1. Role of survey physicians: the Italian experience Simona Giampaoli Istituto Superiore di Sanità Rome, Italy

2. Physical examination (Seven Countries Study) Mouth – number of teeth edentulous Thyroid – presence of goiter Heart - sounds Lung - murmurs Abdomen - liver Pulses – arms, legs, etc. Skin Collection of symptoms and signs No diagnoses Only one person made diagnoses reviewing the papers, ECG, etc. (Menotti)

3. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare 20 centres, one per Region OUR ACTIVITIES AT REGIONAL LEVEL inform Health Local Authorities (General Director of the Hospital/District) involve Director of the Cardiology/Prevention/Medicine Unit inform GPs

4. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare Tasks of the Director of Cardiology/Preventive/Medicine Unit: sign the letter of invitation and lab exam results select the nurses employed in the screening nominate the leader of the group (nurse or young medical doctor) GOOD OPPORTUNITY TO TEACH EPIDEMIOLOGY AND HOW TO MEASURE RISK FACTORS IN A PREVENTIVE SETTING

5. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare PROBLEMS Nurses and physicians are used to medical emergencies requiring prompt intervention,…… they are not used to work in preventive settings and to apply standardized procedures requiring specific time frame. Prevention requires time and willingness to talk to patients Usually persons do not like to wait before blood drawing as they are fasting and uncomfortable with blood draw

6. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare Roles of the survey physician reviews and signs lab exams (ECG, spirometry, bone densitometry, laboratory tests) results can be hand-delivered or sent by surface mail (systematic reviews have found that physician advices are associated with quitting smoking in 2% smokers )

8. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare The presence of a physician (GP) increases participation rate

9. Health Examination Survey/ Osservatorio Epidemiologico Cardiovascolare Other limitations (convince physician to collect data using standardized procedures) Cost (select preferably physician in retirement)