AFP Clinical Answers

Aspirin for CVD, Scabies, Intimate Partner Violence, Maternal Vaccines, Caregiver Burden


Am Fam Physician. 2019 Nov 15;100(10):606.

Is low-dose aspirin effective for the primary prevention of CVD in moderate-risk patients?

After five years of treatment in a randomized controlled trial, patients at moderate risk of heart disease who took low-dose aspirin did not show a decrease in coronary events or all-cause mortality and had slightly more gastrointestinal bleeding. Using aspirin for the primary prevention of cardiovascular disease (CVD) is not a one-size-fits-all proposition. We need to risk-stratify patients according to benefits and harms and engage in shared decision-making with each patient.

What is the first-line treatment for scabies?

Permethrin 5% cream (Elimite) is the first-line treatment for scabies. Physicians should educate their patients about correct application of permethrin cream, reminding them that it should be applied to all areas of the body from the neck down, remain on the skin for eight to 14 hours or overnight, washed off, and reapplied in one week. Patients should be told that they may continue to itch for up to two weeks, even after appropriate and effective treatment.

Who should be screened for intimate partner violence (IPV), and what screening tools are recommended?

The U.S. Preventive Services Task Force recommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services. Several screening instruments can be used to screen women for IPV. The following instruments accurately detect IPV in the past year among adult women: Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST).

How effective is prenatal maternal vaccination in preventing pertussis in infants?

Women should receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy regardless of previous immunization history. Infants whose mothers received prenatal immunization had 50% fewer cases of pertussis compared with those whose mothers received postpartum immunization. Prenatal maternal Tdap vaccination is 91% effective in preventing pertussis during the first three months of life and 93% effective in preventing pertussis in the first eight weeks.

What interventions are effective in reducing caregiver burden?

For caregivers of patients with chronic conditions, psychoeducational, skills training, and therapeutic counseling interventions have small to moderate success in decreasing caregiver burden and increasing caregiver quality of life.

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