Search

Objective: The standard method of generating disorder‐specific disability scores has lay raters make rankings between pairs of disorders based on brief disorder vignettes. This method introduces bias due to differential rater knowledge of disorders and inability to disentangle the disability due to disorders from the disability due to comorbidities. Methods: We propose an alternative, data‐driven, method of generating disorder‐specific disability scores that assesses disorders in a sample of individuals either from population medical registry data or population survey self‐reports and uses Generalized Random Forests (GRF) to predict global (rather than disorder‐specific) disability assessed by clinician ratings or by survey respondent self‐reports. This method also provides a principled basis for studying patterns and predictors of heterogeneity in disorder‐specific disability. We illustrate this method by analyzing data for 16 disorders assessed in the World Mental Health Surveys (n = 53,645). Results: Adjustments for comorbidity decreased estimates of disorder‐specific disability substantially. Estimates were generally somewhat higher with GRF than conventional multivariable regression models. Heterogeneity was nonsignificant. Conclusions: The results show clearly that the proposed approach is practical, and that adjustment is needed for comorbidities to obtain accurate estimates of disorder‐specific disability. Expansion to a wider range of disorders would likely find more evidence for heterogeneity. [ABSTRACT FROM AUTHOR]

We aimed to explore the distribution of positive and negative emotions across nine low‐, middle‐ and high‐income countries; and the association between social factors and these emotions. Data were drawn from the SAGE and the COURAGE studies, with 52,553 participants. Emotions were assessed through the day reconstruction method.Sociodemographic characteristics and social factors were also measured. Multiple linear regressions were performed. Finland, China and African countries showed significantly lower scores on the negative emotions, whereas positive emotions were more homogeneous across countries. Loneliness was positively associated with negative emotions and negatively associated with positive ones; frequent social participation was related with higher scores in positive emotions; and lower trust with higher levels of feeling rushed, irritated, depressed and less calm. The extent to which each emotion was felt varied across countries, but there seems to exist an association of social factors with the emotions. [ABSTRACT FROM AUTHOR]

Objectives: To develop and test an internationally applicable mapping function for converting WHODAS‐2.0 scores to disability weights, thereby enabling WHODAS‐2.0 to be used in cost‐utility analyses and sectoral decision‐making. Methods: Data from 14 countries were used from the WHO Multi‐Country Survey Study on Health and Responsiveness, administered among nationally representative samples of respondents aged 18+ years who were non‐institutionalized and living in private households. For the combined total of 92,006 respondents, available WHODAS‐2.0 items (for both 36‐item and 12‐item versions) were mapped onto disability weight estimates using a machine learning approach, whereby data were split into separate training and test sets; cross‐validation was used to compare the performance of different regression and penalized regression models. Sensitivity analyses considered different imputation strategies and compared overall model performance with that of country‐specific models. Results: Mapping functions converted WHODAS‐2.0 scores into disability weights; R‐squared values of 0.700–0.754 were obtained for the test data set. Penalized regression models reached comparable performance to standard regression models but with fewer predictors. Imputation had little impact on model performance. Model performance of the generic model on country‐specific test sets was comparable to model performance of country‐specific models. Conclusions: Disability weights can be generated with good accuracy using WHODAS 2.0 scores, including in national settings where health state valuations are not directly available, which signifies the utility of WHODAS as an outcome measure in evaluative studies that express intervention benefits in terms of QALYs gained. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes and depression are commonly present in the same individuals, suggesting the possibility of underlying shared physiological processes. Inflammation, as assessed with the biomarker C‐reactive protein (CRP), has not consistently explained the observed relationship between diabetes and depression, although both are associated with inflammation and share proposed inflammatory mechanisms. Central adiposity has also been associated with both conditions, potentially by causing increased inflammation. This study uses the World Health Organization's Study on global AGEing and adult health (SAGE) Mexico Wave 1 biomarker data (n = 1831) to evaluate if inflammation and central adiposity mediate the relationship between depression and diabetes. Methods: Depression was estimated using a behavior‐based diagnostic algorithm, inflammation using venous dried blood spot (DBS) CRP, central adiposity using waist‐to‐height ratio (WHtR), and uncontrolled diabetes using venous DBS‐glycated hemoglobin (HbA1c). Results: The association between depression and uncontrolled diabetes was partially mediated by CRP before but not after WHtR was considered. When WHtR was added to the model, it partially mediated the relationship between diabetes and depression while fully mediating the relationship between depression and CRP. Conclusions: These findings suggest that central adiposity may be a more significant mediator between diabetes and depression than inflammation and account for the relationship between these disorders and inflammation. Depression may cause an increase in central adiposity, which then may lead to diabetes, but the increase in known systemic inflammatory pathways caused by central adiposity may not be the key pathological mechanism. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the factors associated with low skeletal muscle mass (SMM), sarcopenia, and sarcopenic obesity using nationally representative samples of people aged ≥65 years from diverse geographical regions of the world. Methods Data were available for 18 363 people aged ≥65 years who participated in the Collaborative Research on Ageing in Europe survey conducted in Finland, Poland, and Spain, and the World Health Organization Study on global AGEing and adult health survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. A skeletal muscle mass index (SMI) was created to reflect SMM. SMM, SMI, and percent body fat (%BF) were calculated with specific indirect population formulas. These estimates were based on age, sex, weight, height, and race. Sarcopenia and sarcopenic obesity were defined with specific cut-offs. Results The prevalence of sarcopenia ranged from 12.6% (Poland) to 17.5% (India), and that of sarcopenic obesity ranged from 1.3% (India) to 11.0% (Spain). Higher %BF was associated with lower SMM in all countries, and with sarcopenia in five countries ( p < 0.001). Compared to high levels of physical activity, low levels were related with higher odds for sarcopenia [OR 1.36 (95%CI 1.11-1.67)] and sarcopenic obesity [OR 1.80 (95%CI 1.23-2.64)] in the overall sample. Also, a dose-dependent association between higher numbers of chronic diseases and sarcopenic obesity was observed. Conclusions Physical activity and body composition changes such as high %BF are key factors for the prevention of sarcopenia syndrome. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days); (2) to document differences in physical activity patterns by sex and age; and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion. Methods The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old; 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data. Results Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females ( P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men ( P < 0.01) and women ( P < 0.001). AEE was positively correlated with BMI in men ( P < 0.01) and women ( P < 0.05). Finally, women who were more socially integrated had greater AEE ( P < 0.01). Conclusions This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations. Am. J. Hum. Biol. 28:412-420, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives Changes in sleep patterns often occur in older adults. Previous studies have documented associations between sleep duration, sleep quality, and obesity risk in older individuals, yet few studies have examined these trends in lower-income countries. The present cross-sectional study uses nationally representative datasets from six countries to examine these relationships. Methods Two hypotheses related to obesity risk and sleep patterns were tested using data from the first wave of the World Health Organization's Study on global AGEing and adult health (SAGE). This longitudinal study draws on samples of older adults ( >50 years old) in six middle-income countries (China, Ghana, India, Mexico, Russian Federation, and South Africa). Self-report data were used to measure sleep duration, sleep quality, lifestyle and sociodemographic information, while anthropometric measurements were collected to assess body mass index (BMI) and waist circumference (WC). Multiple linear regressions were used to examine the relationship between sleep patterns and obesity risk while controlling for lifestyle factors. Results Shorter sleep durations in both men and women were significantly associated with higher BMI and WC measures ( P < 0.05). Low sleep quality did not significantly contribute to increased obesity risk. Surprisingly, high sleep quality was significantly associated with increased male BMI and WC in China and India ( P < 0.01). Conclusions This study documented an association between short sleep duration and increased obesity risk, which is important given the global increase of obesity-related diseases. Am. J. Hum. Biol. 26:803-812, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

COURAGE in Europe was a 3-year project involving 12 partners from four European countries and the World Health Organization. It was inspired by the pressing need to integrate international studies on disability and ageing in light of an innovative perspective based on a validated data-collection protocol. COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of the built environment and social networks on health, disability, quality of life and well-being. The main survey was conducted by partners in Finland, Poland and Spain where the survey has been administered to a sample of 10 800 persons, which was completed in March 2012. The newly developed and validated COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in ageing population, and the COURAGE in Europe Project has created valid and reliable scientific evidence, demonstrating cross-country comparability, for disability and ageing research and policy development. It is therefore recommended that future studies exploring determinants of health and disability in ageing use the COURAGE-derived methodology. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of built environment and social networks on health, disability quality of life and well-being., The COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in the ageing population., The COURAGE in Europe Consortium recommends that future studies exploring determinants of health and disability in ageing use COURAGE-derived methodology. [ABSTRACT FROM AUTHOR]

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10 800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking., The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment., Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment. [ABSTRACT FROM AUTHOR]

A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model., The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends., The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment. [ABSTRACT FROM AUTHOR]

The aim of the study was to create a simplified, easy implementable multidimensional instrument to assess all relevant elements of the structure and function of social network within individuals across different European countries and to provide the tool for health professionals and policy makers. The analysis was based on the sample of 10 446 non-institutionalized adult population from Finland, Poland and Spain. The Social Network Questionnaire Collaborative Research on Ageing in Europe Social Network Index (COURAGE-SNI) was part of the COURAGE questionnaire. The indicators of the functioning of social network ties (close relations), frequency of direct contact and general support were evaluated. Functions were assess within the main structural components as spouse, parents, children, grandchildren, other relatives, friends, coworkers and neighbours. The exploratory factor analysis revealed five main latent components of social network with one component composed of hierarchical part. The confirmatory factor analysis provided an acceptable fit for the model. The generalize partial credit model was used to calculate factor scores for five components of the COURAGE-SNI considering the social networks of 'spouse/partner', 'parents', 'other family members', 'neighbours' and 'friends and co-workers'. The scores for every component were recalculated so as to provide the social network saturation ranged from 0 (the lowest) to 100% (the highest possible). Finally, the COURAGE-SNI score was obtained as the sum of weighted information calculated by the item response theory procedure for every aforementioned component. In summary, the COURAGE-SNI showed good reliability and content validity and seems to be a promising tool for the assessment of the social network phenomenon across European countries. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The Courage-SNI is a new tool to assess the construct of social network in population studies., The Courage-SNI is an instrument useful to identify high risk groups or populations whose social network is poorer. [ABSTRACT FROM AUTHOR]

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning., The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor., New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations. [ABSTRACT FROM AUTHOR]

Objectives To determine the profile and determinants of successful aging in a developing country characterized by low life expectancy and where successful agers may represent a unique group. Design Community-based cohort study. Setting Eight contiguous states in the Yoruba-speaking region of Nigeria. Participants A multistage clustered sampling of households was used to select a representative sample of individuals (N = 2,149) aged 65 and older at baseline. Nine hundred thirty were successfully followed for an average of 64 months between August 2003 and December 2009. Measurements Lifestyle and behavioral factors were assessed at baseline. Successful aging, defined using each of three models (absence of chronic health conditions, functional independence, and satisfaction with life), was assessed at follow-up. Results Between 16% and 75% of respondents could be classified as successful agers using one of the three models while 7.5% could be so classified using a combination of all the models. Correlations between the three models were small, ranging from 0.08 to 0.15. Different features predicted their outcomes, suggesting that they represent relatively independent trajectories of aging. Whichever model was used, more men than women tended to be classified as aging successfully. Men who aged successfully, using a combination of all the three models, were more likely never to have smoked (adjusted odds ratio (a OR) = 4.7, 95% confidence interval (CI) = 1.55-14.46) and to report, at baseline, having contacts with friends (a OR = 4.2, 95% CI = 1.0-18.76) or participating in community activities ( aOR = 16.0, 95% CI = 1.23-204.40). In women, there was a nonlinear trend for younger age at baseline to predict this outcome. Conclusion Modifiable social and lifestyle factors predicted successful aging in this population, suggesting that health promotion targeting behavior change may lead to tangible benefits for health and well-being in old age. [ABSTRACT FROM AUTHOR]

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10 800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking., The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment., Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment. [ABSTRACT FROM AUTHOR]

A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model., The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends., The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment. [ABSTRACT FROM AUTHOR]

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning., The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor., New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations. [ABSTRACT FROM AUTHOR]

The aim of the study was to create a simplified, easy implementable multidimensional instrument to assess all relevant elements of the structure and function of social network within individuals across different European countries and to provide the tool for health professionals and policy makers. The analysis was based on the sample of 10 446 non-institutionalized adult population from Finland, Poland and Spain. The Social Network Questionnaire Collaborative Research on Ageing in Europe Social Network Index (COURAGE-SNI) was part of the COURAGE questionnaire. The indicators of the functioning of social network ties (close relations), frequency of direct contact and general support were evaluated. Functions were assess within the main structural components as spouse, parents, children, grandchildren, other relatives, friends, coworkers and neighbours. The exploratory factor analysis revealed five main latent components of social network with one component composed of hierarchical part. The confirmatory factor analysis provided an acceptable fit for the model. The generalize partial credit model was used to calculate factor scores for five components of the COURAGE-SNI considering the social networks of 'spouse/partner', 'parents', 'other family members', 'neighbours' and 'friends and co-workers'. The scores for every component were recalculated so as to provide the social network saturation ranged from 0 (the lowest) to 100% (the highest possible). Finally, the COURAGE-SNI score was obtained as the sum of weighted information calculated by the item response theory procedure for every aforementioned component. In summary, the COURAGE-SNI showed good reliability and content validity and seems to be a promising tool for the assessment of the social network phenomenon across European countries. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The Courage-SNI is a new tool to assess the construct of social network in population studies., The Courage-SNI is an instrument useful to identify high risk groups or populations whose social network is poorer. [ABSTRACT FROM AUTHOR]

This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy-makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly-available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions. [ABSTRACT FROM AUTHOR]

Résumé Dans cet article, nous évaluons dans quelle mesure le versement de pensions et l'assurance-maladie permettent de prévenir les problèmes de santé au sein de la population âgée des pays en développement. Nous avançons que, jusqu'à une période récente, les grandes orientations définies en matière de protection sociale n'accordaient pas suffisamment de place à la prévention des risques pour la santé, donnant la priorité à la réduction de la pauvreté monétaire au moyen de transferts monétaires. Nous montrons que les responsables de l'action publique ne doivent pas partir du principe que l'octroi d'une pension de retraite se traduit systématiquement par une amélioration de l'état de santé des personnes âgées parce que peu de données valident ce postulat. Nous examinons ensuite les effets de l'extension des régimes d'assurance maladie aux personnes âgées sur leur santé, en nous intéressant plus particulièrement à l'hypertension. Nous indiquons, en nous appuyant sur de nouvelles données relatives au Ghana, au Mexique et à l'Afrique du Sud recueillies par l' Organisation mondiale de la santé, que les personnes âgées couvertes par une assurance-maladie n'ont guère plus de chances que leurs homologues non assurées d'être conscientes de souffrir d'une affection comme l'hypertension et de bénéficier d'un traitement efficace. Néanmoins, qu'elle soit ou non couverte par une assurance-maladie, la grande majorité de la population âgée atteinte d'hypertension ne bénéficie pas d'un traitement efficace. Ces difficultés d'accès aux soins sont davantage liées au fait que les personnes âgées n'ont pas conscience de leurs problèmes de santé et à des carences au niveau de l'offre de soins plutôt qu'à des obstacles financiers. Par conséquent, dans les pays en développement, notamment dans les zones rurales, les régimes de retraite ou d'assurance-maladie ne peuvent induire une amélioration de l'état de santé des personnes âgées que s'ils s'accompagnent de programmes d'éducation pour la santé et de dépistage, et si l'offre de soins est adaptée. De surcroît, ces mesures doivent faire partie intégrante des stratégies de protection sociale classiques et non être conçues comme complémentaires de ces stratégies. Or, dans la pratique, la protection sociale et la promotion de la santé sont encore considérées comme des sphères presque entièrement distinctes l'une de l'autre, si bien que la mise au point de mesures globales se heurte à d'importantes barrières institutionnelles. [ABSTRACT FROM AUTHOR]

Resumen Este artículo evalúa con qué eficiencia las pensiones y el seguro de enfermedad previenen los problemas de salud de las personas mayores en los países en desarrollo. Hasta hace poco los programas de protección social no prestaban la atención suficiente a la prevención de los riesgos de enfermedad y, en su lugar, se centraban en la reducción de la pobreza a través de transferencias monetarias. El artículo señala que existen pocas pruebas fiables de que el pago de pensiones a las personas mayores mejore su salud y que los responsables de políticas no deberían dar por sentados estos efectos. Más adelante aborda el efecto que ejerce la cobertura de los regímenes de seguro de enfermedad en la situación sanitaria de las personas mayores, con particular referencia a la hipertensión. A partir de datos de la Organización Mundial de la Salud recientemente disponibles sobre Ghana, México y Sudáfrica se desprende que las personas mayores con un seguro de enfermedad tienen probabilidades ligeramente superiores de estar al tanto de afecciones como la hipertensión y son más propensos a su tratamiento. No obstante, aseguradas o no, la gran mayoría de las personas mayores con hipertensión no se somete a un tratamiento eficaz. Las observaciones muestran que los principales obstáculos para el tratamiento tienen que ver con la conciencia que las personas puedan tener de su propio estado de salud junto con la accesibilidad al suministro de servicios y no tanto con cuestiones financieras. Por consiguiente, la capacidad de las pensiones o del seguro de enfermedad de mejorar la situación sanitaria de las personas mayores en dichos países, en particular en las zonas rurales, depende en gran parte de la educación sanitaria, de los exámenes médicos y de la prestación adecuada de servicios de salud. Estas medidas deben considerarse parte integrante -y no complementaria- de las estrategias corrientes de protección social. Sin embargo, en la práctica, la protección social y la promoción de la salud siguen tratándose como esferas casi totalmente separadas. Esto genera importantes barreras institucionales para el proyecto de medidas mixtas. [ABSTRACT FROM AUTHOR]

Auszug In diesem Artikel beurteilen wir die Wirksamkeit von Rentenbereitstellung und Krankenversicherung für die Krankheitsprävention bei älteren Menschen in Entwicklungsländern. Wir behaupten, dass in den Sozialschutzagenden bis vor kurzem der Prävention von Gesundheitsrisiken zu wenig Aufmerksamkeit gewidmet und stattdessen das Schwergewicht auf die Verringerung der Einkommensarmut durch Geldtransfers gelegt worden ist. Im vorliegenden Beitrag wird gezeigt, dass wenige zuverlässige Beweise vorliegen, aus denen sich ableiten ließe, dass die Bereitstellung von Rentenleistungen für ältere Menschen deren Gesundheitszustand verbessert, und dass dieses Ergebnis daher von den Entscheidungsträgern nicht als gesichert vorausgesetzt werden sollte. Wir befassen uns anschließend damit, wie die Einbeziehung älterer Menschen in Krankenversicherungssysteme deren Gesundheit beeinflusst und gehen konkret auf die Ergebnisse bei Bluthochdruck ein. Unter Bezugnahme auf die erst seit kurzem verfügbaren Daten von der Weltgesundheitsorganisation für Ghana, Mexiko und Südafrika wird gezeigt, dass sich ältere Menschen, die über eine Krankenversicherung verfügen, Gesundheitsproblemen wie Bluthochdruck mit geringfügig grösserer Wahrscheinlichkeit bewusst sind, und dass sie diese höchstwahrscheinlich unter Kontrolle haben. Dessen ungeachtet wird die überwiegende Mehrheit älterer Menschen mit Bluthochdruck - ob versichert oder nicht versichert - nicht wirksam behandelt. Es zeigt sich, dass die hauptsächlichen Hindernisse zur Behandlung vorallem mit dem Bewusstsein und Leistungsangebot zu tun haben und weniger mit den Finanzen. Folglich hängt die Fähigkeit von Renten- oder Krankenversicherungen, zu besseren Gesundheitsergebnissen älterer Menschen in solchen Ländern wie auch in ländlichen Gebieten beizutragen, stark von der Gesundheitserziehung, von medizinischen Untersuchungen und einem geeigneten Leistungsangebot ab. Diese Interventionen sollten als ein integraler Bestandteil von Standard-Sozialschutzstrategien betrachtet werden und nicht in Ergänzung zu diesen. In der Praxis werden jedoch Sozialschutz und Gesundheitsförderung weiterhin als fast vollständig separate Bereiche behandelt, und müssen daher als substanzielle institutionelle Hindernisse zur Entwicklung kombinierter Interventionen angesehen werden. [ABSTRACT FROM AUTHOR]

Aims. The factor structure of DSM-IV substance disorder criteria is examined among alcohol, cannabis, cocaine and opiate users to determine the dimensionality of abuse and dependence criteria within each of these drug classes and whether a common construct can be generalized across drug classes. Design. 12-month criterion prevalence was assessed as part of the World Health Organization's Study on the Reliability and Validity of the Alcohol and Drug Use Disorder Instruments in various settings at eight sites around the world using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A majority of respondents were recruited from non-treatment settings. In addition to exploratory factor analysis, confirmatory factor analysis was used to analyse factor structures using weighted least square methods and tetrachoric correlation matrices. Multi-sample analysis techniques were used to model differences between drug-classes. Findings. In the full data analyses identified a single factor solution for each user population and across user populations. However, analyses of data from users reporting low to moderate symptomatology identified a two-dimensional construct among alcohol, cannabis and opiate users consisting of a major "dependence" factor and a lesser "abuse" factor. In addition, results showed that neither the abuse criterion "(A2) use in physical hazardous situations" or the dependence criterion "(D7) use despite knowledge of psychological/physical problems" were central to the latent construct in any of the user populations, except for D7 among alcohol users. Conclusions. The multi-dimensional results found among users with low to moderate symptomatology indicate that: (1) previous results from relatively homogeneous populations may have been biased towards lesser order solutions, and that (2) the DSM-IV substance disorder criteria describe at least two distinct phenomena, supporting the current DSM-IV organization of substance disorder criteria. Further work needs to evaluate whether prevalent symptoms are present in random or predictable combinations, whether combinations reflecting a specific hierarchy of severity can be identified, and whether incident symptoms are accumulated in a predictable pattern, within specific user populations and across user populations. [ABSTRACT FROM AUTHOR]

Aims: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity., Design: Cross-sectional, representative household surveys., Setting: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative., Participants: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence)., Measurements: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes., Findings: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries., Conclusions: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high., (© 2019 Society for the Study of Addiction.)

Background and Aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups., Design: Cross-sectional household surveys., Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative., Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users., Measurements: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI)., Findings: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems., Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable., (© 2018 Society for the Study of Addiction.)

Background: Previous single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder., Methods: Using representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n=46,071) and 11 developing (n=49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria., Results: Between 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries., Discussion and Conclusions: Despite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria., Scientific Significance: These findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment., (Copyright © American Academy of Addiction Psychiatry.)