Assuntos
Pediatria , Humanos , Criança , Pediatria/normas , Serviços Preventivos de Saúde/normas , Estados Unidos , Política de SaúdeAssuntos
Doenças Cardiovasculares , Complicações do Diabetes , Serviços Preventivos de Saúde , Humanos , Diabetes Mellitus , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Complicações do Diabetes/complicações , Complicações do Diabetes/terapiaRESUMO
BACKGROUND: Potentially preventable readmissions of surgical oncology patients offer opportunities to improve quality of care. Identifying and subsequently addressing remediable causes of readmissions may improve patient-centered care. OBJECTIVES: To identify factors associated with potentially preventable readmissions after index cancer operation. METHODS: The New York State hospital discharge database was used to identify patients undergoing common cancer operations via principal diagnosis and procedure codes between the years 2010 and 2014. The 30-day readmissions were identified and risk factors for potentially preventable readmissions were analyzed using competing risk analysis. RESULTS: A total of 53,740 cancer surgeries performed for the following tumor types were analyzed: colorectal (CRC) (42%), kidney (22%), liver (2%), lung (25%), ovary (4%), pancreas (4%), and uterine (1%). The 30-day readmission rate was 11.97%, 47% of which were identified as potentially preventable. The most common cause of potentially preventable readmissions was sepsis (48%). Pancreatic cancer had the highest overall readmission rate (22%) and CRC had the highest percentage of potentially preventable readmissions (51%, hazard ratio [HR] 1.42, 95% confidence interval [95%CI] 1.28-1.61). Risk factors associated with preventable readmissions included discharge disposition to a skilled nursing facility (HR 2.22, 95%CI 1.99-2.48) and the need for home healthcare (HR 1.61, 95%CI 1.48-1.75). CONCLUSIONS: Almost half of the 30-day readmissions were potentially preventable and attributed to high rates of sepsis, surgical site infections, dehydration, and electrolyte disorders. These results can be further validated for identifying broad targets for improvement.
Assuntos
Assistência ao Convalescente , Desidratação , Neoplasias , Readmissão do Paciente/estatística & dados numéricos , Serviços Preventivos de Saúde , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica , Desequilíbrio Hidroeletrolítico , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Desidratação/prevenção & controle , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Neoplasias/classificação , Neoplasias/epidemiologia , Neoplasias/cirurgia , New York/epidemiologia , Alta do Paciente/normas , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Melhoria de Qualidade , Medição de Risco , Sepse/epidemiologia , Sepse/etiologia , Sepse/fisiopatologia , Instituições de Cuidados Especializados de Enfermagem/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Desequilíbrio Hidroeletrolítico/epidemiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/prevenção & controleRESUMO
Importance: Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. Objective: To estimate changes in US Preventive Service Task Force guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. Design, Setting, and Participants: This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. Exposures: Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. Main Outcomes and Measures: Primary outcomes were US Preventive Services Task Force guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. Results: Among 20â¯557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. Conclusions and Relevance: This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.
Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Comitês Consultivos , Idoso , Estudos Transversais , Detecção Precoce de Câncer/normas , Etnicidade/estatística & dados numéricos , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou , Serviços Preventivos de Saúde/normas , Grupos Raciais/estatística & dados numéricos , População Rural/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: In May 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer (PCa) screening for ages 55-69 be an individual decision. This changed from the USPSTF's May 2012 recommendation against screening for all ages. The effects of the 2012 and 2018 updates on pathologic outcomes after prostatectomy are unclear. METHODS: This study included 647 patients with PCa who underwent prostatectomy at our institution from 2005 to 2018. Patient groups were those diagnosed before the 2012 update (n = 179), between 2012 and 2018 updates (n = 417), and after the 2018 update (n = 51). We analyzed changes in the age of diagnosis, pathologic Gleason grade group (pGS), pathologic stage, lymphovascular invasion (LVI), and favorable/unfavorable pathology. Multivariable logistic regression adjusting for pre-biopsy covariables (age, prostate-specific antigen [PSA], African American race, family history) assessed impacts of 2012 and 2018 updates on pGS and pathologic stage. A p < 0.05 was statistically significant. RESULTS: Median age increased from 60 to 63 (p = 0.001) between 2012 and 2018 updates and to 64 after the 2018 update. A significant decrease in pGS1, pGS2, pT2, and favorable pathology (p < 0.001), and a significant increase in pGS3, pGS4, pGS5, pT3a, and unfavorable pathology (p < 0.001) was detected between 2012 and 2018 updates. There was no significant change in pT3b or LVI between 2012 and 2018 updates. On multivariable regression, diagnosis between 2012 and 2018 updates was significantly associated with pGS4 or pGS5 and pT3a (p < 0.001). Diagnosis after the 2018 update was significantly associated with pT3a (p = 0.005). Odds of pGS4 or pGS5 were 3.2× higher (p < 0.001) if diagnosed between 2012 and 2018 updates, and 2.3× higher (p = 0.051) if after the 2018 update. Odds of pT3a were 2.4× higher (p < 0.001) if diagnosed between 2012 and 2018 updates and 2.9× higher (p = 0.005) if after the 2018 update. CONCLUSIONS: The 2012 USPSTF guidelines negatively impacted pathologic outcomes after prostatectomy. Patients diagnosed between 2012 and 2018 updates had increased frequency of higher-risk PCa and lower frequency of favorable disease. In addition, data after the 2018 update demonstrate a continued negative impact on postprostatectomy pathology. Thus, further investigation of the long-term effects of the 2018 USPSTF update is warranted.
Assuntos
Biópsia , Detecção Precoce de Câncer , Guias de Prática Clínica como Assunto/normas , Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata , Fatores Etários , Biópsia/métodos , Biópsia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Medição de Risco , Tempo , Tempo para o Tratamento , Estados Unidos/epidemiologiaRESUMO
Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and improve patient health. This article presents recommendations related to patients with certain medical conditions who are planning to undergo common dental procedures, such as cleanings, extractions, restorations, endodontic procedures, abscess drainage, and mucosal biopsies. Specifically, prophylactic antibiotics are not recommended for preventing prosthetic joint infections or infectious endocarditis except in certain circumstances. Anticoagulation and antiplatelet therapies typically should not be suspended for common dental treatments. Elective dental care should be avoided for six weeks after myocardial infarction or bare-metal stent placement or for six months after drug-eluting stent placement. It is important that any history of antiresorptive or antiangiogenic therapies be communicated to the dentist. Ascites is not an indication for initiating prophylactic antibiotics before dental treatment, and acetaminophen is the analgesic of choice for patients with liver dysfunction or cirrhosis who abstain from alcohol. Nephrotoxic medications should be avoided in patients with chronic kidney disease, and the consultation should include the patient's glomerular filtration rate. Although patients undergoing chemotherapy may receive routine dental care, it should be postponed when possible in those currently undergoing head and neck radiation therapy. A detailed history of head and neck radiation therapy should be provided to the dentist. Multimodal, nonnarcotic analgesia is recommended for managing acute dental pain.
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Odontologia , Procedimentos Cirúrgicos Bucais , Serviços Preventivos de Saúde , Liberação de Cirurgia/métodos , Antibioticoprofilaxia/métodos , Contraindicações , Odontologia/métodos , Odontologia/normas , Humanos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos Cirúrgicos Bucais/métodos , Planejamento de Assistência ao Paciente/organização & administração , Exame Físico/métodos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normasRESUMO
Clinical preventive service recommendations from the US Preventive Services Task Force (USPSTF) are based on transparent, systematic, and rigorous methods that consider the certainty of the evidence and magnitude of net benefit. These guidelines aim to address the needs of diverse populations. Biological sex and gender identity are sources of diversity that are not often considered in studies of clinical preventive services that inform the recommendations, resulting in challenges when evaluating the evidence and communicating recommendations for persons in specific gender identification categories (man/woman/gender nonbinary/gender nonconforming/transgender). To advance its methods, the USPSTF reviewed its past recommendations that included the use of sex and gender terms, reviewed the approaches of other guideline-making bodies, and pilot tested strategies to address sex and gender diversity. Based on the findings, the USPSTF intends to use an inclusive approach to identify issues related to sex and gender at the start of the guideline development process; assess the applicability, variability, and quality of evidence as a function of sex and gender; ensure clarity in the use of language regarding sex and gender; and identify evidence gaps related to sex and gender. Evidence reviews will identify the limitations of applying findings to diverse groups from underlying studies that used unclear terminology regarding sex and gender. The USPSTF will use gender-neutral language when appropriate to communicate that recommendations are inclusive of people of any gender and will clearly state when recommendations apply to individuals with specific anatomy associated with biological sex (male/female) or to specific categories of gender identity. The USPSTF recognizes limited evidence to inform the preventive care of populations based on gender identity.
Assuntos
Identidade de Gênero , Serviços Preventivos de Saúde , Sexo , Comitês Consultivos , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Serviços Preventivos de Saúde/normas , Pessoas Transgênero , Estados UnidosAssuntos
Codificação Clínica/métodos , Intervenção em Crise , Tentativa de Suicídio , Intervenção em Crise/métodos , Intervenção em Crise/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Inglaterra/epidemiologia , Humanos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Melhoria de Qualidade , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricosRESUMO
INTRODUCTION: The crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. METHODS: A rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. RESULTS: Thirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. CONCLUSIONS: The promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.
Assuntos
COVID-19/psicologia , Pessoal de Saúde/psicologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Serviços de Saúde do Trabalhador/métodos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Doenças Profissionais/etiologia , Doenças Profissionais/psicologia , Serviços de Saúde do Trabalhador/normas , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Autocuidado/métodos , Autocuidado/normasAssuntos
Serviços Preventivos de Saúde , Comportamento Sexual , Infecções Sexualmente Transmissíveis , Determinantes Sociais da Saúde , Adolescente , Comportamento do Adolescente , Saúde do Adolescente/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Fatores de Risco , Educação Sexual/métodos , Educação Sexual/normas , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/psicologia , Estados Unidos/epidemiologiaAssuntos
Saúde do Adolescente , Comitês Consultivos , Saúde da Criança , Medicina Baseada em Evidências/métodos , Serviços Preventivos de Saúde/métodos , Adolescente , Saúde do Adolescente/normas , Comitês Consultivos/normas , Criança , Saúde da Criança/normas , Educação , Medicina Baseada em Evidências/normas , Humanos , Serviços Preventivos de Saúde/normas , Estados UnidosAssuntos
Intoxicação por Chumbo/diagnóstico , Programas de Rastreamento/métodos , Serviços Preventivos de Saúde/métodos , Comitês Consultivos/normas , Criança , Educação , Humanos , Intoxicação por Chumbo/epidemiologia , Programas de Rastreamento/normas , Serviços Preventivos de Saúde/normas , Medição de Risco/métodos , Medição de Risco/normasRESUMO
Native American youth endure a complex interplay of factors that portend greater risk-taking behaviors and contribute to marked health disparities experienced in adolescence. The Asdzáán Be'eená ("Female Pathways" in Navajo) program was developed as a primary prevention program to prevent substance use and teen pregnancy among Navajo girls. The Asdzáán Be'eená program consists of 11 lessons delivered to dyads of girls ages 8 to 11 years and their female caregivers. Feasibility, acceptability, and preliminary impact on risk and protective factors were assessed through a pre-/post study design. Data were collected from girls and their female caregivers at baseline, immediate, and 3 months postprogram completion. Forty-seven dyads enrolled in the study, and 36 completed the 3-month evaluation. At 3 months postprogram, girls reported significant increases in self-esteem, self-efficacy, parent-child relationship, social support, cultural, and sexual health knowledge. Caregivers reported increased family engagement in Navajo culture and parent-child communication and improved child functioning (fewer internalizing and externalizing behaviors). Findings suggest Asdzáán Be'eená has potential to break the cycle of substance use and teen pregnancy in Native communities by improving protective and reducing risk factors associated with these adverse health outcomes. Additional rigorous efficacy trials are necessary to establish program effectiveness.
Assuntos
Indígenas Norte-Americanos , Gravidez na Adolescência , Serviços Preventivos de Saúde , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Indígenas Norte-Americanos/educação , Relações Pais-Filho , Gravidez , Gravidez na Adolescência/prevenção & controle , Serviços Preventivos de Saúde/normas , Serviços Preventivos de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
INTRODUCTION: Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for annual wellness visits (AWV), which are primarily conducted by PCPs and may be useful for older adults undergoing dialysis. METHODS: We used the OptumLabs® Data Warehouse to identify a cohort of 1,794 Medicare Advantage (MA) enrollees initiating dialysis in 2014-2017 and examined whether MA enrollees (1) were seen by a PCP during an outpatient visit and (2) received an AWV in the year following dialysis initiation. RESULTS: In the year after initiating dialysis, 93 % of MA enrollees had an outpatient PCP visit but only 24 % received an annual wellness visit. MA enrollees were less likely to see a PCP if they had Charlson comorbidity scores between 0 and 5 than those with scores 6-9 (odds ratio (OR) = 0.59, 95 % CI: 0.37-0.95), but more likely if seen by a nephrologist (OR = 1.60, 95 % CI: 1.01-2.52) or a PCP (OR = 15.65, 95 % CI: 9.26-26.46) prior to initiation. Following dialysis initiation, 24 % of MA enrollees had an AWV. Hispanic MA enrollees were less likely (OR = 0.57, 95 % CI: 0.39-0.84) to have an AWV than White MA enrollees, but enrollees were more likely if they initiated peritoneal dialysis (OR = 1.54, 95 % CI: 1.07-2.23) or had an AWV in the year before dialysis initiation (OR = 4.96, 95 % CI: 3.88-6.34). CONCLUSIONS: AWVs are provided at low rates to MA enrollees initiating dialysis, particularly Hispanic enrollees, and represent a missed opportunity for better care management for patients with ESKD. Increasing patient awareness and provider provision of AWV use among dialysis patients may be needed, to realize better preventive care for dialysis patients.
Assuntos
Falência Renal Crônica/terapia , Medicare , Serviços Preventivos de Saúde/estatística & dados numéricos , Diálise Renal , Adolescente , Adulto , Idoso , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Serviços Preventivos de Saúde/normas , Estados Unidos , Adulto JovemAssuntos
COVID-19 , Osteoporose , Fraturas por Osteoporose , Serviços Preventivos de Saúde/normas , Qualidade de Vida , Risco Ajustado , Idoso , Conservadores da Densidade Óssea/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Osteoporose/complicações , Osteoporose/prevenção & controle , Fraturas por Osteoporose/mortalidade , Fraturas por Osteoporose/prevenção & controle , Fraturas por Osteoporose/psicologia , Risco Ajustado/métodos , Risco Ajustado/normas , Fatores de Risco , SARS-CoV-2 , Prevenção Secundária/métodosAssuntos
Ansiedade , COVID-19 , Fumar Cigarros , Depressão , Saúde das Minorias , Serviços Preventivos de Saúde , Fumar , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Fumar Cigarros/epidemiologia , Fumar Cigarros/psicologia , Fumar Cigarros/terapia , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Saúde Global/tendências , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Saúde das Minorias/etnologia , Saúde das Minorias/tendências , Distanciamento Físico , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , SARS-CoV-2 , Política Antifumo , Fumar/epidemiologia , Fumar/psicologia , Fumar/tendências , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Fatores SocioeconômicosRESUMO
[Figure: see text].
Assuntos
Anti-Hipertensivos/administração & dosagem , Acidente Vascular Cerebral Hemorrágico , Hipertensão , AVC Isquêmico , Medição de Risco , Idoso , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Feminino , Fatores de Risco de Doenças Cardíacas , Acidente Vascular Cerebral Hemorrágico/diagnóstico , Acidente Vascular Cerebral Hemorrágico/etiologia , Acidente Vascular Cerebral Hemorrágico/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , AVC Isquêmico/diagnóstico , AVC Isquêmico/etiologia , AVC Isquêmico/prevenção & controle , Masculino , Conduta do Tratamento Medicamentoso/normas , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Planejamento de Assistência ao Paciente/normas , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricosRESUMO
Health maintenance for women of reproductive age includes counseling and screening tests that have been demonstrated to prevent disease and improve health. This article focuses mainly on conditions that are more common in women or have a unique impact on female patients. Family physicians should be familiar with evidence-based recommendations for contraception and preconception care and should consider screening patients for pregnancy intention. The American Academy of Family Physicians recommends against screening pelvic examinations in asymptomatic women; the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to make a recommendation for or against screening pelvic examinations. The USPSTF recommendations for women in this age group include screening for obesity and other cardiovascular risk factors, depression, intimate partner violence, cervical cancer, HIV, hepatitis C virus, tobacco use, and unhealthy alcohol and drug use as part of routine primary care. Breast cancer screening with mammography is recommended for women 50 years and older and should be individualized for women 40 to 49 years of age, although other organizations recommend earlier screening. Screening for sexually transmitted infections is based on age and risk factors; women younger than 25 years who are sexually active should be screened routinely for gonorrhea and chlamydia, whereas screening for syphilis and hepatitis B virus should be individualized. Immunizations should be recommended according to guidelines from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices; immunizations against influenza; tetanus; measles, mumps, and rubella; varicella; meningococcus; and human papillomavirus are of particular importance in women of reproductive age. To have the greatest impact on health, physicians should focus on USPSTF grade A and B recommendations with patients.