Frailty is a multidimensional concept of vulnerability closely associated with ageing and adverse health outcomes, including mortality, chronic diseases and functional impairments. Despite its clinical relevance, the conceptualisation of frailty remains challenging, highlighting the need to explore how it relates to general health decline over time.

To evaluate whether a Frailty Index is associated with subsequent decline in self-rated health (SRH) over 13 months in older adults.

Longitudinal cohort design.

A total of 660 community dwelling participants aged 65 and older from Canton Ticino, Southern Switzerland, were included. The follow-up period, conducted as part of the Corona Immunitas study, spanned from September 2020 to November 2021.

The Rockwood Frailty Index categorised participants into frail, prefrail and robust groups based on 30 variables across seven domains. SRH trajectories were analysed over time using linear mixed-effects models, adjusting for socio-demographic and health-related covariates.

From 660 participants, 41.5% were robust, 48.2% prefrail and 10.3% frail at baseline, with baseline mean SRH 4.22, 3.74 and 2.97, respectively. SRH declined over 13 months in all groups (β=–0.009, p

Frail individuals experience a more pronounced decline in SRH compared with robust and prefrail individuals, highlighting their heightened vulnerability. The Rockwood Frailty Index was associated with health deterioration over time and clearly distinguished between frailty states, supporting its use to identify older adults at higher risk of subsequent health decline and to inform early detection and prevention strategies in older populations.

Early screening for autism spectrum disorder (ASD) can enhance educational and health outcomes for affected children. This narrative systematic review explores school-based screening tools used around the world to identify children with ASD and explore the differences across socio-demographic groups.

Systematic review of electronic databases (EMBASE, MEDLINE, PsycINFO, Cochrane and Scopus) in October 2024 of papers published between 2011 and 2024.

Mainstream school-based settings globally.

Children aged 4–16 years old attending mainstream school.

School-based screening tools for ASD, including all types of informant and format of tools reported in eligible studies.

Primary outcomes included prevalence of screen positives, sensitivity and specificity of the screening tools. Secondary outcomes included participants’ sex, socioeconomic status and ethnicity, and the relation of this to the primary outcomes.

Of 7765 eligible articles, 14 studies were included in this review. We identified eight different school-based ASD screening tools. Study populations ranged from 103 to 16 556 children, with sensitivity and specificity varying by screening tool used, age group, setting and ASD prevalence. The percentage of children screening positive for ASD ranged from 0.7% to 8.5%. Studies were conducted in Europe (n=6), Western Pacific (n=4), the Americas (n=3) and Eastern Mediterranean (n=1) regions. No studies explicitly explored accuracy or validity outcomes based on ethnicity or socioeconomic status. Half of the 14 studies (n=7) reported the sensitivity and specificity of the screening tools; sensitivity ranged from 58% to 94% and specificity from 61% to 100%. There was insufficient evidence to recommend any single ASD screening tool.

ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations.