Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study.

In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 µg vaccine. Methods: Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose' and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results: After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio' 3.14; 95% confidence interval' 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P < 0.001). Conclusions: A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral response.

Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients.

According to preliminary data, seroconversion after mRNA SARS-CoV-2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop at least a cellular response that could offer a certain grade of protection against SARS-CoV-2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney-pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS-CoV-2-pre-immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS-CoV-2-naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S-ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA-1273 SARS-CoV-2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.

INFOSA-DEM: programa dirigido a figuras cuidadoras de personas con demencia / INFOSA-DEM: a programme targeted to caregivers of persons with dementia

OBJETIVO: evaluar el impacto del Programa Informativo, Formativo y de Apoyo Social para figuras cuidadoras de personas con demencia (INFOSA-DEM), en relación al bienestar emocional, evaluando el tiempo de permanencia del efecto del programa a los tres y seis meses post-intervención. MÉTODO: se llevó a cabo un diseño cuasi-experimental, multicéntrico, no aleatorizado con grupo intervención (GI) y grupo control (GC). La asignación al GI y GC se realizó a través de muestreo no probabilístico, de asignación intencional, teniendo en cuenta la disponibilidad de las figuras cuidadoras para asistir a las sesiones del proprama diseñado. La recogida de datos fue efectuada por medio de entrevistas personales con la cuidadora o cuidador en el domicilio de la persona con demencia, antes de la intervención y a los tres y seis meses de seguimiento. Se recogieron variables de bienestar emocional y calidad de vida, entre otras. Se llevó a cabo análisis descriptivo y comparativo en los tres momentos de medida. RESULTADOS: participaron 160 figuras cuidadoras, 74 en GC y 86 en GI. A los tres meses se observó un efecto positivo en el bienestar emocional en el GI en comparación con un pequeño efecto negativo entre los controles. Teniendo en cuenta las tres visitas se comprobó que la mejora en dimensión salud relacionada con el bienestar emocional de los cuidadores del GI se mantuvo incluso después de seis meses, aunque las diferencias no fueron estadísticamente significativas. CONCLUSIÓN: los programas educativos dirigidos a cuidadores informales basados en terapias psicoeducativas y teorías cognitivo-conductuales parecen tener efectos positivos en la mejora del bienestar emocional de los cuidadores, y mejora la calidad del rol de la figura cuidadora

OBJECTIVE: to evaluate the impact of the Information, Training and Social Support programme for caregivers of persons with dementia (INFOSA-DEM) in terms of emotional wellbeing, evaluating the duration of the effect of the program at three and six months after the intervention. METHOD: a multicenter and non-randomized study was conducted, with quasi-experimental design, and with an Intervention Arm (IA) and a Control Arm (CA). Participants were allocated to IA or CA though non-probabilistic sample, with intentional allocation, taking into account the availability of the caregivers to attend the sessions of the programme designed. Data were collected through personal interviews with the caregiver at the home of the person with dementia, before the intervention and at three and six months of follow-up. Emotional wellbeing and quality of life variables were collected, among others. Descriptive and comparative analysis was conducted at the three points of measurement. RESULTS: the study included 160 caregivers, 74 in the CA and 86 in the IA. At three months, a positive effect was observed in the emotional wellbeing of the Intervention Arm, vs. a slight negative effect among Control participants. Taking into account all three visits, it was confirmed that the improvement in the dimension health associated with the emotional wellbeing of caregivers in the Intervention Arm was sustained even after six months; however, differences were not statistically significant. CONCLUSION: educational programs targeted to informal caregivers and based on psychoeducational therapies and cognitive-behavioural theories seem to have positive effects in terms of an improvement in the emotional wellbeing of caregivers, and there is an improvement in the quality of the caregiver role

Integrated Management of Pain in Advanced Dementia.

AIM: Develop and evaluate the implementation of a protocol for comprehensive management of pain in advanced dementia. METHOD: Quasi-experimental study carried out between September 2015 and May 2016 in an acute geriatric unit. Following development of the protocol and nurse training, 22 participants were recruited through consecutive sampling to form the intervention group (IG). Pain assessment was performed using the Pain Assessment in Advanced Dementia Spanish version (PAINAD-Sp) instrument and by nurse report-rating using the Numeric Rating Scale (NRS) and control group, with pain assessment through nurse-report using an NRS. Interventions carried out following perception of pain were done according to the actions algorithm created for this purpose. Follow-up was carried out daily during the hospital stay. RESULTS: Some 98% of the actions were performed correctly following the protocol. All (100%) of patients had a scheduled prescription for analgesics. Significant differences between mean pain scores at admission and discharge were found through PAINAD-Sp using a Wilcoxon sign test of -2.9543 (p = .004). Analysis of pain perception scores revealed a statistically significant positive correlation between the number of nonpharmacological actions performed and the pain score values obtained in the IG (rho Spearman: 0.617, p < .001) and the control group (rho Spearman: 0.922, p < .001). A high correlation was also observed in the IG between assessments conducted using PAINAD-Sp and NRS (intraclass correlation coefficient: 0.921). CONCLUSIONS: The implementation of an agreed-upon, standardized protocol for comprehensive pain management in advanced dementia, including nurse training, leads to systematic application of all the protocol stages, and therefore better pain management.

Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review.

AIM: To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND: In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN: A quantitative systematic review. DATA SOURCES: Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS: The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS: A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions. CONCLUSION: Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy. IMPACT: Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.

Prevalencia del consumo de tabaco en pacientes en tratamiento renal sustitutivo. Dependencia y actitudes ante el abandono / Prevalence of smoking in patients undergoing renal replacement therapy. Dependence and attitudes towards abandonment

Objetivo: Determinar la prevalencia del consumo de tabaco en pacientes en diálisis, el grado de dependencia y la predisposición para dejar de fumar. Material y Método: Se incluyeron un total de 157 pacientes en diálisis peritoneal y hemodiálisis. Se realizó un registro a cada uno de los pacientes, con datos relacionados con su historia médica y tratamiento. Se identificó la situación actual en relación al consumo, y se administró una batería de cuestionarios. Resultados: La prevalencia de exfumadores fue de 42.04% y la de fumadores activos del 15.28%. Presentando la mayor parte de ellos un consumo diario moderado y un grado de dependencia leve en el 70.8% de los casos. Conclusion: Más de la mitad de los fumadores activos en nuestra población se encuentran motivados y preparados para el abandono, por lo que se recomienda establecer medidas facilitadoras promuevan el abandono (AU)

Objective: To determine the prevalence of smoking in dialysis patients, the degree of dependence and the predisposition to quit smoking. Material and Method: A total of 157 patients were included in peritoneal dialysis and hemodialysis. Each patient was enrolled, with data related to their medical history and treatment. The current situation in relation to consumption was identified, and different questionnaires were administered. Results: The prevalence of ex-smokers was 42.04% and active smokers, 15.28%. Most of them presented moderate daily consumption and a mild degree of dependence in 70.8% of the cases. Conclusion: More than half of active smokers in our population are motivated and prepared for abandonment, so it is recommended to establish facilitative measures that promote abandonment (AU)