Economic evaluation of percutaneous cryoablation vs conventional surgery in extra-abdominal desmoid tumours in the Spanish healthcare system.

BACKGROUND: Desmoid tumours (DTs) or deep fibromatosis are benign soft-tissue tumours, sometimes locally aggressive, requiring intervention on some cases. Surgery has been the gold standard, but new less invasive techniques such as percutaneous cryoablation have proved their effectiveness, reducing health resources and complications. The study aimed to compare the total cost of percutaneous cryoablation and conventional surgery for patients with extra-abdominal and/or abdominal wall DTs, candidates for local ablative treatment in Spain. METHODS: A cost-analysis model was developed. An expert panel provided data about resource consumption for the percutaneous cryoablation technique and validated the epidemiology used for target population estimation. Unitary resources cost (€ 2022) derived from local cost databases. A retrospective analysis of 54 surgical cases in 3 Spanish hospitals was performed to estimate the cost of conventional surgery based on the cost of the Diagnosis-Related group (DRG) codes identified on this patient sample, weighted by each DRG proportion. The total cost for each alternative included intervention cost and complications cost, considering debridement required in 4.5% of cases with percutaneous cryoablation and minor surgery for surgical site infection in 18.0% for conventional surgery. RESULTS: The total cost for percutaneous cryoablation (€ 5774.78/patient-year) was lower than the total cost for conventional surgery (€ 6780.98/patient-year), yielding cost savings up to € 80,002 in 1 year for the entire cohort of 80 patients with DTs eligible for intervention estimated in Spain. One-way sensitivity analyses confirmed the results' robustness. CONCLUSION: Percutaneous cryoablation versus conventional surgery would yield cost savings for the management of DT patients in Spain. CRITICAL RELEVANCE STATEMENT: This manuscript provides insight into the economic impact derived from the savings related to the use of percutaneous cryoablation for desmoid-type tumours from the perspective of the Spanish National Healthcare System, providing useful information for the health decision-making process. KEY POINTS: • Desmoid tumours are locally aggressive and may require local therapy. • Percutaneous cryoablation procedure is less invasive than the conventional surgery. • Cost comparison shows savings associated to percutaneous cryoablation use.

Cost-Effectiveness of the COVID-19 Test, Trace and Isolate Program in Colombia.

BACKGROUND: During the COVID-19 pandemic, Test-Trace-Isolate (TTI) programs have been recommended as a risk mitigation strategy. However, many governments have hesitated to implement them due to their costs. This study aims to estimate the cost-effectiveness of implementing a national TTI program to reduce the number of severe and fatal cases of COVID-19 in Colombia. METHODS: We developed a Markov simulation model of COVID-19 infection combined with a Susceptible-Infected-Recovered structure. We estimated the incremental cost-effectiveness of a comprehensive TTI strategy compared to no intervention over a one-year horizon, from both the health system and the societal perspective. Hospitalization and mortality rates were retrieved from Colombian surveillance data. We included program costs of TTI intervention, health services utilization, PCR diagnosis test, productivity loss, and government social program costs. We used the number of deaths and quality-adjusted life years (QALYs) as health outcomes. Sensitivity analyses were performed. FINDINGS: Compared with no intervention, the TTI strategy reduces COVID-19 mortality by 67%. In addition, the program saves an average of $1,045 and $850 per case when observed from the social and the health system perspective, respectively. These savings are equivalent to two times the current health expenditures in Colombia per year. INTERPRETATION: The TTI program is a highly cost-effective public health intervention to reduce the burden of COVID-19 in Colombia. TTI programs depend on their successful and speedy implementation. FUNDING: This study was supported by the Colombian Ministry of Health through award number PUJ-04519-20 received by EPQ AVO and SDS declined to receive any funding support for this study. The contents are the responsibility of all the individual authors.

[Contribution of the occupational health to the COVID-19 pandemic control.] / Contribución de la salud laboral al control de la pandemia por covid-19 en España.

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Cuando la Organización Mundial de la Salud declaró la Covid-19 como una emergencia de salud pública de importancia internacional, el Ministerio de Sanidad convocó a las autoridades sanitarias, laborales, de seguridad social, Inspección de Trabajo y Seguridad Social, Instituto Nacional de Seguridad y Salud en el Trabajo, empresarios, sindicatos, servicios de prevención de riesgos laborales, mutuas y sociedades científicas de la medicina y enfermería del trabajo, para colaborar en el control de la transmisión del SARS-CoV-2 en el ámbito de las empresas. La Ponencia de Salud Laboral de la Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud, elaboró el Procedimiento para los servicios de prevención de riesgos laborales frente a la exposición al SARS-CoV-2, que se ha actualizado 15 veces hasta la fecha. En él se recogen las medidas de prevención a implantar en los centros de trabajo: de carácter organizativo y de protección colectiva, de protección personal, de trabajador especialmente vulnerable y nivel de riesgo, de estudio y manejo de casos y contactos ocurridos en la empresa, de colaboración en la gestión de la incapacidad temporal y, más recientemente, de reincorporación y gestión de las y los trabajadores vacunados. Como resultado de esos marcos de cooperación y colaboración se desplegaron una serie de actividades en los lugares de trabajo que son descritas en este artículo.

Healthy aging determinants and disability among older adults: SABE Colombia.

OBJECTIVE: To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging. METHODS: This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression. RESULTS: The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability. CONCLUSIONS: Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

Asociación entre la termografía por infrarrojo, parámetros antropométricos y gasto energético de reposo en hombres / Association between infrared thermography, anthropometry parameters and rest energy expenditure in men

RESUMEN: Es reconocido que un incremento de la grasa corporal subcutánea es capaz de alterar el patrón de liberación de calor a través de la piel. Sin embargo, la asociación con otras variables antropométricas y la influencia del gasto energético en reposo (GER), han sido escasamente abordadas. Este estudio determinó la relación de la temperatura de la piel con variables antropométricas, peso corporal y GER de hombres adultos sanos. Participaron en el estudio un total de 24 varones sanos de 33,9±8,7 años de edad, 85,8±9,7 kg de peso corporal, 172,5±6,1 cm de estatura y 28,9±3,4 kg/m2 de índice de masa corporal (IMC). Se realizaron evaluaciones antropométricas, de termografía por infrarrojo y del GER por calorimetría indirecta, con analizador de gases. La temperatura promedio de los 6-pliegues, y las individuales (toracoabdominales, supra-espinal y abdominal), tuvieron correlaciones negativas con el IMC, perímetro de cintura, índice cintura cadera, índice cintura estatura, y la sumatoria de 6 pliegues; todos con p<0,05. Además, la temperatura del pliegue supraespinal tuvo una correlación negativa con el porcentaje de masa adiposa (MA%), r=0,47(p=0,0194). La MA% y el IMC tuvieron correlaciones negativas con el GER, con r=-0,59 (p=0,002) y r=-0,53 (p=0,006), respectivamente. El promedio de temperatura de los 6-pliegues presentó una correlación positiva con el GER (r=0,44; p=0,02). La composición corporal causa una modificación en los patrones de termografía superficial local, sin afectar la relación entre el promedio de la temperatura superficial total con el GER, pudiendo éste ser un factor predictor.

SUMMARY: It is known that an increase in the subcutaneous body fat can alter the pattern of heat release through the skin. However, the relationship with other anthropometric variables and the influence of the Resting Energy Expenditure (REE) have scarcely been addressed. To determine the relationship of skin temperature with different anthropometric variables, body weight, and the REE of healthy adult males. The participants were a total of 24 healthy males of 33.9±8.7 years-old, 85.8±9.7 kg of body mass, 172.5±6.1 cm of height, and 28.9±3.4 kg/m2 of body mass index (BMI). Anthropometric, infrared thermography, and indirect calorimetry REE assessments were performed with gas analyzer. The six skinfolds average temperature, as well as the individual skinfolds (thoracoabdominal, supraspinal, and abdominal), had negative correlations with the BMI, waist circumference, waist- hip ratio, waist-to-height ratio, and the sum of the six skinfolds, all with p<0.05. In addition, the temperature of the supraspinal fold had a negative correlation with the percentage of fat mass (MA%), r=0.47 (p=0.0194). MA% and BMI had negative correlations with REE, with r=-0.59 (p=0.002) and r=-0.53 (p=0.006), respectively. The six-skinfolds average temperature presented a positive correlation with the REE (r=0.44; p=0.02). Body composition changes cause a modification in the local surface thermography patterns without affecting the relationship between the average total body surface temperature with the REE; therefore, this could act as a predictive factor.

Healthy aging determinants and disability among older adults: SABE Colombia

[ABSTRACT]. Objective. To identify the main factors associated with disability in older adults in Colombia, adjusted accord-ing to structural and intermediary determinants of healthy aging.Methods. This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built envi-ronment, and health care systems. Data analysis employed multivariate logistic regression.Results. The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activi-ties of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low edu-cational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.Conclusions. Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

[RESUMEN]. Objetivo. Determinar los principales factores asociados con la discapacidad en personas mayores en Colom-bia, ajustados según determinantes estructurales e intermediarios del envejecimiento saludable.Métodos. Este estudio empleó datos transversales de 23 694 adultos de más de 60 años provenientes de la encuesta nacional Colombia SABE. Se analizaron los determinantes estructurales como las variables demográficas y de situación socioeconómica. Las variables intermediarias se clasificaron en tres bloques: capacidad intrínseca, entorno físico y construido, y sistemas de atención de salud. El análisis de datos empleó la regresión logística con múltiples variables.Resultados. La prevalencia de la discapacidad general fue de 21% en la actividad cotidiana, 38% en la activi-dad cotidiana instrumental y 33% en la discapacidad relacionada con la movilidad. Se asoció la discapacidad con los determinantes estructurales sociodemográficos, como edad avanzada, sexo femenino, residencia en entornos rurales, estar soltero o divorciado, vivir solo, un nivel educativo bajo y tener etnicidad indígena o negra. Con respecto a los determinantes relativos a la situación socioeconómica, la principal influencia en la discapacidad fueron los ingresos netos bajos, la situación socioeconómica baja, una percepción insuficiente de ingresos y un plan de seguro de salud subsidiado. Los determinantes intermediarios de la capacidad intrínseca, como la mala salud informada por la propia persona, la multimorbilidad, la poca fuerza en el puño, un estilo de vida sedentario, las adversidades económicas desde la primera infancia, la carencia de apoyo social y la falta de participación en actividades se asociaron de manera significativa con la discapacidad.Conclusiones. Las medidas que tienen un efecto sobre los principales factores asociados con la discapaci-dad, como la reducción de las inequidades en materia de salud, mediante políticas, estrategias y actividades, pueden contribuir significativamente al bienestar y la calidad de vida de las personas mayores colombianas.

[RESUMO]. Objetivo. Identificar os principais fatores associados à incapacidade em idosos na Colômbia, ajustados de acordo com os determinantes estruturais e intermediários do envelhecimento saudável.Métodos. Este estudo usou dados transversais de 23.694 adultos com mais de 60 anos de idade que partic-iparam da pesquisa nacional SABE Colômbia. Determinantes estruturais, como variáveis demográficas e de condição socioeconômica, foram analisados. As variáveis intermediárias foram classificadas em três blocos: capacidade intrínseca, ambiente físico e construído, e sistemas de saúde. A análise dos dados empregou regressão logística multivariada.Resultados. A prevalência de incapacidade em geral foi de 21% para as atividades da vida diária, 38% para atividades instrumentais da vida diária e 33% para restrição de mobilidade. Constatou-se associação da incapacidade com determinantes estruturais sociodemográficos, como idade avançada, sexo feminino, residência em área rural, estado civil solteiro ou divorciado, viver sozinho, baixa escolaridade e etnia indígena/negra. Com relação aos determinantes da condição socioeconômica, baixa renda líquida, pertencimento ao estrato socioeconômico mais pobre, percepção de renda insuficiente e ter um plano de seguro-saúde sub-sidiado exerceram grande influência sobre a incapacidade. Determinantes intermediários da capacidade intrínseca, como autopercepção de saúde ruim, multimorbidade, força de preensão reduzida, estilo de vida sedentário, adversidade econômica na primeira infância, ausência de suporte social e não participação em atividades foram significativamente associados à incapacidade.Conclusões. Ações que afetem os principais fatores associados à incapacidade, como a redução das iniq-uidades em saúde por meio de políticas, estratégias e atividades, podem contribuir significativamente para o bem-estar e a qualidade de vida dos idosos colombianos.

The healthy aging phenotype in older people in Manizales / [Fenotipo de envejecimiento saludable de personas mayores en Manizales].

Introduction: The healthy aging phenotype is present in those individuals that age with low morbidity, no functional or cognitive deterioration, and retain an acceptable level of wellness and social participation. Objective: To establish the frequency of the healthy aging phenotype in older people in the community using a multidimensional, a biomedical, and a psychosocial model and to identify the predicting factors in each model. Materials and methods: We conducted a cross-sectional, observational and descriptive study. We assessed individuals (n= 402; 50.1% female) aged 65 years or older (69.2 years average) from the urban area of Manizales. The healthy aging phenotype included five domains: biomarkers of physiological and metabolic health, physical capability, cognitive function, and social and psychological wellbeing. We also analyzed sociodemographic- and health-related factors. Results: In the multidimensional model the prevalence of the healthy aging phenotype was 15.5% while in the biomedical model it was 12.3% and in the psychosocial one it was 63.3%. Good self-perceived health was an independent predictor of healthy aging in all the models assessed. Having enough income was a predictor in the biomedical and psychosocial models while being married was the only significant predictor in the psychosocial model. Conclusions: The prevalence of the healthy aging phenotype was low in the biological and multidimensional models (1 of every 10 individuals) and higher in the psychosocial one (6 of every 10 persons). However, independent predictor factors were the same in all models: Self-perceived good or very good health, having enough income and being married.

Introducción. El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social. Objetivo. Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos. Materiales y métodos. Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud. Resultados. La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial. Conclusiones. La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.

Fenotipo de envejecimiento saludable de personas mayores en Manizales / The healthy aging phenotype in older people in Manizales

Introducción. El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social. Objetivo. Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos. Materiales y métodos. Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud. Resultados. La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial. Conclusiones. La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.

Introduction: The healthy aging phenotype is present in those individuals that age with low morbidity, no functional or cognitive deterioration, and retain an acceptable level of wellness and social participation. Objective: To establish the frequency of the healthy aging phenotype in older people in the community using a multidimensional, a biomedical, and a psychosocial model and to identify the predicting factors in each model. Materials and methods: We conducted a cross-sectional, observational and descriptive study. We assessed individuals (n= 402; 50.1% female) aged 65 years or older (69.2 years average) from the urban area of Manizales. The healthy aging phenotype included five domains: biomarkers of physiological and metabolic health, physical capability, cognitive function, and social and psychological wellbeing. We also analyzed sociodemographic- and health-related factors. Results: In the multidimensional model the prevalence of the healthy aging phenotype was 15.5% while in the biomedical model it was 12.3% and in the psychosocial one it was 63.3%. Good self-perceived health was an independent predictor of healthy aging in all the models assessed. Having enough income was a predictor in the biomedical and psychosocial models while being married was the only significant predictor in the psychosocial model. Conclusions: The prevalence of the healthy aging phenotype was low in the biological and multidimensional models (1 of every 10 individuals) and higher in the psychosocial one (6 of every 10 persons). However, independent predictor factors were the same in all models: Self-perceived good or very good health, having enough income and being married.

Religiosity and self-rated health among older adults in Colombia.

OBJECTIVE: To identify the relationship between religiosity and self-rated health among older adults in Colombia. METHODS: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders. RESULTS: Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR 0.92 95% CI 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women. CONCLUSION: Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious.

OBJETIVO: Identificar la relación entre religiosidad y el auto reporte de salud entre adultos mayores en Colombia. MÉTODOS: Los datos provienen del estudio SABE (Salud, Bienestar y Envejecimiento) Colombia, una encuesta transversal realizada en 2015 en la que participaron 18,871 adultos de 60 años o más que viven en la comunidad y provienen de zonas urbanas y rurales en Colombia. La religiosidad fue autoevaluada (qué tan religiosa eres: nada, algo o muy). La autoevaluación de la salud durante los 30 días previos se evaluó como muy buena, buena, regular, mala o muy mala, analizada como variable ordinal (1-5) usando la regresión logística ponderada, ajustando por factores de confusión. RESULTADOS: La edad avanzada, el sexo femenino, estar casado, y tener bajo nivel socioeconómico se asociaron con ser más religiosos. Los análisis multivariados demostraron que ser más religioso se asociaba con mejor salud autoevaluada (OR= 0.92; IC 95%= 0.86-0.99; p= 0.038). Sin embargo hubo una interacción significativa entre género y religiosidad sobre la salud autoevaluada (p= 0.002), tal que la relación entre religiosidad y salud fue mas fuerte en los hombres (OR= 0.86; IC 95%= 0.79-0.94; p= 0.001), pero no fue significativa en mujeres. CONCLUSIÓN: Los adultos mayores en Colombia que se consideran a sí mismos más religiosos, especialmente los hombres, tienen menos probabilidades de percibir su salud como pobre en comparación con aquellos que son menos religiosos.

Abuse in Colombian elderly and its association with socioeconomic conditions and functionality.

OBJECTIVE: To describe the presence of abuse in elderly people in Colombia and its association with socio-demographic and functional conditions. METHODS: Cross-sectional and descriptive research. Data were taken from the SABE Colombia Survey, a population study, with a national representative sample of 23,694 adults aged over 60 years. Presence and type of abuse by partners or family members, members were investigated. Generalized linear models with Poisson link function were used to estimate the causes of the prevalence of abuse by area of residence, region, age, sex, dependence on activities of daily living and living arrangements. RESULTS: 15.1% of the elderly in Colombia reported some type of abuse, and over 50% reported more than one form of abuse. Abuse proportion is greater in people who are aged 60-69, in women, people with lower levels of education, people who belong to lower socioeconomic status, people who live alone, people who live with children, and people in urban areas. The most frequent abuse form is psychological, followed by neglect and physical abuse. Dependence on basic and instrumental daily living activities increases the probabilities of suffering abuse. CONCLUSIONS: Home is a risky place for the elderly people, especially for those with functional dependence, those who belong to low socioeconomic strata and women. Results should encourage debate among researchers, professionals and decision makers on public policy about necessary actions and means to change violent family dynamics in homes with elderly people.

OBJETIVO: Describir la presencia de maltrato en las personas mayores en Colombia y su asociación con condiciones sociodemográficas y funcionales. MÉTODOS: Estudio transversal y descriptivo. Se tomaron los datos de la Encuesta SABE Colombia, un estudio poblacional, con una muestra representativa a nivel nacional de 23,694 adultos mayores de 60 años. Se indagó por la presencia y tipo de maltrato, por parte de los miembros de la familia, hogar o convivientes. Se utilizaron modelos lineares generalizados con función de vínculo de Poisson para estimar las razones de prevalencia de maltrato por zona de residencia, región, edad, sexo, dependencia en actividades de la vida diaria y convivencia. RESULTADOS: Reportaron algún tipo de maltrato el 15.1% de las personas mayores en Colombia y más de la mitad refiere más de una forma de maltrato. Hay mayor proporción de maltrato en las personas de 60-69 años, en mujeres, con menor escolaridad, quienes viven en estratos bajos, solos, con hijos y en zona urbana. El maltrato más frecuente es el psicológico, seguido de negligencia y maltrato físico. La dependencia en actividades básicas e instrumentales de la vida diaria, incrementa la probabilidad de sufrir maltrato. CONCLUSIONES: El hogar es un lugar de riesgo para los adultos mayores, especialmente aquellos con dependencia funcional, de estratos bajos y mujeres. Los resultados deberán animar el debate entre investigadores, profesionales y tomadores de decisiones de política publica, en torno a las acciones y los medios necesarios para transformar las dinámicas familiares violentas en hogares con personas mayores.

Religiosity and self-rated health among older adults in Colombia / Religiosidad y el auto-reporte de salud entre adultos mayores en Colombia

Abstract Objective: To identify the relationship between religiosity and self-rated health among older adults in Colombia. Methods: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders. Results: Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR: 0.92, 95% CI: 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR: 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women. Conclusion: Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious.

Resumen Objetivo: Identificar la relación entre religiosidad y el auto reporte de salud entre adultos mayores en Colombia. Métodos: Los datos provienen del estudio SABE (Salud, Bienestar y Envejecimiento) Colombia, una encuesta transversal realizada en 2015 en la que participaron 18,871 adultos de 60 años o más que viven en la comunidad y provienen de zonas urbanas y rurales en Colombia. La religiosidad fue autoevaluada (qué tan religiosa eres: nada, algo o muy). La autoevaluación de la salud durante los 30 días previos se evaluó como muy buena, buena, regular, mala o muy mala, analizada como variable ordinal (1-5) usando la regresión logística ponderada, ajustando por factores de confusión. Resultados: La edad avanzada, el sexo femenino, estar casado, y tener bajo nivel socioeconómico se asociaron con ser más religiosos. Los análisis multivariados demostraron que ser más religioso se asociaba con mejor salud autoevaluada (OR= 0.92; IC 95%= 0.86-0.99; p= 0.038). Sin embargo hubo una interacción significativa entre género y religiosidad sobre la salud autoevaluada (p= 0.002), tal que la relación entre religiosidad y salud fue mas fuerte en los hombres (OR= 0.86; IC 95%= 0.79-0.94; p= 0.001), pero no fue significativa en mujeres. Conclusión: Los adultos mayores en Colombia que se consideran a sí mismos más religiosos, especialmente los hombres, tienen menos probabilidades de percibir su salud como pobre en comparación con aquellos que son menos religiosos.

Abuse in Colombian elderly and its association with socioeconomic conditions and functionality / Maltrato en adultos mayores colombianos y su asociación con condiciones socioeconómicas y funcionalidad

Abstract Objective: To describe the presence of abuse in elderly people in Colombia and its association with socio-demographic and functional conditions. Methods: Cross-sectional and descriptive research. Data were taken from the SABE Colombia Survey, a population study, with a national representative sample of 23,694 adults aged over 60 years. Presence and type of abuse by partners or family members, members were investigated. Generalized linear models with Poisson link function were used to estimate the causes of the prevalence of abuse by area of residence, region, age, sex, dependence on activities of daily living and living arrangements. Results: 15.1% of the elderly in Colombia reported some type of abuse, and over 50% reported more than one form of abuse. Abuse proportion is greater in people who are aged 60-69, in women, people with lower levels of education, people who belong to lower socioeconomic status, people who live alone, people who live with children, and people in urban areas. The most frequent abuse form is psychological, followed by neglect and physical abuse. Dependence on basic and instrumental daily living activities increases the probabilities of suffering abuse. Conclusions: Home is a risky place for the elderly people, especially for those with functional dependence, those who belong to low socioeconomic strata and women. Results should encourage debate among researchers, professionals and decision makers on public policy about necessary actions and means to change violent family dynamics in homes with elderly people.

Resumen Objetivo: Describir la presencia de maltrato en las personas mayores en Colombia y su asociación con condiciones sociodemográficas y funcionales. Métodos: Estudio transversal y descriptivo. Se tomaron los datos de la Encuesta SABE Colombia, un estudio poblacional, con una muestra representativa a nivel nacional de 23,694 adultos mayores de 60 años. Se indagó por la presencia y tipo de maltrato, por parte de los miembros de la familia, hogar o convivientes. Se utilizaron modelos lineares generalizados con función de vínculo de Poisson para estimar las razones de prevalencia de maltrato por zona de residencia, región, edad, sexo, dependencia en actividades de la vida diaria y convivencia. Resultados: Reportaron algún tipo de maltrato el 15.1% de las personas mayores en Colombia y más de la mitad refiere más de una forma de maltrato. Hay mayor proporción de maltrato en las personas de 60-69 años, en mujeres, con menor escolaridad, quienes viven en estratos bajos, solos, con hijos y en zona urbana. El maltrato más frecuente es el psicológico, seguido de negligencia y maltrato físico. La dependencia en actividades básicas e instrumentales de la vida diaria, incrementa la probabilidad de sufrir maltrato. Conclusiones: El hogar es un lugar de riesgo para los adultos mayores, especialmente aquellos con dependencia funcional, de estratos bajos y mujeres. Los resultados deberán animar el debate entre investigadores, profesionales y tomadores de decisiones de política publica, en torno a las acciones y los medios necesarios para transformar las dinámicas familiares violentas en hogares con personas mayores.

Social and Economic Predictors of Worse Frailty Status Occurrence Across Selected Countries in North and South America and Europe.

BACKGROUND: Frailty, a state of vulnerability to poor resolution of homoeostasis after a health stressor, may be a result of cumulative decline in many physiological systems across the life course and its prevalence and incidence rates vary widely depending on the place and population subgroup. OBJECTIVE: This study aims to examine social and economic factors as predictors of worse frailty status over 2 years of follow-up in a sample of community-dwelling older adults from the International Mobility in Aging Study. METHODS: We analyzed 2012 baseline and 2014 follow-up (n = 1,724) data on participants from a populational-based, longitudinal study conducted in 4 countries (e.g., Brazil, Colombia, Albania, and Canada). Frailty was defined according to the Fried's phenotype and Poisson regression models with robust standard errors were performed to estimate the relative risks of becoming frail. RESULTS: In our study, 366 (21.2%) participants migrated to a worse stage of frailty. After statistical adjustment (e.g., participant age, sex, and study site), insufficient income (RR = 1.40; 95% CI = 1.00-1.96) and having partner support (RR = 0.80; 95% CI = 0.64-1.01) were predictors of incident frailty status. CONCLUSION: Notably, transitions in frailty status were observed even in a short range of time, with sociodemographic factors predicting incident frailty.

Differences in energy expenditure, amount of physical activity and physical exertion level during a Zumba fitness class among adult women who are normal weight, overweight and obese.

BACKGROUND: One of the most popular expressions of massive group classes of aerobic physical activity is Zumba fitness. The aim of the study was to compare and relate the energy expenditure and the amount and intensity of physical effort during a Zumba fitness class in women with different Body Mass Index (BMI). METHODS: Body displacements of 61 adult women who performed a one-hour Zumba session were evaluated with triaxial accelerometers. In order to observe the effect of BMI women were divided into normal weight (N.=26), overweight (N.=21) and obese groups (N.=14). RESULTS: The average number of steps was 4533.3±1351 and the percentage of total class time of moderate to vigorous intensity (% MVPA) was 53.8±14.4%. The metabolic intensity average was 3.64±1.1 MET, with an energy expenditure by total body mass of 3.9±1.6 kcal/kg. When analyzing groups, the normal weight group had a greater number of steps (5184.2±1561.1 steps/class) compared to overweight (4244.8±1049.3 steps/class) and obese women (3756.9±685.7 steps/class) with P<0.05. Also, the normal weight group spent a lower percentage of class time at the lower levels of intensity (sedentary and lifestyle activity levels) and more time at the highest levels (vigorous and very vigorous) compared to obese women (P<0.05). Participants with a normal weight obtained a higher % MVPA (62.1±15%) compared to overweight (50.1±9.4%) and obese (44.1±11.9%) groups with P<0.05. A metabolic intensity of 4.6±1.9 MET in the normal weight group was higher compared to 3.5±1.0 MET in the overweight (P<0.05) and 3.1±1.2 MET in the obese group (P<0.05), was observed. The subjective perception of effort was 7.84±0.9 (Borg CR 10), no differences between groups. Also we observed in all participants that at higher BMI values, there were lower energy expenditure values per kilo of weight (r=-0.40; P<0.001), metabolic intensity (r=-0.39; P<0.001), step counts (r=-0.43; P<0.001) and % MVPA (r=-0.50; P<0.001). CONCLUSIONS: These results show that a higher BMI is associated with a lower intensity of effort, energy expenditure and amount of physical activity during a one-hour Zumba class, restricting to overweight and obese women to achieving the effort parameters recommended to control weight and improve cardiovascular fitness.

Valoración de la respuesta plaquetaria al uso de antagonistas del receptor p2y12 utilizando el test de reactividad plaquetaria verifynow®, en pacientes sometidos a neurointervencionismo / Monitoring the Plaquetary Response to the Use of P2Y12 Receptor Antagonists Using the Platelet Reactivity Test Verifynow™ in Patients Who Underwent Neurointervencionism Procedures

Objetivo: Valorar la respuesta plaquetaria al uso de los antagonistas del receptor P2Y12 mediante el test VerifyNow® en pacientes sometidos a neurointervencionismo. Metodología: Estudio descriptivo transversal retrospectivo, con 89 pacientes intervenidos entre 2014 y 2017, de los cuales, 78 cumplieron los criterios de inclusión. Todos los casos recibieron protocolo de antiagregación dual. El resultado por evaluar con el test corresponde a la respuesta de los pacientes al uso de antagonistas del receptor P2Y12. La respuesta baja a los inhibidores de P2Y12 se manifestó en aquellos con un valor de PRU > de 240; la respuesta alta se les atribuyó a aquellos con valores de PRU < 60. Resultados: La mayor parte de los intervenidos (69,2 %) respondieron normalmente. Las complicaciones de la población en estudio fueron del 9,1 %, incluidos 2 fallecimientos, de los cuales, uno fue de un paciente de baja respuesta. Conclusiones: La respuesta plaquetaria individual de la población estudiada frente al uso de clopidogrel mediante el test VerifyNow® fue variable y heterogénea. Se evidenció en el estudio que el 14,3 % de los pacientes que tuvieron complicaciones tenían el PRU fuera del rango objetivo y del total de pacientes que presentaron valores dentro del rango objetivo solo el 2 % presentaron complicaciones menores.

Cultura de seguridad del paciente percibida en una muestra de enfermeros en hospitales de Corrientes Capital 2017 / Culture of patient safety perceived in a sample of nurses in hospitals of Corrientes Capital 2017

Objetivo: Describir la cultura de seguridad del paciente referida por el personal de enfermeríaDiseño: estudio descriptivo y transversal. Lugar: Hospitales públicos de la ciudad de Corrientes, 2017.Participantes: personal de enfermería, para la recolección de los datos se utilizó el cuestionario de versión española del cuestionario Hospital Survey on Patient Safety Culture. Resultados: se observó en cuanto a la percepción que poseen sobre la cultura de la seguridad del paciente, el 45,84% percibe que es positiva, el 93,01 % manifestó como positiva la notificación de errores.Las acciones para promover la seguridad por parte de la supervisión el 59,64% percibieron que existe cultura en este aspecto, el 80% de las repuestas fueron positivas para la percepción sobre la cultura del aprendizaje organizacional y la mejora continua.En la dimensión, trabajo en equipo el 84 ,6% percibió que existe cultura en este aspecto y el 70,7% que existe comunicación abierta en la organización.El 85,1% percibe que existe un Feedback y comunicación del error, el 61,5% manifestó que existe una cultura de respuesta no punitiva.El 53,9% percibe que hay cultura en la dotación de personal, y el 63,9% de las respuestas fue positiva en relación a la gerencia.El 63,9% percibe que trabaja en equipos multidisciplinario, y el 60,9% percibe una cultura de seguridad en la transferencia y el traspaso del paciente a los servicios.Conclusión: El personal de enfermería percibe como baja la cultura de la seguridad en los Hospitales. Existen varias dimensiones de la cultura por mejorar

Summary:Objective: To describe the safety culture of the patient referred by the nursing staffDesign: descriptive and cross-sectional study.Place: Public hospitals of the city of Corrientes, 2017.Participants: nurses, the questionnaire for the Spanish version of the Survey on Patient Safety Culture questionnaire was used to collect data.Results: it was observed in the perception that they have on the safety culture of the patient, 45.84% perceive that it is positive, 93.01% showed as positive the notification of errors.The actions to promote safety by supervision 59.64% perceived that there is culture in this regard, 80% of the responses were positive for the perception about the culture of organizational learning and continuous improvement.In the dimension, teamwork 84, 6% perceived that there is culture in this aspect and 70.7% that there is open communication in the organization.85.1% perceive that there is a feedback and communication of the error, 61.5% stated that there is a culture of non-punitive response.53.9% perceived that there was culture in staffing, and 63.9% of the responses were positive in relation to management.63.9% perceive that they work in multidisciplinary teams, and 60.9% perceive a safety culture in the transfer and transfer of the patient to the services.Conclusion: Nurses perceive the culture of safety in Hospitals as low. There are several dimensions of culture to be improved

Resumo:Para descrever a cultura de segurança do paciente encaminhados por enfermeirosDesenho: estudo descritivo.Local: Hospitais públicos na cidade de Corrientes, 2017.Foi utilizado enfermeiros, para coleta de dados questionário versão espanhola do Inquérito aos Hospitais da Cultura de Segurança do Paciente: Participantes.Resultados: Observou-se na percepção que têm sobre a cultura de segurança do paciente, 45,84% percebem é positivo, a 93,01% relataram o relatório de erros como positivo.Ações para promover a segurança, monitorando a 59,64% perceberam que a cultura existe nesta área, 80% das respostas foram positivas para a percepção de cultura organizacional de aprendizagem e melhoria contínua.Em dimensão, trabalho em 84, 6% sentiram que a cultura existe nesta área e 70,7% que não há uma comunicação aberta dentro da organização.85,1% perceber que existe um feedback de erro e comunicação, 61,5% referido que existe uma cultura de resposta não punitiva.53,9% percebem que não há cultura em termos de pessoal, e 63,9% das respostas foram positivas em relação à gestão.63,9% percebem a trabalhar em equipas multidisciplinares, e 60,9% percebem uma cultura de segurança na transferência e entrega de serviços paciente.Conclusão: Os enfermeiros percebida baixa cultura de segurança em hospitais. Existem várias dimensões de cultura para melhorar

SABE Colombia: Survey on Health, Well-Being, and Aging in Colombia-Study Design and Protocol.

Objective. To describe the design of the SABE Colombia study. The major health study of the old people in Latin America and the Caribbean (LAC) is the Survey on Health, Well-Being, and Aging in LAC, SABE (from initials in Spanish: SAlud, Bienestar & Envejecimiento). Methods. The SABE Colombia is a population-based cross-sectional study on health, aging, and well-being of elderly individuals aged at least 60 years focusing attention on social determinants of health inequities. Methods and design were similar to original LAC SABE. The total sample size of the study at the urban and rural research sites (244 municipalities) was 23.694 elderly Colombians representative of the total population. The study had three components: (1) a questionnaire covering active aging determinants including anthropometry, blood pressure measurement, physical function, and biochemical and hematological measures; (2) a subsample survey among family caregivers; (3) a qualitative study with gender and cultural perspectives of quality of life to understand different dimensions of people meanings. Conclusions. The SABE Colombia is a comprehensive, multidisciplinary study of the elderly with respect to active aging determinants. The results of this study are intended to inform public policies aimed at tackling health inequalities for the aging society in Colombia.

Social differences associated with the use of psychotropic drugs among men and women aged 65 to 74 years living in the community: the International Mobility in Aging Study (IMIAS).

BACKGROUND: Elderly persons make greater use of psychotropic drugs, but there are few international studies on social differences in the use of these medications. The aim of this study is to examine social differences in the use of psychotropic drugs among persons aged 65-74 years in the International Mobility in Aging Study (IMIAS). METHODS: The sample consisted of 1,995 participants in the IMIAS 2012 baseline study in Saint-Hyacinthe (Canada), Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). During home visits, all medication taken by the participants in the previous 15 days was recorded. We then used the Anatomical Therapeutic Chemical classification system to code psychotropic drugs as anxiolytics, sedatives, hypnotics (ASH); antidepressants (ADP); or analgesics, antiepileptics, or antiparkinsonians (AEP). Prevalence ratios for psychotropic drug use according to sex, education, income, and occupation were estimated by fitting a Poisson regression and controlling for demographic and health covariates. RESULTS: Psychotropic drug use was higher among Canadian participants than among those living outside Canada. Prevalence of AEP drug use was higher for women than men in the Canadian and Latin American sites. In Tirana, antidepressant drugs were rarely used. Socioeconomic differences varied among sites. In the Canadian cities, low socioeconomic standing was associated with higher frequency of psychotropic drug use. In the Latin American cities, elderly people with high education and income levels showed a higher level of antidepressant drug use, while people with manual occupations had a higher use of AEP drugs. In Tirana, ASH drug use was higher among those with low income. CONCLUSION: An inverse association was observed between socioeconomic standing and psychotropic drug use in Canada, while the opposite was true in Latin America. Albania was notable for an absence of antidepressant use and greater use of ASH drugs among low-income groups.

Factores de servicios de salud y satisfacción de usuarias asociados al acceso al control prenatal / Fatores de serviços de saúde e satisfação de usuarias associados ao aceso ao controle pré-natal / Factors of health services and users satisfaction associated to antenatal care access

Objetivo: Describir los factores de los servicios de salud y satisfacción de usuarias que se asocian con el acceso al control prenatal (CP) en instituciones de salud de Manizales y Cali. Materiales y métodos: Estudio de casos y de controles con una muestra de gestantes que asistieron al CP en 7 instituciones. Se aplicó un cuestionario para la recolección de información a 823 gestantes. Otro cuestionario fue aplicado a 4 enfermeras encargadas de manejar los programas de CP. La variable dependiente fue el acceso al CP y las independientes: la presencia de barreras administrativas, económicas, geográficas y percepción del trato, orientación brindada y aspecto físico de los servicios de salud. Las variables que indagaron por las estrategias de búsqueda activa fueron: proporción de gestantes inscritas en el primer trimestre, utilización de folletos y carteles informativos para generar conciencia sobre la importancia del acceso oportuno al CP. Resultados: Factores como la etnia (P = 0, 01), el tipo de afiliación al régimen de salud (P = 0,001), actividad de la madre en el último mes (P = 0,04), baja capacidad económica (P = 0,038), no estar afiliada al Sistema General de Seguridad Social en Salud (SGSSS) (P < 0,001) y la tramitología (P = 0,003) presentaron diferencias significativas entre los grupos. En ambos grupos se encontraron valoraciones positivas del trato, orientación y aspecto físico en los servicios de salud. Conclusiones: Aspectos como la disminución del gasto de bolsillo, las incomodidades derivadas de la atención y de las instalaciones, además del buen trato, respeto, empatía con las gestantes deben ser parte de los planes de mejoramiento de la calidad de la atención del CP

Objectives: Describe the Factors of health services and users’ satisfaction associated to the access to antenatal care (AC) at health institutions in Manizales and Cali. Materials and Methods: Case-control case study with a sample of pregnant women attending the AC in seven centers. A questionnaire was applied to 823 pregnant women to collect information. Another questionnaire was applied to four nurses in charge of the AC programs. The dependent variable was the access to the AC and the independent variables were the presence of administrative, economic, and geographic barriers, and perception of care, guidance provided and the physical appearance of health services. The variables that queried about active search strategies were: the proportion of pregnant women registered in the first trimester, use of brochures or posters raise awareness of timely access to AC. Results: Factors such as ethnicity (P = 0.01), the type of health insurance (P = 0.001), activity of the mother in the last month (P = 0.04), low economic capacity (P = 0.038), not being Affiliated to any health system (P < 0.001) and paperwork (P = 0.003) had significant differences between the groups. Both groups had positive opinions about treatment, counseling and physical appearance of health services. Conclusions: Aspects such as the decreased spending, the inconvenience arising from the care and facilities, in addition to good treatment, respect, empathy with pregnant women should be part of plans for the improvement of the quality of care of the AC

Objetivo: Descrever os fatores dos serviços de saúde e satisfação de usuárias que se associam com o aceso ao controle pré-natal (CP) em instituições de saúde de Manizales e Cali. Materiais e Métodos: Estudo de casos e de controles com uma amostra de gestantes que assistiram ao CP em 7 instituições. Aplicou se um questionário para a relação de informação a 823 gestantes. Outro questionário foi aplicado a 4 enfermeiras encarregadas de manejar os programas de CP. A variedade dependente foi o aceso ao CP e as independentes: A presencia de barreiras administrativas, econômicas, geográficas e percepção do trato, orientação brindada e aspeto físico dos serviços de saúde. As variáveis que indagaram pelas estratégias de busca ativa foram: proporção de gestantes inscritas no primeiro trimestre, utilização panfletos e cartaz informativos para gerar consciência sobre a importância do aceso oportuno ao CP. Resultados: Fatores como a etnia (P = 0, 01), o tipo de afiliação ao regime de saúde (P = 0,001), atividade da mãe no ultimo mês (P = 0,04), baixa capacidade econômica (P = 0,038), não estar afiliada ao Sistema Geral de Segurança Social em Saúde (SGSSS) (P < 0,001) e o excesso de tramites (P = 0,003) apresentaram diferencias significativas entre os grupos. Os dois grupos encontraram se valorações positivas do trato, orientação e aspecto físico nos serviços de saúde. Conclusões: Aspectos como a diminuição do gasto de bolso, o incomodam o derivado da atenção e das instalações, além do bom trato, respeito, empatia com as gestantes devem ser parte dos planos de melhoramento da qualidade da atenção do CP