[Functional dependence and support for the older persons in Mexico, 2001-2026Dependência funcional e apoio em idosos no México, 2001-2026]. / Dependencia funcional y apoyo para personas mayores de México, 2001-2026.

OBJECTIVES: Identify the factors associated with future functional dependence in the elderly in Mexico and with receiving or not receiving support for basic activities of daily living (ADLs); and project the prevalence of functional dependence in 2026. METHODS: Data from the 2001 National Health and Aging Study (ENASEM) and from the 2012 and 2015 follow-up rounds were used. A multinomial logistic regression model was used to analyze factors associated with future dependence, and a logistic regression model was used for factors associated with receiving or not support. The projected number of older persons with functional dependence in 2026 was based on data from the 2015 ENASEM and on estimated rates from the model of future dependence. RESULTS: Older people, those with a lower educational level, those with hypertension, arthritis, or diabetes, those who had suffered a stroke or fall, and those with some degree of prior functional dependence had a significantly higher risk of mild or severe dependence and death within 11 years, compared to the reference group. Older people and those with severe dependence had higher odds of receiving support compared to reference groups. By 2026, it is estimated that 18.9% of older people in Mexico will have mild dependence and 9.3% will be severely dependent. CONCLUSIONS: Factors associated with future dependence and death were age, educational level, certain chronic diseases, having fallen, and having prior functional dependence; the factors associated with receiving support for basic ADLs were severe dependence and age. It is estimated that the prevalence of dependence will increase 2.1 times over 25 years (2001-2026).

OBJETIVOS: Identificar os fatores associados à dependência funcional futura e a receber apoio para a realização das atividades básicas da vida diária (ABVD) em pessoas idosas e fazer uma projeção da dependência funcional nesta população no México em 2026. MÉTODOS: Analisaram-se dados obtidos no Estudo Nacional de Saúde e Envelhecimento do México (ENASEM) de 2001 e em rodadas subsequentes da pesquisa de 2012 e 2015. Utilizou-se um modelo de regressão logística multinomial para analisar os fatores associados à dependência funcional futura da pessoa idosa e um outro modelo de regressão logística para analisar os fatores associados a receber apoio. As projeções para 2026 de idosos em situação de dependência foram feitas com base nos dados do ENASEM de 2015 e nas estimativas do modelo de dependência futura. RESULTADOS: Idade avançada, nível de escolaridade mais baixo, ter hipertensão, artrite, diabetes, história de embolia cerebral ou quedas e possuir algum grau de dependência funcional anterior foram os fatores que se associaram a um risco significativamente maior de dependência funcional (leve ou grave) e morte nos 11 anos seguintes em comparação aos grupos de referência. Idosos com idade avançada ou dependência grave apresentaram uma maior probabilidade de receber apoio para a realização das ABVD em comparação aos grupos de referência. A projeção para 2026 no México é que 18,9% das pessoas idosas terão dependência leve e 9,3% dependência grave. CONCLUSÕES: Os fatores associados a dependência funcional futura e morte foram idade, nível de escolaridade, certas doenças crônicas, história de quedas e dependência funcional anterior. Ter idade avançada e dependência grave severa foram os fatores associados a receber apoio para a realização das ABVD. Estima-se que a prevalência de dependência funcional em pessoas idosas aumentará 2,1 vezes em 25 anos (2001-2026).

Dependencia funcional y apoyo para personas mayores de México, 2001-2026

[RESUMEN]. Objetivos. Identificar los factores asociados con la dependencia funcional futura de las personas mayores en México, así como con recibir o no apoyo para la realización de actividades básicas de la vida diaria (ABVD), y proyectar la prevalencia de la dependencia funcional en 2026.Métodos. Se utilizaron los datos del Estudio Nacional de Salud y Envejecimiento (ENASEM) del 2001 y las rondas de seguimiento de 2012 y 2015. Se estimó un modelo de regresión logística multinomial para analizar los factores asociados con la dependencia futura y un modelo de regresión logística para los factores asociados con recibir o no apoyo. Para las proyecciones de personas mayores en situación de dependencia en 2026 se utilizaron los datos del ENASEM del 2015 y los coeficientes estimados del modelo de dependencia futura.Resultados. Las personas de más edad, las que tenían un nivel de educación más bajo, las que padecían de hipertensión, artritis, diabetes, las que habían sufrido una embolia cerebral o alguna caída, y las que tenían algún nivel de dependencia funcional previa presentaron un riesgo significativamente mayor de dependencia (leve o severa) y de fallecer en los 11 años siguientes respecto a sus referencias. Las personas de mayor edad o con dependencia severa tuvieron mayores probabilidades de recibir apoyo respecto a sus referen-cias. Para el año 2026, se estima que el 18,9% de las personas mayores en México tendrá dependencia leve y el 9,3% dependencia severa.Conclusiones. Los factores asociados con la dependencia futura y con fallecer fueron la edad, el nivel educacional, algunas enfermedades crónicas, haberse caído y tener dependencia funcional previa; los factores asociados con recibir apoyo para la realización de ABVD fueron tener dependencia severa y la edad. Se estima que la prevalencia de la dependencia aumentará 2,1 veces en 25 años (2001-2026).

[ABSTRACT]. Objectives. Identify the factors associated with future functional dependence in the elderly in Mexico and with receiving or not receiving support for basic activities of daily living (ADLs); and project the prevalence of functional dependence in 2026.Methods. Data from the 2001 National Health and Aging Study (ENASEM) and from the 2012 and 2015 follow-up rounds were used. A multinomial logistic regression model was used to analyze factors associated with future dependence, and a logistic regression model was used for factors associated with receiving or not support. The projected number of older persons with functional dependence in 2026 was based on data from the 2015 ENASEM and on estimated rates from the model of future dependence.Results. Older people, those with a lower educational level, those with hypertension, arthritis, or diabetes, those who had suffered a stroke or fall, and those with some degree of prior functional dependence had a significantly higher risk of mild or severe dependence and death within 11 years, compared to the reference group. Older people and those with severe dependence had higher odds of receiving support compared to reference groups. By 2026, it is estimated that 18.9% of older people in Mexico will have mild dependence and 9.3% will be severely dependent.Conclusions. Factors associated with future dependence and death were age, educational level, certain chronic diseases, having fallen, and having prior functional dependence; the factors associated with receiving support for basic ADLs were severe dependence and age. It is estimated that the prevalence of dependence will increase 2.1 times over 25 years (2001-2026).

[RESUMO]. Objetivos. Identificar os fatores associados à dependência funcional futura e a receber apoio para a reali-zação das atividades básicas da vida diária (ABVD) em pessoas idosas e fazer uma projeção da dependência funcional nesta população no México em 2026.Métodos. Analisaram-se dados obtidos no Estudo Nacional de Saúde e Envelhecimento do México (ENASEM) de 2001 e em rodadas subsequentes da pesquisa de 2012 e 2015. Utilizou-se um modelo de regressão logís-tica multinomial para analisar os fatores associados à dependência funcional futura da pessoa idosa e um outro modelo de regressão logística para analisar os fatores associados a receber apoio. As projeções para 2026 de idosos em situação de dependência foram feitas com base nos dados do ENASEM de 2015 e nas estimativas do modelo de dependência futura.Resultados. Idade avançada, nível de escolaridade mais baixo, ter hipertensão, artrite, diabetes, história de embolia cerebral ou quedas e possuir algum grau de dependência funcional anterior foram os fatores que se associaram a um risco significativamente maior de dependência funcional (leve ou grave) e morte nos 11 anos seguintes em comparação aos grupos de referência. Idosos com idade avançada ou dependência grave apresentaram uma maior probabilidade de receber apoio para a realização das ABVD em comparação aos grupos de referência. A projeção para 2026 no México é que 18,9% das pessoas idosas terão dependên-cia leve e 9,3% dependência grave.Conclusões. Os fatores associados a dependência funcional futura e morte foram idade, nível de escolari-dade, certas doenças crônicas, história de quedas e dependência funcional anterior. Ter idade avançada e dependência grave severa foram os fatores associados a receber apoio para a realização das ABVD. Esti-ma-se que a prevalência de dependência funcional em pessoas idosas aumentará 2,1 vezes em 25 anos (2001-2026).

Snapshot of the Use of Urban Green Spaces in Mexico City during the COVID-19 Pandemic: A Qualitative Study.

The present qualitative research explores the factors that have influenced the use of urban green spaces (UGS) in Mexico City during the COVID-19 pandemic and the implications of their usage on residents' well-being. This study was conducted using a combination of solicited audio and written diaries, photography, and in-depth interviews with 16 participants, aged 22 to 58. The article provides a critical reflection on the incentives and deterrents to the UGS use of participants while social distancing measures were in place. The results show that in Mexico City: (1) participants' lack of access to UGS has hampered their use, mainly among those of low-income neighborhoods; (2) UGS size did not directly impact participants' UGS use during the pandemic; and (3) women were deterred from accessing UGS due to safety concerns related to the fear of violence. Overall, the results suggest that UGS use has served as a coping mechanism to decrease the effects of stress and isolation caused by the pandemic, increasing users' physical and mental well-being. This study's conclusions can help develop future citizen participation tools that are useful for resilience in urban design, as they provide interesting insights into the perceptions of residents, such as the most valued characteristics of UGS.

A turnaround strategy: improving equity in order to achieve quality of care and financial sustainability in Italy.

BACKGROUND: Equity, financial sustainability, and quality in healthcare are key goals embraced by universal health systems. However, systematic performance management strategies for achieving equity are still weaker than those aimed at achieving financial sustainability and quality of care. Using a vertical equity perspective, the overarching aim of this paper is to examine how improving equity in quality of care impacts on financial sustainability. We applied a simulation to indicators of the heart failure clinical pathway in Tuscany (central Italy), in order to quantify the equity gaps and financial resources that could be reallocated in the absence of performance inequities. METHODS: The analysis included all patients hospitalized for heart failure as a principal diagnosis in 2014. We selected five indicators: hospitalization rate, 30-day readmission, cardiology visits, and the utilization of beta-blockers, and ACE inhibitors and sartans. For each indicator, the simulation followed three steps: 1) stratification by socioeconomic status (SES), using education as a proxy for SES; 2) computation of the vertical equity indicator; and 3) assessment of the financial value of the equity gap. RESULTS: All indicators showed performance gaps regarding inequities across SES-groups. For the hospitalization rate and 30-day readmission, resources could have been reallocated, if the performance of patients with a low SES had been equal to the performance of patients with a high SES, which amounted to €2,144,422 and €892,790 respectively. In contrast, limited additional resources would have been required for prescriptions and cardiology visits. CONCLUSIONS: Reducing equity gaps by improving the performance of low-SES patients may be a crucial strategy to achieving financial sustainability in universal coverage healthcare systems. Universal healthcare systems, which aim to pursue financial sustainability and quality of care, are thus urged to develop performance management actions to improve equity. This approach should not only include the measurement and public disclosure of equity indicators but be part of a comprehensive evidence-based strategy for the management of chronic conditions along the clinical pathway.

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy.

BACKGROUND: There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). METHODS: A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). RESULTS: Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47-0.94; OR age > 75 years 0.72, 95% CI:0.54-0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58-0.93). CONCLUSIONS: Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

"Peri-border" health care programs: the Ecuador-Peru experience.

OBJECTIVE: To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. METHODS: A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. RESULTS: The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. CONCLUSIONS: Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system.

"Peri-border" health care programs: the Ecuador-Peru experience / Programas de atención de salud en zonas fronterizas: la experiencia de Ecuador y Perú

OBJECTIVE: To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. METHODS: A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. RESULTS: The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. CONCLUSIONS: Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system.

OBJETIVO: Determinar los principales puntos fuertes y débiles, y las dificultades del programa de atención de salud en la zona fronteriza entre Ecuador y Perú, y analizar las disposiciones legislativas, de gestión y de organización adoptadas para integrar los sistemas nacionales de salud de ambos países en la zona fronteriza. MÉTODOS: Se llevó a cabo un estudio de casos descriptivo y cualitativo mediante el empleo de tres métodos complementarios: la revisión bibliográfica y el análisis de documentos oficiales peruanos y ecuatorianos, nacionales y binacionales; 18 entrevistas semiestructuradas a informantes clave; y una encuesta dirigida a todo el personal sanitario de la microrred binacional Suyo-Macará. RESULTADOS: La principal dificultad del programa estribó en la ausencia de reciprocidad; los ciudadanos peruanos tenían derecho a servicios de atención de salud gratuitos en Ecuador, pero los ciudadanos ecuatorianos no recibían la misma prestación en Perú. También se señaló la necesidad de mejoras en materia de recursos humanos del sistema binacional. La principal fortaleza del programa fue su estructura organizativa, diseñada principalmente para la implantación de 1) la red binacional; y 2) un sistema de referencia y contrarreferencia de los pacientes que incluye la transferencia de la información clínica de los pacientes. CONCLUSIONES: A pesar de las considerables dificultades, los programas de atención de salud en zonas fronterizas son factibles y reproducibles. El éxito de los programas parece depender en gran medida de que se cumplan una serie de condiciones tales como 1) la consolidación del memorándum binacional original mediante un acuerdo binacional vinculante entre ambos países; 2) la consecución de estándares similares en ambos países en cuanto a la provisión y la calidad de los servicios de atención de salud, con especial hincapié en la complementariedad; y 3) la creación de un sistema binacional de información integrado.