Incidence of mental disorders in the general population aged 1-30 years disaggregated by gender and socioeconomic status.

PURPOSE: The objective of this study was to estimate the incidence and age of onset of mental disorders diagnosed by gender and socioeconomic status (SES) in children, adolescents, and young adults up to 30 years of age in the whole population of the Basque Country (Spain). METHODS: All mental health diagnoses documented in Basque Health Service records from 1 January 2003 to 31 December 2018, were classified into eight clusters: anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, depression, psychosis/personality disorders, substance use, eating disorders, and self-harm. We calculated incidence and cumulative incidence for each cluster, disaggregated by gender, and socioeconomic status (SES). Poisson regression analyses were performed. RESULTS: Overall, 9,486,853 person-years of observation were available for the 609,281 individuals included. ADHD and conduct disorders were diagnosed in the first decade, anxiety and depression disorders in the second and third decades, and psychosis/personality and substance use in the third. The cumulative incidence at 18 years of age for any type of disorder was 15.5%. The group with low SES had a statistically significantly higher incidence of all eight clusters. The incidence of ADHD, conduct disorders, depression, psychosis/personality disorders, and substance use was higher in males and that of anxiety, eating disorders and self-harm was higher in females. CONCLUSIONS: The incidence of mental disorders is high among children, adolescents, and young adults in the Basque Country underlining the need for preventive interventions. Marked differences by gender and SES highlight mental health inequalities, especially for depression and psychosis in low SES males.

Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project.

PURPOSE: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country.

BACKGROUND: Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The aim of this study is to evaluate the impact of CareWell integrated care model for older patients with multimorbidity in the Basque Country. METHODS: The CareWell program for older patients with multimorbidity, based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The program was deployed in four healthcare areas in the Basque Country. The control group was formed by two organizations in which the program had not been deployed and regular care procedures were applied. Participants, older patients (aged ≥65) with two or more chronic conditions (at least one being chronic obstructive pulmonary disease, chronic heart failure, or diabetes mellitus), categorized as complex according to a risk stratification algorithm, were followed up to 12 months. The impact of the program on the use of health resources, clinical effectiveness, and satisfaction was evaluated using a mixed-method approach. Semi-structured interviews were performed to assess satisfaction with the newly deployed model and mixed regression models to measure the effect of the intervention throughout the follow-up period. RESULTS: Two hundred patients were recruited (101 intervention and 99 control), mostly males (63%) with a mean age of 79 years and age-adjusted Charlson Comorbidity Index of 9.7 on average. Relevant differences between the groups were observed for all dimensions. In the intervention group, the number of hospitalizations and visits to emergency centers was reduced, and the number of primary care contacts increased. Clinical changes were also observed, such as a decrease in the body mass index and blood glucose levels. The satisfaction level was high for all stakeholders. CONCLUSION: The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations. The satisfaction with this model of care was high. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03042039 . Registered 3 February 2017 - Retrospectively registered.

Description of frail older people profiles according to four screening tools applied in primary care settings: a cross sectional analysis.

BACKGROUND: Regarding the health care of older populations, WHO recommends shifting from disease-driven attention models towards a personalized, integrated and continuous care aimed to the maintenance and enhancement of functional capacities. Impairments in the construct of functional intrinsic capacity have been understood as the condition of frailty or vulnerability. No consensus has been yet reached regarding which tools are the most suitable for screening this kind of patients in primary care settings. Tools based on the measurement of functional performance such as Timed up and go test (TUG), Short Physical Performance battery (SPPB), self-completed questionnaires like Tilburg Frailty Indicator (TFI) and clinical judgement, as the Gerontopole Frailty Scale (GFS) may be adequate. The objective of this work is to describe and compare characteristics of community-dwelling individuals identified as vulnerable or frail by four tools applied in primary care settings. METHODS: Cross sectional analysis developed in primary care services in two regions of Spain. Community-dwelling independent individuals aged 70 or more willing to participate were recruited and data was collected via face-to-face interviews. Frailty was assessed by TUG, SPPB, TFI and GFST. Also socio-demographic characteristics, lifestyle habits and health status data (comorbidities, polypharmacy, self-perceived health), were collected. Multiple correspondence analysis (MCA) and cluster analysis were used to identify groups of individuals with similar characteristics. RESULTS: Eight hundred sixty-five individuals were recruited, 53% women, with a mean age of 78 years. Four clusters of participants emerge. Cluster 1 (N = 263) contained patients categorized as robust by most of the studied tools, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail or vulnerable by at least one of the tools. Significant differences were found between clusters. CONCLUSIONS: The assessed tools identify different profiles of patients according to their theoretical construct of frailty. There is a group of patients that are identified by TUG and SPPB but not by GFS or TFI. These tools may be useful in primary care settings for the implementation of a function- driven clinical care of older patients.

Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies.

PURPOSE: The objective of this study was to evaluate the psychometric properties of the Constant-Murley Score (CMS) in various shoulder pathologies, based on a systematic review and expert standardized evaluations. METHODS: A systematic review was performed in MEDLINE and EMBASE databases. Titles and abstracts were reviewed and finally the included articles were grouped according to patients' pathologies. Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally. RESULTS: Five individual pathologies (i.e. subacromial, fractures, arthritis, instability and frozen shoulder) and two additional groups (i.e. various pathologies and healthy subjects) were considered. Overall EMPRO scores ranged from 58.6 for subacromial to 30.6 points for instability. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder. Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the other evaluated attributes. CONCLUSIONS: The current evidence does not support the CMS as a gold standard in shoulder evaluation. Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed. LEVEL OF EVIDENCE: Systematic review.

Inflammaging and Frailty Status Do Not Result in an Increased Extracellular Vesicle Concentration in Circulation.

In the last decades extracellular vesicles (EVs) have emerged as key players for intercellular communication. In the case of inflammation, several studies have reported that EV levels are increased in circulation during inflammatory episodes. Based on this, we investigated whether aging results in elevated EV number, as a basal proinflammatory status termed "inflammaging" has been described in aged individuals. Moreover, we also hypothesized that frailty and dependence conditions of the elderly could affect EV concentration in plasma. Results showed that inflammaging, frailty or dependence status do not result in EV increase, at least in the total number of EVs in circulation. These results open a new perspective for investigating the role of EVs in human aging and in the inflammaging process.

Non-specific protection against severe COVID-19 associated to typhoid fever and DTP vaccination.

Trained immunity (TRAIM) or the enhanced non-specific immune response after primary stimulation by infection or vaccination is a recent but well-recognized concept. To verify its predictions, our objective was to determine the effects of two bacterial vaccines, typhoid fever (TFV) and diphtheria-tetanus-pertussis (DTP) on the infection, hospitalization and death frequencies associated to COVID-19 in a retrospective study on subjects vaccinated or not with TFV and DTP in the 4 years prior to the start of COVID-19 pandemia in the Basque Country (Spain). The studied outcome records were split into two periods according to COVID-19 vaccination, the pre-vaccination (ACV) from March to December 2020 and the post-vaccination (PCV) from September 2021 to June 2022). In total, 13,673 subjects were vaccinated against TFV and 42,997 against DTP. A total of 2,005,084 individual records were studied in the ACV period and 1,436,693 in the PCV period. The proportion of infection, hospitalization and death associated to COVID-19 among controls in ACV was 4.97 %, 7.14 % and 3.54 %, respectively vs. 7.20 %, 2.24 % and 0.10 % among TFV subjects. Regarding DTP, the proportions were 4.97 %, 7.12 % and 3.58 % for controls and 5.79 %, 5.79 % and 0.80 % for vaccinees. In the PCV period, the proportion of infection, hospitalization and death among controls was 21.89 %, 2.62 % and 0.92 %, respectively vs. 31.19 %, 0.76 %, 0.00 % among TFV. For DTP, infection, hospitalization and death proportions were 21.89 %, 2.62 % and 0.92 %, respectively, among controls vs. 32.03 %, 1.85 % and 0.24 % among vaccinated subjects. The corresponding combined ACV and PCV odds ratios (OR) for SARS-CoV2 infection were 1.505 (95%CI 1.455-1.558; p < 0.0001; reduction -41.85 %) and 1.633 (95%CI 1.603-1.662; p < 0.0001; reduction -51.74 %), for TFV and DTP, respectively. Regarding COVID-19 associated hospitalization, the OR were 0.295 (95%CI 0.220-0.396; p = 0.0001; reduction 69.74 %) and 0.667 (95%CI 0.601-0.741; p = 0.0001; reduction 32.44 %), for TFV and DTP, respectively). COVID-19 associated death OR were 0.016 (95%CI 0.002-0.113, p < 0.0001; reduction 98.38 %) and 0.212 (95%CI 0.161-0.280; p = 0.0001; reduction 78.52 %), for TFV and DTP, respectively. We conclude that TRAIM effects by TFV and DTP vaccination in the four years prior to the pandemic SARS-CoV2 were supported by slightly increased infection rates, but strongly reduced COVID-19 associated hospitalization and death rates.

Socioeconomic and gender inequalities in mental disorders among adolescents and young adults.

BACKGROUND: Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. MATERIALS AND METHODS: We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. RESULTS: Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). CONCLUSIONS: Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.

Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol.

Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.

Variables associated with COVID-19 severity: an observational study of non-paediatric confirmed cases from the general population of the Basque Country, Spain.

OBJECTIVES: To investigate which were the most relevant sociodemographic and clinical variables associated with COVID-19 severity, and uncover how their inter-relations may have affected such severity. DESIGN: A retrospective observational study based on electronic health record data. PARTICIPANTS: Individuals ≥14 years old with a positive PCR or serology test, between 28 February and 31 May 2020, belonging to the Basque Country (Spain) public health system. Institutionalised and individuals admitted to a hospital at home unit were excluded from the study. MAIN OUTCOME MEASURE: Three severity categories were established: primary care, hospital/intensive care unit admission and death. RESULTS: A total of n=14 197 cases fulfilled the inclusion criteria. Most variables presented statistically significant associations with the outcome (p<0.0001). The Classification and Regression Trees recursive partitioning methodology (based on n=13 792) suggested that among all associations, those with, age, sex, stratification of patient healthcare complexity, chronic consumption of blood and blood-forming organ, and nervous system drugs, as well as the total number of chronic Anatomical Therapeutic Chemical types were the most relevant. Psychosis also emerged as a potential factor. CONCLUSIONS: Older cases are more likely to experience more severe outcomes. However, the sex, underlying health status and chronic drug consumption may interfere and alter the ageing effect. Understanding the factors related to the outcome severity is of key importance when designing and promoting public health intervention plans for the COVID-19 pandemic.

Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi.

INTRODUCTION: Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project in a health system, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM). PATIENTS AND METHODS: Randomised clinical trial with two groups of 12-14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups. RESULTS: There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity. CONCLUSIONS: The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM.

Nursing Home Survey on Patient Safety Culture: Cross-cultural Validation Data From Spanish Nursing Homes.

OBJECTIVES: Developing an adequate patient safety culture is a relevant objective for all health care levels. The Nursing Home Survey on Patient Safety Culture (NHSOPS) is a 12-dimension tool assessing safety culture in nursing homes (NH) for elder people. The psychometric properties of its Spanish adaptation are evaluated in this study. METHODS: Nursing homes with 15 beds or more, located in the Basque Country (North Spain), were invited in the study. All staff types were allowed to participate. Internal consistency was tested with Cronbach's α. Convergent and divergent validity with Spearman's correlations. Two-sample t test was used for known-groups validity. The NHSOPS dimensionality was tested with confirmatory factor analysis (CFA), and its stability in consecutive administrations (test-retest) was explored. RESULTS: Five hundred fifty-three valid baseline and 83 retest replies were received. The data suggest that the NHSOPS can be represented by a 10-factor model. Two items (A6 and A10) had loadings of less than 0.12. The rest survey items obtained loadings of greater than 0.40. Estimated correlations supported the convergent and divergent validity of the survey. Managers and administrators, as well as staff considering their NH to be a safe place for residents, obtained higher NHSOPS scores, suggesting acceptable known-groups validity. On the other hand, test-retest variation was considerable. CONCLUSIONS: The current data support a simpler model, similar to that of the Norwegian NHSOPS validation. The stability of the scale should be further assessed in a bigger sample. Test-retest reliability and developing an adequate scoring scheme are issues worth of further study.

Multimorbidity and functional status in older people: a cluster analysis.

PURPOSE: Multimorbidity and frailty are complex conditions often present in older people. The aim of this study was to identify clusters of chronic diseases in robust and frail individuals and compare sociodemographic and health characteristics between these clusters. METHODS: This cross-sectional study used information from electronic health records and a baseline assessment, which included the Timed Up and Go test of physical performance as a measure of frailty. Multiple correspondence and cluster analyses were performed to identify groups. RESULTS: A total of 813 individuals (55.1% women; mean age 77.4 years, SD = 5.0) were studied. Frail individuals (n = 244) were older and had a poorer health status than robust individuals (n = 569). Three clusters were identified among the robust (RC1, n = 348; RC2, n = 139 and RC3, n = 82) and four among the frail individuals (FC1, n = 164; FC2, n = 23; FC3, n = 44 and FC4, n = 13). The RC1 and FC1 had a better health status (specifically, less polypharmacy, lower chronic disease burden and better self-perceived health) than RC2-RC3 and FC2-FC3-FC4, respectively. Diseases associated with mobility limitation and limb pain were more common in RC2 and FC2 than in the other clusters. Cardiovascular diseases and risk factors were more prevalent in RC3 and FC3. Among the frail a new cluster emerged, FC4, containing individuals with higher rates of cognitive and eye problems and a clearly poor health status. CONCLUSION: This exploratory study may provide relevant information for the clinical management of older patients with multimorbidity, even though the chronic disease clusters identified were similar in robust and frail individuals.

Tackling frailty at primary care: evaluation of the effectiveness of a multicomponent intervention through a randomised controlled trial: study protocol.

INTRODUCTION: This project focuses on how frailty is addressed in primary healthcare (PHC) and will evaluate the effectiveness of a multifactorial intervention (considering the appropriateness of the pharmaceutical prescription, the nutritional care provided and the exercise intervention) for persons with frailty, in terms of improving their functional capacity and reducing the incidence of adverse events related to frailty. The final evaluation will be made at 12 months' follow-up. METHODS AND ANALYSIS: Pragmatic multicentre cluster randomised controlled clinical trial, single blind with two arms: multifactorial intervention in PHC versus usual follow-up. The randomisation unit is the patient list and the analysis unit is the patient. In addition, a cost-effectiveness study and a qualitative study will be carried out, the latter based on semistructured interviews and focus groups. Two hundred persons (100 per study branch) all aged ≥70 years, presenting frailty, but functionally independent and resident in the community, will be recruited. A baseline evaluation will be carried out prior to the intervention, with follow-up at 6 and 12 months. The main study variables considered will be functional capacity and incidence of adverse events; the secondary variables considered will be the patients' sociodemographic characteristics, nutritional status, level of physical activity and drug consumption, together with data on comorbidity, cognitive and affective status and health-related quality of life. Data will be analysed according to the intention-to-treat principle using a 5% significance level. ETHICS AND DISSEMINATION: The study will at all times be conducted in strict accordance with the provisions of the Declaration of Helsinki and with the national legislation regulating patients' autonomy. All patients recruited will be asked to provide written informed consent before taking part in the clinical trial. On completion of the study, the principal investigator expects to publish the results of this research in a peer-reviewed open access scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN17143761.

[Effect of changing reference growth charts on the prevalence of short stature]. / Efecto del cambio de gráficas de crecimiento de referencia en la prevalencia de talla baja.

INTRODUCTION: Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area. SUBJECTS AND METHODS: A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3rd percentile of the study sample were calculated. RESULTS: There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls). CONCLUSIONS: The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change.

Impact Assessment of an Innovative Integrated Care Model for Older Complex Patients with Multimorbidity: The CareWell Project.

OBJECTIVES: To evaluate the impact in terms of use of health services, clinical outcomes, functional status, and patient's satisfaction of an integrated care program, the CareWell program, for complex patients with multimorbidity, supported by information and communication technology platforms in six European regions. DATA SOURCES: Primary data were used and the follow-up period ranged between 8 and 12 months. STUDY DESIGN: A quasi-experimental study, targeting chronic patients aged 65 or older, with 2 or more conditions - one of them necessarily being diabetes, congestive heart failure or congestive obstructive pulmonary disease. The intervention group received the integrated care program and the control group received usual care. Generalized mixed regression models were used. DATA COLLECTION: Data were obtained from individual interviews and electronic clinical records. PRINCIPAL FINDINGS: Overall, 856 patients were recruited (475 intervention and 381 control). In the intervention group, the number of visits to emergency rooms was significantly lower, and the number of visits to the general practitioners and primary care nurses was higher than in the control group. CONCLUSION: The CareWell program resulted in improvements in the use of health services, strengthening the role of PC as the cornerstone of care provision for complex patients with multimorbidity.

T cells and immune functions of plasma extracellular vesicles are differentially modulated from adults to centenarians.

Aging is a universal and complex process that affects all tissues and cells types, including immune cells, in a process known as immunosenescence. However, many aspects of immunosenescence are not completely understood, as the characteristics of the immune cells of nonagenarians and centenarians or the features and implications of extracellular vesicles (EVs). In this study, we analyzed blood samples from 51 individuals aged 20-49 and 70-104 years. We found that senescent CD8 cells accumulate with age, while there is a partial reduction of senescent CD4 cells in nonagenarians and centenarians. Moreover, plasma EVs carry T cell specific markers, but no accumulation of "senescent-like EVs" was found within any of analyzed age groups. Our functional studies of cocultures of peripheral blood mononuclear cells and EVs showed that EVs enhance T cell viability and, under phytohemagglutinin stimulation, they influence cytokine secretion and cell activation in an age-dependent manner. These results underline the importance of EVs on the immune system functioning, and open new perspectives to further study their implication in human aging.

Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial.

AIM: The purpose of this study was to assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region. METHODS: A two-year follow-up randomised controlled trial. The intervention consisted of 6 weekly structured peer-to-peer workshops. The primary outcome was change in HbA1c levels. Secondary outcomes included other clinical measures, quality of life, self-efficacy, life-style changes, medication and use of healthcare services. Mixed effect models were fitted. RESULTS: n=297 patients were recruited in each study arm. Baseline HbA1c levels were comparable in both groups with an overall mean 7.1 (SD=1.2). The intervention did not significantly modify HbA1c, or other cardiovascular variables. Significant improvements were seen in self-efficacy, and in particularly its disease control component. Certain differences were also observed in the use of healthcare resources and medication consumption. High workshop participation and satisfaction rates were achieved. CONCLUSION: HbA1c reductions are difficult to obtain in adequately controlled patients. On the other hand, raising awareness on one's disease can increase disease control self-efficacy. This finding, accompanied by reduced medication consumption and healthcare use rates, highlights that usual care would be benefited by incorporating certain SDSMP aspects. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

Dietary Patterns and Their Relationship with Frailty in Functionally Independent Older Adults.

The impact of dietary patterns rather than single foods or nutrients on health outcomes is increasingly recognized. This cross-sectional study examines the dietary patterns of 527 non-institutionalized functionally independent older people aged ≥70 years from Gipuzkoa (Spain). Sociodemographic characteristics, health status, anthropometric measures and dietary data are collected. Multiple correspondence analysis (MCA) and cluster analysis are performed to identify dietary patterns and groups of individuals. Frequency of selected food items and compliance with food recommendations are included in the MCA. A high proportion of the sample population are overweight or obese, whereas only 3.3% are at risk of malnutrition (determined with the Mini Nutritional Assessment). Frail individuals (n = 130), measured with the Timed-Up and Go test are older, have a lower educational level, are more obese, present a poorer health status (more depressive symptoms, polypharmacy and falls, among others) and worse compliance with food recommendations than robust individuals (n = 392). Three groups of individuals are identified: cluster one (n = 285), cluster two (n = 194) and cluster three (n = 48). A gradient of increasing frailty and poorer health status is observed from cluster one to cluster three. The latter also shows the poorest dietary pattern, regarding dietary recommendations. The use of an easy-to-use tool to assess diet allows detection of differences among the three clusters. There is a need to increase awareness on the implementation of nutritional screening and a subsequent dietary assessment in primary care settings to provide nutritional care to elder, and moreover, frail individuals.