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INTRODUCTION

A primary goal of health care is to prevent disease or to detect it early enough that interventions will be more effective. The ultimate goal of preventive strategies is to avoid premature death. However, as longevity has increased dramatically worldwide over the last century (largely as a result of public health practices), increasing emphasis is placed on prevention for the purpose of preserving quality of life and extending the healthspan, not just the life span. Focusing on health promotion, rather than just disease prevention, may also provide greater motivation for pts to pursue lifestyle changes or adhere to clinician recommendations. Empowering pts with strategies to achieve positive health goals after discussing risks (i.e., smoking) can provide more effective adherence and better long-term outcomes.

In general, screening is most effective when applied to relatively common disorders that carry a large disease burden and have a long latency period. Early detection of disease has the potential to reduce both morbidity and mortality; however, screening asymptomatic individuals carries some risk. False-positive results can lead to unnecessary laboratory tests and invasive procedures and can increase pt anxiety. Several measurements have been derived to better assess the potential gain from screening and prevention interventions:

  • Number of subjects needed to be screened to alter the outcome in one individual

  • Absolute impact of screening on disease (e.g., lives saved per thousand screened)

  • Relative impact of screening on disease outcome (e.g., the % reduction in deaths)

  • The cost per year of life saved

  • The increase in average life expectancy for a population

As part of a routine health care examination, history should include medication use, allergies, vaccination history, dietary history, use of alcohol and tobacco, sexual practices, safety practices (seat belt and helmet use, gun possession), and a thorough family history. Routine measurements should include assessments of height, weight, body-mass index, and blood pressure. Screening should also be considered for domestic violence and depression.

Counseling by health care providers should be performed at health care visits. Tobacco and alcohol use, diet, and exercise represent the vast majority of factors that influence preventable deaths. While behavioral changes are frequently difficult to achieve, it should be emphasized that studies show even brief (<5 min) tobacco counseling by physicians results in a significant rate of long-term smoking cessation. Instruction about self-examination (e.g., skin, breast, testicular) should also be provided during preventative visits.

The top causes of age-specific mortality and corresponding preventative strategies are listed in Table 205-1. Formal recommendations from the U.S. Preventive Services Task Force are listed in Table 205-2.

TABLE 205-1Age-Specific Causes of Mortality and Corresponding Preventive Options

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