RESUMO
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: 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: 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
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic resulted in an unprecedented expansion in telehealth, but little is known about differential use of telehealth according to demographics, rurality, or insurance status. METHODS: We performed a cross-sectional analysis of 7742 family medicine encounters at a single USA institution in the initial month of the COVID-19 public health emergency (PHE). We compared the demographics of those using telehealth during the PHE to those with face-to-face visits during the same time period; we also compared the demographics of those using full audio-video to those using audio-only. RESULTS: The likelihood of any telehealth visit in the first 30 days of telehealth expansion was higher for women, those age 65 years and older, self-pay patients, and those with Medicaid and Medicare as primary payers. The likelihood of a telehealth visit was reduced for rural residence and Black or other races. Among all telehealth visits, the likelihood of a full audio-video telehealth visit was reduced for patients who were older, Black, from urban areas, or who were self-pay, Medicaid, or Medicare payer status. DISCUSSION: Significant disparities exist in telehealth use during the COVID-19 PHE by age, race, residence and payer.
Assuntos
COVID-19 , Telemedicina , Humanos , Estados Unidos/epidemiologia , Feminino , Idoso , COVID-19/epidemiologia , Medicare , Estudos Transversais , Saúde PúblicaRESUMO
DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. RECOMMENDATION: The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.
Assuntos
Sobrepeso , Serviços Preventivos de Saúde , Feminino , Humanos , Obesidade/prevenção & controle , Sobrepeso/complicações , Sobrepeso/prevenção & controle , Aumento de Peso , Saúde da MulherRESUMO
CONTEXT: Age-adjusted death rates for heart disease are higher in rural areas than in urban areas. Lay advisors could potentially facilitate improvement in cardiovascular health outcomes. The aim of this systematic review and meta-analysis is to estimate lay advisor intervention effects on cardiovascular health metrics in rural populations. EVIDENCE ACQUISITION: Searches of databases including MEDLINE, CINAHL, and Scopus from 1975 through October 2017 retrieved 323 citations, of which 272 abstracts were reviewed. Two authors independently abstracted data from eligible studies. Analysis was conducted in March 2018. EVIDENCE SYNTHESIS: Of 21 articles included in the systematic review, eight were RCTs and 13 were pre- and post-intervention studies. Of the RCTs, three took place in the U.S. Only two studies had low risk of bias. Using a random effects model, meta-analysis of six RCTs (1,641 participants) showed that lay advisor interventions in rural residents were associated with improvement in HbA1c of 0.4% (95% CI=0.13, 0.66, p=0.004, I2=60.65%). From four RCTs (873 participants), lay advisor interventions significantly improved BMI with pooled effect of 2.18 (95% CI=1.13, 3.24, p<0.001, I2=0.00%). Most studies had normal baseline blood pressure and cholesterol levels before intervention, and no significant effects were noted for these outcomes. Diverse types of measures used for diet, physical activity, and smoking precluded statistical synthesis. CONCLUSIONS: Lay advisor interventions had significant positive effects on glycemic control and BMI for rural residents; however, further rigorous studies are needed in U.S. rural populations, and elements of effective lay advisor interventions require further investigation.
Assuntos
Agentes Comunitários de Saúde/psicologia , Cardiopatias/psicologia , Cardiopatias/terapia , Pressão Sanguínea/fisiologia , Dieta , Exercício Físico/fisiologia , Humanos , População RuralAssuntos
Licenciamento em Medicina/estatística & dados numéricos , Área Carente de Assistência Médica , Assistentes Médicos/estatística & dados numéricos , Competência Clínica , Avaliação Educacional , Missouri , Assistentes Médicos/legislação & jurisprudência , Atenção Primária à Saúde , Recursos HumanosAssuntos
Aconselhamento/normas , Detecção Precoce de Câncer , Programas de Rastreamento/normas , Educação de Pacientes como Assunto/normas , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
Allowing low-risk pregnant women to eat less restrictive diets during labor may not only make them happier, but may shorten labor, too.
Assuntos
Trabalho de Parto , Ingestão de Alimentos , Feminino , Humanos , GravidezRESUMO
Patients on warfarin plus antiplatelet/NSAID regimens are likely to benefit from the gastroprotective effect of PPIs. For patients taking warfarin alone, it's a different story.
Assuntos
Hemorragia Gastrointestinal/prevenção & controle , Inibidores da Bomba de Prótons/administração & dosagem , Varfarina/efeitos adversos , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Esquema de Medicação , Quimioterapia Combinada , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Varfarina/administração & dosagemRESUMO
Adding cyclobenzaprine or oxycodone/acetaminophen to naproxen for the treatment of acute low back pain does nothing more than increase adverse effects.
Assuntos
Acetaminofen/uso terapêutico , Amitriptilina/análogos & derivados , Dor Lombar/tratamento farmacológico , Relaxantes Musculares Centrais/uso terapêutico , Naproxeno/uso terapêutico , Oxicodona/uso terapêutico , Amitriptilina/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
The SPRINT trial demonstrated the benefits--and risks--of reaching a systolic target <120 mm Hg in non-diabetic patients at high risk for CV events. Here's who might benefit.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Antagonistas de Receptores de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Masculino , Planejamento de Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
According to JAMA's retraction statement, the first author of the article admitted to data fabrication following an internal investigation.² The source article does not provide subgroup analysis to determine how much of an effect the fabricated data may have had on the final reported outcome.
RESUMO
Parents no longer need to struggle to get their kids to drink electrolyte solutions during episodes of mild gastroenteritis; apple juice works just as well.
Assuntos
Desidratação/terapia , Eletrólitos/administração & dosagem , Medicina de Família e Comunidade/normas , Hidratação/métodos , Sucos de Frutas e Vegetais , Gastroenterite/dietoterapia , Guias de Prática Clínica como Assunto , Administração Oral , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento , Estados UnidosRESUMO
Adding simvastatin to standard wound care improves ulcer healing rates and times as well as the patient's quality of life.