Tuberculosis (TB) is the leading cause of infection-related mortality in the world, and cases in the United States are increasing. Prompt diagnosis, isolation, and treatment improve patient outcomes and reduce onward transmission. Screening of contacts and high-risk persons for asymptomatic TB infection and treatment of those testing positive reduces progression to disease. TB disease should be suspected in persons with compatible symptoms, risk factors, and consistent imaging. Microbiological confirmation requires an acid-fast smear, nucleic acid amplification test, and culture. Treatment, guided by drug sensitivity testing, requires multiple antibiotics given for 4 to 9 months and monitoring for drug toxicity and clinical response.
BACKGROUND:The 1959 World Health Organization (WHO) definition of anemia is widely used, but its relationship with mortality in the general adult population is uncertain. OBJECTIVE:To evaluate associations between baseline hemoglobin concentration and long-term mortality by age and sex. DESIGN:Prospective cohort study. SETTING:Population-based cohort in the United Kingdom. PARTICIPANTS:502 188 adults (median age, 58 years; 54.4% women) recruited from 2006 to 2010; hemoglobin concentration was measured in 477 876 (95.2%). Analyses were stratified by sex and age (<60 vs. ≥60 years). Median follow-up was 13.6 years. MEASUREMENTS:Hemoglobin concentration categorized relative to WHO sex-specific thresholds (men, <13.0 g/dL; women, <12.0 g/dL). Outcomes were all-cause, cardiovascular, and cancer mortality. RESULTS:All-cause mortality showed a U-shaped association with hemoglobin concentration, with lowest risk 1 to 3 g/dL above the WHO threshold. In the primary adjusted model, the 10-year standardized cumulative incidence (SCI) was 4.5% in the reference group versus 12.5% among participants more than 2 g/dL below the threshold (absolute risk difference [ARD], +8.1 percentage points; 95% CI, 6.7 to 9.4 percentage points); over the entire follow-up, the adjusted hazard ratio (HR) was 2.87 (CI, 2.54 to 3.25). Among those 0 to 1 g/dL above the threshold, the 10-year SCI was 5.3% (ARD, +0.8 percentage points; CI, 0.7 to 1.0 percentage points) and the adjusted HR was 1.18 (CI, 1.15 to 1.21). Associations were less consistent in women younger than 60 years. Patterns for cardiovascular and cancer mortality were similar at low and borderline concentrations but attenuated at higher concentrations. LIMITATION:Single baseline hemoglobin concentration measurement; predominantly White population. CONCLUSION:Mortality was lowest at hemoglobin concentrations 1 to 3 g/dL above current WHO thresholds, with higher mortality below and above this range. These hypothesis-generating findings should not define new thresholds but may inform clinical interpretation and evaluation of borderline hemoglobin concentration values. PRIMARY FUNDING SOURCE:None.
BACKGROUND:Hospitalizations for alcohol use disorder (AUD) are common and morbid. Outpatient follow-up after discharge is critical for reducing alcohol use and subsequent readmissions, but effective interventions to support this transition are unknown. PURPOSE:To summarize evidence on the effectiveness of hospital-based interventions to improve outpatient follow-up for AUD. DATA SOURCES:Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL (January 2000 to February 2025). STUDY SELECTION:Two authors independently reviewed abstracts and full-text articles to identify hospital-based trials and cohort studies that evaluated interventions to improve outpatient AUD follow-up versus usual care or an active comparator. DATA EXTRACTION:Study data were extracted by 2 authors using a standardized template. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and GRADE (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS:Seventeen studies of 21 interventions (12 randomized clinical trials [RCTs] [n = 1917], 3 nonrandomized trials [n = 459], and 2 cohort studies [n = 9974]) were included. Interventions were heterogeneous, and most (85%) included several components: behavioral (76%), care coordination (76%), medication management (14%), and social support (33%). Eight interventions (38%) reported improved linkage to outpatient follow-up. Effective interventions generally combined behavioral and care coordination with AUD medications or social support. Effect sizes across RCTs ranged from an 8% absolute decrease to a 30% absolute increase in outpatient follow-up. The certainty of evidence was low due to the high risk of bias and imprecision of results. LIMITATION:Only English-language publications were included. CONCLUSION:Few intervention studies of low certainty improved posthospitalization follow-up for patients with AUD. Given the substantial morbidity associated with untreated AUD, high-quality RCTs testing various components of interventions are needed. PRIMARY FUNDING SOURCE:None. (PROSPERO: CRD42025636943).
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Endocrinology: [Formula: see text] Geriatrics: [Formula: see text] Rheumatology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].
CLINICAL IMPACT RATINGS:Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Critical Care: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Gastroenterology: [Formula: see text] Public Health: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Endocrinology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text] Nephrology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Nephrology: [Formula: see text] Hematology: [Formula: see text].
BACKGROUND:Maternal folic acid prevents neural tube defects, but associations of parental folate and vitamin B12 with birth defects remain unclear. OBJECTIVE:To quantify associations of parental vitamin B12 and red blood cell (RBC) folate with offspring birth defects. DESIGN:Prospective cohort study. SETTING:Shanghai Preconception Cohort, China. PARTICIPANTS:3032 couples (73 birth defect cases) with biomarkers sampled within 4 months before conception, and 17 765 women (327 birth defect cases) sampled at 4 months' gestation or earlier. MEASUREMENTS:Standardized predicted prevalences of birth defects ascertained among live births, stillbirths, and abortions due to fetal abnormalities were estimated using weighted logistic regression. RESULTS:Higher preconception parental levels of vitamin B12 were associated with lower predicted prevalences of birth defects in dose-response analyses. For preconception maternal vitamin B12 from the lowest (<148 pmol/L) to highest (≥590 pmol/L) categories, predicted prevalence decreased from 49.6 to 16.2 cases per 1000 pregnancies; paternal vitamin B12 showed a similar but attenuated pattern (55.5 to 24.0 cases per 1000 pregnancies). Preconception parental RBC folate showed imprecise patterns of lower predicted prevalence. For postconception maternal RBC folate, predicted prevalence was lower at levels of 906 to 1131 nmol/L than at levels below 453 nmol/L (16.5 vs. 25.7 cases per 1000 pregnancies), with little further reduction at higher levels. For postconception maternal vitamin B12, predicted prevalence changed little across lower categories but was lower at higher levels (11.8 vs. 20.4 cases per 1000 pregnancies at ≥590 vs. 148 to 294 pmol/L, respectively). LIMITATION:Residual confounding. CONCLUSION:Periconception parental vitamin B12 and postconception maternal RBC folate were associated with lower predicted prevalences of birth defects. PRIMARY FUNDING SOURCE:National Key Research and Development Program of China, National Natural Science Foundation of China, and Chinese Academy of Medical Sciences.
