Ángel Otero

Factors associated with cell phone use in adolescents in the community of Madrid (Spain).

The purpose of this research is to measure cell phone use among high school adolescents and the factors associated with intensive cell phone use (depressive symptoms, social isolation, drug and alcohol use, school failure, and cell phone dependence). We conducted a cross-sectional survey study of 1,328 adolescents aged 13 to 20 years in nine secondary schools of the Community of Madrid between January to April 2007. The mean age of sample participants was 15.7 years. Almost all (96.5%) had their own cell phone (80.5% had one, and 15.9% had two or more). Some 54.8% take it to school and 46.1% keep it on during class; 41.7% use it intensively. The estimated prevalence of cell phone dependence was 20% (26.1% in females, 13% in males). Intensive cell phone use was associated with female sex, rural school location, good family economy, smoking tobacco, excessive alcohol consumption, depression, cell phone dependence, and school failure. More health education is needed to promote correct and effective cell phone use among adolescents. Factors associated with intensive use and dependence should be considered for possible intervention activities.

Forecasting malaria incidence based on monthly case reports and environmental factors in Karuzi, Burundi, 1997-2003.

BackgroundThe objective of this work was to develop a model to predict malaria incidence in an area of unstable transmission by studying the association between environmental variables and disease dynamics.MethodsThe study was carried out in Karuzi, a province in the Burundi highlands, using time series of monthly notifications of malaria cases from local health facilities, data from rain and temperature records, and the normalized difference vegetation index (NDVI). Using autoregressive integrated moving average (ARIMA) methodology, a model showing the relation between monthly notifications of malaria cases and the environmental variables was developed.ResultsThe best forecasting model (R2adj = 82%, p < 0.0001 and 93% forecasting accuracy in the range ± 4 cases per 100 inhabitants) included the NDVI, mean maximum temperature, rainfall and number of malaria cases in the preceding month.ConclusionThis model is a simple and useful tool for producing reasonably reliable forecasts of the malaria incidence rate in the study area.

Self-rated health among older adults: a cross-national comparison

Self-rated health (SRH) may have different implications in various social and cultural settings. However, few studies are available concerning SRH among older persons across countries. The aim of this study was to analyse whether there are cross-national differences in the association between status characteristics, several diseases common among older persons, activities of daily living (ADL), and SRH. The study base was the Comparison of Longitudinal European Studies on Aging (CLESA), which includes data from six population-based studies on aging conducted in Finland, Israel, Italy, The Netherlands, Spain and Sweden. The study population comprised 5,629 persons, with participants from all countries except Italy. Logistic regression analyses were used to assess the relationship between status characteristics, health conditions, ADL and SRH. To examine whether the association among status characteristics, health conditions, ADL and outcome differed across the CLESA countries, interaction terms defined as “variable*country” were considered separately for each variable. Regression analyses revealed that sex, education, lifetime occupation, heart disease and respiratory disease were differently distributed across countries. Among homogeneous factors, marital status (OR=1.21), hypertension (OR=1.41), stroke (OR=1.67), diabetes (OR=2.15), cancer (OR=1.47), musculoskeletal diseases (OR=2.44), and ADL (OR=2.72) turned out to be significantly associated with fair or poor SRH. The results indicate that there are differences in self-ratings of health across countries. These differences cannot be explained entirely by status characteristics, self-reported diseases or functional ability. However, an important finding was that in all countries most of the indicators of medical and functional health were homogeneously associated with SRH.

Volumen y tendencias de la dependencia asociada al envejecimiento en la población española

Fundamento: El aumento creciente del envejecimiento poblacional, especialmente evidente en Espana, resalta la importancia de aproximarse a cuantificar y estimar la evolucion de la dependencia en la poblacion espanola de 65 y mas anos. Metodos: El volumen de dependencia se calculo aplicando las prevalencias estimadas para 1993 y 1999 en el estudio longitudinal «Envejecer en Leganes» a los censos de 1991 y 2001. La poblacion de estudio la constituia una muestra aleatoria de 1.560 personas que vivian en sus domicilios en Leganes (Madrid). La tasa de respuesta inicial fue del 82% (n=1.283). Se volvieron a recoger datos de los participantes iniciales en 1995 (n=827), en 1997 (n=666) y en 1999 (n=475). La dependencia se definio como la necesidad de ayuda en al menos una de ocho tareas de Actividades Basicas de la Vida Diaria (ABVD). La prevalencia de dependencia segun ano de encuesta, edad, sexo y nivel de instruccion se estimo mediante modelos multinivel para medidas repetidas. Resultados: En el periodo 1993-1999 se observa una disminucion en la dependencia para las ABVD tanto en hombres como en mujeres hasta los 83 anos. A edades mas avanzadas esta tendencia se invierte. La prevalencia es mayor en mujeres y en personas con bajo nivel de instruccion. El numero de personas dependientes aumenta de 903.276 a 995.338 entre 1991 y 2001, existiendo un envejecimiento de la poblacion dependiente. Conclusiones: La dependencia aparece a edades mas tardias en las sucesivas cohortes. Esto implica una mayor esperanza de vida libre de discapacidad y una mayor complejidad de los cuidados necesarios para las poblaciones dependientes, que estaran constituidas fundamentalmente por mujeres muy ancianas. Las consecuencias para el futuro de las pensiones, las reformas laborales y los sistemas de servicios de salud y cuidados de larga duracion son importantes.

The effect of social relationships on survival in elderly residents of a Southern European community: a cohort study

BackgroundComparative evidence regarding the effects of social relationships on mortality in Mediterranean communities will increase our knowledge of their strengths and the ways in which they influence longevity across cultures. Men and women may benefit differently from social relationships because of cultural differences in gender roles. Psychosocial mechanisms such as social support, which may explain the effects of social networks, may also vary by culture.MethodsDetailed information on the social relationships of a representative sample of 1,174 community-dwelling older adults was collected in Leganés, a city in central Spain. Mortality over a 6-year follow-up period was ascertained. Information on socio-demographic, health and disability variables was also collected. Cox proportional hazards models were fitted separately for men and women and for the combined sample.ResultsHaving a confidant was associated with a 25% (95% CI 5–40%) reduction in the mortality risk. The hazard ratio for lack of social participation was 1.5 (95% CI 1.3–1.7). Being engaged in meaningful roles protected against mortality, while receipt of emotional support did not affect survival. These results were comparable for men and women. Having contact with all family ties was associated with reduced mortality only in men. Structural aspects of social networks make a unique contribution to survival, independently of emotional support and the role played in the lives of significant others.ConclusionIn this elderly Southern European population, the beneficial effects of social networks, social participation, engagement in the life of significant others and having a confidant call for public policies that foster intergenerational and community exchanges.

Decreasing prevalence of disability in activities of daily living, functional limitations and poor self-rated health: a 6-year follow-up study in Spain

Background and aims: Forecasting functional status in elderly populations is uncertain. Our aim is to provide evidence of population trends of Activities of Daily Living (ADL) disability, functional limitations and self-rated health. Methods: Data come from a longitudinal study of aging in Leganés (Spain), collected in 1993, 1995, 1997 and 1999, on a representative sample of 1560 community dwelling people over 65. Response rate at baseline was 82%. ADL disability was defined as needing help in at least one of the following: walking across a small room, taking a shower, toileting, getting out of bed, getting up from a chair, using the toilet, dressing and eating. Functional limitations were based on questions of difficulty with upper and lower limbs. Self-rated health was assessed with a single question. ADL disability, functional limitations and self-rated health were regressed on age, survey year, sex and education. Results: There are significant declines in ADL disability, functional limitations and poor self-rated health at every age and up to very advanced ages. Over 90, the ADL disability trend may be reversed, with the emergence of a very old and disabled population. Women and people with little education have a higher prevalence of disability, functional limitations and poor health, when compared with men and those with higher education. Conclusions: Results suggest the postponement of severe disability onset in this Spanish population, leading to longer healthy life expectancy, and support the emergence of a very disabled population over 90 years of age.

Physicians' migration in Europe: an overview of the current situation.

BackgroundThe migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon.MethodsSearch of secondary databases about the presence of european doctors working abroad, through two search engines in the Internet (Google and Pubmed) and a survey of professional organisations and regulators in countries of the European Union.ResultsThe United Kingdom has more foreign doctors than all other European countries for which figures are available (Ireland, France, Germany, Norway, Portugal, Italy, Austria and Poland). Some 74,031 foreign doctors are registered in the UK, 30.94% of the total. European countries with the highest percentage of doctors working abroad are Ireland (47.5%, or 10,065 doctors) and Malta (23.1%, 376 doctors). The data obtained from Norway, France and Germany do not indicate an increase in the migration of professionals from countries recently incorporated into the EU.ConclusionThere is significant mobility and heterogeneous distribution of doctors within the EEA and it should be cause for concern among health care authorities. However, there is no evidence about a possible increase in this phenomenon after the recent expansion of the EU.

SEX DIFFERENCES IN THE PREVALENCE OF FRAILTY IN A POPULATION AGED 75 AND OLDER IN SPAIN

ACKNOWLEDGMENTS Conflict of Interest: The authors declare that there are no conflicts of interest related to this letter. No external funding, apart from the support of the authors’ institution, was available for this study. Author Contributions: Akhter R. and Hassan N. N. M.: study concept and design, data analysis, interpretation of data, and preparation of the manuscript. Moriya S., Kashiwazaki H., and Inoue N.: study concept and design. Morita M: study concept and design, acquisition of subjects and data, and manuscript preparation. Sponsor’s Role: None.

Unmet home care needs among community-dwelling elderly people in Spain.

Background and aims: Sociodemographic changes affecting the elderly population and the family role in providing home care call for reorganization of formal community care services. The aim of this study was to determine the prevalence of home care needs and the factors associated with unmet home care needs among community-dwelling elderly people in Spain. Methods: The data were derived from a representative sample of community-dwelling elderly people living in a town of the metropolitan area of Madrid (N=1135). Dependency for daily, weekly and monthly activities was based on disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). Insufficient help was estimated as an indicator of unmet needs. Logistic regressions were fitted to identify correlates of unmet needs for each type of activity. Results: Overall, 14, 39, and 50% of subjects reported dependency for daily, weekly and monthly activities, respectively. Of these, 40, 27, and 12% reported receiving inadequate assistance. Unmet needs were strongly associated with low monthly income, low educational level, living alone, and symptoms of depression. Families were the exclusive source of almost all assistance provided, few persons reporting the use of additional formal community care sources. Conclusions: There are considerable social and material inequalities in access to home care. In view of the poor coverage of the public system for home and personal care, these inequalities may widen in the near future. New public policy initiatives are needed to provide affordable formal family-support services.

Validation of the Seven-Minute Screen Neurocognitive Battery for the Diagnosis of Dementia in a Spanish Population-Based Sample

Objective: To validate the Seven-Minute Screen Neurocognitive Battery (7MS) in an elderly population-based sample to identify dementia using a new scoring method. Methods: Five hundred and twenty-seven home-dwelling elderly were assessed with a neurological and neuropsychological exam. The total score of the 7MS was the sum of z scores of its subtests. Dementia was diagnosed according to DSM-IV. The ROC curve and the diagnostic parameters of the 7MS were calculated. Results: The 7MS could be fully applied in 416 cases (78.9%), and 48 were diagnosed as demented independently of the 7MS. The four 7MS subtests correctly classified 97.6% of cases by discriminant analysis; orientation and memory were the most discriminative. Factorial analysis showed a single dimension in the 7MS. The ROC curve area for diagnosis of dementia was 0.996 (95% CI 0.992–1), sensitivity 100%, specificity 95.1%, and diagnostic accuracy 96.8%. All these parameters were higher than those of other cognitive screening tests. Dementia explained 54.9% of the variance of the 7MS, and age 3.1%; sex and education did not have a significant effect. Conclusions: The 7MS is a valid tool for the diagnosis of dementia, even when cognitive decline is mild, although it may not be appropriate for extensive epidemiological surveys.