Bem-estar subjetivo em idosas com e sem cancro da mama em remissão

O aumento exponencial da população idosa e da sua esperança média de vida em consonância com o aumento da incidência do cancro da mama nesta faixa etária constituem uma problemática a nível mundi al. Objetivos: Averiguar se os dois grupos amostrais de idosas, com e sem cancro da mama em remissão, apresentam diferenças significativas nos totais de Bem - Estar Subjetivo (BES) e das suas dimensões afetiva e cognitiva. Método: A amostra é composta por 38 7 idosas, não institucionalizadas, com idades compreendidas entre os 75 e os 100 anos ( M = 85,27; DP = 6,59; intervalo 75 - 100) e que foram distribuídas em dois grupos: com cancro da mama em remissão e sem cancro da mama. Foram aplicados o questionário demo gráfico foi aplicado, a Escala de Satisfação com a Vida (ESV) e a Escala de Afeto Positivo e de Afeto Negativo (PANAS). Resultados: O grupo com cancro da mama em remissão apresentou resultados médios da escala e subescalas de BES superiores aos resultados médios do grupo sem cancro da mama, principalmente na subescala dos Afeto Positivo (AP). Estas diferenças foram estatisticamente significativas. Conclusão: Apesar do diagnóstico do cancro da mama representar uma ameaça importante ao BES das idosas, estas p articipantes apresentaram um total significativamente mais elevado o que as restantes.

CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients

Introduction: As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. Methods: We studied all admissions for community-acquired bacterial pneumonia over 1 year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. Results: A total of 396 patients were included, 49 HIV positive and 347 HIV negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p<0.0001), its predictive value for mortality being maintained in both groups (p¼0.03 and p<0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio 7.1 CI 95% [2.6–19.5]). Patients with<200 CD4 cells/mL presented similar CURB- 65 adjusted mortality (adjusted odds ratio 1.7 CI 95% [0.2–15.2]), but higher risk of intensive care unit admission (adjusted odds ratio 5.7 CI 95% [1.5–22.0]) and orotracheal intubation (adjusted odds ratio 9.1 CI 95% [2.2–37.1]), compared to HIV-negative patients. These two associations were not observed in the>200 CD4 cells/mL subgroup (adjusted odds ratio 2.2 CI 95% [0.7–7.6] and adjusted odds ratio 0.8 CI 95% [0.1–6.5] respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p>0.05). Conclusions: High CURB-65 scores and CD4 counts<200 cells/mL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.

The old and the oldest-old: Do they have different perspectives on adjustment to aging?

Background: Older adults experience varying challenges in old age. This study aims to explore the indicators of adjustment to aging (AtA) and to examine the potential explanatory mechanisms of a correlational model for AtA for the old and oldest-old adults. Methods: This qualitative study comprised demographics and semistructured interviews. Complete information on 152 older adults aged between 75 years and 102 years (mean ¼ 83.76 years; standard deviation ¼ 6.458). Data was subjected to content analysis. The correlational model of indicators of AtA was analyzed using a multiple correspondence analysis. Results: “Occupation and achievement” was the most mentioned indicator of AtA by the old participants (17.7%), whereas “existential meaning and spirituality” was the most verbalized indicator of AtA for the oldest-old participants (16.9%). AtA was explained by a three-factor model for each age group. For the old participants, the largest factor “occupational and social focus” accounted for 33.6% of total variance, whereas for the oldest-old participants, “spirituality and health focus” represented 33.5% of total variance. Conclusion: The outcomes presented in this paper stressed the varied perspectives concerning AtA, contoured in two different models, and the need of considering these when designing and implementing programs in health care for the old and the oldest-old.