Table 3. Ages 25-64 Years

Interventions Considered and Recommended for the Periodic Health Examination  Leading Causes of Death 
Malignant neoplasms 
Heart diseases 
Motor vehicle and other unintentional injuries 
Human immunodeficiency virus (HIV) infection 
Suicide and homicide
Interventions for the General Population
SCREENING Injury Prevention
A. Blood pressure 
A. Pharmacologic treatment if DBP>90 mmHg (CAN)
 B. Lap/shoulder belts
B. Height and weight, BMI (US) B. Motorcycle/bicycle/ATV helmets
A. Total blood cholesterol and HDL (men ages 35 and older, women ages 45 and older) (US) 
B. Diet/drug Tx for high chol/LDL (men ages 30-59) (CAN)
B. Smoke detector* (US)
B. Papanicolaou (Pap) test (women) [1] A. Hearing Impairment: Noise control and hearing protection (CAN)
A. Fecal occult blood test [2] and/or B. sigmoidoscopy (>=50 yr), or (US) colonoscopy q 10 years >=50 yr B. Removal/safe storage of firearms (US)
A. Mammogram +/- clinical breast exam [3] (women 50-69 yr)(CAN); women age 40 and older (US) Sexual Behavior
B. Assess for problem drinking; Counsel  B. STD prevention: avoid high risk behavior, *condoms/female barrier with spermicide*
B. Rubella serology or vaccination hx [4] (women of childbearing age)  B. Unintended pregnancy: contraception (US)
B. Screen for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up
Dental Health
COUNSELING B. Regular visits to dental care provider (US)
Substance Use A. Floss, brush with fluoride toothpaste daily [*]
A. Tobacco cessation; counseling, offer pharmacological therapy. 
B. Consider referral to validated cessation program (CAN)
IMMUNIZATIONS
B. Avoid alcohol/drug use while driving, swimming, boating, etc. (US)  A. Tetanus-diphtheria (Td) boosters (US)
Diet and Exercise B. Rubella [4] (women of childbearing age)
B. Limit fat & cholesterol; maintain caloric balance; emphasize grains, fruits, vegetables (CAN) A. Influenza vaccination (CAN)
B. Adequate calcium intake (women)(US)
B. Post-menopausal women: calcium 1,000-1,500 mg daily and vitamin D 400-800 IU daily (CAN)
 CHEMOPROPHYLAXIS
B. Regular activity (CAN) [*] A. Folic acid supplementation(women planning or capable of pregnancy)
B. Counseling re: sun exposure, clothing (CAN) A. Discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease (US) [5] 
Framingham 10 year risk:             Date:         ASA discussed?
Interventions for High Risk Populations
POPULATION POTENTIAL INTERVENTIONS 
Cardiovascular risk factors/diabetes
Adults with risk factors for coronary heart disease (US) Screen with total cholesterol and HDL (men age 20 to 35, women age 20 to 45)
Adults with hypertension or hyperlipidemia Screen for Type II diabetes
Adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease (US) Intensive behavioral dietary counseling
Adults with BMI >=30 (US) Intensive counseling and behavioral interventions to promote sustained weight loss
Diabetics (CAN) Fundoscopy/retinal photography, microalbumin
Smokers (CAN) Dietary advice on leafy green vegetables and fruits
Cancers
Breast Cancer risk >1.66% over 5 years (CAN)
Counseling on benefits and risks of using tamoxifen to reduce likelihood of breast cancer
Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (US)
Refer for genetic counseling and evaluation for BRCA testing
Hereditary Colon Cancer Family (CAN) Colonoscopy
First degree relative with melanoma (CAN) Physical exam, skin
Infections; vaccinations
Susceptible to measles, mumps, or varicella  MMR ; varicella vaccine
Institutionalized persons (US) Hepatitis A vaccine ; PPD ; pneumococcal vaccine ; influenza vaccine 
Health care/lab workers (US) Hepatitis B vaccine ; hepatitis A vaccine ; PPD; influenza vaccine 
Blood product recipients (US) HIV screen ; hepatitis B vaccine; hepatitis C screen(?)
Contact of household influenza case (CAN) Neuraminidase inhibitor prophylaxis if initiated within 36-48 hours of onset in index case
Individuals exposed to index influenza cases Amantadine prophylaxis
Certain chronic medical conditions Consider: PPD;  pneumococcal vaccine; influenza vaccine; outreach strategies for influenza vaccination
Travelers to developing countries (US) Consider: Hepatitis B vaccine ; hepatitis A vaccine
First Nations persons (US) Consider: Hepatitis A vaccine; PPD; Pneumococcal vaccine
High-risk sexual behavior Consider: RPR/VDRL ; screen for gonorrhea (female) , HIV, chlamydia (female); hepatitis B vaccine ; hepatitis A vaccine
Injection or street drug use Consider: RPR/VDRL; HIV screen ; hepatitis B vaccine; hepatitis A vaccine ; PPD; advice to reduce infection risk
TB contacts; immigrants; alcoholics; homeless Consider: PPD
TB household contacts and certain skin test converters (CAN) INH Prophylaxis
Obstetrics; pediatrics
Previous pregnancy with neural tube defect (US) Folic acid 4.0 mg
Child maltreatment (CAN) Home visits
Osteoporosis
Women age 60 and over with risk factors for osteoporosis (US)
Post menopausal women with risk factors(CAN)[6]
Screen for osteoporosis with DEXA

[1] Women who are or have been sexually active and who have a cervix: q <= 3 yr.
[2] Annually.
[3] Mammogram q1-2 yr, or mammogram q1-2 yr with annual clinical breast examination.
[4] Serologic testing, documented vaccination history, and routine vaccination (preferably with MMR) are equally acceptable alternatives.
[5] Balance of benefits and harms most favourable with 10 year Framingham risk greater than 6%
[6] Previous fragility fracture, weigh less than 132 lbs, ORAI score 9 or more, SCORE 6 or more
[*] The ability of clinician counseling to influence this behavior is unproven.