Periodic health examination

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Periodic health examination

  1. 1. ‫بسم ا الرحمن‬ ‫الرحیم‬
  2. 2. Preventive Medicine Homayouni MD 10/Oct/2011 /139018/‫مهر‬
  3. 3. Live sensibly - among a thousand people , only one die a natural death the rest succumb to irrational modes of living Maimonides AD 1135-1204 ‫ابو عمران موس بن میمون بن عبدال القراطبی‬
  4. 4. A small number of modifiable factors underlies a large number of death and disabilities
  5. 5. Criteria of a good screening test 1) High sensitivity & specificity 2) High positive predictive Value 3) Simplicity & Cost 4) Safety 5) Acceptable to patient & physician 6) Labeling
  6. 6. Tier Definition addresses the entire population (national, local community, school, district) and aim to Universal prevention prevent or delay the abuse of alcohol, tobacco, and other drugs. All individuals, without screening, are provided with information and skills necessary to prevent the problem. focuses on groups whose risk of developing problems of alcohol abuse or dependence is above average. The subgroups may be distinguished by characteristics such as age, Selective prevention gender, family history, or economic status. For example, drug campaigns in recreational settings. involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviors. Identifiers may include falling grades Indicated prevention among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc.
  7. 7. Aspirin Aspirin for primary prevention of cardiovascular events Men ages 45 to 79, women ages 55 to 79, when benefits outweigh harms: A
  8. 8. Diabetes mellitus There are no randomized trials examining the ffectiveness of screening for diabetes. Models suggest that creening for diabetes in people with elevated blood pressure may be cost-effective because of effects of blood pressure management on cardiovascular outcomes [34,35]. owever, these models are based on evidence that people with diabetes benefit from tighter blood pressure control than people without diabetes. Recent trials (eg, ACCORD-BP) cast some doubt on this assumption [36].
  9. 9. Dyslipidemia Screening for dyslipidemia Average risk- men >35: A Increased risk: men 20-35, women >20: B Screen with TC and HDL: B
  10. 10. Abdominal aortic aneurysm Ruptured abdominal aortic aneurysm (AAA) is a catastrophic but uncommon event. The great majority of the 9000 annual US deaths from AAA rupture are in men between the ages of 65 and 75 years who are current or former smokers. Open surgical repair of AAA ≥5.5 cm reduces deaths associated with AAA rupture, at a cost of increased surgical procedures.
  11. 11. Colorectal cancer Patients should be asked about first and second degree relatives who have had colorectal cancer. Screening and prevention recommendations for patients with a family history of colorectal cancer, as well as genetic screening, are discussed in detail elsewhere
  12. 12. Hypertension Hypertension in the US accounts for 35 percent of myocardial infarctions and strokes, 49 percent of episodes of heart failure, and 24 percent of premature deaths [9]. High blood pressure is diagnosed when systolic blood pressure (SBP) is ≥140 mmHg, or diastolic blood pressure (DBP) is ≥90mmHg , on two or more visits over a period of several weeks
  13. 13. Lung cancer Reducing the risk of lung cancer should focus on those people who smoke tobacco and on targeted populations (i.e, adolescents) who are at risk of initiating tobacco use. Avoidance and cessation of tobacco use could potentially reduce the incidence and mortality from lung cancer by about 90 percent.
  14. 14. Smoking Screen for tobacco use and provide tobacco cessation interventions Adults: A Pregnant women: A
  15. 15. Osteoporosis Screening for osteoporosis Women ages 65+ and women 60-64 with risk factors: B
  16. 16. Prostate cancer Screening for prostate cancer is controversial. The benefits of screening (ie, reducing prostate cancer mortality) are small, in that they accrue to only a small number of men (no more than one in 1,400) and only after nine years [24]. Benefits may be outweighed by the significant harms of screening that affect many more men (need for biopsy, and impotence or incontinence occurring in at least 50 percent of men who undergo treatment for a disease that may be indolent).
  17. 17. What not to do Adult screening and prevention recommendations of USPSTF (December ) 2009) D recommendations (discourage testing Service Population Screening for abdominal aortic aneurysm Women Aspirin and NSAIDs to prevent colorectal cancer Men under age 45; women under age 55 Aspirin to prevent CHD Men under age 45 Aspirin to prevent ischemic stroke Women under age 55 Screening for bacterial vaginosis Average risk Screening for breast cancer by teaching BSE All women Screening for asymptomatic bacteriuria Men and non-pregnant women Beta carotene supplements Adults Screening for bladder cancer Adults
  18. 18. Screening for hepatitis C Not at increased risk Chemoprevention of breast cancer Women not at increased risk of breast cancer BRCA mutation testing for breast and ovarian cancer Women whose family history is not associated with an increased risk for deleterious mutations in BRCA 1 or BRCA 2 Cervical cancer screening with Pap smear Women over age 65 who have had previous negative screens; women who have had total hysterectomy for benign disease Screening for coronary heart disease Adults not at increased risk (ECG, ) ETT, or EBCT Screening for hepatitis B infection General population Serologic screening for genital herpes simplex Asymptomatic pregnant women; asymptomatic adolescents and adults Postmenopausal hormone therapy for primary prevention of chronic problems Postmenopausal women with or without a hysterectomy: estrogen plus progestin or estrogen alone
  19. 19. Screening for idiopathic scoliosis Adolescents Screening for ovarian cancer Women Screening for pancreatic cancer Adults Screening for peripheral arterial disease Adults Screening for syphilis Not at increased risk Screening for testicular cancer Men Screening for asymptomatic carotid artery stenosis Adult men and women Screening for chronic obstructive pulmonary disease with spirometry Adult men and women Screening for prostate cancer Men ages 75 and older Screening for colorectal cancer Men and women ages 86 years and older
  20. 20. Rec’s U.S.P.S.T.F. A B Abdominal Aortic Aneurysm: Screening Never smoked 65 y __________________________________________________________ Bacterial Vaginosis in Pregnancy: Screening (2001) Bacteriuria: Screening (2004) Bladder Cancer: Screening (2004) Blood Pressure: Screening (2003) 19 Y Breast Cancer: Screening (2002) / Preventive Medication (2002) Breastfeeding: Counseling (2003)
  21. 21. C Carotid Artery Stenosis: Screening (1996) Cervical Cancer: Screening (2003) Chlamydial Infection: Screening (2001) Colorectal Cancer: Screening (2002) Coronary Heart Disease: Screening (2004) ___________________________________________ D Dementia: Screening (2003) Dental Caries in Preschool Children: Screening (2004) Depression: Screening (2002) Diabetes Mellitus: Screening (2003) Diet: Counseling(2003) Down Syndrome: Screening (1996) Drug Abuse: Screening (1996) ____________________________________________ F Family Violence: Screening (2004)
  22. 22. G Gestational Diabetes: Screening (2003) Glaucoma: Screening (2005) Gonorrhea: Screening (2005) Gynecologic Cancers: Counseling(1996) ___________________________________________ H Hearing Impairment: Screening (1996) Hearing, Newborn: Screening (2001) Hemoglobinopathies: Screening (1996) Hepatitis B Virus Infection: Screening (2004) Hepatitis C Virus Infection: Screening (2004) Herpes Simplex, Genital: Screening (2005) Home Uterine Activity Monitoring: Screening (1996) Hormone Replacement Therapy: Preventive Medication (2005) Household and Recreational Injuries: Counseling (1996) Human Immunodeficiency Virus (HIV) Infection: Screening (2005) / Counseling (1996) Hypothyroidism, Congenital: Screening (1996)
  23. 23. I Idiopathic Scoliosis in Adolescents: Screening (2004) Immunizations, Adult: Immunizations (1996) Immunizations, Childhood: Immunizations (1996) Intrapartum Electronic Fetal Monitoring: Screening (1996) ____________________________________________ L Lead Levels in Childhood and Pregnancy: Screening (1996) Lipid Disorders: Screening (2001) Lung Cancer: Screening (2004) ___________________________________________ M N O Motor Vehicle Injuries: Counseling(1996) ____________________________________________ Neural Tube Defects: Screening (1996) ____________________________________________ Obesity in Adults: Screening (2003) / Counseling (1996) Oral Cancer: Screening (2004) Osteoporosis: Screening (2002) Overweight in Children and Adolescents: Screening (2005) Ovarian Cancer: Screening (2004)
  24. 24. P Pancreatic Cancer: Screening (2004) Peripheral Arterial Disease: Screening (2005) Phenylketonuria: Screening (1996) Physical Activity: Counseling (2002) Postexposure Prophylaxis for Selected Infectious Diseases: Preventive Medication (1996) Preeclampsia: Screening (1996) Prostate Cancer: Screening (2002) _______________________________________ R Rh Incompatibility: Screening (2004) Rubella: Screening (1996) _______________________________________ S Skin Cancer: Screening (2001) / Counseling (2003) Suicide Risk: Screening (2004) / Counseling (1996) Syphilis: Screening (2004)
  25. 25. T Testicular Cancer: Screening (2004) Thyroid Disease: Screening (2004) Thyroid Cancer: Screening (1996) Tobacco Use: Screening (2003) Tuberculous Infection: Screening (1996) _________________________________________________ U Ultrasonography in Pregnancy: Screening (1996) Unintended Pregnancy: Counseling (1996) _________________________________________________ V Visual Impairment: Screening (1996) Visual Impairment in Children Ages 0-5: Screening (2004) Vitamin Supplementation to Prevent Cancer and Coronary Heart Disease: Counseling (2003) _________________________________________________ Y Youth Violence: Counseling (1996)
  26. 26. What not to do Adult screening and prevention recommendations of USPSTF (December ) 2009) D recommendations (discourage testing Service Population Screening for abdominal aortic aneurysm Women Aspirin and NSAIDs to prevent colorectal cancer Men under age 45; women under age 55 Aspirin to prevent CHD Men under age 45 Aspirin to prevent ischemic stroke Women under age 55 Screening for bacterial vaginosis Average risk Screening for breast cancer by teaching BSE All women Screening for asymptomatic bacteriuria Men and non-pregnant women Beta carotene supplements Adults Screening for bladder cancer Adults
  27. 27. Screening for hepatitis C Not at increased risk Chemoprevention of breast cancer Women not at increased risk of breast cancer BRCA mutation testing for breast and ovarian cancer Women whose family history is not associated with an increased risk for deleterious mutations in BRCA 1 or BRCA 2 Cervical cancer screening with Pap smear Women over age 65 who have had previous negative screens; women who have had total hysterectomy for benign disease Screening for coronary heart disease Adults not at increased risk (ECG, ) ETT, or EBCT Screening for hepatitis B infection General population Serologic screening for genital herpes simplex Asymptomatic pregnant women; asymptomatic adolescents and adults Postmenopausal hormone therapy for primary prevention of chronic problems Postmenopausal women with or without a hysterectomy: estrogen plus progestin or estrogen alone
  28. 28. Screening CVD HTN AAA Obesity & eating disorder Hyperlipemia TB if at risk Physical , sexual and emotional abuse Learning and school problems Substance use
  29. 29. Behavior and emotion for depression & suicide Sexual behavior STD HIV Cancer DM Vision and hearing problems
  30. 30. Recommended tests
  31. 31. ‫داستان نقش ویتامینها‬ ‫در جلوگیری از بیماریها‬
  32. 32. Folic acid pregnancy Cancer → Colorectal CVD → Homocictein HTN Hearing loss
  33. 33. Vitamin D Osteoporosis Falls Cancer(±)
  34. 34. Vitamin E Cancer(−) CVD(−) Dement ion(−) Infection(−) DVT(+)
  35. 35. Antioxidant Vitamin A (Retinol) Cancer (±) CVD(−) Immunity (+) in children Fraction (+) Retic factor Cataract (−)
  36. 36. Vitamin C Cancer (−) CVD (−) Cataract , Maculadegeration (−)
  37. 37. Vitamin B2 Riboflavin(−) Vitamin B5 Pyridoxine(±) Vitamin B12 Cobalamin Poor intake
  38. 38. Summery * Folia acid supplementation may prevent neural tube defects in many women, especially as these defects occur before pregnancy is detected in most cases. ( See “Folic acid” above). * Vitamin D supplementation with calcium many reduce fracture rates and falls. ( See “Vitamin D” above). * Vitamin B12 supplementation, particularly those at high risk for deficiency, many prevent neurologic disease (eg, dementia, poor balance). (See “Vitamin B12 (cobalamin)” above).

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