Combining Spirometry and the ARISCAT Respiratory Risk Assessment Can Improve Postoperative Outcomes and Reduce Mortality Risk in Mexico.

Introduction: Although a major goal of preoperative evaluation is to identify risk factors and improve postoperative outcomes, current clinical guidelines in Mexico indicate that preoperative spirometry should only be performed on patients with pulmonary disease. The aim of this study was to compare the incidence of postoperative complications (POC), mortality, and risk factors among adults who did or did not undergo preoperative spirometry, based on their Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk level. Material and methods: An observational, retrospective and comparative study design was used to identify 2059 patients from the General Hospital of Mexico who had an ARISCAT assessment during 2013-2017. Patients were classified in two groups: ARISCAT with spirometry (n = 1306) and ARISCAT without spirometry (n = 753). Chi-square, Fisher's exact test and the Student's t-tests were used to compare groups. Logistic regression was used to identify factors associated with an increased risk of POC and mortality. Results: In the ARISCAT with spirometry group, 11% of patients had POC, compared with 48% of patients in the ARISCAT without spirometry group. High-risk ARISCAT patients who did not receive spirometry had higher mortality (18%), than those who underwent spirometry (0.4%). Logistic regression results indicate that not performing preoperative spirometry increases the probability of POC and mortality. Conclusions: Our findings suggest that the combined use of preoperative spirometry and ARISCAT is associated with reduced POC and mortality. Future clinical guidelines should recommend the use of preoperative spirometry for patients with a moderate or high ARISCAT level in Mexico.

Introducción: La evaluación preoperatoria se centra en identificar los factores de riesgo y mejorar los resultados posoperatorios; las guías clínicas actuales en México indican la espirometría preoperatoria solo en pacientes con enfermedad pulmonar. El objetivo fue comparar la incidencia de complicaciones posoperatorias (CPO), la mortalidad y los factores de riesgo en pacientes clasificados por su nivel de riesgo de la escala de riesgo respiratorio en pacientes quirúrgicos de Cataluña (ARISCAT) sometidos o no a una espirometría preoperatoria. Material y métodos: Estudio observacional, retrospectivo y comparativo. Se clasificaron 2.059 pacientes del Hospital General de México durante 2013 a 2017; en dos grupos: ARISCAT con espirometría (n = 1.306) y ARISCAT sin espirometría (n = 753). Se aplicaron pruebas de X2, f de Fisher y t de Student para comparar los grupos y análisis de regresión logística para identificar los factores asociados a mayor riesgo de CPO y mortalidad. Resultados: Las CPO en el grupo ARISCAT con espirometría se presentaron en 11% de los pacientes, en comparación con el grupo ARISCAT sin espirometría (48%). Los pacientes ARISCAT sin espirometría de alto riesgo tuvieron una mortalidad más elevada (18%), en comparación con los pacientes que sí la realizaron (0.4%). Los resultados de la regresión logística indican que no realizar la espirometría preoperatoria incrementa la probabilidad de CPO y mortalidad. Conclusiones: Nuestros hallazgos sugieren que el uso combinado de espirometría preoperatoria y ARISCAT se asocia con menores CPO y mortalidad. Las guías clínicas futuras deberán recomendar el uso de la espirometría preoperatoria para pacientes con un nivel moderado o alto de ARISCAT en México.

Direct medical cost of COVID-19 in children hospitalized at a tertiary referral healthcare center in Mexico City.

Introduction: Despite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations. Objective: To estimate the direct medical costs of COVID-19, focusing on children in Mexico. Method: Data about resources consumed during hospital stays were extracted from the medical records of patients hospitalized at a Mexican tertiary healthcare institution. Other sources of information were the unit prices of inputs and the salaries of health personnel. A micro-costing methodology was used to obtain cost results by age group over different hospital areas. Data analysis was performed with descriptive statistics and regression models to evaluate the predictors of total cost. Results: One hundred and ten medical records were reviewed of which 57.3% corresponded to male patients and the mean age was 7.2 years old. The estimated average cost per patient was US$5,943 (95% CI: US$4,249-7,637). When the costs of the three clinical areas were summed, only the 5-10 years old group showed a maximum cost of US$14,000. The regression analysis revealed the following factors as significant: sex, age, staying at an emergency room, having a positive bacterial culture, and having comorbidities. Discussion: The cost results were somewhat similar to those reported in children from the USA, but only regarding low severity COVID-19 cases. However, comparability between these types of studies should be done with caution due to the huge differences between the healthcare systems of countries. The study cost results may help public decision-makers in budget planning and as inputs for future cost-effectiveness studies about interventions regarding COVID-19.

Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico.

Background: An automated hand-hygiene monitoring system (AHHMS) was implemented in October 2019 at the Hospital Infantil de México Federico Gómez (HIMFG), a tertiary pediatric referral hospital, in four of the hospital wards with the highest rates of Healthcare Associated Infections (HAIs). The clinical and economic impact of this system had not yet been assessed prior to this study. This study aimed to evaluate if the AHHMS is a cost-effective alternative in reducing HAIs in the HIMFG. Methodology: A full cost-effectiveness economic assessment was carried out for the hospital. The alternatives assessed were AHHMS implementation vis-a-vis AHHMS non-implementation (historical tendency). The outcomes of interest were infection rate per 1,000 patient-days and cost savings as a result of prevented infections. Infection rate data per 1,000 patient-days (PD) were obtained from the hospital's Department of Epidemiology with respect to the AHHMS. As regards historical tendency, an infection-rate model was designed for the most recent 6-year period. Infection costs were obtained from a review of available literature on the subject, and the cost of the implemented AHHMS was provided by the hospital. The assessment period was 6 months. The incremental cost-effectiveness ratio was estimated. Costs are reported in US Dollars (2021). Univariate sensitivity and threshold analysis for different parameters was conducted. Results: The total estimated cost of the AHHMS alternative represented potential savings of $308,927-$546,795 US Dollars compared to non-implementation of the system (US$464,102 v. US$773,029-$1,010,898) for the period. AHHMS effectiveness was reflected in a diminished number of infections, 46-79 (-43.4-56.7%) compared to non-implementation (60 v. 106-139 infections). Conclusion: The AHHMS was found to be a cost-saving alternative for the HIMFG given its cost-effectiveness and lower cost vis-a-vis the alternate option. Accordingly, the recommendation was made of extending its use to other areas in the hospital.

Patterns of Muscle-Related Risk Factors for Sarcopenia in Older Mexican Women.

Early detriment in the muscle mass quantity, quality, and functionality, determined by calf circumference (CC), phase angle (PA), gait time (GT), and grip strength (GSt), may be considered a risk factor for sarcopenia. Patterns derived from these parameters could timely identify an early stage of this disease. Thus, the present work aims to identify those patterns of muscle-related parameters and their association with sarcopenia in a cohort of older Mexican women with neural network analysis. Methods: Information from the functional decline patterns at the end of life, related factors, and associated costs study was used. A self-organizing map was used to analyze the information. A SOM is an unsupervised machine learning technique that projects input variables on a low-dimensional hexagonal grid that can be effectively utilized to visualize and explore properties of the data allowing to cluster individuals with similar age, GT, GSt, CC, and PA. An unadjusted logistic regression model assessed the probability of having sarcopenia given a particular cluster. Results: 250 women were evaluated. Mean age was 68.54 ± 5.99, sarcopenia was present in 31 (12.4%). Clusters 1 and 2 had similar GT, GSt, and CC values. Moreover, in cluster 1, women were older with higher PA values (p < 0.001). From cluster 3 upward, there is a trend of worse scores for every variable. Moreover, 100% of the participants in cluster 6 have sarcopenia (p < 0.001). Women in clusters 4 and 5 were 19.29 and 90 respectively, times more likely to develop sarcopenia than those from cluster 2 (p < 0.01). Conclusions: The joint use of age, GSt, GT, CC, and PA is strongly associated with the probability women have of presenting sarcopenia.

Variables Impacting the Quality of Care Provided by Professional Caregivers for People with Mental Illness: A Systematic Review.

People with mental illness may need the support of caregivers in certain areas of their lives, and there is an increasing need for quality care for people with mental health problems by qualified health professionals. Often, these professionals may develop so-called burnout syndrome, although some authors point out that positive emotions may also arise. In addition, several variables can act as both protectors and stressors. Therefore, the main aim of the current study is to identify variables related to the professional care of people with mental illness (i.e., protective or stressor variables) through a systematic review. The review was conducted according to the PRISMA guidelines with a final selection of 20 articles found in the Web of Science, PubMed, ScienceDirect and Dialnet databases between the months of October and November 2019, and updated in June 2022. The results show that job satisfaction is a strong predictor of the quality of care, and that congruence between personal and organizational values is a very important factor. Meanwhile, working in the same job for successive years, working in community mental health teams and experiencing burnout act as stressors and reduce the quality of care provided.

Preoperative risk assessment and spirometry is a cost-effective strategy to reduce post-operative complications and mortality in Mexico.

AIM: Combining preoperative spirometry with the Assess Respiratory Risk in Surgical Patients in Catalunia (ARISCAT) risk scale can reduce post-operative complications and improve patient survival. This study aimed to assess the cost-effectiveness of performing spirometry or not in conjunction with the ARISCAT scale, to reduce post-operative complications and improve survival among adult patients undergoing elective surgery in Mexico. METHODS: A cost-effectiveness analysis (CEA) was performed to compare the specific cost and health outcomes associated with the combined use of the ARISCAT scale and preoperative spirometry (Group 1), and the use of the ARISCAT scale without preoperative spirometry (Group 2). The health outcomes evaluated were post-operative complications and survival. The perspective was from the health care provider (Hospital General de México) and direct medical costs were reported in 2019 US dollars. A decision tree with a time horizon of eight months was used for each health outcome and ARISCAT risk level. RESULTS: The combined use of the ARISCAT scale and spirometry is more cost-effective for reducing post-operative complications in the low and moderate-risk levels and is cost-saving in the high-risk level, than use of the ARISCAT scale without spirometry. To improve patient survival, ARISCAT and spirometry are also more cost-effective at the moderate risk level, and cost-saving for high-risk patients, than using the ARISCAT scale alone. CONCLUSIONS: The use of preoperative spirometry among patients with a high ARISCAT risk level was cost-saving, reduced post-operative complications, and improved survival. Our findings indicate an urgent need to implement spirometry as part of preoperative care in Mexico, which is already the standard of care in other countries.

Item-Level Psychometric Analysis of the Psychosocial Processes at Work Scale (PROPSIT) in Workers.

The structural attributes and correlates of items have an effect on their composite scores and exploring them strengthens the content validity of a measure adapted to another context. The objective of this study was to evaluate the item properties of a measure of psychosocial work factors (PWFs). Data were collected through a web platform from 188 Peruvian working adults (men = 101, 50.5%) holding various professions and jobs. The instrument was the Psychosocial Processes at Work Scale (PROPSIT), adapted for the Peruvian context. The distributional characteristics, the efficiency of its response options and its correlates with engagement, occupational self-efficacy, general stress and psychological distress (explored with a coefficient of maximum information and another of monotonic association) were analyzed. It was found that the items were asymmetrically distributed, without statistical normality and with a response tendency at low (for psychosocial risk factors (PSRFs)) and medium (favorable psychosocial resources) levels. The number of efficient response options was lower (approximately five options) than the original structure (seven options). The monotonic associations with gender and age were essentially zero and theoretically converged with the external constructs, except for some items related to job demands. The contributions of the results to the content validity of the PROPSIT and the orientation of working hypotheses about PROPSIT item constructs and measures of work effects are discussed.

Last Year of Life, Frailty, and Out-of-Pocket Expenses in Older Adults: A Secondary Analysis of the Mexican Health and Aging Study.

OBJECTIVE: To determine the association of frailty with out-of-pocket expenses (OOPEs) during the last year of life of Mexican older adults. METHODS: Cross-sectional secondary analysis of the Mexican Health and Aging Study (MHAS), a representative population-based cohort study. Health care expenses were estimated, and a probit model was used to estimate the probability that older adults had OOPE. A general linear model was applied to explain OOPE magnitudes. RESULTS: A total of 55.8% of individuals reported having OOPE with a mean of 3,261 USD. Average OOPE for hospitalization during the last year of life was 7,011.9 USD. Older adults taking their own medical decisions during the last year of life expended less than those who did not. CONCLUSION: No affiliation to health services, frailty, and health decision-making by others increased the probability of OOPE. The magnitude is determined by age, hospitalization, medical visits, affiliation, frailty, and health decision-making by others.

Disability-Adjusted Life Years for the COVID-19 Pandemic in the Mexican Population.

Mexico is one of the countries most affected by the COVID-19 disease. Although there is vast information on the disease, there still are unknown data on the societal and economic cost of the pandemic. To estimate this impact, the disability-adjusted life years (DALYs) can be a useful tool. Objective: To assess the DALYs due to COVID-19 in Mexico. Methods: We used the data released by the Mexican Ministry of Health to estimate the DALYs by the sum of the years of life lived with disability (YLDs) and the years of life lost (YLLs). Results: A total of 1,152,885 confirmed cases and 324,570 suspected cases of COVID-19 have been registered. Half of the cases were men, with a median age of 43.4 ± 16.9 years. About 8.3% died. A total of 39,202 YLDs were attributable to COVID-19. The total YLLs caused by COVID-19 were 2,126,222. A total of 2,165,424.5 DALYs for COVID-19 were estimated. The total DALYs were the highest in people between 50 and 59 years. The DALYs for each COVID-19 case were the highest in individuals between 60 and 79 years. Conclusion: The DALYs generated by the COVID-19 represent a more significant disease burden than that reported for other causes, such as the 2009 H1N1 influenza pandemic. Although it impacts all age groups in terms of disability, the most affected group are people over 50 years of age, whose risk of death is higher.

Correction to: A survival analysis of COVID-19 in the Mexican population.

An amendment to this paper has been published and can be accessed via the original article.

Predictors of Quality of Life among Parents of Children with Chronic Diseases: A Cross-Sectional Study.

Quality of life (QOL) is a key aspect of the health care process for children with chronic diseases and their families. Although clinical evidence regarding the impact of chronic disease on children exists, few studies have evaluated the effects of the interaction between sociodemographic and psychosocial factors on the family caregiver's QOL, indicating a significant gap in the research literature. The present study aimed to identify the predictors of the QOL of parents of children with chronic diseases. Three parental sociodemographic predictors (age, schooling, and family income) and four psychosocial predictors (family functioning, social support, depression, and resilience) were examined. In this cross-sectional study, 416 parents of children with chronic diseases who were hospitalized at a National Institute of Health in Mexico City were interviewed. The participants completed a sociodemographic variables questionnaire (Q-SV) designed for research on family caregivers of children with chronic disease. The predicted variable was assessed through the World Health Organization Quality of Life Questionnaire. The four psychosocial predictors were assessed through the Family Functioning Scale, Social Support Networks Scale, Beck Depression Inventory, and Measurement Scale of Resilience. The regression model explained 42% of the variance in parents' QOL. The predictors with positive weights included age, schooling, monthly family income, family functioning, social support networks, and parental resilience. The predictors with negative weights included depression. These findings suggest that strong social relationships, a positive family environment, family cohesion, personal resilience, low levels of depression, and a family income twice the minimum wage are variables associated with better parental QOL.

A survival analysis of COVID-19 in the Mexican population.

BACKGROUND: At present, the Americas report the largest number of cases of COVID-19 worldwide. In this region, Mexico is the third country with most deaths (20,781 total deaths). A sum that may be explained by the high proportion of people over 50 and the high rate of chronic diseases. The aim of this analysis is to investigate the risk factors associated with COVID-19 deaths in Mexican population using survival analysis. METHODS: Our analysis includes all confirmed COVID-19 cases contained in the dataset published by the Epidemiological Surveillance System for Viral Respiratory Diseases of the Mexican Ministry of Health. We applied survival analysis to investigate the impact of COVID-19 on the Mexican population. From this analysis, we plotted Kaplan-Meier curves, and constructed a Cox proportional hazard model. RESULTS: The analysis included the register of 16,752 confirmed cases of COVID-19 with mean age 46.55 ± 15.55 years; 58.02% (n = 9719) men, and 9.37% (n = 1569) deaths. Male sex, older age, chronic kidney disease, pneumonia, hospitalization, intensive care unit admission, intubation, and health care in public health services, were independent factors increasing the risk of death due to COVID-19 (p < 0.001). CONCLUSIONS: The risk of dying at any time during follow-up was clearly higher for men, individuals in older age groups, people with chronic kidney disease, and people hospitalized in public health services.

Early estimation of the risk factors for hospitalization and mortality by COVID-19 in Mexico.

BACKGROUND: Due to a high prevalence of chronic non-degenerative diseases, it is suspected that COVID 19 poses a high risk of fatal complications for the Mexican population. The present study aims to estimate the risk factors for hospitalization and death in the Mexican population infected by SARS-CoV-2. METHODS AND FINDINGS: We used the publicly available data released by the Epidemiological Surveillance System for Viral Respiratory Diseases of the Mexican Ministry of Health (Secretaría de Salud, SSA). All records of positive SARS-CoV-2 cases were included. Two multiple logistic regression models were fitted to estimate the association between hospitalization and mortality, with other covariables. Data on 10,544 individuals (57.68% men), with mean age 46.47±15.62, were analyzed. Men were about 1.54 times more likely to be hospitalized than women (p<0.001, 95% C.I. 1.37-1.74); individuals aged 50-74 and ≥74 were more likely to be hospitalized than people aged 25-49 (OR 2.05, p<0.001, 95% C.I. 1.81-2.32, and OR 3.84, p<0.001, 95% C.I. 2.90-5.15, respectively). People with hypertension, obesity, and diabetes were more likely to be hospitalized than people without these comorbidities (p<0.01). Men had more risk of death in comparison to women (OR = 1.53, p<0.001, 95% C.I. 1.30-1.81) and individuals aged 50-74 and ≥75 were more likely to die than people aged 25-49 (OR 1.96, p<0.001, 95% C.I. 1.63-2.34, and OR 3.74, p<0.001, 95% C.I. 2.80-4.98, respectively). Hypertension, obesity, and diabetes presented in combination conveyed a higher risk of dying in comparison to not having these diseases (OR = 2.10; p<0.001, 95% C.I. 1.50-2.93). Hospitalization, intubation and pneumonia entail a higher risk of dying (OR 5.02, p<0.001, 95% C.I. 3.88-6.50; OR 4.27, p<0.001, 95% C.I. 3.26-5.59, and OR = 2.57; p<0.001, 95% C.I. 2.11-3.13, respectively). Our study's main limitation is the lack of information on mild (asymptomatic) or moderate cases of COVID-19. CONCLUSIONS: The present study points out that in Mexico, where an important proportion of the population has two or more chronic conditions simultaneously, a high mortality rate is a serious risk for those infected by SARS-CoV-2.

Interpopulation Similarity of Sex and Age-Related Body Composition Variations Among Older Adults.

The aim of the study was to analyze sex and age-related body composition variations among older adults from the Brazilian, Italian, and Mexican population. A cross-sectional analysis was conducted in 1103 community-dwelling older adults (634 women and 469 men), aged 60 to 89 years, living in Brazil (n = 176), Italy (n = 554), and Mexico (n = 373). Anthropometric measurements were taken, BMI was calculated, and impedance measurements were obtained (resistance, R, reactance, Xc). Specific bioelectrical impedance vector analysis (specific BIVA) was applied, with the specific vector defined by impedance, or vector length (Z = (Rsp2 + Xcsp)0.5), and phase angle (PA = arctan Xc/R 180/π). Population, sex, and age differences in anthropometric and bioelectrical variables were evaluated by means of a two way ANOVA. The mean bioelectrical vectors were graphed by confidence ellipses and statistically compared by the Hotelling's T2 test. The three population groups showed differences in body mass and composition (p < 0.001): the Brazilian sample was characterized by greater body dimensions, longer vectors (higher relative content of fat mass), and lower phase angles (lower skeletal muscle mass). Men were taller and heavier than women (p < 0.001) but had a similar BMI (p = 0.102). They also had higher phase angle (higher skeletal muscle mass) (p < 0.001) and lower vector length (lower %FM) (p < 0.001). In the three population groups, the oldest individuals showed lower anthropometric and phase angle values with respect to the youngest ones (p < 0.001), whereas the vector length did not change significantly with age (p = 0.665). Despite the differences between sexes and among populations, the trend of age-related variations was similar in the Brazilian, Italian, and Mexican older adults.

Multidimensional dependency subgroups in community-dwelling older adults: A latent class analysis.

OBJECTIVES: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership. MATERIAL AND METHODS: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership. RESULTS: Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile. CONCLUSIONS: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.

OBJETIVO: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. MÉTODOS: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. RESULTADOS: Se identificaron tres grupos de clases basados en los nueve identificadores. "Adultos mayores activos" estaba compuesto por el 64%. "Relativamente independiente" y "Discapacidad física" comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de "Adultos mayores activos" y "Relativamente independiente" eran comparativamente más uniformes. El grupo de "discapacidad física" comprenden a los individuos más propensos a un perfil de dependencia. CONCLUSIONES: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional.

Multidimensional dependency subgroups in community-dwelling older adults: A latent class analysis / Subgrupos de dependencia multidimensional en adultos mayores que viven en la comunidad: un análisis de clase latente

Abstract Objectives: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership. Material and methods: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership. Results: Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile. Conclusions: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.

Resumen Objetivo: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. Métodos: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. Resultados: Se identificaron tres grupos de clases basados en los nueve identificadores. "Adultos mayores activos" estaba compuesto por el 64%. "Relativamente independiente" y "Discapacidad física" comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de "Adultos mayores activos" y "Relativamente independiente" eran comparativamente más uniformes. El grupo de "discapacidad física" comprenden a los individuos más propensos a un perfil de dependencia. Conclusiones: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional.

Gasto de bolsillo en salud durante el último año de vida de adultos mayores mexicanos: análisis del Enasem / Out of pocket expenditure on health during the last year of life of Mexican elderly: analysis of the Enasem

Resumen: Objetivo: Estimar el gasto de bolsillo (GB) durante el último año de vida en adultos mayores (AM) mexicanos. Material y métodos: Estimación del GB del último año de vida de AM, ajustando por tipo de manejo, afiliación y causa de muerte. Se emplearon datos del Estudio Nacional de Salud y Envejecimiento en México (2012). Los gastos en medicamentos, consultas médicas y hospitalización durante el año previo a la muerte conforman el GB. El GB se ajustó por inflación y se reporta en dólares americanos 2018. Resultados: La media de GB fue $6 255.3±18 500. En el grupo de atención ambulatoria el GB fue $4 134.9±13 631.3. El GB en hospitalización fue $7 050.6±19 971.0. Conclusiones: La probabilidad de incurrir en GB es menor cuando no se requiere hospitalización. Con hospitalización, la afiliación a la seguridad social y atenderse en hospitales públicos juega un papel protector.

Abstract: Objective: To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). Materials and methods: Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. Results: The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. Conclusions: The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role.

[Out of pocket expenditure on health during the last year of life of Mexican elderly: analysis of the Enasem]. / Gasto de bolsillo en salud durante el último año de vida de adultos mayores mexicanos: análisis del Enasem.

OBJECTIVE: To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). MATERIALS AND METHODS: Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. RESULTS: The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. CONCLUSIONS: The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role.

OBJECTIVE: Estimar el gasto de bolsillo (GB) durante el último año de vida en adultos mayores (AM) mexicanos. MATERIALS AND METHODS: Estimación del GB del último año de vida de AM, ajustando por tipo de manejo, afiliación y causa de muerte. Se emplearon datos del Estudio Nacional de Salud y Envejecimiento en México (2012). Los gastos en medicamentos, consultas médicas y hospitalización durante el año previo a la muerte conforman el GB. El GB se ajustó por inflación y se reporta en dólares americanos 2018. RESULTS: La media de GB fue $6 255.3±18 500. En el grupo de atención ambulatoria el GB fue $4 134.9±13 631.3. El GB en hospitalización fue $7 050.6±19 971.0. CONCLUSIONS: La probabilidad de incurrir en GB es menor cuando no se requiere hospitalización. Con hospitalización, la afiliación a la seguridad social y atenderse en hospitales públicos juega un papel protector.

Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis.

AIM: This systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries. METHODS: Five databases were searched from 1990-2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results. RESULTS: The 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644-0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522-0.732) as compared to Brazil (0.396; 0.249-0.564). Prevalence for Montenegro (0.416; 0.237-0.621) and Malaysia (0.475; 0.177-0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries. CONCLUSIONS: In this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396).