Pascale Alisa, Beal Margaret W, Fitzgerald Thérèse
Department of Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts.
Womens Health Issues. 2016 Mar-Apr;26(2):135-46. doi: 10.1016/j.whi.2015.11.003. Epub 2016 Jan 23.
The annual pap smear for cervical cancer screening, once a mainstay of the well woman visit (WWV), is no longer recommended for most low-risk women. This change has led many women and their health care providers to wonder if they should abandon this annual preventive health visit altogether. Changing guidelines coinciding with expanded WWV coverage for millions of American women under the Patient Protection and Affordable Care Act have created confusion for health care consumers and care givers alike. Is there evidence to support continued routine preventive health visits for women and, if so, what would ideally constitute the WWV of today?
A scoping review of the literature was undertaken to appraise the current state of evidence regarding a wide range of possible elements to identify priority areas for the WWV.
A population health perspective taking into consideration the reproductive health needs of women as well as the preventable and modifiable leading causes of death and disability was used to identify eight domains for the WWV of today: 1) reproductive life planning and sexual health, 2) cardiovascular disease and stroke, 3) prevention, screening, and early detection of cancers, 4) unintended injury, 5) anxiety, depression, substance abuse, and suicidal intent, 6) intimate partner violence, assault, and homicide, 7) lower respiratory disease, and 8) arthritis and other musculoskeletal problems.
The WWV remains a very important opportunity for prevention, health education, screening, and early detection and should not be abandoned.
宫颈癌筛查的年度巴氏涂片检查，曾经是健康女性体检（WWV）的主要项目，现在已不再推荐大多数低风险女性进行。这一变化让许多女性及其医疗服务提供者怀疑是否应该完全放弃这种年度预防性健康检查。《患者保护与平价医疗法案》扩大了数百万美国女性的WWV覆盖范围，同时指南的改变给医疗消费者和护理人员都带来了困惑。是否有证据支持继续为女性进行常规预防性健康检查？如果有，那么理想情况下，当今的WWV应该包括哪些内容？
对文献进行范围综述，以评估关于广泛可能要素的现有证据状态，从而确定WWV的优先领域。
从人群健康的角度出发，考虑女性的生殖健康需求以及可预防和可改变的主要死亡和残疾原因，确定了当今WWV的八个领域：1）生殖生活规划与性健康，2）心血管疾病和中风，3）癌症的预防、筛查和早期检测，4）意外伤害，5）焦虑、抑郁、药物滥用和自杀倾向，6）亲密伴侣暴力、袭击和凶杀，7）下呼吸道疾病，8）关节炎和其他肌肉骨骼问题。
WWV仍然是预防、健康教育、筛查和早期检测的非常重要的机会，不应被放弃。
