Background Lifestyle factors have been studied for dementia risk, but few have comprehensively assessed both Alzheimer’s disease (AD) and cerebrovascular disease (CBVD) pathologies. Objective Our research aims to determine the relationships between lifestyle and various dementia pathologies, challenging conventional research paradigms. Methods Analyzing 1231 Wisconsin Registry for Alzheimer’s Prevention (WRAP) study participants, we focused on Life Simple Seven (LS7) score calculations from questionnaire data and clinical vitals. We assessed brain health indicators including CBVD, AD, and cognition. Results Higher (healthier) LS7 scores were associated with better CBVD outcomes, including lower percent white matter hyperintensities and higher cerebral blood flow, and higher Preclinical Alzheimer’s Composite 3 and Delayed Recall scores. No significant associations were observed between LS7 scores and AD markers of amyloid and tau accumulation. Conclusion This study provides evidence that the beneficial effects of LS7 on cognition are primarily through cerebrovascular pathways rather than direct influences on AD pathology.

Objective Nearly half of Wisconsin women live in rural areas, where access to obstetrical care remains a major concern. Rural communities are often disproportionately affected by national emergencies. This study aimed to evaluate the impact of the COVID-19 pandemic on severe maternal morbidity (SMM) rates across Wisconsin, with a focus on geographic variation. Study Design A retrospective cohort study was conducted using Wisconsin Hospital Association coding data for all births in Wisconsin from March 1, 2017 to March 31, 2023. The pre-pandemic period was defined as 3/1/2017 – 2/29/2020, and the pandemic period as 3/1/2020 to 3/31/2023. Generalized additive logistic regression models assessed changes in the SMM rates by ZIP code. Statistical analyses were performed using the mgcv package in R. Results Among 334,366 births (172,737 pre pandemic and 161,629 during the pandemic) there were 2,210 SMM events (0.7%). The SMM rate increased from 0.6% pre-pandemic to 0.8% during the pandemic (RR 1.33, 95% CI 1.23–1.45, p<0.0001). However, no significant geographic variation in the pandemic’s impact on SMM rates was observed (p=0.56). The most common SMM diagnoses during the pandemic included acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome. Conclusion There is strong evidence that the COVID-19 pandemic was associated with an increase in SMM events. Despite concerns about rural healthcare access, no geographic disparities were found, suggesting that further efforts are needed to analyze SMM events in rural areas.

Background Over-the-counter (OTC) medication misuse among older adults is a patient safety concern, exacerbated by limited patient engagement about potential risks. Senior Safe™, a pharmacy-based intervention using human-factors engineering and participatory design,specifically, shelf signage, product repositioning, and patient engagement to nudge safer choices. Despite its safety intent, and demonstrated effectiveness, it was important to determine the intervention’s impact on its financial sustainability. Methods This study evaluated Senior Safe’s effect on daily unit sales of OTC analgesic, sleep, and cough/cold/allergy products across 65 community pharmacies in a Midwestern health system. Using Generalized Linear Mixed Model regressions with Poisson distribution, the analyses compared daily unit sales pre- and post-intervention trends for products marked with Green Banners (safer), Red Stop Signs (high-risk), or Behind-the-Counter (BTC) signage (very high-risk), controlling for pharmacy type, size, location, open hours, and staff hours. Results Senior Safe was associated with increased sales of safer analgesics and cough/cold/allergy medications (IRR = 1.064 and 1.106), along with significant decreases in unit sales of BTC and Red Stop Sign products (IRR = 0.424-0.869). These findings suggest a substitution effect, where patients chose safer alternatives rather than forgoing OTC purchases. Operational factors, such as longer open hours and higher staffing levels, were positively associated with safer product unit sales. Conclusions Senior Safe successfully shifted consumer behavior toward safer OTC medication use without reducing overall sales volume, suggesting patient safety interventions can be financially sustainable in retail pharmacy settings. These results support broader implementation of low-cost, system-level interventions that align safety with business operations.

IMPORTANCE: Over seven million U.S. adults experience persistent health issues after COVID-19, known as “long COVID”. Although multiple guidelines recommend the inclusion of functional status in long COVID diagnostic criteria, more evidence is needed to guide this recommendation. This study explored the adjusted odds of developing long COVID by pre-infection symptoms and functional status, and the feasibility of estimating functional status using health records data. DESIGN & METHODS: Retrospective cohort study of U.S. adults with history of COVID-19 enrolled in a multicenter national cohort study through July 2022 (All of Us Controlled Tier CDR 7.0), using diagnostic, procedure, and billing codes from the health record, and baseline survey responses. The risk of long COVID was estimated using logistic regression by pre-infection (-5 years) incidences of (a) at least one symptom common in long COVID, and (b) functional status, and adjusted for disease and demographic characteristics. RESULTS: N = 65,464 met inclusion criteria; n=40,655 had post-infection occurrences of at least one symptom (long COVID group), n=24,809 had none (recovered). Adjusted odds ratios of developing long COVID increased with older age, female sex, Black racial identity, earlier variant, non-vaccination, lower pre-infection self-reported mental and cognitive health, and number of pre-infection symptoms. Adjusted odds were not significantly affected by any single pre-infection symptom, self-rated physical ability, or EHR-derived indicators of prior functional impairment. CONCLUSIONS. In this model, there was no significant difference in risk of long COVID based on either pre-infection total incidences of long COVID symptoms (compared to the average of 4) or pre-infection functional impairment. This suggests that long COVID was associated with a change from baseline functioning and health, including in people with pre-infection incident symptoms and functional impairments. The impacts of co-occurring pre-infection symptoms requires further investigation. Both harmonized electronic health records data and patient-reported outcomes contribute important data for developing the diagnostic utility of functional status changes in long COVID.

Motor difficulties are common in autistic individuals and may contribute to challenges in social development. Understanding the association between motor and social skills could inform interventions to improve developmental outcomes. Using data from the Study to Explore Early Development—a large, diverse sample of rigorously characterized preschool-aged autistic children in the United States—we aimed to (a) describe the frequency of motor challenges using multiple standardized instruments; and (b) evaluate associations between motor and social skills. Children were identified from health and education organizations and birth records. Caregivers completed standardized interviews and questionnaires, and children completed comprehensive developmental evaluations to determine autism status. Among 2,039 children meeting the study autism criteria, 67.3% exhibited motor scores ⩾2 standard deviations below the mean on at least one measure. Motor difficulties were more prevalent in the fine motor (up to 63.4%) than gross motor (14.2%) domain and among children with significant visual reception delays (up to 92.8%) than those without these delays (up to 32.0%). After adjusting for covariates, fine motor skills were significantly associated with social challenges in both functional and autism-specific domains. These findings highlight the importance of motor development in early autism evaluations.