National Institutes of Health (U.S.)

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world’s largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, “Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research,” devoted to key topics within the field of alcohol research. This article is based on Dr. Shah’s presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

Author/s:

Ramissoon, R., Shah, V. H.

Care of Patients With New, Continuing, or Recurring Symptoms After Acute SARS-CoV-2 Infection

Saige Blanchard — Tue, 07 Jun 2022 05:00:00 +0000

Date Added:

June 7, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

May 27, 2022

URL:

Care of Patients With New, Continuing, or Recurring Symptoms After Acute SARS-CoV-2 Infection

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M22-1636

Keywords

PMID (1):

35622410

MeSH

post-acute COVID-19 syndrome

COVID-19

SARS-CoV-2

pandemics

National Institutes of Health (U.S.)

Guidance on how to evaluate and manage patients with prolonged COVID symptoms. James W. Mold, MD, MPH

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As the pandemic of acute SARS-CoV-2 infection continues, there is another pandemic that shadows it—the growing population of people who have new, continuing, or recurring symptoms long after initial infection. Many refer to this condition as “long COVID,” and the National Institutes of Health's (NIH) official name for the condition is postacute sequelae of SARS-CoV-2 (PASC). Whatever we call it, the current limited understanding of the pathophysiology, epidemiology, and course of this condition makes caring for these patients a vexing challenge.

Author/s:

Laine, C., Cotton, D.

Facilitating rapid access to addiction treatment: a randomized controlled trial

Bethie Seay — Thu, 03 Jun 2021 05:00:00 +0000

Date Added:

June 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1186/s13722-021-00240-y

PMID (1):

34034821

MeSH

referral and consultation

Emergency Service, hospital

patient acceptance of healthcare

National Institutes of Health (U.S.)

Not surprisingly, rapid access to addiction treatment works better than delayed access.

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Background: Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization.

Methods: Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment.

Results: Of the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups.

Conclusion: Providing immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months. Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751.

Author/s:

Srivastava, Anita, Clarke, Sarah, Hardy, Kate, Kahan, Meldon

Considerations for Wearing Masks: Help Slow the Spread of COVID-19

Brian Desmarais — Thu, 19 Nov 2020 16:10:50 +0000

Date Added:

November 19, 2020

Publisher:

CDC

Publication Date:

November 12, 2020

URL:

Considerations for wearing Masks: Help Slow the Spread of COVID-19

Type:

Patient Education Materials

Format:

Web Page

MeSH

COVID-19

severe acute respiratory syndrome coronavirus 2

pandemics

masks

Centers for Disease Control and Prevention

National Institutes of Health (U.S.)

Advice from the CDC regarding wearing masks during the COVID-19 pandemic. James W. Mold, MD, MPH

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Not available.

Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis

Brian Desmarais — Wed, 12 Jun 2019 01:48:41 +0000

Date Added:

June 11, 2019

Journal/Publication:

Annals of Internal Medicine

Publication Date:

June 11, 2019

URL:

Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0223

Keywords

blood pressure

stroke

cardiovascular

MeSH

White Coat Hypertension

blood pressure

cardiovascular diseases

Research Personnel

Blood Pressure Determination

hypertension

National Institutes of Health (U.S.)

stroke

Untreated white coat hypertension appears to increase the risk of adverse cardiovascular events and death by around 35%. James W. Mold, MD, MPH

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BACKGROUND:

The long-term cardiovascular risk of isolated elevated office blood pressure (BP) is unclear.

PURPOSE:

To summarize the risk for cardiovascular events and all-cause mortality associated with untreated white coat hypertension (WCH) and treated white coat effect (WCE).

DATA SOURCES:

PubMed and EMBASE, without language restriction, from inception to December 2018.

STUDY SELECTION:

Observational studies with at least 3 years of follow-up evaluating the cardiovascular risk of WCH or WCE compared with normotension.

DATA EXTRACTION:

2 investigators independently extracted study data and assessed study quality.

DATA SYNTHESIS:

27 studies were included, comprising 25 786 participants with untreated WCH or treated WCE and 38 487 with normal BP followed for a mean of 3 to 19 years. Compared with normotension, untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio [HR], 1.36 [95% CI, 1.03 to 2.00]), all-cause mortality (HR, 1.33 [CI, 1.07 to 1.67]), and cardiovascularmortality (HR, 2.09 [CI, 1.23 to 4.48]); the risk of WCH was attenuated in studies that included stroke in the definition of cardiovascular events(HR, 1.26 [CI, 1.00 to 1.54]). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 [CI, 0.91 to 1.39]), all-cause mortality (HR, 1.11 [CI, 0.89 to 1.46]), or cardiovascular mortality (HR, 1.04 [CI, 0.65 to 1.66]). The findings persisted across several sensitivity analyses.

LIMITATION:

Paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity.

CONCLUSION:

Untreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension.

PRIMARY FUNDING SOURCE:

National Institutes of Health.

Author/s:

M.G., Cohen, J.B., Lotito, M.J., Denker, M.G., Cohen, D.L., Townsend, R.R.

Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review

Brian Desmarais — Thu, 23 May 2019 13:11:29 +0000

Date Added:

May 23, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

U.S. Department of Health & Human Services

Publication Date:

April 23, 2019

URL:

https://www.ncbi.nlm.nih.gov/pubmed/?term=Long-Term%20Drug%20Therapy%20and%20Dru…

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.7326/M19-0533.

Keywords

MeSH

Raloxifene Hydrochloride

Databases, Bibliographic

National Institutes of Health (U.S.)

Information Storage and Retrieval

bias

Health Services Research

Femoral Fractures

This is a systematic review of current evidence regarding medications for post-menopausal osteoporosis. James W. Mold, MD, MPH

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BACKGROUND:

Optimal long-term osteoporosis drug treatment (ODT) is uncertain.

PURPOSE:

To summarize the effects of long-term ODT and ODT discontinuation and holidays.

DATA SOURCES:

Electronic bibliographic databases (January 1995 to October 2018) and systematic review bibliographies.

STUDY SELECTION:

48 studies that enrolled men or postmenopausal women aged 50 years or older who were being investigated or treated for fracture prevention, compared long-term ODT (>3 years) versus control or ODT continuation versus discontinuation, reported incident fractures (for trials) or harms (for trials and observational studies), and had low or medium risk of bias (ROB).

DATA EXTRACTION:

Two reviewers independently rated ROB and strength of evidence (SOE). One extracted data; another verified accuracy.

DATA SYNTHESIS:

Thirty-five trials (9 unique studies) and 13 observational studies (11 unique studies) had low or medium ROB. In women with osteoporosis, 4 years of alendronate reduced clinical fractures (hazard ratio [HR], 0.64 [95% CI, 0.50 to 0.82]) and radiographic vertebral fractures (both moderate SOE), whereas 4 years of raloxifene reduced vertebral but not nonvertebral fractures. In women with osteopenia or osteoporosis, 6 years of zoledronic acid reduced clinical fractures (HR, 0.73 [CI, 0.60 to 0.90]), including nonvertebral fractures (high SOE) and clinical vertebral fractures (moderate SOE). Long-term bisphosphonates increased risk for 2 rare harms: atypical femoral fractures (low SOE) and osteonecrosis of the jaw (mostly low SOE). In women with unspecified osteoporosis status, 5 to 7 years of hormone therapyreduced clinical fractures (high SOE), including hip fractures (moderate SOE), but increased serious harms. After 3 to 5 years of treatment, bisphosphonate continuation versus discontinuation reduced radiographic vertebral fractures (zoledronic acid; low SOE) and clinical vertebral fractures (alendronate; moderate SOE) but not nonvertebral fractures (low SOE).

LIMITATION:

No trials studied men, clinical fracture data were sparse, methods for estimating harms were heterogeneous, and no trials compared sequential treatments or different durations of drug holidays.

CONCLUSION:

Long-term alendronate and zoledronic acid therapies reduce fracture risk in women with osteoporosis. Long-termbisphosphonate treatment may increase risk for rare adverse events, and continuing treatment beyond 3 to 5 years may reduce risk for vertebral fractures. Long-term hormone therapy reduces hip fracture risks but has serious harms.

PRIMARY FUNDING SOURCE:

National Institutes of Health and Agency for Healthcare Research and Quality. (PROSPERO: CRD42018087006).

Author/s:

Fink, Howard A., MacDonald, Roderick, Forte, Mary L., Rosebush, Christina E., Ensrud, Kristine E., Schousboe, John T., Nelson, Victoria A., Ullman, Kristen, Butler, M., Olson, Carin M., Taylor, Brent C., Brasure, Michelle, Wilt, Timothy J.