Mejorando la calidad de vida en personas mayores con el síndrome del declive: el rol de la terapia ocupacional en Atención Primaria

Resumen: Objetivos: Evaluar el efecto de una intervención de terapia ocupacional en usuarios diagnosticados recientemente de síndrome del declive, con una disminución en el índice de Barthel y/o Lawton en el último mes y susceptible de mejora según criterio clínico. Diseño: Estudio cuasiexperimental longitudinal no controlado. Intervención pre-post. Emplazamiento: Centro de salud Sant Hipòlit de Voltregà. Osona, Barcelona. Participantes: Pacientes remitidos por el profesional de enfermería, trabajo social o medicina de familia del centro con diagnóstico reciente de síndrome del declive que pueda beneficiarse de una intervención con terapia ocupacional. Intervenciones: Tras la visita inicial de valoración se llevaron a cabo cuatro sesiones de capacitación para mejorar la independencia funcional, la movilidad y adaptación del entorno doméstico, ofreciendo formación a los cuidadores principales. Mediciones principales: Se valoró la autonomía del paciente a través de la escala de Barthel y Lawton, la calidad de vida a través del cuestionario EuroQol (EQ-5D) y la adecuación del hogar a través del cuestionario de valoración de adecuación del hogar. Resultados: Se observaron mejoras en la autonomía en las actividades de la vida diaria (p = 0,003), la movilidad (p = 0,001) y la adaptación de la vivienda (p < 0,001). Se redujo el nivel de ansiedad/depresión (p = 0,028), y la puntuación media del estado de salud aumentó notablemente (p < 0,001). Conclusiones: Este estudio destaca la mejora en la calidad de vida y de la autonomía de las actividades de la vida diaria básicas (ABVD) de las personas atendidas por terapia ocupacional, enfatizando la necesidad de adaptación del hogar y el apoyo familiar. Abstract: Objective: To evaluate the effect of an occupational therapy intervention in users recently diagnosed with the decline syndrome, who have experienced a decrease in the Barthel and/or Lawton index in the last month and susceptible to improvement based on medical opinion. Design: Non-controlled, quasi-experimental longitudinal study. A pre-post intervention. Location: Sant Hipòlit de Voltregà health centre. Osona, Barcelona. Participants: Patients referred by the centre's primary care nursing, social work or medical staff with a recent diagnosis of decline syndrome who may benefit from the intervention of an occupational therapy professional. Intervention: Following the initial assessment visit, four training sessions were conducted to improve functional independence, mobility and adaptation of the home environment, providing training to primary caregivers. Main measurements: Patient autonomy was assessed using the Barthel and Lawton scales, quality of life using the EuroQol questionnaire (EQ-5D) and home suitability using the home suitability assessment questionnaire. Results: Improvements were observed in autonomy in activities of daily living (p = 0.003), mobility (p = 0.001) and housing adaptation (p < 0.001). The level of anxiety/depression was reduced (p = 0.028), and the mean health status score increased markedly (p < 0.001). Conclusions: This study highlights the improvement in the quality of life and autonomy in the basic activities of daily living for individuals receiving occupational therapy, emphasizing the need for home adaptation and family support

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old