Tag: nevin manimala

Health Rep. 2025 Jul 16;36(7):15-28. doi: 10.25318/82-003-x202500700002-eng.

ABSTRACT

BACKGROUND: Most older Canadians would prefer to stay in their own homes and communities rather than move to long-term care (LTC) facilities. A growing older population, limited LTC capacity, and costs have increased demand for initiatives that enable people to age in their communities for as long as possible.

METHODS: Data from the 2019/2020 Canadian Health Survey on Seniors were used to estimate the prevalence of four types of supports and services (SSs) that assist with living in the community: home adaptations, informal care, home care, and community support services. Separate multivariable logistic regressions for each SS, stratified by age group (65 to 79 years and 80 years or older), examined associations with need-related factors, enabling resources, and predisposing characteristics.

RESULTS: At 25.0% of 65- to 79-year-olds and 51.9% of those aged 80 years or older, home adaptations were the most prevalent SS used in Canada. Use of home care, community support services and informal care was less common, ranging from 5.5% to 11.6% among Canadians aged 65 to 79 and 17.2% to 33.2% among those aged 80 or older. Nonetheless, substantial proportions of the younger (65.4%) and older (31.8%) age groups reported no SS use. In general, having a poor health status, having impairment, not driving, being older, living alone, having a regular health care provider, and being a woman increased the odds of using SSs.

INTERPRETATION: Understanding the factors associated with SS use can help inform policies and programs aimed at assisting older Canadians with aging in the community.

PMID:40789000 | DOI:10.25318/82-003-x202500700002-eng

Health Rep. 2025 Jul 16;36(7):3-14. doi: 10.25318/82-003-x202500700001-eng.

ABSTRACT

BACKGROUND: Low staffing levels and high turnover rates are longstanding issues in long-term care (LTC) facilities that were further exacerbated by the COVID-19 pandemic. Consequently, residents and staff were disproportionately affected, with high morbidity and mortality rates. This study examines changes in staffing levels, overall and by direct care worker category, across the LTC facilities sector by ownership status in Canada before and during the pandemic. It also explores differences in facility expenditures allocated towards employee wages, benefits, and subcontracts across homes by ownership status.

DATA AND METHODS: Data were from the 2020 and 2021 Nursing and Residential Care Facility Survey, which collected information on facility characteristics, including expenses, revenue, ownership status, and staffing levels. Summary statistics and multivariate linear regression models were used to examine the association between staffing levels and ownership status, with analyses stratified by direct care worker category.

RESULTS: On average, public LTC facilities had higher staffing levels and spent a greater proportion of their total costs on employee wages and benefits before and during the pandemic, compared with for-profit and non-profit private facilities. While the total hours of care per resident day (HPRD) increased during the pandemic, there were notable variations by region, ownership status, and direct care worker category. For example, Ontario public nursing homes provided 10% more HPRD from registered nurses during the pandemic, compared with the period before.

INTERPRETATION: Staffing levels of direct care workers in LTC facilities, overall and separately, are associated with ownership status. Allocation of employee-related expenses also differed by ownership. Further research is needed to explore interactions between ownership status, staffing levels, and quality of care for residents.

PMID:40788999 | DOI:10.25318/82-003-x202500700001-eng

Ophthalmic Plast Reconstr Surg. 2025 Aug 11. doi: 10.1097/IOP.0000000000003007. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the subjective assessment of 8 orbital CT features for predicting dysthyroid optic neuropathy (DON).

METHODS: Scan montages from 137 orbits without DON and 121 with DON were each graded independently by 3 observers for 8 imaging features: namely, degree of apical crowding, extraocular muscle enlargement, expansion of orbital fat, clarity of the superior orbital fissure, fat prolapse through the superior orbital fissure, medial wall bowing, general orbital vascular congestion, and dilation of the superior ophthalmic vein. Gradings were analyzed individually and also averaged across observers. Associations with DON were assessed using univariate and multivariate logistic regression, and performance of the latter was assessed using area under the receiver-operating-characteristic curve, sensitivity, specificity, and calibration plots.

RESULTS: Unadjusted models showed apical crowding (p < 0.001), extraocular muscle enlargement (p < 0.001), vascular congestion (p = 0.001), and medial wall bowing (p < 0.001) were each associated with DON, across all observers. Models for observers 1 and 3 included only apical crowding, with a 1-unit grading-increase giving, respectively, a 2.88-fold and 3.04-fold increase in DON odds (p < 0.001). The observer 2 model included extraocular muscle enlargement (odds ratio: 2.95; p < 0.001) and vascular congestion (odds ratio: 2.57; p = 0.023). The “averaged-score” model for all observers included only apical crowding, with a 3.76-fold increased odds per unit increase in grading (p < 0.001). The models showed borderline-acceptable discrimination (area under the receiver-operating-characteristic curve: 0.68-0.75) and good calibration, with the averaged-score model performing best.

CONCLUSIONS: Apical crowding, extraocular muscle enlargement, vascular congestion, and medial wall bowing are key predictors of DON, with apical crowding being the most influential.

PMID:40788673 | DOI:10.1097/IOP.0000000000003007

Ophthalmic Plast Reconstr Surg. 2025 Aug 11. doi: 10.1097/IOP.0000000000002989. Online ahead of print.

ABSTRACT

PURPOSE: To examine long-term outcomes of brow lift procedures, comparing surgical and fixation methods.

METHODS: Inclusion required original human research, at least 1 brow lift surgery cohort, quantitative measurements for brow elevation with a measure of statistical spread, and a mean follow-up of at least 6 months. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, article screening and data collection were conducted by 2 independent reviewers. Random-effects models were conducted to estimate pooled lateral, central, and medial brow elevation and pooled complication rates.

RESULTS: Of the 22 studies included, there were 2,127 brows, and the weighted average of follow-up intervals was 20.9 months. The lateral, central, and medial brow elevated significantly (p < 0.0001) by 3.8 mm, 3.02 mm, and 2.41 mm, respectively, with small/moderate heterogeneity. There were no significant differences between pre- and post-trichial long-term elevation or complication rates. Tined implant fixation had significantly greater lateral elevation (p = 0.0192) and significantly greater dysesthesia rates (p = 0.027) compared with suture fixation.

CONCLUSIONS: This study provides evidence supporting the long-term efficacy of brow lifts with a favorable safety profile. When choosing a technique, physicians should understand that while there were no significant differences between pretrichial and post-trichial brow lifts, tined implants for brow fixation trended towards greater lateral brow elevation and increased rates of dysesthesia compared to using sutures.

PMID:40788666 | DOI:10.1097/IOP.0000000000002989

Diabetes. 2025 Aug 11:db250067. doi: 10.2337/db25-0067. Online ahead of print.

ABSTRACT

The “omnigenic” hypothesis postulates that polygenic effects of common variants on typical complex traits coalesce via trans effects on the expression of a relatively sparse set of “core” effector genes and their encoded proteins in relevant tissues. The objective of this study was to identify core proteins for type 1 diabetes. We used summary statistics for single nucleotide polymorphism associations with plasma levels of 5,130 proteins in three large cohorts, including the UK Biobank, to compute genome-wide aggregated trans effects (GATE) scores for protein levels in two type 1 diabetes case-control studies (6,828 case individuals, 416,000 control individuals). GATE scores for 27 proteins were associated with type 1 diabetes. Of these, 14 were replicated between data sets, 11 had support in Mendelian randomization analysis, and 9 had experimental support in mouse models of autoimmune diabetes. The strongest associations were for immune checkpoints (PDCD1, CD5, TIGIT, and LAG3), chemokines, and innate immune system proteins (NCR1 and KLRB1). While PDCD1 is a known cause of monogenic autoimmune diabetes, neither it nor most of the core proteins identified here were previously reported as genome-wide association study hits for type 1 diabetes. These results identify possible drug targets with genetic support for causality and suggest that programmed cell death protein 1 agonists under development for other indications should be trialed for type 1 diabetes prevention.

ARTICLE HIGHLIGHTS: Demonstrating genetic evidence for a role of a protein in disease gives important support for its potential as a drug target. We aimed to identify proteins that have genetic evidence to support a causal role in the pathogenesis of type 1 diabetes. We found 27 core proteins had genetic evidence of causality for type 1 diabetes. Top hits included immune checkpoints (PDCD1, CD5, TIGIT, and LAG3) and innate immune system proteins (NCR1 and KLRB1). These results identify possible drug targets and suggest that programmed cell death protein 1 agonists should be trialed for type 1 diabetes prevention.

PMID:40788656 | DOI:10.2337/db25-0067

JAMA Netw Open. 2025 Aug 1;8(8):e2526321. doi: 10.1001/jamanetworkopen.2025.26321.

ABSTRACT

IMPORTANCE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with increased risk of diabetic retinopathy (DR) and nonarteritic anterior ischemic optic neuropathy (NAION). The risk of sight-threatening complications associated with GLP-1 RAs is underexamined.

OBJECTIVE: To investigate whether the use of GLP-1 RAs in patients with T2D is associated with the development of DR, NAION, or DR complications.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of adults (aged ≥18 years) with T2D and a recent hemoglobin A1c level of 6.5% or higher was conducted between January 1, 2015, and September 30, 2022, using the TriNetX database. The cohort was divided into 2 groups, adjusted for baseline characteristics through propensity score matching (PSM), based on whether the individuals received prescriptions for a GLP-1 RA. The statistical analysis was conducted on October 10, 2024.

EXPOSURES: At least 2 prescriptions of a GLP-1 RA given 6 months apart.

MAIN OUTCOMES AND MEASURES: Cox proportional hazard regression models were used to evaluate the primary outcome: association between GLP-1 RAs and the risk of incident DR, NAION, or sight-threatening complications over a 2-year follow-up period.

RESULTS: After PSM, 185 066 individuals (mean [SD] age, 59.0 [12.5] years; 93 389 females [50.5%]) were prescribed GLP-1 receptor agonists. Use of GLP-1 RAs was associated with an increased incidence of DR (hazard ratio [HR], 1.07; 95% CI, 1.03-1.11), while no statistically significant difference was observed in the risk of NAION (HR, 1.26; 95% CI, 0.94-1.70). In a subgroup analysis of 32 695 patients with preexisting DR, GLP-1 RAs were not associated with progression to proliferative DR (HR, 1.06; 95% CI, 0.97-1.15) or diabetic macular edema (HR, 0.98; 95% CI, 0.95-1.01) but were associated with a lower occurrence of vitreous hemorrhages (HR, 0.74; 95% CI, 0.68-0.80), neovascular glaucoma (HR, 0.78; 95% CI, 0.68-0.88), or blindness (HR, 0.77; 95% CI, 0.73-0.82).

CONCLUSIONS AND RELEVANCE: In this cohort study of individuals with T2D, GLP-1 RA use was associated with a modestly increased risk of incident DR; however, fewer patients experienced sight-threatening DR complications, including blindness, even among those with preexisting DR. These findings suggest that all patients with T2D treated with GLP-1 RAs, regardless of preexisting DR, should be regularly screened and monitored for potential complications of T2D.

PMID:40788647 | DOI:10.1001/jamanetworkopen.2025.26321

JAMA Netw Open. 2025 Aug 1;8(8):e2526353. doi: 10.1001/jamanetworkopen.2025.26353.

ABSTRACT

IMPORTANCE: Characterizing population-level changes in type 1 diabetes (T1D) management can inform public health policies and interventions.

OBJECTIVE: To characterize trends and disparities in glycemic control and use of diabetes technology among US youths and adults with T1D.

DESIGN, SETTING, AND PARTICIPANTS: This serial, cross-sectional analysis used the Optum Labs Data Warehouse, a national, deidentified database of electronic health records, to identify US youths (aged <18 years) and adults (aged ≥18 years) with T1D. Data were obtained from records from January 1, 2009, to December 31, 2023.

EXPOSURES: Calendar years divided into 3-year study periods from 2009 to 2011 to 2021 to 2023.

MAIN OUTCOMES AND MEASURES: Glycemic control (mean hemoglobin A1c level, <7%) and use of diabetes technology (continuous glucose monitoring systems and/or insulin pumps) were defined using laboratory data and prescriptions, procedures, and diagnoses codes from electronic health records.

RESULTS: A total of 186 590 participants with T1D was identified (mean [SD] age, 40 [19] years; 96 766 [52%] male; 12 493 [7%] Hispanic, 2819 [2%] non-Hispanic Asian, 21 459 [12%] non-Hispanic Black, and 141 847 [76%] non-Hispanic White). Of these, 26 853 participants were youths (mean [SD] age, 12 [4] years; 14 060 [52%] male; 19 822 [74%] non-Hispanic White) and 159 737 were adults (mean [SD] age, 45 [16] years; 82 706 [52%] male; 122 025 [76%] non-Hispanic White). From the 2009-2011 to 2021-2023 study periods, the prevalence of glycemic control (mean hemoglobin A1c level <7%) increased from 7% (95% CI, 7%-8%) to 19% (95% CI, 19%-20%) in youths (P < .001 for trend) and 21% (95% CI, 21%-22%) to 28% (95% CI, 28%-29%) in adults (P < .001 for trend). During this same period, there was a substantial increase in the percentage of patients using continuous glucose monitoring (4% to 82% for youths; 5% to 57% for adults), insulin pumps (16% to 50% for youths; 11% to 29% for adults), and both devices concurrently (1% to 47% for youths; 1% to 22% for adults) (P < .001 for trend for all). The prevalence of glycemic control and use of diabetes technology were lowest in Hispanic, non-Hispanic Black, and Medicaid-insured youths and adults, and differences persisted or increased over time.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, there was a rapid increase in the use of diabetes technology and notable improvements in glycemic control among youths and adults with T1D during the past 15 years. Nonetheless, the prevalence of glycemic control remained low, and racial, ethnic, and socioeconomic differences grew over time.

PMID:40788645 | DOI:10.1001/jamanetworkopen.2025.26353

JAMA Netw Open. 2025 Aug 1;8(8):e2526406. doi: 10.1001/jamanetworkopen.2025.26406.

ABSTRACT

IMPORTANCE: Medicare Advantage (MA) plans have had the ability to offer long-term services and supports (LTSS) supplemental benefits (eg, in-home support services, adult day health services, caregiver support, home-based palliative care, and nonopioid pain management) since 2019. However, it is largely unknown how available these benefits currently are among MA plans.

OBJECTIVE: To examine the prevalence of LTSS supplemental benefits among MA plans and enrollment within these plans.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used publicly available Centers for Medicare & Medicaid Services data on MA plan benefits and enrollment from January 2019 to April 2025 to examine changes in the offering of and access to LTSS supplemental benefits among MA plans as well as the enrollment within such plans. The analysis was limited to those MA plans that were identified as health maintenance organization or preferred provider organization plans. Data analyses were performed from November 2024 to March 2025.21.4.

MAIN OUTCOMES AND MEASURES: MA plans offering LTSS supplemental benefits, the share of MA beneficiaries enrolled in a MA plan with LTSS benefits at the county level, and benefit generosity between newer and older MA plans.

RESULTS: In this study of 4521 MA plans in 2019 and 6614 MA plans in 2025, the number of MA plans offering any LTSS benefits increased from 581 to 814 from 2019 to 2025; however, the share of such plans slightly decreased from 12.9% to 12.3%. A mean (SD) of 21.4% (20.9%) of MA beneficiaries at the county level were enrolled in plans offering supplemental benefits in 2019, which decreased to 7.9% (12.7%) in 2025. The share of plans offering in-home support services, adult day services, home-based palliative care, and nonopioid pain management increased by 4.6, 0.02, 1.1, and 1.9 percentage points, respectively, whereas caregiver support services decreased by 5.6 percentage points. Lastly, when comparing newer and older MA plans offering LTSS benefits, newer MA plans offered 0.59 (95% CI, 0.48-0.70) more benefits than older MA plans.

CONCLUSIONS AND RELEVANCE: In this cohort study, the availability of LTSS benefits within MA plans in 2025 was essentially no different than it was when benefits were first offered. The share of MA beneficiaries enrolled in a plan offering LTSS decreased during the same time frame, suggesting that there is still untapped potential for MA plans to offer LTSS supplemental benefits.

PMID:40788644 | DOI:10.1001/jamanetworkopen.2025.26406

JAMA. 2025 Aug 11. doi: 10.1001/jama.2025.11420. Online ahead of print.

NO ABSTRACT

PMID:40788641 | DOI:10.1001/jama.2025.11420

JAMA Neurol. 2025 Aug 11. doi: 10.1001/jamaneurol.2025.2236. Online ahead of print.

ABSTRACT

IMPORTANCE: Sex differences may contribute to disparities in dementia outcomes.

OBJECTIVE: To understand the association between sex and mortality and health care services use after dementia diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study used Medicare enrollment data and took place from 2014 to 2021 with up to 8 years of follow-up. Analysis was performed from April 2024 to April 2025. This study included 5 721 711 patients 65 years or older with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia with at least 1 year of prior fee-for-service Medicare enrollment.

EXPOSURES: Sex, determined from Medicare enrollment data, derived from Social Security Administration records.

MAIN OUTCOMES AND MEASURES: The primary outcome was hazard of all-cause mortality, estimated with Cox proportional hazard regression. Secondary outcomes included hazards of use of common health care services, such as all-cause hospitalizations, skilled nursing facility stays, receipt of neuroimaging services, and physical/occupational therapy.

RESULTS: A total of 5 721 711 patients (3 302 579 female and 2 419 132 male) with incident dementia between 2014 and 2021 were included in the study. Female patients had lower crude 1-year mortality rates (21.8% vs 27.2% for male patients; P < .001) and lower rates of all-cause hospitalizations (46.9% vs 50.5%; P < .001). The unadjusted hazard of death associated with male sex was 1.30 (95% CI, 1.29-1.31; P < .001). After adjustment for age, race and ethnicity, Medicaid dual eligibility, medical comorbidity burden, and access to health care resources, the association was modestly attenuated (adjusted hazard ratio, 1.24; 95% CI, 1.23-1.26; P < .001). Similarly, the unadjusted hazard ratio of all-cause hospitalization associated with male sex was 1.13 (95% CI, 1.12-1.14; P < .001); the adjusted hazard ratio was 1.08 (95% CI, 1.08-1.09; P < .001). Male patients also had increased hazards of hospice stay, neuroimaging services, and hospitalization for neurodegenerative disease diagnosis or behavioral disturbance.

CONCLUSIONS AND RELEVANCE: In this study, male patients with dementia had higher mortality rates and higher use of many health care services, especially hospital stays, than comparable female patients. Strategies to slow mortality and decrease health care use among male patients with dementia may be particularly impactful in limiting the burden of dementia. Given higher incidence of dementia among women, a focus on efforts to prevent dementia is necessary to achieve population-level health equity in dementia-attributable mortality by sex.

PMID:40788638 | DOI:10.1001/jamaneurol.2025.2236