USPSTF issues draft recommendations on violence and abuse screening, vitamin D and calcium supplementation

The U.S. Preventive Services Task Force (USPSTF) has issued two draft guidance statements, one on screening for intimate partner violence and abuse of elderly and vulnerable adults and another on vitamin D and calcium supplementation to prevent cancer and osteoporotic fractures in adults.

In updating its 2004 recommendation on screening for violence and abuse, the Task Force recommended that clinicians screen women of childbearing age (14 to 46 years old) for intimate partner violence, and provide or refer women to intervention services when appropriate. This is a grade B recommendation (high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial).

The Task Force also found there isn't enough evidence to assess the balance of benefits and harms of screening all elderly people or adults with physical or mental dysfunction for abuse or neglect. It found no evidence on appropriate screening intervals.

The Task Force examined the accuracy of 14 screening tools for identifying intimate partner violence through an examination of randomized, controlled trials and other systematic reviews. Screening instruments with the highest levels of sensitivity and specificity for identifying intimate partner violence are:

• HITS (Hurt, Insult, Threaten, Scream) (English and Spanish versions),
• OAS/OVAT (Ongoing Abuse Screen/Ongoing Violence Assessment Tool),
• STaT (Slapped, Threatened, and Throw),
• HARK (Humiliation, Afraid, Rape, Kick),
• CTQ-SF (Modified Childhood Trauma Questionnaire–Short Form) and
• WAST (Woman Abuse Screen Tool).

The draft recommendations will be open for public comment through July 10.

For vitamin D and calcium, the Task Force found that there is insufficient evidence:

• to assess the balance of the benefits and harms of vitamin D supplementation, with or without calcium, for the primary prevention of cancer in adults,
• to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men or
• to assess the balance of the benefits and harms of daily supplementation with >400 IU of vitamin D₃ and 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.

The Task Force recommends against daily supplementation with ≤400 IU of vitamin D₃ and 1,000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women. This is a grade D recommendation (There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits).

These draft recommendations will also be open for public comment through July 10.