April Back to Basics, 2011 POPULATION HEALTH: Periodic Health Exam, Epidemiology & Community Medicine Based on slides prepared by Dr. R. Spasoff

April PERIODIC HEALTH EXAMINATION (1) Clinical Guidelines for primary and preventive care Targeted and Evidence based Objectives target common conditions for each age group Use periodic health exam for health promotion/disease prevention interventions. Case-finding and screening for disease & risky behaviours

April Classification of Recommendations A Good evidence to recommend B Fair evidence to recommend C Existing evidence is conflicting and does not allow to make a recommendation for or against D Fair evidence to recommend against E Good evidence to recommend against I insufficient evidence to recommend

April Elements Discussion Physical exam Tests Therapy

April Gen Pop- Discussion Dental Hygiene (community fluoridation, brushing, flossing) (A) Noise control, hearing protection (A) Seatbelt use (B) Injury prevention (bicycle helmets, smoke detectors) (B) Moderate physical activity (B)

April Gen Pop- Discussion Avoid sun exposure and wear protective clothing (B) Problem drinking screening, counselling (B) Counselling to protect against STI’s (B) Nutritional counselling on fat and cholesterol (B)

April Gen Pop- Physical Exam Clinical breast exam women age (A) Blood pressure measurement (B) BMI measurement in obese adults (B)

April Gen Pop- Tests Mutiphase screening with FOB test adults>50 q1-2 yrs (A) Sigmoidoscopy adults > 50 freq not established (B) Bone Mineral Density (1 major or 2 minor criteria)

April 20119

10 The Canadian Task Force on Preventive Health Care concludes that there is fair evidence to recommend screening postmenopausal women to prevent fragility fractures (no or low trauma fractures) (grade B recommendation). Although there is no direct evidence that screening reduces fractures, there is good evidence that screening is effective in identifying postmenopausal women with low bone mineral density and that treating osteoporosis can reduce the risk of fractures in this population (grade A recommendation).

April Gen Pop- Tests Fasting lipid profile Controversial Fasting glucose- hypertension and hyperlipidemia Mammography women q1-2 yrs (A) Sexually active women Pap Smear q1y x2, then q3y if both normal

Gen Pop- Tests not Recommended PSA still has insufficient evidence to justify screening Syphilis tests should not be done routinely Breast self exam (D)- fair evidence of no benefit and good evidence of harm April

April Gen Pop- Therapy Folic Acid supplementation women of child bearing age (A) Pharmacologic treatment of hypertension with diastolic BP>90 mm Hg

April Special Pops- Smokers Counsel on smoking cessation Nicotine replacement therapy (A) Referral to smoking cessation program (B) Dietary advice on leafy green vegetables and fruits (B)

April Special Pops- Pediatric Discussion –Home visits to high risk families (A) –Inquiry into developmental milestones (B) Physical –Repeated examination of hips hearing and eyes (A) –Serial heights weights and head circumference (B) –Visual acuity testing (>2 yrs) (B)

April Special Pops- Pediatric Tests –Routine hemoglobin fir high risk populations (sickle cell and thalassemia) (B) –Blood lead screening for high risk infants (B) Therapy –Immunization

April Special Pops- Adolescents Counsel on sexual activity and contraceptive methods (B) Counsel to prevent smoking initiation (B)

April Perimenopausal Women Counsel on osteporosis Counsel on risks and benefits of hormone replacement therapy (B)

Special Pops- adults>65 Followup on caregiver concern of cognitive impairment (A) Multidisciplinary post-fall assessment (B) Visual acuity (Snellen) (B) Hearing impairment (B)

Special Pops- Familial First degree relative with melanoma –Full body skin exam (B) Familial Adenomatous Polyposis –Sigmoidoscopy and genetic testing (B) Heridtary non-polyposis colorectal cancer –Colonoscopy (B) April

Special Pops- Other Tb high risk –Mantoux testing (A) –INH chemoprophylaxis for close contacts and recent convertors (B) STI high risk –Voluntary HIV antibody screening (A) –Gonrrhea screening (A) –Chlamydia screening (B) April