top medical research topics 2019

Research Topics & Ideas: Healthcare

F inding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Topics & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Need a helping hand?

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

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18 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you give me research titles that i can conduct as a school nurse

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

Hi, may I please be assisted with research topics in the medical laboratory sciences

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Hot topics and trends in cardiovascular research

1 Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg O/N1 704, Herestraat 49, Leuven, Belgium

2 ECOOM, Department of Managerial Economics, Strategy and Innovation, KU Leuven, Naamsestraat 61, Leuven, Belgium

Wolfgang Glänzel

3 Department Science Policy & Scientometrics, Library of the Hungarian Academy of Sciences, Arany János u. 1, Budapest, Hungary

Karin R Sipido

Associated data.

Comprehensive data on research undertaken in cardiovascular medicine can inform the scientific community and can support policy building. We used the publication output from 2004 to 2013 and the 2014 references to these documents, to identify research topics and trends in the field of cardiovascular disease.

Methods and results

Text fragments were extracted from the titles and abstracts of 478 000 publications using natural language processing. Through machine-learning algorithms, these text fragments combined to identify specific topics across all publications. A second method, which included cross-references, assigned each publication document to a specific cluster. Experts named the topics and document clusters based on various outputs from these semi-automatic methods. We identified and labelled 175 cardiovascular topics and 20 large document clusters, with concordance between the approaches. Overarching, strongly growing topics in clinical and population sciences are evidence-based guidance for treatment, research on outcomes, prognosis, and risk factors. ‘Hot’ topics include novel treatments in valve disease and in coronary artery disease, and imaging. Basic research decreases its share over time but sees substantial growth of research on stem cells and tissue engineering, as well as in translational research. Inflammation, biomarkers, metabolic syndrome, obesity, and lipids are hot topics across population, clinical and basic research, supporting integration across the cardiovascular field.

Growth in clinical and population research emphasizes improving patient outcomes through novel treatments, risk stratification, and prevention. Translation and innovation redefine basic research in cardiovascular disease. Medical need, funding and publishing policies, and scientific opportunities are potential drivers for these evolutions.

Introduction

Current policies for public funding of health research increasingly focus on innovation, with a final goal to improve health outcomes. 1 To support policies, roadmaps are established, for example for diabetes 2 and respiratory 3 diseases. In the USA, the joint Academies developed a document to guide national policy in health 4 with a dedicated document for cardiovascular medicine 5 that includes general directions for research. In Europe, building a roadmap for cardiovascular research is one of the tasks of the ERA-CVD network. 6 Expert opinion guides the exercise but a macro and global-level overview of past cardiovascular research can enrich the debate and strengthen the basis for recommendations. The breadth of cardiovascular research is astounding, 7 with research undertaken across a variety of institutions and with each piece of research having its own scope/focus or topic. It is thus challenging to review and summarize all the research that has been undertaken.

Identifying all the relevant research is the first hurdle to overcome, then classifying or identifying topics of research is the next significant hurdle. Journal classification systems offer little assistance, as they are not granular enough to identify more specific topics within broader fields. Thesauri or medical dictionaries, such as PubMed or the International Classification of Diseases (ICD), do not offer an overview of time-dependent changes in topics or changing concepts.

Identifying key topics using semi-automatic approaches based on text analysis is an alternative solution that takes advantage of recent developments in high-level informatics. As this is not reliant on a predefined classification, it may result in different outcomes. Various methods use natural language processing (NLP) to extract topics or clusters from text. For example, the bibliometric community has compared the results when varying methods are applied to a set of astronomy publications, focusing on the importance having topic expert input throughout the process. 8 The recent CardioScape project analysed abstracts of 2476 research projects awarded 2010–12 as published by funding bodies. The authors assigned research project to topics, based on the abstract text, using a semi-automatic process that tested and trained the data to more quickly allocate abstracts to a topic than depending solely on expert review. They produced a detailed taxonomy or classification of cardiovascular research based on the list of topics of the European Society of Cardiology, creating a hierarchical list of over 600 topics. 9

Here, we aim to identify topics in published cardiovascular research and their evolution between 2004 and 2013, assessing whether they have appeared, disappeared, or changed over time. In a comprehensive approach, we use a combination of existing methods for text mining, network analysis, and clustering, and further develop these tools to handle a large dataset of >400 000 publications.

In our study, we use two different and complementary approaches. A first one detects topics across the collection of publications, counting number of documents, and relations between topics. A second one maps document networks into clusters with an identifiable subject of research. These approaches are described here in brief, with more detail provided in the Supplementary material online .

Data sources

The dataset includes the reference, abstract, address, and citation data for 478 006 cardiovascular publications from 2004 to 2013, including 2014 references to these documents, using an expert informed search strategy and references to core cardiovascular journals, as previously published. 7 The documents span across >5000 journals, and include cardiovascular publications in leading general journals in medical and life sciences ( Supplementary material online , Table S1 ). We obtained the data from Clarivate Analytics Web of Science Core Collection (WoS) through a custom data license held by ECOOM, KU Leuven.

Text pre-processing

We took all titles and abstracts of the above publications, and extracted the noun phrases (text fragments of various lengths) using the NLP framework developed at Stanford. 10 Supplementary material online , Figure S1 illustrates the subsequent data flow for the analysis.

Topic modelling

For this approach, we applied latent Dirichlet allocation (LDA) 11 to the above-mentioned text fragments from the titles and abstracts of all publications. This LDA approach groups the text fragments to identify topics and allocates documents to topics. In this approach, a document contributes to several topics. Of note, general terms or terms that are used frequently across the majority of documents are filtered out as part of the methodology, resulting in groups of highly specific text fragments and, consequently, topics, as illustrated in Supplementary material online , Figure S2 .

At least three cardiovascular experts (listed in the Acknowledgements section) named each topic based on a set of the top 40 text fragments representing a topic. Further rounds of cross-review validated and consolidated the naming process. A final review of all topics ensured naming consistency across the topics and allowed for additional expert-based classification as clinical, basic, or population research.

We then calculated the number of documents that contributed to a topic, using probability analysis in LDA. Furthermore, we calculated the co-occurrence of topics in the publications, and visualized the outcome of this network analysis using VOSViewer ( www.vosviewer.com ). 12

Document clustering

For this second approach, the dataset was reduced to two periods, and we analysed the cardiovascular publications from 2006 to 2008 and those from 2011 to 2013, separately. For each time period, we then calculated the similarities between documents based on the noun phrase text fragments from the titles and abstracts of all publications and based on the references in these publications, using adapted cosine calculations and a hybrid document clustering algorithm, as previously described. 13 We then applied the Louvain 14 community detection algorithm to identify clusters of similar documents. For this method, each document is only located in one cluster. Subsequently, we applied the DrL/OpenOrd algorithm 15 to map and visualize the documents and clusters. We used R 16 in a high-powered cloud-based parallelized computing environment for all operations.

We identified and described the core documents, 13 the most common text fragments, as well as, the most highly cited documents and the most productive authors in each cluster, to name the clusters. For each document cluster, we identified the most highly representative topics from the LDA topic model.

Evolution of cardiovascular topics—trends and ‘hot’ topics

We identified 175 topics, listed alphabetically in Supplementary material online , Table S2 . This list groups specific topics within areas such as atherosclerosis, coronary artery disease, arrhythmias, heart failure, and their evolution over time.

For a visual and comprehensive overview, we prepared a map of the topics and their interrelation, based on co-occurrence within publications using a network analysis ( Figure ​ Figure1 1 A ). This map identifies different categories of research: population (at the top, blue), clinical (left, green/yellow), and basic research (right, red). Large topics in each category define overarching interests such as Evidence-guided-treatment and Outcomes and prognosis in clinical research, and Epidemiology of CVD and risk factors in population research, topics that have seen large growth in numbers of publications since 2004 ( Figure ​ Figure1 1 B ). Cell signalling and gene transcription is a central topic for basic research, with modest growth ( Figure ​ Figure1 1 B ).

Main areas and organization of research focus. ( A ) Visual presentation of the topics in 2013 and how they relate to each other, based on how often the topics are included in the same publication. Each circle represents one topic and each group of topics is highlighted in a separate colour; the most similar documents and clusters are located closer to each other based on VOSviewer mapping. ( B ) Evolution of overarching topics.

More focused ‘hot’ topics that experienced a large growth in number of publications are presented in Figure  2 .

Topics with large growth. For population research, the eight topics that increased more than two-fold in volume are shown; for clinical research, 27 topics increased more than two-fold and 10 of these are presented; for basic research only two topics had more than a two-fold increase, and the top 8 growers are presented. Overarching topics are shown in Figure ​ Figure1 1 B .

In population research, risk factors with research on metabolic syndrome, lipids, diabetes, physical activity, and mental health are prominent. In clinical research, patient management after myocardial infarction (MI) and outside the hospital are leading topics, but the true ‘hot’ topic was aortic valve disease that saw a surge of interest, related to transaortic valve repair, starting 2008. Though still small in numbers, heart failure research and stem cells saw substantial growth. This last clinical topic complements the major hot topics in basic research, on stem cells and cardiac repair and tissue engineering. In basic research, increasing translational output in metabolic syndrome and diabetes use mostly mouse models. Focused topics are organelle studies on mitochondria and endoplasmic reticulum.

Table  1 complements the fast growing topics of Figure  2 with additional leading 2013 topics. Most of these also have grown since 2004, but two topics, even if large, seem to have lost momentum, i.e. longitudinal studies on blood pressure, and basic research in cardiac electrophysiology.

Large topics in 2013

PCOS, polycystic ovary syndrome.

Only four topics in clinical, and none in population research, saw a decrease, whereas seven topics in basic research saw a decline in output ( Figure ​ Figure3 3 A ). Across all topics, the growth in publication output, measured as the number of documents in 2013 divided by the number of documents in 2004, was significantly larger in clinical and population research topics than in basic research topics ( Figure ​ Figure3 3 B ).

Unequal growth of research output across categories. ( A ) Topics that saw a decrease of >5%, i.e. 4/102 clinical and 7/50 basic research topics. ( B ) Average growth in each category. Each dot presents a topic; the values are the fractional growth, i.e. the number of documents in 2013 divided by the number of documents in 2004. Kruskal–Wallis followed by Dunn’s test for multiple comparisons; *** P < 0.0001 basic vs. clinical and vs. population.

When considering the overall output and growth of publications across the categories of population, clinical and basic research, the data suggest that the share of basic research publications is declining.

Document clusters define large research areas and trends

The size of topics represents the activity within each of these—documents contribute to more than one topic. In a complementary approach, we examined how documents group together based on the similarity of their text and of their references, whereby each document can belong to one cluster only, effectively dividing the total publication output into different areas. The hybrid clustering algorithm was applied to two datasets, i.e. the publications from 2006 to 2008 and 2011 to 2013.

In each period, 10 large clusters emerged, accounting for >90% of all documents.

To identify trends, we compare the two periods and examine the evolution over time ( Figure  4 ). In the graph legends, emerging areas are marked by green triangle, decreasing ones with a red triangle. Risk scoring in the population and related patient management are the leading areas, growing over time (top position). In 2011–13, a large cluster emerges that relates to gene and stem-cell therapy, including research on inducible pluripotent stem cells. Documents within this cluster include research on ischaemic heart disease and arrhythmias. Haemodynamics and biomechanics are another emerging area that includes documents on atherosclerosis and vascular diseases such as aneurysms, but also heart failure and assist devices. Aortic valve disease is a newly defined area in 2011–13. Imaging also becomes very prominent as an area in its own right. Whereas in 2006–08, hypertension was a defined area, this is no longer identifiable in 2011–13.

Distribution of document clusters in 2006–08 and in 2011–13. ( A ) In 2006–08, the 10 largest clusters represent 93% of the total publication output in this period. ( B ) In 2011–13, the 10 largest clusters represent 92% of the total publication output in this period. The colour codes for similar clusters are maintained across the periods. However, some clusters are present in only one period. The clusters are arranged by size, reading clockwise from the top, and the legends arranged accordingly. Red triangles mark clusters that disappeared and green triangles emerging clusters.

For the last period, we also examined the structure and interrelation of clusters, using a graphical rendering, giving insight in the size, composition, and presence of subclusters ( Figure  5 ).

Document clusters’ map 2011–13. A visual presentation of documents in clusters and subclusters: the most similar documents and clusters are located closer to each other, based on the DrL two-dimensional mapping layout technique.

In this force-directed DrL graph layout, the documents and clusters are mapped to minimize the distance between the most similar documents and maximize the distance between non-linked documents. This produces a two-dimensional co-ordinate layout where the documents closest to each other share the most similarities since they share common text fragments and references. Conversely, documents and clusters on the edges of the graph have the least similarity to other documents or clusters.

Cluster 2 on gene and stem cells is dense and separate, yet touches and interacts with Cluster 5 [acute coronary syndrome (ACS) and MI]. Cluster 9 on imaging is spread out in subclusters at different locations, including one near Cluster 5 (ACS and MI), and one near Cluster 4 (heart failure). Cluster 8 (arrhythmias) is also split with one part closer to heart failure, another to anticoagulation and atrial fibrillation.

Further naming the subclusters is presently beyond reach, as it would require a lot of expert input and resources. However, linking the clusters and the topics adds granularity to the larger research areas and provides internal methodological validation of the cluster naming.

Table  2 presents the most highly associated topics in the ten largest document clusters in each period. Overall, agreement with the LDA topics is high and provides more detail on the research contained in the clusters. E.g., the cluster ‘Haemodynamics’ is now showing different areas of focus, i.e. in congenital disease, aortic, and valvular diseases; the topic ‘Arrhythmias’ is more populated with device research in the second time period compared to the first.

Cluster names and topics present within clusters

AF, atrial fibrillation; ANS, autonomic nervous system; BP, blood pressure; CABG, coronary artery bypass grafting; CRT, cardiac resynchronization therapy; CT, computed tomography; CV, cardiovascular; DES, drug-eluting stent; ECG, electrocardiogram; HF, heart failure; LV, left ventricular; NOAC, new oral anticoagulant; PTCI, percutaneous transluminal coronary intervention; RV, right ventricle; STEMI, ST elevated myocardial infarction.

The method for identification of topics in cardiovascular publication output allowed the visualization and evaluation of trends in cardiovascular research. Over a 10-year period significant shifts occur.

Identification of cardiovascular research topics through natural language processing

In cardiovascular research, topics are generally predefined in a taxonomy that can be hierarchical and/or matrix structured. The CardioScape project approach (see Introduction section) was well suited to its purpose of the analysis of 2476 project abstracts in a single time period and using an existing taxonomy has the advantage of recognizable areas of research. The bottom-up approach used here lent itself well to analysis of much larger numbers of documents and generated a topic list that represents the interests from the community during the period under study.

A recent study by the WHO working to identify cardiovascular disease research output from random sets of publications from PubMed required a significant amount of expert-based review of only a small proportion of the published articles. 17 The current approach was more comprehensive in coverage of the field, but despite reliance on advanced automated analysis, experts still had an important role in interpreting and linking concepts to validate the results.

In the current naming of topics and clusters, experts frequently used terms that connect to a classic hierarchical list in the field, including major diseases, and recognizing clinical, population, and basic discovery research. Nevertheless, the approach uncovered specific emerging areas of research such as transcatheter aortic valve implantation (TAVI), topics consistent with broad trends, such as risk stratification and evidence-based guidance, and innovation (gene and stem cell research). Some of these terms would not appear in a classic taxonomy and thus the NLP approach offers novel insights.

The present study was not attempting to classify all research but to capture and identify the most common and evolving topics over time in the cardiovascular field by using a comprehensive set of cardiovascular publications across some 5000 journals.

Emphasis on improving clinical care and risk assessment

The most represented and fast growing topics across the documents are evidence-based guidance for treatment and research on outcomes and prognosis. These result underscore the attention given to guidelines and evidence based medicine (EBM). 18–23 Part of this research is likely to represent the large number of clinical trials taking place in the cardiovascular field, 24 which over time have had a significant effect on the reduction of mortality from CVD due to establishing the effectiveness and safety of a number of drugs and medical interventions in cardiovascular disease. 25 The presence of policy related topics, such as the topics on quality of care and health economics likewise supports the focus on implementation research and a shift of focus from reducing acute mortality to care in chronic disease.

Growth of research on risk factors emphasizes the importance of preventative medicine, evident in both the topics analysis and the document cluster analysis. However, some specific blood pressure studies declined over time, perhaps reflecting the change in focus on the single risk factor of ‘blood pressure’ to a multivariable spectrum and newly identified risk factors. We have also previously shown that hypertension has moved more closely to clinical cardiovascular research over time. 26

Smaller topics illustrate crosstalk with non-cardiovascular diseases, because of shared risk factors or common methods used in research or occurrence of cardiovascular complications. The latter is particularly evident in two topics that focus on cardiovascular complications in pregnancy and in cancer.

Innovation and translation in clinical and basic science

Major diseases such as ischaemic heart disease and arrhythmias, remain present over time but shifts can be seen. There is for example, a larger focus on atrial fibrillation, in particular embolic risk, on novel treatments, such as stem cells in heart failure, and transcatheter aortic valve interventions as a dominant element within the topic of valvular heart disease. 19 Imaging is present in several topics but emerges as a cluster in its own right in the document analysis. Many of these changes are driven by technological innovation and translation.

Basic research as a whole saw its share decline, but with interesting shifts in content. Although the topic analysis and mapping identifies basic research topics as a category, there are complementarities across categories. Stem cell research, tissue engineering, and biomechanical factors saw rapid growth and are also present in clinical topics. This also applies to inflammation and diabetes. Animal models for disease are rapidly growing topics consistent with growth of translational research.

An analysis of the countries of authorship of the publications in the emerging clusters of discovery research shows that the USA leads in the number and share of publications (30%+), followed mostly by Germany, or the UK or Italy. However, for the large document cluster on genes and stem cells in 2011–13, the second most productive country is China, contributing 17.5% of the publications in this cluster (Supplementary material online, Figure S3 ).

Interestingly, inflammation, biomarkers, metabolic syndrome, obesity, and lipids are hot topics with growing research output in population, clinical and basic research, indicating integration and crosstalk across the spectrum of cardiovascular research.

Drivers of change

Technology and opportunity-driven scientific interest, but also strategic choices and funding policies are likely to influence trends in research. CardioScape studied public and charity funding in the years 2010–12 and describes major investments in clinical research. Yet the share of publication output globally for clinical research appears to be substantially larger than the share of funding for clinical research reported in CardioScape. This could be explained by clinical research funded by other sources, such as industry or local funding, which are not included in the CardioScape analysis. Also, the present data represent global output. Major research investments in China, and the emphasis on clinical research in the USA, can contribute to some of the global trends.

The slower growth in basic science could reflect a slower growth in investment. This can be absolute or relative towards the increasing costs of advanced research methodology. Another reason could be editorial pressure for more comprehensive papers that may reduce quantity to the benefit of rich content in individual papers.

Finally, growing translational research may blur the boundaries between basic and clinical research and lead to an apparent slower growth in discovery research.

Policy perspectives

Policy development is a forward looking exercise. In health research, medical needs identified by health data and expert opinion, are an important consideration. 27 Past research output helps to identify areas that may need more investment. Research funders also use input from society. 28 When assessing current priorities in cardiovascular research for the Dutch 28 and British 29 Heart Foundations we can see that research into heart failure and arrhythmias are common across their top priorities. Focus on healthy lifestyles is a top priority in the Dutch Heart Foundation as well as in the US vision and strategic agenda. 4 , 5 At the macro-level, the data presented here indicate that some of the main issues presented in these research agendas are actively pursued but others less so.

Study limitations

Limitations of studying research topics have been addressed in the bibliometric field. 8 The reliance of expert input is a limitation and potential source of bias that we tried to minimize by using mixed panels.

The current approach was not sufficiently granular to extract recent emerging topics that contain a limited number of documents. In addition, publication output is somewhat delayed vs. actual research and experts may be aware of ongoing research with still limited output. In this case, the method and dataset can be used to interrogate about specific developments (see Supplementary material online , Table S3 for data on micro-RNA and personalized medicine).

As the data set ends in 2013, very recent developments are not covered. This relates to the methodological complexity. Web of Science data including 2014 references were available mid-2015, the cardiovascular publications dataset was complete in 2016 and algorithms for analysis including re-iterative expert review required another 18 months. A similar time lag is seen in other studies that rely on data mining and processing. 9 Congress abstracts could be considered as a source to identify emerging topics but have several limitations. They are of a different nature than papers and the scope of a congress shapes content of selected abstracts. We provide a complementary survey of 3000 abstracts from the 2018 congress of the European Society of Cardiology, illustrating the strong presence of clinical research at this event, within the topics of Clusters 1 and 3–7 of Table  2 ( Supplementary material online , Figure S4 ). Two emerging topics were cardio-oncology and digital health, each representing however <25 abstracts.

In the present analysis, quality and impact of studies in a particular domain were not evaluated, though highly cited papers were part of the cluster identification. In their analysis of poorly cited papers covering 165 000 papers in 1997–2008, Ranasinghe et al . 30 noted the highest percentage of poorly cited papers in the clinical and population research category. Nevertheless, as they and others 31 have noted, citations are not the only parameter to assess impact, in particular in clinical medicine.

Conclusions

Identification of leading research topics and trends illustrates the emphasis on improving clinical medicine, and the growing interest in risk stratification and preventive medicine. Translation and innovation redefine cardiovascular research. Linking the present data with the insights of the professional community and of funders and society, may contribute to the building of a future research roadmap.

Supplementary Material

Ehz282_supplementary_data, acknowledgements.

The authors thank to the following experts for their review of the text fragments and input into the names of the topics: Dr Matthew Amoni, Dr Peter Haemers, Prof Sian Harding, Dr Frederik Helsen, Prof Gerd Heusch, Prof Tatiana Kuznetsova, Prof Tobias Op‘t Hof, Prof Frank Rademakers, Dr Sander Trenson, Dr Bert Vandenberk, and Dr Maarten Vanhaverbeke.

D.G. had a PhD Fellowship through KU Leuven.

Conflict of interest: K.R.S. is Past Editor-in-Chief of Cardiovascular Research (2013–17). W.G. is Editor-in-Chief of Scientometrics .

77 interesting medical research topics for 2024

Last updated

25 November 2023

Reviewed by

Brittany Ferri, PhD, OTR/L

Short on time? Get an AI generated summary of this article instead

Medical research is the gateway to improved patient care and expanding our available treatment options. However, finding a relevant and compelling research topic can be challenging.

Use this article as a jumping-off point to select an interesting medical research topic for your next paper or clinical study.

• How to choose a medical research topic

When choosing a research topic , it’s essential to consider a couple of things. What topics interest you? What unanswered questions do you want to address? 

During the decision-making and brainstorming process, here are a few helpful tips to help you pick the right medical research topic:

Focus on a particular field of study

The best medical research is specific to a particular area. Generalized studies are often too broad to produce meaningful results, so we advise picking a specific niche early in the process. 

Maybe a certain topic interests you, or your industry knowledge reveals areas of need.

Look into commonly researched topics

Once you’ve chosen your research field, do some preliminary research. What have other academics done in their papers and projects? 

From this list, you can focus on specific topics that interest you without accidentally creating a copycat project. This groundwork will also help you uncover any literature gaps—those may be beneficial areas for research.

Get curious and ask questions

Now you can get curious. Ask questions that start with why, how, or what. These questions are the starting point of your project design and will act as your guiding light throughout the process. 

For example: 

What impact does pollution have on children’s lung function in inner-city neighborhoods? 

Why is pollution-based asthma on the rise? 

How can we address pollution-induced asthma in young children? 

• 77 medical research topics worth exploring in 2023

Need some research inspiration for your upcoming paper or clinical study? We’ve compiled a list of 77 topical and in-demand medical research ideas. Let’s take a look. 

• Exciting new medical research topics

If you want to study cutting-edge topics, here are some exciting options:

COVID-19 and long COVID symptoms

Since 2020, COVID-19 has been a hot-button topic in medicine, along with the long-term symptoms in those with a history of COVID-19. 

Examples of COVID-19-related research topics worth exploring include:

The long-term impact of COVID-19 on cardiac and respiratory health

COVID-19 vaccination rates

The evolution of COVID-19 symptoms over time

New variants and strains of the COVID-19 virus

Changes in social behavior and public health regulations amid COVID-19

Vaccinations

Finding ways to cure or reduce the disease burden of chronic infectious diseases is a crucial research area. Vaccination is a powerful option and a great topic to research. 

Examples of vaccination-related research topics include:

mRNA vaccines for viral infections

Biomaterial vaccination capabilities

Vaccination rates based on location, ethnicity, or age

Public opinion about vaccination safety 

Artificial tissues fabrication

With the need for donor organs increasing, finding ways to fabricate artificial bioactive tissues (and possibly organs) is a popular research area. 

Examples of artificial tissue-related research topics you can study include:

The viability of artificially printed tissues

Tissue substrate and building block material studies

The ethics and efficacy of artificial tissue creation

• Medical research topics for medical students

For many medical students, research is a big driver for entering healthcare. If you’re a medical student looking for a research topic, here are some great ideas to work from:

Sleep disorders

Poor sleep quality is a growing problem, and it can significantly impact a person’s overall health. 

Examples of sleep disorder-related research topics include:

How stress affects sleep quality

The prevalence and impact of insomnia on patients with mental health conditions

Possible triggers for sleep disorder development

The impact of poor sleep quality on psychological and physical health

How melatonin supplements impact sleep quality

Alzheimer’s and dementia 

Cognitive conditions like dementia and Alzheimer’s disease are on the rise worldwide. They currently have no cure. As a result, research about these topics is in high demand. 

Examples of dementia-related research topics you could explore include:

The prevalence of Alzheimer’s disease in a chosen population

Early onset symptoms of dementia

Possible triggers or causes of cognitive decline with age

Treatment options for dementia-like conditions

The mental and physical burden of caregiving for patients with dementia

• Lifestyle habits and public health

Modern lifestyles have profoundly impacted the average person’s daily habits, and plenty of interesting topics explore its effects. 

Examples of lifestyle and public health-related research topics include:

The nutritional intake of college students

The impact of chronic work stress on overall health

The rise of upper back and neck pain from laptop use

Prevalence and cause of repetitive strain injuries (RSI)

• Controversial medical research paper topics

Medical research is a hotbed of controversial topics, content, and areas of study. 

If you want to explore a more niche (and attention-grabbing) concept, here are some controversial medical research topics worth looking into:

The benefits and risks of medical cannabis

Depending on where you live, the legalization and use of cannabis for medical conditions is controversial for the general public and healthcare providers.

Examples of medical cannabis-related research topics that might grab your attention include:

The legalization process of medical cannabis

The impact of cannabis use on developmental milestones in youth users

Cannabis and mental health diagnoses

CBD’s impact on chronic pain

Prevalence of cannabis use in young people

The impact of maternal cannabis use on fetal development 

Understanding how THC impacts cognitive function

Human genetics

The Human Genome Project identified, mapped, and sequenced all human DNA genes. Its completion in 2003 opened up a world of exciting and controversial studies in human genetics.

Examples of human genetics-related research topics worth delving into include:

Medical genetics and the incidence of genetic-based health disorders

Behavioral genetics differences between identical twins

Genetic risk factors for neurodegenerative disorders

Machine learning technologies for genetic research

Sexual health studies

Human sexuality and sexual health are important (yet often stigmatized) medical topics that need new research and analysis.

As a diverse field ranging from sexual orientation studies to sexual pathophysiology, examples of sexual health-related research topics include:

The incidence of sexually transmitted infections within a chosen population

Mental health conditions within the LGBTQIA+ community

The impact of untreated sexually transmitted infections

Access to safe sex resources (condoms, dental dams, etc.) in rural areas

• Health and wellness research topics

Human wellness and health are trendy topics in modern medicine as more people are interested in finding natural ways to live healthier lifestyles. 

If this field of study interests you, here are some big topics in the wellness space:

Gluten sensitivity

Gluten allergies and intolerances have risen over the past few decades. If you’re interested in exploring this topic, your options range in severity from mild gastrointestinal symptoms to full-blown anaphylaxis. 

Some examples of gluten sensitivity-related research topics include:

The pathophysiology and incidence of Celiac disease

Early onset symptoms of gluten intolerance

The prevalence of gluten allergies within a set population

Gluten allergies and the incidence of other gastrointestinal health conditions

Pollution and lung health

Living in large urban cities means regular exposure to high levels of pollutants. 

As more people become interested in protecting their lung health, examples of impactful lung health and pollution-related research topics include:

The extent of pollution in densely packed urban areas

The prevalence of pollution-based asthma in a set population

Lung capacity and function in young people

The benefits and risks of steroid therapy for asthma

Pollution risks based on geographical location

Plant-based diets

Plant-based diets like vegan and paleo diets are emerging trends in healthcare due to their limited supporting research. 

If you’re interested in learning more about the potential benefits or risks of holistic, diet-based medicine, examples of plant-based diet research topics to explore include:

Vegan and plant-based diets as part of disease management

Potential risks and benefits of specific plant-based diets

Plant-based diets and their impact on body mass index

The effect of diet and lifestyle on chronic disease management

Health supplements

Supplements are a multi-billion dollar industry. Many health-conscious people take supplements, including vitamins, minerals, herbal medicine, and more. 

Examples of health supplement-related research topics worth investigating include:

Omega-3 fish oil safety and efficacy for cardiac patients

The benefits and risks of regular vitamin D supplementation

Health supplementation regulation and product quality

The impact of social influencer marketing on consumer supplement practices

Analyzing added ingredients in protein powders

• Healthcare research topics

Working within the healthcare industry means you have insider knowledge and opportunity. Maybe you’d like to research the overall system, administration, and inherent biases that disrupt access to quality care. 

While these topics are essential to explore, it is important to note that these studies usually require approval and oversight from an Institutional Review Board (IRB). This ensures the study is ethical and does not harm any subjects. 

For this reason, the IRB sets protocols that require additional planning, so consider this when mapping out your study’s timeline. 

Here are some examples of trending healthcare research areas worth pursuing:

The pros and cons of electronic health records

The rise of electronic healthcare charting and records has forever changed how medical professionals and patients interact with their health data. 

Examples of electronic health record-related research topics include:

The number of medication errors reported during a software switch

Nurse sentiment analysis of electronic charting practices

Ethical and legal studies into encrypting and storing personal health data

Inequities within healthcare access

Many barriers inhibit people from accessing the quality medical care they need. These issues result in health disparities and injustices. 

Examples of research topics about health inequities include:

The impact of social determinants of health in a set population

Early and late-stage cancer stage diagnosis in urban vs. rural populations

Affordability of life-saving medications

Health insurance limitations and their impact on overall health

Diagnostic and treatment rates across ethnicities

People who belong to an ethnic minority are more likely to experience barriers and restrictions when trying to receive quality medical care. This is due to systemic healthcare racism and bias. 

As a result, diagnostic and treatment rates in minority populations are a hot-button field of research. Examples of ethnicity-based research topics include:

Cancer biopsy rates in BIPOC women

The prevalence of diabetes in Indigenous communities

Access inequalities in women’s health preventative screenings

The prevalence of undiagnosed hypertension in Black populations

• Pharmaceutical research topics

Large pharmaceutical companies are incredibly interested in investing in research to learn more about potential cures and treatments for diseases. 

If you’re interested in building a career in pharmaceutical research, here are a few examples of in-demand research topics:

Cancer treatment options

Clinical research is in high demand as pharmaceutical companies explore novel cancer treatment options outside of chemotherapy and radiation. 

Examples of cancer treatment-related research topics include:

Stem cell therapy for cancer

Oncogenic gene dysregulation and its impact on disease

Cancer-causing viral agents and their risks

Treatment efficacy based on early vs. late-stage cancer diagnosis

Cancer vaccines and targeted therapies

Immunotherapy for cancer

Pain medication alternatives

Historically, opioid medications were the primary treatment for short- and long-term pain. But, with the opioid epidemic getting worse, the need for alternative pain medications has never been more urgent. 

Examples of pain medication-related research topics include:

Opioid withdrawal symptoms and risks

Early signs of pain medication misuse

Anti-inflammatory medications for pain control

• Identify trends in your medical research with Dovetail

Are you interested in contributing life-changing research? Today’s medical research is part of the future of clinical patient care. 

As your go-to resource for speedy and accurate data analysis , we are proud to partner with healthcare researchers to innovate and improve the future of healthcare.

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What We Learned in 2019: Health and Medicine

By Knvul Sheikh

It’s not easy to say that any particular development in health or medicine was the most important in a given year. But if we had to choose some highlights, we would opt for these unforgettable events and findings.

Read about the year in science news here ;

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Illnesses tied to vaping became an epidemic

Since mid-August, 2,506 lung injury cases and 54 deaths linked to vaping have been reported. Most patients were otherwise healthy and in their late teens and 20s . But after using a vaping device to inhale nicotine, THC or a combination of the two, many ended up in an emergency room, gasping for breath.

The likely culprit: an additive made with vitamin E oil. Several states and cities have imposed bans, mainly on flavored e-cigarettes as a precaution.

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The legal battle over opioids didn’t get any easier

As the number of opioid-related lawsuits against the pharmaceutical industry grew to nearly 3,000 nationwide this year, breakthroughs, however tentative, began to emerge. Oklahoma, the first state to go to trial, won a judgment against Johnson & Johnson for $465 million ; the first federal trial, for two Ohio counties, settled just before opening arguments, for $20.4 million .

But there are indications that years of litigation lie ahead.

Purdue Pharma, which makes OxyContin, and the Sackler family who control the company, offered to settle all cases and sought bankruptcy protection to restructure. But two dozen states oppose the deal , saying the family itself should pay more. Three giant drug distributors and two manufacturers offered their own comprehensive settlement . But many states and thousands of local governments have flatly rejected it.

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Top 20 Research Studies of 2019 for Primary Care Physicians

Affiliations.

• 1 University of Georgia, Athens, GA, USA.
• 2 McGill University, Montreal, Quebec, Canada.
• PMID: 32412223

In 2019, regular surveillance of 110 English-language research journals identified 254 studies that met the criteria to become POEMs (patient-oriented evidence that matters). Physician members of the Canadian Medical Association rated these POEMs for their relevance to patients in their practices. This article summarizes the clinical questions and bottom-line answers from the top 20 POEMs of 2019. Taking blood pressure medications at night results in a large mortality reduction over six years compared with morning dosing. Automated devices are the best way to measure blood pressure. Nonfasting lipid profiles are preferred over fasting lipid profiles, and nonfasting and fasting lipid profiles are equally effective at predicting risk. The benefit of statins for primary prevention in people 75 years and older is uncertain at best. Aspirin has no net benefit for primary prevention of cardiovascular disease and has no effect on cancer outcomes. An Italian study found fecal immunochemical testing over five biennial screening cycles has a similar colorectal cancer yield as screening colonoscopy, whereas a meta-analysis found that taking aspirin, an anticoagulant, or a nonsteroidal anti-inflammatory drug has no impact on the positive predictive value of fecal immunochemical testing. Regarding infections, a meta-analysis showed that patients presenting with symptoms of acute respiratory tract infection are unlikely to have pneumonia if vital signs and the lung examination findings are normal. For streptococcal pharyngitis (strep throat), penicillin V at a dosage of 800 mg four times a day for five days is at least as effective as a dosage of 1,000 mg three times a day for 10 days. A primary care study in the United Kingdom reinforced that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient, because these infections can take three weeks or more to fully resolve. Among direct oral anticoagulants, apixaban has the lowest bleeding risk, and cotreating with a proton pump inhibitor significantly reduces bleeding risk. Single ibuprofen doses from 400 to 800 mg significantly reduce acute pain to a similar degree. The two-dose recombinant zoster vaccine is much more effective than the single-dose live, attenuated vaccine but with a greater risk of injection site pain. Exercise helps reduce the risk of falls in older adults. Practice guidelines from 2019 on antithrombotics for atrial fibrillation, the management of type 2 diabetes mellitus, and screening for breast cancer were judged to be especially relevant.

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Top 10 Most Read Perspectives of 2019

The National Academy of Medicine’s  NAM Perspectives  platform extends the National Academies’ convening and advising functions by providing a venue for leading health, medical, science, and policy experts to reflect on issues and opportunities important to the advancement of health, health care, and biomedical science.  NAM Perspectives  are individually-authored papers that do not reflect consensus positions of the NAM, the National Academies, or the authors’ organizations. They are not reports of the National Academies.

Below, we are pleased to present the top 10 most read  NAM Perspectives papers of 2019. These manuscripts cover a wide array of issues, from clinician burnout and well-being to the social determinants of health. Please enjoy revisiting these NAM Perspectives , and  sign up to receive more Perspectives in 2020 !  If you are interested in authoring an  NAM Perspectives paper in 2020, please be in touch with Jenna Ogilvie at [email protected].

10. Patient-Centered, Integrated Health Care Quality Measures Could Improve Health Literacy, Language Access, and Cultural Competence

I. Bau, R. A. Logan, C. Dezii, B. Rosof, A. Fernandez, M. Paasche-Orlow, and W. F. Wong

Patient-Centered, Integrated Health Care Quality Measures Could Improve Health Literacy, Language Access, and Cultural Competence recommends the integration of health care quality improvement measures for health literacy, language access, and cultural competence. The paper also notes the importance of patient-centered and equity-based institutional performance assessments or monitoring systems. The authors support the continued use of specific measures such as assessing organizational system responses to health literacy or the actual availability of needed language access services such as qualified interpreters as part of overall efforts to maintain quality and accountability.

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9. Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool

A. Billioux, K. Verlander, S. Anthony, and D. Alley

Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool reviews the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Model, tested by the Center for Medicare and Medicaid Innovation, designed to addresses this critical gap between clinical care and community services in the current health care delivery system. With input from a panel of national experts and after review of existing screening instruments, CMS developed a 10-item screening tool to identify patient needs in 5 different domains that can be addressed through community services (housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety). Clinicians and their staff can use this short tool across a spectrum of ages, backgrounds, and settings, and it is streamlined enough to be incorporated into busy clinical workflows. Just like with clinical assessment tools, results from this screening tool can be used to inform a patient’s treatment plan as well as make referrals to community services.

8. Core Principles & Values of Effective Team-Based Health Care

P. Mitchell, M. Wynia, R. Golden, B. McNellis, S. Okun, C. E. Webb, V. Rohrbach, and I. Von Kohorn

Core Principles & Values of Effective Team-Based Health Care  presents basic principles and personal values that characterize interprofessional team-based care. Developed by individual participants from the IOM’s Best Practices Innovation Collaborative, the authors identified key findings from health care literature and used interviews with 11 teams located across the United States to clarify how these factors shape effective team-based care. The principles and values reviewed are intended to help guide clinicians, patients, administrators, and other stakeholders in health care seeking high-value team-based care that focuses on the goals and priorities of patients and their families. In its conclusion, the discussion paper outlines four themes to guide the growth of team-based health care delivery.

7. Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature

A. C. Essary, K. S. Bernard, B. Coplan, R. Dehn, J. G. Forister, N. E. Smith, and V. L. Valentin

While much is known about the prevalence of burnout among physicians and nurses, little is known about burnout in the physician assistant (PA) profession. Approximately 50 percent of physicians and 35 percent of nurses report symptoms of burnout. Burnout is linked to increased health care costs, medical errors, and poor patient outcomes. The PA profession emerged in the 1960s in response to workforce shortages in rural and underserved communities. The profession has evolved from one designed for primary care to one that is adaptable to broad workforce demands. PAs are now employed in almost all medical specialties, including those with physicians reporting high rates of burnout. The authors believe that Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature is the first paper to explore the literature that relates specifically to PA burnout and career and job satisfaction.

6. Gender-Based Differences in Burnout: Issues Faced by Women Physicians

K. Templeton, C. Bernstein, J. Sukhera, L. M. Nora, C. Newman, H. Burstin, C. Guille, L. Lynn, M. L. Schwarze, S. Sen, and N. Busis

Individual, institutional, and societal risk factors for the development of burnout can differ for women and men physicians. While some studies on physician burnout report an increased prevalence among women, this finding may be due to actual differences in prevalence, the assessment tools used, or differences between/among the genders in how burnout manifests. Gender-Based Differences in Burnout: Issues Faced by Women Physicians reviews the prevalence of burnout in women physicians and contributing factors to burnout that are specific for women physicians. Understanding, preventing, and mitigating burnout among all physicians is critical, but such actions are particularly important for the retention of women physicians, given the increasing numbers of women in medicine and in light of the predicted exacerbation of physician shortages.

5. Nurse Suicide: Breaking the Silence

J. Davidson, J. Mendis, A. R. Stuck, G. DeMichele, and S. Zisook

Nurse Suicide: Breaking the Silence aims to raise awareness of and begin to build an open dialogue regarding nurse suicide. Recent exposure to nurse suicide raised our awareness and concern, but it was disarming to find no organization-specific, local, state, or national mechanisms in place to track and report the number or context of nurse suicides in the United States. This paper describes our initial exploration as we attempted to uncover what is known about the prevalence of nurse suicide in the United States. Our goal is to break through the culture of silence regarding suicide among nurses so that realistic and accurate appraisals of risk can be established and preventive measures can be developed.

4. Alternatives to Antibiotics: Why and How

H. K. Allen

Alternatives to Antibiotics: Why and How discusses how the antibiotic resistance problem is caused by the evolution and transfer of genes that confer resistance to medically important antibiotics into human pathogens. The acquisition of such resistance genes by pathogens complicates disease treatment, increases health care costs, and increases morbidity and mortality in humans and animals. As antibiotic resistance continues to evolve, antibiotics of so-called last resort become even more precious. Reducing or preventing the dissemination of antibiotic resistance genes into human pathogens is currently of high international importance.

3. Burnout Among Health Care Professionals: A Call to Explore and Address this Underrecognized Threat to Safe, High-Quality Care

L.N. Dyrbye, T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers

Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care discusses how the United States health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities. Among the changes affecting clinical practice are new payment and delivery approaches, electronic health records, patient portals, and publicly reported quality metrics—all of which change the landscape of how care is provided, documented, and reimbursed. Navigating these changes are health care professionals (HCPs), whose daily work is critical to the success of health care improvement. Unfortunately, as a result of these changes and resulting added pressures, many HCPs are burned out, a syndrome characterized by a high degree of emotional exhaustion and high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work.

2. Social Determinants of Health 101 for Health Care: Five Plus Five

As defined by the World Health Organization (WHO), the social determinants of health (SDoH) are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. The social determinants of health also determine access and quality of medical care—sometimes referred to as medical social determinants of health. Future opportunities may exist in genetics and biological determinants; however, whether modifying these will be as feasible as modifying the social determinants of health is unknown. Social Determinants of Health 101 for Health Care: Five Plus Five considers what we know and what we need to learn about SDoH to achieve the national quality strategy of better care, healthy people/healthy communities, and affordable care.

1. Implementing Optimal Team-Based Care to Reduce Clinician Burnout

C. D. Smith, C. Balatbat, S. Corbridge, A. L. Dopp, J. Fried, R. Harter, S. Landefeld, C. Martin, F. Opelka, L. Sandy, L. Sato, and C. Sinsky

Team-based health care has been linked to improved patient outcomes and may also be a means to improve clinician well-being. The increasingly fragmented and complex health care landscape adds urgency to the need to foster effective team-based care to improve both the patient and team’s experience of care delivery. Implementing Optimal Team-Based Care to Reduce Clinician Burnout describes key features of successful health care teams, reviews existing evidence that links high-functioning teams to increased clinician well-being, and recommends strategies to overcome key environmental and organizational barriers to optimal team-based care in order to promote clinician and patient well-being.

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ROLAND GRAD, MD, MSc, AND MARK H. EBELL, MD, MS

Am Fam Physician. 2021;104(1):41-48

Related letter: Should Muscle Relaxants Be Used as Adjuvants in Patients With Acute Low Back Pain?

Published online June 9, 2021.

Author disclosure: Dr. Grad has no relevant financial affiliations. Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor's Note.

This article summarizes the top 20 research studies of 2020 identified as POEMs (patient-oriented evidence that matters), including the two most highly rated guidelines of the year on gout and chronic obstructive pulmonary disease (COPD). Regarding COVID-19, handwashing and social distancing through stay-at-home orders or quarantine measures are effective at slowing the spread of illness. Use of proper face masks (not gaiters or bandanas) is also effective at preventing transmission. This is important because the virus can infect others during the presymptomatic phase. Aspirin can no longer be recommended for the primary prevention of cardiovascular disease. Human papillomavirus vaccination is strongly associated with reduced risk of invasive cervical cancer, especially in women who were vaccinated before 17 years of age. When a woman who is postmenopausal has a screening bone mineral density test, rechecking the test after three years does not help to identify those who will have a fragility fracture. A higher daily step count is associated with lower all-cause mortality. After one year of follow-up, physical therapy is preferred to glucocorticoid injections for osteoarthritis of the knee; acetaminophen is ineffective for acute low back pain or pain due to knee or hip osteoarthritis; and adding a muscle relaxant to ibuprofen does not improve functional outcomes or pain in people reporting moderate to severe back pain one week after starting treatment. Although short-term antibiotics and steroids are effective in treating acute exacerbations of COPD, not much else is. Successful communication with patients seeking an antibiotic for a flulike illness can be achieved with combinations of messaging, including information on antibiotic resistance and the self-limiting nature of the illness. A new prediction rule effectively identifies patients with a history of penicillin allergy who have a low likelihood of positive findings on allergy testing. Low-value screening tests in asymptomatic, low-risk patients often lead to further testing, diagnostic procedures, or referrals. A new tool helps determine the amount of change needed to signify a real difference between two laboratory values in the same person over time. Finally, a pillar of our specialty, continuity of care, is associated with decreased all-cause mortality.

Annually for 22 years, a team of clinicians has systematically reviewed English-language medical journals to identify original research most likely to change and improve primary care practice. The team includes experts in family medicine, pharmacology, hospital medicine, and women's health. 1 , 2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if applied in practice, the results would change what some physicians do by prompting them to adopt a new practice or discontinue an old one that has been shown to be ineffective or harmful. Adopting POEMs in clinical practice should improve patient outcomes. Of more than 20,000 research studies published in 2020 in the journals reviewed by the POEMs team, 306 met criteria for validity, relevance, and practice change. These POEMs are emailed daily to subscribers of Essential Evidence Plus (Wiley-Blackwell, Inc.).

The Canadian Medical Association purchases a POEMs subscription for its members, many of whom receive the daily POEM. As these physicians read a POEM, they can rate it using a validated questionnaire. This process is called the Information Assessment Method ( https://www.mcgill.ca/iam ). POEM ratings address the domains of clinical relevance, cognitive impact, use of this information in practice, and expected health benefits if that POEM is applied to a specific patient. 3 , 4 In 2020, each of the 306 daily POEMs was rated by an average of 1,230 physicians.

In this article, we present the 20 most clinically relevant POEMs as rated by Canadian Medical Association members in 2020. This is the 10th installment of our annual series ( https://www.aafp.org/afp/toppoems ). As we write this article, the pandemic rolls on. However, beyond COVID-19, our patients continue to face the usual (and unusual) health problems of everyday life. Thus, we summarize the clinical question and bottom-line answer for research studies identified as a top 20 POEM, organized by topic and followed by a brief discussion. This set of 20 POEMs includes the two most relevant practice guidelines of the year. The full POEMs are available online at https://www.aafp.org/afp/poems2020 .

The year 2020 saw the emergence of SARS-CoV-2, a novel coronavirus that causes the COVID-19 illness, and 54 POEMs addressed the epidemiology, diagnosis, treatment, and prognosis of patients with COVID-19. Not surprisingly, the four most highly rated POEMs of the year and five in the top 20 provided evidence regarding preventive measures ( Table 1 ) . 5 – 10 These were published early in the pandemic and provided important evidence for family physicians to share with their patients.

The most highly rated POEM was originally published in 2015 and reissued in 2020 after the content was updated for COVID-19. The study was a large pragmatic trial in the United Kingdom that randomized participants to a brief online hand-washing intervention or usual care. Those who completed the intervention had fewer respiratory tract infections over the next four months (51% vs. 59%; P < .001; number needed to treat = 12). 5

The next COVID-19 POEM was a Cochrane review. 6 The authors reviewed the results of modeling studies of COVID-19 and previous coronavirus pandemics, as well as four observational studies. They concluded that quarantine measures are effective in slowing the spread of infection, especially when implemented early and in conjunction with other public health measures.

The third POEM summarized the results of two ecologic studies. The first compared COVID-19 incidence rates in eight Iowa counties that did not have stay-at-home orders with seven neighboring Illinois counties that had such orders in place. 7 The second compared a Georgia county that implemented stay-at-home orders approximately two weeks before the rest of Georgia with seven surrounding counties. 8 In both studies, earlier implementation of stay-at-home orders was associated with a lower incidence of COVID-19.

Another POEM summarized the results of one of the earliest studies to evaluate the effectiveness of different kinds of masks for preventing the spread of respiratory droplets. 9 Using laser technology, 14 types of masks were evaluated. Gaiters and bandanas were essentially useless, polypropylene and surgical masks were much better, and N95 masks were best.

An important factor in the rapid spread of COVID-19 was transmission by asymptomatic people. One of the first publications to report this was described in the next POEM. Chinese researchers studying infector-infectee transmission pairs found that the peak of infectiousness occurs about one day before symptom onset, and that 44% of secondary cases occur during the presymptomatic period. 10 Another study (not among the top 20 POEMs) reviewed cohorts in which the entire group was tested for COVID-19 during an outbreak and found that the rates of asymptomatic or presymptomatic infection are 75% or higher in young adult populations and approximately 40% overall. 11

Prevention and Screening

POEMs addressing prevention topics are summarized in Table 2 . 12 – 15 The first was a meta-analysis of randomized trials comparing aspirin with placebo as primary prevention. It compared four studies that recruited patients since 2005, with older studies that largely recruited patients in the 1980s and 1990s. The newer studies no longer found that patients taking aspirin for primary prevention have significant reductions in cancer incidence or mortality, cardiovascular mortality, or nonfatal myocardial infarction. Any benefits were countered by harms, such as increased gastrointestinal bleeding. 12 Perhaps we are doing a better job of screening for cancer and preventing cardiovascular events through use of statins and antihypertensives, lessening the need for aspirin in prevention.

We often tell our patients to walk more, but does walking affect mortality? The next POEM used data from a national sample of U.S. residents whose daily steps were measured between 2003 and 2006. 13 All-cause mortality was 77 per 1,000 person-years for those with less than 4,000 steps per day; 21 per 1,000 for those with 4,000 to 7,999 steps per day; 7 per 1,000 for those with 8,000 to 11,999 steps per day; and 4.8 per 1,000 for those with at least 12,000 steps per day. Step intensity was not significantly associated with mortality after controlling for total daily steps. Bottom line? Higher step counts are associated with lower all-cause mortality, suggesting our patients should keep walking. 13

When a woman who is postmenopausal has a screening bone mineral density test, the question arises about whether to repeat the test and, if so, how often? The third POEM in this group is a cohort study from the Women's Health Initiative, which showed that information gained from a second test three years after the first does not add predictive value beyond the first test result. Because bone density changes little over time, one bone mineral density test at around 65 years of age is likely to be sufficient for the purpose of screening to prevent a fragility fracture. 14

Studies have shown that human papillomavirus (HPV) vaccination can reduce the likelihood of precancerous abnormalities identified on a Papanicolaou (Pap) test. The next POEM is a Swedish study that used data from a national health registry to compare the risk of invasive cervical cancer in 527,871 vaccinated women vs. 1,145,112 unvaccinated women. 15 After adjusting for differences between groups, the incidence rate ratio (IRR; the ratio of the incidence of cancer in vaccinated people to that in unvaccinated people) for invasive cervical cancer was 0.37 (95% CI, 0.21 to 0.57). For women who were vaccinated before 17 years of age, the IRR was only 0.12 (95% CI, 0.00 to 0.34), whereas for those vaccinated between 17 and 30 years of age, the IRR was 0.47 (95% CI, 0.27 to 0.75). HPV vaccination is strongly associated with a lower risk of invasive cervical cancer, especially when given early.

Musculoskeletal

Three POEMs addressing musculoskeletal topics are summarized in Table 3 . 16 – 19 The first is a study that randomized adults with knee osteoarthritis to up to three corticosteroid injections or up to eight physical therapy sessions in the first six weeks, with additional sessions as needed. 16 The rapid and large improvement in the first month for both groups is somewhat surprising, with relatively little further improvement the rest of the year. This suggests regression to the mean may have contributed to the observed improvement (i.e., patients were identified when their arthritis was flaring up and would have improved no matter what). Also, the open-label design may have contributed to a Hawthorne effect (alteration of behavior by the participants of a study who know they are being observed) for those in the physical therapy group and a placebo effect for those in the injection group. A Cochrane review concluded that glucocorticoid injections are effective, although primarily in the two to four weeks following injection. 17 Overall, the physical therapy group did better at one year, with continued improvement, whereas the injection group plateaued after the first month. 16

The next POEM is a systematic review of randomized controlled trials of acetaminophen compared with placebo for pain relief in adults. 18 It showed that acetaminophen is more effective than placebo in providing some pain relief in patients with acute migraine and might be more beneficial than placebo (which also works well) for tension headaches. A single dose of acetaminophen is about twice as likely as placebo to reduce postpartum perineal pain, and it may be effective (but not as effective as other treatments) for acute renal colic. Importantly, acetaminophen is ineffective for patients with acute low back pain or pain due to knee or hip osteoarthritis.

The last POEM in this category addresses a drug class often prescribed for back pain. In people with moderate to severe low back pain who are taking a nonsteroidal anti-inflammatory drug, such as ibuprofen (up to 600 mg three times per day), does the addition of a muscle relaxant improve function or reduce pain? No. 19 This finding reminds us of an earlier randomized controlled trial from the same author that was a top POEM of 2015. At that time, we advised not adding cyclobenzaprine to naproxen for patients with acute low back pain. 20

Respiratory

Two top POEMs on respiratory topics are summarized in Table 4 . 21 , 22 One is a meta-analysis of randomized controlled trials of treatment in patients with an exacerbation of chronic obstructive pulmonary disease. 21 This shows that antibiotics and corticosteroids are effective in treating acute exacerbations in outpatient and inpatient settings, regardless of the severity of the exacerbation. Current research does not provide good guidance on which antibiotic is best or on the optimal dose or duration of corticosteroid treatment. Notably, studies performed in critically ill patients were not included in this analysis.

The other POEM addresses the tricky issue of communicating with patients who appear to be seeking an antibiotic for a flulike illness. It is a randomized trial conducted online in the United Kingdom showing that patients receiving the combination of a fear-based message about increased antibiotic resistance and an empowering message are less likely to visit a physician for their next respiratory tract infection (45.1% to 46.1% vs. 29.2%; P < .001) and less likely to request an antibiotic (52.5% to 54.7% vs. 42.3%; P < .001) than those receiving only fear-based messaging. 22

Miscellaneous

Four top POEMs do not fall easily into a single category ( Table 5 ) . 23 – 26 The first is about a new clinical prediction rule to identify patients who report a penicillin allergy but are unlikely to have a true allergy if tested. The FAST rule is as follows—five years or less since the reaction: 2 points; anaphylaxis, angioedema, or severe cutaneous reaction: 2 points; treatment required for reaction: 1 point. Patients with a score of 0 have a less than 1% likelihood of a positive result on allergy testing, and those with a score of 1 or 2 have a 5% likelihood. 23

The COVID-19 pandemic upended medical practice, leading to large reductions in the use of health care services. For example, the Canadian Urological Association recommended the cessation of prostate-specific antigen screening for prostate cancer until the resolution of the pandemic. 27 In this context, the next POEM reminds us to avoid low-value screening tests in asymptomatic, low-risk patients because they often lead to further testing, diagnostic procedures, or referrals. 24 Specifically, screening tests in low-risk patients, such as chest radiography and electrocardiography in adults as part of an annual health examination and Pap tests in those younger than 21 years or older than 69 years, should be avoided.

How many patients still ask for annual blood tests despite physicians counseling them on the low yield for doing this? The next POEM was the top non–COVID-related POEM of 2020 for clinical relevance. 25 This POEM describes a new online tool ( https://www.bmj.com/content/368/bmj.m149 ) to illustrate the variability in a single laboratory value (such as the A1C test) and the amount of change needed to signify a real difference between two values in the same person over time. For example, given the variability inherent in total cholesterol measurements, it is difficult to detect a clinically important change within a one-year period.

Our final miscellaneous POEM is a systematic review of the value of a pillar of family medicine—personal continuity of care. This is defined by an ongoing relationship with a physician that builds the physician-patient relationship and promotes the healing power of interactions. This core principle of family medicine stands up to scientific scrutiny by demonstrating an associated reduction in mortality. 26

Practice Guidelines

POEMs sometimes summarize high-impact clinical practice guidelines. Key messages from the two highest rated guidelines, addressing gout and chronic obstructive pulmonary disease, are summarized in Table 6 . 28 , 29

The full text of the POEMs discussed in this article is available at https://www.aafp.org/afp/poems2020 .

A list of top POEMs from previous years is available at https://www.aafp.org/afp/toppoems .

Editor's Note: This article was cowritten by Dr. Mark Ebell, deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Because of Dr. Ebell's dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP 's medical editors. In addition, the article underwent peer review and editing by three of AFP 's medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Sumi Sexton, MD, Editor-in-Chief

The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia for their work as peer reviewers; Joulé, Inc., for supporting the POEMs CME program in Canada; Pierre Pluye, PhD, for codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499.

Ebell MH, Barry HC, Slawson DC, et al. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355.

Grad RM, Pluye P, Mercer J, et al. Impact of research-based synopses delivered as daily e-mail: a prospective observational study. J Am Med Inform Assoc. 2008;15(2):240-245.

Pluye P, Grad RM, Johnson-Lafleur J, et al. Evaluation of email alerts in practice: part 2. Validation of the information assessment method. J Eval Clin Pract. 2010;16(6):1236-1243.

Little P, Stuart B, Hobbs FDR, et al. An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial [published correction appears in Lancet . 2015;386(10004):1630]. Lancet. 2015;386(10004):1631-1639.

Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020(4):CD013574.

Lyu W, Wehby GL. Comparison of estimated rates of coronavirus disease 2019 (COVID-19) in border counties in Iowa without a stay-at-home order and border counties in Illinois with a stay-at-home order. JAMA Netw Open. 2020;3(5):e2011102.

Ebell MH, Bagwell-Adams G. Mandatory social distancing associated with increased doubling time: an example using hyperlocal data. Am J Prev Med. 2020;59(1):140-142.

Fischer EP, Fischer MC, Grass D, et al. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Sci Adv. 2020;6(36):eabd3083.

He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19 [published correction appears in Nat Med . 2020;26(9):1491–1493]. Nat Med. 2020;26(5):672-675.

Oran DP, Topol EJ. Prevalence of asymptomatic SARSCoV-2 infection: a narrative review. Ann Intern Med. 2020;173(5):362-367.

Moriarty F, Ebell MH. A comparison of contemporary versus older studies of aspirin for primary prevention. Fam Pract. 2020;37(3):290-296.

Saint-Maurice PF, Troiano RP, Bassett DR, et al. Association of daily step count and step intensity with mortality among US adults. JAMA. 2020;323(12):1151-1160.

Crandall CJ, Larson J, Wright NC, et al. Serial bone density measurement and incident fracture risk discrimination in postmenopausal women. JAMA Intern Med. 2020;180(9):1232-1240.

Lei J, Ploner A, Elfström KM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020;383(14):1340-1348.

Deyle GD, Allen CS, Allison SC, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020;382(15):1420-1429.

Jüni P, Hari R, Rutjes AWS, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015(10):CD005328.

Saragiotto BT, Abdel Shaheed C, Maher CG. Paracetamol for pain in adults. BMJ. 2019;367:l6693.

Friedman BW, Irizarry E, Solorzano C, et al. A randomized, placebo-controlled trial of ibuprofen plus metaxalone, tizanidine, or baclofen for acute low back pain. Ann Emerg Med. 2019;74(4):512-520.

Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572-1580.

Dobler CC, Morrow AS, Beuschel B, et al. Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis. Ann Intern Med. 2020;172(6):413-422.

Roope LSJ, Tonkin-Crine S, Herd N, et al. Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messages about antimicrobial resistance. BMC Med. 2020;18(1):110.

Trubiano JA, Vogrin S, Chua KYL, et al. Development and validation of a penicillin allergy clinical decision rule. JAMA Intern Med. 2020;180(5):745-752.

Bouck Z, Calzavara AJ, Ivers NM, et al. Association of low-value testing with subsequent health care use and clinical outcomes among low-risk primary care outpatients undergoing an annual health examination. JAMA Intern Med. 2020;180(7):973-983.

McCormack JP, Holmes DT. Your results may vary: the imprecision of medical measurements. BMJ. 2020;368:m149.

Baker R, Freeman GK, Haggerty JL, et al. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600-e611.

Kokorovic A, So AI, Hotte SJ, et al. A Canadian framework for managing prostate cancer during the COVID-19 pandemic: recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association. Can Urol Assoc J. 2020;14(6):163-168.

FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout [published correction appears in Arthritis Rheumatol . 2021;73(3):413]. Arthritis Rheumatol. 2020;72(6):879-895.

Nici L, Mammen MJ, Charbek E, et al. Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society Clinical Practice Guideline [published correction appears in Am J Respir Crit Care Med. 2020;202(6):910]. Am J Respir Crit Care Med. 2020;201(9):e56-e69.

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2022 Research Highlights — Basic Research Insights

Noteworthy NIH advances in basic research include progress in understanding and treating Alzheimer’s disease, discoveries about how the microbiome affects human health, and learning how mosquitos find us.

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2021 Research Highlights — Human Health Advances

NIH accomplishments in disease prevention, diagnosis, and treatment include progress in COVID-19 control, a drug that delays type 1 diabetes onset, and devices in the brain that help paralyzed people communicate.

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2021 Research Highlights — Promising Medical Findings

NIH findings with potential for enhancing human health include new drugs and vaccines in development for COVID-19, advances in Alzheimer’s disease research, and the design of a wireless, biodegradable pacemaker.

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2021 Research Highlights — Basic Research Insights

Noteworthy NIH advances in basic research include progress in understanding SARS-CoV-2, new approaches to developing antibiotics, and the discovery of a brain receptor linked to puberty and growth.

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2020 Research Highlights — Human Health Advances

NIH accomplishments in disease prevention, diagnosis, and treatment include COVID-19 vaccines and treatments, better diagnosis of prostate cancer, and methods for early detection of Alzheimer’s disease.

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2020 Research Highlights — Promising Medical Findings

NIH findings with potential for enhancing human health include new approaches to COVID-19, a universal mosquito vaccine, and advances in restoring vision.

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2020 Research Highlights — Basic Research Insights

Noteworthy NIH advances in basic research include progress in understanding SARS-CoV-2, discovery of an exercise-induced protein that generates new brain cells and improves memory, and a new pain-suppression center in the brain.

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2019 Research Highlights — Human Health Advances

NIH accomplishments in disease prevention, diagnosis, and treatment include treatments for the Ebola virus, gene therapy that reverses a rare immune disorder, and a blood test to detect myalgic encephalomyelitis/chronic fatigue syndrome

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2019 Research Highlights — Promising Medical Findings

NIH findings with potential for enhancing human health include a way to predict which people at risk for psychosis may progress to full psychosis, insights into recurrent tonsillitis, and a patch to replace damaged retinal cells.

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2019 Research Highlights — Basic Research Insights

Noteworthy NIH advances in basic research include evidence linking enterovirus infections with acute flaccid myelitis, insights into how disrupted sleep may lead to heart disease, and nanoparticle robots that sweep away biofilms.

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2018 Research Highlights — Clinical Advances

NIH accomplishments in the prevention, diagnosis, and treatment of human disease include progress on preventing opioid overdoses, an antibody combination that suppresses HIV, and fecal transplants that restore gut microbes after antibiotics.

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2018 Research Highlights — Promising Medical Advances

NIH findings with potential for enhancing human health include vaccines against HIV, anthrax, and plague, a wearable ultrasound patch to track blood pressure, and a technique to regrow neurons across scarred spinal tissue.

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2018 Research Highlights — Insights From the Lab

Noteworthy NIH advances in basic research include new insights into cancer, identification of a human skeletal stem cell, and an experimental male contraceptive that blocks sperm movement.

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2017 Research Highlights — Clinical Advances

NIH accomplishments in the prevention, diagnosis, and treatment of human disease. These include progress on two Ebola vaccines, a bionic pancreas to treat type 1 diabetes, and a genetic test that improves blood thinner dosing.

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2017 Research Highlights — Promising Medical Advances

NIH findings with potential for enhancing human health include understanding how dietary factors influence disease risk, combatting the epigenetic effects of outdoor air pollution, and methods to detect prions in blood and skin.

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2017 Research Highlights — Insights from the Lab

Noteworthy NIH advances in basic research include a 3-D model of human brain development and disease, a virus linked to food sensitivity, and a new role discovered for the thalamus.

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2016 Research Highlights — Clinical Breakthroughs

NIH accomplishments in the prevention, diagnosis, and treatment of human disease. These include a way to restore blood sugar control in type 1 diabetes, food allergy prevention, and an experimental malaria vaccine.

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2016 Research Highlights — Promising Medical Advances

NIH findings with potential for enhancing human health include advances in ZIka research, gene editing techniques, and diagnosing prostate cancer.

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2016 Research Highlights — Insights from the Lab

Noteworthy NIH advances in basic research include an expanded map of the human brain, nanoparticles that convert white fat to calorie-burning brown fat, and a 3-D cell culture model of the placenta.

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2015 Research Highlights — Clinical Advances

NIH accomplishments in the prevention, diagnosis, and treatment of human disease. These include a test to tailor breast cancer tumor treatments, a noninvasive treatment to help paralyzed men gain movement, and a tool that may predict suicide risk.

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2015 Research Highlights — Promising Medical Advances

NIH findings with potential for enhancing human health include advances in Ebola research, progress in fighting HIV, and the development of custom 3-D printed nerve scaffolds to aid tissue regeneration.

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2015 Research Highlights — Insights from the Lab

Noteworthy NIH advances in basic research include charting human genetic variation across the globe, the discovery of lymphatic vessels in the central nervous system, and insights into energy-burning fat cells.

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Findings with potential for enhancing human health.

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Prevention, Diagnosis, and Treatment of Human Disease.

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Findings with Potential for Enhancing Human Health.

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Prevention, Diagnosis and Treatment of Human Disease.

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Australians are living longer than most people in English-speaking OECD countries, new research says

By Ahmed Yussuf

Topic: Health

The study found Australia had the lowest inequality for both men and women when compared to other English-speaking OECD nations. ( Pixabay: Mircea Iancu )

An international study has found Australia has a better life expectancy compared to other English-speaking OECD nations.

The worst performer was the United States, despite spending the most on healthcare compared to any other OECD nation.

What's next?

Some experts have said Australia should not become complacent highlighting large disparities in health outcomes between Indigenous and non-Indigenous people.

People living in Australia have better health outcomes and face less inequality compared to other high-income countries in the Anglosphere.

That is according to research published in the open access medical journal BMJ Open.

International researchers analysed several English-speaking countries such as New Zealand, Canada, the United States and the United Kingdom to review life expectancy between 1990 and 2018.

They found Australia was the best performer in life expectancy at birth since the 1990s.

"Australia performs well, but still has room for improvement, particularly in the area of reducing inequalities among its indigenous populations," researchers said.

"Overall, Australia offers a potential model for lower-performing Anglophone countries, such as the USA and UK, to follow to reduce both premature mortality and inequalities in life expectancy."

What does Australia's age and gender distribution look like?

The Australian Bureau of Statistics issued new data looking at the age and gender distribution across the country for 2023.

Darwin had the youngest median age out of all other capital cities in Australia.

Beidar Cho, the ABS' head of demography, said that Darwin was a year younger than the next youngest capital, Canberra.

"[Darwin] was also the only capital where males outnumbered females, with 104.7 males for every 100 females," Ms Cho said.

Australian National University demographer Liz Allen said the data showed a clear geographical picture of where Australia was aging.

"Aging is quite pronounced in some geographic areas across Australia, particularly in more regional areas outside of capital cities. With that, we see enormous age disparities, particularly in regional and remote areas," she said.

"When it comes to Darwin and the Northern Territory generally, we can see there that, as a result of differences in population composition.

"We see a much younger population, and that would be driven by a higher birth rate, and of course, the makeup of Indigenous people in communities there."

Dr Allen said governments across all levels should not be too fixated on aggregate figures because there was a danger of missing more complicated issues happening underneath.

"That is that there are areas of highly concentrated age disparities, and that presents enormous challenges," she said.

"Because there's no one size fits all here, there needs to be tailored service provision in local areas to accommodate and support communities to avoid any adverse social outcomes."

Why Australia is leading in life expectancy

The study in BMJ open has suggested that Australia's high number of people born overseas was a possible explanation for its performance compared to other English-speaking OECD nations.

Health economist Martin Hensher said that it was an established phenomenon that countries with high levels of immigration tend to have better levels of life expectancy.

"So basically, young immigrants arrive and they tend to be healthier than the locals, so they drive up life expectancy," he said.

The study also highlighted lower smoking rates, public health campaigns regarding gun ownership and mental health, as well as the country's healthcare system as reasons for Australia doing better than other countries.

Australia had about a four to five-year life expectancy advantage over the US and a one to 2.5-year advantage over Canada, New Zealand and the UK.

The worst performer in life expectancy every year since 2001 has been the US, despite its healthcare spending, both per person and as a share of GDP, being higher than any other OECD nation.

Dr Hensher highlighted despite the study looking into the years between 1990 and 2018, Australia still has better life expectancy rates than the other countries included in the research.

"Our COVID response was massively superior to most of these other countries. So we didn't have the big dip in life expectancy that particularly America and the United Kingdom had," he said.

Australia also had the lowest within-country inequality for both men and women, particularly for ages over 40.

New Zealand and the US had the highest inequality among women, while the UK, New Zealand and the US had the highest among men.

Experts warn Australia should not be complacent 

Dr Hensher said Australia's growing economic inequalities could see life expectancy fall if governments do not act to effectively combat it.

"We also need to keep pushing on these public health measures that improve health. So the very obvious example is the watering down of the restrictions on gambling advertising that's a step in the wrong direction," he said.

He said for Australia to continue to see better health outcomes, and prevent further inequalities, there needed to be more action on critical determinants of health such as housing and air quality.

"If we do let increasing numbers of people become homeless, that absolutely will lead to reduced life expectancy and poorer health down the track.

"We need to get on top of making sure that every Australian has access to decent housing, we need to be working hard on air pollution, which particularly in urban areas is quite a driver of preventable diseases."

One of the key areas of improvement for Australia highlighted in the study was the disparity in health outcomes between Indigenous and non-Indigenous communities.

"We need to not rest on our laurels here because what you can see in this [journal] article is that they show that the outlier in Australia is the Northern Territory," he said.

"That reflects the terrible inequalities in poor health status that the Indigenous population, particularly in the Northern Territory, suffer."

Building a robust mental health workforce

Vol. 55 No. 6 Print version: page 8

• Becoming a Psychologist
• Teaching Psychology as a Subject

For this month’s column, I spoke with Karen Naufel, PhD, chair of APA’s Board of Education Affairs (BEA), about the important work BEA is doing to secure the future of psychology training and the biggest challenges facing the training community.

APA’s strategic plan aims “to prepare the field of psychology for current and future opportunities and challenges.” What major challenges has the BEA identified?

BEA is addressing several challenges, including the growing mental health crisis. The most recent Health Resources and Services Administration data show that many areas in the United States are in dire need of mental health providers, and providers predict that wait times to see a mental health provider are only likely to increase. These challenges augment the need for many more qualified mental health service providers.

Unfortunately, “ Great Cliff ,” a term describing how the ebbing birth rate of U.S. citizens is affecting enrollment in higher education, will likely slow the growth of mental health providers. Lower enrollment could lead to closures of colleges and universities, and to mergers of academic programs that could dilute the quality of a psychology education. These changes in higher education could also lead to fewer students seeing possibilities for psychology-related careers. The application of psychology enhances education at all levels, so these effects may ripple into pre-K–12 education as well.

How is the BEA addressing these challenges?

BEA is taking steps to advance education and credentialing for ­master’s-level health service psychology, which has the potential to go a long way toward addressing our nation’s mental health needs. Focusing on master’s-level health service provider credentialing offers opportunities to increase the number and diversity of qualified mental health professionals in the field, including extending psychology’s reach into underserved areas.

Indeed, BEA’s mission advances education in psychology at multiple points in a person’s academic career, as well as applying psychology to promote education in schools through the work of APA’s Center for Psychology in Schools and Education. APA’s Quality Principles for Undergraduate Education in Psychology and Guidelines for the Undergraduate Psychology Major (version 3.0)  are resources that promote education in psychology at the undergraduate level. Similarly, APA’s Teachers of Psychology in Secondary Schools and Committee on Associate and Baccalaureate  Education  provide  a wealth of support and resources that promote top-notch psychology education at the high school and undergraduate levels, respectively, and provide entry points into the discipline.

Despite the many challenges ahead, I am incredibly grateful to BEA members and others in the training community who are dedicated to creating high-quality educational opportunities at every step in the academic journey and to growing the mental health workforce our country needs.

● Dr. de las Fuentes is the 2024 APA president and works as a licensed psychologist in independent practice in Austin, Texas.

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Elevating Women's Voices to Improve Maternal Mental Health

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Elevating Women's Voices to Improve Maternal Mental Health is the third event in the NIH Women’s Health Roundtable Series  , which focuses on important women’s health topics, such as maternal mental health, as part of the  White House Initiative on Women’s Health Research  . This series was developed as a recommended action in response to the Presidential Memorandum  to bring attention to priority topics within the Department of Health and Human Services (HHS) and to disseminate information on federally supported research areas.

The roundtable is also featured in the National Institute of Mental Health’s (NIMH) Office of Disparities Research and Workforce Diversity Webinar Series , which focuses on mental health equity research topics. The event is co-hosted by the NIH Office of Research on Women’s Health (ORWH)  and NIMH.

The goals of this roundtable are to:

• Spotlight high-priority research areas related to women's mental health during pregnancy and the postpartum period, up to one year following childbirth.
• Share information on how NIMH-supported research advances the development of and access to screening, diagnostics, and preventive and treatment interventions to improve women’s mental health during the perinatal period.
• Explain how maternal mental health research can reduce the burden of mental illnesses that contribute to maternal morbidity and mortality.
• Identify and explore gaps in areas critical to women’s research outlined within the Executive Order on Advancing Women's Health Research and Innovation (EO 14120)  and the 2024-2028 NIH-Wide Strategic Plan for Research on the Health of Women   .

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FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants

FDA News Release

Today, the U.S. Food and Drug Administration approved and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines (2024-2025 formula) to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. The mRNA COVID-19 vaccines have been updated with this formula to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA COVID-19 vaccines manufactured by ModernaTX Inc. and Pfizer Inc.

In early June, the FDA advised manufacturers of licensed and authorized COVID-19 vaccines that the COVID-19 vaccines (2024-2025 formula) should be monovalent JN.1 vaccines. Based on the further evolution of SARS-CoV-2 and a rise in cases of COVID-19, the agency subsequently determined and advised manufacturers that the preferred JN.1-lineage for the COVID-19 vaccines (2024-2025 formula) is the KP.2 strain, if feasible.

“Vaccination continues to be the cornerstone of COVID-19 prevention,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “These updated vaccines meet the agency’s rigorous, scientific standards for safety, effectiveness, and manufacturing quality. Given waning immunity of the population from previous exposure to the virus and from prior vaccination, we strongly encourage those who are eligible to consider receiving an updated COVID-19 vaccine to provide better protection against currently circulating variants.”

The updated mRNA COVID-19 vaccines include Comirnaty and Spikevax, both of which are approved for individuals 12 years of age and older, and the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine, both of which are authorized for emergency use for individuals 6 months through 11 years of age.

What You Need to Know

• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated, authorized Moderna COVID-19 Vaccine.
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
• Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least 2 months after the last dose of any COVID-19 vaccine.
• Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty or the updated, approved Spikevax; if previously vaccinated, the dose is administered at least 2 months since the last dose of any COVID-19 vaccine.
• Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine fact sheets.

Individuals who receive an updated mRNA COVID-19 vaccine may experience similar side effects as those reported by individuals who previously received mRNA COVID-19 vaccines and as described in the respective prescribing information or fact sheets. The updated vaccines are expected to provide protection against COVID-19 caused by the currently circulating variants. Barring the emergence of a markedly more infectious variant of SARS-CoV-2, the FDA anticipates that the composition of COVID-19 vaccines will need to be assessed annually, as occurs for seasonal influenza vaccines.

For today’s approvals and authorizations of the mRNA COVID-19 vaccines, the FDA assessed manufacturing and nonclinical data to support the change to include the 2024-2025 formula in the mRNA COVID-19 vaccines. The updated mRNA vaccines are manufactured using a similar process as previous formulas of these vaccines. The mRNA COVID-19 vaccines have been administered to hundreds of millions of people in the U.S., and the benefits of these vaccines continue to outweigh their risks.

On an ongoing basis, the FDA will review any additional COVID-19 vaccine applications submitted to the agency and take appropriate regulatory action.

The approval of Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to BioNTech Manufacturing GmbH. The EUA amendment for the Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula) was issued to Pfizer Inc.

The approval of Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to ModernaTX Inc. and the EUA amendment for the Moderna COVID-19 Vaccine (2024-2025 Formula) was issued to ModernaTX Inc.

Related Information

• Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
• Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
• Moderna COVID-19 Vaccine (2024-2025 Formula)
• Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula)
• FDA Resources for the Fall Respiratory Illness Season
• Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2024
• June 5, 2024, Meeting of the Vaccines and Related Biological Products Advisory Committee

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, radiation-emitting electronic products, and for regulating tobacco products.

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New findings on tuberculosis could change how we treat inflammatory disorders

by Katherine Fenz, Rockefeller University

Tuberculosis (TB) is a confounding scourge. It's the leading cause of death from infectious disease in the world, and yet it's estimated that those deaths represent perhaps 5% of infections with Mycobacterium tuberculosis (Mtb). Antibiotics can take credit for saving the lives of some of those with Mtb, but a chasm nevertheless persists between the prevalence of infection and the targeted severity of its impact. A growing body of evidence suggests genetic vulnerabilities to TB account for that gap.

Now researchers from The Rockefeller University have found another rare mutation that leaves its carriers much more likely to become ill with TB—but, curiously, not with other infectious diseases. This finding, recently published in Nature , may upend long held assumptions about the immune system .

It's long been known that an acquired deficiency of a pro-inflammatory cytokine called TNF is linked to an increased risk of developing TB. The current study, led by Rockefeller's Stéphanie Boisson-Dupuis and Jean-Laurent Casanova, revealed a genetic cause of TNF deficiency, as well as the underlying mechanism: a lack of TNF incapacitates a specific immune process in the lungs, leading to severe—but surprisingly targeted—illness.

The findings suggest that TNF, long considered a key galvanizer of the immune response, might actually play a much narrower role—a discovery with far-reaching clinical implications.

"The past 40 years of scientific literature have attributed a wide variety of pro-inflammatory functions to TNF," says Casanova, head of the St. Giles Laboratory of Human Genetics of Infectious Diseases. "But beyond protecting the lungs against TB, it may have a limited role in inflammation and immunity."

Casanova's lab has been studying the genetic causes of TB for more than two decades through field work in several countries and a wide network of collaborating physicians across the world. They maintain an ever-growing database of whole-exome sequences from a global pool of patients—more than 25,000 people to date. Of those, some 2,000 have had TB.

Over the years they've identified several rare genetic mutations that render some people vulnerable to TB . For example, mutations in a gene called CYBB can disable an immune mechanism called the respiratory burst, which produces chemicals called reactive oxygen species (ROS). Despite its pulmonary-sounding name, the respiratory burst takes place in immune cells throughout the body.

ROS help pathogen-consuming white blood cells called phagocytes (from the Greek for "eating") to destroy the invaders they've devoured. If ROS aren't produced, those pathogens can thrive unchecked, leading to debilitating complications. As a result, carriers of this CYBB mutation become vulnerable to not just TB but to a wide variety of infectious diseases.

For the current study, the team suspected that a similar inborn error of immunity may lay behind the severe, recurring TB infections experienced by two people in Colombia—a 28-year-old woman and her 32-year-old cousin—who had been repeatedly hospitalized with significant lung conditions. In each cycle, they initially responded well to anti-TB antibiotics, but within a year, they were sick again.

Puzzlingly, however, their long-term health records showed that their immune systems functioned normally, and that they were otherwise healthy.

A telling deficiency

To find out why they were particularly prone to getting TB, the researchers performed whole-exome sequencing on the two, as well as a genetic analysis of their respective parents and relatives.

The two were the only members of their extended family with a mutation in the TNF gene, which encodes for proteins linked to the regulation of a variety of biological processes. Short for " tumor necrosis factor ," increased TNF production is also associated with a variety of conditions, including septic shock, cancer, rheumatoid arthritis, and cachexia, which causes dangerous weight loss.

The protein is largely secreted by a type of phagocyte called a macrophage, which relies on the ROS molecules generated by the respiratory burst to finish off pathogens they've consumed.

In these two patients, the TNF gene failed to function, preventing the respiratory burst from occurring, and thus the creation of ROS molecules. As a result, the patients' alveolar macrophages, located in their lungs, were overrun with Mtb.

"We knew that the respiratory burst was important for protecting people against various types of mycobacteria, but now we know that TNF is actually regulating the process," says Boisson-Dupuis. "And when it's missing in alveolar macrophages, people will be susceptible to airborne TB."

She adds, "It's very surprising that the people we studied are adults who have never been sick with other infectious diseases, despite being repeatedly exposed to their microbes. They are apparently selectively at risk for TB."

Treatment potential

The discovery also solves a long-standing mystery about why TNF inhibitors, which are used to treat autoimmune and inflammatory diseases, raise the chances of contracting TB. Without TNF, a key part of the defense against it is defunct.

The findings may lead to a radical reassessment of TNF's role in immune function—and new treatment possibilities.

"TNF is required for immunity against Mtb, but it seems to be redundant for immunity against many other pathogens," Casanova says. "So the question is, what other pro-inflammatory cytokines are doing the jobs we thought TNF was doing? If we can discover that, we may be able to block these cytokines rather than TNF to treat diseases where inflammation plays a role."

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