Bienestar psicológico en adultos mayores institucionalizados y no institucionalizados del Municipio de Rionegro

RESUMEN: El bienestar psicológico es un estado que se relaciona con el equilibrio entre aspectos físicos, psicológicos y sociales, así como el dominio que el sujeto tiene sobre su propio entorno. También implica la presencia de procesos positivos, en relación a la satisfacción y la calidad de vida de acuerdo a los propios criterios del individuo (Ryff, 1995). A su vez, está asociado al logro de metas, crecimiento personal y percepción que la persona tiene acerca de diversos aspectos de su vida. El presente estudio tuvo por objeto analizar las diferencias y similitudes de las dimensiones del bienestar psicológico: autoaceptación, relaciones positivas, autonomía, dominio del entorno, crecimiento personal y propósito en la vida, entre adultos mayores institucionalizados y no Institucionalizados. Para dar cumplimiento a este objetivo, participaron 50 adultos mayores institucionalizados y no institucionalizados del municipio de Rionegro. Se les aplicó la Escala de Bienestar psicológico de Ryff (1989) la cual aborda dichas dimensiones del bienestar. Los resultados mostraron que existen diferencias estadísticamente significativas en las dimesiones de autoaceptación y crecimiento personal. Se analizó como el bienestar es un componente importante del envejecimiento exitoso y la calidad de vida. Se puede decir que no estar en condiciones de institucionalización, proporciona niveles más óptimos en cuanto a bienestar, pero estar en una institución no generó malestar para la población evaluada, la cual se adaptaba fácilmente al contexto y establecía relaciones adecuadas con las personas del asilo, aun con las limitaciones del contexto.ABSTRACT: The psychological well-being is a state related to the equilibrium between physical, psychological and social aspects, as well as the domain of the individual over his own environment. This also implies the presence of positive processes in relation to satisfaction and quality of life in accordance with the individual’s own criteria (Ryff, 1995). In turn, this is related to the achievement of goals, personal growth and the perception that the person has about different aspects of his life. The purpose of this study was to analyze the differences and similarities of the dimensions of psychological well-being: self-acceptance, positive relations, autonomy, environment domain, personal growth, and life purposes in institutionalized and non-institutionalized older adults. To accomplish this objective, 50 institutionalized and non-institutionalized older adults, from the municipality of Rionegro, participated. The Ryff´s psychological well-being scale (1989) was applied to them, which includes the dimensions of well-being mentioned above. The results showed that there are statically significant differences in the dimensions of self-acceptance and personal growth. It was analyzed how the well-being is an important component of successfully aging and quality of life. We can say that not to be in conditions of institutionalization, provides more optimum levels in terms of well-being, but the fact of being in an institution didn't generate discomfort for the population evaluated, which was more easily adapted to the context and also established suitable relations with people in the nursing home, even with the limitations of the context

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk