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On the average, each day longer you live the longer you are likely to live, yet the closer to dying you become.

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The goal of health maintenance (HM) is to help people live longer and healthier lives.

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In this chapter, the findings and positions of the United States Preventative Service Task Force (USPSTF) are emphasized because it generates the most comprehensive and evidence-based recommendations of any organization. Hence, knowing the USPSTF grading system for its recommendations is important (Table 15-1). The USPSTF it is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is the leading independent panel of private-sector experts in prevention and primary care. The rest of this chapter lays out HM by the age groups 18-39, 40-49, 50-59, 60-74, and 75 years or older. USPSTF Grade A & B recommendations are emphasized with highlights some areas of special interest or controversy, including sections on immunizations and aspirin. Health maintenance involves three types of prevention: primary, secondary, and tertiary (Figure 15-1).

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Table 15-1. Wilson-Jungner Criteria for Appraising the Validity of a Screening Program.
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Prevention

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Primary Prevention

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Targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition (eg, childhood vaccination programs, water fluoridation, smoking prevention programs, clean water, and sanitation). The disease does not exist. The goal is to prevent development of disease.

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Secondary Prevention

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Targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications (eg, routine Papanicolaou smears, and screening for hypertension, diabetes, or hyperlipidemia). The disease does exist, but the person is unaware (asymptomatic). The goal is to identify and treat people with disease.

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Tertiary Prevention

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Targets individuals with a known disease, with the goal of limiting or preventing future complications (eg, rigorous treatment of diabetes mellitus, and post–myocardial infarction treatment with β-blockers and aspirin). The disease exists and there are symptoms. The goal ...

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