Adults

Importance: Hepatitis B virus (HBV) infection affects an estimated 254 million people worldwide and causes approximately 1.1 million deaths annually. In 2022, there were approximately 1.2 million new HBV infections worldwide and 14 000 in the US.

Observations: HBV is a DNA virus transmitted through percutaneous or mucosal exposure to infected blood, semen, or body fluids. Mother-to-child transmission, which is the principal cause of chronic HBV infection globally, occurs in 70% to 90% of infants born to mothers who are hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive and in 5% to 20% of those born to HBsAg-positive/HBeAg-negative mothers. However, HBV vaccination and administration of hepatitis B immune globulin within 12 to 24 hours of birth prevent approximately 94% of perinatal infections, and adding antiviral therapy in pregnant women with high HBV DNA reduces transmission to less than 1%. Although universal birth-dose HBV vaccination is the most effective strategy for eliminating HBV infection, global birth-dose HBV vaccine coverage was only 45% in 2024. The risk of developing chronic infection (HBsAg positive for more than 6 months) is 90% if HBV infection occurs during infancy, 30% in children aged 1 to 5 years, and less than or equal to 5% in immunocompetent adolescents and adults. HBV infection is diagnosed by serologic testing: HBsAg indicates ongoing infection, antibody to HBsAg indicates immunity, and antibody to hepatitis B core antigen indicates ongoing or past infection. Serum HBV DNA levels quantify virus-replication activity. Assessment of liver inflammation and fibrosis with alanine aminotransferase (ALT) and noninvasive tests such as Fibrosis-4 index and liver elastography guide treatment decisions. Chronic HBV infection may progress to cirrhosis and hepatocellular carcinoma (HCC); the 5-year cumulative risk of cirrhosis is 8% to 15% in untreated chronic HBV infection, and annual HCC incidence is 3% to 5% among patients with cirrhosis. Antiviral therapies-pegylated interferon alfa and nucleos(t)ide analogues (entecavir or tenofovir)-suppress HBV DNA replication and reduce the risk of HCC by approximately 50%. Antiviral treatment is recommended for all patients with chronic HBV and cirrhosis and for those without cirrhosis who have high HBV DNA with elevated ALT or significant inflammation/fibrosis. Patients at high risk of HCC should undergo surveillance with ultrasonography and alpha-fetoprotein testing every 6 months.

Conclusions and relevance: HBV infection causes approximately 1.1 million deaths annually worldwide. Universal HBV vaccination, particularly birth-dose administration, is the most effective strategy to prevent HBV infection. Among patients with HBV infection, antiviral therapy decreases progression to cirrhosis and liver failure and reduces the risk of HCC.

Author/s:

Wen-Juei Jeng, Terry Cheuk-Fung Yip, Anna S. Lok

Treatment of Anxiety for Adults in Primary Care Settings: A Review

Megan George — Tue, 05 May 2026 13:42:15 +0000

Date Added:

May 5, 2026

Journal/Publication:

JAMA Internal Medicine

Publication Date:

May 4, 2026

URL:

Treatment of Anxiety for Adults in Primary Care Settings: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.0395

Keywords

anxiety

Anxiety disorders

anxiety disorder

PMID (1):

42081227

MeSH

anxiety

anxiety disorder

anxiety disorders

Medically Unexplained Symptoms

Humans

Adults

Selective Serotonin Reuptake Inhibitors

Cognitive Behavioral Therapy

Benzodiazepines

Norepinephrine

A review of the various categories of anxiety disorders in adults and their management. James W. Mold, MD, MPH

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Importance Anxiety disorders and symptoms are prevalent and burdensome, and patients are most likely to seek treatment in primary care settings. However, anxiety is underdetected and undertreated. This narrative review details behavioral and pharmacological treatment options that are feasible and effective in primary care.

Observations Screening for anxiety is recommended for primary care patients younger than 65 years. Given that anxiety often involves somatic symptoms, assessment should include patient-reported symptom measures, clinical interview, physical examination, and appropriate laboratory tests. For subthreshold symptoms (those that do not meet diagnostic criteria for anxiety disorders) and adjustment-related anxiety, starting with self-help and behavioral treatment is recommended. When deciding between behavioral, pharmacological, or combined treatment for anxiety disorders, consider the presentation, patient preferences, potential adverse effects, and treatment history, and engage in shared decision-making. Cognitive-behavioral therapy (CBT) is the first-line behavioral treatment for anxiety. Brief CBT in primary care delivered by embedded behavioral health clinicians is effective. First-line pharmacotherapy for anxiety disorders includes several selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, which tend to be well tolerated without considerable long-term adverse effects. The main decision for pharmacological treatment is between a daily medication and a short-acting medication taken as needed for intermittent symptoms or while awaiting the effect of a daily medication. Benzodiazepines are not recommended due to risk of adverse effects, especially with long-term use. The Collaborative Care Management model, which involves collaboration between primary care clinicians, consulting psychiatrists, and care managers who monitor patient progress and provide behavioral treatment, improves anxiety outcomes compared to usual primary care.

Conclusions and Relevance Clinicians should recognize common anxiety presentations and understand how to differentiate between anxiety and other psychiatric or medical conditions. Referring patients to behavioral health specialists for CBT and/or prescribing recommended pharmacotherapy with Collaborative Care Management can help to reduce patient morbidity and improve functioning.

Author/s:

Robyn L. Shepardson, Jeffrey S. Khan, Katherine A. Buckheit

What Parents Need to Know About Screen Time and Language Development

Megan George — Tue, 28 Apr 2026 16:08:19 +0000

Date Added:

April 28, 2026

Journal/Publication:

JAMA

Publication Date:

April 27, 2026

URL:

What Parents Need to Know About Screen Time and Language Development

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jamapediatrics.2026.0125

Keywords

PMID (1):

42043796

MeSH

Information for parents about the hazards to children of excessive screen time. James W. Mold, MD, MPH

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Early childhood exposure to screen time is becoming more common as mobile devices and televisions are part of most households. That is the same time when children, especially those in their first 3 years, are having an explosion of language and acquiring their speech and language skills. Screen time, especially on mobile devices, can be useful to keep children entertained at home and on the go. However, children who have more screen time may have fewer chances to talk with others, affecting their speech and language development. Current guidelines recommend that children younger than 18 months should not have any screen exposure, and children aged 2 to 5 years should be limited to 1 hour of screen time per day.

Current studies show that screen time keeps children from hearing adult words. Children and parents both vocalize or talk less when children engage with screens. There are also fewer back-and-forth conversations between children and caregivers. Spending more time with screens, even background television, may result in reductions in speech. Having a language-rich home environment promotes strong language skills, school readiness, and healthy brain development. If a child does engage with screens, there are ways to support speech development. Some ways to watch and use screens are better than others.

Author/s:

Lillian E. Sutton, Lindsay A. Thompson

Secondary Prevention after Ischemic Stroke

Megan George — Wed, 04 Mar 2026 18:17:01 +0000

Date Added:

March 4, 2026

Journal/Publication:

New England Journal of Medicine

Publication Date:

February 18, 2026

URL:

Secondary Prevention after Ischemic Stroke

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2415601

Keywords

Acute Ischemic Stroke

prevention

Strokes

PMID (1):

41707139

MeSH

A review of the causes of ischemic stroke and the risk reduction strategies available to prevent recurrences. James W. Mold, MD, MPH

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The risk of recurrent ischemic stroke can be reduced by managing modifiable risk factors and instituting a regimen of mechanism-specific secondary stroke prevention. Strategies for secondary prevention should be instituted as early as possible. Poststroke monitoring of risk metrics, lifestyle behaviors, and medication recommendations is of key importance.

Author/s:

Karen L. Furie, Peter J. Kelly

IgA Nephropathy in Adults: A Review

Megan George — Wed, 04 Mar 2026 18:10:22 +0000

Date Added:

March 4, 2026

Journal/Publication:

JAMA

Publication Date:

January 26, 2026

URL:

IgA Nephropathy in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2025.25020

Keywords

Antigen-Antibody Complex

IgA Nephropathy

Renal Insufficiency

Angiotensin Receptor Antagonists

renin-angiotensin system

MeSH

Glomerulonephritis

IGA

Antigen-Antibody Complex

Inflammation

Scarring

renal insufficiency

Angiotensin Receptor Antagonists

renin-angiotensin system

blood pressure

Adults

Humans

A comprehensive review of what we know about IgA nephropathy. James W. Mold, MD, MPH

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Importance IgA nephropathy (IgAN) is a chronic kidney disease involving deposition of IgA-containing immune complexes in the glomerulus, causing glomerular inflammation and scarring. It is the most common immune-mediated glomerular disease worldwide, and affects an estimated 198 887 to 208 184 persons in the US. Up to 50% of patients with IgAN develop kidney failure within 10 years of diagnosis.

Observations IgAN typically presents with nephritic syndrome and usually occurs in younger adults, with a mean age at diagnosis of 34 to 45 years. Incidence is highest in East Asia. Approximately 60% of cases are detected incidentally with hematuria or proteinuria on urinalysis. Up to 30% of patients present with episodic visible hematuria, often concomitantly with an upper respiratory or gastrointestinal tract infection (synpharyngitic hematuria). Less common presentations include nephrotic syndrome (<5%) and rapidly progressive glomerulonephritis (<5%). When IgAN is suspected (due to hematuria, proteinuria, or reduced kidney function), initial workup should include quantification of proteinuria and assessment for other causes of nephritic syndrome (eg, lupus nephritis). Adults with suspected IgAN and proteinuria greater than or equal to 0.5 g per day should undergo kidney biopsy. The diagnosis of primary IgAN is based on presence of IgA-dominant immune deposits in the glomerular mesangium after excluding other causes of this histologic appearance, ie, IgA vasculitis, IgA-dominant infection-related glomerulonephritis, and secondary IgAN from diseases such as cirrhosis, inflammatory bowel disease, celiac disease, infection (eg, viral hepatitis), and autoimmune diseases (eg, axial spondyloarthritis). Based on the Kidney Disease: Improving Global Outcomes 2025 clinical practice guideline for the management of IgAN, treatment for patients with proteinuria greater than 0.5 g per day includes behavioral modifications (eg, dietary sodium <2 g/d, smoking cessation, weight control, exercise), antihypertensive medications for goal blood pressure less than 120/70 mm Hg, and therapies to reduce the formation of IgA-containing immune complexes (eg, targeted-release budesonide), decrease glomerular injury (eg, systemic glucocorticoids, iptacopan), and manage existing IgAN-induced nephron loss (eg, renin-angiotensin system inhibitor or dual endothelin angiotensin receptor antagonist [eg, sparsentan] alone or in combination with a sodium-glucose cotransporter 2 inhibitor).

Conclusions and Relevance IgAN is the leading cause of immune-mediated glomerular disease worldwide. Patients with suspected IgAN and proteinuria greater than or equal to 0.5 g per day should undergo kidney biopsy to confirm the diagnosis. Treatment of IgAN includes behavioral modifications, blood pressure management, and therapies to decrease formation of IgA-containing immune complexes (eg, targeted-release budesonide), reduce immune complex–mediated glomerular injury (eg, systemic glucocorticoids, iptacopan), and manage IgAN-induced nephron loss (eg, renin-angiotensin system inhibitor, dual endothelin angiotensin receptor antagonist, and sodium-glucose cotransporter 2 inhibitor).

Author/s:

Sinead Stoneman, Jia Wei Teh, Michelle Marie O’Shaughnessy

Does This Patient Have Volume Overload? The Rational Clinical Examination

Megan George — Tue, 03 Mar 2026 15:47:01 +0000

Date Added:

March 3, 2026

Journal/Publication:

JAMA

Publication Date:

February 23, 2026

URL:

Does This Patient Have Volume Overload? The Rational Clinical Examination

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.0446

Keywords

Intravascular Volume Overload

Venous Pressure

Natriuretic Peptides

Auscultation

PMID (1):

41729549

MeSH

A review of the evaluation of patients with possible volume overload. James W. Mold, MD, MPH

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Importance: Accurate assessment of intravascular volume facilitates management decisions about fluid management in patients with volume overload.

Objective: To identify the most accurate clinical examination, radiographic, and laboratory findings for assessing volume overload in nonintubated patients.

Data sources and study selection: MEDLINE was searched (1946 to January 6, 2026) to identify peer-reviewed English-language studies about the diagnostic accuracy of the clinical examination of spontaneously breathing patients with intravascular volume overload.

Data extraction and synthesis: Three authors independently extracted data for each finding and calculated sensitivity, specificity, and likelihood ratios (LRs). A 2-level mixed logistic regression model was used to pool estimates.

Results: Forty studies, involving 11 490 adult patients, were included, with a prevalence of volume overload of 35% to 69%. Thirty-three of those studies evaluated patients with dyspnea. Prevalence of volume overload was more likely when the physical examination revealed jugular venous distention with the highest point of pulsation more than 3 cm in a vertical line above the sternal angle (LR, 4.1 [95% CI, 2.9-5.6]; specificity, 92%), lower extremity edema (LR, 2.2 [95% CI, 1.5-3.1]; specificity, 80%), or crackles on auscultation (LR, 2.7 [95% CI, 1.7-4.5]; specificity, 81%). Vascular congestion on chest radiography increased the likelihood of intravascular volume overload (LR, 5.9 [95% CI, 2.9-12.0]; specificity, 91%). Point-of-care ultrasonography that identified bilateral pulmonary B-lines suggested volume overload (LR, 4.0 [95% CI, 2.6-6.1]; specificity, 77%), and absence of pulmonary B-lines made volume overload unlikely (LR, 0.09 [95% CI, 0.04-0.23]; sensitivity, 93%). Inferior vena cava collapsibility index of less than 50% increased the likelihood of volume overload (LR, 3.9 [95% CI, 2.5-6.1]; specificity, 79%), and a collapsibility index of at least 50% made it less likely (LR, 0.22 [95% CI, 0.11-0.45]; sensitivity, 82%). Point-of-care ultrasonographic measurement of jugular venous pressure (JVP; >8 cm) also increased the likelihood of volume overload (LR, 2.8 [95% CI, 2.2-3.5]; specificity, 71%), although JVP of 8 cm or less identified patients less likely to have volume overload (LR, 0.26 [95% CI, 0.20-0.33]; sensitivity, 81%). A plasma brain-type natriuretic peptide (BNP) level of 100 ng/mL or higher was the single best test to identify those most likely to have volume overload (LR, 6.9 [95% CI, 2.4-20.4]; specificity, 87%), and a normal value made it less likely (LR, 0.14 [95% CI, 0.08-0.24]; sensitivity, 87%).

Conclusions and relevance: A BNP level of 100 ng/mL or higher and presence of vascular congestion on chest radiography may be the most useful tests to identify patients with volume overload. Absence of pulmonary B-lines using point-of-care ultrasonography or BNP levels of less than 100 ng/mL may be most useful to exclude volume overload.

Author/s:

Benjamin Drum, Bryce La Course, Mark Kelly, Audrey York, Emily Worrall, Jennifer Martins, Stacy Johnson, Edmund A Liles Jr

Pertussis Infection in Adults

Megan George — Fri, 27 Feb 2026 01:31:28 +0000

Date Added:

February 26, 2026

Journal/Publication:

JAMA

Publication Date:

February 18, 2026

URL:

Pertussis Infection in Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26153

Keywords

Pertussis

Bordetella pertussis

whooping cough

PMID (1):

41706481

MeSH

A concise review of pertussis infection in adults. (Much more common than you might think.) James W. Mold, MD, MPH

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Pertussis, or whooping cough, is a highly contagious respiratory illness caused by Bordetella pertussis, a fastidious gram-negative coccobacillus that is a human pathogen without known animal or environmental reservoirs. There are 8 additional known Bordetella species, 3 of which can cause respiratory illness in humans: B parapertussis (which causes infection clinically indistinguishable from pertussis), B bronchiseptica, and B holmesii.

Author/s:

Paul B. Cornia, Benjamin A. Lipsky

Calcium pyrophosphate deposition disease

Megan George — Mon, 02 Feb 2026 15:53:10 +0000

Date Added:

February 2, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

February 2, 2026

URL:

Calcium pyrophosphate deposition disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.250933

Keywords

pseudogout

calcium pyrophosphate deposition disease

MeSH

Calcium Pyrophosphate

adrenal cortex hormones

Inflammation

Adults

Humans

Calcium Pyrophostphate Deposition Disease

Pseudogout

A concise review of calcium pyrophosphate deposition disease ("pseudogout"). James W. Mold, MD, MPH

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Calcium pyrophosphate deposition (CPPD) disease is caused by CPP crystal accumulation in musculoskeletal tissues, leading to inflammation
Symptomatic CPPD disease (formerly known as “pseudogout”) is more common in older than younger adults and typically affects joints with previous damage. Chondrocalcinosis visible on radiographs affects 10% of adults and 50% of those older than 80 years, but most people are asymptomatic and findings are noted incidentally.1

The most common presentation is acute inflammatory monoarthritis affecting the wrists or knees, which resolves within 4 weeks
Extra-articular structures can also be affected, leading to acute inflammatory tendinitis. Crowned dens syndrome comprises 5% of CPPD disease presentations and can mimic bacterial meningitis, manifesting with acute cervical neck pain, fever, and elevated inflammatory markers with CPPD at C1 to C2, seen on computed tomography. The chronic (> 3 mo) inflammatory phenotype presents with hand or wrist symmetric polyarthritis, or with recurrent flares, and can be misdiagnosed as seronegative rheumatoid arthritis. Calcium pyrophosphate deposition disease and osteoarthritis can co-exist — underlying CPPD disease should be considered in patients with osteoarthritis at atypical locations (e.g., metacarpophalangeal joints, wrists, ankles, shoulders, elbows).2

Diagnosis can be confirmed with CPP crystals identified from synovial fluid, or the presence of the crowned dens syndrome
Although used for research, the 2023 Classification Criteria have high sensitivity (99.2%) and specificity (92.5%), thereby providing a diagnostic framework.2 Supportive diagnostic features include acute knee or wrist inflammatory arthritis in an older adult, osteoarthritis at atypical areas, or CPPD on imaging.3

Patients younger than 60 years at diagnosis should be assessed for associated metabolic diseases
Investigations for secondary causes of CPPD disease include calcium (hypercalcemia), parathyroid hormone (hyperparathyroidism), ferritin, transferrin saturation (hemochromatosis), magnesium (hypomagnesemia), and alkaline phosphatase (hypophosphatasia).2

Corticosteroids, colchicine, and nonsteroidal antiinflammatory drugs can treat acute flares4
Inflammatory arthritis lasting more than 3 months or recurrent flares (> 2/yr) should prompt rheumatology referral for consideration of chronic suppressive colchicine, hydroxychloroquine, or methotrexate (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.250933/tab-related-content).5

Author/s:

Timothy S.H. Kwok, Gregory Choy

What Is Ovarian Cancer?

Megan George — Fri, 05 Dec 2025 17:01:51 +0000

Date Added:

December 5, 2025

Journal/Publication:

JAMA

Publication Date:

December 4, 2025

URL:

What Is Ovarian Cancer?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.18446

Keywords

MeSH

Poly(ADP-ribose) Polymerase Inhibitors

Carcinoma

Ovarian Epithelial

Minimally Invasive Surgical Procedures

Poly(ADP-ribose) Polymerases

Fallopian Tubes

Endometriosis

biopsy

Information for patients about ovarian cancer. James W. Mold, MD, MPH

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Ovarian cancer is a malignancy of the ovary, the female reproductive organ that produces eggs.

How Common Is Ovarian Cancer?
Among women worldwide, ovarian cancer is the eighth most common malignancy and cause of cancer death. In 2022, ovarian cancer was diagnosed in about 325 000 individuals and caused 206 839 deaths worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 will die of it.1

What Are the Risk Factors for Ovarian Cancer?
Risk factors for ovarian cancer include older age (the most common age at diagnosis is 63 years), a family history of breast cancer or ovarian cancer, endometriosis (a chronic inflammatory disease in which uterine lining cells are found outside of the uterus), and never having given birth. About 25% of ovarian cancers are due to inherited genetic variants, primarily in BRCA1 and BRCA2 genes.

What Are the Symptoms of Ovarian Cancer?
At the time of diagnosis, most patients with ovarian cancer have symptoms such as abdominal pain, bloating, urgent or frequent urination, and/or increased abdominal size. Signs and symptoms of advanced ovarian cancer may include a mass in the abdominal area, weight loss, and trouble breathing due to abdominal swelling or from fluid surrounding the lungs.

How Is Ovarian Cancer Diagnosed and Staged?
Ovarian cancer is often diagnosed and staged based on findings from a pelvic ultrasound, abdominal computed tomography (CT) scan, and/or abdominal magnetic resonance imaging (MRI). Total-body positron emission tomography (PET) can detect cancer that has spread to more distant sites in the body. To help with staging, some patients may undergo diagnostic laparoscopy, a minimally invasive surgical procedure, in which clinicians look for a tumor within the abdomen and perform biopsies to assess for ovarian cancer.

Stage I ovarian cancer is limited to the ovary or fallopian tube. Stage II cancer has spread beyond the ovaries and fallopian tubes but is still confined within the pelvis. Stage III cancer involves sites outside the pelvis such as nearby lymph nodes or other areas of the abdomen. Stage IV cancer involves organs or tissues outside the abdominal cavity, such as the liver, spleen, or lungs.

How Is Ovarian Cancer Treated?
All patients diagnosed with ovarian cancer should undergo genetic testing, including for BRCA1/2 variants, to help guide treatment and counseling. First-line treatment for patients with early-stage (I and II) ovarian cancer is surgery, including removal of both ovaries and fallopian tubes, the uterus, lymph nodes, and fatty tissue covering the abdominal organs, followed by chemotherapy. Patients with stage I cancer who are considering having children may undergo more limited surgery with removal of the cancerous ovary and fallopian tube, leaving in place the other ovary and fallopian tube and the uterus.

Treatment for patients with stages III and IV (advanced) ovarian cancer includes both surgery and chemotherapy, often combined with individualized targeted therapies such as bevacizumab and/or poly–ADP ribose polymerase (PARP) inhibitors.

Prognosis After Treatment for Ovarian Cancer
Patients with stages I and II ovarian cancer have a 5-year overall survival rate of 70% to 95%. The 5-year overall rate for stages III and IV ovarian cancer is 10% to 40%. However, 5-year survival is about 70% among patients with advanced-stage ovarian cancer who have BRCA genetic variants and are treated with PARP inhibitors.

Author/s:

Rebecca Voelker

Pharmacologic Treatment of Perinatal Depression

Megan George — Fri, 21 Nov 2025 19:44:10 +0000

Date Added:

November 21, 2025

Journal/Publication:

JAMA Insights

Publication Date:

November 19, 2025

URL:

Pharmacologic Treatment of Perinatal Depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.17250

Keywords

Pharmacology

Perinatal Depression

Major Depressive Disorder

abuse

depression

PMID (1):

41259042

A review of the treatment of patients with perinatal depression with an emphasis on pharmalogic therapy. James W. Mold, MD, MPH

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Approximately 1 in 7 individuals are affected by perinatal depression, defined as a depressive episode occurring during pregnancy or within 12 months after delivery. Although the diagnostic criteria are similar to those of major depressive disorder, perinatal depression may also include symptoms such as difficulty forming an emotional attachment with the fetus or infant, persistent doubts about parenting abilities, and intrusive thoughts of harm to self or infant.1 Mental health conditions are leading contributors to maternal mortality in the US; among reporting states, the rate of death from perinatal suicide ranges from 4.2 to 21.4 per 100 000 pregnancies.2 Untreated or undertreated perinatal depression increases other maternal risks, including limited engagement in care, impaired relationships, substance use, preeclampsia, and suicide, as well as fetal or neonatal risks, including preterm birth, low birth weight, and disrupted attachment with long-term developmental consequences.3 Individuals from marginalized communities, such as those who are non–English speaking, uninsured, or geographically isolated, experience a higher prevalence of perinatal depression and are at increased risk of underdiagnosis and undertreatment.3

Risk factors for perinatal depression include a personal or family history of depression, abuse, stressful life events, low socioeconomic status, adolescent or single parenthood, and pregnancy complications, such as preterm birth or pregnancy loss. Each factor individually confers only a small increase in risk, making accurate prediction based on clinical factors challenging.4 Therefore, to facilitate early identification and treatment, universal screening during and after pregnancy is recommended. The American College of Obstetricians and Gynecologists (ACOG) recently issued 2 Clinical Practice Guidelines on perinatal mental health, 1 on screening and diagnosis5 and 1 on treatment and management,3 highlighting opportunities for obstetricians to address existing health gaps.

Author/s:

Emily S. Miller, S. Karlene Cunningham, Lauren M. Osborne

Dental Caries in Adults

Hope Smashey — Thu, 13 Nov 2025 16:20:53 +0000

Date Added:

November 13, 2025

Journal/Publication:

JAMA Insights

Publication Date:

November 12, 2025

URL:

Dental Caries in Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.19029

Keywords

Fluorides

Adults

Cross-Sectional Studies

MeSH

cholinergic antagonists

Tooth Loss

Dental Caries

Dental Caries Susceptibility

A review of the causes, presentations, and management of patients with dental caries with an emphasis on what primary care clinicians can do the help patients until they can see a dentist. James W. Mold, MD, MPH

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Dental caries (tooth decay or cavities) refers to demineralization of teeth, which occurs after bacteria metabolize dietary carbohydrates into acid. More than 90% of US adults experience caries and 26% have untreated caries.

Author/s:

Elizabeth Alpert, Hugh Silk, Lisa Simon

What Should I Know About Stopping Routine Cancer Screening?

Rowan Hutchins — Sun, 19 Mar 2023 05:00:00 +0000

Date Added:

March 19, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 13, 2023

URL:

What Should I Know About Stopping Routine Cancer Screening?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.0088

Keywords

cancer

cancer screening

Neoplasms

PMID (1):

36912847

MeSH

early detection of cancer

Information for patients on when and why to stop getting screening tests for cancer. James W. Mold, MD, MPH

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Cancer screening tests are not perfect. Test results may suggest cancer when there is none (false-positive screen). They can also miss cancer even if it is present (false-negative screen). False-positive results can lead to emotional stress and more testing without improving health. Screening tests may also lead to overdiagnosis. Overdiagnosis is when screening tests find slow-growing forms of cancer that would never have caused symptoms or affected health if left undetected.

Author/s:

Zhang, Grace, Incze, Michael

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

Brian Desmarais — Wed, 29 Jul 2020 15:21:15 +0000

Date Added:

July 29, 2020

Publisher:

Centers for Disease Control and Prevention

Publication Date:

July 24, 2020

URL:

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

Type:

Clinical Research Results

Format:

Article

DOI (1):

http://dx.doi.org/10.15585/mmwr.mm6930e1

MeSH

COVID-19

public health

outpatients

severe acute respiratory syndrome coronavirus 2

Severe Acute Respiratory Syndrome

Public Health Practice

Telephone

Surveys and Questionnaires

Young Adult

Adults

It often takes a long time to recover from COVID-19. James W. Mold, MD, MPH

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Summary

What is already known about this topic?

Relatively little is known about the clinical course of COVID-19 and return to baseline health for persons with milder, outpatient illness.

What is added by this report?

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

What are the implications for public health practice?

COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions. Effective public health messaging targeting these groups is warranted.

Author/s:

Tenforde, M.W., Kim, S.S., Lindsell, C.J., Rose, E.B.

Immunization Strategies to Span the Spectrum of Immunocompromised Adults

John Bayhi — Sat, 15 Feb 2020 20:43:08 +0000

Date Added:

February 15, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier, Inc.

Publication Date:

February 14, 2020

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1016/j.mayocp.2019.09.002

Keywords

MeSH

Immunogenicity, Vaccine

Centers for Disease Control and Prevention, U.S.

risk assessment

This is a concise review of the principles involved in the immunization of patients who are immunocompromised. James W. Mold, MD, MPH

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The Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention provides annual recommendations for routine adult immunizations. Many recommendations consider patient factors such as age, medical conditions, and medications that increase an individual’s risk for infection with a vaccine-preventable disease. These factors, particularly those that lead to immunocompromise, may also alter the risk-benefit ratio for live vaccines, and/or lead to decreased vaccine immunogenicity and effectiveness. The provider may need to consider alternative vaccination strategies, including higher antigen dose vaccines, adjuvanted vaccines, avoidance of live vaccines, and careful timing of vaccination to optimize safety and effectiveness in immunocompromised populations. This thematic review discusses general principles regarding immunization of adults across the spectrum of immunocompromise, examines current guidelines and studies that support them, and outlines future research needs.

Author/s:

Whitaker, JA

Recommended Adult Immunization Schedule, United States, 2020

Brian Desmarais — Tue, 04 Feb 2020 15:28:01 +0000

Date Added:

February 4, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

February 4, 2020

Volume:

Online

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-0046

Keywords

guidelines

adult immunization

MeSH

Immunization Schedule

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services (U.S.)

Adults

2020 guidelines for adult immunizations with printable charts. James W. Mold, MD, MPH

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In October 2019, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020. The 2020 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2020 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org).

Author/s:

Freedman, M., Kroger, A., Hunter, P., Ault, K.A.