Tag: nevin manimala

Age Ageing. 2025 Aug 29;54(9):afaf247. doi: 10.1093/ageing/afaf247.

ABSTRACT

BACKGROUND: Little is known about how ambulatory care sensitive condition (ACSC)-related readmissions can be reduced in acute care settings.

OBJECTIVE: This study examined the association between transitional care for hospitalised older patients with ACSC and ACSC-related readmissions.

METHODS: This retrospective observational cohort study included patients aged 65 years and older admitted with ACSC as the primary diagnosis from 1 April 2022 to 31 January 2023, using linked data from the Diagnosis Procedure Combination and the medical functions of the hospital beds database. The primary outcomes were cumulative readmissions within 1-7, 1-14, 1-21, 1-30 and 1-60 days, analysed using inverse probability treatment weighting regression models.

RESULTS: Among 85 582 patients from 711 hospitals, 39 916 (46.6%) were female, with a median age of 82 years (interquartile range: 75-88); 57 127 (66.8%) patients received transitional care. The overall readmission rates were 2.9%, 6.0%, 8.7%, 11.4% and 17.5% among total hospitalisations within 7, 14, 21, 30 and 60 days, respectively. Overall, transitional care was associated with reduced odds of ACSC-related readmission, with odds ratios ranging from 0.72 (95% CI: 0.65-0.78) within 7 days to 0.91 (95% CI: 0.87-0.95) within 60 days. The association between transitional care and readmission varied by ACSC category. In chronic ACSC, the association was strongest for 7-day readmission, followed by a downward trend. In acute and vaccine-preventable ACSC, the association was strongest for 7-day readmission but levelled off after 21 days.

CONCLUSIONS: Transitional care in acute care hospitals may be associated with a reduced risk of early readmissions due to ACSC when older patients are hospitalised.

PMID:40924407 | DOI:10.1093/ageing/afaf247

Patient. 2025 Sep 9. doi: 10.1007/s40271-025-00768-0. Online ahead of print.

ABSTRACT

BACKGROUND: Migraine care is often suboptimal owing to undertreatment, variation in clinical outcomes and administration methods among existing treatments, and between- and within-individual heterogeneity in the clinical course of migraine. In response to these challenges, preference studies have been increasingly conducted to inform treatment decision-making and development. However, gaps remain in understanding how treatment preferences have been assessed across different migraine studies.

OBJECTIVE: The aim was to synthesize existing evidence to inform the design and conduct of future preference migraine research. This review examined treatment attributes included in preference studies, focusing on how attributes were developed, framed, and presented; how their values were analyzed and reported; and whether these values differed by respondent characteristics.

METHODS: A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025614690). Embase, MEDLINE, and the Cochrane Library were searched for relevant stated preference studies on migraine treatments (October 2024). Two researchers independently screened studies, and data were extracted using a predefined template. Extracted information included study characteristics, methods for attribute and instrument development, choice task design, attribute framing, and analytical approaches. Narrative synthesis and descriptive statistics were used to summarize findings. Attribute importance was assessed by deriving relative rankings of attributes from marginal utilities or importance scores across studies.

RESULTS: Overall, 18 studies were reviewed from the 186 that were screened. Stated preference methods comprised discrete choice experiment (n = 12), conjoint analysis (n = 1), contingent valuation method (n = 3), thresholding (n = 1), and time trade-off (n = 1). In total, 13 studies reported their attribute development methods, using literature review only (n = 2), expert consultation only (n = 1), and multi-method approaches combining literature reviews with qualitative research and/or expert or payer consultation (n = 10). In addition, 17 studies included at least 1 benefit attribute, resulting in 26 unique attributes grouped into seven overarching concepts. Risk attributes were included in 11 studies, with injection site reactions (n = 5), gastrointestinal effects (n = 4), and cognitive effects (n = 3) as the most common adverse events. Administration-related attributes appeared in ten studies, with mode and/or frequency of administration being the most common (n = 10). Eight studies used visual aids to illustrate attributes. Preference heterogeneity was explored in 14 studies, primarily on the basis of sex (n = 9), monthly migraine days (n = 8), and treatment experience (n = 7).

CONCLUSIONS: This review reveals substantial variation in how treatment attributes were selected, framed, and analyzed across studies. Greater methodological consistency in attribute development, framing, and reporting, along with more robust exploration of preference heterogeneity, is needed to enhance the comparability, validity, and application of future preference research in migraine care.

PMID:40924386 | DOI:10.1007/s40271-025-00768-0

Curr Atheroscler Rep. 2025 Sep 9;27(1):88. doi: 10.1007/s11883-025-01339-2.

ABSTRACT

PURPOSE OF REVIEW: This review examines cardiovascular disease (CVD) risk prediction models relevant to older adults, a rapidly expanding population with elevated CVD risk. It discusses model characteristics, performance metrics, and clinical implications.

RECENT FINDINGS: Some models have been developed specifically for older adults, while several others consider a broader age range, including some older individuals. These models vary in terms of predictors, outcomes, horizon, and statistical approaches, with some accounting for competing risks and considering age-predictor interactions. Discrimination is generally acceptable and more modest in older versus younger individuals. Calibration shows great variation across populations. Accurate CVD risk prediction is essential to guide individualized prevention strategies and support shared decision-making in older adults. CVD risk prediction in this population is challenged by age-related CVD risk heterogeneity, elevated competing risk due to non-CVD mortality, and comorbidities. Further refinement by incorporating geriatric-specific factors may help to enhance discrimination.

PMID:40924377 | DOI:10.1007/s11883-025-01339-2

J Behav Med. 2025 Sep 9. doi: 10.1007/s10865-025-00598-3. Online ahead of print.

ABSTRACT

Indigenous Peoples experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the U.S. Though the management of type 2 diabetes requires regular healthcare visits, North American Indigenous individuals with diabetes do not always utilize the healthcare available to them, and this lack of utilization may lead to poor health outcomes over time. Drawing on literature showing that North American Indigenous patients experience discrimination in healthcare and that experiencing discrimination in healthcare is associated with healthcare avoidance and/or delay, the current study conceptualized unmet healthcare utilization as healthcare avoidance and used path analysis with longitudinal data (four points of data collection) to examine the relationships between healthcare discrimination, healthcare avoidance, and self-rated health in a sample of 192 Indigenous adults with type 2 diabetes from the northern Midwest U.S. We found that healthcare avoidance was negatively associated with baseline self-rated health, and that healthcare avoidance partially explained the negative effect of lifetime healthcare discrimination on self-rated health at the final follow-up of the study. These results show that healthcare avoidance statistically mediates the relationship between healthcare discrimination and self-rated health and suggest that healthcare avoidance is an important mechanism linking healthcare discrimination to worse self-rated health over time. Ultimately, we argue that creating more inclusive and less microaggressive healthcare spaces is important for individual health outcomes and macro-level health inequities. Continued efforts to understand instances of and to diminish healthcare mistreatment of Indigenous Peoples are recommended.

PMID:40924353 | DOI:10.1007/s10865-025-00598-3

J Behav Med. 2025 Sep 9. doi: 10.1007/s10865-025-00595-6. Online ahead of print.

ABSTRACT

Estimating statistical power is essential for designing behavioral medicine studies efficiently and conserving finite resources. Sometimes behavioral medicine researchers are interested in calculating power for 1-sided z-tests of individual parameters (e.g., slopes) in complex models such as multilevel structural equation models or multilevel mixture regression models. For such models, calculating power for 1-sided z-tests is cumbersome because: (a) online z-test power calculator tools are inapplicable, (b) commonly-used power analysis software provides power only for 2-sided z-tests and does not allow changing alpha, and (c) published power tables typically provide power results only for 2-sided z-tests. Hence, here we introduce straightforward and resource-efficient conversion formulas to estimate the power of 1-sided z-tests of individual parameters in any model by using direct power conversions from the corresponding 2-sided tests. We then implement these conversion formulas in accessible R and Excel software. This brief report thus provides behavioral medicine researchers with a convenient and practical solution for power calculation that minimizes the time, financial, and computational resources typically needed for power estimation.

PMID:40924352 | DOI:10.1007/s10865-025-00595-6

Biol Trace Elem Res. 2025 Sep 8. doi: 10.1007/s12011-025-04817-5. Online ahead of print.

ABSTRACT

This study aimed to evaluate fluoride concentrations in a variety of commonly consumed teas and Herbal infusions in Brazil and assess potential Health risks associated with their ingestion. A total of 21 samples were analyzed, including 12 loose-leaf and 9 commercially bagged products. Fluoride quantification was performed using a validated spectrophotometric method, and a deterministic and probabilistic human Health risk assessment was conducted. Fluoride concentrations ranged from 0.5 mg/L (eucalyptus) to 52.8 mg/L (hibiscus) in loose-leaf samples, and from 7.5 mg/L (anis) to 47.9 mg/L (hibiscus) in bagged products. Statistically significant differences (p < 0.05) were observed in six of the nine comparable samples between formats. The non-carcinogenic risk assessment revealed that 3 out of 21 samples, hibiscus (both forms) and boldo (loose-leaf), exceeded the acceptable HQ > 1. Monte Carlo simulation confirmed these findings, with hibiscus infusions showing HQ > 1 in over 90% of the 10,000 iterations. Additionally, the average HI exceeded 1 in six loose-leaf and all bagged samples, with hibiscus reaching a peak HI of 18.06. These findings suggest that the consumption of certain teas and infusions, especially those with high fluoride concentrations, may contribute to excessive fluoride intake and potential health risks. The results support the need for clearer labeling and stricter regulation of fluoride content in tea and infusion products, particularly in countries like Brazil where their consumption is increasing.

PMID:40924350 | DOI:10.1007/s12011-025-04817-5

Odontology. 2025 Sep 9. doi: 10.1007/s10266-025-01196-0. Online ahead of print.

ABSTRACT

This study aimed to investigate the age-related alterations in mesial roots of mandibular first molar in terms of root canal curvature values, dentin thickness, interorifice distance, deviation from apical foramen, and location of apical foramen using a three-dimensional curvature measurement method and micro-computed tomography (micro-CT). Forty-five mesial roots of mandibular first molars from three age groups (Group 1: ≤ 30 years, Group 2: 31-59 years, Group 3: ≥ 60 years) were scanned using micro-CT. The central axis of each mesiobuccal and mesiolingual canal was analyzed using cubic B-spline curves to calculate canal curvature. Dentin thickness, deviation of apical foramen from the anatomical apex, and the location of apical foramen in mesiobuccal and mesiolingual canals were measured and recorded. Statistical analyses, including one-way ANOVA, Mann-Whitney U, Kruskal-Wallis and Pearson’s correlation tests, were performed to assess age-related differences in curvature, interorifice distance, and dentin thickness with a 5% significance threshold. No statistically significant differences in root canal curvature were observed across the three age groups (p > .05), although a slight increase in curvature was noted in Group 3. Interorifice distance was significantly lower in Group 2 (p < .05), but no significant relationship was found between mesiobuccal curvature and interorifice distance. Dentin thickness, however, showed significant variations: Groups 1 and 2 exhibited thinner mesial dentin (2-6 mm levels), while Group 3 demonstrated greater distal dentin thickness (5-8 mm levels) (p < .05). Apical foramen location and deviation remained consistent across age groups (p > .05), predominantly situated centrally on the root surface. While root canal curvature did not vary significantly with age (p > .05), dentin thickness showed notable age-related differences (p < .05). A significant correlation was observed between the mesiolingual canal curvature and interorifice distance, but no such correlation was found for the mesiobuccal canal. A significant age-related increase in dentin thickness in both the mesiobuccal and mesiolingual canals underscores the impact of secondary dentin deposition, which is probably uniform as the root canal curvature seems to remain relatively stable across the lifespan in mandibular first molars.

PMID:40924341 | DOI:10.1007/s10266-025-01196-0

Environ Monit Assess. 2025 Sep 9;197(10):1094. doi: 10.1007/s10661-025-14390-y.

ABSTRACT

Understanding the intricate relationship between land use/land cover (LULC) transformations and land surface temperature (LST) is critical for sustainable urban planning. This study investigates the spatiotemporal dynamics of LULC and LST across Delhi, India, using thermal data from Landsat 7 (2001), Landsat 5 (2011) and Landsat 8 (2021) resampled to 30-m spatial resolution, during the peak summer month of May. The study aims to target three significant aspects: (i) to analyse and present LULC-LST dynamics across Delhi, (ii) to evaluate the implications of LST effects at the district level and (iii) to predict seasonal LST trends in 2041 for North Delhi district using the seasonal auto-regressive integrated moving average (SARIMA) time series model. LULC classification is performed using the random forest (RF) approach, and the LULC-LST relationships are statistically examined using a one-way ANOVA paired with Tukey’s HSD post hoc test, Pearson’s correlation and simple linear regression analysis. The SARIMA model is employed to predict district-level LST for North Delhi in 2041. The results highlight significant LULC-driven LST variations across Delhi, with urban expansion and post-harvest agriculture lands contributing to the temperature increase. Bare land and urban areas exhibited the highest LST, while vegetation and waterbodies consistently recorded lower temperatures. The surface urban heat island intensity was predominantly pronounced in densely built-up areas including the Aerocity region. The district-level analysis reveals substantial spatial heterogeneity, with western districts predominated by agriculture and major urban expansion recording the highest LST, while the southern-central districts experienced lower temperatures due to influence of floodplains, vegetation and ridges. The correlation analysis demonstrated a strong positive association between urban expansion and LST (r = 0.98), while the one-way ANOVA test indicated significant differences in LST across LULC classes (F(4, 148,238) = 9646, p < 0.05, n = 3). The SARIMA-based projections for North Delhi predict escalating temperatures in all seasons by 2041, with a root mean squared error of 2.1. The finding emphasises the need for adaptive urban planning, advocating for strategic integration of vegetation buffers around industrial zones, landfills and along agriculture-urban interfaces to mitigate heat and inform future urban development policies such as the Master Plan Delhi 2041.

PMID:40924334 | DOI:10.1007/s10661-025-14390-y

J Neurooncol. 2025 Sep 9. doi: 10.1007/s11060-025-05212-9. Online ahead of print.

ABSTRACT

PURPOSE: Breast cancer (BC) is the most frequent cancer among women and the second leading cause of central nervous system (CNS) metastases. While the epidemiology of CNS metastases from BC has been well described, little is known about the treatment patterns and outcomes of young women < 40 years of age with BC that is metastatic to the CNS.

METHODS: In this retrospective analysis, we identified patients with metastatic breast cancer (MBC) to the CNS who were treated at the Sunnybrook Odette Cancer Center, Toronto, Canada between 2008 and 2018. Young women were defined as those who were < 40 years of age at the time of diagnosis of CNS metastases. Descriptive statistics were completed, and survival analyses performed.

RESULTS: Similar clinical and pathological characteristics were observed among young and older women with CNS metastases. However, young women were significantly more likely to develop leptomeningeal metastatic disease (LMD) than older women (39.6% vs. 22.3%, p = 0.004). Additionally, young women were significantly more likely to be re-treated for CNS metastases (43.4% vs. 24.5%, p = 0.003). There was no significant difference in median brain-specific progression-free survival (bs-PFS) (log-rank p = 0.35) or overall survival (OS) (log-rank p value = 0.52) between young and older women.

CONCLUSIONS: Women < 40 years of age were more likely to develop LMD than women ≥ 40 years of age. Although young women were also more likely to be re-treated for progression of CNS metastases, their bs-PFS and OS were not inferior to those ≥ 40 years of age.

PMID:40924327 | DOI:10.1007/s11060-025-05212-9

J Neurooncol. 2025 Sep 9. doi: 10.1007/s11060-025-05206-7. Online ahead of print.

ABSTRACT

PURPOSE: Resection of glioblastomas infiltrating the motor cortex and corticospinal tract (CST) is often linked to increased perioperative morbidity. Navigated transcranial magnetic stimulation (nTMS) motor mapping has been advocated to increase patient safety in these cases. The additional impact of patient frailty on overall outcome after resection of cases with increased risk for postoperative motor deficits as identified with nTMS needs to be investigated.

METHODS: Patients with newly diagnosed motor eloquent glioblastomas were retrospectively evaluated. Patients underwent nTMS- and tractography-based neuronavigation. Demographic, imaging- and nTMS-derived data and the 11-item modified frailty index (mFI-11) were collected. Primary endpoint was discharge home after tumor resection. A 4-item score comprising preoperative motor deficit, mFI-11 ≥ 2 points, distance to the CST < 12 mm and infiltration of nTMS-positive cortex was established to predict overall outcome.

RESULTS: N = 64 patients with a mean age of 64.8 ± 9.6 years (60.9% male) were included. 46 patients (71.9%) could be discharged to their homes. Risk factors for non-home discharge were greater mFI-11 (p = 0.027), surgery-related motor deficit (p < 0.001) and overall complications (p < 0.001 for non-surgical and p = 0.006 for surgical complications). In multiple regression analyses, mFI-11 and surgery-related deficit were statistically robust. The 4-item score predicted non-home discharge with an AUC = 0.745, 95%CI = 0.62-0.87, p < 0.001.

CONCLUSION: In patients with newly diagnosed motor-eloquent glioblastomas, nTMS-based planning helps to predict postoperative surgery-related motor deficits. Patient frailty needs to be respected in decision making in addition to nTMS- and tractography-based planning in order to avoid postsurgical motor deficits and to keep overall surgical morbidity on a low level.

PMID:40924322 | DOI:10.1007/s11060-025-05206-7