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One-Minute Telegram

Last updated: March 26, 2025

Introductiontoggle arrow icon

The One-Minute Telegram is a biweekly digest of the latest medical research. It is designed for our colleagues who want to keep up with medical literature without having to comb through a flood of new research. Every paper has been carefully selected and summarized by our team of physician editors to bring you the most important developments as concisely as possible. Integration of AMBOSS tooltips and links to related content ensures you have all the context you need at your fingertips. Whether you're on your way home from a long shift or just taking a break on a busy day, you'll always find a minute to stay current. Subscribe by clicking on the image or via the link in “Tips and Links” below.

See also the One-Minute Telegram Archive 2024, One-Minute Telegram Archive 2023, One-Minute Telegram Archive 2022, One-Minute Telegram Archive 2021, and One-Minute Telegram Archive 2020.

Q1 2025toggle arrow icon

Edition 119 - March 29, 2025toggle arrow icon

Want to increase vaccination rates? Talk to your patients!

One-Minute Telegram 119-2025-1/3

10-second takeaway

Vaccine hesitancy is increasingly recognized as a public health threat in both medical literature and the media, but which interventions improve vaccination uptake remains unclear. In this systematic review of 44 randomized controlled trials (RCTs), face-to-face conversations between patients and health care providers and bundled interventions resulted in the greatest increase in vaccination rates; isolated electronic health record (EHR) reminders resulted in the smallest increase. Outpatient primary care clinics should consider bundled interventions to address vaccine hesitancy, ideally with opportunities for face-to-face conversations.

Study breakdown

  • Study population: 44 RCTs that assessed interventions aimed at increasing adult vaccination rates
  • Study design: systematic review of previously published RCTs
    • Eligible studies:
    • Interventions involved single or bundled activities targeting clinicians, patients, or both, e.g.:
      • Patient and/or clinician education about vaccines
      • Reminders to order vaccines (clinicians) or to be vaccinated (patients)
      • Increasing vaccine access (e.g., standing vaccination orders, vaccine clinics, reducing vaccine cost, nurse home visits)
    • Interventions included face-to-face discussions with patients, EHR reminders, and new opportunities to administer vaccinations.
    • Primary outcome: vaccination rates following intervention compared to historical rates or rates following usual care
  • Main results
    • RCTs were heterogeneous.
      • Single intervention not involving face-to-face contact with patients: 24 trials
      • Bundled interventions: 9 trials
      • Intervention involving face-to-face contact: number not specified
      • Seven different vaccines or combinations of vaccines were studied.
    • The increase in vaccination rate from baseline varied by intervention.
      • Reminding clinicians to order vaccines: 4–32%
      • EHR prompts: 1–16%
      • Bundled interventions: 4–42%
      • Intervention with face-to-face patient contact
        • Group outpatient visits: 13–17%
        • Home visits: 6–17%
        • Provider recommendation: 15%
  • Limitations include:
    • Most RCTs had a high or unclear bias, which may have positively biased the results.
    • Reported interventions were often vague and not easily reproducible, limiting generalizability.
    • The effectiveness of individual components in bundled interventions was not reported, limiting the ability to analyze individual components in aggregate.
  • Study funding: None
  • Original study: Interventions in primary care to increase uptake of adult vaccines: a systematic review [1]
  • Related AMBOSS content: Vaccine hesitancy

Nirsevimab is the real-world deal for reducing RSV severity in infants

One-Minute Telegram 119-2025-2/3

10-second takeaway

Passive immunization of infants with nirsevimab has been shown to reduce the severity of RSV-associated lower respiratory tract infection (RSV-LRTI) in clinical trials, but real-world effectiveness remains unproven. In this national population-based cohort study conducted in France, passive immunization with a single dose of nirsevimab reduced the incidence of RSV-LRTI-related hospitalization, oxygen therapy, and ventilation support in infants compared to no immunization. Passive immunization of infants with nirsevimab is a pivotal population-based strategy for reducing the severity of RSV-LRTI, which is the leading cause of hospitalization for respiratory illness in this age group.

Study breakdown

Long-acting ART: a good choice for individuals with HIV viremia?

One-Minute Telegram 119-2025-3/3

10-second takeaway

Long-acting antiretroviral therapy (LA-ART) with cabotegravir/rilpivirine is approved for individuals with HIV with viral suppression from the use of oral ART, but studies on the use of LA-ART in individuals with viremia are lacking. In this cohort study in a single HIV clinic in San Francisco, the percentage of individuals with viral suppression after 48 weeks of LA-ART was high in both those with viremia at therapy initiation (98%) and those without viremia at initiation (99%). Individuals with HIV viremia and adherence challenges with daily ART may benefit from LA-ART as an alternative to oral ART.

Study breakdown

  • Study population: 370 adults with HIV receiving LA-ART (median age, 44 years; 80% cisgender men, 4% cisgender women, 10% transgender women)
  • Study design: cohort study
    • Setting: single HIV clinic in San Francisco, CA
    • Exposure: presence vs. absence of HIV viremia (viremia defined as HIV RNA level ≥ 30 copies/mL) at LA-ART initiation
    • Outcome: percentage of individuals with viral suppression (HIV RNA level < 30 copies/mL)
    • Follow-up: 48 weeks
  • Main results
    • At therapy initiation, 129 individuals had detectable viremia and 241 did not have detectable viremia.
    • The percentage of individuals with viral suppression after 24 and 48 weeks of LA-ART was similar in those with and without viremia at initiation.
      • 24 weeks: 97% (CI 93–100%) of individuals with viremia vs. 99% (99–100%) without viremia
      • 48 weeks: 98% (93–99%) of individuals with viremia vs. 99% (97–100%) without viremia
    • Median time to undetectable viral load in individuals with viremia at initiation: 32 days (30–45 days)
  • Limitations include:
    • As data was collected from a single center, results might not be generalizable to populations in other regions or HIV clinics.
    • The observational nature of the study limits the ability to establish causality.
  • Study funding: National Institutes of Health/National Institute of Allergy and Infectious Diseases
  • Original study: HIV viral suppression with use of long-acting antiretroviral therapy in people with and without initial viremia. [3]
  • Related AMBOSS articles: Human immunodeficiency virus infection

Edition 118 - March 15, 2025toggle arrow icon

Human vs. machine: a diagnostic draw

One-Minute Telegram 118-2025-1/3

10-second takeaway

Computerized diagnostic decision support systems (CDDSSs), which use patient data and algorithms to assist clinicians in diagnosis, have shown potential in vignette and retrospective studies. In this multicenter Swiss study, adults presenting to the emergency department (ED) with select diagnostically challenging symptoms (nontraumatic abdominal pain, fever of unknown origin, syncope, nonspecific symptoms) were randomized to usual care or CDDSS-assisted evaluation, with no difference in diagnostic quality. These findings reinforce the growing body of evidence that CDDSSs may not improve diagnostic accuracy in real-world acute care settings.

Study breakdown

  • Study population: 1204 adults (median age 53 years, 51% female) presenting to the ED with nontraumatic abdominal pain, fever of unknown origin, syncope, or nonspecific symptoms (e.g., malaise, weakness, dizziness)
  • Study design: multicenter, cluster-randomized crossover trial
    • Setting: 4 emergency departments in Switzerland
    • Intervention: diagnosis made with the support of a CDDSS (DDX-BRO; n = 559) compared to diagnosis without (usual care; n = 645)
    • Primary outcome: risk to diagnostic quality determined by any of the following
      • Unscheduled medical care
      • Change in diagnosis
      • Unexpected ICU transfer within 24 hours of ED presentation
      • Death
    • Follow-up: 14 days after ED discharge
  • Main results
    • No difference in the primary outcome between the intervention and usual care groups
    • Risk to diagnostic quality: CDDSS 18% vs. usual care 18% (aOR 0.96; 95% CI, 0.71–1.30)
    • Unscheduled medical care: CDDSS 12% vs. usual care 11% (aOR 1.21; 0.84–1.74)
    • Change in diagnosis: CDDSS 7% vs. usual care 9% (aOR 0.73; 0.47–1.13)
    • Death and unscheduled intensive care admission were rare in both groups.
  • Limitations include:
    • Treating physicians could not be blinded to intervention.
    • Results may not be generalizable to patient populations with different presentations.
    • The benefit of CDDSS in settings where individual clinicians are responsible for decision-making may have been underestimated because patient cases were discussed among multiple health care providers (e.g., resident and attending physicians) at the participating sites.
  • Study funding: Swiss National Science Foundation and University Hospital Bern
  • Original study: Diagnoses supported by a computerised diagnostic decision support system versus conventional diagnoses in emergency patients (DDX-BRO): a multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial. [4]

Yellow fever vaccine: less is equal

One-Minute Telegram 118-2025-2/3

10-second takeaway

Yellow fever is endemic in much of South America and Africa; a single dose of live attenuated yellow fever vaccine provides lifelong protection, but the supply is limited. The Noninferiority Fractional-Doses Trial for Yellow Fever Vaccine (NIFTY) compared seroconversion rates of three fractional doses of yellow fever vaccine to the standard dose using noninferiority analysis. The 1000 IU and 500 IU doses were found to be noninferior to the standard dose of vaccine in adults in Uganda and Kenya in terms of both seroconversion and persistent immunity at 2 years. These results may support a public health approach that significantly stretches the limited supply of yellow fever vaccine.

Study breakdown

  • Study population: 480 adults aged 18–59 years (mean age 39.7 years, 62% women, 8% HIV positive) with no history of yellow fever vaccination or infection
  • Study design: double-blind, randomized noninferiority trial
    • Setting: 2 clinical trial research centers in Uganda and Kenya or a fractional dose of 1000 IU, 500 IU, or 250 IU.
    • Primary outcome: seroconversion 28 days after vaccination (defined as antibody titer ≥ 4 times higher than baseline)
    • Additional assessments include: antibody titers 1 and 2 years after vaccination, postvaccination viremia
    • Follow-up: 2 years
  • Main results
    • For the primary outcome, all fractional doses were noninferior to the standard dose in the intention-to-treat analysis; 500 IU and 1000 IU doses were noninferior in the per-protocol analysis.
    • Intention-to-treat analysis
      • Seroconversion at day 28
        • Standard dose: 98% (95% CI, 94–100%)
        • 1000 IU and 500 IU: 98% (94–100%)
        • 250 IU: 94% (88–97%)
      • Difference in seroconversion between fractional and standard dose at day 28
        • 1000 IU: 0.01% (95% CI, -5.0 to 5.1%)
        • 500 IU: 0.01% (-5.0 to 5.1%)
        • 250 IU: -4.4% (-9.4 to 0.7%)
      • Difference in seroconversion between fractional and standard dose at 1 year
        • 1000 IU: -1.8% (95% CI, -7.5 to 4.0%)
        • 500 IU: -1.7% (-7.4 to 4.0%)
        • 250 IU: -7.1% (-12.8 to -1.3%)
      • Difference in seroconversion between fractional and standard dose at 2 years
        • 1000 IU: -4.8% (95% CI, -13.9 to 4.3%)
        • 500 IU: -2.7% (-11.7 to 6.3%)
        • 250 IU: -11.6% (-20.6 to -2.6%)
    • Three severe vaccine-related adverse events were reported.
  • Limitations include:
  • Study funding: European and Developing Countries Clinical Trials Partnership and the Wellcome Trust
  • Original study: Low-dose yellow fever vaccine in adults in Africa [5]
  • Related AMBOSS articles: Yellow fever

Vitamin D supplementation no defense against acute respiratory infections

One-Minute Telegram 118-2025-3/3

10-second takeaway

Low serum vitamin D levels have been associated with an increased risk of acute respiratory infections (ARIs), and an earlier meta-analysis found that vitamin D supplementation is modestly effective in preventing ARIs. However, this updated systematic review and meta-analysis by the same group found that vitamin D supplementation does not protect against ARIs compared to placebo. While individuals with vitamin D deficiency should receive vitamin D supplementation, it is unlikely that vitamin D supplementation plays a role in preventing ARIs.

Study breakdown

Edition 117 - March 1, 2025toggle arrow icon

Expanding options for medication abortion

One-Minute Telegram 117-2025-1/3

10-second takeaway

Induced abortion using a combination of mifepristone and misoprostol is safe and highly effective up to 77 days’ gestation; however, in many regions, mifepristone is expensive and availability is limited. In this two-stage clinical study, a medication abortion regimen combining the emergency contraceptive ulipristal acetate with misoprostol was shown to be effective and deemed acceptable to study participants. Larger, randomized studies are needed to confirm these findings and further elucidate the role of ulipristal in medication abortion.

Study breakdown

  • Study population: adults (≥ 18 years) with an intrauterine pregnancy seeking abortion before 64 days’ gestation and a BMI ≤ 32 kg/m2
  • Study design: two-stage proof-of-concept study
  • Main results
    • Primary outcome
    • Acceptability outcomes
      • Satisfaction: 130/133 participants (97.7%; 95% CI, 95.2–100%) were satisfied or very satisfied; no participants were unsatisfied.
      • Pain acceptability
        • Median pain score: 8 (IQR, 6–9)
        • 113/133 participants (85%; 78.9–91%) found the pain acceptable or very acceptable; 8 (6%; 2–10.1%) considered it unacceptable or very unacceptable.
  • Limitations include:
    • The small sample size limits the ability to assess safety.
    • Stage 2 was originally planned as a noninferiority trial with historical controls who received misoprostol monotherapy. The trial was not conducted, preventing direct efficacy comparisons.
    • The study population was drawn from one health center in one geographic area, limiting generalizability.
  • Study funding: OPTions Initiative
  • Original study: A proof-of-concept study of ulipristal acetate for early medication abortion [7]
  • Related AMBOSS articles: Induced abortion

Avian influenza: rising cases (and egg prices) but no evidence of human-to-human transmission

One-Minute Telegram 117-2025-2/3

10-second takeaway

Avian influenza A(H5N1) has been causing widespread infection in US poultry and cows; before 2024, only 1 human case had been identified in the US. This case series describes the 46 human cases of H5N1 identified in the US since March 2024. Almost all patients were exposed to infected poultry or cows, and no human-to-human transmission was confirmed. The illness was mild (the most common symptom was conjunctivitis), and detection rates were highest with conjunctival swabs. Providers should consider collecting conjunctival specimens in addition to respiratory specimens to more accurately identify patients with H5N1 infection.

Study breakdown

  • Study population: 46 individuals with laboratory-confirmed influenza A(H5N1) infection
  • Study design: descriptive case series
    • Setting: routine influenza surveillance conducted by state and local public health departments between March and October 2024
    • Case identification
    • Outcomes
      • Case characteristics were collected using standardized case report forms.
      • Specimens were sent to the CDC for testing using real-time RT-PCR and genetic sequencing for H5N1.
  • Main results
    • 46 patients with H5N1 infection were identified.
      • 25 patients were exposed to infected cows.
      • 20 were exposed to infected poultry.
      • 1 had no known exposure.
    • Disease course
      • Illness was mild: No patients became critically ill or died, but no patients were asymptomatic.
      • Conjunctivitis was the most common symptom (93%), followed by fever (49%) and respiratory symptoms (36%).
      • Median duration: 4 days
    • Diagnostics
    • Management: Most patients (87%) received oseltamivir, starting at a median of 2 days after symptom onset.
    • No household contacts of patients with animal exposure had H5N1 infection.
  • Limitations include:
    • Monitoring varies between farms, and cases may be underreported or missed.
    • Some data was missing from case report forms, and some case reports were collected before symptom resolution.
    • It was not possible to identify specific behaviors that increase the risk of infection.
  • Study funding: Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases cooperative agreement of the CDC (grant CK19-1904)
  • Original study: Highly pathogenic avian influenza A(H5N1) virus infections in humans [8]
  • Related AMBOSS content: Zoonotic influenza

Liraglutide: weight-loss drugs for children?

One-Minute Telegram 117-2025-3/3

10-second takeaway

Liraglutide is FDA-approved for the treatment of obesity in children ≥ 12 years of age, but its safety and efficacy in younger children is unknown. This pharmaceutical industry-sponsored randomized, placebo-controlled trial showed that in children aged 6–11 years, liraglutide combined with lifestyle modifications was more effective for weight loss than placebo combined with lifestyle modifications. However, just like adults, children regained weight after liraglutide was stopped. While liraglutide may become part of the toolkit for childhood obesity, it’s unclear whether it’s a game-changer or just a short-term solution.

Study breakdown

  • Study population: 82 children (aged 6–11 years) with obesity
  • Study design: randomized, double-blind phase 3 placebo-controlled trial
    • Setting: 23 clinical trial sites in 9 countries
    • Intervention: liraglutide 3 mg subcutaneously once daily or placebo, plus lifestyle modifications for 56 weeks
    • Primary endpoint: percentage change in BMI from baseline to week 56
    • Safety endpoints: rates of adverse events and serious adverse events
    • Post-treatment follow-up: 26 weeks
  • Main results
    • Primary endpoint: BMI decreased 5.8% in the liraglutide group and increased 1.6% in the placebo group (mean difference, -7.4%; 95% CI, -11.6 to -3.2%).
    • ≥ 5% reduction in BMI was seen in:
      • 46% in the liraglutide group
      • 9% in the placebo group (adjusted OR, 6.3; 1.4 to 28.8)
    • At the end of the post-treatment follow-up period (week 82), both groups had gained weight; mean change in BMI from baseline was:
      • -0.8% in the liraglutide group
      • 6.7% in the placebo group
    • Rates of adverse events and serious adverse events were similar in the two groups; gastrointestinal disorders were the most common adverse events.
  • Limitations include:
    • There is a lack of consensus on meaningful weight loss in children.
    • Most participants (70%) were White, limiting the generalizability of the results.
    • Long-term safety and efficacy studies are needed.
  • Study funding: Novo Nordisk
  • Original study: Liraglutide for children 6 to <12 years of age with obesity — a randomized trial [9]

Edition 116 - February 15, 2025toggle arrow icon

Valentine’s Day edition

One-Minute Telegram 116-2025-1/3

  • Love bytes: the sweet and strange world of AI relationships. Valentine’s Day may be over, but romance is still very much AI-live. A study of over 35,000 AI chatbot users revealed that people are forming emotional connections with their digital friends (or more than friends). From heartfelt chats to playful role-play, these AI BFFs bring joy, love, and laughter. But it’s not all sunshine and rainbows. While users love to morph chatbots into ideal companions, virtual intimacy can take an unsettling turn when feelings bounce back across the uncanny valley and you realize you’ve fallen for beautifully scripted code.

So, whether you spent February 14th with your soulmate, solo, or swapping Valentine’s wishes with a bot, one thing is clear: AI is staking its claim as the low-maintenance date of the future. Too bad it can’t pick up the check...

Original study

Finding love in algorithms: deciphering the emotional contexts of close encounters with AI chatbots [10]

Sepsis immunotherapy: thymosin α1 falls short, but could some still benefit?

One-Minute Telegram 116-2025-2/3

10-second takeaway

Adjunctive immunomodulatory therapy is a promising candidate for improving sepsis outcomes by targeting immune dysregulation and immunosuppression. Previous small studies have suggested that the immunomodulator thymosin α1 may reduce mortality in patients with sepsis. However, in this large double-blind, placebo-controlled randomized clinical trial of sepsis in China, treatment with thymosin α1 did not reduce 28-day all-cause mortality compared to placebo, although potential differential effects were noted in older adults and patients with diabetes. Studies targeting selected patient groups may better elucidate the role of immunomodulatory therapy in sepsis.

Study breakdown

  • Study population: 1106 adults aged 18–85 years (median age, 65 years; 69% male) diagnosed with sepsis according to the Sepsis-3 criteria
  • Study design: multicenter, double-blind, placebo-controlled phase 3 trial
    • Setting: 22 medical centers in China between September 2016 and December 2020
    • Intervention: subcutaneous injection of 1.6 mg thymosin α1 or placebo every 12 hours for 7 days (in addition to standard treatment)
    • Primary outcome: 28-day all-cause mortality (modified intention-to-treat analysis)
    • Secondary outcomes included:
    • Follow-up: 90 days
  • Main results
    • No overall effect on the primary outcome, which occurred in 127 participants (23.4%) in the thymosin α1 group and 132 (24.1%) in the placebo group (HR, 0.99; 95% Cl, 0.77–1.27)
    • In subgroup analyses, there was a potential differential effect.
      • Thymosin α1 appeared protective in individuals with diabetes (HR, 0.58; 0.35–0.99) but had no significant effect in those without diabetes (HR, 1.16; 0.87–1.53): P for interaction = 0.04.
      • Thymosin α1 showed a potentially harmful effect in individuals aged < 60 years (HR, 1.67; 1.04–2.67) but not in those aged ≥ 60 years (HR, 0.81; 0.61–1.09): P for interaction = 0.01. However, in a post hoc analysis, no harmful effect was seen after adjusting for organ support before randomization.
    • Secondary and safety outcomes: no significant differences between groups
  • Limitations include:
    • Observed mortality rates (∼ 24%) were lower than hypothesized (35%), suggesting sicker patients with greater immune dysregulation were underrepresented.
    • The study may have been underpowered based on the projected difference of 8% between the intervention and placebo groups.
    • Timing from sepsis onset to randomization was uncertain. Most patients had multiple immune marker abnormalities at randomization, suggesting that treatment may not have been initiated early enough.
  • Study funding: the Sun Yat-sen University Clinical Research Program 5010, Guangdong Clinical Research Center for Critical Care Medicine, and SciClone Pharmaceuticals
  • Original study: The efficacy and safety of thymosin α1 for sepsis (TESTS): multicentre, double blinded, randomised, placebo controlled, phase 3 trial [11]
  • Related AMBOSS articles: Sepsis

ADHD linked to shorter life expectancy

One-Minute Telegram 116-2025-3/3

10-second takeaway

Attention deficit hyperactivity disorder (ADHD) has been linked to poor health outcomes and an increased risk of premature death, but data on life expectancy deficits in individuals with ADHD is lacking. In this cohort study, mortality data from a national UK database showed that individuals diagnosed with ADHD had a significantly shorter life expectancy than matched controls. Further studies are needed to identify modifiable risk factors for premature death in this population.

Study breakdown

  • Study population: identified from 9,561,450 people in 792 general care practices
    • Exposed group: 30,039 adults aged ≥ 18 years diagnosed with ADHD (21.82% female; median age at cohort entry, 18.95 years for male individuals and 22.10 years for female individuals)
    • Comparison group: 300,390 adults matched by age, sex, and primary care practice
  • Study design: matched retrospective cohort study
    • Setting: UK electronic primary care health records from IQVIA Medical Research Data from 2000 to 2019
    • Exposure: ADHD diagnosis
    • Outcome: all-cause death
    • Data on baseline comorbidities and variables included:
  • Main results
    • Mortality rates were higher in adults with ADHD than in controls.
      • Male individuals: 0.83% vs. 0.52%
      • Female individuals: 2.22% vs. 1.35%
    • ADHD was associated with a significant reduction in apparent life expectancy compared to controls.
      • Male individuals: -6.78 years (95% CI, -9.11 to -4.50)
      • Female individuals: -8.64 years (-10.91 to -6.55)
    • Rates of all baseline comorbidities and variables were higher in adults with ADHD than in controls.
  • Limitations include:
    • The ADHD group may not have accurately represented all adults with ADHD, as it is estimated that only 1 in 9 adults with ADHD are diagnosed.
    • Individuals with comorbidities may have been overrepresented in the ADHD group, as more health care contacts may have increased ADHD diagnosis rates, potentially leading to an overestimation of mortality in this group.
    • Years of life lost could not be attributed to specific causes, as data on cause of death was not available.
    • Race, ethnicity, and gender diversity were not accounted for and may have led to confounding.
  • Study funding: Dunhill Medical Trust
  • Original study: Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. [12]
  • Related AMBOSS articles: Attention deficit hyperactivity disorder

Edition 115 - February 1, 2025toggle arrow icon

Morning coffee: think fast, live long!

One-Minute Telegram 115-2025-1/3

10-second takeaway

Coffee, the world’s most popular psychoactive stimulant, lowers the risk of diabetes, cardiovascular disease (CVD), and death, but does the time of consumption matter? In this observational study, drinking coffee only in the morning was associated with decreased all-cause mortality and CVD-specific mortality compared to coffee abstinence. There was no difference in mortality between those drinking coffee all day and those abstaining from coffee. Coffee consumption late in the day may interfere with the body’s natural circadian rhythms, reducing coffee’s anti-inflammatory effects, but more research is needed to demonstrate this causality.

“Without my morning coffee, I’m just like a dried-up piece of roast goat.” - Johann Sebastian Bach

Study breakdown

  • Study population: 40,725 US adults participating in the National Health and Nutrition Examination Survey from 1999 to 2018
  • Study design: observational cohort study
    • Timing of coffee consumption was determined using self-reported dietary recall.
    • Clustering analysis was used to identify coffee drinking patterns (for caffeinated and decaffeinated coffee).
      • Non-coffee drinkers
      • Morning type: consumption from 4 a.m. to 11:59 a.m.
      • All-day type: consumption throughout the day
    • Death and death rate information were obtained from the National Death Index until the end of 2019.
    • Outcomes
  • Main results
    • All-cause mortality
      • The morning-type group had a lower risk of all-cause mortality than non-coffee drinkers (HR, 0.88; 95% CI, 0.81–0.96).
      • All-cause mortality was lowest in those who consumed 2–3 cups of coffee per day in the morning (HR, 0.71; 0.60–0.86).
      • The risk of all-cause mortality was similar in the all-day-type group and non-coffee drinkers (HR, 0.99; 0.9–1.10).
    • Cause-specific mortality
      • The morning-type group had a lower risk of CVD-specific mortality than non-coffee drinkers (HR, 0.69; 0.55–0.87) but similar rates of cancer-specific mortality (HR, 0.97; 0.75–1.25).
      • The risk of CVD-specific and cancer-specific mortality was similar in the all-day-type group and non-coffee drinkers.
      • Similar associations were observed for caffeinated and decaffeinated coffee drinking.
  • Limitations include:
    • Results were based on self-reporting, which is subject to recall bias.
    • Morning-type coffee consumption may be a marker of unmeasured confounding variables (e.g., regular work hours, healthy lifestyle).
  • Study funding: The National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Disease; and National Institute of Health
  • Original study: Coffee drinking timing and mortality in US adults. [13]
  • Related AMBOSS articles: Stimulant intoxication and withdrawal

Bone up on the updated USPSTF recommendations for osteoporosis screening to prevent fragility fractures

One-Minute Telegram 115-2025-2/3

10-second takeaway

Osteoporosis occurs in over 25% of women in the US aged 65 years and older and is associated with an increased risk of fragility fractures, often accompanied by secondary complications. The US Preventive Services Task Force (USPSTF) recommends osteoporosis screening for all women 65 years of age and older and for younger postmenopausal women with one or more risk factors for osteoporosis to prevent fragility fractures. There are no recommendations for screening for osteoporosis in men. In a separate statement, the USPSTF also provides recommendations for the prevention of falls in older adults to further reduce the risk of fragility fractures.

Recommendations breakdown

Sharing isn’t always caring: preventing TB transmission with levofloxacin

One-Minute Telegram 115-2025-3/3

10-second takeaway

Every year, half a million people develop multidrug-resistant tuberculosis (MDR-TB), but little is known about how to prevent transmission to close contacts. In this meta-analysis of two phase 3 trials, individuals taking daily levofloxacin had a 60% lower risk of contracting TB from a household contact with MDR-TB than those taking a placebo. Low-grade musculoskeletal events more frequently occurred in the levofloxacin group than in the placebo group; there was no association between levofloxacin and severe adverse events (AEs). Further research is needed to determine the optimal duration and cost-effectiveness of levofloxacin prophylaxis.

Study breakdown

  • Study population: 2963 individuals with household exposure to MDR-TB or rifampin-resistant TB and evidence of latent Mycobacterium tuberculosis (Mtb) infection, HIV infection, or (in the Vietnam study only) severe malnutrition
  • Study design: combined analysis of two randomized placebo-controlled phase 3 trials
    • Study 1: Vietnam Quinolones for MDR-TB (VQUIN)
      • Primarily included adults in Vietnam
      • 2041 participants (median age, 40 years)
    • Study 2: Tuberculosis Child Multidrug-resistant Preventive Therapy (TB-CHAMP)
      • Children in South Africa
      • Initially limited to children < 5 years of age but later expanded to children ≤ 17 years of age
      • 922 participants (median age, 2.8 years)
  • Main results
    • Incidence of TB at 54 weeks was lower in the levofloxacin group than in the placebo group (relative difference in cumulative incidence, 0.41; 95% CI, 0.18–0.92).
    • NNT to prevent one case of TB at 54 weeks
      • VQUIN: 193 (95% CI, 98–5158)
      • TB-CHAMP: 56 (30–466)
    • The incidence of severe AEs was similar in the levofloxacin and placebo groups (risk ratio, 1.07; 95% CI, 0.7–1.65).
    • The risk of developing musculoskeletal AEs was significantly higher in the levofloxacin group than in the placebo group (risk ratio, 6.36; 4.3–9.42).
      • 97% were nonsevere (grade 1 or 2) AEs.
      • The association was not seen in children < 10 years of age.
  • Limitations include:
    • Results are not generalizable to all high-risk groups.
    • Genotyping was not used to establish whether new cases of TB were contracted from the household contact or another source.
    • Other factors that could influence treatment efficacy (e.g., geographical setting) were not considered.
  • Study funding: UK Medical Research Council, Australian National Health and Medical Research Council, UNITAID, and others
  • Original study: A meta-analysis of levofloxacin for contacts of multidrug-resistant tuberculosis. [15]
  • Related AMBOSS articles: Tuberculosis

Edition 114 - January 18, 2025toggle arrow icon

Cognitive behavioral therapy for long COVID: a small but meaningful step?

One-Minute Telegram 114-2025-1/3

10-second takeaway

Post-COVID-19 condition (PCC) is an often debilitating complication of COVID-19 infection, but evidence-based management for PCC is limited. In this randomized clinical trial, patients with mild to moderate PCC participating in an outpatient rehabilitation program using a cognitive behavioral therapy (CBT) approach had significantly better physical functioning than those receiving usual care, with a small to moderate effect size. Clinicians may consider referral to outpatient CBT for certain patients with PCC depending on implementation feasibility and patient preference.

Study breakdown

  • Study population: 314 individuals aged ≥ 16 years (mean age, 43 years; 72% female) with mild to moderate PCC
  • Study design: pragmatic randomized clinical trial
    • Setting: single outpatient referral center clinic in Norway between February 2022 and April 2024
    • Intervention: Participants were randomized 1:1 to either usual care or an outpatient rehabilitation program consisting of visits every 2–6 weeks (total 2–8 visits) based on a cognitive and behavioral approach.
    • Primary outcome
      • Change in 36-Item Short Form Health Survey Physical Function Subscale (SF-36-PFS) scores between enrollment (T0) and immediately after intervention completion (T1)
      • Higher scores indicate better physical functioning.
    • Secondary outcomes included:
      • SF-36-PFS score 12 months after enrollment (T2)
      • Symptom scores (e.g., for cognitive difficulties, anxiety and depression, bodily pain, and smell and taste abnormalities)
    • Safety outcomes included:
      • Contact with primary health care services
      • Hospital admissions
      • Occurrence of new disease
    • Follow-up: 12 months
  • Main results
    • Primary outcome
      • Improvement in SF-36-PFS at T1 was significantly greater in the intervention group vs. the usual care group (score difference, 9.2; 95% CI, 4.3–14.2).
      • The effect size was small to moderate (Cohen’s d = 0.43).
    • Secondary outcomes
      • SF-36-PFS at T2 was sustained, favoring the intervention group.
      • Except smell and taste abnormalities and bodily pain, all secondary outcome measures at T2 (and most at T1) favored the intervention group over the usual care group, with small to moderate effect sizes.
    • Safety outcomes: Self-reported health statuses at T1 and T2 were better in the intervention group than in the usual care group for most items, except hospital admissions and new disease occurrence at T2.
  • Limitations include:
    • Blinding was not possible, potentially leading to the placebo effect.
    • Participants had only moderate impairment, and results may not be generalizable to patients with severe PCC.
  • Study funding: Akershus University Hospital and others
  • Original study: Brief outpatient rehabilitation program for post–COVID-19 condition: a randomized clinical trial. [16]
  • Related AMBOSS articles: COVID-19

Less frequent breast cancer screening does not correlate with higher breast cancer stage at diagnosis

One-Minute Telegram 114-2025-2/3

10-second takeaway

In 2009, the USPSTF recommended increasing breast cancer screening intervals for women with an average risk. In this retrospective cohort study using US data from 2004 to 2019, the incidence of in situ breast cancer in women aged ≥ 40 years decreased since 2009, aligning with the reduced use of screening mammography after the guideline changes. However, there was no correlation between the change in recommendations and breast cancer stage at diagnosis or type of surgical treatment. Surgical trends shifted toward breast-conserving surgeries and reconstructive approaches over time. This result may reassure primary care physicians that the shift in recommendations has not resulted in a higher incidence of advanced breast cancer at diagnosis and may have reduced unnecessary interventions and anxiety caused by false-positive results.

Study breakdown

  • Study population: 2,022,250 women aged ≥ 40 years with breast cancer (17.5% aged 40–49 years, 63.2% aged 50–74 years, and 19.2% aged ≥ 75 years)
  • Study design: population-based, epidemiological, retrospective cohort study
  • Main results
    • In situ breast cancer
      • Rates increased until 2009 in women aged 40–49 years and until 2008 in women aged ≥ 50 years.
      • This was followed by a decline across all age groups; rates stabilized after 2016 in women aged ≥ 75 years.
    • Localized breast cancer
      • Rates increased steadily from 2004 to 2019 in women aged 40–74 years.
      • Rates in women aged ≥ 75 years rose from 2004 to 2011, declined from 2011 to 2017, and sharply increased from 2017 to 2019.
    • Regional breast cancer
      • Rates decreased until 2016 in women aged 40–49 years, until 2019 in women aged 50–74 years, and from 2008 to 2017 in women aged ≥ 75 years.
      • Rates remained largely stable across all age groups thereafter.
      • Distant breast cancer: Rates remained stable from 2012 for women aged 40–74 years, while the rates consistently increased for women aged ≥ 75 years between 2004 and 2019.
    • Surgical therapy
      • Partial mastectomy: Rates increased in women aged ≥ 75 years and after 2012 in women aged 50–74 years.
      • Total mastectomy: Rates consistently declined in women aged 40–49 years and ≥ 75 years, and, after 2012, in women aged 50–74 years.
      • Total mastectomy with reconstruction: Rates steadily rose in women aged 40–49 years throughout the study period and until 2012 in women aged 50–74 years.
  • Limitations include:
    • The SEER registries do not capture the entire US population, limiting the generalizability of the findings.
    • The risk of confounding by unmeasured factors (e.g., the introduction of digital breast tomosynthesis in 2011, which may have biased results by increasing early-stage cancer detection despite reduced screening) makes it difficult to isolate the true impact of the 2009 guideline changes.
    • The study did not account for how breast cancers were detected (i.e., screening vs. symptom-based), which could influence the observed incidence rates and treatment patterns.
    • The follow-up period after the guideline change was limited to 10 years, which may not have been sufficient time to capture certain trends.
  • Study funding: National Institute of General Medical Sciences
  • Original study: Changes to the US Preventive Services Task Force screening guidelines and incidence of breast cancer. [17]
  • Related AMBOSS articles: Breast cancer

Hemochromatosis comorbidities: iron overload may not be the only link

One-Minute Telegram 114-2025-3/3

10-second takeaway

Previously, the increased risk of diabetes and other comorbidities (e.g., liver disease) in individuals with hereditary hemochromatosis was thought to be linked to iron overload. In this prospective cohort study, individuals homozygous for HFE C282Y had a higher risk of liver diseases and diabetes than non-carriers. Furthermore, the risk of diabetes was also higher in those with normal transferrin saturation and ferritin levels. Individuals homozygous for HFE C282Y with diabetes had a higher risk of death than non-carriers with diabetes. These findings highlight the need for clinicians to remain vigilant for diabetes and its complications in individuals with hereditary hemochromatosis, even in those with normal iron and ferritin levels and transferrin saturation.

Study breakdown

Referencestoggle arrow icon

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