Viki Zunzunegui - Academia.edu (original) (raw)

Papers by Viki Zunzunegui

Reproductive Health, 2011

Background: Since 2001, a referral system has been operating in Kayes (Mali) to reduce maternal a... more Background: Since 2001, a referral system has been operating in Kayes (Mali) to reduce maternal and perinatal deaths. Normal deliveries are managed in community health centers (CHC). Complicated cases are referred to a district health center (DHC) or the regional hospital (RH). Women with obstetric emergencies can directly access the DHC and the RH. Objective: To assess, in women presenting with an obstetric complication: 1) the effects of the point of entry into the referral system on joint mother-newborn survival; and 2) the effects of the configuration of healthcare team at the CHCs on joint mother-newborn survival. Method: Cross-sectional study of 7,214 women users of the referral system in the region of Kayes in 2006-2009. Bivariate probit equations were fitted to estimate joint mother-newborn survival. The marginal effects of the point of entry into the referral system and of the configuration of the healthcare team at the CHCs were evaluated with a probit bivariate regression. Results: Entering the referral system at the RH was associated with the best joint mother-newborn survival; the most qualified the CHCs team was, the best was mother-newborn survival. Distance traveled interacts with the point of entry and the configuration of the CHCs team. For women coming from far (over 50 km), going directly to the RH increased the probability of joint mother-newborn survival by 11.90% (p < 0.001) as compared with entry at the CHC. Entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50% (p < 0.001). Among women who go first to a CHC, physician presence increased joint mother-newborn survival, compared with having no physician and fewer than three professionals. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less. Conclusion: Mother-newborn survival in the Kayes maternal referral system is influenced by combined effects of the point of care, the skill configuration of CHC personnel and distance traveled.

International Journal for Quality in Health Care, 2014

Objective. Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in su... more Objective. Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes. Design. Cross-sectional analysis of data from a cluster-randomized trial called QUARITE. Setting. Mali and Senegal, West Africa. Participants. Thirty-one referral hospitals and 612 obstetrical patients. Intervention. The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics. Main Outcome Measure. Obstetrical quality of care measured through a validated chart abstraction tool. Results. Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care. Conclusions. PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.

International Journal for Quality in Health Care, 2012

Medical recordkeeping is essential to assuring quality health care. Records aid in the medical ma... more Medical recordkeeping is essential to assuring quality health care. Records aid in the medical management of patients while serving epidemiological purposes. Medical recordkeeping is often inadequate in resource-limited settings, which threatens the quality of health care. In this study, by way of example, we make the case for increased attention to medical recordkeeping by illustrating how poor charting and archiving can threaten the quality of care. We make suggestions to improve the adequacy of medical recordkeeping by emphasizing recent technological innovations applied to resource-limited settings and the need to instil a culture of recordkeeping.

Atención Primaria, 2003

Objectives. To calculate the prevalence of urinary incontinence and to identify linked factors in... more Objectives. To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. Design. Population survey. Setting. Leganés (Madrid). Participants. Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). Main measurements. Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. Results. The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. Conclusions. Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Aging Clinical and Experimental Research, 2006

Background and aims: Forecasting functional status in elderly populations is uncertain. Our aim i... more Background and aims: Forecasting functional status in elderly populations is uncertain. Our aim is to provide evidence of population trends of Activities of Daily Living (ADL) disability, functional limitations and self-rated health. Methods: Data come from a longitudinal study of aging in Leganés (Spain), collected in 1993, 1995, 1997 and 1999, on a representative sample of 1560 community dwelling people over 65. Response rate at baseline was 82%. ADL disability was defined as needing help in at least one of the following: walking across a small room, taking a shower, toileting, getting out of bed, getting up from a chair, using the toilet, dressing and eating. Functional limitations were based on questions of difficulty with upper and lower limbs. Self-rated health was assessed with a single question. ADL disability, functional limitations and self-rated health were regressed on age, survey year, sex and education. Results: There are significant declines in ADL disability, functional limitations and poor self-rated health at every age and up to very advanced ages. Over 90, the ADL disability trend may be reversed, with the emergence of a very old and disabled population. Women and people with little education have a higher prevalence of disability, functional limitations and poor health, when compared with men and those with higher education. Conclusions: Results suggest the postponement of severe disability onset in this Spanish population, leading to longer healthy life expectancy, and support the emergence of a very disabled population over 90 years of age.

Depression is an important public health problem among the elderly population due to its high pre... more Depression is an important public health problem among the elderly population due to its high prevalence and its association with disability, mortality and use of health services. Most studies have shown that lack of social networks is associated with depression but results are not clear. In Quebec and in Canada, little evidence exists on the prevalence of depression in the elderly population and on its associations with social relationships. Few studies have examined the associations between social relationships and health services utilisation among the depressed elderly patients. The aim of this work was to examine the role of social relationships on the presence of depression and on the consultation with a health professional by the elderly patient with depression, in Québec. More specifically, this work aimed at examining if: 1) the associations between social relationships and depression varied in rural and urban areas; 2) the associations between social relationships and depression were different in men and in women and 3) assessing the role of social relationships in the consultation of a health professional by the elderly patients with depression. To attain these objectives we have written three articles using data from the ESA survey, conducted in 2005-2006 on a representative sample of 2670 community dwelling people over 65 in Quebec. Depressive disorders (including major and minor depression) were measured by the DSM-IV criteria using the ESA questionnaire developed by the research team which excludes the criteria on limitations of social functioning. Social relationships were measured by aspects of social networks (marital status and diversity of ties), engagement in community social activities (religious attendance, frequenting social centers, and volunteerism), social support and perception of usefulness and presence of conflict in the relationships with spouse, children, siblings and friends. Multiple logistic regressions were adjusted to estimate odds ratios and their 95 % confidence intervals. Prevalence of depression was higher among those living in urban and rural areas of Quebec compared with metropolitan Montreal. Volunteerism, social support and not having conflict with the spouse were associated with lower frequency of depression independently of the area of residence. Women had higher prevalence of depression vi compared with men. Lack of a confident was associated with higher frequency of depression both in men and in women. Men who were widows and those who were not involved in volunteer work had higher odds of depression than men in other marital situations and men who were volunteering. Marital status and volunteer work were not associated with depression in women. However, conflict in marriage was associated with depression in women. Relationships with children, siblings and friends are not associated with depression in this population of elderly people from Quebec. Concerning consultation with a health professional for symptoms of depression, we have shown that approximately half of those depressed elderly, both among men and among women, have not consulted for their symptoms in the last 12 months. Consultation is associated with high levels of support, but the immediate network (spouse and siblings) seems to act as a substitute for depressed elderly men, reducing their frequency of consultation. Given the scarcity of Canadian studies on depression prevalence among the elderly population, these results on depression and its associated factors provide important information for clinicians and decision makers for planning and targeting of services by area of residence and for both men and women.

European Journal of Ageing, 2011

This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-depen... more This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal study ''Aging in Leganes'', launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65-85 at baseline. The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated with increased mortality risk in older men and in those who can read and write in this Mediterranean population. Given current improvements in education and decreasing gender inequality, health professionals in Spain should pay attention to both current SRH and declines in SRH in their patients regardless of gender and literacy. Keywords Self-rated health Á Time-dependent covariate Á Mortality Á Cohort analysis Á Older persons

BMC Pregnancy and Childbirth, 2012

Background: In Mali and Senegal, over 1% of women die giving birth in hospital. At some hospitals... more Background: In Mali and Senegal, over 1% of women die giving birth in hospital. At some hospitals, over a third of infants are stillborn. Many deaths are due to substandard medical practices. Criterion-based clinical audits (CBCA) are increasingly used to measure and improve obstetrical care in resource-limited settings, but their measurement properties have not been formally evaluated. In 2011, we published a systematic review of obstetrical CBCA highlighting insufficient considerations of validity and reliability. The objective of this study is to develop an obstetrical CBCA adapted to the West African context and assess its reliability and validity. This work was conducted as a sub-study within a cluster randomized trial known as QUARITE. Methods: Criteria were selected based on extensive literature review and expert opinion. Early 2010, two auditors applied the CBCA to identical samples at 8 sites in Mali and Senegal (n = 185) to evaluate inter-rater reliability. In 2010-11, we conducted CBCA at 32 hospitals to assess construct validity (n = 633 patients). We correlated hospital characteristics (resource availability, facility perinatal and maternal mortality) with mean hospital CBCA scores. We used generalized estimating equations to assess whether patient CBCA scores were associated with perinatal mortality. Results: Results demonstrate substantial (ICC = 0.67, 95% CI 0.54; 0.76) to elevated inter-rater reliability (ICC = 0.84, 95% CI 0.77; 0.89) in Senegal and Mali, respectively. Resource availability positively correlated with mean hospital CBCA scores and maternal and perinatal mortality were inversely correlated with hospital CBCA scores. Poor CBCA scores, adjusted for hospital and patient characteristics, were significantly associated with perinatal mortality (OR 1.84, 95% CI 1.01-3.34). Conclusion: Our CBCA has substantial inter-rater reliability and there is compelling evidence of its validity as the tool performs according to theory.

Depression Research and Treatment, 2013

The objective of this study was to describe changes in depression and its correlates, in communit... more The objective of this study was to describe changes in depression and its correlates, in community-dwelling elderly, over a 12-month period. Data come from a longitudinal ESA Study (Enquête sur la Santé des Aînés) of elderly persons (n= 2752). Depression was measured using the DSM-IV criteria. Polytomous logistic regression was used to assess relations, over time, between participant’s characteristics and depression. Among the 164 (5.9%) subjects, who were depressed at baseline, 19.5% were continuously ill cases and 80.4% had recovered, 12 months later. In polytomous regression, factors increasing the probability of the three depression states (persistence, recovery, and incidence) were daily hassles, stress intensity, and fair/poor self-rated mental health. Depression in old age is dynamic. Available prognostic factors can be taken into account to help direct treatment to elderly at highest risk of a poor prognosis.

BMC Public Health, 2009

Background: Social networks predict longevity across societies but specific mechanisms are largel... more Background: Social networks predict longevity across societies but specific mechanisms are largely unknown. The aim of this work was to examine the role of children in the longevity of elderly men and women in a cohort of community dwelling elderly people in Spain. Methods: The data were taken from the "Aging in Leganes" cohort study with 15 years of followup. The baseline population was an age-and sex-stratified random sample of community dwelling people over 65 living in Leganés (Madrid) in 1993. Poor relationship with at least one child, emotional support and the perceived roles elders play in the lives of their children, extended family, spouse and friends were assessed at baseline. Cox proportional hazards models were fit to investigate the effects of social roles variables on longevity, adjusting for a wide range of socioeconomic, behavioural and health covariates. Results: In the fully adjusted model, having a poor relationship with at least one child increased mortality by 30%. Elderly persons who felt their role in their children's lives was important (HR = 0.70; 95% CI 0.54; 0.91) had a lower mortality risk than those who felt they played a small role. Feeling loved and listened to by one's children did not have an effect on survival. Maintaining an important role in the extended family was also significantly associated with survival. Conclusion: In this Mediterranean population, maintaining an important role in the lives of one's children is associated with survival. Functions of social networks related to meaning of life and different forms of social support may have important effects on mortality, and these functions may vary across cultures according to family norms and values.

Health and Quality of Life Outcomes, 2010

Background: The late life disability instrument (LLDI) was developed to assess limitations in ins... more Background: The late life disability instrument (LLDI) was developed to assess limitations in instrumental and management roles using a small and restricted sample. In this paper we examine the measurement properties of the LLDI using data from the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2003

Objectives. To examine the influence of social networks and social engagement on cognitive declin... more Objectives. To examine the influence of social networks and social engagement on cognitive decline in a populationbased cohort of elderly people, and to assess gender differences in the effect of social relations on cognition. Methods. A longitudinal study of community-dwelling people over 65 was carried out. Cognitive function (orientation and memory) in 1997 and cognitive decline (absent, mild, and severe) over 4 years (1993-1997) were assessed using an instrument previously validated for populations with a low level of education. The effect of social networks, social integration, and social engagement with friends, children, and relatives on cognitive function and cognitive decline was estimated by multiple linear and logistic regressions after adjusting for age, sex, education, depressive symptoms, systolic and diastolic blood pressure, and functional status. Results. Poor social connections, infrequent participation in social activities, and social disengagement predict the risk of cognitive decline in elderly individuals. The probability of cognitive decline was lower for both men and women with a high frequency of visual contact with relatives and community social integration. Engagement with friends seemed to be protective for cognitive decline in women but not in men. Discussion. This longitudinal study indicates that few social ties, poor integration, and social disengagement are risk factors for cognitive decline among community-dwelling elderly persons. The nature of the ties that influence cognition may vary in men and women.

The Journals of Gerontology: Series B, 2005

We assessed conjoint trajectories of cognitive decline and social relations over 7 years on a rep... more We assessed conjoint trajectories of cognitive decline and social relations over 7 years on a representative sample of community-dwelling elderly persons. We analyzed data using repeated measurement models. Social integration, family ties, and engagement with family were associated with cognitive function at advanced ages, controlling for education and introducing depressive symptoms, functional limitations, and chronic conditions as intervening variables. Association of social integration, through participation in community activities, with change in cognitive decline was more significant at advanced ages. Having friends was significantly associated with change in cognitive function in women only. Our findings have important implications for clinical medicine and public health because associations of social relations with cognitive function suggests that they may help to maintain cognitive function in old age.

Menopause, 2008

Objective-To test the associations of menopausal status, timing of menopause and hysterectomy wit... more Objective-To test the associations of menopausal status, timing of menopause and hysterectomy with physical performance at age 53y Design-Using data on women participating in the MRC National Survey of Health and Development who have been followed up since birth in March 1946 (N=1386) associations of interest were examined. Menopausal status, grip strength, chair rises and standing balance time were assessed at age 53y and covariates were measured across life. Results-Women who were post-menopausal and not using hormone replacement therapy (HT) at age 53y had lower mean grip strength than women who were still pre-or peri-menopausal at this age. However, this trend of decreasing grip strength across the three natural menopausal categories (from pre-to post-menopausal) was explained by current body size. Those women who had undergone hysterectomy before age 40y had significantly weaker grip strength than women who had undergone hysterectomy at later ages-in fully adjusted analyses those women who had a hysterectomy before age 40y had a mean grip strength 5.21kg (95% CI: 2.18, 8.25) lower than women who had a hysterectomy between ages 50 and 53y. There were no significant associations between menopausal status or age at hysterectomy and chair rise or standing balance time and also no significant associations between timing of menopause and any of the performance measures. Conclusions-Women who have hysterectomies at young ages represent a group who may require more support than other women to achieve and maintain good physical performance, especially muscle strength, in mid-life.

European Journal of Ageing, 2005

The associations between prevalence, incidence and recovery from activities of daily living (ADL)... more The associations between prevalence, incidence and recovery from activities of daily living (ADL) disability and social ties among community-dwelling persons over 65 in Finland, The Netherlands and Spain are examined. Data were harmonized in the CLESA study. The baseline sample was composed of 3,648 subjects between 65 and 85 years old, living in Finland, The Netherlands and Spain. Disability in four activities of daily living was determined at baseline and at follow-up. Social participation, number of family ties and presence of friends were added to obtain a social ties index. Logistic regressions were fitted to the prevalence, incidence and recovery data to estimate the associations between disability and social ties, adjusting for education, comorbidity and self-rated health. The modifying effects of country, age and sex were tested in all models. For every country, the social ties index, having friends and social participation were negatively associated with ADL disability prevalence. ADL incidence was negatively related to the number of family ties, with a stronger relationship in Spain than in The Netherlands or Finland. ADL recovery was associated with the social ties index. No age or gender differences in these associations were found. Social ties appear to generate a beneficial effect on the maintenance and restoration of ADL function. While social ties play an important role in maintaining and restoring function in all three countries, family ties appear to generate a stronger effect on protection from disability incidence than does social participation, and the strength of this effect varies by culture.

International Journal of Epidemiology, 2001

Although international research has consistently shown that lack of social support is associated ... more Although international research has consistently shown that lack of social support is associated with increased mortality 1-7 and poor health, 4,8-9 studies on the effects of specific sources of social support in different cultures are needed. It is widely recognized that children play an important role in the wellbeing of the elderly but little is known about the specific effects

PloS one, 2016

To examine the relationships between physical function and gender-stereotyped traits and whether ... more To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context. A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimat...

Ageing and Society, 2010

ABSTRACTThe aim of this study was to document the perceptions of elders in six Caribbean countrie... more ABSTRACTThe aim of this study was to document the perceptions of elders in six Caribbean countries about ‘active ageing’ and on the basis of their reports to make recommendations to improve their situation. Data were collected principally through 31 focus group discussions conducted in both urban and rural areas. Comparative analysis was carried out of the qualitative information, focusing on three components of ‘active ageing’: health and social services access and use, social support, and economic circumstances. Most of the participants were women, aged 60–79 years, of lower socio-economic status and from urban areas. Large disparities in the responses of Caribbean societies to population ageing were indicated, as well as unequal opportunities to obtain health care and social services, public transport, income and food by both socio-economic status and location. Home-care services are either insufficient or non-existent. Some elders receive social and financial support from relati...

Chronic diseases in Canada, 2010

The objective of this study was to examine if social relationships have a differential associatio... more The objective of this study was to examine if social relationships have a differential association with the presence of depression in men and women aged 65 and over. Data came from a survey of a representative sample of 2670 community-dwelling older adults in Quebec. Depressive disorders were measured using DSM-IV criteria. The prevalence of depression was 17.8% for women and 7.6% for men. Men reported a greater diversity of ties but less support than women. Having a confidant and/or being engaged in a good marital relationship was negatively associated with depression in both men and women. Compared with married people in general, widowhood was associated with a considerably higher risk of depression in men than in women. Compared with non-volunteers in general, men who volunteer were at considerably lower risk of depression than women who volunteer. This exploratory study could serve as a basis for future longitudinal studies on the impact of community activities and volunteering ...

European Journal of Ageing - EUR J AGEING

This study examines the relations between self-rated health (SRH) at baseline, SRH as a time-depe... more This study examines the relations between self-rated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal study “Aging in Leganes”, launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65–85 at baseline. The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated with increased mor...