Screening children for family violence: a review of the evidence for the US Preventive Services Task Force

BACKGROUND We wanted to evaluate the benefits and harms of screening children in primary health care settings for abuse and neglect resulting from family violence by examining the evidence on the performance of screening instruments and the effectiveness of interventions.     

Behavioral interventions for smoking cessation among adolescents: a rapid review and meta-analysis for the Korea Preventive Services Task Force

ObjectivesThe aim of this study was to evaluate the effectiveness of behavioral smoking cessation interventions among adolescents.Methods MEDLINE, CENTRAL, Embase, CINAHL, KoreaMed, and KMbase were searched from inception to June 2020. Systematic reviews (SRs) or meta-analyses of randomized controlled trials (RCTs) were initially searched to perform a rapid SR. After selecting the final SR, RCTs after the publication year of the selected SR were searched. The primary outcome was smoking status after at least 6 months of follow-up, and the secondary outcome was smoking status at 4 weeks. Two reviewers independently assessed the selected studies’ quality using the Cochrane risk of bias tool. The meta-analysis utilized a Mantel-Haenszel fixed-effect model reporting the relative risk (RR) and 95% confidence interval (CI). The subgroup analysis utilized Cochrane’s Q.Results Thirty-two RCTs (11,637 participants) from a single SR were meta-analyzed. After 6 months of follow-up, the intervention group had significantly higher abstinence rates (RR, 1.30; 95% CI, 1.20−1.41; I²=26.46%). At 4 weeks of follow-up, the intervention group also had significantly higher abstinence rates (RR, 1.92; 95% CI, 1.49–2.47; I²=0.00%). The subgroup analysis indicated a significant difference in the abstinence rate according to the study setting and the period between intervention completion and follow-up.Conclusion This review showed that adolescent behavioral smoking cessation intervention programs significantly increased abstinence rates compared to the usual care.     

Comparison between US Preventive Services Task Force recommendations and Medicare coverage

PURPOSE The US Preventives Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before implementation of health reform.METHODS We recorded all Medicare coverage for preventive services as listed in the Medicare preventive services guide of 2007 (including the 2009 update) for all recommended (A-or B-rated) USPSTF and not recommended (D-rated) guidelines for preventive screening and counseling in adults aged 65 years and older. We analyzed 2 components of preventive care: preventive coordination (risk assessment, patient motivation, and arranging of preventive service) and the preventive service itself. The main outcome measure was the percentage of agreement between USPSTF recommendations and Medicare coverage.RESULTS The USPSTF recommended 15 preventive interventions for adults aged 65 years and older. Although Medicare partially reimbursed 93% of recommended services, full reimbursement for the preventive coordination, as well as the service, was available for only 7% of these services. This partial coverage is available mostly as part of the Welcome to Medicare Visit. Further, the USPSTF recommended against 16 preventive services; Medicare reimbursed clinicians for 44% of these services.CONCLUSIONS Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries.     

Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force

OBJECTIVE: The purpose of this study was to examine the effectiveness of counseling to promote a healthy diet among patients in primary care settings. DESIGN AND DATA SOURCES: We conducted a MEDLINE search from 1966 to December 2001. STUDY SELECTION: We included randomized controlled trials of at least 3 months' duration with measures of dietary behavior that were conducted in patient populations similar to those found in primary care practices. We excluded studies that reported only biochemical or anthropomorphic endpoints, had dropout rates greater than 50%, or enrolled patients based on the presence of a chronic disease. DATA EXTRACTION: One author extracted relevant data from each included article into evidence tables. Using definitions developed by the research team, two authors independently rated each study in terms of its effect size, the intensity of its intervention, the patient risk level, and the use of well-proven counseling techniques. DATA SYNTHESIS: We identified 21 trials for use in this review. Dietary counseling produces modest changes in self-reported consumption of saturated fat, fruits and vegetables, and possibly dietary fiber. More-intensive interventions were more likely to produce important changes than brief interventions, but they may be more difficult to apply to typical primary care patients. Interventions using interactive health communications, including computer-generated telephone or mail messages, can also produce moderate dietary changes. CONCLUSIONS: Moderate- or high-intensity counseling interventions, including use of interactive health communication tools, can reduce consumption of saturated fat and increase intake of fruit and vegetable. Brief counseling of unselected patients by primary care providers appears to produce small changes in dietary behavior, but its effect on health outcomes is unclear.     

Screening for high blood pressure: a review of the evidence for the U.S. Preventive Services Task Force

CONTEXT: In 1996, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for hypertension. Since that time, the published literature on hypertension has expanded rapidly, necessitating a new examination of the evidence supporting screening. OBJECTIVE: Update the 1996 evidence review on screening for hypertension. DATA SOURCES: The 1996 Guide to Clinical Preventive Services, recent systematic reviews, and focused searches of MEDLINE were used to identify new evidence relevant to detecting and treating hypertension. STUDY SELECTION: When a good quality, recent systematic review was available, it was used to summarize previous research; MEDLINE was searched only for more recent articles. Two authors reviewed abstracts (and full texts, if necessary) of potentially relevant articles to determine if they should be included. DATA EXTRACTION: One author extracted data from included studies into evidence tables. DATA SYNTHESIS: Hypertension can be effectively detected through office measurement of blood pressure. Treatment of elevated blood pressure in adults can reduce cardiovascular events. The magnitude of risk reduction depends on the degree of hypertension and the presence of other cardiovascular risk factors. Available studies have found no important adverse effects on psychological well-being and mixed effects on the absenteeism rates of adults who are screened and labeled as being hypertensive. CONCLUSIONS: Substantial indirect evidence supports the effectiveness of screening adults to detect hypertension and treating them to reduce cardiovascular disease.     

Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis

ObjectiveThe consumption of fruits and vegetables (FV) may contribute to the prevention of many diseases. However, children at school age do not eat an enough amount of those foods. We have systematically reviewed the literature to assess the effectiveness of school interventions for promoting the consumption of FV.MethodsWe performed a search in MEDLINE, EMBASE, CINAHL and CENTRAL. We pooled results and stratified the analysis according to type of intervention and study design.ResultsNineteen cluster studies were included. Most studies did not describe randomization method and did not take the cluster's effect into account. Pooled results of two randomized controlled trials (RCTs) of computer-based interventions showed effectiveness in improving consumption of FV [Standardized Mean Difference (SMD) 0.33 (95% CI 0.16, 0.50)]. No significant differences were found in pooled analysis of seven RCTs of multicomponent interventions or pooling results of two RCTs evaluating free/subsidized FV interventions.ConclusionsMeta-analysis shows that computer-based interventions were effective in increasing FV consumption. Multicomponent interventions and free/subsidized FV interventions were not effective. Improvements in methodology are needed in future cluster studies. Although these results are preliminary, computer-based interventions could be considered in schools, given that they are effective and cheaper than other alternatives.     

Analysis & commentary: The US Preventive Services Task Force should consider a broader evidence base in updating its diabetes screening guidelines

Diabetes, especially type 2 diabetes, is on the rise throughout the United States. Several national health organizations and professional medical societies advocate screening people in high-risk groups for diabetes. However, the US Preventive Services Task Force recommends screening only adults with hypertension. We examined evidence supporting screening high-risk adults, including studies using intermediate outcomes and modeling studies. We found a broad range of evidence of practical relevance to diabetes screening that merits consideration in developing new screening guidelines. This evidence could inform recommendations to expand coverage to screening of other high-risk groups and could facilitate the prevention and early treatment of diabetes. We recommend that the US Preventive Services Task Force consider these expanded sources of evidence and revise its recommendations accordingly.     

Community interventions to promote healthy social environments: early childhood development and family housing. A report on recommendations of the Task Force on Community Preventive Services.

The sociocultural environment exerts a fundamental influence on health. Interventions to improve education, housing, employment, and access to health care contribute to healthy and safe environments and improved community health. The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of early childhood development interventions and family housing interventions. The topics selected provide a unique, albeit small, beginning of the review of evidence that interventions do effectively address sociocultural factors that influence health. Based on these reviews, the Task Force strongly recommends publicly funded, center-based, comprehensive early childhood development programs for low-income children aged 3-5 years. The basis for the recommendation is evidence of effectiveness in preventing developmental delay, assessed by improvements in grade retention and placement in special education. The Task Force also recommends housing subsidy programs for low-income families, which provide rental vouchers for use in the private housing market and allow families choice in residential location. This recommendation is based on outcomes of improved neighborhood safety and families' reduced exposure to violence. The Task Force concludes that insufficient evidence is available on which to base a recommendation for or against creation of mixed-income housing developments that provide safe and affordable housing in neighborhoods with adequate goods and services. This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and discusses implications for applying the interventions locally.     

Breastfeeding promotion interventions and breastfeeding practices: a systematic review

Introduction

Exclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months. Breastfeeding has been shown to have a protective effect against gastrointestinal infections, among other benefits. Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence, especially EBF, up to recommended standards and also to decrease infant morbidity.

Methods

A systematic literature search was conducted for RCTs and quasi-experimental studies comparing breastfeeding education or support to routine care. The effect of interventions was observed for exclusive, predominant, partial and no breastfeeding rates. The time intervals of interest were day 1, <1 month, and 1 to 5 months. Outcome-specific evidence was graded according to the Child Health Epidemiology Reference Group (CHERG) rules using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria and recommendations were made from studies in developing countries for inclusion into the Lives Saved Tool (LiST) model.

Results

After reviewing 4600 abstracts, 372 studies were selected for full text screening and 110 of these studies were finally included. Statistically significant increases in EBF rates as a result of breastfeeding promotion interventions were observed: 43% at day 1, 30% at <1 month, and 90% at 1-5 months. Rates of ‘no breastfeeding’ reduced by 32% at 1 day, 30% at <1 month, and 18% at 1-5 months. The effect of interventions on the rates of predominant and partial breastfeeding were non-significant.

Conclusion

Breastfeeding education and/or support increased EBF rates and decreased no breastfeeding rates at birth, <1 month and 1-5 months. Combined individual and group counseling appeared to be superior to individual or group counseling alone. Interventions in developing countries had a greater impact than those in developed countries.

     

The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: A systematic review

The goal of the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) is to be the leading diet and physical activity journal. To achieve this aim we embrace and publish a number of different research designs from small, but in depth, qualitative studies to large scale cohort studies. IJBNPA prioritises research based on randomised controlled trials (RCTs), systematic reviews (with or without meta-analyses, as appropriate), and well conducted observational studies that expand knowledge and understanding of the area. IJBNPA will also consider and publish other study designs that are of sufficient quality such as strong or ground-breaking methodological papers, rigorous qualitative studies, debate papers and commentaries. However, due to the demands on the journal, we publish pilot studies only in exceptional circumstances and we do not publish protocol papers or letters to the editors. The goal of this editorial is to highlight to our readers and authors the process by which we identify which papers to review and publish along with our editorial priorities.