prevalence

Narcolepsy

Nathan Hinkle — Fri, 11 Sep 2026 05:00:00 +0000

Date Added:

September 11, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

September 9, 2026

Pages:

E1-E2

URL:

Narcolepsy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.14685

Keywords

MeSH

RPR Commentary: A concise review of what we currently understand about narcolepsy. James W. Mold, MD, MPH

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Narcolepsy is a chronic neurologic disorder that causes severe daytime sleepiness and impaired quality of life. Symptoms typically begin around age 10 to 20 years, yet diagnosis is often delayed for more than a decade.1 Narcolepsy is classified into narcolepsy type 1 (NT1; narcolepsy with cataplexy) and narcolepsy type 2 (NT2; narcolepsy without cataplexy), with estimated global prevalences of 19 and 23 per 100 000 persons, respectively.2

Author/s:

Kiran P. Maski, Thomas Scammell

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Megan George — Tue, 11 Nov 2025 14:43:19 +0000

Date Added:

November 11, 2025

Journal/Publication:

JAMA

Publication Date:

November 10, 2025

URL:

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.19615

Keywords

liver disease

steatotic liver disease

MASLD

Steatohepatitis

PMID (1):

41212550

MeSH

Glucagon-Like Peptide-1 Receptor Agonists

semaglutide

cardiovascular diseases

prevalence

diabetes mellitus

diabetes mellitus, type 2

Prediabetic State

liver cirrhosis

A review of metabolic dysfunction–associated steatotic liver disease in adults. James W. Mold, MD, MPH

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Importance Metabolic dysfunction–associated steatotic liver disease (MASLD) includes a range of liver conditions, progressing from isolated steatosis (characterized by fat accumulation in the liver without inflammation) to metabolic dysfunction–associated steatohepatitis (MASH), which involves fat accumulation and inflammation in the liver. The presence of MASLD is associated with increased morbidity and mortality due to liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers.

Observations The most common chronic liver disease worldwide, MASLD affects approximately 30% to 40% of the general adult population globally (with varying prevalence across continents), including approximately 60% to 70% of individuals with type 2 diabetes and approximately 70% to 80% of those with obesity. It is typically diagnosed based on an ultrasonographic finding of hepatic steatosis, along with at least 1 of 5 features of the metabolic syndrome (abdominal overweight or obesity, prediabetes or type 2 diabetes, hypertension, elevated level of plasma triglycerides, and low level of high-density lipoprotein cholesterol) for women who consume less than 140 g/wk of alcohol (<2 standard drinks/d) and for men who consume less than 210 g/wk (<3 standard drinks/d) and have no other known causes of steatosis such as use of a particular medication (eg, corticosteroids, tamoxifen, or methotrexate), hepatitis C, or iron overload. Other risk factors for MASLD include older age (≥50 years) and male sex (male:female ratio approximately 2). The Fibrosis-4 index (a scoring system incorporating age, serum levels of aspartate aminotransferase and alanine aminotransferase, and platelet count) and vibration-controlled transient elastography (a noninvasive imaging technique) are commonly used to stage hepatic fibrosis in patients with MASLD. Cardiovascular disease is the leading cause of death, followed by certain extrahepatic cancers (primarily gastrointestinal, breast, and gynecologic cancer) and liver-related complications, including cirrhosis, hepatic decompensation (ascites, hepatic encephalopathy, or variceal bleeding), and hepatocellular carcinoma. First-line treatment of MASLD involves behavioral modifications (including hypocaloric low-carbohydrate and low-fat diets, physical exercise, and avoidance of alcohol) and management of type 2 diabetes, obesity, hypertension, and hyperlipidemia. Bariatric surgery should be considered for patients with MASLD and a body mass index greater than 35. Resmetirom (a liver-directed, thyroid hormone receptor β-selective agonist) and subcutaneous semaglutide (a glucagon-like peptide-1 receptor agonist) are conditionally approved by the US Food and Drug Administration (FDA) for the treatment of adults with MASH who have moderate to advanced fibrosis.

Conclusions A highly prevalent condition among adults worldwide, MASLD is associated with liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers. First-line treatment includes behavioral modifications, including a weight-reducing diet, physical exercise, and avoidance of alcohol. Resmetirom and semaglutide are conditionally FDA-approved medications for the treatment of adults with MASH and moderate to advanced fibrosis.

Author/s:

Herbert Tilg, Salvatore Petta, Norbert Stefan, Giovanni Targher

Uterine Fibroids

Alex Haga — Tue, 23 Apr 2024 17:28:25 +0000

Date Added:

April 23, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

April 10, 2024

URL:

Uterine Fibroids

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.0447

Keywords

MeSH

A review of current knowledge regarding uterine fibroids and what to do about them. James W. Mold, MPH

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Uterine fibroids are sex–steroid responsive benign tumors primarily composed of smooth muscle cells and extracellular matrix that develop in the wall of the uterus.1 They are one of the most common neoplasms in reproductive-aged women. Lifetime prevalence estimates in premenopausal women range from 40% to 89%, depending on the method of detection, the study population, and the ages of those studied. Fibroids can range in size from less than 1 cm to more than 20 cm. Although not all individuals with fibroids have symptoms, typical symptoms include abnormal uterine bleeding/heavy menstrual bleeding (AUB/HMB), pelvic bulk symptoms (protruding abdomen, pressure on bladder and bowels), pain, and reproductive morbidity (ie, infertility). Due to their high prevalence and associated symptoms, fibroids are the leading cause of hysterectomy in the US and account for up to $34 billion annually in direct and indirect costs.

Author/s:

Marsh, E.E., Wegienka, G., Williams, D.R.

Nonspecific Low Back Pain

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

May 5, 2022

Issue:

Volume:

386

Pages:

1732-1740

URL:

Nonspecific Low Back Pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2032396

Keywords

back pain

Nonspecific Low Back Pain

MeSH

A review of what we think we know about non-specific low back pain. James W. Mold, MD, MPH

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Low back pain typically defined as pain below the costal margin and above the inferior gluteal folds with or without leg pain 1 is worldwide the most prevalent and most disabling of the conditions that are considered to benefit from rehabilitation 2 In a systematic review that included 165 studies from 54 countries the mean point prevalence of low back pain in the general adult population was approximately 12 with a higher prevalence among persons 40 years of age or older and among women the lifetime prevalence was approximately 40 3 Low back pain is classified as specific pain and other symptoms that are caused by specific pathophysiological mechanisms of nonspinal or spinal origin or nonspecific back pain with or without leg pain without a clear nociceptive-specific cause 4 Nonspinal causes of specific low back pain include hip conditions diseases of the pelvic organs e g prostatitis and endometriosis and vascular e g aortic aneurysm or systemic disorders spinal causes include herniated disk spinal stenosis fracture tumor infection and axial spondyloarthritis Lumbar disorders with radicular pain due to nerve-root involvement have a higher prevalence 5 to 10 than other spinal causes the two most frequent causes of such back pain are herniated disk and spinal stenosis 5 The overall prevalence of the other spinal disorders is low among patients with acute low back pain For example among 1172 patients who presented to primary care clinicians in Australia with acute low back pain only 11 0 9 were found to have serious spinal conditions mostly fractures during 1 year of follow-up 6 The authors of a Dutch study that involved primary care patients reported axial spondyloarthritis in almost one quarter of adults 20 to 45 years of age who presented with chronic low back pain 7 although these findings have not been replicated In contrast to low back pain caused by specific identifiable causes nonspecific low back pain probably develops from the interaction of biologic psychological and social factors 4 and it accounts for approximately 80 to 90 of all cases of low back pain 1 Low back pain is usually classified according to pain duration as acute 6 weeks subacute 6 to 12 weeks or chronic 12 weeks

Author/s:

Chiarotto, A., Koes, B. W.

Lateral epicondylosis

Saige Blanchard — Mon, 28 Feb 2022 06:00:00 +0000

Date Added:

February 28, 2022

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact Inc.

Publication Date:

February 22, 2022

Issue:

Volume:

194

URL:

Lateral epicondylosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.211047

Keywords

Tennis Elbow

Elbow

Condition

Common Extensor Origin

MeSH

A quick and dirty summary of the diagnosis and management of tennis elbow from out Canadian colleagues. James W. Mold, MD, MPH

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Lateral epicondylosis tennis elbow is a degenerative noninflammatory condition of the common extensor origin at the lateral epicondyle of the elbow Tennis elbow has a prevalence of 1 3 peaking at age 35 50 years 1 It is associated with smoking and with a combination of repetitive and forceful manual activities 2

Author/s:

Li, Y., Liu, F., Badre, A.

Food Allergy Prevention: Early Versus Late Introduction of Food Allergens in Children

Saige Blanchard — Tue, 08 Feb 2022 06:00:00 +0000

Date Added:

February 8, 2022

Journal/Publication:

Cureus Journal of Medical Science

Publisher:

Cureus

Publication Date:

January 9, 2022

URL:

Food Allergy Prevention: Early Versus Late Introduction of Food Allergens in Children

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7759/cureus.21046

Keywords

MeSH

Food Hypersensitivity

allergens

A summary of what we know about the introduction of foods in infancy and the risk of subsequent food allergies. James W. Mold, MD, MPH

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The emergence of food allergies in children is crucial for various medical fields seeking a viable strategy for allergy prevention. The most well-recognized approach adopted by numerous health care and government institutions hinges on the delay in the introduction of food allergens, which supposedly protects infants from sensitization and decreases the possibility of allergy development. However, recent experimental findings indicate that the benefits of this approach might be overestimated, as early exposure to allergenic foods has been shown to yield more advantageous outcomes. Multiple investigations on the causes of allergic diseases report that avoiding food allergies might be related to early consumption of these allergens. Alternatively, delaying the contact with allergenic nourishments, explored in contemporary research, has been proven to result in a higher prevalence of allergies among children, originating such conditions as atopic diseases and extreme sensitization to foods. The current paper compares the two prominent strategies of allergenic food introduction, gathering the most pertinent modern evidence to distinguish whether exposure to food allergens should be delayed or advanced.

Author/s:

Djossi, S. K., Khedr, A., Neupane, B., Proskuriakova, E., Jada, K., Mostafa, J. A.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021-22 Influenza Season

Bethie Seay — Thu, 26 Aug 2021 05:00:00 +0000

Date Added:

August 26, 2021

Type:

Public Health Announcements

MeSH

Influenza A Virus, H1N1 Subtype

SARS-CoV-2

influenza, human

vaccines, inactivated

Pregnancy Trimester, Third

Inpatients

prevalence

united states food and drug administration

Centers for Disease Control and Prevention, U.S.

Intensive Care Units

Cell Culture Techniques

delivery of health care

The 2021-2022 CDC recommendations regarding administration of influenza vaccines.

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This report updates the 2020–21 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2020;69[No. RR-8]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021–22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4).

The 2021–22 influenza season is expected to coincide with continued circulation of SARS-CoV-2, the virus that causes COVID-19. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient visits, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Recommendations for the use of COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, and additional clinical guidance is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-v....

Updates described in this report reflect discussions during public meetings of ACIP that were held on October 28, 2020; February 25, 2021; and June 24, 2021. Primary updates to this report include the following six items. First, all seasonal influenza vaccines available in the United States for the 2021–22 season are expected to be quadrivalent. Second, the composition of 2021–22 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. U.S.-licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture–based and recombinant vaccines), an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Third, the approved age indication for the cell culture–based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), has been expanded from ages ≥4 years to ages ≥2 years. Fourth, discussion of administration of influenza vaccines with other vaccines includes considerations for coadministration of influenza vaccines and COVID-19 vaccines. Providers should also consult current ACIP COVID-19 vaccine recommendations and CDC guidance concerning coadministration of these vaccines with influenza vaccines. Vaccines that are given at the same time should be administered in separate anatomic sites. Fifth, guidance concerning timing of influenza vaccination now states that vaccination soon after vaccine becomes available can be considered for pregnant women in the third trimester. As previously recommended, children who need 2 doses (children aged 6 months through 8 years who have never received influenza vaccine or who have not previously received a lifetime total of ≥2 doses) should receive their first dose as soon as possible after vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. For nonpregnant adults, vaccination in July and August should be avoided unless there is concern that later vaccination might not be possible. Sixth, contraindications and precautions to the use of ccIIV4 and RIV4 have been modified, specifically with regard to persons with a history of severe allergic reaction (e.g., anaphylaxis) to an influenza vaccine. A history of a severe allergic reaction to a previous dose of any egg-based IIV, LAIV, or RIV of any valency is a precaution to use of ccIIV4. A history of a severe allergic reaction to a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency is a precaution to use of RIV4. Use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction. For ccIIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or any component of ccIIV4 is a contraindication to future use of ccIIV4. For RIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or any component of RIV4 is a contraindication to future use of RIV4.

This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2021–22 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration–licensed indications. Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu); vaccination and health care providers should check this site periodically for additional information.

Author/s:

Grohskopf, L. A., Alyanak, E., Ferdinands, J. M., Broder, K. R., Blanton, L. H., Talbot, H. K., Fry, A. M.

Screening for Prediabetes and Type 2 Diabetes

Bethie Seay — Thu, 26 Aug 2021 05:00:00 +0000

Date Added:

August 26, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2021.12531

The U.S. Preventive Services Advisory Committee recommends screening nonpregnant adults aged 35 – 70 with BMI >25 for prediabetes and diabetes. While there is no recommendation regarding how often to screen, they mention that every 3 years seems reasonable based upon the evidence they reviewed.

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IMPORTANCE An estimated 13% of all US adults (18 years or older) have diabetes, and 34.5%
meet criteria for prediabetes. The prevalences of prediabetes and diabetes are higher in older
adults. Estimates of the risk of progression from prediabetes to diabetes vary widely, perhaps
because of differences in the definition of prediabetes or the heterogeneity of prediabetes.
Diabetes is the leading cause of kidney failure and new cases of blindness among adults in the
US. It is also associated with increased risks of cardiovascular disease, nonalcoholic fatty liver
disease, and nonalcoholic steatohepatitis and was estimated to be the seventh leading cause
of death in the US in 2017. Screening asymptomatic adults for prediabetes and type 2
diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of
improving health outcomes.
OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a systematic
review to evaluate screening for prediabetes and type 2 diabetes in asymptomatic,
nonpregnant adults and preventive interventions for those with prediabetes.
POPULATION Nonpregnant adults aged 35 to 70 years seen in primary care settings who have
overweight or obesity (defined as a body mass index 25 and 30, respectively) and no
symptoms of diabetes.
EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for
prediabetes and type 2 diabetes and offering or referring patients with prediabetes to
effective preventive interventions has a moderate net benefit.
CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for prediabetes
and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians
should offer or refer patients with prediabetes to effective preventive interventions.
(B recommendation)

Author/s:

US Preventative Services task Force

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Saige Blanchard — Fri, 13 Aug 2021 18:17:11 +0000

Date Added:

August 13, 2021

Journal/Publication:

Nature Portfolio

Publisher:

Springer Nature

URL:

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Keywords

MeSH

attention deficit disorder with hyperactivity

COVID-19

headache

Publications

The SARS-2 COVID-19 virus is a nasty little germ. It seems to cause a host of long-lasting symptoms. James W. Mold, MD, MPH

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COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to
months after initial recovery. This systematic review and meta-analysis aims to identify studies
assessing the long-term efects of COVID-19. LitCOVID and Embase were searched to identify articles
with original data published before the 1st of January 2021, with a minimum of 100 patients. For
efects reported in two or more studies, meta-analyses using a random-efects model were performed
using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were
followed. A total of 18,251 publications were identifed, of which 15 met the inclusion criteria. The
prevalence of 55 long-term efects was estimated, 21 meta-analyses were performed, and 47,910
patients were included (age 17–87 years). The included studies defned long-COVID as ranging from 14
to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2
developed one or more long-term symptoms. The fve most common symptoms were fatigue (58%),
headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary
teams are crucial to developing preventive measures, rehabilitation techniques, and clinical
management strategies with whole-patient perspectives designed to address long COVID-19 care.

Author/s:

S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., Villapol, S.

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Brian Desmarais — Thu, 22 Oct 2020 14:30:11 +0000

Date Added:

October 22, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

October 20, 2020

Issue:

Volume:

324

Pages:

1543-1556

URL:

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1001/jama.2020.17024

MeSH

cardiovascular diseases

Patient Advocacy

comorbidity

Abstracting and Indexing

A guideline for the medical care of adults with Down’s Syndrome (see Results section). James W. Mold,. MD, MPH

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Abstract

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients.

Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome.

Evidence review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence.

Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome.

Conclusions and relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.

Author/s:

Tsou, Amy Y., Bulova, Peter, Capone, George, Chicoine, Brian, Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup

Perioperative alcohol cessation intervention for postoperative complications

Brian Desmarais — Sat, 15 Aug 2020 19:59:34 +0000

Date Added:

August 15, 2020

Journal/Publication:

The Cochrane Database of Systematic Reviews

Publication Date:

November 8, 2018

Issue:

Volume:

URL:

Perioperative alcohol cessation intervention for postoperative complications

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD008343.pub3.

MeSH

Postoperative Complications

This Cochrane review suggests that efforts to help adults with a history of risky alcohol consumption to quit prior to and following surgery reduces surgical complications including mortality. That isn’t surprising, but we haven’t always paid as much attention to alcohol consumption as we have to smoking as a risk factor for surgical complications. James W. Mold, MD, MPH

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Background: Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018.

Objectives: To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption.

Search methods: We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information.

Selection criteria: We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies.

Data collection and analysis: We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach.

Main results: We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.

Authors' conclusions: This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.

Conflict of interest statement

Hanne Tønnesen has authored all three of the studies included in this review (Egholm 2017; Tønnesen 1999a; Tønnesen 2002).

Julie Weber Melchior Egholm, Johanna Adami, and Bolette Pedersen have authored one of the included studies (Egholm 2017).

Hanne Tønnesen is also the primary investigator for the ongoing study (NCT02188446).

Therefore, to avoid any potential bias, Carsten B Juhl extracted data and checked the interpretation against study reports and any available study registration details or protocols as an independent review author.

Author/s:

Egholm, Julie W., Pedersen, Bolette, Møller, Ann M., Adami, Johanna, Juhl, Carsten B., Tønnesen, Hanne

The Unrecognized Prevalence of Primary Aldosteronism

John Bayhi — Tue, 26 May 2020 21:01:14 +0000

Date Added:

May 26, 2020

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

May 26, 2020

Volume:

Online ahead of print

URL:

The Unrecognized Prevalence of Primary Aldosteronism

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M20-0065

Keywords

primary aldosteronism

hypertension

cardiovascular disease

PMID (1):

32449886

MeSH

Essential Hypertension

Cross-Sectional Studies

prevalence

cardiovascular diseases

Hyperaldosteronism

hypertension

Hypoakalemia

Blood Pressure Determination

Academic Medical Centers

Potassium

Sodium

This study suggests (confirming what Dr. David Kem at OU has long taught) that primary aldosteronism is much more common than generally thought, occurring in as many as 11% of people with normal BP and 22% of those with hard to control HTN. Usual diagnostic tests aren’t very accurate. We should probably be using spironolactone more often. James W. Mold, MD, MPH

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Background:

Primary aldosteronism is a nonsuppressible renin-independent aldosterone production that causes hypertension and cardiovascular disease.

Objective:

To characterize the prevalence of nonsuppressible renin-independent aldosterone production, as well as biochemically overt primary aldosteronism, in relation to blood pressure.

Design:

Cross-sectional study.

Setting:

4 U.S. academic medical centers.

Participants:

Participants with normotension (n = 289), stage 1 hypertension (n = 115), stage 2 hypertension (n = 203), and resistant hypertension (n = 408).

Measurements:

Participants completed an oral sodium suppression test, regardless of aldosterone or renin levels, as a confirmatory diagnostic for primary aldosteronism and to quantify the magnitude of renin-independent aldosterone production. Urinary aldosterone was measured in participants in high sodium balance with suppressed renin activity. Biochemically overt primary aldosteronism was diagnosed when urinary aldosterone levels were higher than 12 µg/24 h.

Results:

Every blood pressure category had a continuum of renin-independent aldosterone production, where greater severity of production was associated with higher blood pressure, kaliuresis, and lower serum potassium levels. Mean adjusted levels of urinary aldosterone were 6.5 µg/24 h (95% CI, 5.2 to 7.7 µg/24 h) in normotension, 7.3 µg/24 h (CI, 5.6 to 8.9 µg/24 h) in stage 1 hypertension, 9.5 µg/24 h (CI, 8.2 to 10.8 µg/24 h) in stage 2 hypertension, and 14.6 µg/24 h (CI, 12.9 to 16.2 µg/24 h) in resistant hypertension; corresponding adjusted prevalence estimates for biochemically overt primary aldosteronism were 11.3% (CI, 5.9% to 16.8%), 15.7% (CI, 8.6% to 22.9%), 21.6% (CI, 16.1% to 27.0%), and 22.0% (CI, 17.2% to 26.8%). The aldosterone–renin ratio had poor sensitivity and negative predictive value for detecting biochemically overt primary aldosteronism.

Limitation:

Prevalence estimates rely on arbitrary and conventional thresholds, and the study population may not represent nationwide demographics.

Conclusion:

The prevalence of primary aldosteronism is high and largely unrecognized. Beyond this categorical definition of primary aldosteronism, there is a prevalent continuum of renin-independent aldosterone production that parallels the severity of hypertension. These findings redefine the primary aldosteronism syndrome and implicate it in the pathogenesis of “essential” hypertension.

Primary Funding Source:

National Institutes of Health.

Author/s:

Brown, JM, Siddiqui, M, Calhoun, DA, Carey, RM, Hopkins, PN, Williams, GH, Vaidya, A

Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis

Brian Desmarais — Sat, 11 Apr 2020 18:25:13 +0000

Date Added:

April 11, 2020

Journal/Publication:

JAMA Network Open

Publisher:

Journal of American Medical Association

Publication Date:

April 1, 2020

URL:

Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.2370.

Keywords

MeSH

substance withdrawal syndrome

Health Behavior

A meta-analysis of the incidence (47%) and predictors (concomitant tobacco or other substance abuse) of cannabis withdrawal symptoms. James W. Mold, MD, MPH

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IMPORTANCE:

Cannabis withdrawal syndrome (CWS)-a diagnostic indicator of cannabis use disorder-commonly occurs on cessation of heavy and prolonged cannabis use. To date, the prevalence of CWS syndrome has not been well described, nor have the factors potentially associated with CWS.

OBJECTIVES:

To estimate the prevalence of CWS among individuals with regular or dependent use of cannabinoids and identify factors associated with CWS.

DATA SOURCES:

A search of literature from database inception to June 19, 2019, was performed using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles.

STUDY SELECTION:

Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional).

DATA EXTRACTION AND SYNTHESIS:

All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. Cannabis withdrawal syndrome prevalence was estimated using a random-effects meta-analysis model, alongside stratification and meta-regression to characterize heterogeneity.

MAIN OUTCOMES AND MEASURES:

Cannabis withdrawal syndrome prevalence was reported as a percentage with 95% CIs.

RESULTS:

Of 3848 unique abstracts, 86 were selected for full-text review, and 47 studies, representing 23 518 participants, met all inclusion criteria. Of 23 518 participants included in the analysis, 16 839 were white (72%) and 14 387 were men (69%); median (SD) age was 29.9 (9.0) years. The overall pooled prevalence of CWS was 47% (6469 of 23 518) (95% CI, 41%-52%), with significant heterogeneity between estimates (I2 = 99.2%). When stratified by source, the prevalence of CWS was 17% (95% CI, 13%-21%) in population-based samples, 54% in outpatient samples (95% CI, 48%-59%), and 87% in inpatient samples (95% CI, 79%-94%), which were significantly different (P < .001). Concurrent cannabis (β = 0.005, P < .001), tobacco (β = 0.002, P = .02), and other substance use disorders (β = 0.003, P = .05) were associated with a higher CWS prevalence, as was daily cannabis use (β = 0.004, P < .001).

CONCLUSIONS AND RELEVANCE:

These findings suggest that cannabis withdrawal syndrome appears to be prevalent among regularusers of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.

Author/s:

Bahji, A., Stephenson, C., Tyo, R., Hawken, E.R., Seitz, D.P.

Tinnitus

John Bayhi — Mon, 23 Mar 2020 21:17:31 +0000

Date Added:

March 23, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 16, 2020

URL:

Tinnitus

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.0697

Keywords

tinnitus

hearing loss

noise

PMID (1):

32176246

MeSH

A nice review of what we currently know about tinnitus. James W. Mold, MD, MPH

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Tinnitus is an auditory perception in the absence of an auditory stimulus. It may be associated with acoustic trauma (eg, exposure to loud noise), chronic hearing loss, emotional stressors, or spontaneous occurrence. The psychopathological reaction to the perceived auditory stimulus is an enormous source of distress and disability for many patients with tinnitus. National health surveys estimate that nearly 10 in 100 adults experience some form of tinnitus. Among workers exposed to occupational noise, the prevalence of tinnitus is 15 per 100. Of these, tinnitus is burdensome and chronic for roughly 20 million and extreme and debilitating tinnitus for 2 million US residents. Many patients with tinnitus report that the auditory perception impairs sleep, concentration, and cognitive function required for day-to-day functioning. Among the nearly 4.5 million US military veterans receiving service-connected compensation, 42% receive compensation for tinnitus, which makes it the most prevalent service-connected disability. The number of veterans who receive compensation due to tinnitus is nearly 60% greater than the number of veterans who receive compensation for hearing loss, which is the condition with the second most disability claims.

Author/s:

Piccirillo, JF, Rodebaugh, TL, Lenze, EJ

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

John Bayhi — Sat, 14 Mar 2020 20:31:53 +0000

Date Added:

March 14, 2020

Journal/Publication:

MMWR Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

March 13, 2020

Issue:

Volume:

Pages:

265-270

URL:

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm6910a3

Keywords

alcohol use

screening and brief intervention

alcohol SBI

binge drinking

PMID (1):

32163383

MeSH

Behavioral Risk Factor Surveillance System

Fetal Alcohol Spectrum Disorders

Public Health Practice

health personnel

Evidence-Based Medicine

insurance coverage

Telephone

Centers for Disease Control and Prevention

U.S.

Longitudinal Studies

The CDC recommends screening all adults for binge drinking with a single question and recommending reduction to those who screen positive. James W. Mold, MD, MPH

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What is already known about this topic?

Binge drinking increases the risk for adverse health conditions and death. Alcohol screening and brief intervention (SBI), recommended by the U.S. Preventive Services Task Force (USPSTF) for all adults in primary care, is effective in reducing binge drinking.

What is added by this report?

In 2017, 81% of survey respondents were asked by their health care provider about alcohol consumption and 38% about binge drinking at a checkup in the past 2 years. Among those asked about alcohol use and who reported current binge drinking, 80% received no advice to reduce their drinking.

What are the implications for public health practice?

Implementation of alcohol SBI as recommended by USPSTF, coupled with population-level evidence-based interventions, can reduce binge drinking among U.S. adults.

Author/s:

McKnight-Eily, LR, Okoro, CA, Turay, K, Acero, C, Hungerford, D