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

Meaning of Preventive Recommendations

LEVEL RECOMMENDATION EXPLANATION A Strongly Recommended Good Evidence for improved outcomes and the benefit significantly outweighs potential harm B Recommend At least fair evidence C No recommendation At least fair evidence for improved outcomes but not clear whether benefit outweighs potential harm D Recommends against At least fair evidence for ineffectiveness or that harm outweighs benefit INo recommendation Evidence is lacking, poor, or conflicting, and relative benefit and harm can not be estimated

The Periodic Health Examination From birth to 10 years: Measure the height and weight of children (Recommendation B) Screen all newborns for hemoglobinopathies, phenylketonuria, and congenital hypothyroidism (Recommendation A) High -risk children should be screened for anemia when the infant is 6-12 months old (Recommendation B)

Screen for lead levels at age 12 months (B) Do not screen children with urinalysis (D) High-risk children should be screened for tuberculosis by PPD test (A) Infants born to mothers who are positive for HIV or mothers at high risk for HIV infection but with unknown status should be screened for HIV immediately after birth (B)

All bicycle riders should wear a properly fitting helmet (A) Moderate hot-water settings, fire- resistant clothing, and smoke detectors should be used to prevent burns in children (B) Poison control agencies’ numbers should be easily accessible (B) Parents should be counseled on using car seats and seat belts for their children (B)

Physicians should promote breast- feeding (B) Physicians should counsel on the harmful effects of second hand smoke (A) Antibiotic ointment should be applied to newborn’s eyes within 1 hour of birth (A) Fluoride supplementation should be recommended in areas where there is insufficient floride supply in the water (B)

Periodic health examination of the adolescents Measure the height and weight of adolescents to screen for obesity (B) Screen sexually active female adolescents for chlamydial infection (A) Screen high risk female adolescents for gonorrhea (B) Screen with pap-smears within 3 years of the onset of sexual activity(A) Screen for rubella susceptibility in women of child bearing age (A)

Recommend seat belt use (B) Counsel against driving while intoxicated (B) Counsel sexually active adolescents on contraception and protection against sexually transmitted diseases (B) Supplement the diets of all women of child bearing age with folic acid (A) Counsel patients to maintain adequate calcium intake (B)

Cage Screening For Alcohol Abuse C: Have you ever felt you had to cut back on how much you drink? A: Have you ever been annoyed by someone else asking about your drinking? G: Have you ever felt guilty about your drinking or about anything while you were drinking? E: Have you ever had an eye opener in the morning?

HEADS MNEMONIC H: Home, habits E: Education, employment, exercise A: Accidents, activities, ambition, abuse D: Drugs (including alcohol and tobacco), diet, depression S: Sex, suicide

SAFE TEENS S: Sexuality A: Accidents, abuse F: Firearms (i.e, violence) E: Emotions (i.e, depression and suicide) T: Toxins (i.e., tobacco and alcohol) E: Exercise E: Environment (e.g. home, school, friends) N: Nutrition S: Shots, school

Periodic Health Examination For Adults Screen all adults for hypertension (A) Do not screen the general adult population for coronary artery disease (D) Do not screen adults for peripheral vascular disease (D) Screen men between 65 and 75 years who have ever smoked for abdominal aortic aneurysm (B) Screen adults for obesity by means of the body mass index (B)

Screen men older than 35 years and women older than 45 years for hyperlipidemia (A) Begin screening for hyperlipidemia at age 20 for those with other risk factors for heart disease (B) Screen hyperlipidemic and hypertensive adults for diabetes mellitus (B) Screen for osteoporosis at age 65 for women of average risk and at age 60 for women at increased risk

Do not screen for thyroid dysfunction in asymptomatic patients (D) Screen for Chlamydia in all sexually active women younger than age 25 and continue to screen high-risk women older than age 25 (A) Screen all women of childbearing age for immunity to rubella (B) Screen all adults for depression, provided that the resources exist to treat depression after it has been identified (B) Screen all adults for alcohol misuse (B)

Screen all women older than age 40 for breast cancer (B) Screen all sexually active women with a cervix for cervical cancer and its precursors. Begin screening within 3 years of the onset of sexual activity or by age 21 (A) Do not continue to screen for cervical cancer and its precursors in previously screened, low risk women older than 65 years or in women who have undergone a hysterectomy for benign disease (D)

Screen all patients older than age 50 for colorectal cancer (A) Discuss the risks and benefits of and the gaps in scientific knowledge regarding prostate cancer screening with all men older than 50 years (I) Do not screen for ovarian, testicular, pancreatic, or bladder cancer (D) Screen elderly adults for decreased visual acuity (B)

Question elderly adults about hearing difficulties (B) Counsel patients who use tobacco to quit (A) Counsel patients who are at increased risk for diet-related diseases regarding healthy eating and weight loss (B) Discuss the risks and benefits of Tamoxifen or Raloxifene for women at significantly elevated risk for breast cancer (B) Recommend against the use of β- carotene by smokers (D)

Recommend against the use of hormone replacement therapy for the prevention of chronic disease (D) Immunize adults against tetanus and diphtheria every 10 years

Immunize all adults older than 50 years and younger patients with risk factors against influenza annually Immunize adults older than 65 years against pneumococcus with a single immunization Immunize adults without a history of infection or vaccination against varicella

WHO Criteria For A Screening Test The condition being screened for should be an important health problem The natural history of the condition should be well understood There should be a detectable early stage Treatment at an early stage should be of more benefit than at a later stage A suitable test should be devised for the early stage

The test should be acceptable Intervals for repeating the test should be determined Adequate health service provision should be made for the extra clinical workload resulting from screening The physical and psychological risks should be less than the benefits The costs should be balanced against the benefits

Benefits of Screening Tests Screening for colorectal cancer reduces the incidence of and mortality from colorectal cancer by removing pre- malignant adenomatous polips (A) Introduction of a cervical cancer screening program with pap-tests has consistently reduced morbidity and mortality across populations (A)

Mammography screening every months significantly reduces mortality from breast cancer There is insufficient evidence to determine the benefit of SBE (self- breast examination)or CBE (clinical breast examination) (independent of mammography) A

Blood pressure measurement can identify adults at increased risk for cardiovascular disease due to high blood pressure, and treatment of high blood pressure substantially decreases the incidence of cardiovascular disease (A) Lipid screening can identify asymptomatic middle aged people and younger adults at increased risk for CHD, and lipid lowering drug therapy decreases the incidence of CHD in those with abnormal lipid profiles (A)

Screening for AAA and surgical repair of large AAAs (>5.5 cm) in men between the ages who have ever smoked leads to decreased AAA–specific mortality (A) Aspirin decreases the incidence of CHD in adults who are at increased risk for heart disease. Physicians should discuss the benefits and harms of aspirin chemoprevention with adults who are at increased risk for CHD (A )

Brief smoking cessation interventions for adults and extended, tailored counseling for pregnant women are affective in inreasing the proportion of smokers who succesfully quit smoking and remain abstinent (A)

Screening adults for alcohol misuse in primary care settings can accurately identify patients at risk for increased morbidity and mortality, and brief behavoral counseling interventions with follow up produce small to moderate reduction in alcohol consumption that are sustained for 6-12 months or longer (A)

Screening for depression in adults improves the accurate identification of depressed patients in primary care settings and treatment of depressed adults identified in these settings decreases clinical morbidity. Screening should be offered to adults in clinical practices that have systems in place to ensure accurate diagnosis, effective treatment and follow up (A)

Screening high risk women for chlamydial infection reduces the incidence of PID, and community based screening reduces the prevalence of chlamydial infection. Physicians should routinely provide chlamydial screening to all sexually active women age 25 years or younger and other high risk, asymptomatic women (A)

Women with asymptomatic gonorrheal infection have high rates of morbidity from PID, ectopic pregnancy, and chronic pelvic pain. Screening tests can accurately detect gonorrheal infection in those at risk, and treatment is effective. All high risk, sexually active women should be screened for gonorrheal infection (A)

Standard rapid screening tests accurately detect HIV infection, and interventions (e.g.,HAART =Highly active anti-retroviral therapy) reduce the risk of clinical progression and premature death. HIV screening should be offered to all adults and adolescents at high risk for HIV infection (A)

Screening high risk adults for syphilis infection can decrease the morbidity associated with the disease. High risk adults should be offered screening for syphilis infection (A)

In adults who have hypertension and clinically detected diabetes, lowering blood pressure below the conventional target blood pressure value reduces the incidence of cardiovascular events and cardiovascular mortality. For adults who have hyperlipidemia, detecting diabetes substantially improves estimates of individual risk for CHD, which is an integral part of decision-making about lipid-lowering therapy. Patients with hypertension and hyperlipidemia should be offered diabetes screening (A)

Risk for osteoporosis and fracture increases with age and other factors. Bone density measurements accurately predict the risk of fractures in the short term, and treating asymptomatic women with osteoporosis reduces their risk for fracture. All women age 65 years or older and women age 60 years or older at incre ased risk should be offered screening for osteoporosis (A)

The body mass index (BMI) is a reliable and valid method for identifying adults at increased risk for mortality and morbidity due to overweight and obesity. High-intensity counseling and behavioral interventions produce modest, sustained weight loss (typically, 3 to 5 kg for 1 year or more) in adults who are obese. All adult patients should be screened for obesity, and obese adults should be offered intensive counseling and behavioral interventions to promote sustained weight loss (A)

Intensive behavioral dietary counseling should be offered to adults with hyperlipidemia and other known risk factors for cardiovascular and diet- related chronic diseases. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists and dietitians (A)

No useful effect of screening on ovarian, lung and prostate cancer incidence has been shown Post-menopausal hormone replacement therapy has been found to be harmful Screening for lung cancer in men between years old who have smoked 30pack/year with low dose HRCT is recommended.

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