The aim of this study was to compare a non-invasive test of small bowel permeability with a more invasive approach involving endoscopy, mucosal biopsy, and oesophageal pH monitoring for rapidly differentiating gastro-oesophageal reflux (GOR) and cows' milk intolerance in 25 infants with persistent vomiting. Each subject underwent a cellobiose/mannitol permeability study, upper gastrointestinal endoscopy with oesophageal and small bowel biopsies, and a 24 hour pH study.Reflux disease and/or cows' milk intolerance was responsible for vomiting in 24 (96%) of the subjects. Sixteen (64%) of the infants had GOR alone, four (16%) had GOR and cows' milk intolerance, and four (16%) had cows' milk intolerance alone. Morphometric analysis of small bowel biopsies was abnormal in 19% of the patients with GOR alone and in 67% with cows' milk intolerance with or without GOR. The permeability test was abnormal in only 6% of the patients with GOR but in 100% with GOR and cows' milk intolerance and in 100% with cows' milk intolerance alone.The non-invasive permeability study aimed at rapid determination of cows' milk intolerance should pre-empt a more invasive approach in the evaluation of infants with persistent vomiting. (Arch Dis Child 1995; 73: 439-442)

Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

Purpose To screen multidimensional frailty in older people, using a comprehensive geriatric assessment (CGA) tool such as the multidimensional prognostic index (MPI), is a public health priority. Unfortunately, the screening tools available are not able to capture multidimensional frailty. In this work, we aimed to evaluate in a population of hospitalized and ambulatory older patients, the agreement between an abbreviated form of the MPI (ie, BRIEF-MPI) and the standard/full version. Participants and Methods All participants included in the study completed both versions of the MPI, brief and full, which share the following domains: 1) basic and 2) instrumental activities of daily living, 3) mobility/risk of pressure sores, 4) cognition, 5) nutrition, 6) comorbidity, 7) social and 8) number of medications. The agreement between the two instruments was reported using either the mean comparisons with a t -test matched sample, a simple correlation analysis and the Bland–Altman methodology. Results The study sample included 110 participants (mean age=83.2 years, 51.8% women). The mean difference was statistically and clinically irrelevant (mean difference=0.01±0.10; p=0.27). The correlation between brief and full MPI versions was optimal (R=0.82, p<0.0001). Using the Bland–Altman methodology, we observed that only three participants over 110 (=2.73%) were outside the limits of agreement. The accuracy of BRIEF-MPI in predicting multidimensional frailty, as full MPI>0.66, was optimal (area under the curve=0.92, p<0.0001). A BRIEF-MPI value of 0.59 yielded the highest sensitivity and specificity in predicting multidimensional frailty. Conclusion BRIEF-MPI had a good agreement with the full/standard version of the MPI, making this tool as ideal for the screening of multidimensional frailty in older people.

It is essential for welfare systems to predict the health and care needs of people with chronic diseases. The Multidimensional Prognostic Index (MPI) proved excellent accuracy in predicting negative health outcomes. Recently, a selfadministered version of MPI (SELFY-MPI) was developed and validated in community- dwelling subjects showing an excellent agreement between the two instruments regardless of age. This is a feasibility study concerns the implementation of SELFYMPI in five European countries. The SELFY-MPI includes the self-administration of Barthel Index, Instrumental Activities of daily Living (IADL), Test Your Memory (TYM) Test, Mini Nutritional Assessment-Short Form (MNA-SF), comorbidity, number of medications, and the Gijon’s Socio-Familial Evaluation Scale (SFES). A descriptive analysis was performed on the data collected. 300 subjects (mean age 62 years, range 19-88 years; male/female ratio 0.81) completed the SELFY-MPI. The mean value of the SELFY-MPI was 0.131 (range: 0.0- 0.563) showing a significant correlation with age (Pearson coefficient=0.373, P<0.001). The mean value of the SELFYMPI filling time was 15 minutes (range: 5- 45 minutes) showing a significant correlation between age and filling time (Pearson coefficient=0.547, P<0.001). The SELFYMPI is an excellent self-administered tool for comprehensive self-assessment screening of community-dwelling people at risk of physical and cognitive frailty and/or socioeconomic vulnerability.

Background Frailty has been recognized as potential surrogate of biological age and relevant risk factor for COVID‐19 severity. Thus, it is important to explore the frailty trajectories during COVID‐19 pandemic and understand how COVID‐19 directly and indirectly impacts on frailty condition. Methods We enrolled 217 community‐dwelling older adults with available information on frailty condition as assessed by multidimensional frailty model both at baseline and at one‐year follow‐up using Multidimensional Prognostic Index (MPI) tools. Pre‐frail/frail subjects were identified at baseline as those with MPI score >0.33 (MPI grades 2–3). Frailty worsening was defined by MPI difference between 12 months follow‐up and baseline ≥0.1. Multivariable logistic regression was modelled to identify predictors of worsening of frailty condition. Results Frailer subjects at baseline (MPI grades 2–3 = 48.4%) were older, more frequently female and had higher rates of hospitalization and Sars‐CoV‐2 infection compared to robust ones (MPI grade 1). Having MPI grades 2–3 at baseline was associated with higher risk of further worsening of frailty condition (adjusted odd ratio (aOR): 13.60, 95% confidence interval (CI): 4.01–46.09), independently by age, gender and Sars‐CoV‐2 infection. Specifically, frail subjects without COVID‐19 (aOR: 14.84, 95% CI: 4.26–51.74) as well as those with COVID‐19 (aOR: 12.77, 95% CI: 2.66–61.40, p = 0.001) had significantly higher risk of worsening of frailty condition. Conclusions Effects of COVID‐19 pandemic among community‐dwelling frailer individuals are far beyond the mere infection and disease, determining a significant deterioration of frailty status both in infected and non‐infected subjects.