Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement.

Davidson KW, Barry MJ, Mangione CM, et al.

JAMA. 2022 Mar 15;327(11):1061-1067. doi: 10.1001/jama.2022.1806.

Importance: Eating disorders (eg, binge eating disorder, bulimia nervosa, and anorexia nervosa) are a group of psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalences for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively, and are lower in adult men (anorexia nervosa, 0.12%; bulimia nervosa, 0.08%; binge eating disorder, 0.42%). Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in adolescents and adults with a normal or high body mass index. Evidence limited to populations who are underweight or have other physical signs or symptoms of eating disorders was not considered. The USPSTF has not previously made a recommendation on this topic.

Population: Adolescents and adults (10 years or older) who have no signs or symptoms of eating disorders (eg, rapid weight loss, weight gain, or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea).

Evidence Assessment: The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined.

Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. (I statement).

Screening for Lipid Disorders in Children and Adolescents US Preventive Services Task Force Recommendation Statement.

US Preventive Services Task Force
JAMA. 2016;316(6):625-633. doi:10.1001/jama.2016.9852.

Importance  Elevations in levels of total, low-density lipoprotein, and non–high-density lipoprotein cholesterol; lower levels of high-density lipoprotein cholesterol; and, to a lesser extent, elevated triglyceride levels are associated with risk of cardiovascular disease in adults.

Objective  To update the 2007 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in children, adolescents, and young adults.

Evidence Review  The USPSTF reviewed the evidence on screening for lipid disorders in children and adolescents 20 years or younger—1 review focused on screening for heterozygous familial hypercholesterolemia, and 1 review focused on screening for multifactorial dyslipidemia.

Findings  Evidence on the quantitative difference in diagnostic yield between universal and selective screening approaches, the effectiveness and harms of long-term treatment and the harms of screening, and the association between changes in intermediate outcomes and improvements in adult cardiovascular health outcomes are limited. Therefore, the USPSTF concludes that the balance of benefits and harms cannot be determined.

Conclusions and Recommendation  The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. (I statement)

Screening for Autism Spectrum Disorder in Young Children: A Systematic Evidence Review for the U.S. Preventive Services Task Force.

McPheeters M, PhD,Weitlauf A,  Vehorn A,  Taylor C,  Sathe NA,  Shanthi Krishnaswami M, Fonnesbeck C,  Warren ZE.
AHRQ Publication No. 13-05185-EF-1 February 2016

Context: The Centers for Disease Control and Prevention estimates that 1 in 68 children has an autism spectrum disorder (ASD) and the majority of children are not diagnosed until after 4 years of age. Current approaches rely on developmental surveillance, general developmental screening, and/or parental concerns. Systematic screening has been advocated for identifying ASD at earlier ages.

Objective: We systematically reviewed the evidence about benefits and harms of routine screening for ASD in primary care settings.
Methods: We explicitly focused on studies of screening instruments for use in young (≤36 months of age), unselected populations (e.g., universal screening approaches).

Results: We identified 17 unique screening studies reported in 22 papers. The most commonly studied tool was the Modified Checklist for Autism in Toddlers (M-CHAT), including the most recently available variant (M-CHAT-Revised with Followup [M-CHAT-R/F]), which has a positive predictive value of 48 percent in diverse populations of children ages 16 to 30 months. Forty-two studies of good and fair quality addressed interventions for young children. Among these, 17 involved direct provision of intervention to children. Fifteen of these 17 studies assessed cognitive outcomes, and outcomes were significantly more improved in the treatment versus comparison arm in 10 studies. Sixteen of these 17 studies assessed language outcomes, and outcomes were significantly improved in the treatment versus comparison group in 10 studies. Thirteen studies involved parent training. Five of these 13 studies addressed cognitive outcomes, and outcomes were significantly improved in the treatment versus comparison group in one study. Twelve of the 13 studies addressed language outcomes, and outcomes were significantly improved in the treatment versus comparison group in three studies. Thus, 20 studies overall measured cognitive outcomes and 11 reported greater benefit for the intervention group compared to the control group, and language outcomes were significantly improved in treatment versus comparison arms in 13 of 28 studies assessing language. Twelve studies focused on play and interaction and typically measured joint attention as the outcome. Nine out of 10 studies evaluating joint attention outcomes reported greater benefit in the treatment arm compared to the control arm. None of the studies focused on screen-detected children.

Conclusions: Both the M-CHAT and the M-CHAT-R/F, when including the followup interview procedure, have a positive predictive value of around 50 percent in community practices for children between 16 and 30 months of age. Screening tools are widely available. Multiple treatments are available to young children with ASD. Early intensive interventions demonstrate statistically significant improvements in cognitive and language outcomes in children compared to eclectic treatments obtained in the community or other comparison groups, although the studies are generally small, and, within the studies, some children benefit while others do not. We found no studies that directly compared long-term outcomes of screened versus non screened children. More research is needed to determine the benefits and harms of screening the general population.

Procedures for the Evaluation of the Visual System by Pediatricians

Donahue SP, Baker CN; Committee on Practice and Ambulatory Medicine; Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology.
Pediatrics. 2016;137(1):1-9. doi: 10.1542/peds.2015-3597. Epub 2015 Dec 7
PubMed PMDI: 26644488

Vision screening is crucial for the detection of visual and systemic disorders. It should begin in the newborn nursery and continue throughout childhood. This clinical report provides details regarding methods for pediatricians to use for screening.

This clinical report supplements the combined policy statement from the American Academy of Pediatrics (AAP), American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, and American Association of Certified Orthoptists titled “Visual System Assessment in Infants, Children, and Young Adults by Pediatricians.” The clinical report and accompanying policy statement supplant the 2012 policy statement “Instrument-Based Pediatric Vision Screening,” the 2003 policy statement “Eye Examination in Infants, Children, and Young Adults by Pediatricians,” and the 2008 AAP policy statement “Red Reflex Examination in Neonates Infants and Children.” The policy statement articulates the screening criteria and screening methods, and the clinical report explains the various evaluation procedures that are available for use by the pediatrician or primary care physician.

Visual System Assessment in Infants, Children, and Young Adults by Pediatricians

Committee on Practice and Ambulatory Medicine; Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology.
Pediatrics. 2016;137(1):1-3. doi: 10.1542/peds.2015-3596
PubMed PMDI: 26644485

Appropriate visual assessments help identify children who may benefit from early interventions to correct or improve vision. Examination of the eyes and visual system should begin in the nursery and continue throughout both childhood and adolescence during routine well-child visits in the medical home. Newborn infants should be examined using inspection and red reflex testing to detect structural ocular abnormalities, such as cataract, corneal opacity, and ptosis. Instrument-based screening, if available, should be first attempted between 12 months and 3 years of age and at annual well-child visits until acuity can be tested directly. Direct testing of visual acuity can often begin by 4 years of age, using age-appropriate symbols (optotypes). Children found to have an ocular abnormality or who fail a vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.

Recommendations on screening for developmental delay

Canadian Task Force on Preventive Health Care
CMAJ 2016. DOI:10.1503/cmaj.151437
PubMed PMID: 27026672

This guideline focuses on population-based screening of children aged one to four years with no apparent signs of developmental delay, whose parents and clinicians have no concerns about development.

Screening refers to use of a standardized tool to search for developmental delay in children without recognized signs of such delay and whose parents or clinicians have not raised concerns. Screening differs from developmental surveillance, which refers to ongoing monitoring by clinicians of a child’s development, identification of risk factors and elicitation of parental concerns.

Key points:

• There is no evidence from randomized controlled trials (RCTs) that screening children for developmental delay improves health outcomes.
• There is no evidence that commonly used screening tools would consistently identify otherwise unrecognized cases, but there is evidence that the low specicity of these tools would lead to a high proportion of false positives.
• High-quality evidence from RCTs on the effectiveness of treatment for known developmental delay is lacking; a few small trials have suggested that speech and language therapy may improve language impairment and that treatment of autism may improve cognitive function.
• The task force recommends against use of population-based screening with standardized questionnaires in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no specific concerns.
• Clinicians should remain vigilant to deficits in children’s performance in terms of gross and fine motor skills, cognition, speech and language, and personal and social abilities. They should consider further evaluation for children whose development does not meet age-expected milestones.

Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis.

Yin X, Liu Q, Bovet P, Ma C, Xi B.

J Hum Hypertens. 2016 Mar 3.doi: 10.1038/jhh.2016.12. [Epub ahead of print]

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6-18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to  identify pre-high BP and high BP for children aged 6-11 years and adolescents aged 12-18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12-18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6-12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.Journal of Human

Hypertension advance online publication, 3 March 2016; doi:10.1038/jhh.2016.12.

Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.

Albert L. Siu, on behalf of the US Preventive Services Task Force

PediatricsMarch 2016, VOLUME 137 / ISSUE 3

DESCRIPTION: This article describes the update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for major depressive disorder (MDD) in children and adolescents.

METHODS: The USPSTF reviewed the evidence on the benefits and harms of screening, accuracy of primary care–feasible screening tests, and benefits and harms of treatment with psychotherapy, medications, and collaborative care models in patients aged 7 to 18 years.

POPULATION: This recommendation applies to children and adolescents aged ≤18 years who do not have an MDD diagnosis.

RECOMMENDATION: The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged ≤11 years (I statement).

Speech and Language Delay and Disorders in Children Age 5 and Younger: Screening.

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger.
To view the recommendation and the evidence on which it is based, please go to 
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/speech-and-language-delay-and-disorders-in-children-age-5-and-younger-screening.

Population	Asymptomatic children aged ≤5 years whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development
Recommendation	No recommendation. Grade: I statement (insufficient evidence)
Risk Assessment	Risk factors that have been reported to be associated with speech and language delay and disorders include male sex, family history of speech and language impairment, low parental education level, and perinatal risk factors (e.g., prematurity, low birth weight, and birth difficulties).
Screening Tests	The USPSTF found inadequate evidence on specific screening tests for use in primary care settings. Widely used screening tests in the United States include the Ages and Stages Questionnaire, the Language Development Survey, and the MacArthur-Bates Communicative Development Inventory.
Treatment and Interventions	Interventions for childhood speech and language disorders vary widely and can include speech-language therapy sessions and assistive technology (if indicated). Interventions are commonly individualized to each child's specific pattern of symptoms, needs, interests, personality, and learning style.
Balance of Benefits and Harms	The current evidence is insufficient to assess the balance of benefits and harms of screening and interventions for speech and language delay and disorders in young children in primary care settings.
Other Relevant USPSTF Recommendations	The USPSTF recommends screening for hearing loss in all newborn infants, and is developing a recommendation on screening for autism spectrum disorder in young children (available at www.uspreventiveservicestaskforce.org).

Screening programmes for developmental dysplasia of the hip in newborn infants (Review)

Shorter D, Hong T, Osborn DA

The Cochrane Collaboration and published in The Cochrane Library
2011, Issue 9. http://www.thecochranelibrary.com

Background
Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.
Objectives
To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.
Search methods
Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.
Selection criteria
Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.
Data collection and analysis
Three independent review authors assessed study eligibility and quality, and extracted data.
Main results
No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.
One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment.
One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment.
Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate.
Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting.
One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significant difference in late diagnosed DDH but a significant reduction in treatment. No infants in either group received surgery.
Authors’ conclusions
There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.

Approaches to enhancing the early detection of autism spectrum disorders: a systematic review of the literature.

J Am Acad Child Adolesc Psychiatry. 2014Feb;53(2):141-52. doi: 10.1016/j.jaac.2013.11.002. Epub 2013 Nov 19.

Daniels AM(1), Halladay AK(2), Shih A(3), Elder LM(4), Dawson G(5).

Comment in

J AmAcad Child Adolesc Psychiatry. 2014 Feb;53(2):133-4. 

[Are We There Yet? The State of Early Prediction and Intervention in Autism Spectrum Disorder] 

BACKGROUND: A reliable diagnosis of autism can be made as early as 24 months, yet in many children diagnoses are made much later. A delay in diagnosis translates into a missed opportunity to provide early intervention services and to improve outcomes. The aim of the current study was to review the literature on early detection approaches in primary care and other community settings in the United States.

METHODS: A search was conducted of the peer-reviewed and gray literature to identify studies published from January 1990 through January 2013 testing approaches to enhance the early detection of autism in community settings in the United States.

RESULTS: The search identified 40 studies describing 35 approaches, which were grouped into the following categories: awareness (n = 4), routine screening (n = 21), and practice improvement to enhance screening (n = 10). Awareness approaches were associated with positive changes in knowledge of autism-related topics. Routine screening yielded high or increased rates of screening and referrals; however, few studies assessed the effect of screening on age at diagnosis or services enrollment. Practice improvement approaches resulted in increased screening and referral rates and highlighted the importance of adopting a multipronged approach to enhance early detection.

CONCLUSIONS: Although studies that tested screening approaches in community settings found positive results, the effectiveness of such efforts on reducing time to diagnosis and services enrollment remains largely untested. The fact that few studies reported outcomes beyond rates of referral indicates the need for enhanced methodological rigor, particularly with respect to length of follow-up and quality of measures used.

Preventing Dental Caries in Children under 5 Years: Systematic Review Updating USPSTF Recommendation.

Pediatrics. 2013 Aug;132(2):332-50. doi: 10.1542/peds.2013-1469. Epub 2013 Jul15.Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M.

BACKGROUND AND OBJECTIVE: Screening and preventive interventions by primary care 
providers could improve outcomes related to early childhood caries. The objective
of this study was to update the 2004 US Preventive Services Task Force systematic
review on prevention of caries in children younger than 5 years of age.
METHODS: Searching Medline and the Cochrane Library (through March 2013) and
reference lists, we included trials and controlled observational studies on the
effectiveness and harms of screening and treatments. One author extracted study
characteristics and results, which were checked for accuracy by a second author. 
Two authors independently assessed study quality.
RESULTS: No study evaluated effects of screening by primary care providers on
clinical outcomes. One good-quality cohort study found pediatrician examination
associated with a sensitivity of 0.76 for identifying a child with cavities. No
new trials evaluated oral fluoride supplementation. Three new randomized trials
were consistent with previous studies in finding fluoride varnish more effective 
than no varnish (reduction in caries increment 18% to 59%). Three trials of
xylitol were inconclusive regarding effects on caries. New observational studies 
were consistent with previous evidence showing an association between early
childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk
prediction instruments in primary care settings is not available.
CONCLUSIONS: There is no direct evidence that screening by primary care

clinicians reduces early childhood caries. Evidence previously reviewed by the US
Preventive Services Task Force found oral fluoride supplementation effective at
reducing caries incidence, and new evidence supports the effectiveness of
fluoride varnish in higher-risk children.

Screening for Elevated Blood Pressure in Children and Adolescents. A Critical Appraisal

Arnaud Chiolero, MD, PhD; Pascal Bovet, MD, MPH; Gilles Paradis, MD, MSc

JAMA Pediatr. 2013;167(3):266-273. doi:10.1001/jamapediatrics.2013.438

Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.

Hypertension is a major risk factor for cardiovascular diseases (CVDs). Worldwide, 7.1 million deaths (13% of the global total) are due to elevated blood pressure (BP) in adults every year.1

Until recently, hypertension was rarely searched for or diagnosed in children and adolescents. However, the approach toward elevated BP in childhood is changing because of the growing evidence that elevated BP in youth has detrimental lifelong cardiovascular effects.2

The BP level in childhood tracks to the BP level in adulthood, and children with elevated BP have a higher probability of developing hypertension as adults than do children with low BP.3 This BP tracking is a major argument for being concerned with elevated BP early in life; since BP tracks, prevention and treatment of elevated BP early in life can result in a lifelong reduction of BP and of its associated conditions.

Furthermore, elevated BP in childhood is associated with cardiac left ventricular hypertrophy4 and a thickening of the carotid intima-media, a surrogate marker for atherosclerosis and a strong predictor of CVD.5 Raised fibrous plaques of atherosclerosis have been observed in the aorta of children as young as 8 years of age, and the plaque extent has been shown to be associated with BP levels.6

Another reason for the interest in elevated BP in childhood is the increase in the prevalence of obesity. Because obesity is associated with elevated BP at all ages including childhood,7- 9 it is often assumed that the prevalence of hypertension has increased in youth in the last decades,10- 11although such trends have not been observed in all populations.12- 15 Finally, although the clinical approach to the prevention of CVD relies on the identification and treatment of risk factors starting in mid-adulthood, a life-course approach to prevent the development of risk factors starting in childhood offers new avenues for the prevention of hypertension and CVD.16- 17

In view of this evidence, universal BP screening beginning in childhood is advocated.18- 20Undiagnosed elevated BP has become a matter of concern in children.21- 22 Screening for elevated BP may help identify children at increased risk of hypertension and CVD later in life and for whom early treatment could be beneficial.23 Nevertheless, although there is strong evidence that screening for hypertension is beneficial for adults,24- 25 it is unclear whether screening is beneficial for children. Our aim is to critically appraise the evidence and recommendations regarding the screening for elevated BP in children and adolescents.

Asymptomatic Sexually Active Adolescents and Young Adults Should Not Be Screened for Herpes Simplex Virus

Hayley D. Mark, PhD, MPH, RN

JAMA Pediatr. 2013;():1-2. doi:10.1001/jamapediatrics.2013.462.

Herpes simplex virus (HSV) types 1 and 2 are highly prevalent in the general population of the United States. The seroprevalence of HSV-2 and HSV-1 were 17% and 58%, respectively, in a cohort aged 14 to 49 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.1 Seroprevalence is substantially less among adolescents and young adults. Approximately 80% of infected individuals are unaware of their infection and the majority of infections are transmitted by these individuals.2

Type-specific serological assays for HSV became commercially available in 1999, making possible wide-scale screening for HSV-1 and HSV-2. However, the value of HSV screening is controversial. Proponents argue that on detection, asymptomatic carriers can be counseled to use prevention methods and, thus, reduce the possibility of transmission to uninfected partners. Opponents point out the possibility that large numbers of asymptomatic individuals may receive a diagnosis of a stigmatized, chronic infection, with substantial transmission potential, but there are no substantial data to support the effectiveness of HSV screening in changing sexual behaviors or preventing transmission.

The important questions that a clinician must consider in determining the value of HSV screening among asymptomatic sexually active adolescents and young adults are derived from the Wilson and Jungner classic public health report3 on criteria for use of a screening test and include the following: (1) Is the disease an important public health problem? (2) Is an accurate screening test available and is it acceptable to the population? (3) Does screening improve health outcomes and symptoms or reduce transmission of disease? (4) Are the costs and risks of screening less than the benefits?

Primary Care Interventions to Prevent Child Maltreatment: U.S. Preventive Services Task Force Recommendation Statement

Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*

Ann Intern Med. Published online 11 June 2013 doi:10.7326/0003-4819-159-4-201308200-00667

Description: Update of the child abuse and neglect portion of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for family and intimate partner violence.

Methods: The USPSTF commissioned a systematic review on interventions to prevent child maltreatment for children at risk, focusing on new studies and evidence gaps that were unresolved at the time of the 2004 recommendation. Beneficial outcomes considered include reduced exposure to maltreatment and reduced harms to physical or mental health or mortality.

Population: This recommendation applies to children in the general U.S. population from newborn to age 18 years who do not have signs or symptoms of 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)

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.

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force.
Pediatrics published online Jan 18, 2010;DOI: 10.1542/peds.2009-2037

DESCRIPTION: Update of the 2005 US Preventive Services Task Force
(USPSTF) statement about screening for overweight in children and
adolescents.
METHODS: The USPSTF examined the evidence for the effectiveness of
interventions that are primary care feasible or referable. It also examined
the evidence for the magnitude of potential harms of treatment in
children and adolescents.
RECOMMENDATION. The USPSTF recommends that clinicians screen
children aged 6 years and older for obesity and offer them or refer
them to intensive counseling and behavioral interventions to promote
improvements in weight status (grade B recommendation).

Validity of Pure-Tone Hearing Screening at Well-Child Visits.

Donna R. Halloran, MD, MSPH; J. Michael Hardin, PhD; Terry C. Wall, MD, MPH
Arch Pediatr Adolesc Med. 2009;163(2):158-163.
Objective: to estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design: prospective cohort study.
Setting: eight academic and private pediatric practices.
Participants: a subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry.
Intervention: formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children).
Main Exposure: pure-tone audiometry screening.
Main Outcome: measures Audiologic evaluations.
Results: a total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion: in light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.