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Background: Cognitive decline is a major reason for dependence and resource use in long-term care. Objective: We explored whether social activities may prevent cognitive decline of older residents of long-term care facilities. Methods: In a routine care cohort, 3,603 residents of long-term care facilities were assessed on average 4.4 times using the interRAI-Long-Term-Care-Facilities instrument which includes frequency of participation in social activities of long standing interest over the last 30 days and the Cognitive Performance Scale. Linear mixed models repeated measures analyses were performed corrected for age, sex, physical activity, Activities of Daily Living, mood, and health indicators. Results: Social activity was associated with cognitive preservation over time. This association was stronger in those with no or mild cognitive impairment at baseline, relative to those with moderate to severe impairment. Participation in specific social activities such as conversing and helping others showed a similar positive association. The relation between social activity and cognitive impairment appeared to be bi-directional. Conclusions: The protective effects of social activity offer a window of opportunity to preserve cognitive functioning in long-term care residents. [ABSTRACT FROM AUTHOR]

Exploitation of the ever-increasing volume of observational data has become a major challenge for real-world evidence (RWE). Causal inference can be viewed as emulations of clinical trials (ECTs) from real-world data (RWD). This requires in-depth knowledge of data management and modern statistical models, which evolve considerably. We have developed Plug-Stat® to facilitate these analyses. Plug-Stat® is a user-friendly graphical interface of R software implemented with JavaScript and VB.net. The implementation of Plug-Stat® for a specific database consists of two main tasks. The first concerns the automatic importation of data to link the software with the data and to avoid the repetition of data management activities for each study. The second is to define the outcomes and the associated possible confounders. To perform an ECT, we proposed the use of inverse probability weighting, flexible parametric estimation of the propensity score model with B-splines, and robust estimation of the variance. The statistical modeling steps are automatized to direct the user toward the correct methodology without data management. We illustrated the usefulness of Plug-Stat® with several recently published ECTs. In this paper, we presented the outcome comparison of preemptive deceased-donor kidney transplantations versus transplantations after dialysis. The interactive interfaces assist the user in conducting causal research based on ECT, and tutorials are available, offering self-training opportunities. Plug-Stat® reduces the time and, consequently, the cost necessary for different studies from the same cohort. [ABSTRACT FROM AUTHOR]

Objectives: Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6‐years follow‐up was examined. Methods: Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms. Results: The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow‐up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10–19 teeth and used dental prosthesis, 112 (4.2%) had 10–19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0–9 teeth and used dental prosthesis, and 168 (7.6%) had 0–9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96–1.33) for those with 10–19 teeth and OR = 1.36 (95%CI = 1.17–1.58) for those with 0–9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80–1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0–9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49–2.19] more likely to be socially isolated, whereas participants with 0–9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05–1.45] more likely to be socially isolated. Conclusion: Tooth loss was the main predictor for social isolation at follow‐up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss. [ABSTRACT FROM AUTHOR]

Background: Studies on the modifying effects of dietary factors on the association between air pollution and diabetes-related outcomes are limited. We examined whether dietary nutrients could modify the association between long-term air pollution exposure and the development of diabetes. Methods: We used data from the Cardiovascular Disease Association Study, which enrolled adults aged 40–69 years in Korea between 2005 and 2011 and followed them up until 2016 (n = 14,667). Annual concentrations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) at each participant’s residence(s) were estimated using community multiscale air quality models. Intake of 22 dietary nutrients was assessed using a validated food frequency questionnaire during the baseline survey. We examined the product terms between air pollution levels (continuous) and each dietary nutrient (quartile) using Cox regression models, adjusted for potential confounders. Results: PM2.5 [hazard ratio (HR) = 1.49, 95 % confidence interval (CI): 1.11, 2.00] and NO2 (HR = 1.29, 95 % CI: 1.12, 1.49) concentrations were found to be associated with incident diabetes. NO2 levels interacted with dietary intake of retinol, vitamin A, and cholesterol (p-values for interaction

The serological response to the influenza virus vaccine is highly heterogeneous for reasons that are not entirely clear. While the impact of demographic factors such as age, body mass index (BMI), sex, prior vaccination and titer levels are known to impact seroconversion, they only explain a fraction of the response. To identify signatures of the vaccine response, we analyzed 273 protein levels from 138 serum samples of influenza vaccine recipients (2019–2020 season). We found that levels of proteins functioning in cholesterol transport were positively associated with seroconversion, likely linking to the known impact of BMI. When adjusting seroconversion for the demographic factors, we identified additional, unexpected signatures: proteins regulating actin cytoskeleton dynamics were significantly elevated in participants with high adjusted seroconversion. Viral strain specific analysis showed that this trend was largely driven by the H3N2 strain. Further, we identified complex associations between adjusted seroconversion and other factors: levels of proteins of the complement system associated positively with adjusted seroconversion in younger participants, while they were associated negatively in the older population. We observed the opposite trends for proteins of high density lipoprotein remodeling, transcription, and hemostasis. In sum, careful integrative modeling can extract new signatures of seroconversion from highly variable data that suggest links between the humoral response as well as immune cell communication and migration. [ABSTRACT FROM AUTHOR]

Introduction: Right ventricular failure (RVF) after cardiac surgery is an important risk factor for morbidity and mortality. Its diagnosis is challenging, and thus, its incidence and predictors are not well-established. We investigated the incidence, complications, and variables associated with clinically relevant post-operative RVF.Methods: We included all patients who underwent cardiac surgery with cardiopulmonary bypass between 2016 and 2019 in a cardiac surgery center with standardized diagnostic and therapeutic management of RVF. RVF was considered only if clinically relevant: associated with hemodynamic instability requiring catecholamine support and inhaled nitric oxide relayed by sildenafil.Results: Overall, 3,826 patients were included, of whom, 110 (2.9%) developed post-operative RVF. Mortality was not different among patients who developed post-operative RVF, compared with the rest of the cohort (1.8 vs. 0.7%, p = 0.17). Using a composite outcome that combined death, reintubation, stroke, and prolonged intensive care unit stay (more than 14 days) yielded an incidence of 6.6%, and RVF was associated with this composite outcome with an odds ratio of 3.6 (2.2–5.8), p < 0.001. In a multivariable model, pre-operative variables independently associated with post-operative RVF were pre-operative atrial fibrillation (AF) {adjusted odds ratio (adjOR) 3.22 [95% confidence interval (95%CI) = 1.94–5.36], p < 0.001}, left ventricle ejection fraction below 50% [adjOR = 2.55 (95%CI = 1.52–4.33), p < 0.001], systolic pulmonary artery pressure above 55 mmHg [adjOR = 8.64 (95%CI = 5.27–14.1); p < 0.001], mitral valve surgery [adjOR = 2.17 CI (95%CI = 1.28–3.66), p = 0.004], and tricuspid valve surgery [adjOR = 10.33 (95%CI = 6.14–17.4), p < 0.001]. In patients who developed post-operative RVF requiring treatment, 32 (29.1%) showed RV dysfunction before surgery.Conclusion: In this cohort study, 2.9% of patients developed clinically significant post-operative RVF. Moreover, RVF was associated with severe adverse outcomes, including death, strokes, reintubation, and prolonged intensive care unit stay.

Diabetes mellitus is associated with serious complications, with foot ulcers and amputation of limbs among the most debilitating consequences of late diagnosis and treatment of foot ulcers. Thus, prediction and on-time treatment of diabetic foot ulcers (DFU) are of great importance for improving and maintaining patients' quality of life and avoiding the consequent socio-economical burden of amputation. In this study, we use Danish national registry data to understand the risk factors of developing diabetic foot ulcers and amputation among patients with diabetes. We analyze the data of 246,705 patients with diabetes to assess some of the main risk factors for developing DFU/amputation. We study the socioeconomic information and past medical history of the patients. Factors, such as low family disposable income, cardiovascular disorders, peripheral artery, neuropathy, and chronic renal complications are among the important risk factors. Mental disorders and depression, albeit not as pronounced, still pose higher risks in comparison to the group of people without these complications. We further use machine learning techniques to assess the practical usefulness of such risk factors for predicting foot ulcers and amputation. Finally, we outline the limitations of working with registry data sources and explain potentials for combining additional public and private data sources in future applications of artificial intelligence (AI) to improve the prediction of diabetic foot ulcers and amputation.

In this study, we examine cohort trends in who did and did not delay sex until marriage for U.S. women born between 1938 and 1985 using Cycles 3–7 of the National Survey of Family Growth. We find that roughly half of women born in the late 1930s and early 1940s were already sexually active prior to marriage. Especially rapid increases in not delaying sex until marriage occurred for women born between 1942–43 and 1954–55, with subsequent cohorts experiencing less rapid increases and with premarital sex reaching a plateau of roughly 85 to 90 percent for those born after 1962. Our continuous-time competing-risk models illustrate the methodological dangers of using single-decrement procedures for questions such as who did and did not delay sex until marriage. More generally, our findings suggest that the decoupling of sex and marriage was underway well before the so-called "sexual revolution" of the late 1960s and early 1970s.

Poor outcomes following Clostridium difficile infection (CDI) have been associated with advanced age, presence of cancer and C. difficile PCR-ribotype 027. The impact of baseline risk factors on clinical outcomes was evaluated using data from the EXTEND study, in which rate of sustained clinical cure (SCC) in the overall population was significantly higher with an extended-pulsed fidaxomicin (EPFX) regimen than with vancomycin. Patients aged ≥ 60 years received EPFX (fidaxomicin 200 mg twice daily, days 1–5; once daily on alternate days, days 7–25) or vancomycin (125 mg four times daily, days 1–10). We analysed outcomes by advanced age, cancer diagnosis, CDI severity, prior CDI occurrence and infection with PCR-ribotype 027. The primary endpoint was SCC 30 days after end of treatment (EOT; clinical response at test-of-cure with no subsequent recurrence). SCC rates 30 days after EOT did not differ significantly between EPFX (124/177, 70.1%) and vancomycin (106/179, 59.2%) regardless of age, cancer diagnosis, CDI severity and prior CDI. In patients with PCR-ribotype 027, SCC rate 30 days after EOT was significantly higher with EPFX (20/25, 80%) than with vancomycin (9/22, 40.9%) (treatment difference, 39.1%; 95% CI, 13.2–64.9; P = 0.006). Subgroup analyses from the EXTEND study suggest that EPFX is efficacious as a potential treatment for CDI regardless of age, cancer diagnosis, infection with PCR-ribotype 027, CDI severity or prior CDI. ClinicalTrials.gov identifier: NCT02254967. [ABSTRACT FROM AUTHOR]

In this study, we examine cohort trends in who did and did not delay sex until marriage for U.S. women born between 1938 and 1985 using Cycles 3-7 of the National Survey of Family Growth. We find that roughly half of women born in the late 1930s and early 1940s were already sexually active prior to marriage. Especially rapid increases in not delaying sex until marriage occurred for women born between 1942-43 and 1954-55, with subsequent cohorts experiencing less rapid increases and with premarital sex reaching a plateau of roughly 85 to 90 percent for those born after 1962. Our continuous-time competing-risk models illustrate the methodological dangers of using single-decrement procedures for questions such as who did and did not delay sex until marriage. More generally, our findings suggest that the decoupling of sex and marriage was underway well before the so-called "sexual revolution" of the late 1960s and early 1970s. [ABSTRACT FROM AUTHOR]