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Screening. Introduction to Primary Care: a course of the Center of Post Graduate Studies i n FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Objectives. Describe the role of P eriodic Health Examination (PHE) in primary care Count three diseases with highest mortality

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Introduction to Primary Care:

a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417

Tel: 4912326 – Fax: 4970847



  • Describe the role of Periodic Health Examination(PHE) in primary care

  • Count three diseases with highest mortality

  • Mention PHE guideline resources

  • Explain the effective screening criteria used in PHE

  • Aware of the risks in PHE

  • Aware of the importance of PHE and preventive medicine in primary care.


1Diseased, diagnosed & controlled

2Diagnosed, uncontrolled

3Undiagnosed or wrongly

diagnosed disease

4Risk factors for disease

5Free of risk factors

Diagnosed disease

Undiagnosed or

wrongly diagnosed disease

Iceberg phenomenon ?

The high mortality diseases in saudi arabia

The High mortality diseases in Saudi Arabia

  • Symptoms /Signs ill defined ……24.64%

  • Diseases of CVS………………...21.82%

  • Injury / Poisoning……………….18.31%

  • Conditions perinatal period……..9.88%

  • Neoplasms………………………4.55%

  • Diseases of RS…………………. 4.38%

    MOH- Saudi Arabia

Evidence based recommendations

Evidence Based Recommendations



Screening involves the utilization of a

diagnostic procedure to check for the presence

of a disease prior to the manifestation of

clinical symptoms

Goal of screening

Goal of screening

The goal of screening and evaluation is to

prevent the onset of disease or the worsening

of an existing disease.

For example, measurement of blood pressure

is intended to detect hypertension so as to

initiate treatment and prevent subsequent

morbidity (e.g., stroke or renal failure) or mortality.

World health organization principles of screening

World Health Organization — Principles of Screening

The Wilson-Jungner Criteria. Public Health Paper 1968, Geneva, WHO

  • The condition should be an important health problem.

  • There should be a treatment for the condition.

  • Facilities for diagnosis and treatment should be available.

  • There should be a latent stage of the disease.


  • There should be a test or examination for the condition.

  • The test should be acceptable to the population.

  • The natural history of the disease should be adequately understood.

  • There should be an agreed policy on who to treat.

  • The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.

  • Case-finding should be a continuous process, not just a "once and for all" project.

Types of screening

Types of screening

  • Mass

  • Targeted

  • Multiple or Multiphasic

  • Case-finding or opportunistic

Risk in screening

Risk in Screening

  • Adverse effects of screening procedure (e.g. Stress, anxiety, radiation exposure, chemical exposure).

  • Stress and anxiety caused by a “False Positive” screening result.

  • Unnecessary investigation and treatment of false positive results.


  • Prolonging knowledge of an illness if nothing can be done about it.

  • A false sense of security caused by false negatives, which may even delay final diagnosis.

  • Overuse/waste of medical resources.

  • Unnecessary and uncomfortable procedures looking for a disease that is unlikely

Periodic health examination

Periodic Health Examination

The purpose of the periodic health

examination is to evaluate health status,

screen for risk factors and disease, and

provide preventive counseling interventions in

an age-appropriate manner

Importance of phe

Importance of PHE

  • Educate patients aboutbehavioral patterns or environmental exposures thatpose risks for future diseases.

  • Examples include

    • counseling about smoking prevention and cessationto prevent lung cancer and emphysema,

    • seat belt useto prevent motor-vehicle injuries, or

    • modifyingsexual practices to prevent the spread of sexuallytransmitted disease.

Sources for information of phe

Sources for information of PHE

  • AAFP recommended

  • Canadian Task Force on Preventive

  • NHS Screening.


  • PHE.

Screening phe programs in saudi arabia

Screening / PHE programs in Saudi Arabia

  • Annual periodic health examination for all diabetic and hypertensive patients registered at PHC

  • Cervical screening

  • Breast cancer screening in some areas

  • Pre-marital screening (genetic dis., infectious dis.)

  • Well baby clinic



  • Counseling during the periodic health examination is also very important, for this is where physicians recommend changes in lifestyle that can affect future morbidity and mortality

    • Premarital

    • Risky behaviours

      • Smoking

    • According to age group

    • Healthy diet

    • Exercise...



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