Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.


The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. (B recommendation)

Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on primary care interventions to prevent tobacco use in children and adolescents.

Methods: The USPSTF reviewed the evidence on the effectiveness of primary care interventions on the rates of initiation or cessation of tobacco use in children and adolescents and on health outcomes, such as respiratory health, dental and oral health, and adult smoking. The USPSTF also reviewed the evidence on the potential harms of these interventions.

Population: This recommendation applies to school-aged children and adolescents. The USPSTF has issued a separate recommendation statement on tobacco use counseling in adults and pregnant women.

Recommendation: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

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The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Group Well-Child Care: An Analysis of Cost.

• Hiromi Yoshida, 
• Ada M. Fenick, 
• and Marjorie S. Rosenthal

CLIN PEDIATR 0009922813512418, first published on December 10, 2013  doi:10.1177/0009922813512418
Objective.To determine if group well-child visits (WCV) can be cost neutral compared with individual WCV by varying health care providers, group size, and physician salary.Method. We created 6 economic models to evaluate the costs of WCV: 3 for individual WCV delivered by (1) advanced practice registered nurse (APRN), (2) resident, and (3) attending and 3 for group WCV delivered by (4) APRN with a nurse and social worker; (5) resident with an attending, nurse, and child life specialist; and (6)attending with a nurse. For group WCV, we performed sensitivity analyses on group size and duration of provider participation. Results. We achieved cost-neutrality at 4 families in the APRN group WCV model; at 3, 4, 5, and 6 families in the resident model with 30, 45, 60, and 90 minutes of attending supervision, respectively; and at 4 and 5 families in the low and high attending salary model, respectively. Conclusion. Group WCV can be delivered in a cost-neutral manner by optimizing group size and provider participation.

Insufficient evidence for the use of a physical examination to detect maltreatment in children without prior suspicion: a systematic review.

Eva MM Hoytema van Konijnenburg^13*†, Arianne H Teeuw^1†, Tessa Sieswerda-Hoogendoorn¹, Arnold G E Leenders² and Johanna H van der Lee¹

Systematic Reviews 2013, 2:109  doi:10.1186/2046-4053-2-109

Background

Although it is often performed in clinical practice, the diagnostic value of a screening physical examination to detect maltreatment in children without prior suspicion has not been reviewed. This article aims to evaluate the diagnostic value of a complete physical examination as a screening instrument to detect maltreatment in children without prior suspicion.

Methods

We systematically searched the databases of MEDLINE, EMBASE, PsychINFO, CINAHL, and ERIC, using a sensitive search strategy. Studies that i) presented medical findings of a complete physical examination for screening purposes in children 0–18 years, ii) specifically recorded the presence or absence of signs of child maltreatment, and iii) recorded child maltreatment confirmed by a reference standard, were included. Two reviewers independently performed study selection, data extraction, and quality appraisal using the QUADAS-2 tool.

Results

The search yielded 4,499 titles, of which three studies met the eligibility criteria. The prevalence of confirmed signs of maltreatment during screening physical examination varied between 0.8% and 13.5%. The designs of the studies were inadequate to assess the diagnostic accuracy of a screening physical examination for child maltreatment.

Conclusions

Because of the lack of informative studies, we could not draw conclusions about the diagnostic value of a screening physical examination in children without prior suspicion of child maltreatment.