News and Updates for Healthcare Professionals

Temporary disruptions in routine and nonemergency medical care access and delivery have been observed during periods of considerable community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). However, medical care delay or avoidance might increase morbidity and mortality risk associated with treatable and preventable health conditions and might contribute to reported excess deaths directly or indirectly related to COVID-19.

The U.S. Food and Drug Administration’s mission is to protect and promote the public health, both in the U.S. and globally, by ensuring the safety and effectiveness of the products we regulate. Nowhere is this public health mission more evident than in the FDA’s role in the scientific and regulatory oversight of vaccines. One of the agency’s highest priorities is ensuring the quality, safety and effectiveness of vaccines. This deep and abiding commitment is something that we consider essential to engendering the public’s trust in vaccines.

Strategies for Patient, Family, and Caregiver Engagement

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, today announced that it has awarded 11 grants with a total first-year value of approximately $17 million to establish the Centers for Research in Emerging Infectious Diseases (CREID).

A consensus statement published in Diabetes Care outlines the benefits and barriers associated with diabetes self-management education and support (DSMES) in adults with type 2 diabetes.

In the United States, it is estimated that about 37 million adults have chronic kidney disease (CKD).1 Generally, sleep problems have been associated with higher mortality risk, chronic diseases such as heart disease, and progression of CKD.2-4 As a considerable proportion of the US population has reported sleep problems, prevalence is generally higher in adults with CKD than adults without CKD.3

In the 2013-2014 National Health and Nutrition Examination Survey, two in five (41.0%) adults with CKD stages 3 and 4 reported trouble sleeping compared with 29.2% in adults with CKD stages 1 and 2* and 27.1% in adults with no CKD. The percentage reporting sleep disorders was also higher in adults with CKD stages 3 and 4 (17.7%) and CKD stages 1 and 2 (13.6%) than in adults without CKD (9.6%). Nocturia (waking up during the night to urinate) was also more prevalent in adults with CKD—39.4% in CKD stages 3 and 4 and 38.7% in CKD stages 1 and 2—compared with 24.3% in adults with no CKD. On the other hand, inadequate sleep was similar among adults with and without CKD.

The higher burden of sleep problems among adults with CKD, especially with stages 3 and 4, highlights the importance for early detection and management of these symptoms in the primary and specialty care settings.

References:

1. Centers for Disease Control and Prevention. Chronic Kidney Disease Basics website. https://www.cdc.gov/kidneydisease/basics.html.
2. Centers for Disease Control and Prevention. Sleep and Sleep Disorders website. https://www.cdc.gov/sleep/index.html.
3. Shieu M, Morgenstern H, Bragg-Gresham J, et al. US trends in prevalence of sleep problems and associations with chronic kidney disease and mortality. Kidney360. 2020;1(6):458–468. DOI: https://doi.org/10.34067/KID.0000862019.
4. Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888–895. DOI: 10.1136/thoraxjnl-2015-206970.

Foot ulcers are the leading cause of lower limb amputations in the United States.

EGT has reached yet another milestone and has published its 600th Guideline Brief and Scorecard. This represents guidelines from 77 developer organizations and covers more than 52 clinical topics.

Large PCORI-, NIH-funded trial examined multipronged intervention in real-world settings.

Million Hearts® understands that hospitals and health systems are challenged, working hard, and adjusting to meet the needs of their patients, employees, and communities during the pandemic. Focusing on cardiovascular health has never been more important. The Million Hearts® Hospitals & Health Systems Recognition Program recognizes institutions working systematically to improve the cardiovascular health of their communities through focus on Million Hearts® priority areas:

1. Keeping People Healthy
2. Optimizing Care
3. Improving Outcomes for Priority Populations
4. Innovating for Health

The application for recognition remains open to multihospital health systems, hospitals with and without ambulatory care, medical practices unaffiliated with hospitals, community health centers, and any clinical entity whose leaders consider it eligible. Even if an institution chooses not to apply, the application form itself offers a plethora of proven strategies for improving the cardiovascular health of patients and communities.

Apply now; our next review deadline in July 30, 2020. Achieve a Million Hearts® Hospitals & Health Systems designation to showcase your institution’s commitment to both clinical quality and overall cardiovascular health.

My heart is with you in support.

Laurence Sperling, MD, FACC, FACP, FAHA, FASPC

Executive Director, Million Hearts®

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for unhealthy drug use. That Task Force found that clinicians should ask adults about their drug use and connect people who have a problem to care. More research is needed to make a recommendation for teens. The final recommendation statement can also be found in the June 9, 2020 online issue of JAMA.

These findings should not be considered clinical advice but are being shared to assist the public health response to COVID-19

State of Aging and Health in America: Data Brief Series are topic-specific documents focusing on public health issues related to older adults. These briefs provide public health professionals with the most recent data available on health and aging related conditions, including the importance of brain health, the management of chronic conditions, and caregiving burdens, to help identify needs and mitigate the future effects of a growing older population.

What if each of us had individualized dietary recommendations that helped us decide what, when, why, and how to eat to optimize our health and quality of life? This precision nutrition approach — developing targeted and effective diet interventions in a diverse population — is among the ambitious goals set out by the 2020-2030 Strategic Plan for National Institutes of Health Nutrition Research.

Older adults, 65 years and older, are at higher risk for severe illness. COVID-19 is a new disease and we are learning more about it every day. Information is available in multiple languages.

In the United States, nearly half (45%) of adults have high blood pressure, or hypertension,1 a principal or contributing cause of death for more than 472,000 people in 2017.2 Hypertension and chronic kidney disease (CKD) are closely linked. Hypertension is not only among the most important risk factors for CKD but is almost always present in people with CKD, occuring in 85% to 95% of those with advanced CKD (stages 3–5).3

Albuminuria, or protein in the urine, is associated with duration and severity of hypertension and is a risk factor for CKD and CKD progression, cardiovascular events such as heart attacks and stroke, and early death.4 Despite guidelines to screen for albuminuria in all patients with hypertension,5,6 urine albumin testing is not frequently done in clinical practice. In the Veterans Health Administration system, although the percentage of patients with urine albumin results was higher with increasing age, less than one-third of patients with hypertension were tested for albuminuria in 2018 (figure).

Laboratory tests for albuminuria are reliable, simple, and relatively inexpensive. Testing is an important step to identifying CKD and evaluating risk for cardiovascular disease and kidney disease progression. This is especially needed among patients with hypertension.

References:

1. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
2. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death, 1999–2017. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed January 7, 2019.
3. Rao MV, Qiu Y, Wang C, Bakris G. Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999–2004. Am J Kidney Dis. 2008;51(4 suppl 2):S30–S37.
4. Matsushita K, Ballew SH, Astor BC, et al. Cohort profile: the Chronic Kidney Disease Prognosis Consortium. Int J Epidemiol. 2013;42(6):1660–1668.
5. Krammer HJ, Townsend RR, Griffin K, et al. KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline. Am J Kidney Dis. 2019;73(4):437–458.
6. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–1187.

As Alzheimer’s disease gains more national attention as a public health crisis, the Centers for Disease Control and Prevention, the Alzheimer’s Association, and Emory University’s Rollins School of Public Health have an updated, flexible resource to help prepare the future public health workforce.

A Public Health Approach to Alzheimer’s and Other Dementias is a free curricular resource created for use by university faculty. The curriculum introduces students of public health and related disciplines to information about Alzheimer’s and other dementias, as well as to public health approaches to address Alzheimer’s as a multilayered, growing public health challenge.

Module 1

NEW — Module 2

Curriculum Features:

• Modules are peer-reviewed and ready to use.
• Modules can be used together or individually.
• Faculty can easily adapt and incorporate the modules into existing course content.
• Curriculum content is linked to public health competencies.

Each module includes a faculty guide and a PowerPoint presentation with talking points, as well as selected case studies, video resources, sample test questions, and engaging learning activities for the classroom.

NEW: Videos in American Sign Language
Older adults are at higher risk of getting sick and having significant health complications from the coronavirus disease 2019 (COVID-19).

“Living document” expected to be updated often as new clinical data accrue.

Systematic Reviews Now Available

Opioid Treatments for Chronic Pain
(Systematic Review, released on April 16, 2020)

The review assesses the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies.

Nonopioid Pharmacologic Treatments for Chronic Pain
(Systematic Review, released on April 16, 2020)

The review evaluates the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events.

Noninvasive Nonpharmacological Treatment for Chronic Pain
(Systematic Review, released on April 16, 2020)

The review assesses noninvasive nonpharmacological treatments for common chronic pain conditions.

NIH-funded research reveals protein network changes that may be druggable targets, biomarkers.

First paper from NIH-funded “A4” study supports amyloid as target for prevention.

The piece raises several important concerns regarding COVID-19 for specific vulnerable populations.

The National Library of Medicine (NLM), part of the National Institutes of Health, is working on multiple fronts to aid in the COVID-19 response through new initiatives with the global publishing community and artificial intelligence researchers. NLM is expanding access to scientific papers on coronavirus for researchers, care providers, and the public, and for text-mining research. This work makes use of NLM’s PubMed Central® (PMC), a digital archive of peer-reviewed biomedical and life sciences literature. PMC currently provides access to nearly 6 million full-text journal articles.

CDC’s Division of Nutrition, Physical Activity, and Obesity launched a program called Programs to Reduce Obesity in High Obesity Areas, also referred to as HOP, and this collection highlights the program’s approach and describes both overarching and program-specific evaluation findings. Seven of the articles highlight the work of land-grant universities, and one describes HOP’s implementation approach, evaluation framework, and key findings.

SARS-CoV-2 stability similar to original SARS virus.

NIH-funded study reports advance in blood-based detection of ptau181, a biomarker of Alzheimer’s disease.

Variability in sleep duration and timing may represent new and independent heart disease risk factor.

Study enrolling hospitalized adults with COVID-19 in Nebraska.