RESUMO
Importance: Speech and language delays and disorders can pose significant problems for children and their families. Evidence suggests that school-aged children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening for speech and language delay and disorders in children 5 years or younger. Population: Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children who do not present with signs or symptoms or parent/caregiver concerns. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms. (I statement).
Assuntos
Transtornos do Desenvolvimento da Linguagem , Programas de Rastreamento , Criança , Humanos , Comitês Consultivos , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Pré-Escolar , Doenças AssintomáticasRESUMO
Importance: Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43â¯170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate. Objective: The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review. Population: Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer. Evidence Assessment: The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density. Recommendation: The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).
Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Mamografia , Humanos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/diagnóstico por imagem , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Imageamento por Ressonância Magnética , Fatores Etários , Ultrassonografia Mamária , Estados Unidos , Programas de RastreamentoRESUMO
Importance: Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention growth charts from 2000. The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on interventions (behavioral counseling and pharmacotherapy) for weight loss or weight management in children and adolescents that can be provided in or referred from a primary care setting. Population: Children and adolescents 6 years or older. Evidence Assessment: The USPSTF concludes with moderate certainty that providing or referring children and adolescents 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit. Recommendation: The USPSTF recommends that clinicians provide or refer children and adolescents 6 years or older with a high BMI (≥95th percentile for age and sex) to comprehensive, intensive behavioral interventions. (B recommendation).
Assuntos
Terapia Comportamental , Índice de Massa Corporal , Obesidade Infantil , Humanos , Adolescente , Criança , Obesidade Infantil/terapia , Obesidade Infantil/prevenção & controle , Redução de Peso , Encaminhamento e Consulta , Atenção Primária à Saúde , Feminino , AconselhamentoRESUMO
Importance: Falls are the leading cause of injury-related morbidity and mortality among older adults in the US. In 2018, 27.5% of community-dwelling adults 65 years or older reported at least 1 fall in the past year and 10.2% reported a fall-related injury. In 2021, an estimated 38â¯742 deaths resulted from fall-related injuries. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling adults 65 years or older. Population: Community-dwelling adults 65 years or older at increased risk of falls. Evidence Assessment: The USPSTF concludes with moderate certainty that exercise interventions provide a moderate net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF concludes with moderate certainty that multifactorial interventions provide a small net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. Recommendation: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation).
Assuntos
Acidentes por Quedas , Terapia por Exercício , Vida Independente , Idoso , Humanos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Comitês Consultivos , Exercício Físico , Atenção Primária à Saúde , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
Importance: Child maltreatment, which includes child abuse and neglect, can have profound effects on health, development, survival, and well-being throughout childhood and adulthood. The prevalence of child maltreatment in the US is uncertain and likely underestimated. In 2021, an estimated 600â¯000 children were identified by Child Protective Services as experiencing abuse or neglect and an estimated 1820 children died of abuse and neglect. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of primary care-feasible or referable behavioral counseling interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of maltreatment. Population: Children and adolescents younger than 18 years who do not have signs or symptoms of or known exposure to maltreatment. Evidence Assessment: The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of primary care interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of or known exposure to maltreatment. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. (I statement).
Assuntos
Maus-Tratos Infantis , Atenção Primária à Saúde , Adolescente , Criança , Humanos , Comitês Consultivos , Terapia Comportamental , Maus-Tratos Infantis/mortalidade , Maus-Tratos Infantis/prevenção & controle , Serviços de Proteção Infantil/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
Importance: Genital herpes is a common sexually transmitted infection caused by 2 related viruses, herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). Infection is lifelong; currently, there is no cure for HSV infection. Antiviral medications may provide clinical benefits to symptomatic persons. Transmission of HSV from a pregnant person to their infant can occur, most commonly during delivery; when genital lesions or prodromal symptoms are present, cesarean delivery can reduce the risk of transmission. Neonatal herpes infection is uncommon yet can result in substantial morbidity and mortality. Objective: To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on targeted key questions to systematically evaluate the evidence on accuracy, benefits, and harms of routine serologic screening for HSV-2 infection in asymptomatic adolescents, adults, and pregnant persons. Population: Adolescents and adults, including pregnant persons, without known history, signs, or symptoms of genital HSV infection. Evidence Assessment: The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. Recommendation: The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. (D recommendation).
Assuntos
Herpes Genital , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Programas de Rastreamento , Complicações Infecciosas na Gravidez , Testes Sorológicos , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/psicologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Testes Sorológicos/efeitos adversos , Testes Sorológicos/métodos , Testes Sorológicos/psicologia , Herpes Simples/diagnósticoRESUMO
Importance: Skin cancer is the most commonly diagnosed cancer in the US. There are different types of skin cancer varying in disease incidence and severity. Basal and squamous cell carcinomas are the most common types of skin cancer but infrequently lead to death or substantial morbidity. Melanomas represent about 1% of skin cancer and cause the most skin cancer deaths. Melanoma is about 30 times more common in White persons than in Black persons. However, persons with darker skin color are often diagnosed at later stages, when skin cancer is more difficult to treat. Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for skin cancer in asymptomatic adolescents and adults. Population: Asymptomatic adolescents and adults who do not have a history of premalignant or malignant skin lesions. Evidence Assessment: The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in asymptomatic adolescents and adults. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adolescents and adults. (I statement).
Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Detecção Precoce de Câncer , Programas de Rastreamento , Melanoma , Neoplasias Cutâneas , Adolescente , Adulto , Humanos , Detecção Precoce de Câncer/efeitos adversos , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Melanoma/diagnóstico , Exame Físico/efeitos adversos , Exame Físico/métodos , Medição de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/prevenção & controle , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnósticoRESUMO
Importance: Familial hypercholesterolemia and multifactorial dyslipidemia are 2 conditions that cause abnormally high lipid levels in children, which can lead to premature cardiovascular events (eg, myocardial infarction and stroke) and death in adulthood. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for lipid disorders in asymptomatic children and adolescents. Population: Asymptomatic children and adolescents 20 years or younger without a known diagnosis of a lipid disorder. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient and the balance of benefits and harms for screening for lipid disorders in asymptomatic children and adolescents 20 years or younger cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. (I statement).
Assuntos
Dislipidemias , Programas de Rastreamento , Adolescente , Criança , Humanos , Comitês Consultivos , Dislipidemias/complicações , Dislipidemias/diagnóstico , Dislipidemias/terapia , Lipídeos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Serviços Preventivos de Saúde , Medição de Risco , Adulto Jovem , Doenças Assintomáticas , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controleRESUMO
Importance: Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years. Population: Asymptomatic children and adolescents aged 5 to 17 years. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. Recommendations: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).
Assuntos
Cárie Dentária , Saúde Bucal , Adolescente , Criança , Humanos , Comitês Consultivos , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Qualidade de Vida , Programas de Rastreamento , Pré-Escolar , Doenças Assintomáticas , Atenção Primária à Saúde , Doenças Estomatognáticas/diagnóstico , Doenças Estomatognáticas/prevenção & controle , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
Importance: Oral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults. Population: Asymptomatic adults 18 years or older. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. Recommendations: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement).
Assuntos
Cárie Dentária , Doenças Periodontais , Adulto , Humanos , Programas de Rastreamento/efeitos adversos , Saúde Bucal , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Cárie Dentária/etiologia , Serviços Preventivos de Saúde , Doenças Periodontais/diagnóstico , Doenças Periodontais/prevenção & controle , Atenção Primária à SaúdeRESUMO
Importance: Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality in the US. The rate of hypertensive disorders of pregnancy has been increasing from approximately 500 cases per 10â¯000 deliveries in 1993 to 1021 cases per 10â¯000 deliveries in 2016 to 2017. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertensive disorders of pregnancy. Population: Pregnant persons without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit. Recommendation: The USPSTF recommends screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy. (B recommendation).
Assuntos
Hipertensão Induzida pela Gravidez , Feminino , Humanos , Gravidez , Comitês Consultivos , Hipertensão Induzida pela Gravidez/diagnóstico , Serviços Preventivos de Saúde , Programas de Rastreamento , Determinação da Pressão ArterialRESUMO
Importance: An estimated 1.2 million persons in the US currently have HIV, and more than 760â¯000 persons have died of complications related to HIV since the first cases were reported in 1981. Although treatable, HIV is not curable and has significant health consequences. Therefore, effective strategies to prevent HIV are an important public health and clinical priority. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of preexposure prophylaxis with antiretroviral therapy for the prevention of HIV acquisition, and the diagnostic accuracy of risk assessment tools to identify persons at increased risk of HIV acquisition. Population: Adolescents and adults who do not have HIV and are at increased risk of HIV. Evidence Assessment: The USPSTF concludes with high certainty that there is a substantial net benefit from the use of effective antiretroviral therapy to reduce the risk of acquisition of HIV in persons at increased risk of acquiring HIV. Recommendation: The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV. (A recommendation).
Assuntos
Antirretrovirais , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Adulto , Humanos , Comitês Consultivos , Antirretrovirais/administração & dosagem , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/normas , Serviços Preventivos de Saúde , Saúde Pública , Medição de Risco/métodos , Medição de Risco/normas , Estados Unidos/epidemiologiaRESUMO
Importance: Neural tube defects are among the most common congenital malformations in the US, with an estimated 3000 pregnancies affected each year. Many of these neural tube defects are caused by low folate levels in the body. Objective: The US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on the benefits and harms of folic acid supplementation. Population: Persons who are planning to or could become pregnant. Evidence Assessment: The USPSTF concludes that, for persons who are planning to or could become pregnant, there is high certainty that folic acid supplementation has a substantial net benefit to prevent neural tube defects in their offspring. Recommendation: The USPSTF recommends that all persons planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. (A recommendation).
Assuntos
Suplementos Nutricionais , Deficiência de Ácido Fólico , Ácido Fólico , Defeitos do Tubo Neural , Complicações na Gravidez , Feminino , Humanos , Gravidez , Comitês Consultivos , Ácido Fólico/administração & dosagem , Ácido Fólico/uso terapêutico , Programas de Rastreamento , Defeitos do Tubo Neural/etiologia , Defeitos do Tubo Neural/prevenção & controle , Serviços Preventivos de Saúde , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/diagnóstico , Deficiência de Ácido Fólico/tratamento farmacológico , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Concepcional/normasRESUMO
Importance: Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults. Population: Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults. Recommendation: The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).
Assuntos
Ansiedade , Programas de Rastreamento , Feminino , Gravidez , Humanos , Idoso , Programas de Rastreamento/efeitos adversos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Serviços Preventivos de Saúde , MedoRESUMO
Importance: Major depressive disorder (MDD), a common mental disorder in the US, may have substantial impact on the lives of affected individuals. If left untreated, MDD can interfere with daily functioning and can also be associated with an increased risk of cardiovascular events, exacerbation of comorbid conditions, or increased mortality. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening, accuracy of screening, and benefits and harms of treatment of MDD and suicide risk in asymptomatic adults that would be applicable to primary care settings. Population: Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for MDD in adults, including pregnant and postpartum persons and older adults, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on the benefit and harms of screening for suicide risk in adults, including pregnant and postpartum persons and older adults. Recommendation: The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons and older adults. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in the adult population, including pregnant and postpartum persons and older adults. (I statement).
Assuntos
Transtorno Depressivo Maior , Programas de Rastreamento , Suicídio , Adulto , Idoso , Feminino , Humanos , Masculino , Gravidez , Depressão/diagnóstico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Medição de Risco , Estados UnidosRESUMO
Importance: In the US, tuberculosis remains an important preventable disease, including active tuberculosis, which may be infectious, and latent tuberculosis infection (LTBI), which is asymptomatic and not infectious but can later progress to active disease. The precise prevalence rate of LTBI in the US is difficult to determine; however, estimated prevalence is about 5.0%, or up to 13 million persons. Incidence of tuberculosis varies by geography and living accommodations, suggesting an association with social determinants of health. Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on LTBI screening and treatment in asymptomatic adults seen in primary care, as well as the accuracy of LTBI screening tests. Population: Asymptomatic adults 18 years or older at increased risk for tuberculosis. Evidence Assessment: The USPSTF concludes with moderate certainty that there is a moderate net benefit in preventing active tuberculosis disease by screening for LTBI in persons at increased risk for tuberculosis infection. Recommendation: The USPSTF recommends screening for LTBI in populations at increased risk. (B recommendation).
Assuntos
Tuberculose Latente , Adulto , Humanos , Tuberculose Latente/complicações , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Tuberculose Latente/etiologia , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Medição de Risco , Tuberculose/epidemiologia , Tuberculose/etiologia , Tuberculose/prevenção & controle , Estados Unidos/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricosRESUMO
PURPOSE: Improving patients' self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabetes mellitus (T2DM). METHODS: This cohort study, in a safety-net primary care practice, enrolled patients with uncontrolled T2DM and psychosocial risk factors. Patients were identified through a practice diabetes registry or by clinicians' referrals. The CHWs engaged patients in trust building and sensemaking to understand their social context, identify goals, navigate health care, and connect to community resources. Primary outcome was progress through 3 prospectively defined stages of self-care: outreach (meeting face-to-face); stabilization (collaborating to address patients' life circumstances); and self-care generativity (achieving self-care competencies). Secondary outcomes were change in hemoglobin A1c (HbA1c) and need for urgent care, emergency department, or hospital visits. RESULTS: Of 986 participating patients, 27% remained in outreach, 41% progressed to stabilization, and 33% achieved self-care generativity. Repeated measures ANOVA demonstrates an overall decline in HbA1c, without group differences, through the 4th HbA1c measurement (mean follow-up 703 days). Beginning at the 5th HbA1c measurement (mean 859 days), the self-care generativity group achieved greater declines in HbA1c, which widened through the 10th measurement (mean 1,365 days) to an average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% in the stabilization group (P = .003). Rates of emergency department and hospital visits were lower in the self-care generativity group. CONCLUSIONS: Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.
Assuntos
Agentes Comunitários de Saúde , Diabetes Mellitus Tipo 2 , Estudos de Coortes , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/análise , Humanos , Atenção Primária à Saúde , Autocuidado , ConfiançaRESUMO
Importance: Menopause is defined as the cessation of a person's menstrual cycle. It is defined retrospectively, 12 months after the final menstrual period. Perimenopause, or the menopausal transition, is the few-year time period preceding a person's final menstrual period and is characterized by increasing menstrual cycle length variability and periods of amenorrhea, and often symptoms such as vasomotor dysfunction. The prevalence and incidence of most chronic diseases (eg, cardiovascular disease, cancer, osteoporosis, and fracture) increase with age, and US persons who reach menopause are expected on average to live more than another 30 years. Objective: To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal persons and whether outcomes vary by age or by timing of intervention after menopause. Population: Asymptomatic postmenopausal persons who are considering hormone therapy for the primary prevention of chronic medical conditions. Evidence Assessment: The USPSTF concludes with moderate certainty that the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons with an intact uterus has no net benefit. The USPSTF concludes with moderate certainty that the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy has no net benefit. Recommendation: The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation).
Assuntos
Doença Crônica , Estrogênios , Terapia de Reposição Hormonal , Hormônios , Pós-Menopausa , Progestinas , Feminino , Humanos , Doença Crônica/prevenção & controle , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Prevenção Primária , Progestinas/efeitos adversos , Progestinas/uso terapêutico , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Hormônios/efeitos adversos , Hormônios/uso terapêuticoRESUMO
Importance: Current prevalence of obstructive sleep apnea (OSA) in the US is not well established; however, based on cohort and survey data, in 2007-2010 the estimated prevalence of at least mild OSA (defined as an apnea-hypoxia index [AHI] ≥5) plus symptoms of daytime sleepiness among adults aged 30 to 70 years was 14% for men and 5% for women, and the estimated prevalence of moderate to severe OSA (defined as AHI ≥15) was 13% for men and 6% for women. Severe OSA is associated with increased all-cause mortality. Other adverse health outcomes associated with untreated OSA include cardiovascular disease and cerebrovascular events, type 2 diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. Objective: To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for OSA in adults. Population: Asymptomatic adults (18 years or older) and adults with unrecognized symptoms of OSA. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. (I statement).
Assuntos
Programas de Rastreamento , Apneia Obstrutiva do Sono , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comitês Consultivos , Diabetes Mellitus Tipo 2/etiologia , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Prevalência , Qualidade de Vida , Medição de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/mortalidade , Estados Unidos/epidemiologiaRESUMO
Importance: Anxiety disorder, a common mental health condition in the US, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. The 2018-2019 National Survey of Children's Health found that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in children and adolescents. This is a new recommendation. Population: Children and adolescents 18 years or younger who do not have a diagnosed anxiety disorder or are not showing recognized signs or symptoms of anxiety. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for anxiety in children and adolescents aged 8 to 18 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety in children 7 years or younger. Recommendation: The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger. (I statement).