North America is in the midst of its most serious drug-overdose crisis in history. From 1999 through 2015, drug-overdose deaths approximately tripled in the United States, and the majority of such deaths now involve an opioid. In 2016 alone, there were 64,000 drug-overdose deaths in the United States — more than the total number of U.S. military deaths during the Vietnam War. As a result, and despite gains in other areas of medicine and public health, the United States recently experienced its first major decline in life expectancy since 1993.

In this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses.

To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, researchers analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined.

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The prevalence of overweight and obesity is increasing worldwide.1 Epidemiologic studies have identified high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) as a risk factor for an expanding set of chronic diseases, including cardiovascular disease,2,3 diabetes mellitus, chronic kidney disease,2 many cancers,4 and an array of musculoskeletal disorders.5,6 As the global health community works to develop treatments and prevention policies to address obesity, timely information about levels of high BMI and health effects at the population level is

The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their wealthier counterparts. Now, in the latest of a series of reports, the agency documents the finding that rural children from small communities are more likely to have MBDDs than those living in cities and suburbs.

Zika virus (ZIKV) infection during pregnancy has been linked to birth defects, yet the magnitude of risk remains uncertain. Investigators studying the 2013–2014 Zika outbreak in French Polynesia estimated that the risk of microcephaly due to ZIKV infection in the first trimester of pregnancy was 0.95% (95% confidence interval, 0.34 to 1.91), on the basis of eight microcephaly cases identified retrospectively in a population of approximately 270,000 people with an estimated rate of ZIKV infection of 66%.

The age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. Researchers evaluated whether the early introduction of allergenic foods in the diet of breast-fed infants would protect against the development of food allergy.

A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic.

Zika virus (ZIKV), an emerging flavivirus, generally causes mild infection in humans but is associated with severe neurologic complications and adverse fetal outcomes. ZIKV is transmitted to humans primarily by aedes mosquitoes. However, there is some evidence of sexual transmission. Two studies have shown the presence of infectious ZIKV in semen. A recent article described detection of ZIKV RNA in semen 62 days after the onset of illness, but infectious virus was not cultured.

We at the Food and Drug Administration (FDA) continue to be deeply concerned about the growing epidemic of opioid abuse, addiction, and overdose — an epidemic directly related to the increasingly widespread misuse of powerful opioid pain medications.

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