News Briefs: Clinical Practice Updates

This roundup includes the following brief clinical practice updates:

A study (13-page PDF; About PDFs) recently published in the Journal of General Internal Medicine found that morbidly obese women are 20 percent less likely than normal-weight women to have had a recent mammogram. The authors of the meta-analysis suggest that this disparity may contribute to higher postmenopausal breast cancer mortality rates seen in these women.

The study researchers found that in addition to previously reported barriers to mammography (e.g., poor self-esteem, negative body image and embarrassment), a perceived lack of respect from health care professionals and physician bias against obese women also were factors. Furthermore, physicians reported difficulty and inadequate resources and education in providing care for obese women. The study also noted that obesity-related comorbid conditions may hinder referrals for preventive services.

In addition, the researchers found that the relationship between obesity and lack of screening seemed to be limited to white women; rates of mammography among black women in the study were not affected by obesity.

The AAFP has endorsed recently updated U.S. Preventive Services Task Force, or USPSTF, recommendations for the use of aspirin to prevent certain cardiovascular events.

In 2002, the USPSTF recommended that clinicians discuss the use of aspirin with adults who have an increased risk for coronary heart disease. The task force now has updated its recommendations based on new evidence that aspirin may have different benefits and risks in men and women.

The task force now recommends that at-risk men ages 45-79 should take aspirin "when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage." The task force also recommends aspirin for women ages 55-79 "when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage."

The USPSTF has concluded that the evidence is insufficient to assess the balance of benefits and harms of aspirin for men and women ages 80 or older. Finally, the task force recommended against the use of aspirin to prevent myocardial infarction in men ages 44 or younger or to prevent ischemic stroke in women ages 54 or younger because the potential benefits do not outweigh risks.

The U.S. Preventive Services Task Force, or USPSTF, has updated its recommendations for screening adolescents for clinical depression.

In its 2002 recommendations for depression screening, USPTF members said the evidence was insufficient to recommend for or against routine screening of children or adolescents. In the new recommendations, the task force maintained that the evidence remains insufficient to recommend for or against routine screening of children ages 7-11, but it now recommends screening adolescents ages 12-18 when appropriate systems are in place to ensure accurate diagnosis, psychotherapeutic treatment and follow-up care.

The USPTF said that adequate evidence exists to indicate that treating adolescents with selective serotonin reuptake inhibitors, or SSRIs; psychotherapy; or a combination of pharmacotherapy and psychotherapy can decrease depression symptoms. However, the task force noted that treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality and should only be considered if careful clinical supervision is possible.

The CDC has published "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents." The guidelines,
updated for the first time since 2002, were released in an April 10 Morbidity and Mortality Weekly Report. (216-page PDF; About PDFs)

The revised guidelines, which the CDC developed in conjunction with NIH and the HIV Medicine Association of the Infectious Diseases Society of America, include several noteworthy changes:

Physicians can earn a maximum of 3.25 AMA Physician's Recognition Award category 1 CME credits through the CDC by completing and submitting this educational activity by April 10, 2012.