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Biomedical subjects

M V Zunzunegui

Publications and source records attributed to M V Zunzunegui.

At least 19 recordsLinked to original sources
PubMed2005

A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries.

BACKGROUND AND OBJECTIVES: Our aim was to construct a harmonized measure of activities of daily living (ADL) across six countries, and to evaluate the reliability and validity of this measure. METHODS: A population of 9,297 persons, aged 65-89 years, was drawn from the Comparison of Longitudinal European Studies on Aging (CLESA) study, which includes data from five European countries and Israel. Because the number, type, and response format of the ADL items differed across the six studies, a four-item scale was constructed to harmonize the data, using items common to most countries. A procedure was devised to substitute or construct items that were not available in two of the countries. RESULTS: Cronbach's alpha for the four-item ADL measure varied from 0.81 in Spain to 0.92 in Finland, and was similar to the alpha of scales including five or six items. Kappa scores between substituted or constructed items and the actual items varied from 0.50 to 0.78. In all countries, the percentage of persons with ADL disability differed significantly across age and was associated with chronic diseases, poor self-rated health, global disability, and home help utilization. CONCLUSION: The harmonized four-item ADL measure seems a reliable and valid instrument for comparing ADL disability in older people across countries.

Activities of Daily Living↗
PubMed2004

Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65.

The objective was to evaluate the associations between older persons' health status and their social integration and social networks (family, children, friends and community), in two French-speaking, Canadian community dwelling populations aged 65 years and over, using the conceptual framework proposed by Berkman and Thomas. Data were taken from two 1995 surveys conducted in the city of Moncton (n = 1518) and the Montreal neighbourhood of Hochelaga-Maisonneuve (n = 1500). Social engagement (a cumulative index of social activities), networks consisting of friends, family and children and social support were measured using validated scales. Multiple logistic regressions based on structured inclusion of potentially mediating variables were fitted to estimate the associations between health status and social networks. Self-rated health was better for those with a high level of social integration and a strong network of friends in both locations. In addition, in Hochelaga-Maisonneuve family and children networks were positively associated with good health, though the effect of friend networks was attenuated in the presence of disability, good social support from children was associated with good health. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, exercise, locus of control and depressive symptoms were considered intermediary variables between social networks and health. In conclusion, social networks, integration and support demonstrated unique positive associations with health. The nature of these associations may vary between populations and cultures.

Activities of Daily Living↗
PubMed2004

[Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70].

INTRODUCTION: To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. METHODS: We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were obtained in the subgroup of non-demented subjects. RESULTS: The easiest and most efficient method to obtain the total score of the 7MS was the sum of the z-scores of the four subtests. We present the mean values, -1 and -1.5 standard deviations, range and percentiles of the partial and total scores of the 7MS stratified by age (71-75, 76-80, 81-85 and > or = 86 years) and education (less than primary education and primary education or greater) in the subgroup of non-demented subjects. CONCLUSIONS: The normative data of the 7MS obtained in a representative sample of the general elderly population support its rigorous use in the Spanish clinical setting.

Aged↗
PubMed2002

The role of prisons in the HIV epidemic among female injecting drug users.

The objective of this study was to describe factors associated with imprisonment of female injecting drug users (IDUs) and to assess if female IDUs who have been in prison have different HIV risk behaviours when compared to females IDUs who have never been incarcerated. A seroepidemiological survey was conducted of 304 female IDUs recruited in outreach and treatment programmes in Madrid, Spain. Data on sociodemographic characteristics and recent and lifetime risk factors, sexual and reproductive history and history of imprisonment were collected. Bivariate analysis and a logistic regression model were used to identify factors associated with imprisonment. Risk factors for imprisonment were having illegal sources of income, not having a fixed address, leaving education before finishing primary school and starting injection of drugs early in adolescence. HIV risk behaviours were highly prevalent among this population of female IDUs and drug injection in prison was reported by more than one-third of those who had ever been imprisoned. In addition, recent HIV risk behaviour indicators were not associated with imprisonment, suggesting that incarceration did not lead to risk reduction after release from prison. Female IDUs who have been in prison have substantial reproductive health problems that require gynaecological care. These results point to the urgent need for prevention programmes which address HIV and other blood-borne infections using gender specific approaches for women IDUs incarcerated in Spanish prisons.

Adult↗
PubMed2002

Correlates of wellbeing of spousal and children carers of disabled people over 65 in Spain.

BACKGROUND: The aim of this study was to evaluate the associations between carer's wellbeing and stressors and to assess if these associations are different for spousal and children carers of disabled elderly. METHODS: Information was collected by home interviews of a population sample of carers (N = 195), who were providing assistance in activities of daily living to a community-dwelling population over 65. Associations between indicators of wellbeing (number of depressive symptoms, number of physical symptoms, self-perceived health and life satisfaction) and caring stressors were examined, controlling for carer's socio-economic characteristics and health status. Hierarchical logistic regressions were used to fit the data. Religion and social support were included as resources and spousal and children differential associations were tested. RESULTS: The four indicators of wellbeing are moderately correlated, indicating a common underlying concept. Spousal carers have lower socio-economic status, poorer health and lower levels of wellbeing than children carers. However, children carers bear a significantly greater burden. In the multivariate analysis of the associations between wellbeing and stressors, the similarities between spouse and adult child carers are more striking than the differences. Emotional support was consistently associated with higher levels of wellbeing while the associations of religiosity and instrumental support with wellbeing did not reach statistical significance. CONCLUSION: As formal care services are being developed in Spain, their ability to work in a supportive way with family networks should be taken into account. Research should be carried out on patterns of formal care interventions that use the resources in the natural support network of the family.

Aged↗
PubMed2001

Loss to follow-up in a longitudinal study on aging in Spain.

The objectives of this study were to describe follow-up dynamics in a longitudinal study on aging conducted in Spain between 1993 and 1997, and to identify the demographic, behavioral and health characteristics of persons who would later refuse to continue participating, move out of the area or be hard to locate (i.e., become lost to follow-up subjects). Data from the 1993 baseline survey were used to predict the probabilities of being lost to follow-up in the 1995 and 1997 waves. Structural multiple logistic regressions were fitted and mean probabilities were estimated to identify patterns of loss to follow-up. After 4 years, 52% of baseline participants remained in the study, 24% had died, 17% refused to continue participating, and 8.7% were impossible to locate. In the multivariate analysis, advanced age and living alone were independent predictors of loss to follow-up, and none of the health status variables remained significant. However, participation status in previous waves and the number of nonresponse items were strong independent predictors of further non-participation. Our results suggest that an attitude against participation in surveys may be an independent predictor of losses to follow-up and efforts should be made to retain this subgroup of the population in the study. Further research on reasons why people are unwilling to participate in surveys and strategies to retain people in longitudinal studies is needed.

Aged↗
PubMed2001

Determinants of HIV prevalence amongst female IDU in Madrid.

OBJECTIVE: To explore the multitude possible factors associated with HIV in a population of female injecting drug users (IDUs) in Madrid, Spain. DESIGN: A cross-sectional study was undertaken and because of the lack of sampling frame in this population, a convenience sample was recruited from drug treatment, methadone services and street settings. METHODS: Face to face interviews were conducted with 304 female IDUs during October 1995-March 1996. HIV status was determined from antibody testing of blood samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect relationships with HIV prevalence. RESULTS: HIV prevalence in the sample of female IDUs for which HIV status was known (n = 262) was 63%. Factors independently associated with HIV prevalence in the regression analysis included: having a regular HIV positive sexual partner [odds ratio (OR): 12.2], age over 34 years (OR: 3.4), no fixed address (OR: 2.9), co-infection with a sexually transmitted infection (STI) in the last year (OR: 2.8) and ever shared needles (OR: 2.6). CONCLUSIONS: The documentation of the context of risk behaviour in female IDU is important to predict the course of the epidemic and to develop prevention strategies. The sexual partners of female IDUs in Spain are important components in explaining the HIV epidemic in this population as other risk factors, including high risk drug taking behaviour. The findings also highlight the need to target homeless IDUs women and inmate women with outreach services offering preventive interventions. More effective STI prevention and control strategies are also warranted.

Adult↗
PubMed2001

Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain.

OBJECTIVE: To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain. METHODS: A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children. RESULTS: Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology. DISCUSSION: Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.

Activities of Daily Living↗
PubMed2000

Development of simple cognitive function measures in a community dwelling population of elderly in Spain.

OBJECTIVE: To develop and assess the consistency and validity of simple cognitive function measures for an elderly population with low levels of formal education for use in a longitudinal study of dementia. METHODS: Data were from the population longitudinal study 'Growing old in Leganés' (Spain). In 1993, a random sample of 1540 people over 65 was drawn from the City Roll of Leganés from which 1284 (83%) were successfully interviewed. Measures of memory and orientation were based on the SPMSQ (Short Portable Mental Status Questionnaire), the Barcelona test and the short story from EPESE (Established Populations Epidemiologic Studies of the Elderly). Non-response to a test item was coded as an error. Internal consistency was assessed by factor analysis and Cronbach's alpha. Construct validity was examined with multiple linear regressions of the proposed measurements on variables chosen from the existing literature on cognitive function. RESULTS: Two factors, memory and orientation, emerged from the factor analysis. Internal consistency of the proposed indexes for memory and orientation was acceptable. Memory and orientation scores were summed into one summary index of cognition. Associations between covariates and both cognitive indexes were in the expected direction. Among those highly functional, orientation was influenced by illiteracy due to higher error rates in the time orientation items based on dates; however, memory and summary scores were not significantly different by literacy status. A large proportion of the variance in IADL was explained by the memory and orientation measures. CONCLUSION: The memory and orientation indexes are valid and reliable measurements of cognitive function for use in a population of community dwelling elderly with low levels of formal education and high rates of illiteracy.

Aged↗
PubMed2000

Women, drugs and HIV/AIDS: results of a multicentre European study.

BACKGROUND: In the light of rising human immunodeficiency virus (HIV) incidence rates amongst women in Western Europe, a multicentred, cross-sectional study was undertaken to explore the multitude of possible factors associated with HIV in a population of female injecting drug users (IDU). METHODS: Face-to-face interviews were conducted with 1198 female IDU recruited from a variety of settings in Paris, Madrid, Rome, London and Berlin. Their HIV status was determined from antibody testing of blood or saliva samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect associations between socioeconomic factors, marginalization and risk behaviour with HIV prevalence. RESULTS: The HIV prevalence in the sample of female IDU was 27.8% (range: 1.4% in London and 52.6% in Madrid). Factors independently associated with HIV prevalence in the regression analysis included: age >25 years (OR = 2.0-2.9), left full-time education before age 14 (OR = 2.4), no fixed address (OR = 2.2), previous imprisonment (OR = 1.4), commercial sex (OR = 1.3), having a regular HIV positive sexual partner (OR = 6.6), ever shared needles (OR = 1.5) and any sexually transmitted disease (STD) infection in the last year (OR = 1.7). CONCLUSIONS: The sexual behaviour and partners of female IDU in Western Europe are as important a component in explaining the HIV epidemic in this population as other risk factors, including high-risk drug taking behaviour. Homeless IDU women may be an important residual risk group warranting future preventive interventions and women with a history of STD should be a particular target for health education. Differences in HIV prevalence across cities are very large and may be related to differences in harm reduction policies.

Adolescent↗
PubMed1999

Screening for impaired cognitive function among the elderly in Spain: reducing the number of items in the Short Portable Mental Status Questionnaire.

The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.

Aged↗
PubMed1999

Predictors of functional status in older people living at home.

OBJECTIVE: to describe changes in functional status of community-dwelling Spanish elderly people, followed for 2 years, and to identify socio-demographic and health characteristics that predict functional change. METHOD: we have analysed data from the first two waves of the longitudinal study, Ageing in Leganés, from a representative sample of community-dwelling people aged 65 and over (n=1273). Functional status was categorized according to a hierarchical scale as: completely functional, with functional limitations, with instrumental activities of daily living (IADL) disability, with activities of daily living (ADL) disability or deceased. Multinomial logistic regression was used to estimate the predictive value of selected 1993 socio-demographic and health status variables on 1995 functional status. RESULTS: prevalence of disability based on dependency in any of seven ADL items was 15.5%. Half of the respondents were disabled in at least one of 10 IADLs. Some improved functionally, others deteriorated. Men were more likely to recover function while women were more likely to enter and to remain in the IADL state. Socioeconomic factors were associated to baseline functional status and to functional status change on bivariate analysis. Number of chronic diseases, presence of cognitive problems and depressive symptoms predicted transitions, even after controlling for baseline functional status. CONCLUSION: although estimates of prevalence of disability among people over 65 are higher in Spain than in other European and North American countries, the pattern of functional changes, both in the direction of improvement and decline, seems to be similar.

Activities of Daily Living↗
PubMed1999

Family, religion, and depressive symptoms in caregivers of disabled elderly.

STUDY OBJECTIVE: To explain the variations in depressive symptomatology among primary caregivers of community dwelling activities of daily living disabled elderly and to evaluate the role of family and religiosity on the mental health consequences of caregiving in Spain. DESIGN: Cross sectional study. SETTING: City of Leganés in the metropolitan area of Madrid, Spain. PARTICIPANTS: All caregivers of a representative sample of community dwelling activities of daily living disabled persons, aged 65 and over were approached. The response rate was 85% (n = 194). Depression was assessed by the Center for Epidemiologic Studies Depression (CES-D) Scale. MAIN RESULTS: Controlling for caregivers' income, education, health status, and caregiving stress, religiosity was associated with more depressive symptoms among children caregivers while for spouses the association was negative. Emotional support was negatively associated with depression, but instrumental support was not significant. CONCLUSIONS: Depressive symptomatology is frequent among Spanish caregivers of disabled elderly. This study concludes that religiosity and family emotional support play an important part in the mental health of Spanish caregivers. The role of religiosity may be different according to kinship tie and needs further investigation.

Activities of Daily Living↗
PubMed1998

[Interaction of prescribed drugs in a population over 65 years of age].

OBJECTIVE: To assess the prevalence and the types of drug to drug interactions in a population 65 years and over and to identify the factors associated to the occurrence of interactions. DESIGN: Cross sectional study ("Aging in Leganés"), a community survey. SETTING: Community level. Leganés (Madrid). PATIENTS AND OTHER PARTICIPANTS: People 65 years and over (n = 1284, response rate 83%). MEASUREMENTS AND MAIN RESULTS: Information on use of health services and medication use was collected through home interviews. Drugs were classified by its active components and into therapeutic categories. Drug to drug interactions were identified using Hansten's classification. Bivariate and multivariate analysis were carried out to identify factors associated to the frequency of interactions. RESULTS: The prevalence of drug to drug interactions was estimated as 13.6%. Interactions of clinical significance occurred in 9.9% of the population 65 and over. Hypertension, diabetes, Parkinson and cardiovascular diseases are significatively associated to interactions. The number of visits to the specialists was a risk factor (OR = 2.1 for those with five or more visits), after controlling for specific chronic conditions. Contacts with primary care, age and sex of the elderly were not associated to the frequency of interactions. DISCUSSION: The frequency of interactions is associated to preventable factors. Improvements in the communication between specialists and primary care and cooperation with pharmacists could result in better monitoring of medication use in the elderly.

Aged↗
PubMed1998

Gender differences in depressive symptoms among Spanish elderly.

The aim of this study is to describe gender differences in depressive symptomatology among an elderly Spanish population and to see whether women are more at risk than men and whether the effects of known risk factors for depression differ between the genders. Data come from the study Envejecer en Leganés (Growing Old in Leganés), where a representative sample of community residing elderly was screened by an at-home interview for high depressive symptomatology using the Center for Epidemiologic Studies Depression Scale (CES-D). Sociodemographic characteristics, health status, Activities of Daily Living and Instrumental Activities of Daily Living, disability, social support, and locus of control were measured as possible correlates of depressive symptoms. Screening was completed in 1116 subjects. The prevalence of high depressive symptomatology varied, being 19.6% for men and 46% for women (OR = 3.4; 95% CI = 2.6; 4.5). In addition to gender, comorbidity, low emotional support from children, lack of a confidant, few social activities, and a sense of lack of control were independently associated with high levels of depressive symptoms. None of the interactions of gender by the known risk factors of depression was significant. Although the prevalence of depressive symptomatology is higher in women than in men, the known risk factors do not totally explain the difference between genders in this population of Spanish elderly. This difference could be due to the cultural definitions of gender roles that have affected them throughout their lives.

Activities of Daily Living↗
PubMed1998

A demographic and health survey of Spanish female sex workers: HIV prevalence and associated risk factors.

In order to examine the prevalence of HIV infection and associated risk factors amongst Spanish female prostitutes a multicentre (n = 22) cross-sectional study was conducted between November 1989 and January 1991. Data collected included socioeconomic characteristics, sexual behavior and health status together with blood samples. A total of 1633 prostitutes were recruited into the study. Of these, 1433 (87.8%) consented to blood samples being taken and 180 (12.6%) were HIV positive. HIV seroprevalence was 54.7% for intravenous drug users (IVDUs) versus 3.7% for non-IVDUs. Previous imprisonment, hepatitis B and a partner who was an IVDU were significant predictors of HIV infection according to multivariate logistic regression models.

Adolescent↗