RESUMEN
AIMS: To estimate the prevalence of multimorbidity among European community-dwelling adults, as well as to analyse the association with gender, age, education, self-rated health, loneliness, quality of life, size of social network, Body Mass Index (BMI) and disability. METHODS: A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 63,844) from 17 European countries were selected. Multimorbidity was defined as presenting two or more health conditions. The independent variables were gender, age group, educational level, self-rated health, loneliness, size of network, quality of life, BMI and disability (1+ limitations of basic activities of daily living). Poisson regression models with robust variance were fit for bivariate and multivariate analysis. RESULTS: The prevalence of multimorbidity was 28.2% (confidence interval-CI 95%: 27.5.8-29.0) among men and 34.5% (CI95%: 34.1-35.4) among women. The most common health conditions were cardiometabolic and osteoarticular diseases in both genders, and emotional disorders in younger women. A large variability in the prevalence of multimorbidity in European countries was verified, even between countries of the same region. CONCLUSIONS: Multimorbidity was associated with sociodemographic and physical characteristics, self-rated health, quality of life and loneliness.
Asunto(s)
Enfermedades Óseas/epidemiología , Enfermedades de los Cartílagos/epidemiología , Depresión/epidemiología , Personas con Discapacidad/estadística & datos numéricos , Vida Independiente/estadística & datos numéricos , Síndrome Metabólico/epidemiología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Personas con Discapacidad/rehabilitación , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Multimorbilidad , Prevalencia , Calidad de VidaRESUMEN
OBJECTIVES: To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. METHODS: This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. RESULTS: The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). CONCLUSION: Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.
Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Renta/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multinivel , Distribución por Sexo , Factores Sexuales , Factores SocioeconómicosRESUMEN
ABSTRACT: Objectives: To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. Methods: This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. Results: The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). Conclusion: Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.
RESUMO: Objetivos: Estimar a magnitude das diferenças de gênero na incapacidade entre adultos com 60 anos ou mais e avaliar se elas podem estar associadas à desigualdade social de gênero e aos fatores contextuais socioeconômicos no nível das unidades federativas brasileiras. Métodos: Estudo multinível que utilizou dados de 23.575 adultos mais velhos das 27 unidades federativas que participaram da Pesquisa Nacional de Saúde de 2013. O índice de limitação de atividades foi desenvolvido a partir da teoria de resposta ao item, utilizando-se variáveis de atividades básicas e instrumentais da vida diária. Foram estimadas as associações das variáveis individuais e contextuais com a incapacidade, avaliando-se a magnitude das diferenças entre os gêneros, ao utilizar efeitos de interação de nível cruzado em modelos lineares generalizados multiníveis, incluindo-se apenas as variáveis que foram estatisticamente significantes no modelo final. Resultados: A prevalência de incapacidade foi mais elevada entre as mulheres (37,6%) do que entre os homens (26,5%), totalizando 32,7% dos adultos mais velhos. Na análise multinível ajustada, a incapacidade foi influenciada pela desigualdade de renda (γgini = 0,022, p < 0,001) entre as unidades federativas. Além disso, as diferenças de gênero na incapacidade foram associadas com as desigualdades sociais de gênero (γmgiiXsex = 0,020, p = 0,004). Conclusões: As mulheres tiveram desvantagens maiores de incapacidade quando comparadas aos homens, e estas diferenças foram associadas às desigualdades sociais de gênero entre unidades federativas brasileiras, influenciadas pelas desigualdades de renda.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Encuestas Epidemiológicas/estadística & datos numéricos , Personas con Discapacidad/estadística & datos numéricos , Evaluación de la Discapacidad , Renta/estadística & datos numéricos , Factores Socioeconómicos , Brasil/epidemiología , Actividades Cotidianas , Modelos Lineales , Factores Sexuales , Estudios Transversales , Distribución por Sexo , Disparidades en el Estado de Salud , Análisis Multinivel , Persona de Mediana EdadRESUMEN
The objective of the present study was to examine the magnitude of gender differences in activity limitations among the elderly, and the effect of the health and social individual factors and the context of social gender inequality in Europe. Cross-sectional design was performed. The study population included residents aged 60 years or over from 17 countries that participated in the Survey of Health, Ageing and Retirement in Europe conducted in 2010-13 (n = 49,685). Gender differences in activity limitation in each country was estimated. For multilevel analysis adjusted linear mixed effect models were used, where the intercept and 'sex' were considered random effects, with the 95% confidence intervals. The activity limitation index was created from a two parameter logistic combined models of item response theory. The average activity limitation index was significantly higher in women, (g10 = b1j = 0.36, p < 0.001), and was then controlled by individual and contextual factors, while the extent of these differences varied among countries. The European countries with the greatest gender differences in activity limitations were those with the greatest social gender inequalities, with women presenting a significant disadvantage.
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Actividades Cotidianas , Evaluación de la Discapacidad , Disparidades en el Estado de Salud , Estado de Salud , Anciano , Anciano de 80 o más Años , Estudios Transversales , Europa (Continente) , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
Abstract The objective of the present study was to examine the magnitude of gender differences in activity limitations among the elderly, and the effect of the health and social individual factors and the context of social gender inequality in Europe. Cross-sectional design was performed. The study population included residents aged 60 years or over from 17 countries that participated in the Survey of Health, Ageing and Retirement in Europe conducted in 2010-13 (n = 49,685). Gender differences in activity limitation in each country was estimated. For multilevel analysis adjusted linear mixed effect models were used, where the intercept and 'sex' were considered random effects, with the 95% confidence intervals. The activity limitation index was created from a two parameter logistic combined models of item response theory. The average activity limitation index was significantly higher in women, (g10 = b1j = 0.36, p < 0.001), and was then controlled by individual and contextual factors, while the extent of these differences varied among countries. The European countries with the greatest gender differences in activity limitations were those with the greatest social gender inequalities, with women presenting a significant disadvantage.
Resumo O presente estudo objetivou examinar as magnitudes das diferenças de gênero nas limitações de atividades entre idosos, e o efeito dos fatores sociais e de saúde e o contexto de desigualdades sociais de gênero na Europa. Foi realizado um estudo descritivo retrospectivo de corte transversal. A população do estudo incluiu residentes com 60 ou mais anos de idade de 17 países que participaram do Inquérito de Saúde, Envelhecimento e Reforma na Europa, conduzido em 2010-13 (n = 49.685). Foram estimadas as diferenças de gênero nas limitações de atividades para cada país. Para a análise multinível foram ajustados modelos mistos lineares, onde o intercepto e o 'sexo' foram considerados efeitos aleatórios, com intervalos de confiança de 95%. O índice de limitação de atividades foi criado a partir de modelos combinados de dois parâmetros logísticos, na teoria de resposta ao item. A média do índice de limitação de atividades foi significativamente mais alta em mulheres, (g10 = b1j = 0,36, p < 0,001), controlada por fatores individuais e contextuais, enquanto a extensão destas diferenças de gênero variou entre os países. Os países com as maiores diferenças de gênero nas limitações de atividade foram aqueles com as maiores desigualdades sociais de gênero, com as mulheres apresentando uma desvantagem significativa.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Actividades Cotidianas , Estado de Salud , Evaluación de la Discapacidad , Disparidades en el Estado de Salud , Modelos Logísticos , Factores Sexuales , Estudios Transversales , Encuestas Epidemiológicas , Europa (Continente) , Persona de Mediana EdadRESUMEN
OBJECTIVE: to present a guide with recommendations for translation, adaptation, elaboration and process of validation of tests in Speech and Language Pathology. METHODS: the recommendations were based on international guidelines with a focus on the elaboration, translation, cross-cultural adaptation and validation process of tests. RESULTS: the recommendations were grouped into two Charts, one of them with procedures for translation and transcultural adaptation and the other for obtaining evidence of validity, reliability and measures of accuracy of the tests. CONCLUSION: a guide with norms for the organization and systematization of the process of elaboration, translation, cross-cultural adaptation and validation process of tests in Speech and Language Pathology was created.
Asunto(s)
Comparación Transcultural , Patología del Habla y Lenguaje/instrumentación , Encuestas y Cuestionarios , Traducciones , Guías como Asunto , Humanos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To estimate the prevalence and the associated factors with voice disorders (VDs) in older adults living in nursing homes. STUDY DESIGN: Cross-sectional. METHODS: A sample of 117 Brazilian individuals of both sexes and preserved cognitive function, aged >59 years, living in 10 nursing homes, was studied. VDs were screened using the validated tool "Rastreamento de Alterações Vocais em Idosos" (RAVI-Screening for Voice Disorders in Older Adults). Associated factors included variables related to socioeconomic and demographic profile; nursing home; general health; ear, nose, and throat conditions; lifestyle; functionality; and psychosocial status. Bivariate analysis was performed by Pearson's chi-square or Fisher's exact test. Multivariate analysis was performed by multiple binomial regression. The significance level was 5%. RESULTS: The prevalence of VDs was 39.3% (95% confidence interval [CI] = 30.4-48.1). There was no significant difference in prevalence according to age and sex. Multivariate analysis revealed that the prevalence of VDs were independently associated with anxiety symptoms (prevalence ratio [PR] = 1.97, 95% CI = 1.17-3.29), smoking (PR = 1.56, CI = 1.02-2.38), general daily inactivity (PR = 1.62, CI = 1.10-2.38), temporomandibular disorder (PR = 1.68, CI = 1.11-2.54), choking (PR = 1.53, CI = 1.06-2.20), and self-reported hearing loss (PR = 1.52, CI = 1.04-2.21). CONCLUSION: VDs are common among older adults with preserved cognitive function living in nursing homes. The associated factors with VDs in this population can be prevented, diagnosed, controlled, or treated. Screening procedures and early intervention should be considered.
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Trastornos de la Voz/epidemiología , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Casas de Salud/estadística & datos numéricos , PrevalenciaRESUMEN
AIM: The aim of the study was to determine the cutoff score and clinical consistency of "Screening for Voice Disorders in Older Adults" (RAVI-Rastreamento de Alterações Vocais em Idosos). STUDY DESIGN: This is a prospective, nonrandomized, cross-sectional diagnostic study. METHODS: A sample of 301 subjects, including both sexes, aged 60 and more, and all of whom were living in either a community or an institution, was studied. To determine which subjects had or did not have voice problems, we used a composite reference standard (auditory-perceptual analysis of sustained vowel phonation, auditory-perceptual analysis of connected speech, and vocal self-assessment). The best cutoff score was identified using the receiver operating characteristic (ROC) curve analysis. The clinical consistency indicators were co-positivity, co-negativity, positive and negative predictive values, positive and negative likelihood ratio, and test efficiency. The significance level was 5%. RESULTS: The area under the ROC curve was 0.763 (95% confidence interval: 0.706-0.821), and the best cutoff score for determining which older adults had or did not have a voice disorder was 2. All clinical consistency indicators were satisfactory: co-positivity (79%), co-negativity (60%), predictive positive value (51%), negative predictive value (84%), positive likelihood ratio (2.01), negative likelihood ratio (0.34), and test efficiency (69%). CONCLUSIONS: RAVI has satisfactory indicators of clinical consistency and is able to determine which older adults have voice disorders by a cutoff score of 2. The use of RAVI as a screening tool is recommended to help determine the prevalence of voice disorders in older adults.
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Acústica del Lenguaje , Patología del Habla y Lenguaje/métodos , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Acústica , Factores de Edad , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Juicio , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Autoimagen , Percepción del Habla , Medición de la Producción del Habla , Encuestas y Cuestionarios , Trastornos de la Voz/epidemiología , Trastornos de la Voz/fisiopatologíaRESUMEN
RESUMO Objetivo apresentar um guia com recomendações para a tradução, adaptação, elaboração e processo de validação de testes em Fonoaudiologia. Método as recomendações apresentadas foram baseadas em diretrizes internacionais tradicionais cujo enfoque está na elaboração, tradução, adaptação transcultural e processo de validação de testes. Resultados as recomendações foram compiladas em dois quadros, sendo um deles referente aos procedimentos para tradução e adaptação transcultural e o outro à obtenção de evidências de validade, confiabilidade e medidas de acurácia dos testes. Conclusão foi apresentado um guia com as principais recomendações para a organização e sistematização do processo de elaboração, tradução, adaptação transcultural e processo de validação de testes em Fonoaudiologia.
ABSTRACT Objective to present a guide with recommendations for translation, adaptation, elaboration and process of validation of tests in Speech and Language Pathology. Methods the recommendations were based on international guidelines with a focus on the elaboration, translation, cross-cultural adaptation and validation process of tests. Results the recommendations were grouped into two Charts, one of them with procedures for translation and transcultural adaptation and the other for obtaining evidence of validity, reliability and measures of accuracy of the tests. Conclusion a guide with norms for the organization and systematization of the process of elaboration, translation, cross-cultural adaptation and validation process of tests in Speech and Language Pathology was created.
Asunto(s)
Humanos , Traducciones , Comparación Transcultural , Encuestas y Cuestionarios , Patología del Habla y Lenguaje/instrumentación , Reproducibilidad de los Resultados , Guías como AsuntoRESUMEN
PURPOSE: To determine the validity evidence based on the internal structure and relations to other variables and the reliability of an epidemiologic questionnaire for screening older adults with voice disorders. STUDY DESIGN: This is a prospective, nonrandomized, cross-sectional, validation study. METHODS: To assess the validity evidence based on the internal structure, 160 older adults of both sexes, either community-dwelling or institutionalized, completed the "Rastreamento de Alterações Vocais em Idosos" (RAVI; "Screening for Voice Disorders in Older Adults"). The data were analyzed using item-total and interitem correlations, principal component analysis, confirmatory factor analysis, and differential item functioning. For validity evidence based on relations to other variables, measures of concurrent and discriminant validity were calculated according to the self-reported number of factors associated with voice disorders. Reliability was assessed using a test-retest procedure conducted with 121 older adults with the same characteristics as the previous sample. In this stage, the reproducibility, internal consistency, and measurement error of the instrument were analyzed. RESULTS: The RAVI showed adequate validity evidence based on the internal structure and relations to other variables, as well as good reliability. This indicates that the results produced by the instrument are valid and reliable. CONCLUSIONS: The RAVI is a self-reported outcome questionnaire that yields valid and reliable responses for epidemiologic detection of voice disorders in older adults and can be easily administered by any health care provider. Further ongoing studies will assess accuracy measures and cutoff values of the RAVI.
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Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Factores de Edad , Anciano , Anciano de 80 o más Años , Percepción Auditiva , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de Riesgo , Trastornos de la Voz/epidemiología , Trastornos de la Voz/fisiopatologíaRESUMEN
PURPOSE: To identify the validity evidence based on the content and response processes of the Rastreamento de Alterações Vocais em Idosos (RAVI; "Screening for Voice Disorders in Older Adults"), an epidemiologic screening for voice disorders in older adults. STUDY DESIGN: This is a prospective, nonrandomized, cross-sectional, validation study. METHODS: Criteria for defining the domains and elaborating the questions were established to confirm the validity evidence based on the content. A multidisciplinary committee of 19 experts evaluated the questions, and the relevance and representation of the domains were analyzed using the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI), respectively. For validity evidence based on the response processes, 40 individuals of both sexes, aged ≥60 years, were stratified by demographic and socioeconomic condition. They responded to the RAVI, made suggestions, and their verbal and nonverbal reactions were observed. RESULTS: The first version of the RAVI consisted of 20 questions related to sensations and perceptions associated with the voice. Although the CVI value of 0.80 was satisfactory, the CVI-I and the suggestions of the expert committee indicated that the scale needed to be reformulated. Consultation with older adults indicated a need for further adjustment. The preliminary version of the RAVI consisted of 16 questions. CONCLUSIONS: The two aspects of validity evidence described in the present study were essential for adapting the questions to better fit the construct of the questionnaire. Other aspects of validity evidence and reliability analysis will be described in part II of this study.
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Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Factores de Edad , Anciano , Anciano de 80 o más Años , Percepción Auditiva , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de Riesgo , Trastornos de la Voz/epidemiología , Trastornos de la Voz/fisiopatologíaRESUMEN
INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the clinical characteristics of diabetes and associated cardiovascular risk factors in immigrants with diabetes in Spain. METHODS: A multicenter, observational, cross-sectional study including a cohort of 605 diabetic immigrants and 307 native diabetics was conducted in patients diagnosed with diabetes and treated in primary and specialized care in Spain. A consecutive sampling method was followed. We studied epidemiological, clinical and laboratory variables related to diabetes and the presence of classical risk factors. RESULTS: The immigrant diabetic patient was younger (50.4 [11.5] vs 62.7 [13] years) and had fewer years of diabetes progression (5.8 [6.4] vs 10.5 [8.3] years) (P<.001) compared with native diabetic patients. Immigrants from South America with diabetes were more obese. No statistically significant differences were found in abdominal obesity or the waist/height ratio. Glycemic control was worse in immigrants than in the native Spaniard group (glycosylated hemoglobin, 7.8 [2.2] vs 7.1 [1.5%]), especially among South Asians (8.1[2.5%]) (P<.001), in whom insulin use was lower (12.8% vs 30.7% in other immigrants) (P<.001). However, the prevalence of chronic complications of diabetes was lower among immigrants, particularly that of macrovascular complications (7.7% vs 24.4%) (P<.01). CONCLUSIONS: In our study the profile of immigrant diabetics in Spain is one of a young diabetic without complications, but with worse metabolic control. These findings provide an excellent opportunity to implement preventive measures.