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      Fragilidad y riesgo de dependencia: el cuestionario de Barber en estudios poblacionales Translated title: Frailty and risk of dependency: Barber's questionnaire in population based studies

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          Abstract

          RESUMEN Introducción: La dependencia funcional es un problema creciente, vinculado al incremento de edad, especialmente en países industrializados. Los estudios poblacionales permiten un acercamiento a la magnitud del problema. Objetivo: El cuestionario de Barber es un instrumento ampliamente utilizado para la detección de riesgo de dependencia, vulnerabilidad o fragilidad en adultos mayores. No se han encontrado trabajos que lo apliquen en estudios poblacionales, en los que, por su sencillez, podría resultar útil. Metodología: Se incluyó el cuestionario en una encuesta de salud, con una muestra representativa (n = 1.882 sujetos) de personas de 65 años o más, de una gran ciudad (Madrid, España) y se presentan las evidencias de validez basada en la estructura interna y la relación con otras variables de tipo convergente y discriminante. Resultados: Se obtuvo una solución unifactorial, con adecuada consistencia interna según varios indicadores multivariados. Se encontraron diferencias significativas por sexo, tanto al nivel de la escala como de los ítems. También aparecieron correlaciones significativas entre la puntuación total de la prueba y la de otras variables, como la calidad de vida relacionada con la salud, la edad y la sensación de soledad. Un 58,1% de la muestra obtuvo puntuaciones que sugieren vulnerabilidad (el 65,3% de las mujeres). Conclusiones: Los resultados sugieren la utilidad del cuestionario de Barber, como prueba fiable y válida, para detectar situaciones de fragilidad o vulnerabilidad en adultos mayores, lo que facilitaría la comparabilidad entre encuestas poblacionales, superando la actual tendencia a incluir decenas de preguntas en otras encuestas de índole regional o nacional.

          Translated abstract

          ABSTRACT Introduction: Functional dependence is a growing problem, linked to increasing age, especially in industrialized countries. Population studies allow an approach to the magnitude of the problem. Objectives: Barber's questionnaire is a widely used instrument for the detection of risk of dependence, vulnerability or frailty in older adults. No works have been found that apply it in population-based studies, where, due to its simplicity, it could be useful. Methodology: The questionnaire was included in a Health Survey, with a representative sample (n = 1,882 subjects) of people aged 65 years or more, from a big city (Madrid, Spain) and the evidence of validity is presented based on the internal structure and the relationship with other variables of convergent and discriminant type. Results: A unifactorial solution was obtained, with adequate internal consistency according to several multivariate indicators. Significant differences were found by sex, both at the scale and item level. Significant correlations also appeared between the total test score and other variables, such as health-related quality of life, age, and sense of loneliness. A total of 58.1% of the sample obtained scores suggesting vulnerability (65.3% of the women). Conclusions: The results suggest the usefulness of the Barber questionnaire, as a reliable and valid test, to detect situations of frailty or vulnerability in older adults, which would facilitate comparability between population surveys, overcoming the current tendency to include dozens of questions in other regional or national surveys.

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          Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

          Summary Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Funding Bill & Melinda Gates Foundation.
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            FACTOR: a computer program to fit the exploratory factor analysis model.

            Exploratory factor analysis (EFA) is one of the most widely used statistical procedures in psychological research. It is a classic technique, but statistical research into EFA is still quite active, and various new developments and methods have been presented in recent years. The authors of the most popular statistical packages, however, do not seem very interested in incorporating these new advances. We present the program FACTOR, which was designed as a general, user-friendly program for computing EFA. It implements traditional procedures and indices and incorporates the benefits of some more recent developments. Two of the traditional procedures implemented are polychoric correlations and parallel analysis, the latter of which is considered to be one of the best methods for determining the number of factors or components to be retained. Good examples of the most recent developments implemented in our program are (1) minimum rank factor analysis, which is the only factor method that allows one to compute the proportion of variance explained by each factor, and (2) the simplimax rotation method, which has proved to be the most powerful rotation method available. Of these methods, only polychoric correlations are available in some commercial programs. A copy of the software, a demo, and a short manual can be obtained free of charge from the first author.
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              The alpha and the omega of scale reliability and validity: why and how to abandon Cronbach’ s alpha and the route towards more comprehensive assessment of scale quality

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                Author and article information

                Journal
                geroko
                Gerokomos
                Gerokomos
                Sociedad Española de Enfermería Geriátrica y Gerontológica (Barcelona, Barcelona, Spain )
                1134-928X
                2022
                : 33
                : 2
                : 76-81
                Affiliations
                [1] Madrid orgnameAyuntamiento de Madrid orgdiv1Madrid Salud orgdiv2Departamento de Evaluación y Calidad España
                [5] Madrid orgnameAyuntamiento de Madrid orgdiv1Madrid Salud orgdiv2Departamento de Evaluación y Calidad España
                [4] Madrid orgnameAyuntamiento de Madrid orgdiv1Madrid Salud orgdiv2Departamento de Evaluación y Calidad España
                [2] Madrid orgnameAyuntamiento de Madrid orgdiv1Madrid Salud orgdiv2Departamento de Evaluación y Calidad España
                [3] Madrid orgnameAyuntamiento de Madrid orgdiv1Madrid Salud orgdiv2Departamento de Evaluación y Calidad España
                Article
                S1134-928X2022000200003 S1134-928X(22)03300200003
                3a97c87f-750b-4173-ac09-19ce3bc85576

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 16 October 2020
                : 11 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 6
                Product

                SciELO Spain

                Categories
                Originales

                estudios poblacionales,Older adults,riesgo de dependencia,fragilidad,Adultos mayores,diferencias de género,frailty,population studies,dependency risk,gender differences

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