26 de abril de 2013

The latest recommendations from the USPSTF

B recommendations
The USPSTF recommends:
  • encouraging community-dwelling adults ≥65 years who are at increased risk for falls to take vitamin D supplements and to exercise (or undergo physical therapy) to prevent falls.
  • screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) ≥30 kg/m2 to intensive, multicomponent behavioral interventions.
  • counseling children, adolescents, and young adults ages 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce their risk of skin cancer.
  • screening women of childbearing age for intimate partner violence, such as domestic violence, and providing or referring women who screen positive to intervention services.
C recommendations
The USPSTF recommends against automatically:
  • performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults ≥65 years because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values.
  • initiating counseling on a healthful diet and physical activity with all adults in the general population. Although the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting is small. Clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all of their adult patients.
D recommendations
The USPSTF recommends against:
  • screening with resting or exercise electrocardiography (EKG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for such events.
  • using combined estrogen and progestin to prevent chronic conditions in postmenopausal women.
  • using estrogen to prevent chronic conditions in postmenopausal women who have had a hysterectomy.
  • screening for ovarian cancer.
  • screening for prostate cancer with a prostate-specific antigen (PSA) test.
I statements
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of:
  • screening for hearing loss in asymptomatic adults ages ≥50 years.
  • screening with resting or exercise EKG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.
  • routine screening for chronic kidney disease in asymptomatic adults.
  • counseling adults >24 years about minimizing risks to prevent skin cancer.
  • screening all elderly or vulnerable adults (physically or mentally dysfunctional) for abuse and neglect.
For more on the USPSTF’s grade definitions, see http://www.uspreventiveservicestaskforce.org/uspstf/grades.htmLa suplementación de 800 UI de vitamina D al día durante 12 meses puede reducir el riesgo de una caída de un 17%.
El USPSTF dice ahora que la prueba de PSA por lo general hace más daño que bien.