[Dependence and necessities of non-covered services for the elderly in a health sector of Zaragoza]. / Dependencia y necesidades de cuidados no cubiertas de las personas mayores de una zona de Salud de Zaragoza.

BACKGROUND: Dependency to carry out the activities of daily living (ADL) and home care needs of older adults depend upon factors which are not well understood. Caregiving is mainly provided by the family. The aim of this study is to estimate the prevalence of ADL dependence and associated factors among older adults and to identify associated factors with unmet home care needs in people over age 75 in Zaragoza (Spain). METHOD: A cross-sectional study was conducted on a representative sample of the community dwelling population over age, 75 in one Health Care District in Saragossa in 1998 (n = 351). Data were collected during a personal interview. ADL dependency was assessed by the Katz index. Home care needs were assessed using prevalent norms for desired frequency of care. Sources of informal care, socio-demographic characteristics, self-rated health and depression (Yesavage Geriatric Depression Scale) were considered independent variables. Logistic regression was used to identify factors associated with both ADL dependency and unmet home care needs. RESULTS: Prevalence of ADL dependence is 37.3%. The variables predicting ADL dependence are the perception of poor health, depression, being a female and being over 85 years of age. The prevalence of unmet care needs among ADL dependent individuals is 22.1%. Sources of help are limited to the families. Being a woman and living alone are the stronger risk factors for unmet needs. CONCLUSIONS: A high percentage of older adults are dependent. Informal support is insufficient and confined to the family. The social and health care system in Spain should provide to the family, emotional, financial and social support and special care for disabled people living alone and with limited material resources.

Dependencia y necesidades de cuidados no cubiertas de las personas mayores de una zona de salud de Zaragoza / Dependency and Unmet Need of Care in Older People in a Health Area of Saragossa, Spain

Fundamento: El nivel de autonomía para las actividades del cuidado personal en personas mayores y la necesidad de apoyo no cubiertas dependen de diferentes factores poco conocidos en nuestro medio. Los cuidados en la dependencia se facilitan principalmente por el sistema informal de cuidados. El propósito del estudio es estimar la prevalencia de dependencia para las actividades del cuidado personal y los factores asociados, e identificar los factores asociados con las necesidades de cuidados no cubiertas en personas dependientes, en población mayor de 75 años de Zaragoza. Método: Se realizó un estudio transversal en una muestra representativa de la población no institucionalizada mayor de 75 años, en una Zona de Salud de Zaragoza, en el año 1998 (n=351). Los datos se cumplimentaron a través de una entrevista directa. Se utilizó el índice de Katz para valorar la capacidad funcional para las actividades del cuidado personal y un cuestionario ad hoc para el apoyo informal y el resto de variables. El apoyo informal, las características sociodemográficas, autopercepción de salud y depresión (Escala de Depresión de Yesavage) se consideraron como variables independientes. Se aplicó la regresión logística para identificar los factores asociados a la dependencia y necesidades de cuidados no cubiertas. Resultados: La prevalencia de dependencia para las actividades del cuidado personal es de un 37,3 per cent. Las variables que predicen la dependencia para las actividades del cuidado personal son una mala percepción de salud, depresión establecida, ser mujer y ser mayor de 85 años. La prevalencia de necesidades de apoyo no cubiertas en personas dependientes para las actividades del cuidado personal es de 22,1 per cent. El apoyo informal lo presta la familia. Ser mujer y vivir sola se presenta como un factor de riesgo para no tener las necesidades cubiertas, así como también no estar deprimido. Conclusiones: El porcentaje de personas mayores con dependencia es elevado. El apoyo informal es insuficiente y limitado a la familia. El modelo de atención a las personas mayores en España debería desarrollar servicios de apoyo emocional, económicos y sociales a la familia y establecer una especial atención sobre las personas con dependencia que viven solas y con escasos recursos materiales (AU)

[Effects of air pollution on daily mortality in the city of Zaragoza, Spain, 1991-1995]. / Efectos de la contaminación atmosférica sobre la mortalidad diaria en la ciudad de Zaragoza, España, 1991-1995.

OBJECTIVE: To analyze the short-term impact of air pollution on daily mortality in the City of Zaragoza (Spain). MATERIAL AND METHODS: This ecologic study was conducted in Zaragoza, Spain, from 1991 to 1993. Poisson autoregressive models were constructed to assess the association between air particulate matter and sulphur dioxide SO2 and daily deaths. Four outcome variables were studied: overall mortality (excluding external deaths), mortality in subjects over 69 years of age, mortality due to respiratory disease, and mortality due to cardiovascular disease. A sample size was not obtained. Data analysis was conducted using the statistical software EGRET and SPSS. RESULTS: SO2 levels were significantly associated with cardiovascular deaths (RR = 1.018 IC 95%: 1.001-1.036) and particulate matter levels with respiratory deaths (RR = 1.028 IC 95%: 1.006-1.051). During the warm season, a significant relationship was found between particulate mater and cardiovascular deaths (RR = 1.020 IC 95%: 1.001-1.040). CONCLUSIONS: Low levels of air pollution were found in Zaragoza, with considerable variation in the concentration of air pollutant concentrations and daily respiratory and cardiovascular deaths, particularly during the warm season. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[The EMECAM protocol: an analysis of the short-term effect of air pollution on mortality. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica u la Mortalidad]. / Protocolo EMECAM: análisis del effecto a corto plazo de la contaminacion atmosférica sobre la mortalidad.

The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in Saragossa, 1991-1995. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en Zaragoza, 1991-1995.

BACKGROUND: To assess the short-term impact of pollution on the respiratory death rate in the city of Saragossa throughout the 1991-1995 period and to pinpoint whether any differences exists in terms of age and time of the year. METHODS: The relationship of daily concentrations of smog and SO2 to the daily deaths due to respiratory diseases (CIE-9 460-486) and chronic lung blockage disease and similar EPOC-EA (490-496) was analyzed using Poisson models in keeping with the EMECAM procedure. Possible differences in the impact on those below and over age 70 and according to the six-month period in question were researched. Relative risks (RR) and 95% confidence, intervals (CI95%) WERE CALCULATED FOR 10 micrograms/m3 rises in pollutant. RESULTS: A relationship was found to exist between the respiratory and smog death rate (RR 1.028 CI95% 1.006-1051), the highest risk being during the six-months period of warm weather. For those individuals over age 70, the relationship remained the same throughout this six-month period and was negative for those individuals under age 70. The RR's for the death rate based on EPOC-EA were, overall, 1.038 (CI95% 1.002-1075) and of 1.068 (CI95%: 1.004-1.137) for the six-month period of warm weather. The SO2 pollution showed a positive relationship to the respiratory death rate for the warm period for all ages, RR 1.093 (CI95%: 1.006-1.187) and for those under age 70 (RR 1.240 CI95%: 1.028-1.496). The impact was not conclusive for the cases of pneumonia. CONCLUSIONS: Low levels of air pollution can have a significant impact on the respiratory death rate, especially among the elderly and during the six-month period of warm weather.