Pancreatic cancer challenge in 52 Asian countries: age-centric insights and the role of modifiable risk factors (1990-2019).

Background: Pancreatic cancer is renowned for its elevated incidence and mortality rates on a global scale. The disease burden of pancreatic cancer is anticipated to increase, particularly in Asia, due to its vast and rapidly aging population. Methods: Data from the Global Burden of Disease 2019 were analyzed for pancreatic cancer burden across 52 countries in Asia, including the incidence, mortality, and disability-adjusted life years (DALY) for pancreatic cancer, with a focus on risk factors such as high body mass index (BMI), elevated fasting plasma glucose, and smoking. We applied the Estimated Annual Percentage Change, the Age-Period-Cohort model, and decomposition analysis to evaluate incidence trends and effects. Results: From 1990 to 2019, both incidence and mortality rates of pancreatic cancer in Asia significantly increased, with an average annual standardized incidence rate change of 1.73%. Males consistently exhibited higher rates than females, with smoking as a key risk factor. Central Asia reported the highest rates, and South Asia the lowest. The incidence rose with age, peaking in those aged 70~74. The disease burden increased in all age groups, particularly in populations aged 55 and above, representing 84.41% of total cases in 2019, up from 79.01% in 1990. Pancreatic cancer ranked the fifth in incidence among six major gastrointestinal tumors but presented a significant growth rate of mortality and DALY. Conclusion: With the growing, aging population in Asia, the pancreatic cancer burden is projected to escalate, bringing a significant public health challenge. Hence, comprehensive public health strategies emphasizing early detection, risk modification, and optimized treatment of pancreatic cancer are imperative.

Age-Friendly Approach Is Necessary to Prevent Depopulation: Resident Architectural Designers and Constructors' Evaluation of the Age-Friendliness of Japanese Municipalities.

Japan has the world's largest old population ratio; thus, aging is an urgent societal issue. As global trends seem to be following Japan's social changes, there is an emphasis on municipalities becoming more age-friendly. Hence, we examine the age-friendliness of 135 Japanese municipalities, selecting 240 resident architectural designers and constructors to assess their municipalities using the Age-Friendly Cities and Communities Questionnaire (AFCCQ). The findings indicate that Japan lacks "outdoor spaces and buildings". Additionally, the evaluation of "housing", "community support and health services", and "transportation" in populated municipalities in the past five years was found to be significantly higher than that in depopulated ones. Age-friendliness is significantly affected by the AFCCQ total score (hereafter, Score) based on "housing", "social participation", "community support and health services", "transportation", and "financial situation" evaluations. High specificity (0.939) was found when the score was treated as a marker of depopulation; an age-friendly approach is a necessary condition for preventing depopulation. Furthermore, a lack of "communication and information" was observed in municipalities with a higher rate of single-person households aged 65 years and older. Therefore, resident architectural designers' and constructors' assessments, combined with the AFCCQ, will be a powerful tool for evaluating the age-friendliness of municipalities.

What is the degree of social disability risk in China under the background of the aging population? Social disability risk measurement index system design and evaluation research based on China.

Objective: The impact of the aging population in China varies between regions. It is because regions with different resource endowments, such as those related to economy, population, and medical care, have different degrees of disability risk in the face of the increases in the disabled and semi-disabled older population caused by the overall aging of the population. This study aimed to construct an evaluation system to monitor and measure the degree of social disability risk in different regions in China and to evaluate and compare the degree of social disability risk in different regions using empirical data. Method: This study used the Delphi method to construct a social disability risk measurement index system with macro, meso, and micro dimensions. At the same time, based on the data of CHARLS2018, an AHP-entropy method was used to calculate the index's total weight, and the standard deviation classification method was used to classify the total and criterion-level measurement scores of 28 provinces. Results: The regional degree of social disability risk was analyzed in subdimensions. Our research indicates that China's social disability risk situation is not promising, with a general medium to high-risk level. The score of degree of social disability risk among provinces is consistent with the regional economic development level to a large extent. The risk of social disability varies significantly among the eastern and central, and western regions of China and the provinces within the three regions. Discussion: Currently, the situation facing the degree of social disability risk in China is that the overall risk level of the country is higher, and the difference between regions is significant. It is necessary to take measures to meet better the needs of the aging population and the disabled and semi-disabled older populations in a large-range, large-scale, multilevel way.

Gerontogeriatría en el curso propio "Envejecimiento". Plan de estudios "D" de la carrera de Medicina / Gerontogeriatrics in the own course "Aging". Study plan "D" of the Medicine career

Fundamento: el sector cubano de salud, además de garantizar una atención médico-social al adulto mayor, tiene la misión de formar los recursos humanos especializados en esta área del conocimiento, desde el pregrado en las carreras de las ciencias médicas, y de forma continua y sostenida hasta el posgrado; por lo que se precisa observar el tratamiento de los contenidos relacionados con la Gerontogeriatría en los planes de estudio. Objetivo: caracterizar la representación de la Gerontogeriatría en el curso propio "Envejecimiento" del Plan de estudios "D" de la carrera de Medicina en Cuba. Métodos: se realizó una investigación educativa observacional, descriptiva. Se desarrolló una amplia revisión documental de los planes de estudio y el diseño del curso propio "Envejecimiento" del Plan de estudios "D", precisando el análisis de sus contenidos y su aporte a la Gerontogeriatría. Resultados: se constató que el curso permite la enseñanza de la Gerontología y Geriatría, diseñado con tres objetivos y cinco temas, y contenidos que favorecen la formación gerontogeriátrica en el desempeño de la función de atención médica integral al particular proceso salud enfermedad que se expresa en el adulto mayor. Conclusiones: la Gerontogeriatría está presente en el curso propio "Envejecimiento", representada fundamentalmente con este diseño académico en todo el vigente Plan de estudios "D".

Background: the Cuban health branch, in addition to guaranteeing medical-social care for the elderly, has the mission of training specialized human resources in this area of knowledge, from undergraduate in medical sciences careers, and continuously and sustained until postgraduate; Therefore, it is necessary to observe the treatment of the contents related to Gerontogeriatrics in the study plans. Objective: to characterize the representation of Gerontogeriatrics in the own course "Aging" of the Study Plan "D" of the Medicine career in Cuba. Methods: an observational, descriptive educational research was carried out. An extensive documentary review of the study plans and the design of the own course "Aging" of the Study Plan "D" was carried out, specifying the analysis of its contents and its contribution to Gerontogeriatrics. Results: it was verified that the course allows the teaching of Gerontology and Geriatrics, designed with three objectives and five topics, and contents that favor gerontology and geriatric training in the performance of the function of comprehensive medical attention to the particular health-disease process that is expressed in the elderly. Conclusions: Gerontogeriatrics is present in the own course "Aging", fundamentally represented with this academic design throughout the current Curriculum "D".

[The demographic aging of population: regional trends in Russia].

The article considers evolution of research and views on challenges and menaces of demographic aging process in the works of national and foreign scientists. The characteristics of this process in regions of the Russian Federation consist in special diversity of social economic, climatic, geographical and mental conditions in which demographic processes proceed. This determined availability of various types and stages of demographic aging in regions of the Russian Federation as well as opportunities to temper negative consequences of this process.

Enabling Long-term Predictions and Cost-benefit Analysis Related to Housing Adaptation Needs for a Population Aging in Place: Protocol for a Simulation Study.

BACKGROUND: Policies that promote aging in place are common in Sweden and many other countries. However, the current housing stock cannot sufficiently accommodate a population aging in place considering how functional capacity and housing needs change as people age. To be suitable for all regardless of their functional ability, housing should be designed or adapted to facilitate the performance of activities of daily living. Long-term planning and plausible projections of development 20 to 30 years into the future are needed. OBJECTIVE: The overall aim is to develop simulation models that enable long-term predictions and analysis of potential consequences in terms of societal gains and costs for different large-scale measures and interventions in the ordinary housing stock. METHODS: This study is designed as a simulation study and will broadly apply health impact assessment methods in collaboration with five municipalities in Sweden. Individual interviews and research circles were used to identify current and prioritize potential new policies to improve the accessibility of the housing stock. We will run a series of simulations based on an estimated willingness to pay from discussions with the municipalities. Two to three different prioritized policies will be compared simultaneously using Markov cohort analysis to estimate the potential costs and health impact on the population. Using data from a systematic review and existing population-based data sets with individual-level data on home and health variables, we will calculate parameter estimates for the relations between housing accessibility and health outcomes. The potential impact of selected policy interventions will be estimated in several microsimulations representing people living in the community. Sensitivity analyses will be conducted for each simulation. RESULTS: As of April 2022, open access data was collected, and a systematic review was underway and expected to be completed by November 2022. Collaboration with five municipalities was established in autumn 2020. In spring 2021, the municipalities developed a list of prioritized policy interventions to be tested and used in the simulation models. Inventories of barrier frequencies in ordinary housing started in spring 2022 and are expected to be completed in autumn 2022. Data gathering and analyses for simulation inputs will be completed during 2022 followed by the simulation modeling analyses to be completed in 2023. CONCLUSIONS: Improved accessibility of the ordinary housing stock has the potential to maintain or improve the health of the aging population. This study will generate tools that enable long-term predictions and reliable cost-benefit estimates related to the housing adaptation needs for a population aging in place, thus providing support for the best-informed policy decisions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39032.

Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice-A Cross-Sectional Database Study.

Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18-40 years to 19.7% (41-64 years), 45.3% (65-80 years), and 64.6% (81-92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements. Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.

Protección al adulto mayor: necesario enfoque multidimensional por profesionales de la salud en Cuba / Protection of the elderly: a necessary multidimensional approach by health professionals in Cuba

RESUMEN Introducción: los pronósticos demográficos avizoran que el envejecimiento será uno de los más serios problemas que enfrente la humanidad en este siglo: de allí la necesidad del enfoque multidimensional por los profesionales de la salud. Objetivo: analizar con fines educativos los mecanismos existentes de protección del adulto mayor para un enfoque multidimensional por los profesionales de la salud en Cuba. Métodos: se realizó una revisión de fuentes bibliográficas en SciELO, Google Académico y artículos de revistas impresas y digitales. Se seleccionaron 25 textos por su pertinencia con el estudio. Se evaluaron publicaciones en idioma español de autores cubanos y extranjeros, fundamentalmente de países iberoamericanos. El análisis se centró en libros, tesis, documentos legales y artículos publicados en los últimos 10 años, aunque también se referencian otros de más larga data, por ser clásicos en el tema. Desarrollo: Se constató la existencia de varias políticas médicas y sociales para proteger los adultos mayores e instituciones jurídicas que pueden utilizarse. Para una correcta evaluación multidimensional, los profesionales del sector cubano de la salud necesitan conocer las regulaciones jurídicas referentes a los adultos mayores y el código de familia que regula el derecho de la población de la tercera edad. Conclusiones: Cuba se ubica entre los países con un estado de envejecimiento avanzado; la respuesta estatal al crecimiento del envejecimiento poblacional se ha dirigido, fundamentalmente, a la atención médica y la protección a través de la seguridad social.

ABSTRACT Introduction: demographic forecasts predict that aging will be one of the most serious problems facing humanity in this century: hence the need for a multidimensional approach by health professionals. Objective: to analyze for educational purposes the existing protection mechanisms for the elderly for a multidimensional approach by health professionals in Cuba. Methods: a review of bibliographic sources was carried out in SciELO, Google Scholar and articles from printed and electronic magazines. 25 texts were selected for their relevance to the study. Publications in Spanish by Cuban and foreign authors, mainly from Ibero-American countries, were evaluated. The analysis focused on books, theses, legal documents and articles published in the last 10 years, although others of longer standing are also referenced, as they are classics on the subject. Development: The existence of several medical and social policies to protect older adults and legal institutions that can be used was verified. For a correct multidimensional evaluation, professionals in the Cuban health branch need to know the legal regulations regarding the elderly and the family code that regulates the right of the elderly population. Conclusions: Cuba is located among the countries with a state of advanced aging; The state response to the growth of the aging population has been directed, fundamentally, at medical care and protection through social security.

AGING OF THE CHORNOBYL CATASTROPHE SURVIVORS AND PROBLEMS OF THEIR MENTAL HEALTH SURVEY. / STARINNIa POSTRAZhDALYKh VNASLIDOK ChORNOBYL'S'KOÏ KATASTROFY TA PROBLEMY DOSLIDZhENNIa ÏKhN'OGO PSYKhIChNOGO ZDOROV'Ia.

BACKGROUND: Depopulation processes in Ukraine have been affected by the Chornobyl catastrophe (ChC), but therate of demographic aging of survivors remains uncertain. Although the mental health disorders of the survivors arerecognized internationally, problems of their research remain unresolved. Thus, these areas of research are relevant.Objective is to determine the rate of demographic aging of survivors of the Chornobyl NPP (ChNPP) accident and toanalyze the state of their mental health survey, outlining solutions. MATERIALS AND METHODS: Information and statistical sources for 1986-2019 of the Ministry of Health of Ukraine andthe State Statistics Service of Ukraine on the age of the ChC survivors are used. The results of previous own researchand other scientists using the data of the Clinical and Epidemiological Register (CER) of the State Institution«National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼(NRCRM), the State Register of ChC survivors (SRU), and the Department of Radiation Psychoneurology, Institute ofClinical Radiology, NRCRM are integrated. Theoretical, general scientific, demographic and mathematical-statisticalresearch methods and documentary analysis are used. RESULTS: It is shown that in 2018, compared to 1995, the number of the ChC survivors, who are under the supervi-sion of the Ministry of Health of Ukraine, decreased by almost 987 thousand. The part of people born from personsof the 1st-3rd accounting groups increased in the structure of survivors (from 13.1 % in 1995 to 13.6 %), and thisdecreased in persons living or lived in the territories subject to supervision (75.1 % and 63.1 %, respectively), butin evacuees and Chornobyl clean-up workers (liquidators) this did not change significantly. A high level of aging ofthe ChC survivors (except for the 4th group) is revealed: liquidators - 59.0 %; evacuees - 25.0 %, and residents ofradioactively contaminated territories (RCT) - 30.7 %. It has been proved that the countries of RCT differ signifi-cantly in the number of the ChC survivors and their structure. The increase in the post-accident period indicators ofthe level of aging and the average age of the RCT population indicates negative changes in age parameters and theneed to continue research to identify factors «responsible¼ for such changes. Long-term mental health disordersand neuropsychiatric effects in the ChC survivors have been identified - an excess of cerebrovascular pathology andneurocognitive deficits, especially in liquidators, which may indicate an accelerated aging. Radiation risks havebeen revealed for acute and chronic cerebrovascular pathology and organic mental disorders of non-psychotic andpsychotic levels. Neurophysiological and molecular-biological atypia of aging processes under an exposure to lowdoses of and low dose rate of ionizing radiation have been found. The psyche under the age of 40 years old at thetime of exposure is more vulnerable. Existing statistical and registry data underestimate the level of mental disor-ders in the population of Ukraine, including the ChC survivors by an order of magnitude. CONCLUSIONS: The ChC survivors are aging in the country. The negative tendencies in age parameters of survival indi-cate the need to continue research to identify the factors «responsible¼ for such changes. Mental health disordersand neuropsychiatric effects in the ChC survivors are underestimated. It is necessary to create a national psychiatricregistry of Ukraine and long-term (lifelong) monitoring of survivors with well-planned clinical and epidemiologicalstudies of general and mental health with reliable dosimetric support based on national registries using the latest information technologies.

When Society Ages.

Russia is one of the demographically old countries of the world. The process of demographic aging in our country has a number of specific features associated with a change in the age structure of the population, which are determined by the second stage of depopulation; a significant lag in life expectancy indicators not only from economically developed but also from some developing countries; demographic asymmetry by gender; and rather low indicators of healthy life expectancy, which are calculated without accounting for the gender component, and with the burden of diseases dictated by age and accumulated before the age of 65. The current situation increases the relevance of the search for an effective way out of the process of demographic aging, based on strategic approaches to the formation of public health throughout the entire life cycle of a person, including representatives of older age groups.

Intervención educativa comunitaria para un envejecimiento activo y con calidad de vida / Community educational intervention for active and life quality aging

RESUMEN Fundamento: el envejecimiento poblacional caracteriza la sociedad cubana actual, por lo que se hace necesario promover acciones educativas para este grupo etario. Objetivo: elaborar una intervención educativa comunitaria que contribuya a un envejecimiento activo y con calidad de vida en los adultos mayores del Consejo Popular Falcón-Miller. Métodos: se realizó una investigación acción-participación en el Consejo Popular Falcón Miller, del municipio Placetas, Villa Clara, Cuba, entre septiembre 2019-junio 2020. Se emplearon métodos teóricos: histórico-lógico, análisis-síntesis e inductivo-deductivo; empíricos: análisis documental, entrevista a dirigentes locales y cuestionario a adultos mayores; y matemático-estadísticos, para los valores absolutos y relativos. Resultados: se diagnosticaron potencialidades y carencias en el consejo popular para fortalecer la calidad de vida en los adultos mayores que residen en la demarcación, y las necesidades de capacitación de algunos dirigentes locales, por lo que se elaboró una intervención educativa que responde a indicadores de salud, seguridad, participación, información y conocimientos de este grupo social en los diversos ámbitos. Fue valorada por criterios de especialistas. Conclusiones: el sistema de acciones propuesto en la intervención educativa es variado desde una concepción terapéutica, de capacitación y promoción de salud. Está dirigido a estimular la participación y a socializar conocimientos respecto a temáticas importantes para los adultos mayores, a la deconstrucción de estereotipos de vejez, así como a potenciar actividades educativas y de comunicación para aprender a convivir en un ambiente intergeneracional. Fue valorado como muy adecuado para su aplicación por los especialistas.

ABSTRACT Background: population aging characterizes current Cuban society, so it is necessary to promote educational actions for this age group. Objective: to develop a community educational intervention that contributes to active and life quality aging in the elderly of the Falcón-Miller People´s Council. Methods: an action-participation investigation was carried out in the Falcón Miller People´s Council, of the Placetas municipality, Villa Clara, Cuba, from September 2019 to June 2020. Theoretical methods were used: historical-logical, analysis-synthesis and inductive-deductive; empirical: documentary analysis, interview with local leaders and questionnaire for the elderly; and mathematical-statistical, for absolute and relative values. Results: potentialities and shortcomings were diagnosed in the People´s council to strengthen the quality of life in the elderly residing in the demarcation, and the training needs of some local leaders, for which an educational intervention was developed that responds to indicators of health, safety, participation, information and knowledge of this social group in the various fields. It was evaluated by criteria of specialists. Conclusions: the system of actions proposed in the educational intervention is varied from a therapeutic, training and health promotion concept. It is aimed at stimulating participation and socializing knowledge regarding important issues for the elderly, deconstructing old age stereotypes, as well as promoting educational and communication activities to learn to live together in an intergenerational environment. It was valued as very suitable for its application by the specialists.

[Bed capacity analysis for an intensive care unit : Retrospective analysis and projection for need of intensive care beds in over 65 year olds with selected cardiovascular diseases]. / Bettenkapazitätsanalyse für eine internistische Intensivstation : Retrospektive Analyse und Projektion des Intensivbettenbedarfs bei über 65-Jährigen mit ausgewählten kardiovaskulären Erkrankungen.

BACKGROUND: The increasing number of elderly individuals in the population and the simultaneous increase of the intensive care demand emphasizes the relevance of an efficient bed capacity analysis. Particularly, cardiovascular diseases represent a frequently occurring disease in the population group over 65 years of age. The objective of the following paper is the analysis of the retrospective and prospective intensive care demand by patients over 65 years with 6 selected (cardiovascular) codes of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). METHODS: For the retrospective analysis, data from 2015-2017 were analyzed applying descriptive and bivariate methods. The analysis of the intensive care bed demand was based on the queuing theory. RESULTS: The monthly capacity utilization rates were constantly higher than the target capacity utilization rate of a maximum of 80% and in some cases even higher than 100%. In particular, the demand of patients with I50.14 was very high throughout the entire hospital. The bed demand analysis shows an increase from 9 needed beds in 2017 to 11 beds by 2030 for the 6 diagnosis groups. Regarding the 5 diagnosis groups without I50.14, only approximately half of the required beds were needed, retrospectively and in future. CONCLUSION: The effect of demographic change on the intensive care demand already exists, and a continuing, prospective increase of the demand is expected. The results underline the need of effective and demand-oriented intensive care capacity planning. However, prior to expanding bed capacities, the analysis of admission criteria of intensive care unit patients is necessary to reserve capacities primarily for patients with real intensive care needs.

Longevidade e custo da assistência: o desafio de um plano de saúde de autogestão / Longevity and cost of care: the challenge of a self-managed health plan

Resumo O objetivo deste artigo é analisar a relação entre o custo da assistência e o envelhecimento da população assistida por um plano de autogestão, refletindo sobre possibilidades de enfrentamento do desafio advindo dessa conjunção de fatores. Trata-se de um estudo descritivo do período 1997 a 2016, efetivado a partir de dados secundários provenientes da operadora do plano de saúde em estudo, e outro banco administrativo de operadora de autogestão de grande abrangência nacional. Os idosos (mais de 60 anos) aumentaram no período do estudo 55,5%. Já os chamados "muito idosos" (acima de 80 anos) cresceram em quantidade 332,8%. A população acima de 60 anos corresponde a 25,7% do total sendo responsável por 68,8% das despesas. A grande maioria da população atendida (84,6%) está localizada no Estado no Rio de Janeiro, o qual tem o mais alto custo per capita em saúde no País. Foi encontrada relação entre o envelhecimento da população beneficiária e o aumento das despesas. É imperioso investir em iniciativas de promoção da saúde e prevenção de doenças como forma de melhora da qualidade de vida e viabilidade financeira do plano, além de definir um sub-sistema que delimite e discipline o acesso à rede e seja aceito pelos beneficiários.

Abstract This paper aims to analyze the relationship between the cost of health care and the aging of the population assisted by a self-managed plan, reflecting on the ways to address the challenge arising from this conjunction of population demographic changes. This is a descriptive study of the 1997-2016 period based on secondary data from the management operator of the health plan under study and from another administrative database of a self-managing provider with broad nationwide coverage. Older adults (over 60 years) increased 55% during the study period. On the other hand, the so-called "very old" (over 80 years) grew 332.8%. The population above 60 years corresponds to 25.7% of the total, and accounts for 68.8% of expenses. Most of the population covered (84,6%) is located in the State of Rio de Janeiro, which has the highest per capita health care cost in Brazil. We found a relationship between aging of the beneficiary population and increased expenditure. It is imperative to invest in health promotion and disease prevention initiatives as a way of improving the quality of life and financial sustainability of the plan, and define a subsystem that delimits and regulates access to the network and is accepted by the beneficiaries.

Conhecimento e atitude sobre a diatebes tipo 2 em idosos: estudo de base populacional / Knowledge and attitude towards type 2 diabetes among older adults: a population-based study

Resumo Esta pesquisa teve por objetivo verificar os fatores associados entre o conhecimento e a atitude sobre diabetes mellitus tipo 2 em idosos com a doença. Realizou-se um estudo transversal de base populacional com 204 idosos da rede pública de saúde de Passo Fundo, RS. Para a coleta de dados utilizou-se os questionários: sociodemográfico, de conhecimento DKN-A, de atitudes psicológicas do diabetes ATT-19 e o IPAQ para atividade física. Foi utilizada a regressão logística para as variáveis sociodemográficas, de saúde e os indicadores de adiposidade corporal. Foram realizadas análises brutas e ajustadas com um intervalo de confiança de 95%. Os resultados deste estudo identificaram que o bom conhecimento está associado com a idade maior ou igual 70 anos (OR = 0,44; IC95%: 0,18-1,08), ter atitude positiva para o tratamento da diabetes (OR = 10,4 IC95%: 4,20-18,70) e ser ativo fisicamente (OR = 12,7; IC95%: 6,8-30,10). Na associação com a atitude positiva se manteve associada significativamente a idade maior ou igual 70 anos (OR = 0,35; IC95%: 0,15-0,78), ter um bom conhecimento da diabetes (OR = 8,9; IC95%: 4,30-18,9) e ser ativo fisicamente (OR = 10,1; IC95%: 6,34-20,1). Portanto, o bom conhecimento e a atitude positiva estão associados à idade de 70 anos a mais e ser ativo fisicamente.

Abstract The aim of this study was to identify the factors associated with knowledge and attitude towards type 2 diabetes mellitus among older adults with the disease. A cross-sectional population-based study was conducted on 204 older adults from the public healthcare network of Passo Fundo, RS. Sociodemographic data were collected and the DKN-A, ATT-19 and IPAQ were used for the assessment of diabetes knowledge, psychological attitudes towards diabetes and physical activity, respectively. Logistic regression was applied to evaluate the association with sociodemographic and health variables and indicators of body adiposity. Crude and adjusted analyses were performed with a 95% confidence interval. The results showed that good knowledge is associated with age ≥ 70 years (OR = 0.44; 95%CI: 0.18-1.08), having a positive attitude towards diabetes treatment (OR = 8.9; 95%CI: 4.3-18.9), and being physically active (OR = 10.1; 95%CI: 6.34-20.1). In conclusion, good knowledge and a positive attitude towards diabetes are associated with age older than 70 years and being physically active.

[The impact of demographic aging on the pension systems.]

This article discusses the economic consequences of demographic aging. The relevance of this topic is substantiated. The research problem of this article is to assess the strength of the influence of demographic aging on the financial condition of the pension system in the world. Abstracts of the «macroeconomics of aging¼ theses are reviewed with respect to the financial condition of pension systems with an increase in the share of people over working age. A geographical analysis of deviations of the place of countries in the rating of sufficiency of retirement income and the rating of the Melbourne mercer global pension index from the place of countries in the ranking of demographic aging is carried out. The retirement income sufficiency rating for 48 countries, the Melbourne mercer global pension index rating for 25 countries and the UN developed Old age dependency ratio (OADR) are used as the information base. It is concluded that there is no significant correlation between the aging of the population on the one hand and the financial condition of pension systems on the other. Additionally, it was concluded that there is a certain pattern between the strength of the influence of demographic aging and the economic and geographical region. A possible theoretical justification of the thesis of the thesis «macroeconomics of aging¼ is given. Non-demographic factors of influence on the financial condition of pension systems are considered.

Necesidades de aprendizaje sobre el cuidado del enfermo de Parkinson en su ambiente familiar / Learning needs on the care of Parkinson's patients in their family environment

RESUMEN Fundamento: modificar estilos no saludables y alcanzar mayor y mejor calidad de vida en los adultos mayores con la enfermedad de Parkinson, incluye hacer intervenciones a nivel familiar partiendo de diagnósticos sobre su preparación para enfrentar esa sensible encomienda. Objetivo: determinar el nivel de conocimientos de las familias y sus necesidades de aprendizaje para el manejo del paciente con enfermedad de Parkinson. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal en el Consultorio Médico 2, del Policlínico Universitario "Luis Ángel Ortiz", en el municipio de Manzanillo, periodo enero-julio de 2017. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo; empíricos: la técnica de grupo focal y la encuesta en forma de cuestionario a los cuidadores; y matemático-estadísticos para los valores absolutos y relativos. Resultados: los grupos focales opinaron que los cuidadores tienen insuficiencia de conocimientos clínicos sobre la enfermedad, sus factores de riesgo, el tratamiento higiénico-dietético y rehabilitador, y valoraron como regular la asistencia de los enfermos con sus cuidadores a las consultas; estos constituyentes esenciales de necesidades de aprendizaje fueron corroborados por los propios cuidadores en el cuestionario aplicado. Conclusiones: se determinó la pertinencia de la elaboración de un programa educativo de orientación familiar, con énfasis en la promoción de salud, que contribuya a mejorar el manejo de los cuidadores a los enfermos de parkinson.

ABSTRACT Background: modifying unhealthy styles and achieving greater and better life quality in the elderly with Parkinson's disease includes making interventions at the family level based on diagnoses on their preparation to face this sensitive task. Objective: to determine the level of knowledge of families and their learning needs for the management of patients with Parkinson's disease. Methods: a descriptive, retrospective and longitudinal study was carried out in the doctor´s Office 2, "Luis Ángel Ortiz", University Polyclinic in Manzanillo municipality, from January-to July 2017. Theoretical methods were used: analysis-synthesis and inductive-deductive; Empirical ones: the focal group technique and the questionnaire survey to caregivers; and mathematical-statistics for absolute and relative values. Result: the focal groups were of the opinion that caregivers have insufficient clinical knowledge about the disease, its risk factors, hygienic-dietary and rehabilitative treatment, and valued as so-so the attendance of patients with their caregivers to consultations; these essential constituents of learning needs were corroborated by the caregivers themselves in the questionnaire applied. Conclusions: the relevance of the elaboration of an educational program of family orientation was determined, with emphasis on health promotion, which contributes to improve the management of caregivers to Parkinson's patients.

Pertinencia de la superación posgraduada en la atención al adulto mayor / Relevance of postgraduate upgrading in the care of the elderly

RESUMEN El envejecimiento poblacional que enfrentan Cuba en general y su provincia de Villa Clara como la de más habitantes envejecidos, requiere una mayor preparación de los especialistas en Medicina General Integral para la atención a este grupo poblacional que necesita un cuidado particular para lograr un envejecimiento saludable y con calidad de vida; por tal motivo los autores consideraron pertinente informar sobre una investigación realizada en tres etapas: la identificación de necesidades de aprendizaje de los referidos médicos, el diseño de un grupo de actividades de superación posgraduada para contribuir a elevar su preparación en la atención integral al adulto mayor, y su aprobación por criterios de especialistas para su implementación, a fin de solucionar la problemática que se analiza.

ABSTRACT The population aging that Cuba faces in general and its province of Villa Clara as that of more aging inhabitants, requires a greater preparation of the specialists in Comprehensive General Medicine for the attention to this age group that needs a particular care to achieve a good high quality and healthy ; for this reason, the authors considered it pertinent to report on an investigation carried out in three stages: the identification of learning needs of the referred doctors, the design of a group of postgraduate upgrading activities to help raise their preparation in comprehensive care for the elderly, and its approval by specialists criteria for its implementation, in order to solve the problem that is analyzed.

[Socioeconomic inequalities in health in later life]. / Soziale Ungleichheit und Gesundheit im höheren Lebensalter.

BACKGROUND: Socioeconomic differences in health and life expectancy are key issues for public health and health policy. In the course of demographic change, in addition to childhood, adolescence and middle adulthood, old age is increasingly becoming the focus of attention in research on health inequalities, with a special emphasis on the transition from working age to retirement. OBJECTIVE: How do health inequalities change in the transition from middle to older age and then to very old age? MATERIAL AND METHODS: This article reviews the studies available for Germany, supplemented with new analyses based on the German Health Update study and the German Socioeconomic Panel study. In order to set the findings in the context of international research on health inequalities in old age, selected studies from other countries and international comparative studies are additionally considered. RESULTS: Social differences in health and remaining life-expectancy also exist in older age, although to a slightly lesser extent than in middle age. There is evidence that as age progresses, health inequalities narrow in some health domains but there is also isolated evidence that health inequalities may widen with age. CONCLUSION: The existence of health inequalities in old age indicates that older people from disadvantaged social groups have a particular need for healthcare and support. This poses special challenges for the medical, nursing and psychosocial care system as well as for the social security systems.

Challenges facing the Cuban State arising from demographic aging. / Envejecimiento demográfico en Cuba y los desafíos que presenta para el Estado.

Demographic aging in Cuba, which has been occurring for over two decades, is undoubtedly an achievement of the country’s public health policies and social development. Although the State instituted a system of care aimed at guaranteeing elderly people favorable conditions for aging, the social achievement of greater longevity creates new challenges for social policy, infrastructure, healthcare systems and social inclusion. The Cuban population is diminishing and at the same time, life expectancy is increasing. These two conditions increase the proportion of people aged 60 and over, thus introducing a new scenario of an aging population. The present article analyzes some of the challenges that the Cuban State must face when developing policies that address and preserve the social achievement of a greater longevity, together with the conditions inherent in the development model that the country endorses.

El envejecimiento demográfico en Cuba, visualizado desde hace más de dos décadas, es indudablemente una conquista de las políticas de salud pública y del desarrollo social del país. Aunque el Estado instituyó un sistema de atención encaminado a garantizar a sus personas mayores condiciones favorables para su envejecimiento, el logro social de una mayor longevidad establece nuevos retos en materia de políticas sociales, infraestructuras y servicios de atención e inclusión social hacia el colectivo de los mayores. La población cubana se caracteriza por el decrecimiento y altos índices de esperanza de vida, que incrementan la proporción de personas de 60 y más años, aspecto que introduce un nuevo escenario gerontológico. El presente artículo se propone analizar algunos desafíos hacia el Estado cubano para la conformación de políticas que posibiliten la continuidad del logro social de una mayor longevidad en correspondencia con las condiciones coherentes con el modelo de desarrollo que el país refrenda.