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ASTHMA

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ASTHMA
Disease Prevention Organization Date Population Recommendations Comments Source
Asthma Global Initiative for Asthma (GINA) 2012 Children
  • Pregnant women and parents of young children should be advised not to smoke.

  • Level of Evidence B.

  • Passive smoking increases the risk of allergic sensitization in children.

http://www.ginasthma.org/local/uploads/files/GINA_Pocket_2014_Jun11.pdf
Adults and children over 5 y
  • Reducing exposure to asthma “triggers” can reduce asthma exacerbations and improve asthma control.

    • Mattress encasing for mite control

    • Eliminate suitable environments for cockroaches

    • Eliminate passive smoke exposure

    • Reduce aggravating occupational exposures

http://www.ginasthma.org/local/uploads/files/GINA_Pocket2013_May15.pdf
Back Pain, Low

AAFP

USPSTF

2004 Adults
  • Insufficient evidence for or against the use of interventions to prevent low back pain in adults in primary care settings.

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

http://www.guidelines.gov/content.aspx?id=38619http://www.uspreventiveservicestaskforce.org/3rduspstf/lowback/lowbackrs.htm

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PRIMARY PREVENTION OF CANCER (CA): NCI EVIDENCE SUMMARY 2015

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PRIMARY PREVENTION OF CANCER (CA): NCI EVIDENCE SUMMARY 2015
CA Type Minimize Risk Factor Exposure Strength of Evidence That Modifying or Avoiding Risk Factor Will Reduce CA Therapeutic Strength of Evidence
Breasta,b

Hormone replacement therapy

—Approximately 26% increased incidence of invasive breast cancer (CA) with combination hormone replacement therapy (HRT) (estrogen and progesterone)

—Estrogen alone with mixed evidence—unlikely to increase risk significantly (decreases risk in African Americans)

Ionizing radiation to chest and mediastinum

—Increased risk occurs approximately 10 y after exposure. Risk depends on dose and age at exposure (woman with radiation from age 15 to 30 at highest risk)

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

Alcohol

—RR for intake of 4 alcoholic drinks/d is 1.32

—RR increases approximately 7% for each drink per day

Factors of unproven or disproven association

—Abortions

—Environmental factors

—Diet and vitamins

*epidemiologic studies suggest vitamin D may decrease risk of breast

CA—more studies needed. (N Engl J Med. 2011;364:1385) (Medicine. 2013;92:123)

—Active and passive cigarette smoking

—Use of statin drugs

—Use of low-dose daily aspirin

*Population based studies have shown reduction in breast CA risk but more data needed. (J Clin Oncol. 2010;25:1467. Lancet Oncol. 2012;13:518)

—Use of biphosphonates

Solid

 

 

 

Solid

 

 

Solid

 

 

Solid

TAMOXIFEN (postmenopausal and high-risk premenopausal women)

—Treatment with tamoxifen for 5 y reduced breast CA risk by 40%–50% USPSTF reemphasizes discussion with women at increased risk of breast cancer to strongly consider chemoprevention with selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) (Ann Intern Med. 2013;159:698-718)

—Meta-analysis shows RR = 2.4 (95% confidence interval [CI], 1.5–4.0) for endometrial CA and 1.9 (95% CI, 1.4–2.6) for venous thromboembolic events

RALOXIFENE (postmenopausal women)

—Similar effect as tamoxifen in reduction of invasive breast CA but does not reduce the incidence of noninvasive tumors—studied only in postmenopausal women

—Similar risks ...

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