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PERIODIC HEALTH EXAMINATION

PERIODIC HEALTH EXAMINATION. Assoc . Prof. Dr. Nurver Turfaner Department of Family Medicine. THE WHO DEFINITION OF HEALTH . Health is not only not being ill, but also physical, emotional and social wellness of the individual. PERIODIC HEALTH EXAMINATION.

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PERIODIC HEALTH EXAMINATION

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  1. PERIODIC HEALTH EXAMINATION

  2. Assoc. Prof. Dr. NurverTurfanerDepartment of FamilyMedicine

  3. THE WHO DEFINITION OF HEALTH • Health is not only not being ill, but also physical, emotional and social wellness of the individual.

  4. PERIODIC HEALTH EXAMINATION • Is the evaluation of individuals using standart procedures like physical examination, laboratory analysis,counseling and vaccines with regular intervals.

  5. Meaning of PreventiveRecommendations

  6. ThePeriodicHealthExamination • From birth to 10 years: • Measuretheheightandweight of children (Recommendation B) • Screenallnewbornsforhemoglobinopathies, phenylketonuria, andcongenitalhypothyroidism (Recommendation A) • High -risk childrenshould be screenedforanemiawhentheinfant is 6-12 monthsold (Recommendation B)

  7. Screenforleadlevels at age 12 months (B) • Do not screenchildrenwithurinalysis (D) • High-risk childrenshould be screenedfortuberculosisby PPD test (A) • Infantsborntomotherswhoarepositivefor HIV ormothers at high risk for HIV infection but withunknownstatusshould be screenedfor HIV immediatelyafterbirth (B)

  8. Allbicycleridersshouldwear a properlyfittinghelmet (A) • Moderate hot-watersettings, fire-resistantclothing, andsmokedetectorsshould be usedtopreventburns in children(B) • Poisoncontrolagencies’ numbersshould be easilyaccessible (B) • Parentsshould be counseled on using car seatsandseatbeltsfortheirchildren (B)

  9. Physiciansshouldpromotebreast-feeding (B) • Physiciansshouldcounsel on theharmfuleffects of secondhandsmoke (A) • Antibioticointmentshould be appliedtonewborn’seyeswithin 1 hour of birth (A) • Fluoridesupplementationshould be recommended in areaswherethere is insufficient floride supply in thewater (B)

  10. Periodichealthexamination of theadolescents • Measuretheheightandweight of adolescentstoscreenforobesity (B) • Screensexuallyactivefemaleadolescentsforchlamydialinfection (A) • Screenhigh risk femaleadolescentsforgonorrhea (B) • Screenwithpap-smearswithin 3 years of theonset of sexualactivity(A) • Screenforrubellasusceptibility in women of childbearingage (A)

  11. Recommendseatbeltuse (B) • Counselagainstdrivingwhileintoxicated (B) • Counselsexuallyactiveadolescents on contraceptionandprotectionagainstsexuallytransmitteddiseases (B) • Supplementthediets of allwomen of childbearingagewithfolicacid (A) • Counselpatientstomaintainadequatecalciumintake (B)

  12. CageScreeningForAlcoholAbuse • C: Haveyou ever feltyou had tocutback on howmuchyoudrink? • A: Haveyou ever beenannoyedbysomeone else askingaboutyourdrinking? • G: Haveyou ever feltguiltyaboutyourdrinkingoraboutanythingwhileyouweredrinking? • E: Haveyou ever had an eyeopener in themorning?

  13. HEADS MNEMONIC • H: Home, habits • E: Education, employment, exercise • A: Accidents, activities, ambition, abuse • D: Drugs (includingalcoholandtobacco), diet, depression • S: Sex, suicide

  14. SAFE TEENS • S: Sexuality • A: Accidents, abuse • F: Firearms (i.e, violence) • E: Emotions (i.e, depressionandsuicide) • T: Toxins (i.e., tobaccoandalcohol) • E: Exercise • E: Environment (e.g. home, school, friends) • N: Nutrition • S: Shots, school

  15. PeriodicHealthExaminationForAdults • Screenalladultsforhypertension (A) • Do not screenthe general adultpopulationforcoronaryarterydisease (D) • Do not screenadultsforperipheralvasculardisease (D) • Screen men between 65 and 75 yearswhohave ever smokedforabdominalaorticaneurysm (B) • Screenadultsforobesitybymeans of the body massindex (B)

  16. Screen men olderthan 35 yearsandwomenolderthan 45 yearsforhyperlipidemia (A) • Beginscreeningforhyperlipidemia at age 20 forthosewithother risk factorsforheartdisease (B) • Screenhyperlipidemicandhypertensiveadultsfordiabetesmellitus (B) • Screenforosteoporosis at age 65 forwomen of average risk and at age 60 forwomen at increased risk

  17. Do not screenforthyroiddysfunction in asymptomaticpatients (D) • ScreenforChlamydia in allsexuallyactivewomenyoungerthanage 25 andcontinuetoscreenhigh-risk womenolderthanage 25 (A) • Screenallwomen of childbearingageforimmunitytorubella (B) • Screenalladultsfordepression, providedthattheresourcesexisttotreatdepressionafter it has beenidentified (B) • Screenalladultsforalcoholmisuse (B)

  18. Screenallwomenolderthanage 40 forbreastcancer (B) • Screenallsexuallyactivewomenwith a cervixforcervicalcanceranditsprecursors. Beginscreeningwithin 3 years of theonset of sexualactivityorbyage 21 (A) • Do not continuetoscreenforcervicalcanceranditsprecursors in previouslyscreened, low risk womenolderthan 65 yearsor in womenwhohaveundergone a hysterectomyforbenigndisease (D)

  19. Screenallpatientsolderthanage 50 forcolorectalcancer (A) • Discusstherisksandbenefits of andthegaps in scientificknowledgeregardingprostatecancerscreeningwithall men olderthan 50 years (I) • Do not screenforovarian, testicular, pancreatic, orbladdercancer (D) • Screenelderlyadultsfordecreasedvisualacuity (B)

  20. Questionelderlyadultsabouthearingdifficulties (B) • Counselpatientswhousetobaccotoquit (A) • Counselpatientswhoare at increased risk fordiet-relateddiseasesregardinghealthyeatingandweightloss (B) • Discusstherisksandbenefits of TamoxifenorRaloxifeneforwomen at significantlyelevated risk forbreastcancer (B) • Recommendagainsttheuse of β-carotenebysmokers (D)

  21. Recommendagainsttheuse of hormonereplacementtherapyfortheprevention of chronicdisease (D) • Immunizeadultsagainsttetanusanddiphtheriaevery 10 years

  22. Immunizealladultsolderthan 50 yearsandyoungerpatientswith risk factorsagainstinfluenzaannually • Immunizeadultsolderthan 65 yearsagainstpneumococcuswith a singleimmunization • Immunizeadultswithout a history of infectionorvaccinationagainstvaricella

  23. WHO CriteriaFor A Screening Test • Theconditionbeingscreenedforshould be an importanthealth problem • Thenaturalhistory of theconditionshould be wellunderstood • Thereshould be a detectableearlystage • Treatment at an earlystageshould be of morebenefitthan at a laterstage • A suitable test should be devisedfortheearlystage

  24. The test should be acceptable • Intervalsforrepeatingthe test should be determined • Adequatehealth service provisionshould be madefortheextraclinicalworkloadresultingfromscreening • Thephysicalandpsychologicalrisksshould be lessthanthebenefits • Thecostsshould be balancedagainstthebenefits

  25. Benefits of ScreeningTests • Screeningforcolorectalcancerreducestheincidence of andmortalityfromcolorectalcancerbyremovingpre-malignantadenomatouspolips(A) • Introduction of a cervicalcancerscreening program withpap-tests has consistentlyreducedmorbidityandmortalityacrosspopulations (A)

  26. Mammographyscreeningevery 12-33 monthssignificantlyreducesmortalityfrombreastcancer • There is insufficientevidencetodeterminethebenefit of SBE (self-breastexamination)or CBE (clinicalbreastexamination) (independent of mammography) A

  27. Bloodpressuremeasurement can identifyadults at increased risk forcardiovasculardiseaseduetohighbloodpressure, andtreatment of highbloodpressuresubstantiallydecreasestheincidence of cardiovasculardisease (A) • Lipidscreening can identifyasymptomaticmiddleagedpeopleandyoungeradults at increased risk for CHD, andlipidloweringdrugtherapydecreasestheincidence of CHD in thosewithabnormallipidprofiles (A)

  28. Screeningfor AAA andsurgicalrepair of largeAAAs (>5.5 cm) in men betweentheages 65-75 whohave ever smokedleadstodecreased AAA–specificmortality (A) • Aspirin decreasestheincidence of CHD in adultswhoare at increased risk forheartdisease. Physiciansshoulddiscussthebenefitsandharms of aspirin chemopreventionwithadultswhoare at increased risk for CHD (A)

  29. Briefsmokingcessationinterventionsforadultsandextended, tailoredcounselingforpregnantwomenareaffective in inreasingtheproportion of smokerswhosuccesfullyquitsmokingandremainabstinent (A)

  30. Screeningadultsforalcoholmisuse in primarycaresettings can accuratelyidentifypatients at risk forincreasedmorbidityandmortality, andbriefbehavoralcounselinginterventionswithfollowupproducesmalltomoderatereduction in alcoholconsumptionthataresustainedfor 6-12 monthsorlonger (A)

  31. Screeningfordepression in adultsimprovestheaccurateidentification of depressedpatients in primarycaresettingsandtreatment of depressedadultsidentified in thesesettingsdecreasesclinicalmorbidity. Screeningshould be offeredtoadults in clinicalpracticesthathavesystems in placetoensureaccuratediagnosis, effectivetreatmentandfollowup (A)

  32. Screeninghigh risk womenforchlamydialinfectionreducestheincidence of PID, andcommunitybasedscreeningreducestheprevalence of chlamydialinfection. Physiciansshouldroutinelyprovidechlamydialscreeningtoallsexuallyactivewomenage 25 yearsoryoungerandotherhigh risk, asymptomaticwomen (A)

  33. Womenwithasymptomaticgonorrhealinfectionhavehighrates of morbidityfrom PID, ectopicpregnancy, andchronicpelvicpain. Screeningtests can accuratelydetectgonorrhealinfection in those at risk, andtreatment is effective. Allhigh risk, sexuallyactivewomenshould be screenedforgonorrhealinfection (A)

  34. Standard rapidscreeningtestsaccuratelydetect HIV infection, andinterventions (e.g.,HAART =Highlyactive anti-retroviraltherapy) reducethe risk of clinicalprogressionandprematuredeath. HIV screeningshould be offeredtoalladultsandadolescents at high risk for HIV infection (A)

  35. Screeninghigh risk adultsforsyphilisinfection can decreasethemorbidityassociatedwiththedisease. High risk adultsshould be offeredscreeningforsyphilisinfection (A)

  36. Inadultswhohavehypertensionandclinicallydetecteddiabetes, loweringbloodpressurebelowtheconventionaltargetbloodpressurevaluereducestheincidence of cardiovasculareventsandcardiovascularmortality. Foradultswhohavehyperlipidemia, detectingdiabetessubstantiallyimprovesestimates of individual risk for CHD, which is an integralpart of decision-makingaboutlipid-loweringtherapy. Patientswithhypertensionandhyperlipidemiashould be offereddiabetesscreening (A)

  37. Risk forosteoporosisandfractureincreaseswithageandotherfactors. Bone densitymeasurementsaccuratelypredictthe risk of fractures in theshortterm, andtreatingasymptomaticwomenwithosteoporosisreducestheir risk forfracture. Allwomenage 65 yearsorolderandwomenage 60 yearsorolder at increased risk should be offeredscreeningforosteoporosis (A)

  38. The body massindex (BMI) is a reliableandvalidmethodforidentifyingadults at increased risk formortalityandmorbidityduetooverweightandobesity. High-intensitycounselingandbehavioralinterventionsproducemodest, sustainedweightloss (typically, 3 to 5 kg for 1 yearormore) in adultswhoareobese. Alladultpatientsshould be screenedforobesity, andobeseadultsshould be offeredintensivecounselingandbehavioralinterventionstopromotesustainedweightloss (A)

  39. Intensivebehavioraldietarycounselingshould be offeredtoadultswithhyperlipidemiaandotherknown risk factorsforcardiovascularanddiet-relatedchronicdiseases. Intensivecounseling can be deliveredbyprimarycarecliniciansorbyreferraltootherspecialists, such as nutritionistsanddietitians (A)

  40. No usefuleffect of screening on ovarian, lungandprostatecancerincidence has beenshown • Post-menopausalhormonereplacementtherapy has beenfoundto be harmful • Screeningforlungcancer in men between 50-75 yearsoldwhohavesmoked 30pack/yearwithlowdose HRCT is recommended.

  41. THANK YOU FOR • YOUR ATTENTION

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