preventive medicine research topics

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Preventive medicine articles from across Nature Portfolio

Preventive medicine is a type of medical treatment focused on disease prevention. This strategy could be particularly useful to treat individuals with risk factors for a disease. Strategies used include patient education, lifestyle modification, and therapeutics.

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Vitamin K prophylaxis in neonates: comparing two different oral regimens

• Daijiro Takahashi
• Naoki Egami
• Shouichi Ohga

Simple risk scoring using sinus rhythm electrocardiograms predicts the incidence of atrial fibrillation in the general population

• Hiroyuki Kamada
• Shin Kawasoe
• Mitsuru Ohishi

Systematic review of the effectiveness of standalone passive countermeasures on microgravity-induced physiologic deconditioning

• Syed Shozab Ahmed
• Nandu Goswami
• Tobias Weber

Missed diagnosis—a major barrier to patient access to obesity healthcare in the primary care setting

• Michal Kasher Meron
• Sapir Eizenstein

Effects of obsessive beliefs and anxiety on sexual function in HPV-positive men

• Emrah Yakut
• Esengul Ekici

A longitudinal study of blood pressure circadian rhythm from childhood to early adulthood

• Katerina Massengale
• Xiaoling Wang

News and Comment

In multiple myeloma, monthly treatment with zoledronic acid beyond two years offers sustained protection against progressive bone disease

• Thomas Lund
• Michael Tveden Gundesen
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Comment on “Patients’ perspectives on informational needs surrounding gender affirming vaginoplasty”

• Marco Falcone
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AI-based diabetes care: risk prediction models and implementation concerns

The utilization of artificial intelligence (AI) in diabetes care has focused on early intervention and treatment management. Notably, usage has expanded to predict an individual’s risk for developing type 2 diabetes. A scoping review of 40 studies by Mohsen et al. shows that while most studies used unimodal AI models, multimodal approaches were superior because they integrate multiple types of data. However, creating multimodal models and determining model performance are challenging tasks given the multi-factored nature of diabetes. For both unimodal and multimodal models, there are also concerns of bias with the lack of external validations and representation of race, age, and gender in training data. The barriers in data quality and evaluation standardization are ripe areas for developing new technologies, especially for entrepreneurs and innovators. Collaboration amongst providers, entrepreneurs, and researchers must be prioritized to ensure that AI in diabetes care is providing quality and equitable patient care.

• Serena C. Y. Wang
• Grace Nickel
• Joseph C. Kvedar

Priapism: a new era

• Arthur L. Burnett

Role of steatotic liver disease in prediction and prevention of cardiometabolic diseases

Steatotic liver disease has emerged as an important risk factor for cardiovascular disease, type 2 diabetes mellitus and chronic kidney disease. Successful treatment of steatotic liver disease might also be effective in preventing these cardiometabolic diseases.

• Norbert Stefan
• Amedeo Lonardo
• Giovanni Targher

The case for eliminating racial and ethnic cardiovascular disparities in the USA

Racial and ethnic disparities in cardiovascular health in the USA result in a persistent mortality gap between white and Black individuals, increase health-care costs and compromise an egalitarian society. Solutions to racial inequities require risk factor control and the implementation of evidence-based medicine and anti-racism policies. Overcoming these disparities is not only a practical necessity, but also a moral imperative.

• Keith C. Ferdinand

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Current issue   Volume 57(2); March 2024

• Our Valuable Contributors: Reviewers of 2023 Sue K. Park J Prev Med Public Health. 2024;57(2):95-95. Editorial March 29, 2024
• Editorial Mar 29, 2024 Our Valuable Contributors: Reviewers of 2023 Sue K. Park J Prev Med Public Health. 2024;57(2):95-95.

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Preventive medicine

• Public and occupational health
• Diabetes prevention
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Attitude toward vaccination against COVID-19 and acceptance of the national “QazVac” vaccine in the Aktobe city population, West Kazakhstan: A cross-sectional survey

Saltanat T. Urazayeva, Saulesh S. Kurmangaliyeva,  [ ... ], Saule Balmagambetova

COVID-19 vaccination uptake and determinants of booster vaccination among persons who inject drugs in New York City

Mehrdad Khezri, Courtney McKnight,  [ ... ], Don Des Jarlais

Covid-19 vaccine uptake and its associated factors among adult population in Dangila district, Awi Zone, Northwest Ethiopia: A mixed method study

Girma Tadesse Wassie, Yeshambel Agumas Ambelie,  [ ... ], Denekew Tenaw Anley

“Hurts less, lasts longer”; a qualitative study on experiences of young people receiving high-dose subcutaneous injections of benzathine penicillin G to prevent rheumatic heart disease in New Zealand

Julie Cooper, Stephanie L. Enkel,  [ ... ], Julie Bennett

Enterococcus faecalis phage: A comprehensive genome analysis">Insights into the novel Enterococcus faecalis phage: A comprehensive genome analysis

Sahar Abed, Mohammad Sholeh,  [ ... ], Shaghayegh Nasr

Awareness of fifth metatarsal stress fractures among soccer coaches in Japan: A cross-sectional study

Takayuki Miyamori, Masashi Aoyagi, Yu Shimasaki, Masafumi Yoshimura

Medical resource usage for COVID-19 evaluated using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

Keita Fukuyama, Yukiko Mori,  [ ... ], Tomohiro Kuroda

The prevalence of internalized stigma and its association with HIV viral suppression among fully disclosed adolescents and young adults living with HIV (AYLHIV) receiving HIV care in an HIV clinic in Plateau State, Nigeria

Emmanuel O. Osayi, Oluseye Ajayi,  [ ... ], Albert Anderson

Immortalized hepatocyte-like cells: A competent hepatocyte model for studying clinical HCV isolate infection

Yongyut Pewkliang, Piyanoot Thongsri,  [ ... ], Khanit Sa-ngiamsuntorn

Viral load suppression and its predictor among HIV seropositive people who receive enhanced adherence counseling at public health institutions in Bahir Dar, Northwest Ethiopia. Retrospective follow-up study

Minyichil Birhanu Belete, Abebayehu Bitew, Kebadnew Mulatu

“I’ll take them another day”: A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements

Judy Gichuki, Ben Ngoye, Francis Wafula

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Preventive Medicine Core Content Outline

Core content areas.

25% – I. Clinical Preventive Medicine

Knowledge and skills that enable preventive medicine practitioners to:

• Perform/obtain comprehensive individual health history, including but not limited to lifestyle, occupation, environmental exposures, hobbies, social determinants of health, sexual health, complementary and alternative therapies.
• Assess individual’s health risks based on personal, family, and exposure history, lifestyle choices, and other risk factors.
• Provide evidence-based guidance, advice and/or interventions to modify, mitigate, and/or eliminate risks in order to improve health outcomes and functional status.
• Assess individuals using current standards and guidelines to determine suitability for duty, return to work, school, play/leisure, travel or other essential life activities.

25% – II. Public Health/Population Health Medicine

• Perform population or community health assessment (including defining health questions, collecting, organizing, analyzing and interpreting data) to determine potential relationships, correlations, and/or causations between factors and variables related to health outcomes.
• Develop and communicate policies, guidance, advice and/or interventions to various audiences (e.g., the public, organizations, media, government, publication) to modify, mitigate, and/or eliminate risks in order to improve health outcomes.
• Develop assurance plan including implementation, monitoring, and surveillance recommendations in collaboration with relevant stakeholders (e.g., policy makers, community leaders, business leaders, union representatives, military leaders).

20% – III. Epidemiology, Biostatistics, and Informatics

• Engage in the design of scientifically valid studies to answer questions or address defined hypothesis.
• Interpret and critically review research methodology and integrate study results into a scientifically sound narrative to develop conclusions and/or inform next steps.
• Gather, extract, evaluate, and synthesize data and information from diverse sources to inform decisions related to both population and individual health.
• Communicate scientific knowledge through memos, presentations, posters, articles, media, or other methods to inform stakeholders (e.g., decision-makers, peers, and the public).

15% – IV. Environmental Medicine

• Perform comprehensive evaluation of the environment to identify risks to which individuals or populations are exposed.
• Develop and implement plans to mitigate, manage, and/or treat individual and population health risks related to environmental factors.
• Develop and inform environmental policies and regulations related to the protection of human health.
• Develop incident management and response plans in collaboration with physician and non-physician professionals.
• Develop and/or advocate for wellness and lifestyle initiatives to address health issues and health disparities arising from environmental conditions.

15% – V. Strategic Healthcare Leadership

• Participate in organizational governance supporting the formulation, implementation, and evaluation of health strategy.
• Participate in quality improvement programs/processes within the organization to improve health outcomes.
• Evaluate health and/or safety initiatives and programs to determine the efficacy and recommend modifications.
• Comply with applicable standards and regulations.

I. Clinical Preventive Medicine

1.01 Risk factors, signs, symptoms, and approaches to prevention related to physical, mental, and behavioral diseases and disorders, including:

1.01.01. Cardiovascular diseases (e.g., peripheral vascular disease, hypertension, Coronary Artery Disease, lipid disorders)

1.01.02. Respiratory diseases (e.g., COPD, asthma, obstructive sleep apnea, pneumoconiosis)

1.01.03. Neoplastic diseases (e.g., colorectal, breast, prostate, leukemia, skin)

1.01.04. Infectious diseases (e.g., STDs, blood borne, zoonotic, parasites, TB, hepatitis, HIV, herpes-zoster, measles, pertussis, Ebola)

1.01.05. Metabolic disorders and nutrition (e.g., metabolic syndrome, diabetes, thyroid disorder, chronic kidney disease, gout)

1.01.06. Musculoskeletal disorders (e.g., spinal pathology including degenerative joint, disc and facet disease, impingement syndrome)

1.01.07. Neurological disorders (e.g., Traumatic brain injury, syncope, CVA, GBS, multiple sclerosis, migraine, occipital neuralgia, trigeminal neuralgia, sensory neural hearing loss, radiculopathy, spinal stenosis)

1.01.08. Oral health, vision and hearing disorders (e.g., dental caries, periodontal disease, oral cancer; refractive error, glaucoma, cataracts, retinal disorders-macular degeneration, diabetic retinopathy; hearing loss, tinnitus)

1.01.09 Reproductive health disorders (e.g., menstrual disorders, preconception care, family planning, ovarian cancer, cervical cancer, uterine cancer)

1.01.10. Dermatological conditions (e.g., melanoma, herpes, impetigo)

1.01.11. Substance use disorders (e.g., opioid addiction, illicit drug use, alcohol, tobacco)

1.01.12. Psychiatric and behavioral disorders (e.g., depression, anxiety, schizophrenia, post-traumatic stress disorder (PTSD), somatoform disorders, ADHD)

1.02. Elements of a comprehensive health assessment and medical history (e.g., immunizations, sleep, hygiene, physical fitness, diet, substance use, travel history, occupation, environmental exposures, hobbies, determinants of health, sexual health, complementary and alternative therapies, supplements)

1.03. Personal preventive plans

1.04. Appropriate screening methods published by organizations (e.g., USPSTF, American Cancer Society, CDC, medical professional societies)

1.05. Lifestyle modification, wellness programs, and nutritional approaches to the prevention of diseases and disorders

1.06. Maternal and child health (e.g., hazardous exposures for women of childbearing age, supplement use [including folic acid], gestational diabetes, genetic screening and counseling)

1.07. Genetics and genetic risk factors

1.08. Social determinants of health

1.09. Use of immunizations (efficacy, administration considerations, potential interactions, risks, special considerations)

1.10. Current standards and guidelines regarding determining suitability for duty, return to work, school, play/leisure, travel or other essential life activities (e.g., FAA criteria, ACOEM practice guidelines, ODG, CDC infections disease guidelines, concussion protocols)

1.11. Complementary and alternative medicine

II. Public Health/Population Health and Medicine

2.01. Community/population transmissible disease concepts (e.g., immunization, herd immunity, disease transmission)

2.02. Population density and its effects (e.g., schools, refugee camps, prisons)

2.03. Considerations for screening method selection for specific communities, populations, or special groups

2.04. Behavioral economics and behavioral change models (e.g., incentivizing health policy, stages of changes, PRECEDE-PROCEED)

2.05. Social and economic factors impacting health (e.g., family and social support, community safety, income, employment)

2.06. Considerations regarding access to care and quality of care (e.g., affordability, quality metrics, value-based metrics, efficacy and cost considerations, social norms and beliefs associated with access to care)

2.07. Population-level interventions to improve health behaviors (e.g., tobacco use, diet and exercise, alcohol and drug use, safe sex practices)

2.08. Health system approach to chronic disease management and chronic disease model

2.09. High risk vs total population interventions

2.10. Health education and promotion theories and models

2.11. Health literacy

2.12. Health disparities and health equity

2.13. Community engagement strategies and advocacy

2.14. Population-level data sources (e.g., NHANES, NHIS, BRFSS, CMS, DOL, WHO, World Data, Robert Wood Johnson Foundation)

2.15. Considerations for surveillance method selection and plan development for specific communities, populations, or special groups

2.16. Ethical concepts and principles related to public health and population medicine

2.17. Legal concepts, principles, cases and legislation related to public health and population medicine

2.18. Communication management techniques

III. Epidemiology, Biostatistics and Informatics

3.01. Design and Methods

3.01.01. Data sources and structures

3.01.02. Study and research design

3.01.03. Biases and control measures

3.01.04. Methods for controlling for confounding variables

3.01.05. Methods to communicate research findings and disseminate information

3.02. Statistical Analysis and Interpretation

3.02.01. Measures of central tendency

3.02.02. Tests of significance

3.02.03. Probability

3.02.04. Hypothesis testing

3.02.05. Type I and type II errors

3.02.06. Confidence intervals

3.02.07. Power

3.02.08. Sample size

3.02.09. Correlation

3.02.10. Causation and association

3.02.11. Strength of evidence

3.02.12. Measurement of effect

3.02.13. Multivariate analysis

3.02.14. Multiple regression

3.02.15. Survival analysis

3.02.16. Meta-analysis

3.02.17. Outcome measures (e.g., number needed to treat, number needed to harm, effective dose, overall survival, quality-adjusted life years)

3.02.18. Tests of clinical significance

3.02.19. Tests of statistical significance

3.02.20. Decision analysis processes, methods, and tools (e.g., decision trees, modeling, ROC curves, Bayesian)

3.02.21. Principles related to systematic review

3.03. Vital Statistics and Demographics

3.03.01. Rates and measures (e.g., infant and maternal mortality rates, surrogate markers, incidence versus prevalence)

3.03.02. Trend analysis (e.g., cluster, typical versus atypical, endemics, epidemics, and pandemics)

3.04. Prevention and Control

3.04.01. Active and passive disease surveillance tools and methods

3.04.02. Screening tests (e.g., specificity v. sensitivity, positive v. negative predictive value)

3.04.03. Outbreak investigation and intervention

3.05. Informatics

3.05.01. Fundamental informatics concepts, models, and theories

3.05.02 Data mining methods and techniques

3.05.03. Information resources (e.g., databases and registries, OSHA, CDC Yellow Book, EPA)

3.05.04. Electronic health records, including order entry, use in decision support, user interfaces, patient portals, information sharing, health information exchanges

IV. Environmental Medicine

4.01. Physiology and physiological changes related to specific environments/activities (e.g., workplace, commercial air travel, recreational diving mountain climbing)

4.02. Environmental agents, including chemical, biological, radiological, nuclear, explosive, and other agents

4.03. Environmental factors related to community health (e.g., air and water quality, sanitation, heat and cold stress, food safety, household and workplace injuries, noise)

4.04. Environmental considerations regarding social determinants of health

4.05. Industrial hygiene principles, methods, tools, and techniques (e.g., exposure dose, noise, radiation, ergonomics, repetitive motion)

4.06. Surveillance methods (monitor, control, and prevent) for infectious diseases

4.07. Principles and activities related to quarantine procedures

4.08. Principles related to interaction of exposures and individuals(e.g., toxicokinetic, toxicodynamic)

4.09. Principles and regulations and guidelines related to levels of exposure (e.g., PEL, TLV, STEL, REL)

4.10. Health conditions related to environmental factors of natural and/or man-made disasters (e.g., climate change, war, migration, resettlement)

4.11. Disaster planning and management models and policies (e.g., National Incident Management System (NIMS), Stafford Act, Defense Support to Civil Authorities, National Guards)

4.12. Methods for hazard control (e.g., engineering, administrative, personal protective measures)

4.13. Methods to assess, manage, and communicate environmental risk

4.14. General scope and impact of major environmental regulations (e.g., Clean Air Act, Clean Water Act, Safe Drinking Water Act) on health and environmental medicine

V. Strategic Healthcare Leadership

5.01. Health care delivery systems and governance structures

5.02. Health care financing and reimbursement systems (e.g., Medicare, insurance, alternative payment methods)

5.03. Healthcare economics concepts

5.04. Leadership principles

5.05. Interprofessional collaboration principles

5.06. Safety considerations (patient and personal)

5.07. Frameworks for program evaluation (e.g., CDC, AHRQ)

5.08. Organizational effectiveness principles

5.09. Strategic planning and policy development

5.10. Contingency planning

5.11. Quality and process improvement methods, tools, and strategies

5.12. Applicable standards and regulations (e.g., Patient protection and affordable care act, Americans with Disabilities Act, HIPAA)

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Preventive Care

Goal: help people get recommended preventive health care services..

Getting preventive care reduces the risk for diseases, disabilities, and death — yet millions of people in the United States don’t get recommended preventive health care services. 1 Healthy People 2030 focuses on increasing preventive care for people of all ages.

Children need regular well-child and dental 2 , 3 visits to track their development and find health problems early, when they’re usually easier to treat. Services like screenings, dental check-ups, and vaccinations are key to keeping people of all ages healthy. But for a variety of reasons, many people don’t get the preventive care they need. Barriers include cost, not having a primary care provider, living too far from providers, and lack of awareness about recommended preventive services. 4 , 5

Teaching people about the importance of preventive care is key to making sure more people get recommended services. Law and policy changes can also help more people access these critical services.

Objective Status

Learn more about objective types

Related Objectives

The following is a sample of objectives related to this topic. Some objectives may include population data.

Preventive Care — General

• Adolescents
• Health Care Access and Quality

Health Policy

Heart disease and stroke, mental health and mental disorders, oral conditions, osteoporosis, pregnancy and childbirth, sensory or communication disorders, sexually transmitted infections, other topics you may be interested in.

Borksy, A., et al. (2018). Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services. Health Affairs, 37 (6). DOI: 10.1377/hlthaff.2017.1248

Centers for Disease Control and Prevention. (2019). Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Retrieved from https://www.cdc.gov/oralhealth/pdfs_and_other_files/Oral-Health-Surveillance-Report-2019-h.pdf  [PDF - 5.3 MB]

Lebrun-Harris, L.A., Canto, M.T., & Vodicka, P. (2019). Preventive Oral Health Care Use and Oral Health Status Among US Children. The Journal of the American Dental Association, 150 (4), 246-258. https://doi.org/10.1016/j.adaj.2018.11.023

Allen, E.M., Call, K.T., Beebe, T.J., McAlpine, D.D., & Johnson, P.J. (2018). Barriers to Care and Healthcare Utilization Among the Publicly Insured. Med Care, 55(3), 207-214. DOI: 10.1097/MLR.0000000000000644

Syed, S.T., Gerber, B.S., & Sharp, L.K. (2014). Traveling Towards Disease: Transportation Barriers to Health Care Access. Journal of Community Health, 38(5), 976-993. DOI: 10.1007/s10900-013-9681-1

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• Frontiers in Nutrition
• Nutrition and Metabolism
• Research Topics

Preventative Medicine: Nutritional and Lifestyle Interventions for Healthy Ageing and Chronic Diseases

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About this Research Topic

With an exponential growth in the ageing population globally, there is an urgent need to seek holistic ways to facilitate healthy ageing and manage chronic diseases to relieve the consequences of significant socio-economic and personal burdens. Efforts should therefore focus on prevention. However, this requires a multidisciplinary approach involving healthcare providers, communities, and individuals. Healthcare providers play a paramount role in educating individuals to adopt a healthy lifestyle, prescribe medications, or recommend supplements. Communities are also essential in providing that needed support network for individuals and patients. Despite the important role of these healthcare and community stakeholders, it is pivotal for individuals to develop a routine of self-care and self-management through the practice of healthy lifestyle choices and behaviours starting from their early years. These health interventions include but are not limited to adequate sleep, physical activity, healthy diets, and the intake of nutritional supplements. This Research Topic aims to report the efficacy and mechanisms of action of lifestyle and/or nutritional interventions that promote healthy ageing; or prevent the occurrence or progression of chronic disease in pre-clinical and clinical studies. Such literature will provide the evidence to inform healthcare providers, communities, individuals, and patients with chronic disease, and to drive health policies and practices that will promote healthy ageing and improve the quality of life for all. We welcome original research (clinical, in vitro, and in vivo studies), review articles, and meta-analyses on lifestyles, including diet, physical activity, sleep, chronic diseases, and healthy ageing. We welcome papers on topics including, but not limited to: • Mechanism of action of novel bioactive agents, nutritional supplements or naturally occurring compounds present in the diet. • Relationship between dietary patterns, food groups, foods or specific nutrients, chronic diseases, and healthy ageing. • Combined effects of diet and sports/physical activity for the prevention of these diseases. • Intersections between nutrition and sleep quality, sleep duration, chronotype, and sleep patterns. The research presented should describe the mechanisms of actions and/or clinical biomarkers involved in the efficacy of the various interventions used to foster healthy ageing and/or manage chronic diseases. The clinical significance of the data must also be addressed. Submissions that do not fulfil these requirements will not be considered for review and publication.

Keywords : Chronic Diseases, Cancer, Healthy Ageing, Bioactive Compounds, Diet, Exercise, Healthy Eating, Lifestyle Medicine, Metabolism, Nutritional Supplements, Physical Activity, Preventative Medicine, Sleep

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Barry MJ, Nicholson WK, Silverstein M. 13th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services [Internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2023 Nov.

13th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services [Internet].

The uspstf in 2024.

In the coming 12 months, it is expected that the USPSTF will continue to:

• Develop and Release New Recommendation Statements
• Work on more than 29 topics that are in progress
• Work on 5 topics nominated for consideration through the public topic nomination process
• Post 8 draft research plans and 12 draft recommendation statements and evidence reports for public comment
• Publish 9 final recommendation statements
• Coordinate With Partners to Develop and Disseminate Recommendations
• Coordinate with the USPSTF Dissemination and Implementation Partners and Federal Liaisons to solicit input and disseminate the recommendations to primary care clinicians and other stakeholders to achieve the benefits of screening tests, behavioral counseling, and preventive medications to improve health outcomes and reduce disparities.
• Address Research Gaps
• Continue close collaboration with AHRQ and NIH’s Office of Disease Prevention to revise best practices for articulating evidence gaps and future research needs.
• Prepare the 14th Annual Report to Congress on high-priority evidence gaps (see Appendix E for a list of prior reports).

The USPSTF appreciates the opportunity to report on its activities, to highlight critical evidence gaps, and to recommend important new areas for research in clinical preventive services. The members of the Task Force look forward to their ongoing work to improve the health of people nationwide.

• Cite this Page Barry MJ, Nicholson WK, Silverstein M. 13th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services [Internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2023 Nov. THE USPSTF IN 2024.
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• Last Updated: Jan 4, 2024 10:49 AM
• URL: https://uscmed.sc.libguides.com/preventivemed

MARK H. EBELL, MD, MS, AND ROLAND GRAD, MD, MSc

June 8, 2020 Editor's Note: The hypertension study (reference 5) is under investigation by the editor of the journal in which it was published due to inconsistencies in the data noted by others. Caution is warranted regarding applying these findings to clinical care.

Am Fam Physician. 2020;101(10):608-617

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus. See Editor's Note . Dr. Grad has no relevant financial affiliations.

In 2019, regular surveillance of 110 English-language research journals identified 254 studies that met the criteria to become POEMs (patient-oriented evidence that matters). Physician members of the Canadian Medical Association rated these POEMs for their relevance to patients in their practices. This article summarizes the clinical questions and bottom-line answers from the top 20 POEMs of 2019. Taking blood pressure medications at night results in a large mortality reduction over six years compared with morning dosing. Automated devices are the best way to measure blood pressure. Nonfasting lipid profiles are preferred over fasting lipid profiles, and nonfasting and fasting lipid profiles are equally effective at predicting risk. The benefit of statins for primary prevention in people 75 years and older is uncertain at best. Aspirin has no net benefit for primary prevention of cardiovascular disease and has no effect on cancer outcomes. An Italian study found fecal immunochemical testing over five biennial screening cycles has a similar colorectal cancer yield as screening colonoscopy, whereas a meta-analysis found that taking aspirin, an anticoagulant, or a nonsteroidal anti-inflammatory drug has no impact on the positive predictive value of fecal immunochemical testing. Regarding infections, a meta-analysis showed that patients presenting with symptoms of acute respiratory tract infection are unlikely to have pneumonia if vital signs and the lung examination findings are normal. For streptococcal pharyngitis (strep throat), penicillin V at a dosage of 800 mg four times a day for five days is at least as effective as a dosage of 1,000 mg three times a day for 10 days. A primary care study in the United Kingdom reinforced that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient, because these infections can take three weeks or more to fully resolve. Among direct oral anticoagulants, apixaban has the lowest bleeding risk, and cotreating with a proton pump inhibitor significantly reduces bleeding risk. Single ibuprofen doses from 400 to 800 mg significantly reduce acute pain to a similar degree. The two-dose recombinant zoster vaccine is much more effective than the single-dose live, attenuated vaccine but with a greater risk of injection site pain. Exercise helps reduce the risk of falls in older adults. Practice guidelines from 2019 on antithrombotics for atrial fibrillation, the management of type 2 diabetes mellitus, and screening for breast cancer were judged to be especially relevant.

Every year for the past 21 years, a team of experts in evidence-based medicine have systematically reviewed more than 110 English-language research journals to identify the original research most likely to change and improve primary care practice. The team includes experts in family medicine, pharmacology, hospital medicine, and women's health. 1 , 2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if applied in practice, the results would change what some family physicians do in patient care by prompting them to adopt a beneficial new practice or discontinue one that is ineffective or harmful. This should improve patient outcomes. Of more than 20,000 research studies published in 2019 in the journals reviewed by the POEMs team, 254 met criteria for validity, relevance, and practice change.

The Canadian Medical Association (CMA) purchases a subscription to POEMs for its members, many of whom receive the daily POEM by email. When members read a POEM, they can rate it with a validated questionnaire called the Information Assessment Method. POEM ratings address the domains of clinical relevance, cognitive impact, use in practice, and expected health benefits if that POEM were to be applied in patient care. 3 , 4 In 2019, each of the 254 POEMs were rated by an average of 1,530 physicians.

In this article, we present the 20 POEMs rated highest for clinical relevance by CMA members in 2019. This installment of our annual series ( https://www.aafp.org/afp/toppoems ) summarizes the clinical question and bottom-line answer for each research study identified as a top 20 POEM, organized by topic and followed by a brief discussion. We also present the three most relevant practice guidelines identified by CMA members. The full text of the POEMs in this article are available at https://www.aafp.org/journals/afp/content/top-poems/2019.html .

Hypertension

Hypertension is among the most common conditions managed by primary care physicians and is the topic of the two POEMs rated most relevant to readers in 2019 ( Table 1 ) . 5 , 6 Researchers randomized 19,168 adults with hypertension to take their antihypertensive medications at bedtime or first thing in the morning. 5 Patients were prescribed an antihypertensive from an approved list of the most common therapies. Patients taking their medications at bedtime had a lower likelihood of the composite outcome of myocardial infarction (MI), coronary revascularization, heart failure, stroke, or cardiovascular death (hazard ratio = 0.55; 95% CI, 0.50 to 0.61; number needed to treat to prevent one event over 6.3 years = 20). All-cause mortality was reduced to a similar extent. This is a large effect for a six-year study, and a practice-changer for many patients and physicians. Best of all, it costs nothing to make this change. See Editor's Note

How we measure blood pressure continues to be a subject of research. The next POEM was a meta-analysis of 31 studies, which included a total of 9,279 patients and compared automated in-office blood pressure readings with in-office manual measurements or ambulatory automated recordings during waking hours (the reference standard). 6 Automated in-office measurements were performed without anyone present to activate the machine and used three to five readings separated by one- to two-minutes. Ambulatory automated measurements were 13.4/5.9 mm Hg lower than the manual in-office measurements and were similar to the in-office automated measurements. To avoid starting or intensifying antihypertensive medication unnecessarily, it is critical to measure blood pressure using an automated device. Patients should also bring in their home device so that it can be calibrated with the office device.

Behavioral Medicine

Behavioral medicine POEMs are summarized in Table 2 . 7 – 9 The first POEM in this group was a well-executed network meta-analysis of medical therapy for generalized anxiety disorder. 7 A network meta-analysis includes studies comparing drugs with each other and with placebo, allowing for direct and indirect comparisons. The meta-analysis included 89 studies involving 25,000 patients and 22 different drugs; none of the studies were longer than 26 weeks. After excluding drugs that were poorly tolerated such as quetiapine (Seroquel), paroxetine (Paxil), and benzodiazepines, the most effective commercially available drugs overall were, in order of effectiveness, bupropion (Wellbutrin), duloxetine (Cymbalta), mirtazapine (Remeron), hydroxyzine, sertraline (Zoloft), pregabalin (Lyrica), venlafaxine, escitalopram (Lexapro), fluoxetine (Prozac), buspirone (Buspar), and citalopram (Celexa). Drugs that did not significantly decrease anxiety scores included imipramine, maprotiline, opipramol (not available in the United States), tiagabine (Gabitril), vilazodone (Viibryd), and vortioxetine (Trintellix). The drugs with the best combination of effectiveness and tolerability were duloxetine, pregabalin, venlafaxine, and escitalopram.

The next POEM included videotaped encounters between 252 patients and 15 English primary care physicians. 8 Patients were asked about the main reason for their visit beforehand, and this reason was almost always addressed during the visit. However, of the 139 patients who identified at least one symptom in the previsit interview, 43 failed to disclose a total of 67 symptoms during the visit, most often stress, worries or sadness; tiredness or sleep problems; problems passing urine; headache; and intimate or other personal problems. Although physicians cannot ask every patient about all of their problems during a visit, it is important to know that patients may not fully disclose symptoms. Physicians should make patients feel as safe as possible while looking for cues to undisclosed symptoms, and routinely asking, “Is there anything else I can help you with?”

The last POEM in the behavioral medicine group was an individual patient data meta-analysis of how early treatment response impacts later outcomes in patients with depression. 9 The researchers combined the individual patient data from 30 randomized trials, with 2,184 patients receiving placebo and 6,058 receiving active therapy. After six weeks of treatment, about 50% of patients in the active treatment group responded to treatment, with 32% achieving remission of symptoms. Response was defined as at least a 50% reduction in the Hamilton Rating Scale for Depression score, and remission was defined as a score of 7 points or less. By 12 weeks, the response rate was 68% in the active treatment group, with 49% achieving remission. Patients with improvement at two weeks were more likely to respond by six weeks, whereas among patients without early improvement, 33% responded by six weeks and 43% by 12 weeks. The absence of an early response does not preclude later response; therefore, physicians should not be too quick to change antidepressant medications.

Cardiovascular

Cardiovascular medicine POEMs are summarized in Table 3 . 10 – 14 The first two POEMs in this group address statin use. Many physicians and laboratory staff continue to insist that patients be fasting for lipid profile testing. The first POEM compared fasting and nonfasting lipid profiles in the same patients four weeks apart. 10 There was little difference between fasting and nonfasting measurements of low-density and high-density lipoprotein cholesterol levels and only a small increase in triglyceride levels (25 mg per dL [0.28 mmol per L]) with nonfasting measurements. Most importantly, the association between lipid levels and subsequent cardiovascular events was identical for fasting and nonfasting lipid measurements. Guidelines support nonfasting lipid measurements. 15 , 16 It is time to simplify our patients' lives and educate local laboratory staff, who often turn away patients who disclose that they are not fasting.

In the next POEM, data were pooled from 28 randomized trials of statins with more than 186,000 total patients. 11 This report focused on the 14,000 patients who were 75 years or older; the median follow-up was five years. There was only a small reduction in the composite outcome of MI and cardiovascular death among all patients (2.6% with statins vs. 3.0% with placebo; number needed to treat = 250 per year); the benefit was significant only in patients with preexisting cardiovascular disease. Statins had no effect on revascularization, stroke, cancer incidence, or cancer mortality.

This was a big year for aspirin studies. The next three POEMs, from two separate trials, examine the benefits and harms of aspirin therapy for primary prevention in contemporary populations. Prior studies that found a net benefit of aspirin for the primary prevention of cardiovascular disease and cancer (mostly colorectal) all recruited patients before 2002. In more recent years, fewer patients smoke or have uncontrolled hypertension, more are taking a statin, and we have widespread colorectal cancer screening. In this context, does aspirin still have a role?

Two aspirin POEMs were from the ASPREE (Aspirin in Reducing Events in the Elderly) trial, which included 19,114 adults 70 years and older in the United States and Australia (65 and older if black or Hispanic). Patients without known cardiovascular disease were randomized to aspirin, 100 mg, or placebo and were followed for a median of 4.7 years. The first POEM found no significant reduction in the likelihood of cardiovascular disease with aspirin, including fatal cardiovascular disease, fatal or nonfatal MI, and fatal or nonfatal ischemic stroke. However, they found a significant increase in major hemorrhages with aspirin. 12 The second POEM from the ASPREE trial found no difference between groups for disability-free survival, defined as a composite of death, dementia, or persistent physical disability. 13 A separate report from the ASPREE investigators (not one of the top 20 POEMs) found an increase in all-cause mortality with aspirin, primarily due to a significant increase in cancer-specific mortality (3.1% vs. 2.3%).

The third aspirin POEM was from the ASCEND (A Study of Cardiovascular Events in Diabetes) trial and included 15,480 adults 40 years and older with diabetes mellitus but no known cardiovascular disease. The patients were randomized to aspirin, 100 mg, or placebo and were followed for a median of 7.4 years. 14 There was a reduction in the composite of nonfatal MI, nonfatal stroke, or cardiovascular death with aspirin, but a corresponding increase in major hemorrhage with no effect on cardiovascular or all-cause mortality.

What do we tell our patients? A recent meta-analysis compared trials of aspirin therapy that recruited patients from 1978 to 2002 with four large trials that recruited patients since 2005. 17 The newer studies showed fewer cardiovascular benefits and no reduction in cancer incidence or mortality with aspirin as primary prevention. Based on a meta-analysis of the four most recent studies with a total of 61,604 patients, for every 1,200 patients taking aspirin instead of placebo for five years, there would be four fewer major cardiovascular events and three fewer ischemic strokes but eight more major hemorrhages, including three more intracranial hemorrhages. This study agrees with recent European guidelines that no longer recommend aspirin for primary prevention. 18 The 2016 U.S. Preventive Services Task Force (USPSTF) and 2019 American College of Cardiology guidelines recommend consideration of aspirin for primary prevention only in selected patients at high cardiovascular risk and low bleeding risk. 19 , 20 The USPSTF recommendation is currently being updated. 21

Cancer Screening

The three POEMs on cancer screening ( Table 4 ) address colorectal cancer. 22 – 24 Fecal immunochemical testing (FIT) is the recommended method for colorectal cancer screening in most countries that have screening programs and is the subject of the first two POEMs in this group. The first POEM is an Italian study that reported the diagnostic yield of five rounds of biennial FIT in persons 50 to 69 years of age submitting a single specimen. 22 The highest rates of detection occurred in the first round, as prevalent cancers were detected, and declined and then stabilized in later rounds. Over the 10-year study, about 25% of men and 18% of women had a positive test result requiring a follow-up colonoscopy. The cumulative rate was 6% for advanced adenoma and 0.85% for colorectal cancer, which are similar to findings in studies of colonoscopy in Italy and the United States. 25 , 26 These results mean we can have confidence in FIT as a screening test while we wait for the results of ongoing randomized trials of FIT vs. colonoscopy-based screening.

The second POEM about FIT was a meta-analysis evaluating the impact of aspirin, nonsteroidal anti-inflammatory drugs, and anticoagulants on the positive predictive value of the test. 23 It could theoretically go in either direction, increasing false positives by making noncancerous lesions more likely to bleed or increasing true positives by making cancers and adenomas more likely to bleed. The researchers found that the use of any of these medications had almost no effect on the positive predictive value, which was approximately 6% for colorectal cancer and 40% for advanced neoplasia. FIT requires only a single specimen and no dietary preparation, and now we know that patients undergoing FIT can continue to take medications that increase bleeding risk.

Finally, a study used a Swedish cancer registry with 173,796 patients to determine the impact of family history on the risk of colorectal cancer. 24 The relative risk of colorectal cancer using no affected relatives as the reference was 1.2 for a single second-degree relative with a history of colorectal cancer, 1.6 for a single first-degree relative or two second-degree relatives, 2.3 for one first-degree relative and one second-degree relative, 2.5 for two first-degree relatives, and 5.4 for one first-degree and two second-degree relatives. However, a previous study found that this family history–related risk is attenuated once patients reach 55 years of age. 27

POEMs on managing infections are summarized in Table 5 . 28 – 30 The first POEM is a meta-analysis of studies that recruited outpatients with acute respiratory tract infections who received chest radiography. 28 The goal was to identify the best sign, symptom, or combination that allows clinicians to rule out community-acquired pneumonia (CAP). The researchers found that for patients with the combination of normal vital signs and normal lung examination findings, the likelihood of CAP is low at 0.4%. This could help reduce unnecessary chest radiography if applied consistently.

The second POEM in this group was selected as one of the top three research studies out of more than 400 presented at the 2019 North American Primary Care Research Group meeting. 29 This Swedish study included 422 adults and children presenting to a primary care physician with moderately severe streptococcal pharyngitis (strep throat). Patients were randomized to penicillin V at a dosage of 800 mg four times a day for five days or 1,000 mg three times a day for 10 days. Those receiving the higher dose over a shorter course of treatment had similar cure rates as those receiving longer-duration therapy, with quicker symptom resolution and no increase in recurrence. Many other studies have found similar results with antibiotics for a range of infections.

An accurate prognosis can potentially help patients avoid unnecessary antibiotic use and return visits. The third POEM in this group recruited 485 healthy children in the United Kingdom, and parents were instructed to contact the researchers every time the child had a respiratory tract infection. 30 One-half of the children had at least one infection, with a median duration of nine days; 90% recovered by day 23. Lower respiratory tract infections were associated with a longer duration of symptoms and ear infections were associated with a shorter duration. This reinforces that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient.

Miscellaneous

Four additional POEMs are summarized in Table 6 . 31 – 34 The first is a cohort study of more than 1.6 million Medicare beneficiaries who started an anticoagulant between 2011 and 2015. 31 Bleeding rates were compared, adjusting for available covariates using propensity score matching (i.e., matching patients who were similar other than choice of anticoagulant). The adjusted incidence of hospitalization for upper gastrointestinal tract bleeding was significantly higher in those who received rivaroxaban (Xarelto) compared with those who received dabigatran (Pradaxa), warfarin (Coumadin), or apixaban (Eliquis); 144 per 10,000 person-years vs. 120, 113, and 73, respectively). For all agents combined, adding a proton pump inhibitor significantly reduced bleeding risk (76 out of 10,000 per year vs. 115 out of 10,000 per year; number needed to treat = 256), although rivaroxaban still had the highest bleeding rate.

The next POEM identified 225 adults presenting to the emergency department with acute pain (mostly musculoskeletal); the average pain score was 6 to 7 out of 10. 32 They were then randomized to a single dose of 400-mg, 600-mg, or 800-mg ibuprofen. An hour after taking the medication, there was no difference between groups, which all had pain scores between 4.4 and 4.5.

The third POEM in this group is a meta-analysis of studies comparing two doses of the recombinant zoster vaccine (Shingrix) with one dose of the live, attenuated vaccine (Zostavax) for the prevention of shingles. 33 Shingrix was more effective but caused more systemic adverse events, although mild, and more injection site pain.

Finally, a systematic review identified 46 studies of the impact of exercise on fall risk in patients 59 years or older. 34 Most of the programs used moderate-intensity exercise, with about one hour of exercise three times per week. The researchers found that exercise significantly decreased the overall risk of falls and resulting injuries but did not affect the risk of multiple falls, hospitalization, or mortality. Fractures were less likely in the exercise group but not significantly.

Practice Guidelines

POEMs sometimes summarize high-impact practice guidelines from important organizations. Key messages from the three highest-rated guidelines are summarized in Table 7 . 35 – 37

The American College of Chest Physicians recommends initiating direct oral anticoagulant therapy in patients with newly diagnosed atrial fibrillation, avoiding aspirin or aspirin plus clopidogrel (Plavix) to prevent thromboembolism, using risk scores for stroke and bleeding, and avoiding cotreatment with aspirin and an anticoagulant if possible. 35

The American Diabetes Association/European Association for the Study of Diabetes guideline for type 2 diabetes mellitus continues to recommend educating patients about diabetes self-management and providing support as the cornerstone of therapy, and metformin as the preferred initial therapy. 36 If a second agent is needed, there are many options, although glucagon-like peptide 1 receptor antagonists or sodium-glucose cotransporter 2 inhibitors are recommended for patients with established heart disease; sodium-glucose cotransporter 2 inhibitors are preferred for patients with heart failure or chronic kidney disease.

The American College of Physicians recommendations for breast cancer screening generally parallel those of the USPSTF, which are supported by the American Academy of Family Physicians. Recommendations include shared decision-making in women 40 to 49 years of age, biennial mammography from 50 to 74 years of age or until the woman's life expectancy is less than 10 years, and eliminating the clinical breast examination as a screening test for women who undergo regular mammography. 37 – 39

The full text of the POEMs discussed in this article is available at https://www.aafp.org/journals/afp/content/top-poems/2019.html .

A list of top POEMs from previous years is available at https://www.aafp.org/afp/toppoems .

Editor's Note: This article was cowritten by Dr. Mark Ebell, who is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Because of Dr. Ebell's dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP 's medical editors. In addition, the article underwent peer review and editing by three of AFP 's medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Sumi Sexton, MD, Editor-in-Chief.

The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for their work in selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia for their work as peer reviewers; Pierre Pluye, PhD, for his work in codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs for the past 26 years.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499.

Ebell MH, Barry HC, Slawson DC, et al. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355.

Grad RM, Pluye P, Mercer J, et al. Impact of research-based synopses delivered as daily e-mail: a prospective observational study. J Am Med Inform Assoc. 2008;15(2):240-245.

Pluye P, Grad RM, Johnson-Lafleur J, et al. Evaluation of email alerts in practice: Part 2. Validation of the information assessment method. J Eval Clin Pract. 2010;16(6):1236-1243.

• Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial [published online October 22, 2019]. Eur Heart J . 2019. Accessed March 10, 2020. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

Roerecke M, Kaczorowski J, Myers MG. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension. A systematic review and meta-analysis. JAMA Intern Med. 2019;179(3):351-362.

Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder [published correction appears in Lancet . 2019;393(10182):1698]. Lancet. 2019;393(10173):768-777.

Paskins Z, Sanders T, Croft PR, et al. Non-disclosure of symptoms in primary care: an observational study. Fam Pract. 2018;35(6):706-711.

de Vries YA, Roest AM, Bos EH, et al. Predicting antidepressant response by monitoring early improvement of individual symptoms of depression: individual patient data meta-analysis. Br J Psychiatry. 2019;214(1):4-10.

Mora S, Chang CL, Moorthy MV, et al. Association of nonfasting vs fasting lipid levels with risk of major coronary events in the Anglo-Scandinavian Cardiac Outcomes Trial–lipid lowering arm. JAMA Intern Med. 2019;179(7):898-905.

Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393(10170):407-415.

McNeil JJ, Wolfe R, Woods RL, et al.; ASPREE Investigator Group. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-1518.

McNeil JJ, Woods RL, Nelson MR, et al.; ASPREE Investigator Group. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379(16):1499-1508.

Bowman L, Mafham M, Wallendszus K, et al.; ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529-1539.

Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016;37(25):1944-1958.

Grundy SM, Stone NJ. 2018 cholesterol clinical practice guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline. Ann Intern Med. 2019;170(11):779-783.

Moriarty F, Ebell MH. A comparison of contemporary versus older studies of aspirin for primary prevention [published online November 21, 2019]. Fam Pract . 2019. Accessed March 10, 2020. https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmz080/5637484

Piepoli MF, Hoes AW, Agewall S, et al.; The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315-2381.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol . 2019;74(10):1429–1430]. J Am Coll Cardiol. 2019;74(10):e177-e232.

Bibbins-Domingo K. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(12):836-845.

U.S. Preventive Services Task Force. Aspirin use to prevent cardiovascular disease and colorectal cancer: preventive medication. April 2016. Accessed February 14, 2010. https://bit.ly/343LnT6

Zorzi M, Hassan C, Capodaglio G, et al. Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test. Gut. 2018;67(12):2124-2130.

Nieuwenburg SAV, Vuik FER, Kruip MJHA, et al. Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis. Gut. 2019;68(5):866-872.

Tian Y, Kharazmi E, Sundquist K, et al. Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study. BMJ. 2019;364:l803.

Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287-1297.

Segnan N, Senore C, Andreoni B, et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology. 2007;132(7):2304-2312.

Schoen RE, Razzak A, Yu KJ, et al. Incidence and mortality of colorectal cancer in individuals with a family history of colorectal cancer. Gastroenterology. 2015;149(6):1438-1445.e1.

Marchello CS, Ebell MH, Dale AP, et al. Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: a systematic review and meta-analysis. J Am Board Fam Med. 2019;32(2):234-247.

Skoog Ståhlgren G, Tyrstrup M, Edlund C, et al. Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. BMJ. 2019;367:l5337.

Hay AD, Anderson E, Ingle S, et al. Respiratory tract infections in children in the community: prospective online inception cohort study. Ann Fam Med. 2019;17(1):14-22.

Ray WA, Chung CP, Murray KT, et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA. 2018;320(21):2221-2230.

Motov S, Masoudi A, Drapkin J, et al. Comparison of oral ibuprofen at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2019;74(4):530-537.

Tricco AC, Zarin W, Cardoso R, et al. Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis. BMJ. 2018;363:k4029.

de Souto Barreto P, Rolland Y, Vellas B, et al. Association of long-term exercise training with risk of falls, fractures, hospitalizations, and mortality in older adults. A systematic review and meta-analysis. JAMA Intern Med. 2019;179(3):394-405.

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Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701.

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Genetics play a big role in your risk of developing heart disease, but so does your lifestyle. Johns Hopkins cardiologists are leaders in preventive cardiology research. With preventive cardiology, the goal is to reduce risk factors and prevent any signs of disease from getting worse.

Preventive cardiology researchers at the Ciccarone Center for Prevention of Cardiovascular Disease work to better prevent heart disease and stroke through research, education and the highest level of clinical care for people at risk for developing cardiovascular and peripheral vascular disease. They study topics such as hypertension (high blood pressure), cholesterol/lipids, diabetes, cigarette smoking, e-cigarettes, physical activity/exercise, diet, overweight and obesity, genetics, inflammation, aging, frailty, racial/ethnic disparities, gender differences, novel biomarkers, subclinical disease imaging, risk prediction, stress/depression, vitamin D and mobile health. The center publishes a robust database of original basic and clinical research findings by Johns Hopkins cardiologists.

A study through the GeneSTAR Research Center looks at heart disease and related risk factors in families where heart disease is prevalent. They research novel risk interventions, cerebrovascular disease risk and attendant metabolic and thrombosis phenotypic risk factors. The study has had a long-term interest in African-American families and disparities in the cardiovascular disease substrate.

Once a patient has been treated for heart disease, speeding recovery and preventing further disease is vital. The Johns Hopkins Corrie mobile health solution promotes skill-building for preventive measures such as diet, exercise and medication habits. The app connects patients with resources to help recovery, and uses mindfulness techniques to improve patient awareness and emotional strength. Patients track data analytics and biofeedback on steps, heart rate and blood pressure with smart tools including an Apple Watch and Bluetooth blood pressure monitor. Using emerging technology in this way, researchers are exploring new options for preventive care.

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Researchers

Michael joseph blaha md mph.

• Director of Clinical Research, Ciccarone Center for the Prevention of Cardiovascular Disease
• Professor of Medicine

Primary Location: Johns Hopkins Health Care & Surgery Center - Green Spring Station, Lutherville, Lutherville, MD

Roger S. Blumenthal MD

• Kenneth Jay Pollin Professor of Cardiology

Gary Gerstenblith MD

• Director of clinical trials, Division of Cardiology

Primary Location: The Johns Hopkins Hospital, Baltimore, MD

Steven Jones MD

• Director, Inpatient Cardiology
• Associate Professor of Medicine

Primary Location: Johns Hopkins Outpatient Center, Baltimore, MD

Thorsten Martin Leucker MD PhD

• Director, Cardiology Fellowship Program

Seth Martin MD

• Director of the Advanced Lipid Disorders Program and Digital Health Lab, Ciccarone Center for the Prevention of Cardiovascular Disease

Erin Donnelly Michos MD

• Director of Women's Cardiovascular Health Research

Chiadi Ndumele MD PhD MHS

Wendy S. Post MD MS

• Lou and Nancy Grasmick Professor of Cardiology

Elizabeth Ratchford MD

• Director, Johns Hopkins Center for Vascular Medicine

Seamus Paul Whelton MD MPH

• Director of the Advanced Subclinical Atherosclerosis Clinic
• Assistant Professor of Medicine

What is Preventive Medicine?

About preventive medicine, preventive medicine .

As a medical specialty recognized by the American Board of Medical Specialties (ABMS), preventive medicine focuses on the health of individuals and communities. The American College of Preventive Medicine (ACPM) believes in supporting initiatives that advance preventive care in our society through education, advocacy, resources, and more.

Preventive medicine is the practice of promoting preventive health care to improve patient well-being. The goal is to ultimately prevent disease, disability, and death. Preventive medicine specialists are licensed preventive medicine physicians that consist of:

Medical doctors (MD)

Doctors of osteopathy (DO)

These professionals evaluate and administer preventive treatment that is derived from possessing expertise in a broad range of health care skills, including:

Biostatistics

Epidemiology

Planning and evaluation of health services

Management of health care organizations

Preventive medicine practice in clinical settings

They apply their expertise in medicine, social, economic, and behavioral sciences to improve the health and quality of life for individuals, families, communities and populations through disease prevention and health promotion. Discover ACPM’s mission, vision, and unique history as a supporter of preventive medicine.

Preventive Medicine Specialties

Preventive medicine has three specialty areas, described in detail, below: 

Public Health and General Preventive Medicine

Public health and general preventive medicine focus on promoting health and preventing disease in individuals and communities. Practitioners in this specialty combine skills and experience in clinical care and public health to support the transformation of health systems and rebuild them, based on the prevention of disease, injury, and death. Practitioners work in a variety of sectors including for:

Corporations

Primary care

Public health departments

Government agencies

Other settings

In each, preventive medicine physicians impact healthcare delivery and health outcomes at the individual, practice, community, and population levels.

Occupational Medicine

Occupational medicine focuses on the physical and mental health of workers by seeking to improve the physical, structural, and social conditions of the workplace. Practitioners work with small business and large corporations to:

Design employee health plans

Improve workplace safety in hazardous environments

Promote health and quality of life in the workforce

Aerospace Medicine

Aerospace medicine focuses on the health, safety and performance of crew members and passengers of air and space vehicles, working closely with support personnel who assist in their operation. Practitioners often live and work in:

Remote locations

Extreme environments

Difficult conditions of physical and psychological stress

These professionals who promote preventive care medicine in even the harshest environments strive to improve health and do so in settings with many unique hazards not found in other work environments.  

Promoting the importance of preventive medicine and supporting preventive medicine physicians around the world is no easy task. However, when we work together, we can move the bar with no limit to what we can accomplish. Join with ACPM today to improve preventive medicine across the medical industry and consider donating to our cause! If you would like more information about our role in supporting preventive care or to get in touch about a membership, contact us at [email protected] or call (202) 466-2044.

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• GUIDELINE WATCH | 
• General Medicine
• Oncology and Hematology
• Ambulatory Medicine
• May 9, 2024

USPSTF Releases New Breast Cancer Screening Guidelines

Molly S. Brett, MD , reviewing US Preventive Services Task Force. JAMA 2024 Apr 30 Henderson JT et al. JAMA 2024 Apr 30 Trentham-Dietz A et al. JAMA 2024 Apr 30

The Task Force now recommends biennial screening for average-risk women who are 40 to 74.

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Screening mammography lowers breast cancer–related mortality, but incidence of invasive breast cancer is increasing among women in their 40s. Compared with white women, Black women are more likely to develop aggressive cancers at younger ages and are at higher risk for breast cancer–related mortality. In 2016, the USPSTF recommended biennial mammograms for middle-aged women (age range, 50–74; grade B) with individualized decision making for those who were 40 to 49 (grade C; NEJM JW Gen Med Feb 1 2016 and Ann Intern Med 2016; 164:279). Now, the Task Force has updated this guideline.

Key Recommendations

These recommendations apply to all people assigned female at birth and at average risk for breast cancer.

The USPSTF recommends biennial screening mammograms for women who are 40 to 74 (grade B) and concludes with moderate certainty that such screening has net benefit in preventing breast cancer–related mortality.

In women who are 75 or older, evidence is insufficient to recommend for or against screening.

For women with dense breasts, the Task Force found inadequate evidence to make a recommendation on benefits and harms of supplemental screening with ultrasound or magnetic resonance imaging after negative mammography.

For women in their 40s, the USPSTF previously recommended shared decision making about screening but stopped short of formally recommending it; now, they recommend screening all women in this age group. A decision analysis estimates this change will avert 1.3 additional breast cancer–related deaths per 1000 women screened biennially during a lifetime of screening — at the expense of an approximately 60% increase in false-positive results.

Expert groups disagree about optimal ages, intervals, and modalities for breast cancer screening. For example, the American Cancer Society strongly recommends screening starting at age 45 (initially annually) and makes a “qualified” (weaker) recommendation to start at age 40. Guidelines differ for several reasons. Few rigorous studies have been designed to compare screening strategies, so most of the Task Force recommendations are based on modeling studies rather than direct evidence. Equally importantly, medical organizations (and individuals) differ in how they weigh harms and benefits of different approaches. For example, computer models suggest that screening biennially instead of annually could lead to a 50% decrease in false positives but a slight increase in breast cancer–related mortality. This tradeoff will seem reasonable to some but unacceptable to others. In several ongoing trials, researchers are comparing standard one-size-fits-all screening schedules and individualized risk-based schedules; those results might help address some areas of uncertainty.

Dr. Brett is an Assistant Professor of Medicine at the University of Colorado.

US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA 2024 Apr 30; [e-pub]. ( https://doi.org/10.1001/jama.2024.5534 )

Henderson JT et al. Screening for breast cancer: Evidence report and systematic review for the US Preventive Services Task Force. JAMA 2024 Apr 30; [e-pub]. ( https://doi.org/10.1001/jama.2023.25844 )

Trentham-Dietz A et al. Collaborative modeling to compare different breast cancer screening strategies: A decision analysis for the US Preventive Services Task Force. JAMA 2024 Apr 30; [e-pub]. ( https://doi.org/10.1001/jama.2023.24766 )

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Topics Aging/Geriatrics Breast Cancer

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• Medical & Health Sciences
• Preventive and Social Medicine

Preventive and Social Medicine Research Papers/Topics

Prevalence and risk factors of camel theileriosis in northern state, sudan.

Abstract A cross sectional study was conducted for determination of camel theileriosis and investigation of associated potential risk factors in Northern State, Sudan. A total of 202 blood samples from camel were collected and examined using Direct smear and Geimsa stain method. The result indicated that camel theileriosis infection was prevalent among camel at Northern State with an overall prevalence of 3%. The following risk factors showed association with camel theileriosis in the univar...

Sero- Prevalence and Risk Factors Associated with Toxoplasma gondii in Cattle in Sharg Elnil and Omdurman Localities, Khartoum State, Sudan

Abstract Toxoplasmosis is an important zoonosis caused by an obligate intracellular parasitic protozoan, Toxoplasma gondii. The disease is distributed worldwide and can affect all warm-blooded vertebrates, including humans. To determine the prevalence and associated risk factors of Toxoplasma gondii infection in cattle, a cross-sectional study was conducted between June and September 2019 from Sharqelnile and Omdurman localities in Khartoum state, Sudan. Serum samples were collected from cat...

Assessment of Knowledge Attitudes and Practices among the Workers of Atbara and Aldamer Slaughter House in River Nile State - Sudan

Abstract The Dim of This research to study The ineae processing houses and how they follow the approved premises which registered by the controlling authority for hygiene management of meat products for human being consumption . The hare chosen 150of the slaughters workers Atbara and Aldamer Localities River Nile State to evaluate The levee of knowledge, attitude and practice of hygiene in slaughter houses workers . The methodology of semi - structured questionnaire is taker to assess the ...

Prevalence and Risk Factors of Sheep Haemonchosis in Khartoum State, Sudan

Abstract A cross sectional study was conducted from March to May 2015 for determination of ovine haemonchosis and investigation of associated potential Risk Factors in Khartoum State, Sudan. A total of 170 fecal samples from Sheep were collected and examined using Direct smear and Centrifugal flotation test and then culture of faeces. The result indicated that natural Haemonchus contortus infection was prevalent among sudanese sheep at Khartoum State with an overall prevalence 6.5%. The foll...

Epidemiological study of Babesiosis in Sheep in Gibash Locality, West Kordufan State

Abstract A cross sectional study was conducted from January to May 2018 to investigate the prevalence Babesia infection in sheep and to assess the relationship between the occurrence of these parasites and factors of age, sex, district, body condition, rising system, ,presence of ticks uses of treatment, uses of acaricides in Gibash locality, west Kordufan state- Sudan. A total of 255 bloods amples were collected from five districts namely: Aumzagaia, Aum-sidare, Diglowa, Gibash Wad-gasim,...

Assessment of Bacteriological Profile and the Factors that Contribute to Food Contamination In Hilat KuKu

Abstract The study was conducted to evaluate food safety in street-vended foods in Khartoum city: A study on the assessment of bacteriological profile and the factors that contribute to food contamination, using standardized survey tool containing 41 questions to test food safety knowledge and practices of 30 street vendors. The analysis of demographic characteristics revealed that the all participants were females and the majority of age group of 31- 40 years (53.3%) most of the vendors hav...

Bacterial Contamination in Broiler Carcasses in slaughter houses , E.coli and Salmonella spp as Models in Jabalawlia Khartoum State –Sudan

ABSTRACT This study was performed in Khartoum State between April to June 2017 .Two types of slaughtering houses , namely; automatic and manual were chosen to evaluate the bacterial count in broiler carcasses in three steps during slaughtering (after slaughtering , scalding and chilling ) , at three sites in broiler carcasses namely ; leg , neck and brisket and from worker’s hands during slaughtering . A total of 70 swab samples were collected ; 35 samples from the automatic slaughterhouse...

Serologic Prevalence of Brucellosis in Horses (Equus Caballus) Stables in Khartoum State - Sudan

ABSTRACT The Rose Bengal Plate Test (RBPT) and serum agglutination test (SAT) were conducted to determine the serologic prevalence of brucellosis in horses in the Khartoum State Sudan. A total of 150 horses that were on stable management system was sampled. During the period from December 2016 to February 2017. Using cross sectional study localities State this included Khartoum, Bahri and Omdurman. The objectives of the study were to determine the prevalence of Brucella antibodies in horses ...

Patients’ Reasons Contributing To Delayed Healthcare- Seeking Behavior For Non-Pregnancy-Related Abnormal Vaginal Bleeding In Bomet County, Kenya

Globally, non-pregnancy related abnormal vaginal bleeding is common. A United States population-based survey of women ages 18 years and above reported an annual prevalence rate of 53 per 1000 women (Kjerulff, Erickson &Langenberg, 2016). The purpose of this study is to determine patients‘ reasons involved in delayed healthcareseeking behavior for non-pregnancy-related abnormal vaginal bleeding in Bomet, Kenya. The objectives of this study are to describe how individual, health beliefs, and ...

A Comparative Study To Estimate The Parameters Of The Shape And Scale Of Weibull Distribution In Sebha-Libya 1962-2013

Abstract This study aimed to estimate the parameter scale è and the shape parameter ë of the Weibull distribution and to compare the estimation methods (Maximum likelihood, Moments, least squares and maximum loss of Minimax) by the mean square error to obtain the best estimate. Actual data for the monthly wind velocity of sebha city -Libya were used for 52 years. The value of median, third quartile, eighty-fifth percentile and the maximum value in each year as measurements and variables of ...

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