1. ‫بسم ا الرحمن‬
‫الرحیم‬

2. Preventive Medicine
Homayouni MD
10/Oct/2011
/139018/‫مهر‬

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. A small number of modifiable factors
underlies a large number of death and
disabilities

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

9. 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.

11. Aspirin
Aspirin for primary prevention of cardiovascular events Men ages 45 to
79, women ages 55 to 79, when benefits outweigh harms: A

12. 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].

13. Dyslipidemia
Screening for dyslipidemia Average risk- men >35: A
Increased risk: men 20-35, women >20: B
Screen with TC and HDL: B

14. 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.

15. 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

16. 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

17. 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.

18. Smoking
Screen for tobacco use and provide tobacco cessation interventions Adults:
A
Pregnant women: A

19. Osteoporosis
Screening for osteoporosis Women ages 65+ and women 60-64 with
risk factors: B

20. 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).

21. 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

22. 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

23. 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

24. 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)

25. 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)

26. 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)

27. 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)

28. 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)

29. 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)

30. 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

31. 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

32. Screening
CVD
HTN
AAA
Obesity & eating disorder
Hyperlipemia
TB if at risk
Physical , sexual and emotional abuse
Learning and school problems
Substance use

33. Behavior and emotion for depression & suicide
Sexual behavior
STD
HIV
Cancer
DM
Vision and hearing problems

36. Recommended tests

37. ‫داستان نقش ویتامینها‬
‫در جلوگیری از بیماریها‬

38. Folic acid pregnancy
Cancer → Colorectal
CVD → Homocictein
HTN
Hearing loss

39. Vitamin D
Osteoporosis
Falls
Cancer(±)

40. Vitamin E
Cancer(−)
CVD(−)
Dement ion(−)
Infection(−)
DVT(+)

41. Antioxidant
Vitamin A (Retinol)
Cancer (±)
CVD(−)
Immunity (+) in children
Fraction (+) Retic factor
Cataract (−)

42. Vitamin C
Cancer (−)
CVD (−)
Cataract , Maculadegeration (−)

43. Vitamin B2
Riboflavin(−)
Vitamin B5
Pyridoxine(±)
Vitamin B12
Cobalamin
Poor intake

44. 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).