Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care

Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. Conclusions Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index

Decreased and Heterogeneous Neutralizing Antibody Responses Against RBD of SARS-CoV-2 Variants After mRNA Vaccination.

The rapid spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerging variants raises concerns about their capacity to evade immune protection provided by natural infection or vaccination. The receptor-binding domain (RBD) of the viral spike protein is the major target of neutralizing antibodies, and viral variants accumulate mutations in this region. In this study, we determined the antibody neutralization capacity against the RBD of SARS-CoV-2 variants Alpha (B.1.1.7), Gamma (P.1), Epsilon (B.1.427), Kappa (B.1.617.1), and Delta (B.1.617.2) in a cohort of healthcare workers naturally infected or receiving COVID-19 mRNA vaccines from Moderna or Pfizer-BioNTech. We show that the five RBD variants displayed an augmented binding to ACE2 compared to the original Wuhan strain. The most significant increase was observed in variants Epsilon and Delta, containing mutation L452R. Using a flow cytometry cell-based assay, we found that SARS-CoV-2-infected subjects presented low levels of RBD-specific neutralizing antibodies against all variants analyzed, except Alpha. However, the neutralizing activity incremented considerably after a subsequent mRNA-vaccine dose, to levels significantly higher than those in naïve individuals receiving two vaccine doses. Importantly, we observed partially impaired neutralizing responses against most variants in fully vaccinated individuals. Variants Gamma and Kappa encompassing RBD E484K/Q mutations presented the highest neutralizing resistance. Furthermore, a wide heterogeneity in the magnitude of RBD-specific neutralizing responses against all tested SARS-CoV-2 variants following both mRNA vaccines was detected. Altogether, our findings provide important knowledge regarding SARS-CoV-2 vaccine-induced immunity, and should be very useful to guide future vaccination regimens and personalized vaccine approaches

Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis

Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs

Calidad de vida percibida de los pacientes complejos en un programa de gestión de casos en atención primaria de salud

Objetivo: Describir la calidad de vida de los pacientes complejos atendidos en un programa de gestión de casos en Atención Primaria de Salud. Material y métodos: Estudio descriptivo transversal, mediante muestreo consecutivo, de los pacientes complejos sin deterioro cognitivo atendidos durante el segundo semestre de 2010 en 2 áreas básicas de salud de Barcelona litoral. Se administró el test EuroQol, mediante entrevista individualizada, analizándose los valores en la escala visual analógica (EQ-EVA), y el índice EuroQol, a partir de las 5 dimensiones clave del instrumento. Resultados: Se analizan 50 pacientes, con una edad media de 71,46 años, de las cuales son mujeres el 66%. De las dimensiones clave, el dolor es el problema más prevalente, presente en el 80% de los casos, seguido de los problemas de movilidad, actividades de la vida cotidiana, y ansiedad/depresión, con el 62,5%, y por último, los problemas para el cuidado personal, con el 47,5%. Los valores globales en EQ-EVA e índice EuroQol son 51,89 (DE 21,19) y 0,53 (DE 0,26), respectivamente. Se ha detectado peor calidad de vida en EQ-EVA e índice EuroQol en mujeres, y en situaciones de soledad, comorbilidad e hiperfrecuentación al hospital. En el caso de EQ-EVA se aprecia una tendencia a puntuar mejor a mayor edad, y sensiblemente inferior en el caso de los hombres que viven solos (EQ-EVA 36,67 ± 15,27). Conclusiones: Los pacientes complejos de nuestro contexto presentan peor calidad de vida que la población >70 años de Cataluña. El uso del EuroQol es útil para realizar comparaciones entre grupos poblacionales

Correction to : Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care

UDTRIA

Validez convergente y discriminativa del índice frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

El índice de fragilidad Frágil-VIG y la escala de Braden son instrumentos validados para la valoración de la fragilidad y el riesgo de desarrollar lesiones relacionadas con la dependencia (LRD) respectivamente. El índice Frágil-VIG es un instrumento multidimensional que permite una evaluación rápida y eficaz del grado de fragilidad en el contexto de la práctica clínica. Objetivo: Investigar la validez convergente y discriminativa del índice Frágil-VIG respecto a la escala de Braden. Métodos Estudio transversal en dos centros de Atención Primaria de Salud de Barcelona (APS). Participaron en el estudio todas las personas incluidas en el programa de atención domiciliaria durante el año 2018, sin criterios de exclusión. Enfermeras de APS administraron el índice Frágil-VIG y la escala de Braden mediante evaluaciones personales en el domicilio de cada participante durante la atención habitual. Las relaciones entre ambos instrumentos se examinaron mediante el coeficiente de correlación de Pearson. Resultados Se incluyeron cuatrocientos doce participantes. La puntuación del índice Frágil-VIG correlacionó negativamente con la escala de Braden (r=-0,597; P<0.0001). Las personas no frágiles tenían un riesgo de padecer LRD sustancialmente menor que las personas con fragilidad moderada y grave. El valor de la escala de Braden disminuyó significativamente a medida que aumentó la puntuación del índice Frágil-VIG. Conclusiones El índice Frágil-VIG demostró validez convergente con la escala de Braden. Su validez discriminativa fue óptima, con una excelente capacidad para diferenciar entre personas con y sin riesgo de padecer LRD. Estos hallazgos proporcionan pruebas adicionales para la validez de constructo del índice Frágil-VIG

Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis

Frailty; Primary Health Care; Home careFragilitat; Atenció primària; Atenció a la llarFragilidad; Atención primaria; Atención en el hogarBackground: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs

Correlates of protection and determinants of SARS-CoV-2 breakthrough infections 1 year after third dose vaccination

Abstract Background The emergence of new SARS-CoV-2 variants and the waning of immunity raise concerns about vaccine effectiveness and protection against COVID-19. While antibody response has been shown to correlate with the risk of infection with the original variant and earlier variants of concern, the effectiveness of antibody-mediated protection against Omicron and the factors associated with protection remain uncertain. Methods We evaluated antibody responses to SARS-CoV-2 spike (S) and nucleocapsid (N) antigens from Wuhan and variants of concern by Luminex and their role in preventing breakthrough infections 1 year after a third dose of mRNA vaccination, in a cohort of health care workers followed since the pandemic onset in Spain (N = 393). Data were analyzed in relation to COVID-19 history, demographic factors, comorbidities, vaccine doses, brand, and adverse events. Results Higher levels of anti-S IgG and IgA to Wuhan, Delta, and Omicron were associated with protection against vaccine breakthroughs (IgG against Omicron S antigen HR, 0.06, 95%CI, 0.26–0.01). Previous SARS-CoV-2 infection was positively associated with antibody levels and protection against breakthroughs, and a longer time since last infection was associated with lower protection. In addition, priming with BNT162b2 followed by mRNA-1273 booster was associated with higher antibody responses than homologous mRNA-1273 vaccination. Conclusions Data show that IgG and IgA induced by vaccines against the original strain or by hybrid immunization are valid correlates of protection against Omicron BA.1 despite immune escape and support the benefits of heterologous vaccination regimens to enhance antibodies and the prioritization of booster vaccination in individuals without recent infections