IMPORTANCE Overweight and obesity have been associated with adverse health effects. OBJECTIVE To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force.

IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018.STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTSOne hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, −1.6 [95% CI, −2.2 to −1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful.CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.Additionally, for the outcome drinks per week, whic...

Gonococcal ophthalmia neonatorum (GON) is a neonatal conjunctival infection transmitted intrapartum from mothers infected with Neisseria gonorrhoeae to their newborns. Although GON is rare in the United States, with 0.4 cases or fewer per 100 000 live births per year during 2013-2017, 1 prevention remains important because of high risk of corneal perforation and blindness, which can develop within 24 hours after delivery. 2 Preventive strategies for GON include screening for and treatment of gonorrhea in pregnant women and ocular prophylaxis in newborns, which is mandated in most states. Since 1996, the US Preventive Services Task Force (USPSTF) has maintained an "A" recommendation for prophylactic ocular topical medication for all newborns for the prevention of GON, based on good evidence that blindness due to GON has become rare in the United States since the implementation of universal preventive medication of infants. This brief evidence update was used by the USPSTF to update its 2011 "A" recommendation. 3 Methods | Because ocular prophylaxis for GON represents a long-established standard of practice, the USPSTF commissioned a targeted review using a reaffirmation updating process to identify "new and substantial evidence sufficient enough to change the prior recommendation." 4 As such, only the interval evidence since the previous systematic review was evaluated. An analytic framework and 2 key questions guided the evidence update (Figure). Detailed methods, including the search strategy, inclusion and exclusion criteria, criteria for critical appraisal, and a list of excluded studies, are available in the full evidence report at http://www. uspreventiveservicestaskforce.org /Page/Document/ UpdateSummaryFinal/ocular-prophylaxis-for-gonococcalophthalmia-neonatorum-preventive-medication1. Results | PubMed and the Cochrane Central Register of Controlled Trials were searched from January 1, 2008, to January 16, 2018. Two reviewers independently reviewed 282 unique citations and 6 full-text articles. No new publications meeting eligibility criteria were identified.

IMPORTANCE Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (Ն65 years) to inform the US Preventive Services Task Force.

IMPORTANCE Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors.