Comparison of the Diagnostic Performance of Five Clinical Questionnaires for Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) remains one of the most prevalent pathologies in the world and is among the leading causes of mortality and morbidity, partially due to underdiagnosis. The use of clinical questionnaires to identify high-risk individuals to take them to further diagnostic procedures has emerged as a strategy to address this problem. Objective: To compare the performance of the COULD IT BE COPD, CDQ, COPD-PS, LFQ, and PUMA questionnaires for COPD diagnosis. Methods: A cross-sectional study was carried out on subjects who underwent spirometry in the third-level center. Data were collected between January 2015 and March 2020. Bivariate analysis was performed between the study variables and the presence of COPD. The area under the receiver operating characteristics curve (AUC-ROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for each questionnaire were calculated. The AUC-ROCs were compared with the DeLong test, considering a p value <0.05 statistically significant. Results: 681 subjects met the inclusion criteria and were taken to the final analysis. The prevalence of COPD was 27.5% (187/681). The mean age of the subjects was 65.9 years (SD ± 11.79); 46.3% (315/681) were female, and 83.6% (569/681) reported respiratory symptoms. Statistically significant relationship was found for COPD diagnosis with male sex, older age, respiratory symptoms, and exposure to wood smoke (p value <0.05). The AUC-ROCs of the questionnaires were between 0.581 and 0.681. The COULD IT BE COPD questionnaire had a lower discriminatory capacity AUC-ROC of 0.581, concerning the other scores (DeLong test, p = 0.0002). Conclusion: The CDQ, COPD-PS, LFQ, PUMA, and COULD IT BE COPD questionnaires have acceptable performance for the diagnosis of COPD together with low sensitivity and specificity. Therefore, its use must be complemented with other diagnostic tests or techniques such as pulmonary function tests.

Envelhecimento, sentido de lugar e planejamento urbano: facilitadores e barreiras / Envejecimiento, sentido de lugar y planificación urbana: facilitadores y barreras / Aging, sense of place and urban planning: facilitators and barriers

RESUMO O planejamento urbano é um processo que compreende sucessivas melhorias voltadas para a qualidade de vida das populações e o envelhecimento populacional pressiona para que instâncias sociais assumam novas posturas sobre os modos de se planejar a cidade. Para compreender a ligação do idoso com o ambiente, é necessário entender os recursos disponíveis no local e as experiências vividas naquele contexto. A partir do sentido de lugar, as pessoas transformam os espaços e são por eles transformados. Assim, esse estudo questionou como moradores idosos de três localidades da cidade de Brasília constroem seu sentido de lugar, a partir da identificação de facilitadores e barreiras enfrentadas diariamente e das demandas para a construção de um ambiente amigável ao envelhecimento. Os dados qualitativos apresentados decorrem do uso de três técnicas de pesquisa: entrevistas face a face, entrevistas caminhadas e diários fotográficos. Fizeram parte do estudo 63 participantes com idade entre 60 e 90 anos. A análise realizada por meio do software Iramuteq permitiu a elaboração de quatro classes relacionadas aos vínculos sociais e comunitários, às atividades das rotinas diárias, aos aspectos simbólicos que refletem o sentido de lugar e a relação com elementos rurais e urbanos percebidos em cada cenário. Estar atento às mudanças resultantes dessa inversão da pirâmide demográfica incide sobre algumas das questões identificadas nesse estudo, mas também confirma o quanto ainda se faz necessário avançar para incluir de modo mais realista a dinâmica relação idoso-ambiente em estudos que abordam o processo de envelhecimento.

RESUMEN El urbanismo es un proceso que comprende sucesivas mejoras encaminadas a la calidad de vida de las poblaciones y el envejecimiento de la población presiona a las instancias sociales para que asuman nuevas posturas sobre las formas de planificar este entorno. Para comprender la percepción del ambiente por parte de los adultos mayores, es necesario comprender los recursos disponibles en el lugar y también las experiencias vividas en ese contexto. Desde el sentido del lugar, las personas transforman espacios y son transformados por ellos. Por lo tanto, este estudio cuestionó cómo los residentes mayores de tres localidades de la ciudad de Brasilia construyen su sentido de lugar, en función de sus identificaciones de los facilitadores y las barreras que se enfrentan a diario y las demandas para construir un ambiente amigable con el envejecimiento. Los datos cualitativos presentados derivan del uso de tres técnicas de investigación: entrevistas personales, entrevistas complementarias y diarios fotográficos. 63 personas mayores entre 60 y 90 años participaron en el estudio. El análisis realizado con el software Iramuteq permitió el desarrollo de cuatro clases relacionadas con los vínculos sociales y comunitarios, actividades de la rutina diaria, aspectos simbólicos que reflejan el sentido del lugar y la relación con los elementos rurales y urbanos percibidos en cada escenario. Conocer los cambios resultantes de esta inversión de la pirámide demográfica se centra en algunos de los problemas identificados en este estudio, pero también confirma cuánto progreso aún se necesita para incluir de manera más dinámica la relación entre el anciano y el ambiente en los estudios que abordan el envejecimiento.

ABSTRACT. The urban planning is a process that comprises successive improvements aimed at the quality of life of populations and the aging of the population puts pressure on social instances to assume new postures about the ways of planning this environment. To understand the elderly's attachment with the environment, it is necessary to understand the resources available in the place and the experiences lived in that context. From the sense of place, people transform spaces and are transformed by them. Thus, this study questioned how elderly residents of three locations in the city of Brasília build their sense of place, based on their identification of facilitators and barriers faced daily and the demands for building an aging-friendly environment. The qualitative data presented derives from the use of three research techniques: face-to-face interviews, go-along interviews, and photographic diaries. Sixty-three elderly persons between 60 and 90 years participated in the study. The analysis carried out using the Iramuteq software allowed the development of four classes related to social and community bonds, activities of daily routines, symbolic aspects that reflect the sense of place and the relationship with rural and urban elements perceived in each scenario. Being aware of the changes resulting from the demographic pyramid's inversion incur on some of the issues identified in this study. However, the results confirm how much further progress is still needed to include more dynamically the elderly-environment relationship in studies that address the aging process.

Cross-National Perspectives on Aging and Place: Implications for Age-Friendly Cities and Communities.

BACKGROUND AND OBJECTIVES: The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting aging in place for older people. While there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places among older people. The objective of this article is to identify the place experiences of older people living across cities and communities in India, Brazil, and the United Kingdom and to discuss implications for the AFCC agenda. RESEARCH DESIGN AND METHODS: A total of 300 semistructured interviews were undertaken with older people across 9 cities and 27 communities in India, Brazil, and the United Kingdom. The data were analyzed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the 3 country teams. RESULTS: The data capture the ways in which place is constructed from the perspective of older people drawing upon social, community, and cultural dimensions of aging across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging, and identity are constructed. DISCUSSION AND IMPLICATIONS: Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of aging and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally.

Researching with older people: an experience in participative mapping and world café techniques / Pesquisando com pessoas idosas: uma experiência com as técnicas de mapeamento participativo e world café / Investigar con personas mayores: una experiencia en tecnicas de mapeo participativo y world café

The multidimensionality of the aging process involves changes in different capacities. The age-friendly cities strategy addressed the need for adaptations in urban spaces that meets the demands of older people's well-being. Thus, the aim of this study was to explore how Participative Mapping and World Café techniques could assist in identifying challenges to the delivery of services and resources to create communities that promote active aging, from the perspectives of older people and stakeholders. The techniques generated co-constructed discussion and shared understandings about the barriers residents face in negotiating and accessing services. Demands associated with the precariousness of local infrastructure, the absence of leisure activities, and a generalized feeling of insecurity in their neighborhoods were recurring themes. The demands led to the conclusion that for healthy aging, the interrelation of objective and subjective factors that take into account the multidimensionality of old age will enable the active participation.

A multidimensionalidade do processo de envelhecimento envolve mudanças em distintas capacidades. A estratégia de cidades amigáveis ao envelhecimento prevê a necessidade de adaptações nos espaços urbanos que atendam às demandas de bem-estar da pessoa idosa. Assim, o objetivo desse estudo foi explorar como as técnicas de Mapeamento Participativo e World Café poderiam auxiliar na identificação de desafios para a oferta de serviços e recursos para criar comunidades promotoras de envelhecimento ativo, a partir da perspectiva de idosos e stakeholders. As técnicas geraram discussões coconstruídas e entendimentos compartilhados sobre as barreiras enfrentadas ao negociar e acessar os serviços. Demandas associadas à precariedade da infraestrutura local, à ausência de atividades de lazer e a um sentimento generalizado de insegurança foram temas recorrentes. As demandas levaram à conclusão de que para o envelhecimento saudável, a interrelação de fatores objetivos e subjetivos que considerem a multidimensionalidade da velhice possibilitará a participação ativa dessa população.

La multidimensionalidad del proceso de envejecimiento implica cambios en diferentes capacidades. La estrategia de ciudades amigables con las personas mayores prevé la necessidad de adaptaciones en los espacios urbanos que respondan a las demandas del bienestar de las personas mayores. Así, el objetivo de este estudio fue explorar cómo las técnicas de Mapeo Participativo y World Café podrían ayudar a identificar desafíos para la prestación de servicios y características para crear comunidades que promuevan el envejecimiento activo, desde la perspectiva de las personas mayores y stakeholders. Las técnicas generaron discusiones co-construidas y entendimientos compartidos sobre las barreras que enfrentan los residentes para negociar y acceder a los servicios. Las demandas asociadas a la precariedad de la infraestructura local, la ausencia de actividades de esparcimiento y un sentimiento generalizado de inseguridad en sus barrios fueron temas recurrentes. Las demandas llevaron a la conclusión de que para un envejecimiento saludable, la interrelación de factores objetivos y subjetivos que tienen en cuenta la multidimensionalidad de la vejez permitirá la participación activa.