Alcohol is a leading cause of liver disease worldwide. Although alcohol abstinence is the crucial therapeutic goal for patients with alcoholic liver disease, these patients have less access to psychosocial, behavioral, and/or pharmacologic treatments for alcohol use disorder. Psychosocial and behavioral therapies include 12-step facilitation, brief interventions, cognitive behavioral therapy, and motivational enhancement therapy. In addition to medications approved by the US Food and Drug Administration for alcohol use disorder (disulfiram, naltrexone, and acamprosate), recent efforts to identify potential new treatments have yielded promising candidate pharmacotherapies. More efforts are needed to integrate treatments across disciplines toward patient-centered approaches in the management of patients with alcohol use disorder and alcoholic liver disease.

Measures of contraceptive effectiveness combine technology and user-related factors. Observational studies show higher effectiveness of long-acting reversible contraception (LARC) compared to short-acting reversible contraception (SARC). Women who choose LARC may differ in key ways from women who choose SARC, and it may be these differences that are responsible for the high effectiveness of LARC. Wider use of LARC is recommended, but scientific evidence of acceptability and successful use is lacking in a population that typically opts for short-acting methods.

This study examined the association of exercise capacity and its change over time with 10-year mortality and incident heart failure (HF). A cohort of older adults was evaluated for exercise capacity with a long distance corridor walk test (LDCW) at baseline and year 4. Ten-year incident HF was for 11.4% for completers, 19.2% for non-completers, and 23.0% for those excluded for safety reasons. The corresponding 10-year mortality was 27.9% for completers, 41.1% for non-completers, and 42.4% for those excluded. Completing an LDCW is strongly associated with lower 10-year mortality and HF risk in older adults.

For survivors of childhood cancer and other pediatric-onset chronic health conditions, the transition to adult care is particularly complex. Understanding which factors are associated with engagement with adult care -- such as age at diagnosis and parental involvement in decision-making -- will help identify and target those patients at risk for loss to follow up.

Using home health care services can delay nursing home admission by an average of 8 months. However, what are the profiles of older persons who are admitted to the nursing home from their own home? In this study, all free-standing certified nursing homes in the US in the Minimum Data Set (MDS) were examined. The most common diagnoses were dementia and diabetes, and 52% had extensive dependency in activities of daily living dependency. There was wide variation from state to state.

Chronic urticaria is defined by continuous or intermittent urticaria for at least 6 weeks. Treatment with antihistamines may not be sufficient in recalcitrant cases, and long-term corticosteroids can cause side effects. Alternative agents may therefore be sought. This retrospective chart review in a single center (n=126) evaluated the safety of alternative agents. Adverse effects were generally mild and reported in 53% of patients on dapsone, 40% on sulfasalazine, 42% on tacrolimus, 16% on hydroxychloroquine, 33% on mycophenolate, 75% on cyclosporine, and 4% on omalizumab. Side effects usually did not require discontinuation. The authors concluded that these alternatives are generally safe when used with proper monitoring.

Frailty puts elders at increased risk of poor health outcomes, including adverse drug effects such as falls. Looking at data from a large prospective study of community-dwelling adults, Ballew et al. found that frailty was associated with reduced kidney function and greater prevalence of hyperpolypharmacy, both challenges for drug dosing. The extent of kidney function in frail individuals depended heavily on the biomarker used to estimate glomerular filtration rate. The authors suggest that using alternative biomarkers to confirm kidney function may be prudent when prescribing medications for this vulnerable population.

Research published in the journal BMC Medicine showed one-third of people with depression who were on a modified Mediterranean diet achieved remission in 12 weeks, compared with 8% of people in a control group. The diet did not result in weight loss, however, and experts commented that adherence may require a level of motivation that would be difficult for some patients with depression to achieve.

Hypoglycemia increased the number of leukocytes among type 1 diabetes patients with normal awareness of hypoglycemia and healthy controls, but not in those with impaired awareness of hypoglycemia, according to a small study in Diabetes. Dutch researchers also found that hypoglycemia increased the expression of inflammation and demargination markers in peripheral blood mononuclear cells.

Physicians and dentists say there is a link between dental and medical health, and now insurance companies are looking at integrating services to improve patient outcomes and reduce costs. Study data showed regular dental exams reduced yearly medical costs and hospital readmissions for some patient groups.

Direct primary care increasingly is seen as an affordable option for people living in rural areas who may not have ready access to care or who cannot afford insurance. Physician Joseph Sheppard of the Free Market Primary Care in Neosho, Mo., said direct primary care reduces administrative burdens and overhead costs associated with insurance coverage.

A scientific statement from the American Heart Association said meal planning and eating breakfast daily may help reduce cardiovascular disease risks. The statement, published in the journal Circulation, also said eating more early in the day and less at night may reduce the likelihood of cardiac and blood vessel diseases.

Playing games, crafts, computer use and socializing are activities that may reduce the risk of mild cognitive impairment in older adults, researchers reported in JAMA Neurology. "Cognitively normal elderly individuals who engage in specific mentally stimulating activities even in late life have a decreased risk of incident MCI," researchers wrote.