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Bushnell acknowledged that many of the recommendations in the guidelines are based on less rigorous evidence than the AHA/ASA would like to consider, but that the evidence is the best
that’s currently available. “We found more gaps than we found evidence for recommendations, and the hope is this is the starting point for new research,” Bushnell said.
news@JAMA FROM JAMA’S DAILY NEWS SITE
USPSTF Advises HBV Screening for US Groups at High Risk of Infection Mike Mitka, MSJ
1004
chronic HBV infection will die of cirrhosis or hepatocellular carcinoma. Screening for HBV infection is usually done by testing for hepatitis B surface antigen (HBsAg), which has a sensitivity and specificity of more than 98%. Diagnosis of chronic HBV infection is characterized by persistence of HBsAg for 6 months or longer, HBV DNA, elevations in liver function tests, and abnormalities on live biopsy. Antiviral drugs are used to treat HBV infection, with the goal of achieving sustained suppression of HBV replication and remission of liver disease to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma. Routine vaccination against HBV infection, begun in the United States in 1991, has changed the epidemiology of the disease. Current US policy calls for universal vaccination of all infants at birth; catch-up vaccination of adolescents; and vaccination of adults at high risk, such as health care workers, injection drug users, and household contacts of patients with HBV infection. Vaccination results in a more than 90% protective antibody response after the third dose in adults and more than 95% protective antibody response in adolescents. The US Centers for Disease Control and Prevention (CDC) recommends individuals screened for HBV infection receive the first dose of vaccine at the same medical visit as the testing. With vaccination proving to be effective, the number of reported acute symptomatic US cases of HBV infection has decreased from more than 20 000 cases annually in the mid-1980s to 2890 cases in 2011. The US death rate of HBV infection in 2010 was an estimated 0.5 deaths per 100 000 persons, with the highest death rates occurring in individuals aged 55 to 64 years, males, and persons of nonwhite, nonblack race.
Texting May Help Reduce Diabetes Risk A 14-week text messaging program helped study participants become more aware of their diabetes risk and make healthier dietary choices, according to recent research. Participants received cell phone texts offering a type 2 diabetes risk assessment and weekly messages with risk-reduction tips. At the study’s end, 83.2% of the 161 participants said they used the program to set physical activity goals; 60% of those individuals met their goals all or most of the time. About two-thirds reported setting weight loss goals; 25.7% met those goals all or most of the time. About half said the program helped them lose weight. http://jama.md/1c39232 Raw Milk Risky, Especially for Children Because some infections linked with drinking raw milk can be life threatening to young children, the American Academy of Pediatrics (AAP) has reaffirmed its stance that children and pregnant women should avoid raw milk products. A Minnesota Department of Health analysis suggested that between 2001 and 2010, nearly 1 in 5 raw milk drinkers became ill from raw milk consumption. One-quarter of those cases occurred in children younger than 5 years and 1 child died. “Given the progress we have made in prevention, there is no reason to risk consuming raw milk in this day and age,” said AAP statement coauthor Jatinder Bhatia, MD. http://jama.md/1di9MSV Rapid Chlamydia Detection A sensitive new assay is able to detect Chlamydia trachomatis in less than 20 minutes, according to researchers in Estonia. The assay uses recombinase polymerase amplification (RPA), a nucleic acid amplification technique that identifies C trachomatis directly from urine samples. When used to test urine samples from 70 patients—51 women and 19 men, all aged 18 to 25 years—the RPA assay had a specificity of 100% and a sensitivity of 83%, meaning that it correctly identified negative test results 100% of the time and accurately detected positive results 83% of the time. http://jama.md/1maBiag
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA March 12, 2014 Volume 311, Number 10
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/20/2015
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ndividuals at high risk for hepatitis B virus (HBV) infection should be screened for such infection, according to a draft recommendation statement from the US Preventive Services Task Force (USPSTF). HBV screening could identify individuals with chronic infection who may benefit from antiviral treatment or other interventions, such as surveillance for hepatocellular carcinoma. The USPSTF’s proposal, issued February 11 and made available for public comment until March 10, applies to individuals at high risk for HBV infection; asymptomatic, nonpregnant adolescents; and adults who have not been vaccinated against HBV infection (http: //tinyurl.com/86anrq2). The USPSTF said this advice merits a B recommendation, meaning that based on available evidence, it had moderate certainty that screening individuals at high risk for HBV infection has “moderate net benefit.” The USPSTF said screening is not recommended for the general US population, which has an estimated prevalence of HBV infection of only 0.3% to 0.5%. Individuals considered at high risk in the United States are those who were born in countries with a prevalence of HBV infection of 2% or greater; other high-risk groups (with a prevalence of HBV infection at or above the 2% threshold) include individuals who are HIV positive, injection drug users, household contacts or sex partners of individuals with HBV infection, and men who have sex with men. Although HBV infection is underreported, it is estimated that between 700 000 and 1.4 million individuals in the United States have chronic HBV infection and that 47% to 95% of infections occur in persons from countries with high HBV prevalence. Up to 25% of individuals with
Bushnell acknowledged that many of the recommendations in the guidelines are based on less rigorous evidence than the AHA/ASA would like to consider, but that the evidence is the best
that’s currently available. “We found more gaps than we found evidence for recommendations, and the hope is this is the starting point for new research,” Bushnell said.
news@JAMA FROM JAMA’S DAILY NEWS SITE
USPSTF Advises HBV Screening for US Groups at High Risk of Infection Mike Mitka, MSJ
1004
chronic HBV infection will die of cirrhosis or hepatocellular carcinoma. Screening for HBV infection is usually done by testing for hepatitis B surface antigen (HBsAg), which has a sensitivity and specificity of more than 98%. Diagnosis of chronic HBV infection is characterized by persistence of HBsAg for 6 months or longer, HBV DNA, elevations in liver function tests, and abnormalities on live biopsy. Antiviral drugs are used to treat HBV infection, with the goal of achieving sustained suppression of HBV replication and remission of liver disease to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma. Routine vaccination against HBV infection, begun in the United States in 1991, has changed the epidemiology of the disease. Current US policy calls for universal vaccination of all infants at birth; catch-up vaccination of adolescents; and vaccination of adults at high risk, such as health care workers, injection drug users, and household contacts of patients with HBV infection. Vaccination results in a more than 90% protective antibody response after the third dose in adults and more than 95% protective antibody response in adolescents. The US Centers for Disease Control and Prevention (CDC) recommends individuals screened for HBV infection receive the first dose of vaccine at the same medical visit as the testing. With vaccination proving to be effective, the number of reported acute symptomatic US cases of HBV infection has decreased from more than 20 000 cases annually in the mid-1980s to 2890 cases in 2011. The US death rate of HBV infection in 2010 was an estimated 0.5 deaths per 100 000 persons, with the highest death rates occurring in individuals aged 55 to 64 years, males, and persons of nonwhite, nonblack race.
Texting May Help Reduce Diabetes Risk A 14-week text messaging program helped study participants become more aware of their diabetes risk and make healthier dietary choices, according to recent research. Participants received cell phone texts offering a type 2 diabetes risk assessment and weekly messages with risk-reduction tips. At the study’s end, 83.2% of the 161 participants said they used the program to set physical activity goals; 60% of those individuals met their goals all or most of the time. About two-thirds reported setting weight loss goals; 25.7% met those goals all or most of the time. About half said the program helped them lose weight. http://jama.md/1c39232 Raw Milk Risky, Especially for Children Because some infections linked with drinking raw milk can be life threatening to young children, the American Academy of Pediatrics (AAP) has reaffirmed its stance that children and pregnant women should avoid raw milk products. A Minnesota Department of Health analysis suggested that between 2001 and 2010, nearly 1 in 5 raw milk drinkers became ill from raw milk consumption. One-quarter of those cases occurred in children younger than 5 years and 1 child died. “Given the progress we have made in prevention, there is no reason to risk consuming raw milk in this day and age,” said AAP statement coauthor Jatinder Bhatia, MD. http://jama.md/1di9MSV Rapid Chlamydia Detection A sensitive new assay is able to detect Chlamydia trachomatis in less than 20 minutes, according to researchers in Estonia. The assay uses recombinase polymerase amplification (RPA), a nucleic acid amplification technique that identifies C trachomatis directly from urine samples. When used to test urine samples from 70 patients—51 women and 19 men, all aged 18 to 25 years—the RPA assay had a specificity of 100% and a sensitivity of 83%, meaning that it correctly identified negative test results 100% of the time and accurately detected positive results 83% of the time. http://jama.md/1maBiag
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA March 12, 2014 Volume 311, Number 10
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/20/2015
jama.com
BrianAJackson/iStock.com
I
ndividuals at high risk for hepatitis B virus (HBV) infection should be screened for such infection, according to a draft recommendation statement from the US Preventive Services Task Force (USPSTF). HBV screening could identify individuals with chronic infection who may benefit from antiviral treatment or other interventions, such as surveillance for hepatocellular carcinoma. The USPSTF’s proposal, issued February 11 and made available for public comment until March 10, applies to individuals at high risk for HBV infection; asymptomatic, nonpregnant adolescents; and adults who have not been vaccinated against HBV infection (http: //tinyurl.com/86anrq2). The USPSTF said this advice merits a B recommendation, meaning that based on available evidence, it had moderate certainty that screening individuals at high risk for HBV infection has “moderate net benefit.” The USPSTF said screening is not recommended for the general US population, which has an estimated prevalence of HBV infection of only 0.3% to 0.5%. Individuals considered at high risk in the United States are those who were born in countries with a prevalence of HBV infection of 2% or greater; other high-risk groups (with a prevalence of HBV infection at or above the 2% threshold) include individuals who are HIV positive, injection drug users, household contacts or sex partners of individuals with HBV infection, and men who have sex with men. Although HBV infection is underreported, it is estimated that between 700 000 and 1.4 million individuals in the United States have chronic HBV infection and that 47% to 95% of infections occur in persons from countries with high HBV prevalence. Up to 25% of individuals with
![[Selective screening of high risk groups].](/assets/img/hold.png)
