Ricardo Ocaña-Riola

The COVID-19 pandemic has significantly impacted progress towards the Sustainable Development Goals (SDGs), particularly SDG 3 (ensuring healthy lives and well-being) and SDG 5 (achieving gender equality), especially for caregivers. Increased demand for informal caregiving has disproportionately impacted caregivers, worsening mental health challenges. Intense burden reinforces traditional gender norms and exacerbates health inequities, linking it closely to both SDGs. This study investigates the relationship between intense caregiving burden and mental health among informal caregivers in Spain, emphasizing gender differences and the mitigating role of perceived social support. This three-time repeated-measures analysis, part of the larger longitudinal CUIDAR-SE study, was conducted in two regions of Spain, Granada (Andalusia) and Gipuzkoa (Basque Country). 261 caregivers (165 female and 96 male) were enrolled in 2021 and followed through 2022 and 2023. Mental health was assessed using the General Health Questionnaire-12 (GHQ-12), with independent variables including age, sex, and caregiving factors (intense burden, social support). Descriptive statistics characterized the caregiving situation by sex, followed by logistic regression to explore associations between GHQ-12 scores and burden, adjusted for age and social support, stratified by sex. Results showed that male caregivers, typically older and caring for spouses, received less informal support and more external assistance than younger female caregivers, whose care was more varied. A positive association was found between caregiving burden and mental health issues: odds ratio (OR) 7.1 (95% CI: 3.7–14.3) in 2021, OR 6.2 (95% CI: 2.8–14.6) in 2022, and OR 4.6 (95% CI: 1.9–12.0) in 2023, adjusting for age and social support. This association was stronger among male caregivers, particularly in 2021. Social support showed a protective effect against mental health problems for men in 2022 and both men and women in 2023. This study underscores the mental health impact of caregiving during the pandemic, revealing gender inequities in caregiving tasks, burden, and mental health distress. The findings emphasize the need for gender-sensitive policies, aligned with the SDGs, to support caregivers’ well-being. Strengthening formal care services and promoting shared caregiving responsibilities are essential to reducing caregiver burden and improving mental health outcomes.

Palliative Sedation (PS) at the end of life is practiced and perceived differently by health professionals depending on the geographical location in which they provide their health care. Taking into account this heterogeneity, it is necessary to expand knowledge and provide data on this clinical practice in different contexts and countries. On the other hand, the identification of factors associated with PS could help healthcare professionals, at an early stage, to identify patients more likely to require sedation. The aim of this study was to describe the prevalence and characteristics related to PS in a specialised Palliative Care setting, as well as to analyse factors that could be associated with this procedure. This was a cross-sectional study including n = 533 patients who died during the study period in a Palliative Care Unit. Clinical and functional (Barthel and Palliative Performance Scale) variables and the level of complexity were collected. For each patient we assessed whether PS had been performed and, if so, we described the type of sedation, continuity and depth, refractory symptoms, medication used, informed consent and place of death. A multivariate logistic regression model was used to analyse the relationship between several independent variables and PS. The prevalence of PS was 16.7% (n = 82). Most frequent refractory symptoms were delirium (36.1%), pain (31.9%) and dyspnoea (25%). Factors associated with having a higher odds of PS were having already started treatment with strong opioids (OR = 2.10; 95% CI = 1.16–3.90) and a lower dependency for activities of daily living (OR = 0.41; 95% CI = 0.23–0.70) on admission at PC. Informed consent for sedation was given mainly by representation and only in 19% of cases by the patient himself. Early opioid use and functional status act as factors associated with PS, becoming as clinical evaluations of particular interest during the disease trajectory, which could help to improve individualised care plans for patients at the end of life.

(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30–5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67–0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention.

Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.

Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.

The main aim of this study was to determine the association of various clinical, functional and pharmacological factors with the physical (PCS) and mental (MCS) summary components of the health-related quality of life (HRQoL) of community-dwelling older adults. Design: Cross-sectional study. Patients and setting: Sample of 573 persons aged over 65 years, recruited at 12 primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The main outcome was HRQoL assessed on the basis of the SF-12 questionnaire. A multinomial logistic regression model was constructed to study the relationship between independent variables and the HRQoL variable, divided into intervals. The average self-perceived HRQoL score was 43.2 (± 11.02) for the PCS and 48.5 (± 11.04) for the MCS. The factors associated with a poorer PCS were dependence for the instrumental activities of daily living (IADL), higher body mass index (BMI), number of medications, and presence of osteoarticular pathology. Female gender and the presence of a psychopathological disorder were associated with worse scores for the MCS. The condition that was most strongly associated with a poorer HRQoL (in both components, PCS and MCS) was that of frailty (odds ratio (OR) = 37.42, 95% confidence interval (CI) = 8.96–156.22, and OR = 20.95, 95% CI = 7.55–58.17, respectively). It is important to identify the determinant factors of a diminished HRQoL, especially if they are preventable or modifiable.

Aim: Analyze the relative risks of critical cardiovascular outcomes and mortality associated with adherence to statin treatment in a clinical setting in people with no history of prior cardiovascular disease (CVD). Methods: A systematic review of the literature was conducted up to December 2016. The outcomes of interest were cardiovascular fatal or nonfatal events and all-cause mortality. Results: A total of 17 articles were included in a qualitative synthesis. Four were case–control nested in a retrospective cohort design and the other 11 were a cohort design. Seven studies compared the best adherer patients with the worst adherers. In the 3 studies (317 603 participants) that considered ischemic heart disease in this group, the pooled reduction in risk was 18% (95% confidence interval [CI]: 14%-22%, I² = 0%); for the CVD outcome, 2 studies (131 477 participants) showed a pooled reduction in risk of 47% (95% CI: 36%-56%, I² = 84.7%) with 1 included study showing a much larger reduction than the others; for the cerebrovascular event (CeVD) outcome, 2 studies (155 726 participants) showed a pooled reduction in risk of 26% (95% CI: 18%-34%, I² = 0%); and for mortality, the reduction in risk was 49% (95% CI: 39%-57%, I² = 62.4%). The other 4 studies (147 859 participants) compared the most adherent group with the rest. These showed a pooled risk reduction of CVD of 22% (95% CI: 6%-27%, I² = 0). Conclusion: Adherence to statins treatment is shown as a key element for primary prevention, although these are observational data and the risk of bias from confounding cannot be ruled out. Standardization of measures of adherence to treatment would improve comparability between studies. Further research is warranted to design effective interventions to improve patients’ adherence.