This study examines the longitudinal relationship between well-being dimensions (evaluative, experiential and eudaimonic) and disability in a representative sample of non-institutionalized adults from the provinces of Madrid and Barcelona (Spain). A total of 1,441 adults were interviewed in 2019–2021 and 2023–2024. Evaluative well-being was measured with the Cantril Self-Anchoring Striving Scale, experiential WB (positive and negative affect) was assessed with a shortened version of the Day Reconstruction Method, eudaimonic WB (EWB) was measured with the Flourishing Scale, and disability with the WHO Disability Assessment Schedule 2.0. Generalized Estimating Equation models were used for analysis. The results show that not having lifetime depression was longitudinally associated with lower disability. Lower negative affect, lower positive affect, higher evaluative well-being, and higher EWB were longitudinally associated with lower disability over the follow-up period. This study provides longitudinal evidence on the importance of WB for disability. It was also found that EWB had the strongest association with disability, supporting its importance as a dimension that should be measured alongside other indicators to study the effect of well-being on disability. To mitigate the impact of disability, it would be important to promote WB and mental health by reducing underlying risk factors.
Risankizumab (RZB) and deucravacitinib (DEU) are both approved for the treatment of moderate-to-severe psoriasis. Physicians value head-to-head comparisons between available therapies to make evidence-based treatment decisions. This study evaluates the safety and efficacy of RZB compared with DEU for the treatment of patients with moderate psoriasis who have not previously received biologic treatment. Patients with moderate psoriasis, eligible for systemic treatment and without prior biologic exposure, were enrolled in a 1:2 ratio to RZB or DEU, respectively. The 52-week treatment was divided into two periods: period A (baseline to week 16) and period B (weeks 16–52). Results from period A are presented here. In period A, patients either received a single subcutaneous injection of RZB 150 mg on day 1 and week 4 or oral DEU 6 mg daily. The coprimary endpoints in period A were achievement of ≥ 90
BACKGROUND:Suicidal ideation is a key mental health concern and a strong predictor of suicide attempts. While loneliness is a well-established correlate of suicidal ideation, few studies have explored how this association varies across sociocultural groups, especially among migrants. OBJECTIVES:The study examines the relationship between migrant status, loneliness, and suicidal ideation among adults aged 18-64 residing in the provinces of Barcelona and Madrid. Specifically, it investigates: (1) whether Latin American immigrants report higher loneliness than native-born Spaniards; (2) whether immigrant status is linked to increased suicidal ideation; and (3) whether the association between loneliness and suicidal ideation differs by migration status. METHODS:Data were drawn from the 2019 'Edad con Salud' cohort, comprising 1724 participants born either in Spain or Latin America. Suicidal ideation and major depressive disorder were assessed using the CIDI 3.0, while loneliness was measured with the 3-item UCLA Loneliness Scale. Ordered and binary logistic regression models were used to estimate associations, including interaction effects between loneliness and migration status. RESULTS:Latin American immigrants reported significantly higher levels of loneliness but not higher rates of suicidal ideation. Loneliness was associated with suicidal ideation only among native-born Spaniards. Depression and poor self-rated health were strong predictors of suicidal ideation across the full sample. CONCLUSIONS:The mental health impact of loneliness appears to be moderated by sociocultural context. Among Latin American immigrants, factors such as familism and the healthy migrant effect may protect against the psychological consequences of loneliness, despite its higher prevalence.
Background:Frailty assessment has emerged as a key component of pre-transplant evaluation. We aimed to validate, across international cohorts, the Hematopoietic Cell Transplantation Frailty Scale (HCT-FS) for the assessment of frailty in adult candidates for allogenic hematopoietic cell transplantation (allo-HCT). HCT-FS is designed for integration into routine workflows using existing resources. Methods:In this prospective, observational cohort study, we evaluated the performance of HCT-FS, a frailty scale that categorises patients as fit, pre-frail, or frail based on a cumulative weighted score derived from eight variables. We enrolled participants across 16 allo-HCT programmes (one in Canada, 15 in Spain). Eligible participants were all adult patients evaluated for frailty at the centres during the time frames: from the Hans Messner Allo-HCT Program at Princess Margaret Cancer Center (PMCC) in Toronto, Canada (2018-2024; where HCT-FS was developed) and from 15 Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) centres across Spain (2022-2023). Frailty was systematically assessed in all candidates for a median of 10 min at the first allo-HCT consultation by haematologists or trained nurses using the HCT-FS. The prognostic accuracy of the HCT-FS was assessed by evaluating its ability to discriminate clinical outcomes across frailty categories in the overall cohort and by testing the consistency of these associations within specific patient subgroups. Data were prospectively updated until February 2025. Findings:Overall, 1077 consecutive adult allo-HCT candidates were enrolled and evaluated across the PMCC (n = 734) and GETH-TC (n = 343) cohorts. The median age was 56 years (range 18-76); 411 patients (38.2%) were over 60, and 640 (59.4%) were male. Based on the HCT-FS, 33.4% patients were fit, 53.7% pre-frail, and 12.8% frail. Frailty was associated with longer hospital stays (23, 25, and 28 days for fit, pre-frail, and frail patients, respectively; p = 0.003) and higher ICU admission rates (Day +180: 7.0%, 10.8%, and 20.3% for fit, pre-frail, and frail patients, respectively; p = 0.002). 2-year OS decreased progressively with increasing frailty: 77.2% for fit, 65.7% for pre-frail, and 52.8% for frail (p < 0.001). Corresponding NRM rates were 11.7%, 19.5%, and 32.2%, respectively (p = 0.001). Multivariable analysis confirmed frailty as a predictor of inferior OS and increased NRM, when adjusting for age, comorbidities, performance status, DRI, and donor type. The HCT-FS maintained robust prognostic accuracy across subgroups stratified by age and comorbidity burden. Interpretation:The HCT-FS provided reliable measures of the frailty status of allo-HCT candidates that are informative for transplant outcomes, supporting its potential applicability in clinical practice. Notably, this tool was successfully integrated into clinical practice without additional resources. Future work is needed to further evaluate the applicability of the scale in transplant settings and whether targeted interventions based on can improve transplant outcomes. Funding:None.
BACKGROUND:The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year. METHODS:PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up. RESULTS:The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; P=0.006). PPG was independently associated with improvement in angina (P=0.017). CONCLUSIONS:In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.
