Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

8 May 2012 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at acollom@acponline.org

1. Evidence Review: Screening Women for Intimate Partner Violence May Have Benefits, Few Harms

Intimate partner violence, or IPV, includes a range of abusive behaviors perpetrated by someone who is in an intimate relationship with the victim. Abusive behaviors may include physical violence, sexual violence, rape, and psychological aggression – all of which have immediate health effects on the victim. While victims and perpetrators can be male or female, women are disproportionately victimized (up to 5.3 million women are affected each year in the U.S.). In 2004, the United States Preventive Services Task Force (USPSTF) found insufficient evidence to support screening women for IPV. To inform an update of its previous recommendation, the Task Force reviewed articles published since 2003 to determine the effectiveness of IPV screening and interventions for women in health care settings in reducing IPV and related health outcomes, the diagnostic accuracy of screening tools, and adverse effects of screening and interventions. The evidence shows that women assigned to screening versus usual care did not have statistically significant improvements in IPV or health outcomes. However, more women in the screened group discussed IPV with their clinician (44 percent versus 8 percent). Clinicians may use questionnaire or interview-type tools to screen women for IPV. According to published research, five of the 13 tools assessed demonstrated high diagnostic accuracy. Few studies reported adverse effects of screening and interventions for IPV, but a large randomized controlled trial indicated no difference in adverse effects between women who were screened and women who were not. But some women who are screened may experience discomfort, loss of privacy, emotional distress, and concerns about further abuse. These data will be used to develop an updated recommendation on screening for IPV.

2. Physician Counseling Increases Sun-Protective Behaviors Among Patients at Greatest Risk for Skin Cancer

Skin cancer is one of the most common types of cancer, affecting more than two million American each year. Having light skin, hair, and eyes increases a patient’s risk for skin cancer, as does over-exposure to ultraviolet rays at an early age. The United States Preventive Services Task Force (USPSTF) recommends that physicians counsel children, adolescents, and young adults aged 10 to 24 years who have fair skin about skin cancer prevention. Evidence published since its 2003 recommendation statement suggest that counseling interventions in the primary care setting moderately increase the use of sun-protective behaviors among younger patients. Low-intensity interventions based on appearance proved effective. For example, physicians showed patients photos taken with a UV camera to demonstrate the extent to which UV rays can damage the skin. The Task Force recommendation applies to asymptomatic patients between the ages of 10 and 24 years with no history of skin cancer. There is insufficient evidence to determine if counseling interventions are effective for changing behavior in older adults.