated cross-sectional average length of life (TCAL) to identify the contributions to survival differences based on 263 million deaths overall. As smoking is the leading cause of premature death, we also compared smoking-attributable mortality between Hong Kong and the high-income countries. FINDINGS: From 1979-2016, Hong Kong accumulated a substantial survival advantage over high-income countries, with a difference of 1·86 years (95% CI 1·83-1·89) for males and 2·50 years (2·47-2·53) for females. As mortality from infectious diseases declined, the main contributors to Hong Kong's survival advantage were lower mortality from cardiovascular diseases for both males (TCAL difference 1·22 years, 95% CI 1·21-1·23) and females (1·19 years, 1·18-1·21), cancer for females (0·47 years, 0·45-0·48), and transport accidents for males (0·27 years, 0·27-0·28). Among high-income populations, Hong Kong recorded the lowest cardiovascular mortality and one of the lowest cancer mortalities in women. These findings were underpinned by the lowest absolute smoking-attributable mortality in high-income regions (39·7 per 100 000 in 2016, 95% CI 34·4-45·0). Reduced smoking-attributable mortality contributed to 50·5% (0·94 years, 0·93-0·95) of Hong Kong's survival advantage over males in high-income countries and 34·8% (0·87 years, 0·87-0·88) of it in females. INTERPRETATION: Hong Kong's leading longevity is the result of fewer diseases of poverty while suppressing the diseases of affluence. A unique combination of economic prosperity and low levels of smoking with development contributed to this achievement. As such, it offers a framework that could be replicated through deliberate policies in developing and developed populations globally. FUNDING: Early Career Scheme (RGC ECS Grant #27602415), Research Grants Council, University Grants Committee of Hong Kong.

Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems.

Importance: The US Preventive Services Task Force (USPSTF) released updated lung cancer screening recommendations in 2021, lowering the screening age from 55 to 50 years and smoking history from 30 to 20 pack-years. These changes are expected to expand screening access to women and racial and ethnic minority groups. Objective: To estimate the population-level changes associated with the 2021 USPSTF expansion of lung cancer screening eligibility by sex, race and ethnicity, sociodemographic factors, and comorbidities in 5 community-based health care systems. Design, Setting, and Participants: This cohort study analyzed data of patients who received care from any of 5 community-based health care systems (which are members of the Population-based Research to Optimize the Screening Process Lung Consortium, a collaboration that conducts research to better understand how to improve the cancer screening processes in community health care settings) from January 1, 2010, through September 30, 2019. Individuals who had complete smoking history and were engaged with the health care system for 12 or more continuous months were included. Those who had never smoked or who had unknown smoking history were excluded. Exposures: Electronic health record-derived age, sex, race and ethnicity, socioeconomic status (SES), comorbidities, and smoking history. Main Outcomes and Measures: Differences in the proportion of the newly eligible population by age, sex, race and ethnicity, Charlson Comorbidity Index, chronic obstructive pulmonary disease diagnosis, and SES as well as lung cancer diagnoses under the 2013 recommendations vs the expected cases under the 2021 recommendations were evaluated using χ2 tests. Results: As of September 2019, there were 341 163 individuals aged 50 to 80 years who currently or previously smoked. Among these, 34 528 had electronic health record data that captured pack-year and quit-date information and were eligible for lung cancer screening according to the 2013 USPSTF recommendations. The 2021 USPSTF recommendations expanded screening eligibility to 18 533 individuals, representing a 53.7% increase. Compared with the 2013 cohort, the newly eligible 2021 population included 5833 individuals (31.5%) aged 50 to 54 years, a larger proportion of women (52.0% [n = 9631]), and more racial or ethnic minority groups. The relative increases in the proportion of newly eligible individuals were 60.6% for Asian, Native Hawaiian, or Pacific Islander; 67.4% for Hispanic; 69.7% for non-Hispanic Black; and 49.0% for non-Hispanic White groups. The relative increase for women was 13.8% higher than for men (61.2% vs 47.4%), and those with a lower comorbidity burden and lower SES had higher relative increases (eg, 68.7% for a Charlson Comorbidity Index score of 0; 61.1% for lowest SES). The 2021 recommendations were associated with an estimated 30% increase in incident lung cancer diagnoses compared with the 2013 recommendations. Conclusions and Relevance: This cohort study suggests that, in diverse health care systems, adopting the 2021 USPSTF recommendations will increase the number of women, racial and ethnic minority groups, and individuals with lower SES who are eligible for lung cancer screening, thus helping to minimize the barriers to screening access for individuals with high risk for lung cancer.

Trends of Colorectal Cancer Incidence in Kazakhstan.

AAMC: Background and objective: Colorectal cancer (CRC) remains one of the most widespread human malignancies. The aim of this study was to study trends of the incidence of CRC in Kazakhstan. Materials and Method: This retrospective study was done using descriptive and analytical methods of oncoepidemiology. Results: During the study period from 2009 to 2018, 28,950 new cases of CRC were recorded, 13,779 (47.6%) cases were allocated to men and 15,171 (52.4%) to women. It was found that the incidence rate of CRC increased from 14.79 (2009) to 17.72 in 2018 and the overall growth was 2.93 cases per 100,000. This increase was due to the age structure ­ ΣΔA=+1.42, the risk of acquiring illness ­ ΣΔR=+1.31, and their combined effect ­ ΣΔRA=+0.20. The component analysis results revealed that the increase in the number of patients with CRC was mainly due to the growth of the population (ΔP=+37.7%), changes in age structure (ΔA=+26.6%), and changes associated with the risk of acquiring illness (ΔR=+24.6%). The number of patients (both sexes) was increasing in many regions largely due to the influence of the age structure of the population. In addition, it was found that growth in the number of patients in most regions, both men and women, was associated primarily with the risk of acquiring illness. Conclusion: The findings of the current study showed increasing trends in the incidence of CRC in all regions of the country. These changes were mainly influenced by demographic factors (population size and age structure), risk of acquiring the disease, and their combined effect.^ieng

Planning for tomorrow: global cancer incidence and the role of prevention 2020-2070.

Cancer is currently the first or second most common contributor to premature mortality in most countries of the world. The global number of patients with cancer is expected to rise over the next 50 years owing to the strong influence of demographic changes, such as population ageing and growth, on the diverging trends in cancer incidence in different regions. Assuming that the latest incidence trends continue for the major cancer types, we predict a doubling of the incidence of all cancers combined by 2070 relative to 2020. The greatest increases are predicted in lower-resource settings, in countries currently assigned a low Human Development Index (HDI), whereas the predicted increases in national burden diminish with increasing levels of national HDI. Herein, we assess studies modelling the future burden of cancer that underscore how comprehensive cancer prevention strategies can markedly reduce the prevalence of major risk factors and, in so doing, the number of future cancer cases. Focusing on an in-depth assessment of prevention strategies that target tobacco smoking, overweight and obesity, and human papillomavirus infection, we discuss how stepwise, population-level approaches with amenable goals can avert millions of future cancer diagnoses worldwide. In the absence of a step-change in cancer prevention delivery, tobacco smoking will remain the leading preventable cause of cancer, and overweight and obesity might well present a comparable opportunity for prevention, given its increasing prevalence globally in the past few decades. Countries must therefore instigate national cancer control programmes aimed at preventing cancer, and with some urgency, if such programmes are to yield the desired public health and economic benefits in this century.

Sentido y significado de vejez de los residentes de la calle Zanja, 2017-2019 / Sense and meaning of old age of residents in Zanja Street, 2017-2019

Introducción: En Cuba, en el 2016, las personas mayores de 60 años constituían el 19,8 por ciento de la población, y La Habana era una de las provincias más envejecidas. En 2018 aumentó a 20,4 por ciento. En la calle Zanja, residen pobladores de distintos grupos étnicos, con herencias y tradiciones culturales diversas y diferentes visiones del sentido y significado de vejez. Objetivo: Caracterizar el sentido de vejez de los adultos mayores y el significado de vejez de los niños, adolescentes, jóvenes y adultos medios, residentes en la calle Zanja. Métodos: Se realizó un estudio exploratorio, a partir de una metodología mixta: cualitativa y cuantitativa. Se utilizó el método observacional y, en consecuencia, se decidió hacer uso de las técnicas de entrevista en profundidad, la observación no participante, con sus correspondientes guías, la técnica porcentual y la triangulación de datos. Resultados: Los adultos mayores manifestaron satisfacción de las necesidades materiales y espirituales en un alto nivel; aunque el 50 por ciento de los jubilados declaró no recibir atención de las organizaciones a las que pertenecían. Un alto porcentaje de adultos medios opinaron que los adultos mayores son personas importantes y útiles, tienen experiencia y constituyen ayuda. Los niños, adolescentes y jóvenes refirieron que lo que más les gusta de sus abuelos es que los quieren y los ayudan y lo que no les gusta es que pelean y se enferman. Conclusiones: Si los adultos mayores son importantes para las familias, comunidad y sociedad, es preciso mejorar las condiciones materiales de su existencia y del entorno y que se sientan reconocidos por sus aportes(AU)

Introduction: In Cuba, in 2016, people over the age of 60 made up 19.8 percent of the population, and Havana was one of the most aged provinces. In 2018 it increased to 20.4 percent. In Zanja Street, people of different ethnic groups reside, with diverse cultural heritage and traditions and different visions of the sense and meaning of old age. Objective: Characterize the sense of old age of older adults and the old-age meaning of children, adolescents, young people and average adults, residing on Zanja Street. Methods: An exploratory study was carried out, based on a mixed methodology: qualitative and quantitative. he observational method was used and, consequently, it was decided to make use of in-depth interview techniques, non-participating observation, with their corresponding guidelines, percentage technique and data triangulation. Results: Older adults expressed satisfaction with material and spiritual needs at a high level; although 50 percent of retirees reported not receiving care from the organizations to which they belonged. A high percentage of average adults said that older adults are important and useful people, they have experience and are helpful. Children, teenagers and young people said that what they love most about their grandparents is that they love and help them and what they don't like is that they argue and get sick. Conclusions: If older adults are important to the families, communities and the society, the material conditions of their life and environment need to be improved, and so they can feel acknowledge for their contributions(AU)

Políticas públicas sobre envejecimiento poblacional promulgadas en el contexto internacional, europeo y español entre 1982-2017 / Public policies on population ageing enacted in the international, European and Spanish contexts from 1982 to 2017

Introducción: El envejecimiento poblacional, problema de relevancia mundial, requiere acción de parte de los organismos políticos y gobiernos. Objetivo: Exponer las principales políticas dirigidas a la atención del envejecimiento poblacional promulgadas en el contexto internacional, el europeo y en las comunidades autónomas españolas entre 1982 y 2017. Métodos: Se realizó un trabajo de revisión y análisis de documentos, que incluyó la búsqueda de fuentes primarias tales como: planes y estrategias oficiales, informes, bases de datos y legislaciones en relación con el tema del envejecimiento poblacional y el envejecimiento activo. La recogida de información se ejecutó de mayo a julio de 2017. Se utilizó la técnica de análisis de contenido para identificar las políticas en el contexto internacional. La ficha diagnóstica para el análisis de las estrategias, se confeccionó a partir de una adaptación de la ficha propuesta en la Estrategia Vasca de Envejecimiento Activo. Conclusiones: El paradigma de la Organización Mundial de la Salud sobre Envejecimiento Activo promulga la perspectiva de la salud, la participación y seguridad de las personas mayores. Marca un hito en la formulación de políticas y estrategias de trabajo a nivel internacional. Las comunidades autónomas españolas han proyectado diversas estrategias, pero se requiere lograr coordinación integrada de sus actuaciones(AU)

Introduction: Population ageing, a problem of global importance, requires actions by political bodies and governments. Objective: Present the main policies aimed to the care of the population aging enacted in the international, European and Spanish autonomous communities' contexts in the period from 1982 to 2017. Methods: A review and analysis of documents was carried out, which included the search for primary sources such as: official plans and strategies, reports, databases and legislation related to the issue of population ageing and active ageing. The information collection was carried out from May to July 2017. The content analysis technique was used to identify policies in the international context; the diagnostic sheet for the analysis of strategies was prepared on the basis of an adaptation of the card proposed in the Basque Active Ageing Strategy. Conclusions: The World Health Organization paradigm on Active Ageing promulgates the perspective of the health, participation and safety of the elderly. It marks a milestone in the formulation of policies and strategies for work at the international level. The Spanish Autonomous Communities have planned various strategies, but it is necessary to achieve integrated coordination of their actions(AU)

La inmigración internacional reciente en la Ciudad de Buenos Aires / Recent international immigration in the City of Buenos Aires

En un nuevo contexto de la migración en la Ciudad de Buenos Aires, el presente informe tiene como objetivo analizar las características sociodemográficas de los principales orígenes que integran el conjunto de inmigrantes externos y que, como se mencionó, presentan particularidades en su composición y antigüedad de residencia en la Ciudad, considerando asimismo desde una perspectiva comparativa a los residentes nacidos en el país. Para este informe se explotaron los datos de la última Encuesta Anual de Hogares disponible correspondiente a 2019 que releva la Dirección General de Estadística y Censos sobre la base de una muestra probabilística de viviendas y hogares residentes en CABA y que contiene preguntas específicas sobre el lugar de nacimiento y el año desde que la persona reside en forma continua, que permiten identificar la antigüedad y cohortes de inmigrantes. (AU)

Biased dispersal can explain fast human range expansions.

Some human fronts spread faster than expected by models based on dispersal and reproduction. The only explanation proposed so far assumes that some autochthonous individuals are incorporated by the expanding populations, leading to faster front speeds. Here we show that simple models without this effect are also consistent with the observed speeds of two fronts (a Khoi-khoi expansion of herders and a Bantu expansion of farmers), provided that the dispersal of individuals is biased (i.e., more probable) in directions closer to the front propagation direction. The physical models presented may also be applied to other kinds of social phenomena, including innovation diffusion, rumor propagation, linguistic fronts, epidemic spread, diffusion in economic space and the evolution of cooperation in spatial systems. They can be also adapted to non-human systems with biased dispersal, including biological invasions, cancer tumors and virus treatment of tumors.

How will the main risk factors contribute to the burden of non-communicable diseases under different scenarios by 2050? A modelling study.

BACKGROUND: The future burden of non-communicable diseases (NCDs) depends on numerous factors such as population ageing, evolution of societal trends, behavioural and physiological risk factors of individuals (e.g. smoking, alcohol use, obesity, physical inactivity, and hypertension). This study aims to assess the burden of NCDs in Europe by 2050 under alternative scenarios. METHODS: This study combines qualitative and quantitative forecasting techniques to examine how population health in Europe may evolve from 2015 to 2050, taking into account future societal trends. Four scenarios were developed (one business-as-usual scenario, two response scenarios and one pessimistic scenario) and assessed against 'best' and 'worst'-case scenarios. This study provides quantitative estimates of both diseases and mortality outcomes, using a microsimulation model incorporating international survey data. FINDINGS: Each scenario is associated with a different risk factor prevalence rate across Europe during the period 2015-2050. The prevalence and incidence of NCDs consistently increase during the analysed time period, mainly driven by population ageing. In more optimistic scenarios, diseases will appear in later ages, while in the pessimistic scenarios, NCDs will impair working-age people. Life expectancy is expected to grow in all scenarios, but with differences by up to 4 years across scenarios and population groups. Premature mortality from NCDs will be reduced in more optimistic scenarios but stagnate in the worst-case scenario. INTERPRETATION: Population ageing will have a greater impact on the spread of NCDs by 2050 compared to risk factors. Nevertheless, risk factors, which are influenced by living environments, are an important factor for determining future life expectancy in Europe.

SARS-COV2/COVID-19 en Colombia: tendencias, predicciones y tensiones sobre el sistema sanitario / SARS-C0V2/COVID-I9 in Colombia: tendencies, predictions, and tensions about health system

RESUMEN Objetivo Analizar la evolución temporal de la primera etapa del COVID-19 en Colombia a través del modelo SIRD. Métodos Se analizó la evolución temporal del COVID-19 según los individuos infectados en Colombia del 6 de marzo al 15 de abril de 2020. Se realizó el modelo SIRD modificando la tasa de transmisión (b) bajo tres escenarios: 1) cuarentena hasta el 1 de julio, 2) cuarentena flexible., hasta el 11 de mayo con un b del 4%, y 3) cuarentena flexible2 hasta el 11 de mayo con b del 8%, con el fin de predecir el número de casos totales y el 5% de infectados en UCI para contrastarlo con el número de camas y personal UCI. Resultados Los escenarios mostraron que levantar la cuarentena el 11 de mayo significará un aumento en el número de infectados, entre 54 105 a 116 081 individuos con COVID-19. Así mismo, la rápida aceleración en la tasa de contagios se traduce en una mayor demanda de camas y personal en UCI: en el escenario de cuarentena flexible2 se colapsarían las 2 650 camas disponibles y se necesitaría de 5 intensivitas y 4 enfermeras por paciente al 1 julio. Conclusión Las medidas de distanciamiento social obligatorias contribuyen al retraso de la saturación del sistema de salud; sin embargo, son difíciles de sostener en el tiempo desde una perspectiva económica. Por lo tanto, para tener una distensión de la cuarentena es necesario adoptar medidas para ampliar la capacidad del sistema de salud y así evitar su colapso.(AU)

ABSTRACT Objective To analyze the temporal progress in the early stage of COVID-19 in Colombia using the SIRD model. Methods We analyzed the temporal progress of COVID-19 based on the number of infected persons between March 6th and April 15th, 2020. The SIRD model was implemented with variation in the rate of transmission (b) in three ways. A. Quarantine until July 11. 2. B. Flexible quarantine, [b=4%]. C. Flexible quarantine2 [b=8%]. Consecutively, we aimed to predict the number of total cases and 5% of infected persons in ICU to match them with the hospital beds and ICU staff. Results The results show that the number of COVID-19 cases will increase from 54 105 to 116 081 approximately, if the quarantine is lifted on May 11. If the infection rate increase, more hospital beds and a bigger ICU staff will be mandatory. The currently 2 650 beds won't be enough in the flexible quarantine2, and five intensive care specialist and four nurses per patient will be needed. Conclusion Measures like mandatory social distancing help delay the saturation of the health care system. However, it's impracticable to maintain them due to a possible economic crisis. Therefore, it's necessary to take action to enhance the ability of the health care system to avoid a collapse.(AU)

Los cuidados de enfermería y el anciano en estado de necesidad en la comunidad / Nursing Cares and the Elderly in a State of Need in the Community

Vislumbrar los factores demográficos ocurridos a nivel mundial sobre los cambios importantes en el envejecimiento poblacional, requiere profundizar en algunos criterios que están indisolublemente relacionados con el cuidado enfermero de estos tiempos. El envejecimiento poblacional como un fenómeno social caracterizado por el aumento en la esperanza de vida y el continuo descenso en la fecundidad, trae consigo enfermedades prevalentes de la tercera edad, que tienen la cualidad de no ser enfermedades curables, sinoque usualmente son degenerativas, lo que con el pasar del tiempo se va traduciendo en cronicidad, con situaciones de dependencia funcional para desempeñarse en las actividades de la vida diaria, y se evidencia con esto un proceso de discapacidad prevalente en el anciano en estado de necesidad.(1) El anciano en estado de necesidad es definido, según el Programa del Adulto Mayor del Ministerio de Salud Pública en Cuba, como un individuo que depende de los cuidadosenfermeros y familiares para garantizar su subsistencia, por su alto estado de dependencia y...(AU)

El envejecimiento de la población chilena y los desafíos para la salud y el bienestar de las personas mayores / The aging of the chilean population and the challenges for health and wellbeing of older people

El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior. Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años. Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores. En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos CONCLUSIONES Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona.

The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context. In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years. The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults. In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter CONCLUSIONS Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care.

Trends in the utilisation rates and acute hospital capacity needs for total hip replacements: results of an analysis of administrative data.

Total hip replacement surgery is the mainstay of treatment for end-stage hip arthritis. In 2014, there were 28227 procedures (incidence rate 252/100000 population). Using administrative data, we projected the future volume of total hip replacement procedures and incidence rates using two models. The constant rate model fixes utilisation rates at 2014 levels and adjusts for demographic changes. Projections indicate 32248 admissions by 2025 or an annual growth of 1.22% (incidence rate 273). The time trend model additionally projects the evolution in age-specific utilisation rates. 34895 admissions are projected by 2025 or an annual growth of 1.95% (incidence rate 296). The projections show a shift in performing procedures at younger age. Forecasts of length of stay indicate a substantial shortening. By 2025, the required number of hospital beds will be halved. Despite more procedures, capacity can be reduced, leading to organisational change (e.g. elective orthopaedic clinics) and more labour intensive stays.