National Institutes of Health Pathways to Prevention Workshop: Research Gaps for Long-Term Drug Therapies for Osteoporotic Fracture Prevention.

On 30 and 31 October 2018, the National Institutes of Health convened the Pathways to Prevention (P2P) Workshop: Appropriate Use of Drug Therapies for Osteoporotic Fracture Prevention to assess the available evidence on long-term (>3 years) use of drug therapies to prevent osteoporotic fractures and identify research gaps and needs for advancing the field. The workshop was cosponsored by the NIH Office of Disease Prevention (ODP), National Institute of Arthritis and Musculoskeletal and Skin Diseases, and National Institute on Aging. A multidisciplinary working group developed the agenda, and an Evidence-based Practice Center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the discussion. During the 1.5-day workshop, invited experts discussed the body of evidence and attendees had the opportunity to comment during open discussions. After data from the evidence report, expert presentations, and public comments were weighed, an unbiased independent panel prepared a draft report that was posted on the ODP Web site for 5 weeks for public comment. This final report summarizes the panel's findings and recommendations. Current gaps in knowledge are highlighted, and a set of recommendations for new, strengthened research to better inform the long-term use of osteoporotic drug therapies is delineated.

A Little Effort Can Withstand the Hardship: Fielding an Internet-Based Intervention to Prevent Depression among Urban Racial/Ethnic Minority Adolescents in a Primary Care Setting.

BACKGROUND: This study explored the implementation of Chicago Urban Resiliency Building (CURB), a randomized clinical trial designed as an Internet-based primary care depression prevention intervention for urban African American and Latino adolescents. METHODS: We utilized a mixed methods analysis to explore four aims. First, we estimated the percent of at-risk adolescents that were successfully screened. Second, we examined clinic site factors and performance. Third, primary care providers (n = 10) and clinic staff (n = 18) were surveyed to assess their knowledge and attitudes about the intervention. Fourth, clinic staff (nursing and medical assistant) interviews were analyzed using thematic analysis to gather perspectives of the implementation process. RESULTS: We found that the estimated percent of at-risk adolescents who were successfully screened in each clinic varied widely between clinics with a mean of 14.48%. Daily clinic communication was suggestive of greater successful screening. Feasibility of screening was high for both primary care providers and clinic staff. Clinic staff exit interviews indicated the presence of community barriers that inhibited successful implementation of the intervention. CONCLUSION: This study shares the challenges and successes for depression screening and implementing Internet-based mental health interventions for urban racial/ethnic minority adolescents in primary care settings.

Chronic opioid use and mortality outcomes in patients admitted with COVID-19: A retrospective cohort study.

BACKGROUND: We hypothesized that chronic opioid users would likely have worse outcomes with COVID-19 infection. METHODS: A retrospective review of electronic medical records was conducted for all COVID-19 patients admitted in two large academic hospitals in New York City from March 1, 2020 to June 30, 2020 during the onset of the COVID-19 pandemic. A total of 1,361 patients (1,289 opioid naïve patients, 72 with chronic opioid use) were included. A propensity score matched analysis was used to create a dataset. A logistic regression using the generalized estimating equations method was used to evaluate oxygen requirements including bilevel positive airway pressure (BiPAP), high flow nasal cannula (HFNC), and mechanical ventilation (MV). Cox models with random match pairs were fitted for time spent until hospital discharge and in-hospital mortality. RESULTS: The propensity score matched analysis did not demonstrate a significant difference between the chronic opioid use group vs the opioid naïve group for the use of oxygen support (p = 0.439), BiPAP (p = 0.377), HFNC (p = 0.978), or MV (p = 0.080), and length of stay (LOS) (p = 0.950). There was also no statistically significant finding for reduced need for MV (odds ratio 0.42, 95 percent CI: 0.16-1.11, p = 0.080) and lower in-hospital mortality (hazard ratio 0.75, 95 percent CI: 0.39-1.43, p = 0.378) in the chronic opioid use group; however, future larger studies will be needed. CONCLUSIONS: Our study did not demonstrate a significant difference in outcomes in patients with COVID-19 with preadmission chronic opioid use vs opioid naïve patients in oxygen requirements, LOS, MV, or mortality. Future studies are needed to further illustrate the impact of opioids on COVID-19 outcomes.

Urban college student self-report of hookah use with health care providers.

OBJECTIVE: This study's purpose was to describe urban college students' communication about hookah with health care providers. PARTICIPANTS: Participants included a random sample of undergraduate urban college students and health care providers. METHODS: Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. RESULTS: Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. CONCLUSION: Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.

A 40-Day Journey to Better Health: Utilizing the DanielFast to Improve Health Outcomes in Urban Church-Based Settings.

Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health education program to determine the impact of the Daniel Fast on physical health and the adoption of healthy behaviors. Methods: Participants attended six-weekly health education sessions in two participating churches, and were provided with a digital healthy eating platform. Results: There was a statistically significant decrease from baseline to post assessment for weight, waist circumference and cholesterol. Participants reported a significant improvement in their overall well-being, social and physical functioning, vitality and mental health. Conclusion: Results of this study demonstrate that dietary recommendations and comprehensive group health education delivered in churches and reinforced on a digital platform can improve physical health, knowledge and psychosocial outcomes.

Competitive behavior in the HMO marketplace.

Are health maintenance organizations (HMOs) less profitable in more competitive markets, and does competition erode unusually high profits over time? To answer these questions, we examined profit rates (as a proportion of revenues) in 1994 and 1997 for all HMOs in 259 metropolitan areas. We found that profits were significantly lower on average in 1994 in markets with more competition, measured alternatively by the number of HMOs or their market concentration. We also found that there was no relationship between a market's relative profit ranking in 1994 and its ranking in 1997; highly profitable markets were not able to preserve their relative standing. Neither the proportion of HMO enrollees in for-profit HMOs nor HMO market penetration was significantly related to profit rates.

Acute phase mediators modulate thrombin-activable fibrinolysis inhibitor (TAFI) gene expression in HepG2 cells.

Thrombin-activable fibrinolysis inhibitor (TAFI) has recently been identified as a positive acute phase protein in mice, an observation that may have important implications for the interaction of the coagulation, fibrinolytic, and inflammatory systems. Activated TAFI (TAFIa) inhibits fibrinolysis by removing the carboxyl-terminal lysines from partially degraded fibrin that are important for maximally efficient plasminogen activation. In addition, TAFIa has been shown to be capable of removing the carboxyl-terminal arginine residues from the anaphylatoxins and bradykinin, thus implying a role for the TAFI pathway in the vascular responses to inflammation. In the current study, we investigated the ability of acute phase mediators to modulate human TAFI gene expression in cultured human hepatoma (HepG2) cells. Surprisingly, we found that treatment of HepG2 cells with a combination of interleukin (IL)-1 and IL-6 suppressed endogenous TAFI mRNA abundance in HepG2 cells (~60% decrease), while treatment with IL-1 or IL-6 alone had no effect. Treatment with IL-1 and/or IL-6 had no effect on TAFI promoter activity as measured using a luciferase reporter plasmid containing the human TAFI 5'-flanking region, whereas treatment with IL-1 and IL-6 in combination, but not alone, decreased the stability of the endogenous TAFI mRNA. Treatment with the synthetic glucocorticoid dexamethasone resulted in a 2-fold increase of both TAFI mRNA levels and promoter activity. We identified a functional glucocorticoid response element (GRE) in the human TAFI promoter between nucleotides 92 and 78. The GRE was capable of binding the glucocorticoid receptor, as assessed by gel mobility shift assays, and mutation of this element markedly decreased the ability of the TAFI promoter to be activated by dexamethasone.