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/ 241 Saudi Diploma in Family Medicine
Dr. Zekeriya Aktürk
Preventive Medicine and Preventive Medicine and Periodic Health Examinations in Primary CarePeriodic Health Examinations in Primary Care
/ 242 Saudi Diploma in Family Medicine
Aim-Objectives
• At the end of this presentation the participants will be;– Able to describe the role of PHE in primary care
– Able to count three diseases with highest mortality
– Able to define PHE
– Able to explain the effective screening criteria used in PHE
– Aware of the risks in PHE
– Able to describe current clinical preventive service recommendations for family practice
– Aware of the importance of PHE and preventive medicine in primary care.
/ 243 Saudi Diploma in Family Medicine
What are primary care physicians doing?Health Care
Health promotion
Risk prevention
Early diagnosis
Complication reduction
Risk reduction
Personal Preventive Medicine!
Primary Prevention Secondary PreventionTertiary
Prevention
/ 244 Saudi Diploma in Family Medicine
Prevention of what?
/ 245 Saudi Diploma in Family Medicine
Reasons of diseases (%)
0
5
10
15
20
25
30
35
40
45
50
Access Genetic Environment Behaviour
/ 246 Saudi Diploma in Family Medicine
Insurance companies:“Mortality decreases in persons undergoing regular health checks!”
CHECK-UP(1921)
PERIODIC HEALTH EXAM was introduced.(1970)
Some diseases don’t have enough clues at the beginning, and when able to diagnose there was no time for treatment: check-up
gone. Changing by personal factors such as age, exposure, sex, and risk
/ 247 Saudi Diploma in Family Medicine
Definition
Evaluation of apparently health individuals in certain time periods, using a number of standard procedures such as counseling, physical examination, immunization, and laboratory investigations is called Periodic Health Examination.
/ 248 Saudi Diploma in Family Medicine
Does it work?
• USA: Mortality from stroke has decreased by 50% since 1972– Early diagnosis and treatment of hypertension
• Mortality from cervix cancer decreased by 80%• Neonatal screening
– Decrease in mental retardation• Phenylketonuria screening• Congenital hypothyroidism
National Center for Health Statistics. http://www.cdc.gov/nchs/r&d/ndi/ndi.htm
/ 249 Saudi Diploma in Family Medicine
Immunization and Polio• Polio eradication in Turkey • Every year 6.5 million children are immunized• Last case seen in 1998
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Morbidite hızı(1/100.000)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
Mortalite hızı(1/1.000.000)
Turkish MoH, polio morbidity and mortality rates. http://www.saglik.gov.tr/extras/istatistikler/temel2000/97.htm
/ 2410 Saudi Diploma in Family Medicine
Think of your daily life
• A 30-year old woman applies to your office. She has no history of disease but afraid of becoming breast cancer. – Should you perform a breast exam?
– Should you teach her breast self exam?
– Should you order a mammography?
• How do you decide?
/ 2411 Saudi Diploma in Family Medicine
1. Prevalence of the disease should be highNo sense to screen diseases with low prevalance.
- Osteogenesis imperfecta: incidence 1/10 000/year
Effective screening criteria
Medline Plus. Medical Encyclopedia. Osteogenesis imperfecta. http://www.nlm.nih.gov/medlineplus/ency/article/001573.htm
/ 2412 Saudi Diploma in Family Medicine
2. Predictive risk factors or tests should be presentThe safety and cost of the test should be known
- CRP: Cheap but not specific - Echocardiograpy: sensitive and specific but expensive
Effective screening criteria
/ 2413 Saudi Diploma in Family Medicine
10 4
6 80
Diseased (Prevalence)
Healthy Specifity
Sensitivity
PPV NPV
(+) Test (-) Test
Basic ParametersPopulation-100 persons
/ 2414 Saudi Diploma in Family Medicine
3. Morbidity and mortality should be highFactors related with morbidity and mortality (beyond the disease itself) :
Effective screening criteria
- Age- Sex- Race- Gegraphical area- Life style (culture)
/ 2415 Saudi Diploma in Family Medicine
/ 2416 Saudi Diploma in Family Medicine
• 0-18 months• Perinatal causes• Congenital anomalies
• 7-12 years• Accidents other than motor vehicle • Motor vehicle accidents
• 19-39 years• Motor vehicle accidents• Suicide
• 65 years and older• Heart diseases• Cerebrovascular diseases
Mortality according to age groups
/ 2417 Saudi Diploma in Family Medicine
4. There should be an acceptable treatmentNo sense to srean untreatable diseases- Lung cancer (?)
5. There should be a prodromal period without complains- AIDS- Syphilis- Cervix cancer- Breast cancer
Effective screening criteria
/ 2418 Saudi Diploma in Family Medicine
4 year
Beginning
Beginning
Symptoms
Symptoms
DEATH
DEATH2 year
1 year6 mo
Aggressive cancer
The same cancer but less aggressive
Screening once a year
The natural course of diseases
/ 2419 Saudi Diploma in Family Medicine
Let’s come back to our example: patient with breast cancer
• It’s an important disease for women– Worldwide 719000 new cases/year. (1/1000)
• Morbidity/mortality• It can be recognized without symptoms
– Mammography
• Curable– Surgery, Chemotherapy, Radiotherapy
• The value of treatment is more than its adverse effects
/ 2420 Saudi Diploma in Family Medicine
Can periodic health examination be harmful?Asymptomatic
person
Screening
Test normal Test abnormal
True negative False negative
Reassurance Delay in diagnosis
True positive False positive
AnxietyTreatment
The average error rate of a test: %5
Ian R. McWhinney. A Textbook of Family Medicine. Oxford University Press, USA 1997.
/ 2421 Saudi Diploma in Family Medicine
• Chest x-ray to screen lung diseases,
• Urinanalysis to screen urinary diseases,
• ECG,
• Microfilm to screen Tbc,
• PSA to screen prostate cancer,
• Self exam to screen breast cancer,
• CBC,
• Influenza immunization for healthy adolescents
The Check-up Chaos
/ 2422 Saudi Diploma in Family Medicine
How is PHE performed?
• Healthy individuals• Counseling
• Immunization
• Home visit
• Prophylaxis
• Physical exam
• Laboratory test
/ 2423 Saudi Diploma in Family Medicine
Any Guidelines for KSA?
/ 2424 Saudi Diploma in Family Medicine