Applicability of the MoCA-S test in populations with little education in Colombia.

OBJECTIVES: The objectives of this study were to report on the use of the Spanish version of the Montreal Cognitive Assessment (MoCA-S) as cognitive screening tool in a population aged 65 to 74 years in the Andes Mountains of Colombia, assessing the influence of education, and to examine its test-retest reliability. METHODS: We performed a cross-sectional study of 150 subjects aged 65 to 74 years recruited from older community social centers in Manizales, Colombia. The Leganes Cognitive Test (LCT), a cognitive screening test for populations with low education, was used to exclude those who were likely to have dementia. The associations between the MoCA total score and cognitive domains and education were examined in the total sample and in those likely free of dementia. MoCA-S test-retest reliability was estimated by the intraclass correlation coefficient (ICC) between two measurements taken 7 days apart. RESULTS: Participants had low levels of formal education (mean years of schooling, 4.8). According to the LCT, the proportion of people screening positive for dementia was 16% (n = 24). The mean MoCA-S scores were 16.1/30 among illiterate subjects, 18.2/30 among those with incomplete primary school, and 20.3/30 among those with complete primary school (p < 0.001). Errors were frequent in the cube and clock drawing, attention-serial subtraction, verbal fluency, and abstraction. Test-retest reliability was high, ICC = 0.86, 95% CI (0.76-0.93). CONCLUSION: The MoCA-S has high reliability in low-educated older Colombians, but scores were strongly dependent on years of education. Social and cultural factors must be considered when interpreting MoCA-S given the high error rates on items that depend on the ability to read and write and on culture.

Socio-demographic correlates of late treatment initiation in a cohort of patients starting antiretroviral treatment in Mali, West Africa.

The objective of this study was to investigate factors correlated with late treatment initiation in a cohort of patients starting treatment in Mali, West Africa, while focusing on the role of sex/gender. This study consisted of a cross-sectional analysis of baseline data from a prospective, observational cohort of patients initiating antiretroviral treatment in Mali. Patient data were analyzed with a gender perspective to examine factors correlated with late treatment initiation, defined as having a CD4 count below 100 cells/µl. Aday and Andersen's conceptual framework of access to medical care was used to classify baseline participant characteristics associated with late treatment initiation. Logistic regression was used to evaluate the modifying effect of sex/gender. Results show that 39% of patients initiated treatment late; significantly more of these were men than women. Sex/gender, marital status, and education were associated with late treatment initiation. Unmarried men and uneducated women were significantly more likely to initiate treatment late. Programs need to target unmarried men while being cognizant that uneducated women are arriving late as well.

Factors influencing duration of exposure with symptoms and costs of occupational asthma.

The most important factor for the prognosis of occupational asthma is the length of exposure with symptoms prior to removal from exposure. We wanted to identify factors, including socioeconomic status, that can influence the delay in submitting a claim to a medicolegal agency after the onset of asthmatic symptoms, and to confirm that this delay is associated with worse respiratory prognosis and higher direct costs. This is a cross-sectional study of subjects who claimed compensation for occupational asthma at the Workers' Compensation Board of Quebec, Canada. Data were collected at re-evaluation ∼2.5 yrs after diagnosis. Information on the number of years with symptoms and removal from exposure was obtained from the medicolegal file. 60 subjects were included in the study. Being older, having a revenue of >30,000 Canadian dollars and having occupational asthma due to high molecular weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Subjects with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for <1 yr generated lower direct costs. These findings might help in surveillance programmes that could be preferentially targeted for these subgroups of workers.

Duration of lack of money for basic needs and growth delay in the Quebec Longitudinal Study of Child Development birth cohort.

OBJECTIVE: To examine the relationship between duration of lack of money for basic needs and growth delay in a birth cohort. METHODOLOGY: Mothers of children (n = 1929) from the Quebec Longitudinal Study of Child Development (QLSCD) participating when the children were ages 2(1/2) and 4 years were interviewed at home and data were extracted from birth records. Children's height at 4 years old was transformed into an age- and sex-adjusted z-score. A z-score under the 10th percentile of the Centers for Disease Control and Prevention population growth curve was equated with growth delay. Lack of money for basic needs (paying for rent, electricity and/or heating, clothing, medications or other needs) when the children were ages 2(1/2) and 4 years was reported by the mother. RESULTS: Only 2.5% of children experienced two episodes of lack of money for basic needs. Logistic regression analyses showed that, after adjusting for confounding variables, the probability of growth delay at 4 years among children whose families experienced two episodes of lack of money was higher than for their peers who had not lacked money (OR 3.43; 95% CI 1.54 to 7.66). Experiencing lack of money only at 2(1/2) years showed higher but not significant odds of growth delay at 4 years (OR 1.51; 95% CI 0.84 to 2.72), whereas the likelihood of growth delay was similar for children who experienced lack of money only at 4 years and for their counterparts who never lacked money (OR 0.74; 95% CI 0.26 to 2.11). CONCLUSION: In an industrialised country toddlers whose families experienced persistent lack of money for basic needs are more likely to have growth delay even after controlling for neonatal conditions and their mothers' characteristics.

Restricciones físicas y farmacológicas de las personas mayores que viven en instituciones / Physical restraints and psychotropic medication in institutionalised older people

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Dimensiones interculturales de las redes sociales: necesidad de armonizar los conceptos y las medidas de las redes sociales en gerontología / Intercultural dimensions in social networks: the need to bring concepts and social network measures into line in gerontology

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Dependencia evitable para las actividades de la vida diaria: una perspectiva de género / Avoidable dependence in activities of daily living: a gender perspective

Introducción: El objetivo del estudio es describir las diferencias de género en la dependencia para las actividades instrumentales o de mantenimiento del ambiente (AMA) en personas mayores de 75 años y examinar las variables asociadas con la dependencia para estas actividades en hombres y mujeres españoles. Población y método: Los datos proceden de un estudio transversal de la población mayor de 75 años que vivía en sus hogares en la Zona Básica de Salud Santa Lucía de Zaragoza capital, en el año 1998 (n = 351) y se cumplimentaron a través de una entrevista personal. Se utilizó la escala de Lawton-Brody para la dependencia en las AMA, el Short Portable Mental Status Questionnaire para el déficit cognitivo, la Geriatric Depresion Scale para la sintomatología depresiva y el índice de Katz para la dependencia en las actividades del cuidado personal. Se comparó la dependencia para las AMA que se realizan dentro y fuera del hogar en hombres y mujeres. Se aplicó un análisis de regresión logística multivariable para evaluar las asociaciones de las variables sociodemográficas y los indicadores de salud con la dependencia en las AMA, por separado para hombres y para mujeres. Resultados: La dependencia para las AMA en nuestra población es muy elevada. En los hombres, la dependencia para las AMA dentro y fuera del hogar no está asociada a las características sociodemográficas ni a los indicadores de salud. En las mujeres, tener una edad avanzada, padecer déficit cognitivo e incapacidad para las actividades del cuidado personal están asociados con una mayor prevalencia de dependencia para las AMA que se realizan dentro del hogar, y la edad avanzada y los síntomas depresivos se asocian con una mayor dependencia para las AMA que se realizan fuera del hogar. Conclusiones: La prevalencia de dependencia es mayor en hombres que en mujeres. En éstas, la dependencia se asocia con su estado de salud, pero no sucede lo mismo en los hombres. El desarrollo de políticas de igualdad de géneros en la distribución de las tareas del hogar podría reducir la dependencia en las actividades ambientales, especialmente en los hombres. (AU)

Incremento en la utilización de servicios hospitalarios por las personas mayores de 55 años: envejecimiento poblacional y respuesta del sistema de servicios de salud / Increase in hospital services utilization by persons aged 55 years or older: population ageing and response of the health system

Objetivo: Examinar los cambios en la tasa de hospitalización entre 1985 y 1994 en España y en Andalucía, y estimar la proporción atribuible al envejecimiento poblacional. Métodos: Se calcula el incremento de las tasas de hospitalización entre 1985 y 1994. Se estiman las altas esperadas en 1994 multiplicando las tasas de hospitalización de 1985 por la población en 1994 para cada grupo de edad. Resultados: Entre 1985 y 1994 se produjo un incremento en la tasa de hospitalización en los mayores de 55 años. El incremento oscila entre el 20,01% (de 55 a 64 años) y el 52% (> 75 años); y el porcentaje atribuible al envejecimiento poblacional es (..) (AU)

Objectives: To examine changes in hospital service utilization between 1985 and 1994 in Spain and Andalucía and to estimate the proportion of change due to population ageing. Methods: The increase in hospitalization rates between 1985 and 1994 was calculated. Expected hospital discharges in 1994, were calculated by multiplying hospital discharge rates in 1985 by the population in 1994 for each age group. Results: Between 1985 and 1994 hospitalization rates increased among persons aged 55 years old order. The increase ranged from (..) (AU)

La importancia de identificar las necesidades de servicios sanitarios y sociales de las personas mayores / Importance of identifying the needs of health care and social services of the elderly

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