Elder abuse experienced by older Mexican women with disabilities: a current and retrospective view on domestic violence.

The objectives of this study were: 1) to estimate the prevalence of child abuse (CA), intimate partner violence (IPV), and elder abuse (EA) in a representative sample of older Mexican women by status, type, and cause of disability; and 2) to examine the associations of EA with CA, IPV, and disability status. We conducted a secondary data analysis of 21,718 women aged 60 years and older. Older women with disabilities had higher prevalences of CA, IPV, and EA than those with some difficulties or without disabilities. In older women whose disability was acquired at birth or due to aggression, this prevalence was especially high. Older women with disabilities and a history of CA and IPV were twice as likely to suffer EA. Policymakers and government leaders should incorporate the matter of violence against women with disabilities into their public agendas. This should be done while considering the women's various disabilities and causes of disability.

Divergences and gaps in life expectancy and health-adjusted life expectancy in Mexico: Contribution analysis of the Global Burden of Disease Study 2019.

INTRODUCTION: Life expectancy (LE) and Health-adjusted life expectancy (HALE) are summary indicators that reflect a population's general life conditions and measure inequities in health outcomes. The objective of this study was to identify the differences in LE and HALE by sex, age group, and state in Mexico from 1990 to 2019. Also, to evaluate whether the changes in HALE are related to sociodemographic indicators and indicators of access to and quality of health services. METHODS: A secondary analysis was performed based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD). Data were obtained for LE (by sex and state) and HALE (by sex, age group, and state) for the years 1990, 2010, and 2019. The correlations between HALE with the Socio-Demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index were estimated for 1990 and 2019 (by total population and sex). RESULTS: LE and HALE had an absolute increase of 6.7% and 6.4% from 1990 to 2019, mainly among women, although they spent more years in poor health (11.8 years) than men. The patterns of LE and HALE were heterogeneous and divergent by state. In 2019, the difference in HALE (for both sex) between the states with the highest (Hidalgo) and the lowest (Chiapas) value was 4.6 years. CONCLUSIONS: Progress in LE and HALE has slowed in recent years; HALE has even had setbacks in some states. Gaps between men and women, as well as between states, are persistent. Public and population policymaking should seek to lengthen LE and focus on ensuring that such years are spent in good health and with good quality of life.

Multimorbidity, Functionality, Socioeconomic and Behavioral Conditions Linked with Mortality in a Cohort of Adults: A Latent Class Analysis.

BACKGROUND: Aging and multimorbidity (MM) are not enough to explain patient heterogeneity and outcomes. The objective of this study was to estimate the effect of multimorbidity patterns and indicators of socioeconomic, behavioral, and functional dimensions on the risk of death in a cohort of people ≥50 years old. METHODS: We analyzed a cohort of 7,342 persons ≥50 years old from the Mexican Health and Aging Study (MHAS), stratified by age groups (50-64, 65-84, ≥85 years old). MM was defined as the co-occurrence of two or more chronic diseases (CDs), and additional analysis included functional, socioeconomic, and behavioral indicators. Prevalence was estimated using descriptive analysis. Latent class analysis (LCA) was used to identify MM patterns, and logistic regression models were performed to estimate the risk of death at two and 18 years of follow-up. RESULTS: The most prevalent conditions were chronic pain, depression, and hypertension, with 60% of the subjects exhibiting MM at the initial evaluation. In all three age groups, indicators of the functional dimension were identified as risk factors for death. Economic precariousness was an additional risk factor in the 65-84 age group while living without a partner was an added risk factor in the ≥85 age group. For the 50-64 age group, "poor" self-perception of health and lack of physical exercise were identified as long-term risk factors for death. CONCLUSION: MM is a complex phenomenon that requires the implementation of age-specific care models. Health, socioeconomic and behavioral conditions should be considered to mitigate the risk of premature death.

Psychometric Properties of the 11-Item De Jong Gierveld Loneliness Scale in a Representative Sample of Mexican Older Adults.

Recent studies have focused on the negative effects of loneliness on health and quality of life in older adults. The De Jong Gierveld Loneliness Scale (DJGLS) has been widely used and has proven to be a valid and reliable instrument for loneliness assessment. However, research on this topic and on the validation of measurement scales among the older population is still incipient. The objective of this study was to examine the psychometric properties of the Spanish version of the 11-item DJGLS in Mexican older adults. Data from a representative sample of cognitively intact older adults aged 60 years and over (mean, standard deviation [SD]) age = 72.0 years (SD 8.1) from two Mexican cities (n = 1913), interviewed face to face at their homes during 2018-2019, were analyzed. The psychometric properties of the DJGLS were examined, including (1) construct validity, examined by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), discriminate validity and convergent validity, (2) reliability, calculated using Cronbach's alpha. The overall data quality was high, and the scaling assumptions were generally met with few exceptions. Using EFA and CFA, the findings showed that the DJGLS presents a two-factor structure (Social Loneliness and Emotional Loneliness), with 11 items that explain 67.2% of the total variance. Reliability is adequate at the full-scale level (Cronbach´s α = 0.899), also for the two subscales Social and Emotional Loneliness (Cronbach´s α = 0.892 and 0.776, respectively). These results highlight that most participants with a low score for depressive symptoms and or with a high social support score belonged to the "No loneliness" group. The results showed that the Spanish version of the 11-item DJGLS is adequate for use in Mexican older adults and should be used not only for loneliness screening but also for social and emotional loneliness assessment.

Type 2 diabetes and depressive symptoms in the adult population in Mexico: a syndemic approach based on National Health and Nutrition Survey.

BACKGROUND: The syndemic approach allows the analysis of clusters of diseases that affect a population in contexts of geographic, social and economic inequalities at the same moment and time. This study aims to analyze, from a syndemic perspective, the relationship between type 2 diabetes (T2D) and depressive symptoms in Mexican adults and its association with individual, contextual and structural factors. METHODS: Observational, cross-sectional study based on secondary data from Mexico's National Health and Nutrition Survey 2018-19. The sample of this study consisted of 16 835 adults, which represented a total of 78 463 734 persons aged ≥ 20 years. Bivariate descriptive analyses were performed and logistic regression models were estimated to analyze the association between T2D and depressive symptoms with various co-variables. In addition, interactions between T2D and depressive symptoms with obesity, educational level, and socioeconomic status were tested. RESULTS: In the study population, 12.2% of adults aged 20 years and older self-reported having T2D, 14.7% had depressive symptoms and 2.8% had both diseases. There was a statistically significant relationship between T2D and depressive symptoms. The prevalence of T2D and depressive symptoms was higher compared to people who did not have these two conditions. Obesity increased the probability of having T2D, while violence was statistically associated with people having depressive symptoms. A low level of education increased the odds ratio of having T2D and depressive symptoms. CONCLUSION: The availability of analytical frameworks such as the syndemic perspective could help to identify areas of opportunity for decision making and actions for population groups that-because of their individual, contextual and structural disadvantages-are at greater risk of experiencing poorer health outcomes due to the presence of T2D and depressive symptoms.

Differences by Sex in the Presentation of Multimorbidity: Longitudinal Study in Mexican Adults Living in the Community, 2001-2018.

Background: Multimorbidity represents a challenge for public health because as populations age, its prevalence increases. The objectives were to describe by sex the multimorbidity patterns from 2001 to 2018 in a cohort of people ≥50 years and in a subcohort with multimorbidity to describe the trajectories and transitions. Materials and Methods: Secondary analysis of the cohort of adults ≥50 years in the Mexican Health and Aging Study. Sociodemographic, health, functionality, and mortality were analyzed. Descriptive analysis was performed, estimation of prevalence by sex and trajectories, and transitions of the multimorbidity patterns with alluvial diagrams. Results: In the full cohort, 53.3% were women and in the subcohort with multimorbidity 66.1%. In both sexes, more cases with multimorbidity were observed among people without schooling, without a job, with a fair or bad economic situation, and with fair or bad self-perception of their health. The chronic diseases (CDs) with the highest prevalence were diabetes mellitus (DM), hypertension (HT), and arthritis and the most prevalent multimorbidity patterns were HT+arthritis and DM+HT. Higher proportion of men transited early to death and the women to other patterns more complex. Conclusion: Women always had higher prevalence of multimorbidity from an early age and with more complex combinations of CDs, but men with multimorbidity died prematurely. It is important to analyze multimorbidity not only from a biological approach but also from a perspective that considers sex inequalities and allows for the development of specific interventions adapted to the particular needs of men and women.

The revictimization of older Mexican women: understanding the accumulation of multiple victimizations throughout a lifetime.

BACKGROUND: The victimization of women constitutes a human rights violation and a health risk factor. The central objectives of this study were to analyze the probability of revictimization among older adult Mexican women and to examine whether child abuse (CA) and/or intimate partner violence (IPV) are associated with a greater risk of elder abuse (EA) victimization. METHODS: We conducted a secondary data analysis of 18416 women 60 and older, based on data from the National Survey on the Dynamics of Household Relationships (2016), which is national and subnational representative. A descriptive analysis was carried out using retrospective self-reports of victimization experiences (CA, IPV, and EA). The prevalence of victimization and multiple victimizations in the various stages of the lives of women, as well as of revictimization among older adult women were obtained. Bayesian logistic regression models were used to examine the associations between victimization, multiple victimization, and EA victimization. RESULTS: A total of 17.3% of the older adult women reported EA in the last year; of these, 81.0% had been revictimized and 14.0% reported CA, IPV, and EA. The risk of EA rose among women who reported a combination of psychological and sexual CA, and psychological, physical and sexual CA and psychological and sexual IPV, and a psychological, economic, physical and sexual IPV. EA was higher among women who had suffered more than one type of violence. CONCLUSION: CA and IPV, particularly sexual abuse and psychological violence, can be risk factors for EA. Screening tools used to prevent and detect EA should include questions about domestic violence over the course of a person's lifetime.

Sociodemographic and Clinical Factors Associated with Severe Obesity in Adults.

BACKGROUND: In the last decades, obesity in general, including severe obesity (BMI ≥40 kg/m2), has increased disproportionately around the world, especially in low-income and lower-middle income regions. AIMS: To analyze sociodemographic and clinical characteristics of people with severe obesity in Mexico, as well as their associated factors. METHODS: A secondary analysis was carried out from the 2018-19 National Health and Nutrition Survey. Descriptive statistics and bivariate analyses by sex were used. Logistic models were estimated to identify the main factors associated with severe obesity. RESULTS: Of the total number of people with obesity in the country (2.2 million people), 3.6% had severe obesity, with an average age of 48.2. There were statistically significant differences by sex in the variables of age group, education, socioeconomic status, health insurance, hypertension, myocardial infarction, and heart failure. Being a woman, having hypertension, and hypertension/diabetes increased the odds of severe obesity. These associations were maintained when comparing people with a BMI <40 kg/m2, with those with a BMI ≥30 kg/m2 and a BMI <40 kg/m2. CONCLUSIONS: Severe obesity must appear on the Mexican political agenda. Data must be produced that can direct decision-making around the promotion of healthy lifestyles, and obesity prevention, treatment, and follow-up, based in people-centered care and through intersectoral strategies, multidisciplinary management, and holistic approaches.

Barriers to managing elder abuse in primary care services: experiences of healthcare providers in Mexico City.

The purpose of this study was to analyze the barriers to managing elder abuse from the perspective of primary care health workers in Mexico City. We performed an ethnographic qualitative-descriptive study. Thirty semi-structured interviews were conducted with healthcare providers associated with three health centers located in areas with medium and high levels of poverty. A phenomenological approach was used to identify themes, subthemes and codes. Three main types of barriers were found: 1) institutional framework; 2) professional competency limitations and the dominance of a biomedical vision; and 3) the invisibilization of elder abuse. These barriers, described by healthcare workers, highlight the complexity involved in integrating the treatment of elder abuse into primary care health services. It is necessary to develop public educational and preventive public policies for elder abuse that are coordinated both with support services to treat such cases as well as with programs to strengthen healthcare providers professional competency.

Comparison between Covid-19 and influenza A(H1N1) pandemic experiences and risk perception in a Mexican university / Experiencias y percepción de riesgo ante la influenza A(H1N1) y Covid-19 en universitarios mexicanos

Abstract: Objective: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a university population. Materials and methods: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. Measures: sociodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. Results: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. Conclusions: The perceptions and experiences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.

Resumen: Objetivo: Comparar las experiencias y percepciones de riesgo entre las pandemias de A(H1N1) y Covid-19 en universitarios. Material y métodos: Encuestas en línea comparables de las epidemias de influenza A(H1N1) -originada en México en 2009- y Covid-19. Evaluaciones: características sociodemográficas, conocimientos, información y comunicación, percepción de riesgo, salud física y mental, efectos en la vida cotidiana, conductas preventivas. Resultados: Participaron 24 998 sujetos; 51.36% de grupo de A(H1N1) y 48.63% del grupo de Covid-19. Se observaron diferencias en la percepción de las epidemias. En influenza A(H1N1) la preocupación fue el sentimiento más frecuente y para Covid-19, la ansiedad. En Covid-19 hubo mayor impacto en la economía familiar y mayor incertidumbre para el regreso a clases. Conclusión: Las percepciones y experiencias de las dos pandemias fueron similares, pero el impacto ha sido mucho mayor para Covid-19 especialmente en la gravedad, economía familiar, conductas preventivas y en la incertidumbre.

Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico.

BACKGROUND: The literature refers that falls are of multifactorial origin, and some authors have proposed to classify risk factors as intrinsic and extrinsic. OBJECTIVE: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in older adults who receive medical care at the Mexican Institute of Social Security. METHODS: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. RESULTS: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. CONCLUSIONS: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

ANTECEDENTES: Las caídas tienen un origen multifactorial. OBJETIVO: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. MÉTODOS: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. RESULTADOS: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. CONCLUSIONES: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Factores intrínsecos y extrínsecos asociados con caídas en adultos mayores: estudio de casos y controles en México / Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico

Resumen Antecedentes: Las caídas tienen un origen multifactorial. Objetivo: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. Métodos: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. Resultados: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. Conclusiones: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Abstract Background: Falls have a multifactorial origin. Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in elderly. Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

Comparison between Covid-19 and influenza A(H1N1) pandemic experiences and risk perception in Mexican university.

OBJECTIVE: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a univer-sity population. MATERIALS AND METHODS: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. MEASURES: so-ciodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. RESULTS: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. CONCLUSIONS: The perceptions and ex-periences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.

Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach.

BACKGROUND: Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis. METHODS: This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach. RESULTS: It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment. CONCLUSION: Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017.

OBJECTIVE: To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017. DESIGN: Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017. PARTICIPANTS: Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved. METHODS: We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017. RESULTS: From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population. CONCLUSIONS: Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.

Epidemiology, progression, and predictive factors of urinary incontinence in older community-dwelling Mexican adults: Longitudinal data from the Mexican Health and Aging Study.

AIMS: To understand the epidemiology, progression, and predictive factors of urinary incontinence (UI) in community-dwelling Mexican adults aged ≥ 50 by sex and UI subtypes (stress, urge, and mixed). METHODS: We analyzed longitudinal UI data in community-dwelling adults aged ≥ 50 (7783 women and 5843 men) for the 2012 to 2015 period of the Mexican Health and Aging Study. We estimated mixed, stress, and urgency incontinence prevalence (2012); 2-year cumulative incidence and remissions (2015); and progression (2012-2015). A multivariate analysis was undertaken to evaluate the predictive factors for UI and its subtypes by sex. RESULTS: The prevalence of UI was higher (27.7%) for women (average age 65.9 ± 9.5) than 12.5% men (average age 67.4 ± 9.3) and increased with age in both sexes (26.7% in women 50 to 59, to 48.5% in ≥ 90; and 6.8% in men 50 to 59, to 26.2% ≥ 90). The most frequent UI subtypes were mixed in women and urge in men. The cumulative incidence of UI was higher in women (22.9%) than men (12.3%) while its remission was higher in men than women. Predictive factors for UI in both sexes were depressive symptoms, a higher number of concomitant diseases and a history of falls; while advanced age was a factor only for men. CONCLUSIONS: UI is a common health problem and its prevalence and severity increase with age. Addressing modifiable risk factors such as depression and falls could decrease the prevalence and incidence of UI and its subtypes. Further studies should also focus on the relationship between mixed UI and male mortality.

Factors associated with environmental barriers of people with disabilities in Mexico.

OBJECTIVE: To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico. METHODS: In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used. RESULTS: The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment. CONCLUSIONS: This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.

Factors associated with environmental barriers of people with disabilities in Mexico

ABSTRACT OBJECTIVE: To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico. METHODS: In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used. RESULTS: The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment. CONCLUSIONS: This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.

Potentially inappropriate prescribing to older adults in ambulatory care: prevalence and associated patient conditions.

PURPOSE: To analyze potentially inappropriate prescribing (PIP), its prevalence and patient conditions associated with this phenomenon, in a cohort of older adults receiving outpatient care in Mexico. METHODS: Data from 1252 adults ≥ 60 years of age, from primary care centers were analyzed. Information included sociodemographic data, medications, chronic diseases, polypharmacy (≥ 5 medications), functional dependence, cognitive impairment and frailty. Three logistic regression models were employed to identify associations between PIP (according to the Beers criteria) and different variable combinations. RESULTS: A total of 41.8% of participants had at least one PIP. The most frequently identified PIPs involved nonsteroidal anti-inflammatory drugs (NSAIDs) and glibenclamide; clonazepam in patients with cognitive impairment; and interactions of warfarin with NSAIDs. In the multivariate analyses, Model 1 showed that frailty and polypharmacy were associated with PIP. In Model 2, only polypharmacy was associated with PIP. For Model 3, lower educational levels, taking hypoglycemics, nervous system disease drugs, antiasthmatics, gastrointestinal disease drugs and anti-inflammatories-antirheumatics and analgesics, were associated with PIP. CONCLUSION: PIP is common in outpatient treatment of health care services in Mexico. Its association with medical and nonmedical factors highlights the need to improve drug treatment quality focused on implementation of effective strategies, such as educative interventions, electronic medication safety alerts, and inclusion of pharmacists in the health team.