Clinical Preventive Medicine
When to Discuss Prostate Cancer Screening With Average-Risk Men
In the U.S. in 2021, nearly 200,000 men will be diagnosed with prostate cancer, and >30,000 will die of the disease.1 Although RCTs have shown that prostate-specific antigen (PSA) screening reduces prostate cancer deaths,2,3 screening carries significant risks of harm and limited absolute benefit over a 10-year horizon.4,5 Given this background, clinical guidelines agree that PSA screening should only be offered to men who indicate a preference for screening after shared decision making with their providers.Understanding the Value of the Wellness Visit: A Descriptive Study
Clinical preventive services can reduce mortality and morbidity, but Americans receive only half of the recommended care. Although wellness visits protect time for clinicians to review needs and discuss care with patients, studies have not shown that having a wellness visit improves health outcomes. This study seeks to understand the types of discussions and volume of care delivered during wellness visits.A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants
Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening.Screening Discordance and Characteristics of Patients With Housing-Related Social Risks
Healthcare systems are increasingly interested in identifying patients’ housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care.A Community Health Worker–Led Multicomponent Program to Promote Cervical Cancer Screening in South Asian Women: A Cluster RCT
South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker–led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong.U.S. Preventive Services Task Force Update and Computed Tomography for Colorectal Cancer Screening Among Privately Insured Population
The Affordable Care Act of 2010 mandated private health plans to fully cover the services recommended by the U.S. Preventive Services Task Force. In June 2016, the Task Force added computed tomography colonography to its list of recommended tests for colorectal cancer screening. This study evaluates the association among the updated recommendation, patient cost-sharing obligations, and the uptake of colorectal cancer screening through computed tomography colonography in the privately insured population.Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence
This study sought to determine whether a provider mobile phone application, used with or without a patient educational tool accessed on a computer tablet, would promote adherence to guidelines for cervical cancer screening and management of abnormal cytology in young women.Motivational Interviewing in the Management of Type 2 Diabetes Mellitus and Arterial Hypertension in Primary Health Care: An RCT
Motivational interviewing is an effective style of collaborative communication for the promotion of lifestyle changes in the management of Type 2 diabetes and arterial hypertension. This study evaluates the effectiveness of motivational interviewing in the management of these conditions in primary health care.Exposure to Weight Management Counseling Among Students at 8 U.S. Medical Schools
Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, observation, and direct experience.Availability of Adult Vaccination Services by Provider Type and Setting
Knowledge regarding the benefits for adult vaccination services under Medicaid's fee-for-service arrangement is dated; little is known regarding the availability of vaccination services for adult Medicaid beneficiaries in MCO arrangements. This study evaluates the availability of provider reimbursement benefits for adult vaccination services under fee-for-service and MCO arrangements for different types of healthcare providers and settings.Aspirin Use and Misuse for the Primary Prevention of Cardiovascular Diseases
Daily aspirin use for primary cardiovascular disease prevention is common among adults. Numerous clinical trials observe reduced cardiovascular disease with regular low-dose aspirin. The U.S. Preventive Services Task Force in 2016 published guidelines for aspirin use, but controversy exists about the side effects, and overuse or underuse may be common despite the guidelines. Using the Task Force recommendations, this paper describes the prevalence of appropriate aspirin use and physician advice in a population sample.Characteristics of Population Health Physicians and the Needs of Healthcare Organizations
Healthcare organizations are transitioning from fee-for-service, volume-based care toward value-based care and the Triple Aim. Physicians have critical roles as leaders and practitioners in this emerging field of population health management; however, the competencies required of these physicians are not well described. The purpose of this study is to explore the approaches of healthcare systems to population health–related functions, the competencies needed, and the characteristics of physicians who lead or staff these functions.Use of Machine Learning to Determine the Information Value of a BMI Screening Program
Childhood obesity continues to be a significant public health issue in the U.S. and is associated with short- and long-term adverse health outcomes. A number of states have implemented school-based BMI screening programs. However, these programs have been criticized for not being effective in improving students’ BMI or reducing childhood obesity. One potential benefit, however, of screening programs is the identification of younger children at risk of obesity as they age.Addiction Medicine After COVID-19: The Imperative of a Trained Workforce
Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, substance use disorder (SUD) remains a pressing issue in the U.S. According to the latest National Survey on Drug Use and Health, the number of Americans afflicted with SUD exceeds 20 million, an estimated 2 million of whom are coping with an opioid use disorder (OUD).1 The efficacy of evidence-based opioid agonist therapy with methadone or buprenorphine notwithstanding, the vast majority of Americans living with OUD do not receive any treatment.Lung Cancer Screening Knowledge, Perceptions, and Decision Making Among African Americans in Detroit, Michigan
Previously, a web-based, patient-facing decision aid for lung cancer screening, shouldiscreen.com, was developed and evaluated. An initial evaluation was completed before the Medicare coverage decision and recruited a nondiverse sample of mostly former smokers, limiting the understanding of the potential effectiveness of the tool among diverse populations. This study evaluates shouldiscreen.com among African Americans in Metro Detroit.Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries
Human papillomavirus–vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, thus opening opportunities for global cost reduction and program sustainability. The determinants of uptake and completion of a 3-dose human papillomavirus vaccination program by adult women in a European context were estimated.Disparities in Breast Cancer Screening Uptake for Women With Mental Illness in the United Kingdom
Although there is evidence of disparities in breast cancer screening for women with mental illness in the U.S., there is a dearth of studies examining this association in the United Kingdom, where health care is provided free at the point of access. This population-based study examines the influence of mental illness, as assessed by the uptake of psychotropic medications, on breast screening uptake in the United Kingdom.Family Health History–Based Cancer Prevention Training for Community Health Workers
Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history–based education and services to the general public. The authors developed the first cancer family history–based genomics training program in cancer prevention tailored for community health workers.The Relationship Between Health Literacy and Nonrecommended Cancer Screening
Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.Variation in Eligible Patients’ Agreeing to and Receiving Lung Cancer Screening: A Cohort Study
Little is known about how clinicians make low-dose computed tomography lung cancer screening decisions in practice. Investigators assessed the factors associated with real-world decision making, hypothesizing that lung cancer risk and comorbidity would not be associated with agreeing to or receiving screening. Though these factors are key determinants of the benefit of lung cancer screening, they are often difficult to incorporate into decisions without the aid of decision tools.Factors Associated With Postpartum Diabetes Screening in Women With Gestational Diabetes and Medicaid During Pregnancy
Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion.Familiarity With and Use of Insufficient Evidence Findings From the Community Preventive Services Task Force
The Community Preventive Services Task Force (CPSTF) is an independent, nonfederal panel of experts that uses systematic reviews to develop recommendations about community preventive services and programs to improve population health. The CPSTF issues an insufficient evidence (IE) finding when the evidence is lacking, inconsistent, or has significant methodologic limitations. An IE finding indicates a need for more research.1 The NIH partners with the Centers for Disease Control and Prevention Community Guide Office to support the CPSTF in making evidence-based recommendations and identifying research gaps.Engaging Community Health Workers to Increase Cancer Screening: A Community Guide Systematic Economic Review
The Community Preventive Services Task Force recommends engaging community health workers to increase breast, cervical, and colorectal cancer screenings on the basis of strong evidence of effectiveness. This systematic review examines the economic evidence of these interventions.Health and Institutional Risk Factors of COVID-19 Mortality in Mexico, 2020
Several studies in developed and developing countries have analyzed the health risk factors associated with COVID-19 mortality. Comorbid diseases are a key explanatory factor behind COVID-19 mortality, but current studies treat comorbidities in isolation, at average-population values, and rarely assess how death risk varies for different health profiles across institutions. Estimating death risk variations for different interactions between comorbid diseases and across healthcare institutions is crucial to gaining a significant depth of understanding in relation to mortality during the pandemic.Barriers to Implementing Cardiovascular Risk Calculation in Primary Care: Alignment With the Consolidated Framework for Implementation Research
Cardiovascular disease risk calculators can inform and guide preventive strategies and treatment decisions by clinicians and patients. However, their uptake in primary care has been slow despite the recommendation in national cardiovascular disease prevention guidelines. Identifying the barriers to the implementation of cardiovascular disease risk calculators is essential for promoting their adoption.
