Category: Statistics

Tijdschr Gerontol Geriatr. 2024 Jun 5;55(2):2-15. doi: 10.54195/tgg18488.

ABSTRACT

Older adults are more at risk for side effects from medications. Mainly anticholinergic side effects can lead to central and peripheral side effects on somatic and cognitive levels. In this study, we determined the anticholinergic load of the medication regimens of residents of a residential care centre using two validated measurement scales. We also examined to which extent the class(es) of medications influence this anticholinergic load. Finally, we analysed the association of a high anticholinergic load with incidents (urinary tract infections, falls, delirium).In this pilot study, we see a high degree of polymedication and use of psychotropic drugs with an anticholinergic effect. On average, we established a score of 1.67 on the ACB and a score of 0.87 on the DBI. The anticholinergic load in the ACB is mainly determined by antipsychotics (β = 0,647, p ‹ 0.001), in the DBI an influence of all medications with total anticholinergic and sedative load (F = 6.764, p ‹ 0.001). A risk score on the DBI has a statistically significant correlation with experiencing a urinary tract infection (F = 5.877, p = 0.018). This influence remains significant after adjusting for covariates.The anticholinergic load of medication regimens in residents is high. An increased anticholinergic load is also associated with urinary tract infection. Reducing the anticholinergic load within residential care centres therefore represents an important challenge for the future.

PMID:40767077 | DOI:10.54195/tgg18488

Tijdschr Gerontol Geriatr. 2025 Jun 10;56(2):6-27. doi: 10.54195/tgg21665.

ABSTRACT

BACKGROUND: The benefit-harm balance of antihypertensive treatment in older adults with advanced dementia is unclear. This study assesses whether discontinuing antihypertensive treatment reduces neuropsychiatric symptoms (NPS) and maintains quality of life (QoL) in nursing home residents with dementia.

METHODS: This outcome-blinded RCT (trial registration: NL7365) randomised Dutch long-term care residents with moderate-to-severe dementia and systolic blood pressure (SBP) ≤160mmHg during antihypertensive treatment (planned sample size n=492) to either antihypertensive treatment discontinuation (n=101) or usual care (n=104). Outcomes were NPS (Neuropsychiatric Inventory-Nursing Home [NPI-NH]) and QoL (Qualidem) at 16 weeks.

RESULTS: 205 participants (median age 86 years [IQR 80-90]; 79.5% female; median SBP 134mmHg [IQR 123-146]) were included. Randomisation ceased prematurely 29 months after start randomisation because of safety concerns, combined with lacking benefits. No significant differences were found between groups for NPI-NH (mean difference 1.6 [95%CI -2.3 to 5.6]) or Qualidem (mean difference -2.5 [95%CI -6.0 to 1.0]). Serious adverse events, such as cardiovascular events or death, occurred in 36% (discontinuation) and 24% (usual care) of the participants (adjusted hazard ratio 1.65 [95%CI 0.98 to 2.79], at a median of 135 (IQR 66-209) days in the discontinuation and 103 (IQR 54-171) days in the usual care group).

CONCLUSION: Because of lacking benefits and an observed increase in adverse events, proactive discontinuation of antihypertensive treatment is not recommended in older adults with dementia.

PMID:40767075 | DOI:10.54195/tgg21665

J Evid Based Integr Med. 2025 Jan-Dec;30:2515690X251363709. doi: 10.1177/2515690X251363709. Epub 2025 Aug 6.

ABSTRACT

Objectivethis meta-analysis evaluates the effects of mind-body exercise (MBE) on cognitive function in older adults with or without mild cognitive impairment (MCI). We examined the impact of different MBE, including yoga, tai chi, qigong, and meditation, on six cognitive domains: attention, executive function, working memory, verbal memory, processing speed, and visual-spatial construction.MethodsWe searched eight electronic databases from inception till August 2024. The literature search, study selection, data extraction, methodological quality assessment and statistical analyses were performed.ResultsA total of 45 studies, comprising 4602 participants, were included. Results indicated that MBE had a moderate positive effect on visual-spatial construction (Hedges’ g = 0.46) and small effects on other domains such as verbal memory (Hedge’s g = 0.24), processing speed (Hedge’s g = 0.26), working memory (Hedges’ g = 0.15) and executive function (Hedges’ g = 0.10). However, there was no improvement in attention (Hedge’s g = 0.08, 95% CI = -0.07 to 0.23). The meta-regression analysis further revealed that participants with MCI experienced greater improvements in visual-spatial construction and executive function than healthy participants. Additionally, significant differences were observed among intervention types, with yoga and tai chi showing stronger effects on visual-spatial construction and verbal memory than meditation.ConclusionsThese findings suggest MBE is an effective intervention for improving cognitive function, especially in MCI populations and with certain types of interventions. Utilization of validated modules for MBE intervention and inclusion of long-term follow-up assessments to establish conclusive findings were also suggested.

PMID:40767037 | DOI:10.1177/2515690X251363709

Med Care. 2025 Jul 1;63(7):507-513. doi: 10.1097/MLR.0000000000002159. Epub 2025 May 6.

ABSTRACT

BACKGROUND: Historically, US Veterans have reported higher chronic disease burden than non-Veterans. However, whether Veteran and Veterans Affairs (VA) coverage status continue to be associated with chronic disease burden or how these associations vary by age, especially among younger Veterans, is unknown.

OBJECTIVE: To examine the number of chronic conditions among male Veterans with and without VA coverage, and male non-Veterans, overall and by age group.

DESIGN AND PARTICIPANTS: Using 2018 National Health Interview Survey data, our sample included 2301 male Veterans and 9243 male non-Veterans.

MAIN MEASURES: The primary outcome was a number of chronic conditions, measured as a count (range 0-15) and categorically (0, 1, 2, 3+). We created a 3-category main independent variable (Veteran with VA coverage, Veteran without VA coverage, non-Veteran). Generalized linear regression models were used to estimate relationships between Veteran and VA coverage status and count of chronic conditions, overall and by age group (18-44, 45-64, 65+), adjusting for sociodemographic characteristics.

KEY RESULTS: Veterans with VA coverage, Veterans without VA coverage, and non-Veterans had an age-standardized mean of 1.44, 1.16, and 1.09 chronic conditions, respectively. In adjusted analyses, Veterans with VA coverage had 0.36 (95% CI: 0.25-0.46) more conditions and Veterans without VA coverage had 0.12 (95% CI: 0.04-0.21) more conditions compared with non-Veterans. In age-stratified analyses, Veterans with VA coverage aged 18-44 had 0.22 (95% CI: 0.06-0.38) more conditions; 45-64, 0.71 (95% CI: 0.41-0.99) more conditions; and 65+, 0.38 (95% CI: 0.18-0.57) more conditions compared with similar-aged non-Veterans.

CONCLUSIONS: Veterans with VA coverage had the greatest number of chronic conditions, including when stratified by age group.

PMID:40766989 | DOI:10.1097/MLR.0000000000002159

Med Care. 2025 Jul 1;63(7):500-506. doi: 10.1097/MLR.0000000000002153. Epub 2025 May 1.

ABSTRACT

BACKGROUND: The COVID-19 pandemic induced a shift to telemedicine, which may have disproportionately affected in-person treatments such as acupuncture therapy.

OBJECTIVES: We measured trends in reimbursed acupuncture between 2018 and 2021. We also measured trends in other types of pain care among patients with low back pain (LBP), which was the most common diagnosis for acupuncture.

RESEARCH DESIGN: A descriptive, retrospective, and claims-based analysis.

SUBJECTS: The sample included any patient who used their insurance to pay for acupuncture, which was defined using Current Procedural Technology (CPT) codes 97810, 97811, 97813, and 97814. In secondary analysis, the sample included only patients with LBP, which were identified using the International Classification of Diseases, 10th Edition code of M54.5.

MEASURES: We tracked reimbursed acupuncture and patient and provider characteristics associated with reimbursed acupuncture. Among patients with LBP, trends in acupuncture were compared with trends in chiropractic care, physical therapy, psychotherapy, as well as prescription fills for gabapentinoids, muscle relaxants, and opioids.

RESULTS: After increasing between 2018 and 2019, there was a 28% decline in the number of patients receiving reimbursed acupuncture between 2019 and 2020. Although acupuncture use increased between 2020 and 2021, it did not reach pre-COVID-19 levels. Acupuncturists comprised a smaller share of providers who billed insurance for acupuncture while the share of providers who identified as rehabilitation specialists increased. Among patients with LBP, use of acupuncture fell more during COVID-19 compared with other types of pain care.

CONCLUSIONS: The COVID-19 pandemic had a disproportionate impact on acupuncture therapy, which may be driven by a reduction in acupuncturists who billed insurance. Future research should assess the long-term impact of COVID-19 on acupuncture use in the United States.

PMID:40766988 | DOI:10.1097/MLR.0000000000002153

Med Care. 2025 Jul 1;63(7):495-499. doi: 10.1097/MLR.0000000000002160. Epub 2025 May 19.

ABSTRACT

BACKGROUND: Older adults with dementia are susceptible to receiving potentially inappropriate medications (PIMs), where the risks likely outweigh the benefits. Medicare advantage prescription drug plans (MA-PDs) cover both medical and prescription drug benefits, creating a financial incentive to reduce PIM use and unnecessary health care costs from adverse drug events, whereas standalone Medicare prescription drug plans (PDPs) used by traditional Medicare beneficiaries are only responsible for outpatient prescription drug costs.

OBJECTIVE: The objective is to compare the use of PIMs between PDP and MA-PD enrollees with dementia.

METHODS: Using 2016-2019 Medicare claims and encounter data, we estimated the associations between Medicare enrollment type and PIM use: (1) potentially harmful drug-disease interactions in older adults with dementia; (2) potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and (3) high-risk medication use in older adults.

RESULTS: MA-PD enrollees had significantly lower utilization of PIMs than standalone PDP enrollees: a 0.7 percentage-point [95% CI: 0.5, 0.8] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia; a 3.1 percentage-point [2.6, 3.5] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and a 0.5 percentage-point [0.4, 0.6] lower prevalence of high-risk medications in older adults.

CONCLUSIONS: MA-PD enrollees with dementia experienced consistently lower prevalence of PIM use than those in PDP. As Medicare advantage enrollment continues to grow, it will be increasingly important to identify and leverage the features of MA-PD plans that promote safe medication prescribing for Medicare beneficiaries with dementia.

PMID:40766987 | DOI:10.1097/MLR.0000000000002160

Foodborne Pathog Dis. 2025 Aug 6. doi: 10.1177/15353141251365831. Online ahead of print.

ABSTRACT

Foodborne botulism is a rare but highly lethal disease. The botulinum neurotoxin (BoNT) that causes botulism is produced by Clostridium botulinum (C. botulinum) and other clostridia. In this study, we characterized C. botulinum strains isolated during food poisoning events in Sichuan Province from 1990 to 2024 by analyzing whole-genome sequencing data. Statistical analyses of the geographical distribution food sources of strains suggested that the primary sources of contamination were associated with specific regions and food types. The isolates were further compared with reference strains using average nucleotide identity analysis to reveal their genetic diversity and evolutionary relationships. Among the eight strains, five strains belonged to Group I, and the other three strains belonged to Group II. All strains belonging to Group I (SC001, SC002, SC003, SC006, and SC009) were assigned to five totally different recognized ST types (ST-2 to ST-51). In addition, analysis of BoNTs subtypes demonstrated that the types of BoNTs causing botulism in Sichuan were mainly types A, B, and E. Among them, some rare subtypes of BoNT reported for the first time in China, such as BoNT/B4, BoNT/E12, and BoNT/A5(B3), and no specific subtypes were predominant in the botulism incidents. This study is critical for disease surveillance and early warning systems, while also providing a basis for food safety regulation, clinical diagnosis, and treatment in the future.

PMID:40766982 | DOI:10.1177/15353141251365831

Head Neck. 2025 Aug 6. doi: 10.1002/hed.70002. Online ahead of print.

ABSTRACT

INTRODUCTION: Recent attention to the role of the microbiome in oral cancer has prompted investigations into its potential contribution to oropharyngeal squamous cell carcinoma (OPSCC), given their anatomical and immunological overlap. However, consistent microbial patterns have not been identified across studies.

METHODS: A systematic review, following PRISMA guidelines, examined studies on the role of the oral/oropharyngeal microbiome in OPSCC development, including its statistical relevance in cancer occurrence and prognosis.

RESULTS: From 131 articles (2017-2025), 19 involving 4502 patients were analyzed. Increases in Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium were noted in OPSCC patients. However, no bacterial taxa were reproducibly identified across all studies, reflecting substantial heterogeneity and limited overlap.

CONCLUSION: HPV, smoking, and cancer affect microbiota composition. The absence of reproducible microbial signatures highlights the need for more standardized, large-scale, and mechanistically driven studies to clarify the microbiome’s role in OPSCC.

PMID:40766980 | DOI:10.1002/hed.70002

HIV AIDS (Auckl). 2025 Aug 1;17:241-249. doi: 10.2147/HIV.S534526. eCollection 2025.

ABSTRACT

BACKGROUND: Understanding barriers to viral undetectability is crucial for developing targeted interventions for populations struggling with treatment adherence. The aim of this study was to investigate the impact of race, education, economic vulnerability and HIV-related stigma on viral load detectability among people living with HIV (PLWHA) in Brazil.

METHODS: This was a cross-sectional, community-based study. The sample consisted of 1767 participants. We used the Brazilian version of the HIV Stigma Index 2.0 questionnaire, the Internalized AIDS-Related Stigma Scale, and a sociodemographic questionnaire. Viral load was self-reported. Data were collected by 30 PLHV themselves in 2019, after receiving training on the Brazilian Stigma Index. Data was analyzed with both descriptive and inferential statistics using SPSS.

RESULTS: Our generalized linear model showed that participants who were non-white, with low education and of lower economic status had a lower likelihood of reporting undetectable viral load (UVL) compared compared to their respective counterparts (white participants, those with higher education, and those of higher economic status). Key population group membership was not significantly associated with UVL. Higher internalized stigma was negatively associated with lower UVL.

CONCLUSION: Our findings highlight the impact of racial, educational and economic disparities and internalized stigma on HIV outcomes and underscore the need for tailored interventions that address the specific challenges faced by different racial/ethnic and more vulnerable groups. These findings challenge the dominant treatment-as-prevention framework that focuses primarily on key populations, suggesting the need to broaden our focus to include other vulnerable populations, such as non-whites and those experiencing economic hardship. Such approach is critical to avoid overlooking situations where community viral load remains high.

PMID:40766976 | PMC:PMC12323862 | DOI:10.2147/HIV.S534526

Prostate Cancer. 2025 Jul 29;2025:4314397. doi: 10.1155/proc/4314397. eCollection 2025.

ABSTRACT

Background: Prostate cancer (PCa) is a prevalent malignancy in men, with increasing incidence and longer wait times for curative surgery, particularly in public health systems. While the impact of surgical wait time (SWT) on oncological outcomes in PCa remains controversial, its influence on patient-reported outcomes has not been thoroughly evaluated. Objective: To assess the impact of SWT on both oncological and psychological outcomes in patients undergoing robot-assisted radical prostatectomy (RARP) for preoperative ISUP grade 2 and 3 PCa. Methods: This retrospective single-center study included patients who underwent RARP for intermediate risk localized PCa between April 2016 and August 2024. Patients were stratified into two groups based on SWT: < 6 months vs. ≥ 6 months. The primary outcome was recurrence-free survival (RFS) for all patients. Secondary outcomes included RFS in a high-risk subgroup defined by pathological features (pT3 stage, seminal vesicle invasion, extracapsular extension, and positive surgical margins), as well as a comparison of functional outcomes between the two groups. Patient-reported outcomes were evaluated using SF-36 (mental and physical components) and the Decision Regret Scale (DRS) at 6 weeks, 3 months, 6 months, and 1 year. Statistical analyses included Kaplan-Meier survival estimates, Cox proportional hazard models, and comparative tests with p < 0.05 considered significant. Results: 218 patients have been included. RFS did not significantly differ between groups (p=0.98), including among high-risk patients (p=1.00). No significant differences were found in extraprostatic extension, seminal vesicle invasion, positive surgical margins, or ISUP upgrading between groups. Similarly, changes in both SF-36 physical and mental and DRS scores showed no statistically significant differences at all time points. Conclusion: In this cohort of patients with intermediate-risk PCa, SWT beyond 6 months did not adversely affect oncological or health-related quality of life outcomes.

PMID:40766967 | PMC:PMC12324907 | DOI:10.1155/proc/4314397