Frailty trends in Catalonia 2017-2021: An epidemiological study with 1.5 million people aged ≥65 years.

OBJECTIVES: Knowledge of frailty prevalence and incidence trends over time is essential for planning the necessary health and social resources. The objective of this study was to assess frailty prevalence, incidence, reversibility and mortality rates, and trends for the population aged ≥65 years in Catalonia over the period 2017-2021. STUDY DESIGN: Longitudinal epidemiological study. METHODS: An observational longitudinal 5-year study (1 January 2017 to 31 December 2021) of the population aged ≥65 years in Catalonia (approximately 1.5 million individuals) was performed using retrospectively collected data from different health databases. Frailty status was evaluated using the electronic Screening Index of Frailty (e-SIF) and categorised as robust, pre-frail, moderately frail or severely frail. RESULTS: Standardised frailty prevalence rates were 10.5 % (2017), 11.8 % (2018), 13.1 % (2019), 12.9 % (2020) and 14.3 % (2021) [p-value for trend = 0.010]. Standardised frailty incidence rates per 1000 non-frail persons/year were 35 (2018), 36 (2019), 28 (2020) and 33 (2021) [p-value for trend = 0.492]. Both prevalence and incidence were higher in women and increased with age. Standardised frailty reversibility rates per 1000 frail persons/year were 123 (2018), 108 (2019) and 121 (2020) [p-value for trend = 0.406], and decreased with age. Standardised mortality rates for frail individuals per 1000 frail persons/year were 93 (2018), 84 (2019) and 110 (2020) [p-value for trend = 0.555], and increased with frailty severity. CONCLUSIONS: Frailty prevalence in Catalonia increased by 36 % between 2017 and 2021; however, no clear trend was evident for frailty incidence and reversibility, while results for mortality were likely to have been influenced by the COVID-19 pandemic.

[Effect of frailty in health resource use in aged cancer patients]. / Efecto de la fragilidad en el consumo de recursos sanitarios en ancianos con cáncer.

OBJECTIVE: To evaluate the effect of frailty on health resource use in aged population with cancer. METHOD: Population-based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people ≥65 years with cancer. RESULTS: Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p=0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). CONCLUSIONS: Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer.

Efecto de la fragilidad en el consumo de recursos sanitarios en ancianos con cáncer / Effect of frailty in health resource use in aged cancer patients

Objetivo Evaluar el efecto de la fragilidad en el consumo de recursos sanitarios en población anciana con cáncer. Método Estudio de cohortes de base poblacional con recogida retrospectiva y seguimiento de enero de 2018 a diciembre de 2019 en personas ≥65 años con cáncer. Resultados Se incluyeron 996 sujetos, con una prevalencia de fragilidad del 22,1%. La mortalidad a los 2 años fue del 14,1% en los frágiles y del 9,0% en los no frágiles (p = 0,028). Independientemente de la edad y del sexo, la fragilidad aumentó el número de hospitalizaciones urgentes (168%) y programadas (64%), las visitas a urgencias (111%), las consultas externas (59%), las sesiones de hospital de día (30%) y las visitas a atención primaria (114%). Conclusiones La fragilidad es más prevalente, condiciona un peor pronóstico y se asocia a un mayor consumo de recursos sanitarios en los ancianos con cáncer. (AU)

Objective To evaluate the effect of frailty on health resource use in aged population with cancer. Method Population-based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people ≥65 years with cancer. Results Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p = 0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). Conclusions Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer. (AU)

Relationship of frailty status with health resource use and healthcare costs in the population aged 65 and over in Catalonia.

BACKGROUND: Frailty is a geriatric syndrome with repercussions on health, disability, and dependency. OBJECTIVES: To assess health resource use and costs attributable to frailty in the aged population. METHODS: A population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective. RESULTS: For 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail. CONCLUSIONS: Our findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.

Geographical, Socioeconomic, and Gender Inequalities in Opioid Use in Catalonia.

Background: In recent years, worldwide opioid use has seen a sharp increase, especially for the treatment of chronic non-cancer pain. Catalonia is no exception to this trend. However, no recent studies have addressed the socioeconomic and gender inequalities in opioid use in the different geographical areas of Catalonia. Methods: We performed an ecological study to analyse the associations between socioeconomic status, gender and the use of opioids in the 372 Health Areas of Catalonia. Robust Poisson models were performed to analyse the data provided from the Central Register of Insured Persons and dispensing data from the Electronic Prescription Database. Results: The results show that socioeconomic status has a major impact on opioid use, with the most deprived areas presenting the highest levels of use. There are major inequalities in the DDD/1,000 inhabitants per areas. Moreover, women have much higher utilization rates than men, especially in more deprived areas. The greatest difference is observed in the use of weak opioids in women: the DDD/1,000 inhabitants per day was 2.34 in the area with the lowest use, compared with 22.18 in the area with the highest use. Conclusions: Our findings suggest that stronger action is needed to promote best practices in prescribing for chronic pain and to reduce socioeconomic and gender variation between geographical areas. This study provides a model for routine monitoring of opioid prescription for targeted interventions aimed at lowering high-dose consumption in specifically identified areas.

Maternal anxiety following delivery, early infant temperament and mother's confidence in caregiving

A mother’s emotional state is a well-known environmental factor that relates to the development of infant temperament. However, some relevant issues have not yet been fully explored. The current study examines the influence of determined maternal, contextual and perinatal variables on infant temperament and the mother’s confidence in caregiving during the first weeks of life. A prospective study was carried out in three-hundred and seventeen newborns and their mothers. Perinatal and socio-demographic variables were recorded. The mother’s anxiety and mood were measured in the first days after childbirth and again at 8 weeks. Infant temperament and the mother’s confidence in caregiving were measured at 8 weeks. A mother’s postpartum anxiety following delivery was the best predictor for most of the variables of infant temperament, including infant irritability (p = .001), and other child variables like infant sleep (p = .0003) and nursing difficulty (p = .001). Contextual-family variables, such as the number of people at home (p = .0024) and whether they were primiparous (p = .001), were the best predictors for a mother's confidence in caregiving. Support was found for an early effect of maternal anxiety on infant temperament. The results have clinical implications for postnatal psychological interventions (AU)

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Maternal anxiety following delivery, early infant temperament and mother's confidence in caregiving.

A mother's emotional state is a well-known environmental factor that relates to the development of infant temperament. However, some relevant issues have not yet been fully explored. The current study examines the influence of determined maternal, contextual and perinatal variables on infant temperament and the mother's confidence in caregiving during the first weeks of life. A prospective study was carried out in three-hundred and seventeen newborns and their mothers. Perinatal and socio-demographic variables were recorded. The mother's anxiety and mood were measured in the first days after childbirth and again at 8 weeks. Infant temperament and the mother's confidence in caregiving were measured at 8 weeks. A mother's postpartum anxiety following delivery was the best predictor for most of the variables of infant temperament, including infant irritability (p = .001), and other child variables like infant sleep (p = .0003) and nursing difficulty (p = .001). Contextual-family variables, such as the number of people at home (p = .0024) and whether they were primiparous (p = .001), were the best predictors for a mother's confidence in caregiving. Support was found for an early effect of maternal anxiety on infant temperament. The results have clinical implications for postnatal psychological interventions.

Immunogenicity and safety of three doses of a bivalent (B:4:p1.19,15 and B:4:p1.7-2,4) meningococcal outer membrane vesicle vaccine in healthy adolescents.

An experimental bivalent meningococcal outer membrane vesicle (OMV) vaccine (B:4:P1.19,15 and B:4:P1.7-2,4) has been developed to provide wide vaccine coverage particularly of the circulating strains in Europe. A randomized, controlled phase II study (study identification number, 710158/002; ClinicalTrials.gov identifier number, NCT00137917) to evaluate the immunogenicity and safety of three doses of the OMV vaccine when given to healthy 12- to 18-year-olds on a 0-2-4 month (n = 162) or 0-1-6 month schedule (n = 159). A control group received two doses of hepatitis A and one of conjugated meningococcal serogroup C vaccine on a 0-1-6 month schedule (n = 157). Immune response, defined as a fourfold increase in serum bactericidal titer using a range of vaccine-homologous or PorA-related and heterologous strains, was determined for samples taken before and 1 month after vaccination; assays were performed at two laboratories. As measured at the GlaxoSmithKline (GSK) laboratory, the OMV vaccine induced an immune response against homologous or PorA-related strains (in at least 51% of subjects against strains of serosubtype P1.19,15 and at least 66% against strains of serosubtype P1.7-2,4) and against a set of three heterologous strains (in 28% to 46% of subjects). Both laboratories showed consistent results for immune response rates. The OMV vaccine had a similar reactogenicity profile for each schedule. Pain preventing normal activities occurred in approximately one-fifth of the subjects; this was significantly higher than in the control group. The immune responses induced by the bivalent OMV vaccine demonstrated the induction of bactericidal antibodies against the vaccine-homologous/PorA-related strains but also against heterologous strains, indicating the presence of protective antigens in OMVs and confirming the potential of clinical cross-protection.

Social paediatrics.

Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective.