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2 Minute Medicine Rewind February 9, 2026
Reproductive Shifts and Ovarian Cancer Risk in Women Aged 40 Years or Older
1. Across the premenopausal and postmenopausal groups, early menarche, later menopause, and longer reproductive span were associated with higher ovarian cancer risk, while parity was associated with lower risk of ovarian cancer.
Evidence Rating Level: 2 (Good)
Although reproductive factors have been associated with ovarian cancer risk, it is unclear whether reproductive factor associations differ by menopausal status and birth cohorts. This study thus assessed the associations between reproductive factors and ovarian cancer risk across menopausal status and birth cohorts. This population-based cohort study used data from South Korea’s National Health Insurance Service (NHIS). Women aged >40 years who underwent NHIS health screening in 2009 were included and followed up until ovarian cancer diagnosis, death, or December 31, 2022. The primary outcome was incident ovarian cancer. In total, 2,285,774 women (932,637 [40.8%] premenopausal, 1, 353,137 [59.2%] postmenopausal; mean [SD] age, 54.9 [10.85] years) were included in the study. Over a mean (SD) follow-up duration of 10.7 (2.99) years, 10,729 ovarian cancer cases were identified. For both premenopausal women and postmenopausal women, early menarche (aged ≤12 vs >16 years) was associated with higher ovarian cancer risk (HR, 1.37; 95% CI, 1.16-1.61] and HR, 1.24; 95% CI, 1.00-1.54), while parity of >2 births was associated with lower ovarian cancer risk (HR, 0.68; 95% CI, 0.58-0.79 and HR, 0.71; 95% CI, 0.60-0.85]). Breastfeeding for >12 months and oral contraceptive use for >1 year were associated with lower ovarian cancer risk in premenopausal women (HR, 0.86; 95% CI, 0.77-0.96 and HR, 0.75; 95% CI, 0.61-0.93) but not postmenopausal women. Among postmenopausal women, later menopause (≥55 years; HR, 1.36; 95% CI, 1.11-1.66), longer reproductive span (≥40 years; HR, 1.21; 95% CI, 1.09-1.34), and hormone replacement therapy use for 2 to 5 years (HR, 1.20; 95% CI, 1.07-1.34) were associated with higher risk of ovarian cancer. Overall, this study found associations between reproductive factors and cancer risk that differed across menopausal status and birth cohorts, highlighting the need for tailored prevention interventions for these populations.
1. Four weeks of telephone-delivered behavioral activation and mindfulness interventions by lay counsellors were associated with reduced loneliness and improved well-being at 12 months among older adults compared to telephone-delivered befriending.
Evidence Rating Level: 1 (Excellent)
Late-life loneliness is associated with poor mental and cognitive health and increased risk of premature mortality. Behavioral activation interventions encourage engagement in rewarding and meaningful activities, while mindfulness interventions foster present-moment awareness and acceptance. Although both interventions have been shown to alleviate loneliness, long-term effects past 6 months are unclear. This study thus investigated the long-term effects of behavioral activation and mindfulness interventions compared with a befriending intervention on reducing loneliness among older adults. This study was part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA), a randomized clinical trial conducted between April 1, 2021, and April 28, 2024. Eligible participants >65 years who were living alone, digitally excluded, lonely, and experiencing financial hardship were included. Participants were randomized 1:1:1 to receive telephone-delivered behavioral activation (Tele-BA), telephone-delivered mindfulness (Tele-MF), or telephone-delivered befriending (Tele-BF [attention control]). Trained lay counsellors delivered eight 30-minute sessions via telephone for 4 weeks. As the control, the tele-BF intervention included emotional and informational support without teaching any psychosocial skills. The primary outcome was loneliness, measured using the UCLA Loneliness Scale (UCLA-LS) and the De Jong Gierveld Loneliness Scale (DJGL). Outcomes were assessed at baseline and at 1, 3, 6, and 12 months of follow-up. Of the 1,151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) randomized, 335 [29.1%] received Tele-BA, 460 [40.0%] received Tele-MF, and 356 [30.9%] received Tele-BF. Intention-to-treat analyses found lower loneliness scores in both the Tele-BA group (UCLA-LS: mean difference [MD], −0.73; 95% CI, −1.29 to −0.16; DJGL: MD, −0.13; 95% CI, −0.23 to −0.03) and Tele-MF group (UCLA-LS: MD, −0.72; 95% CI, −1.24 to −0.20) compared with Tele-BF. At 12-months, between-group differences showed better sleep quality, psychological well-being, perceived social support, and life satisfaction, as well as lower levels of depressive symptoms, anxiety, and perceived stress (overall between-group difference P < .001). Overall, this study found that telephone-delivered behavioral activation and mindfulness interventions by lay counsellors reduced loneliness and enhanced well-being during 12 months in older adults. These results highlight the potential of these interventions in mitigating late-life loneliness
1. Among patients with sepsis-associated encephalopathy, propofol monotherapy was associated with lower one-year all-cause mortality compared to no sedation therapy.
Evidence Rating Level: 2 (Good)
Sepsis-associated encephalopathy (SAE) involves acute progressive brain dysfunction in the absence of direct central nervous system infection. Mortality rate increases with SAE severity. Among critically ill patients, it is important to address distress to reduce the risk of acute and chronic physical and emotional harm. The sedative agents propofol or dexmedetomidine have been recommended for patients with agitation due to anxiety who need ongoing intravenous sedation. However, no large-scale cohort studies have investigated whether sedation therapy independently correlates with one-year all-cause mortality following intensive care unit (ICU) admission. This study thus examined the relationship between sedation therapy and one-year all-cause mortality. This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC)-IV and included patients in the US aged 18-89 with SAE who were treated within the first 24h of admission to the ICU. Sedation therapy was defined as administering propofol, midazolam, dexmedetomidine, or any combination. Among the 4,618 patients included in the study (mean [SD] age = 66.8 +14.7 years, male [%] = 2762 [59.8]), 3,343 were in the sedative and 1,275 in the non-sedative use groups. Compared to SAE patients who did not receive sedation, administering propofol alone was associated with 49% reduced one-year all-cause mortality (hazard ratio [HR], 0.51; 95% CI, 0.40–0.65). The interaction between propofol monotherapy and ventilation support increased one-year all-cause mortality (HR, 0.70; 95% CI, 0.49–1.00, P for interaction = 0.041). Overall, this study found that compared to no sedation therapy, sedation with propofol was associated with lower one-year all-cause mortality among patients with SAE, although ventilation support attenuated the protective effect. These findings highlight the potential benefit of choosing propofol monotherapy for patients with SAE who require sedation.
The impact of polypharmacy on health outcomes in the aged: A retrospective cohort study
1. Polypharmacy was associated with a higher risk of mortality and hospitalization at one-year and five-years among older adults aged >75 years.
Evidence Rating Level: 2 (Good)
Polypharmacy is commonly defined as the use of five or more medicines and is associated with medication non-adherence, cognitive impairment and adverse drug reactions (ADRs). Research findings on polypharmacy have been inconsistent or have had methodological limitations. This study thus investigated the association between polypharmacy with mortality, falls, ADRs and hospitalizations at one and five years. This retrospective cohort study included patients > 75 years old in the UK from the Clinical Practice Research Datalink (CPRD). The study period for the one-year analysis was January 2010-December 2010, and January 2010-December 2014 for the five-year analysis. Polypharmacy was defined as the use of five or more medicines. Out of the 977 patients analyzed (mean [SD] age = 83 +5.52, female [%] =624 [64.10]), the prevalence of polypharmacy was 47% (457/977). At one-year, polypharmacy was associated with a higher risk of mortality (hazard ratio [HR] 2.37; 95% CI, 1.40–3.90) and hospitalization (HR, 2.47; 95% CI, 1.40–4.30). At five-years, polypharmacy was associated with a higher risk of mortality (HR, 1.60; 95% CI, 1.30–2.00) and hospitalization (HR, 1.49; 95% CI, 1.30–1.70]). Falls and ADRs were not associated with polypharmacy, potentially due to inadequate recordings in the CPRD database. Overall, this study found that polypharmacy is a risk factor for mortality and hospitalizations in the short and long term among older adults aged >75 years. These findings highlight the importance of managing inappropriate polypharmacy.
Incidence of psychotic disorders by birth cohort: a population-based cohort study in Ontario, Canada
1. The incidence of psychotic disorders in Ontario has increased in more recent birth cohorts, and the age of diagnosis has decreased.
Evidence Rating Level: 2 (Good)
The incidence trends of psychotic disorders over time in high-income countries have varied across studies and may not capture birth cohort differences that are affected by varying exposures to risk factors. This study thus examined whether the incidence of psychotic disorders has changed across birth cohorts. This retrospective, population-based cohort study using data from 7 health administrative databases in Ontario, Canada, between January 1, 1992, and December 31, 2023, included people aged 14-50 years born between 1960 and 2009. People born between 1960 and 2009 were categorized into 5-year birth cohorts. The primary outcome was diagnosis or care for a nonaffective psychotic disorder, including schizophrenia and schizoaffective disorder SSD, psychosis not otherwise specified (NOS), or both. Out of the 12,231,314 people included in the study, 152,587 (0.9%) were diagnosed with a psychotic disorder (female [%] = 58,860 [38.6]) during the study period. Between 1997 and 2023, the annual incidence of psychotic disorders increased by 60% (62.5 to 99.7 per 100 000 people) among people aged 14 to 20 years. Among those aged 21 to 50 years, incidence rates declined over time, with reductions ranging from of 32.6% to 62.0% across age groups. Compared with those born in 1975 to 1979, the incidence of schizophrenia among those born in 2000 to 2004 was 70% higher (incidence rate ratio [IRR] 1.70, 95% CI interval, 1.63 to 1.78), with increases in psychosis NOS (IRR 2.89, 95% CI 2.73 to 3.06) across birth cohorts being greater than those in SSD (IRR 1.32, 95% CI 1.25 to 1.40). Compared with those born in 1975 to 1979, the percentage of people diagnosed with a psychotic disorder at age 20 years was 104% higher (0.55% vs 0.27%) for those born in 2000 to 2004, and 37.5% higher (1.32% vs 0.96%) at age 30 years for those born in 1990 to 1994. Overall, this study found that the incidence of psychotic disorders in Ontario has increased in more recent birth cohorts and that the age of diagnosis has decreased. Although these findings may reflect improved access to assessment, future research should investigate potential contributors to these trends to inform psychosis intervention services.
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