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"...comprehensive, yet practical, featuring special sections focusing on new STD guidelines, including AIDS; gynecologic concerns, including menstrual problems; and new chapters on menopause, human sexuality, teenage pregnancy and more."...
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"...comprehensive, yet practical, featuring special sections focusing on new STD guidelines, including AIDS; gynecologic concerns, including menstrual problems; and new chapters on menopause, human sexuality, teenage pregnancy and more."
A broader scope of "family planning" services includes not only fertility but also infertility, not only sexually transmitted infections (STIs) but also reproductive tract infections (RTIs) overall, not only menstruation and fertilization but also the preconceptual and interconceptual periods and menopause, and finally, not only reproductive tract problems but the wide range of risk factors that influence a woman's health in general. As reproductive health care expands in scope, however, two goals are paramount. First, the planning, or preventive focus, of family planning must remain a central activity. Second, reproductive health must be recognized for its broader public health impact.
Preventive Health Services
Family planning has always rested on the notion of thoughtful prevention rather than emphasizing the curative orientation practiced in many other medical arenas. This notion of prevention must carry through the entire practice of reproductive health, from providing contraceptives and reducing exposure to STIs to improving a woman's general health so she can conceive and deliver a healthy infant and to minimizing her risk factors for the diseases and injuries that curtail her life or quality of life.
By knowing which conditions commonly afflict your patient's population group, you can make more efficient use of resources and better assess your patient's risk factors. For example, the most common causes of mortality among women in various age groups provide a starting point (Table 1-1). Simply by screening for the risk factors associated with these problems and counseling about prevention, you can provide a high level of care for a substantial proportion of the patient population. In addition, by knowing what other conditions are uncommon or exceedingly rare, you can limit excessive workups and better identify those cases that truly merit extensive and expensive approaches. Health care provision should be based on more than "Can the patient (or the third-party payor) pay for this?"
The U.S. Preventive Services Task Force has designed a recommended schedule of periodic health examinations that cover both general and reproductive health care (Table 1-2). The recommended services reflect only those areas reviewed by the Task Force or those interventions that have documented evidence of value .z3 While many approaches to periodic health screening have been proposed, the Task Force recommendations are considered the blueprint for screening guidelines. These guidelines were developed using an evidence-based methodology. Above all, the Task Force emphasizes that the most cost-effective approach to health is through primary prevention, and primary prevention is most likely met through focused risk assessment and counseling rather than through periodic "one-size-fits-all" laboratory testing and physical examinations. When and how often the preventive services are performed (or other services added) must be based on an individual patient's medical history, physical findings, and risk factors...