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ASTHMA

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Population

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  • –Children.

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Recommendation

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Global Initiative for Asthma (GINA) 2017

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  • –Advise pregnant women and parents of young children not to smoke.

  • –Encourage vaginal delivery.

  • –Minimize use of acetaminophen and broad spectrum antibiotics during first year of life.

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Source

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  • –Global Initiative for Asthma. 2017.

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Comments

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  • –Environmental exposures such as automobile exhaust and dust mites are associated with higher rates of asthma, while others (household pets and farm animals) may be protective. Avoiding tobacco smoke and air pollution is protective, but allergen avoidance measures have not been shown to be effective primary prevention.

  • –Public health interventions to reduce childhood obesity, increase fruit and vegetable intake, improve maternal-fetal health, and reduce socioeconomic inequality would address major risk factors. (Lancet. 2015;386:1075-85)

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BACK PAIN, LOW

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Population

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  • –Adults.

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Recommendation

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AAFP 2004, USPSTF 2004

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  • –Insufficient evidence for or against the use of interventions to prevent low-back pain in adults in primary care settings.

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Sources

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  • –AAFP Clinical Recommendations: Low Back Pain. 2004.

  • –USPSTF. Low Back Pain. 2004.

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Comment

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  • –Insufficient evidence to support back strengthening exercises, mechanical supports, or increased physical activity to prevent low-back pain.

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PRIMARY PREVENTION OF CANCER (CA): NCI EVIDENCE SUMMARY 2017

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BREAST CANCER

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Minimize Known Risk Factor Exposure

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  • Hormone Replacement Therapy

    • Approximately 26% increased incidence of invasive breast cancer with combination hormone replacement therapy (HRT) (estrogen and progesterone-Prempro).

    • Estrogen alone with mixed evidence—unlikely to increase risk of breast cancer significantly (decreases risk in African Americans).

  • Ionizing Radiation to Chest and Mediastinum

    • Increased risk begins approximately 10 y after exposure. Risk depends on dose and age at exposure (woman with radiation from age 15–30 y at highest risk). These patients often have received mediastinal radiation for Hodgkin Lymphoma.

  • Obesity

    • In Women's Health Initiative (WHI), relative risk (RR) = 2.85 for breast CA for women >82.2 kg compared with women <58.7 kg only in post menopausal women

  • Alcohol

    • RR for intake of 4 alcoholic drinks/day is 1.32.

    • RR increases approximately 7% for each drink per day.

    • Family history—risk is doubled if a single first-degree relative develops breast cancer. Five-fold increased risk if 2 first degree relative are diagnosed with breast cancer. (Breast CA Res Treat. 2012; 133:1097).

  • Factors of Unproven or Disproven Association

    • Abortions.

    • Environmental factors.

    • Diet and vitamins.

    • Underarm deoderant/anti-persperpants - no evidence to support increased risk of breast ca. (J Natl Cancer Inst. 2002; 94:1578).

  • –Epidemiologic studies suggest vitamin D may decrease risk of breast cancer and breast cancer recurrence. Randomized controlled trials are needed. (N Engl J Med. 2011;364:1385) (Medicine...

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