Elderly people who reside in long-term care facilities form a frail and vulnerable population, with multiple pathologies and high percentages of cognitive and functional disability.
The aims of this ...study were to assess the safety of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in frail nursing home residents and to evaluate its effectiveness 6 months after full vaccination.
This was an ambispective observational study.
Residents of a long-term care facility in Madrid, Spain.
One hundred and thirty-seven nursing home residents (81.8% female, mean age 87.77 ± 8.31 years) with high comorbidity (61.3% Charlson Index ≥ 3) and frailty (75% Clinical Frail Scale ≥ 7) who received the BNT162B2 mRNA vaccine.
Safety data were collected to evaluate the type of adverse drug reactions and their duration, severity, and causality. Immunogenicity was tested 6 months after the primary vaccination and effectiveness was evaluated by the incidence of SARS-CoV-2 infection, the number of hospital admissions, and mortality due to coronavirus disease 2019 (COVID-19).
Safety: Of the residents, 21.9% had some adverse reaction and 5.8% had a severe or more serious adverse reaction. The most frequent adverse reactions were fatigue (13.1%), pyrexia (12.4%), and headache (7.3%). No association was observed between frailty (including a need for palliative care) and clinical, functional or cognitive status of the participants and the occurrence of adverse events. Immunogenicity and Effectiveness: After 6 months of vaccination, only one case of SARS-CoV-2 infection was confirmed in the vaccinated residents. Most of the nursing home residents presented positive serology (95.2%). Loss of immunogenicity was associated with older age (95.12 ± 3.97 vs. 87.24 ± 8.25 years; p = 0.03) and no previous COVID-19 infection (16.6% vs. 70%; p < 0.001). Binary logistic regression models did not reveal this association.
The BNT162B2 vaccine is well tolerated and effective in nursing home residents, independently of their clinical, functional, cognitive, or frailty characteristics. For the most part, immunogenicity has been maintained over time, regardless of comorbidity, functional status or frailty.
Objectives
To examine the separate and joint association between physical activity and frailty and long‐term all‐cause and cardiovascular disease (CVD) mortality in older adults.
Design
...Population‐based prospective cohort study.
Setting
Cohort representative of the noninstitutionalized Spanish population.
Participants
Individuals aged 60 and older (N=3,896) in 2000–01.
Measurements
Participants reported their physical activity using a validated instrument, and frailty was ascertained using the Fatigue, low Resistance, limitation in Ambulation, Illness and weight Loss (FRAIL) scale. Those with 0 frailty criteria were considered to be robust, with 1 or 2 criteria to be prefrail, and with 3 of more criteria to be frail. Participants were followed until 2014 to identify all‐cause and CVD deaths. Associations were summarized using hazard ratios (HRs) and Cox regression after adjustment for main covariates.
Results
During a median 14 years of follow‐up, 1,801 total deaths occurred, 672 from CVD. Compared with being robust, the multivariate hazard ratio (95% confidence interval) for all‐cause mortality was 1.29 (1.14–1.45) in prefrail individuals, and 2.16 (1.82–2.58) in frail individuals (p‐trend <.001). Compared with being physically inactive, being physically active was associated with a statistically significant 18% (1–32%), 28% (16–39%) and 39% (17–55%) lower all‐cause mortality among robust, prefrail, and frail individuals, respectively (all p <.001). Compared with participants who were robust and physically active, those who were frail and inactive showed the highest all‐cause mortality 2.45 (95%CI: 1.95–3.06); however, the hazard ratio (95% confidence interval) for all‐cause mortality in frail individuals who were physically active was comparable to that in pre‐frail and inactive participants: 1.70 (1.32–2.19) and 1.56 (1.34–1.82), respectively. Mortality of prefrail active participants was similar to that of robust inactive participants. Results were similar for CVD mortality.
Conclusion
Physical activity might partly compensate for the greater mortality risk associated with frailty in old age. J Am Geriatr Soc 66:2097–2103, 2018.
Suicidal behavior (SB) is common in first-episode psychosis (FEP), and cognitive impairment has also been described in psychosis. Despite well-established risk factors for SB in psychosis, the role ...of cognition and insight remains unclear. This study aimed to explore the relationship between history of SB and cognition in recent-onset FEP, distinguishing between neurocognition, social cognition, and metacognition, and including cognitive insight (CI) as a metacognitive variable. The sample consisted of 190 participants with recent-onset FEP recruited from two multicentric studies. Two groups were formed based on presence/absence of a history of SB. Demographic, clinical, and cognitive data were compared by group, including significance level adjustments and size effect calculation. No differences were found regarding demographic, clinical, neurocognitive, social cognition, and metacognitive variables except for CI (18.18 ± 4.87; t = −3.16; p = 0.0020; d = −0.635), which showed a medium effect size. Small to medium effect size were found for attributional style (externalizing bias) (1.15 ± 3.94; t = 2.07; d = 0.482), theory of mind (ToM) (1.73 ± 0.22; t = 2.04; d = −0.403), jumping to conclusions bias (JTC) (23.3 %; X2 = 0.94; V = 0.178). In recent-onset psychosis, neurocognitive functioning was not related to the history of SB. As novelty, individuals with previous SB showed higher CI. Also, regarding social cognition and metacognition, individuals with prior SB tended to present extremely low externalizing bias, better ToM, and presence of JTC.
The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than ...cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain.
Prospective study.
A cohort of 3,677 individuals (1,626 men) aged ≥60 years was followed-up during 14.3 years.
At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions).
During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio HR = 0.67, 95% confidence interval CI = 0.50-0.90) or very active (HR = 0.48, 95%CI = 0.33-0.68), independently of ST. Also, being seated ≥7 h/d vs. <7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02-1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59-3.29) compared to those with moderate/very PA and ST <7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance.
Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of them.
Purpose To examine the separate and joint associations of physical activity and levels of physical, mental, and social health with long-term all-cause and cardiovascular disease (CVD) mortality in ...older adults. Methods A cohort of 4008 individuals representative of the non-institutionalized population of Spain aged 60 years and older was analyzed. Information on physical activity was self-reported. Physical and mental health were assessed with the SF-36 questionnaire, and social health with a 4-item score on network structure and social engagement. Participants were categorized as being in a good, intermediate, or poor health according to tertiles of the score in each health dimension. Analyses were performed with Cox regression and adjusted for main confounders, including levels in the other two health dimensions. Results Over a median follow-up of 14 years, a total of 1811 deaths occurred, 674 due to CVD. Hazard ratios (95% confidence interval) for all-cause mortality were 1.35 (1.18-1.55), 1.18 (1.02-1.36), and 1.37 (1.18-1.58) for poor vs. good physical, mental, and social health, respectively (all p trend<0.001). Being physically active was associated with a 28% (15-39%), 31% (19-42%), and 19% (5-31%) lower all-cause mortality in participants with poor physical, mental, and social health, respectively. In each health dimension, physically active individuals with poor health showed a similar or lower all-cause mortality than those who had intermediate or good health but were physically inactive. Results for CVD mortality were similar to those for all-cause death. Conclusions Physical activity might attenuate the excess all-cause and CVD mortality associated with poor physical, mental, and social health.
Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be ...considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99–4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.
•Presence of JTC is higher in depressive and psychotic patients with history of SB, specially under ambiguous conditions.•Within individuals who exhibited JTC, more had a diagnosis of depression than psychosis, and that is related to older age.•JTC might be considered a transdiagnostic construct present in different psychiatric disorders.
Abstract
Background
Social cognition and metacognition have emerged as cornerstones of research and treatment of schizophrenia. Both constructs are known to influence the onset of psychosis, to ...predict functional outcome and to be associated with symptoms. However, whether the deficits in first-episode psychosis are homogeneous or group in patterns remains to be studied. This study aimed to analyze patterns of social cognitive and metacognitive variables in a sample of subjects with first-episode psychosis.
Methods
We recruited 192 subjects with first-episode psychosis from ten public mental-health services in Spain. We collected: demographic information, measures of functioning, performance in social cognition (the Faces Test, IPSAQ and the Hinting Task), a battery of metacognitive tasks (BCIS, and the Beads Task) and a neuropsychological assessment. We performed a Latent Profile Analysis (LPA) with the metacognitive and social-cognitive variables. The variable importance was assessed via a classification tree (CART) and the mean differences among the resulting groups for clinical, neuropsychological and functioning variables were calculated with ANOVA and Kruskal-Wallis tests.
Results
Our sample was comprised of 192 (62 women) with first-episode psychosis. The mean age of the sample was 27.93(1.39). The mean PANSS total score of the sample was 58.48 (17.79). The average GAF score was 58.93 (12.25). We included 174 cases with complete social-cognitive and metacognitive data in the cluster analysis. We identified three type-VEE clusters (i.e. ellipsoidal clusters with equal shape and orientation) according to BIC (BIC=-3600.651). The 85-15 condition of the Beads Task and the Hinting Task emerged as the most important variables in determining the clustering structure. The first cluster (60.9%) was characterized by average scores in most of the metacognitive and social cognitive variables, but the presence of the jumping to conclusions bias. The second cluster (5.7%) was characterized by low self-reflectiveness, presence of personalizing bias and an excessive number of trials in the beads task. The third cluster (33.5%) was characterized by average scores in all metacognitive tasks but low scores in the social cognitive tasks.
Discussion
We found three clusters in a large sample of subjects with first-episode psychosis. Our results indicate that the three groups differ in the proneness to present deficits in specific domains. Furthermore, in our sample, patients may not exhibit a homogeneous deficit in all social-cognitive and metacognitive variables. Instead, the impairment may be particularly prominent in either social-cognitive or metacognitive variables. Subjects in different clusters may present differences in their clinical characteristics, what could be relevant in the treatment. Therefore, with further research, a thorough assessment of social cognition and metacognition may help personalize the treatment according to the person’s subtype of the deficit.
Congenital cytomegalovirus (cCMV) is the leading cause of non-genetic sensorineural hearing loss and one of the main causes of neurological disability. Despite this, no universal screening programme ...for cCMV has been implemented in Spain. A recent study has shown that early treatment with valaciclovir, initiated in the first trimester and before the onset of signs in the fetus, reduces the risk of fetal infection. This finding favours the implementation of a universal screening programme for cCMV.The aim of this study is to evaluate the performance of a universal screening programme for cCMV during the first trimester of pregnancy in a primary care setting.
This is an observational multicentre cohort study. The study will be conducted in four primary care settings from the Northern Metropolitan Barcelona area and three related hospitals and will last 3 years and will consist of a recruitment period of 18 months.In their first pregnancy visit, pregnant women will be offered to add a CMV serology test to the first trimester screening tests. Pregnant women with primary infection will be referred to the reference hospital, where they will continue treatment and follow-up according to the clinical protocol of the referral hospital, which includes treatment with valacyclovir. A CMV-PCR will be performed at birth on newborns of mothers with primary infection, and those who are infected will undergo neonatal follow-up for at least 12 months of life.For the analysis, the acceptance rate, the prevalence of primary CMV infections and the CMV seroprevalence in the first trimester of pregnancy will be studied.
Ethical approval was obtained from the University Institute Foundation for Primary Health Care Research Jordi Gol i Gurina Ethics Committee 22/097-P dated 27 April 2022.
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