‡Physicians should be aware of and follow their states’ HIV screening requirements. For a more detailed discussion of HIV screening, see Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep 2006;55(RR-14):1–17; quiz CE1–4. See also Routine human immunodeficiency virus screening. ACOG Committee Opinion No. 411. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;112:401–3. §For a more detailed discussion of the reproductive health plain, see The importance of preconception care in the continuum of women’s health care. ACOG Committee Opinion No. 313. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:665–6. ||Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended. ¶For a more detailed discussion of risk assessment and chemoprevention therapy, see Selective estrogen receptor modulators. ACOG Practice Bulletin No. 39. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;100:835–43. #For more information on the use of Td and Tdap, see Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. Centers for Disease Control and Prevention; Advisory Committee on Immunization Practices; Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2006;55(RR-17):1–37. **Leading causes of mortality are provided by the Mortality Statistics Branch at the National Center for Health Statistics. Data are from 2004, the most recent year for which final data are available. The causes are ranked. From American College of Obstetricians and Gynecologists, Primary and preventive care: periodic assessments. ACOG Committee Opinion No. 452. Obstet Gynecol 2009;144:1444–1451.
The task force uses systematic reviews of the evidence on specific topics in clinical prevention that serve as the scientific basis for recommendations. The task force reviews the evidence, estimates the magnitude of benefits and harms, reaches consensus about the net benefit of a given preventive service, and issues a recommendation that is assigned a grade from “A” (strongly recommends), to “B” (recommends), “C” (no recommendations for or against), “D” (recommends against), to “I” (insufficient evidence to recommend for or against) (Table 8.6). The grading system includes suggestions for practice, recommending that the service should be provided, discouraged, or that the uncertainty about the balance of benefits versus harms should be discussed. The levels of certainty regarding net benefit are ranked from high to moderate to low. The task force evaluates services based on age, gender, and risk factors for disease, making recommendations about which preventive services should be included in
Table 8.3 Periodic Assessment Ages 40–64 Years
Health status: medical, surgical, family Contraceptive options for prevention of unwanted pregnancy, including emergency contraception
Use of complementary and alternative medicine —Partner selection
Tobacco, alcohol, other drug use —Barrier protection