Multi-cancer Early Detection Tests, Primary Care, and Shared Decision Making

Double-Blind

Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Review for the American College of Physicians

An update is available for this article. This article has been corrected. The original version of the article and supplement (PDF) is appended to this article as a Supplement. Background: Clinicians and patients want to know the benefits and harms of outpatient treatment options for SARS-CoV-2 infection. Purpose: To assess the benefits and harms of 12 different COVID-19 treatments in the outpatient setting. Data Sources: Epistemonikos COVID-19 L·OVE Platform, searched on 4 April 2022. Study Selection: Two reviewers independently screened abstracts and full texts against a priori–defined criteria. Randomized controlled trials (RCTs) that compared COVID-19 treatments in adult outpatients with confirmed SARS-CoV-2 infection were included. Data Extraction: One reviewer extracted data and assessed risk of bias and certainty of evidence (COE). A second reviewer verified data abstraction and assessments. Data Synthesis: The 26 included studies collected data before the emergence of the Omicron variant. Nirmatrelvir–ritonavir and casirivimab–imdevimab probably reduced hospitalizations (1% vs. 6% [1 RCT] and 1% vs. 4% [1 RCT], respectively; moderate COE). Nirmatrelvir–ritonavir probably reduced all-cause mortality (0% vs. 1% [1 RCT]; moderate COE), and regdanvimab probably improved recovery (87% vs. 72% [1 RCT]; moderate COE). Casirivimab–imdevimab reduced time to recovery by a median difference of 4 days (10 vs. 14 median days [1 RCT]; high COE). Molnupiravir may reduce all-cause mortality, sotrovimab and remdesivir may reduce hospitalization, and remdesivir may improve recovery (low COE). Lopinavir–ritonavir and azithromycin may have increased harms, and hydroxychloroquine may result in lower recovery rates (low COE). Other treatments had insufficient evidence or no statistical difference in efficacy and safety versus placebo. Limitation: Many outcomes had few events and small samples. Conclusion: Some antiviral medications and monoclonal antibodies may improve outcomes for outpatients with mild to moderate COVID-19. However, the generalizability of the findings to the currently dominant Omicron variant is limited. Primary Funding Source: American College of Physicians. (PROSPERO: CRD42022323440)

Detection of Monkeypox Virus in Anorectal Swabs From Asymptomatic Men Who Have Sex With Men in a Sexually Transmitted Infection Screening Program in Paris, France

Professional Courtesy

Black, Incarcerated, and Dying: Reflections on Racism and Inequities in Health Care

Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience

Academic medical centers could play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. This article describes the vaccination program developed by the Boston Medical Center (BMC) health system (New England's largest safety-net health system), its affiliated community health centers (CHCs), and community partners. The program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination in the hardest-hit communities through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. Key strategies included a communication campaign featuring trusted messengers, a focus on health equity, established partnerships with community leaders and CHCs, and strong collaboration with local health departments and the Commonwealth of Massachusetts to ensure equitable allocation of the vaccine supply. Process factors involved the use of robust analytics relying on the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). The vaccination program administered 109 938 first doses, with 94 703 (86%) given at community sites and 2466 (2%) given at mobile sites. Mobile vaccination events were key in reaching younger people living in locations with the highest SVIs. Challenges included the need for a robust operational infrastructure and mistrust of the health system given the long history of economic disinvestment in the surrounding community. The BMC model could serve as a blueprint for other medical centers interested in implementing programs aimed at increasing vaccine uptake during a pandemic and in developing an infrastructure to address other health-related disparities.

Life Expectancy for White, Black, and Hispanic Race/Ethnicity in U.S. States: Trends and Disparities, 1990 to 2019

Background: Life expectancy (LE) differences within and between states by race/ethnicity have not been examined. Objective: To estimate LE for selected race/ethnicity groups in states from 1990 to 2019. Design: Cross-sectional time-series analysis. Setting: United States. Participants: Deidentified death records and Census data were used to construct regression models with smoothed time series of mortality from 1990 to 2019. Measurements: LE at birth, by sex and year, for subgroups of people reporting Hispanic, non-Hispanic Black, or non-Hispanic White race/ethnicity. Results: Disparities in LE across states were 8.0 years for females and 12.2 years for males in 1990 and 7.9 years for females and 7.8 years for males in 2019. When race/ethnicity groups were accounted for, disparities across states were 20.7 years for females and 24.5 years for males in 1990, decreasing to 18.5 years for females and 23.7 years for males in 2019. Disparities across states increased within each race/ethnicity group between 1990 and 2019, with the largest increase for non-Hispanic White males and the smallest for Hispanic females. The disparity between race/ethnicity groups within states decreased for most of the 23 states with estimates for all 3 groups but increased for females in 7 states and males in 5 states. Limitation: Because of small sample size, LE was not estimated for 37 of 153 state-race/ethnicity groups. Conclusion: Disparity in LE across states was greater when race/ethnicity groups were considered. Disparities across all state–race/ethnicity groups in general have decreased over the past 3 decades. Within each race/ethnicity group, disparities across states have increased. Although racial/ethnic disparities decreased in most of the 23 states for which LE was estimated for all 3 groups, they increased for females in 7 states and males in 5 states. Primary Funding Source: National Heart, Lung, and Blood Institute.

Healing Water

The Call: In Vivo