الفحص الدوري الصحي

1. (
‫التوفيق‬ ‫هللا‬ ‫نسأل‬ ‫للجميع‬ ‫هدية‬ ‫المحاضرات‬ ‫هذه‬
)
Periodic Health
Examination
‫وأهميته‬ ‫الدوري‬ ‫الصحي‬ ‫الفحص‬
Dr EZIZ ALFAHD
afkaabba@gmail.com

3. Objectives :
1-Introduction
2- why we need periodic health Examination .
3- what is the content of PHE.
4- Guidelines .
5- National checklist .
6- PHE in Saudi PHCs.
7- References.

4. The pyramid & iceberg phenomenon

5. Health
Promotion / prevention
Health promotion
Education
Prevention
Protection
Health
A state of
complete physical,
mental, social well
being and not
merely the
absence of disease
.

6. Evaluation of apparently health individuals in certain
time periods, using a number of standard procedures
such as counseling, physical examination, immunization,
and laboratory investigations.
1- Definition / aim .
2- content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.

7. It helps in decrease morbidity and mortality :
1- Definition / aim .
2- content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.
MOH - prevalence:
DM ------ 23.7%
HTN------ ¼ Saudi adult
Obesity -- 28.7 % (>15ys)
-- 23% (children)
Overweight -- 30.7% (>15 ys)
-- 9 % (children)
Is it work ??
Early diagnosis and treatment of HTN
in USA >> Mortality from stroke has
decreased by 50%
Mortality from cervix cancer
decreased by 80%
National Center for Health Statistics.
http://www.cdc.gov/nchs/r&d/ndi/ndi.htm

9. 1- counseling
2- Screening :
- physical examination
- Investigation
3- Chemoprophylaxis :
- immunization.
- Medication.
1- Definition / aim .
2- Content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.
< 6 years
6-17 years
18-60 years
> 60 years

10. (under 6 years ) - Counseling
- Breast feeding :
intervention during pregnancy & after birth
- complementary feeding
- passive smoking
- Accident prevention
- Dental health
-insufficient evidence for dental caries examination
under 5 years (I) , Dental R > 1 year
- sun exposure:
5–30 min of sun exposure between 10 AM - 3 PM at least
twice a week (face, arms, legs, or back without sunscreen)
USPSTF The U.S. Preventive Services Task Force
National guideline 2015
- oct 2016 (B)
- oral fluoride supplementation at age >= 6 ms
for children whose water supply is deficient in
fluoride (B) – 2014

11. (under 6 years ) - Screening (examination)
- Denver chart : up to 6 years
- Growth parameters
-post. Fontanel .. 2 ms
-ant. Fontanel .. 2 years
- red reflex.. Abnormal > R
- corneal reflex for ocular alignment(Hirschberg test)
-cover uncover test > 2ys
-visual acuity in >2 ys
-Gross hearing ..N > response to sound ,
eye blinking, turning toward the sound
R > 3 ys for standardize audiometric test
- CVS, Abd, hernia, genitalia, LL, skin
USPSTF
National guideline 2015
- Vision screening : (B)- 2017
* at least once
* in all children aged 3 to 5 years
* to detect amblyopia or its risk factors
(I) -2017
The USPSTF concludes that the current
evidence is insufficient to assess the
balance of benefits and harms of vision
screening in children < 3 years.

12. 1- (under 6 years ) - Screening (examination)
Denver chart up to 6 Growth chart
-
-

13. 1- (under 6 years ) - Screening (examination)
Red reflex

14. 1- (under 6 years ) - Screening (examination)
corneal light reflex (Hirschberg test)

16. (under 6 years )- Chemoprophylaxis (medication)
- Iron to BF/LBWt
- 2mg/kg/day(max 15mg)
- start 1m age --- 12ms
- if <12m & not exclusive BF>> should take
formula with at least 12mg/L of iron
- VitK : 1mg IM after birth to prevent HDN
- HDN (Hemorrhagic disease of the newborn )
- Vit D 400 iu 0-12 m
600 iu 1-13 yrs
USPSTF
National guideline 2015

17. 1- (under 6 years )- Chemoprophylaxis (immunization)
- National schedule

18. 1- counseling
2- Screening :
- physical examination
- Investigation
3- Chemoprophylaxis :
- immunization.
- Medication.
1- Definition / aim .
2- Content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.
< 6 years
6-17 years
18-60 years
> 60 years

19. (6 – 17 years ) - Counseling
- Abuse & violence
- smoking state & cessation
- sun exposure
- STDs
-Depression screening:
mood / loss of interest in past 2 wks ..>12 ys
- oral hygiene/dental Counselling:
dental Referral >1years age then annually
USPSTF
National guideline 2015
(STIs) (B) -2016
-intensive behavioral counseling for all
sexually active adolescents and for adults
who are at increased risk for sexually
transmitted infections.
Depression screening :(B) 2016
-recommends screening for (MDD) at
age12 - 18 years. Screening should be
implemented with adequate systems in
place to ensure accurate dx, effective
treatment, and appropriate f/u.

20. (6 – 17 years ) - screening ( examination )
- BMI plotting chart :
Annually
According to age/gender chart
- mouth examination
USPSTF
National guideline 2015
Obesity (B) - 2017
- The USPSTF recommends screening for
obesity in children and adolescents
> = 6 years and offer or refer them to
comprehensive, intensive behavioral
interventions to improve wt. status.

21. (6 – 17 years ) - screening ( investigation )
- HIV:
- Chlamydia:
USPSTF
National guideline 2015
HIV (A)-2013
- The USPSTF recommends screening for
HIV infection in adolescents and adults
ages 15 to 65 years. Younger adolescents
and older adults who are at increased risk
should also be screened.
Chlamydia (B) 2014
- The USPSTF recommends screening for
chlamydia in sexually active women age
24 years or younger and in older women
who are at increased risk for infection.

22. (6 – 17 years ) - chemoprophylaxis( medication )
-folic acid:
pregnant ..0.4-0.8 mg 1month before &
continue daily 2-3 months of pregnancy
-fluoride: Ask about water if:
<0.3 ppm … 1mg/day
0.3-0.6 ppm.. 0.5 mg/day
> 0.6 ppm … no need
-Vit D
600iu ..13 years
USPSTF
National guideline 2015
Folic acid (A) -2017
- The USPSTF recommends that all
women who are planning or capable of
pregnancy take a daily supplement
containing 0.4 to 0.8 mg (400 to 800 µg)
of folic acid

23. (6 – 17 years ) - chemoprophylaxis( immunization )
- Catch up vaccination :
Varicella , MMR , IPV. OPV, Hbv, Hcv
- Influenza , TDaP , TD, PCV 13, MCV, Hib,
PPSV 23
USPSTF
National guideline 2015
Refer to CDC

24. COFFE BREAK

25. 1- counseling
2- Screening :
- physical examination
- Investigation
3- Chemoprophylaxis :
- immunization.
- Medication.
1- Definition / aim .
2- Content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.
< 6 years
6-17 years
18-60 years
> 60 years

26. (18 – 60 years) - Counseling
- Abuse & violence
- smoking state & cessation
- sun exposure
- behavioral counseling for STDs
-Depression screening
- oral hygiene: at least every 1 year
- Behavioral counseling for obesity
USPSTF
National guideline 2015
Alcohol misuse counseling :(B)- 2013
* adults age>= 18 years for alcohol misuse
* provide behavioral counseling interventions
to reduce alcohol misuse.
Healthy diet and physical activity counseling to
prevent CVD : adults with CVR factors (B)-2014
* offering or referring adults who are
overweight or obese & have additional (CVD)
risk factors to >>>
intensive behavioral counseling interventions to
promote a healthful diet and physical activity
for CVD prevention.

27. (18 – 60 years) - screening (examination)
-BMI & waist
Every 2years in all adult >18 years
- Mouth examination
-BP
every 2ys if <=120/80
Every 1 y if 120-130/80-89
USPSTF
National guideline 2015
Obesity (B) 2012
* Screening all adults for obesity.
* Offer or refer patients + BMI >= 30
kg/m2 to intensive, multicomponent
behavioral interventions.
BP (A) 2015
* Screen adults aged > =18 years .
* Obtaining measurements outside of
the clinical setting for diagnostic
confirmation before starting treatment.

28. (18 – 60 years) - screening (investigation)
- FBS/HbA1c/RBS :
Start 45yrs Q 3 yrs , all adult BMI>=25 with risk factors
- Fasting lipid profile
F>=45 , M>=35 yrs Q5yrs OR Q 1 y if with CVR factors ???
- Pap Smear: on 21 yrs
- mammogram: 50-74y
- STDs :Chlamydia/gonorrhea/ syphilis/ HIV
- Colon ca: >=50 yrs
F occult bld Q 1y
Flexible sigmodos. Q 5ys
Colonoscopy Q 10 yrs
- DEXA : screening for Osteoporosis for lady risk OP Q 1-2
ys
USPSTF
National guideline 2015
Diabetes screening (B) 2015
* 40 to 70 years (overweight or obese).
* Clinicians should offer or refer
patients with abnormal blood glucose
to intensive behavioral counseling
interventions to promote a healthful
diet and physical activity.

29. Cardiovascular Risk Factors Cardiovascular Risk assessment
Framingham Risk assessment
1- F. Hx of premature cardiovascular event
2- hyperlipidemia
3- hypertension
4- physical inactivity
5- obesity / overweight
6- smoking
7- DM
Estimate 10-years risk of developing MI
or Death
1- gender
2- age
3- smoker
4- LDL / total cholesterol
5- HDL
6- DM
7- BP

30. (18 – 60 years) - screening (investigation)
- FBS/HbA1c/RBS :
Start 45yrs Q 3 yrs , all adult BMI>=25 with risk factors
- Fasting lipid profile
F>=45 , M>=35 yrs Q5yrs OR Q 1 y if with CVR factors ???
- Pap Smear: starting at age 21 yrs once/3 yrs then every
3 yrs after 3 consecutive normal sample.
- mammogram: 50-74y
- STDs :Chlamydia/gonorrhea/ syphilis/ HIV
- Colon ca: >=50 yrs
F occult bld Q 1y
Flexible sigmodos. Q 5ys
Colonoscopy Q 10 yrs
- DEXA : risk OP Q 1-2 ys
USPSTF
National guideline 2015
Gonorrhea . (B) -2014
• In sexually active women age < = 24
years and
• in older women who are at increased
risk for infection.
Syphilis : (A) -2016
In adult (non-pregnant) who are at
increased risk for infection.
The USPSTF recommends that clinicians
screen all pregnant women for syphilis
infection. (A) -2009

31. (18 – 60 years) - screening (investigation)
- FBS/HbA1c/RBS :
Start 45yrs Q 3 yrs , all adult BMI>=25 with risk factors
- Fasting lipid profile
F>=45 , M>=35 yrs Q5yrs OR Q 1 y if with CVR factors ???
- Pap Smear: starting at age 21 yrs once/3 yrs then every
3 yrs after 3 consecutive normal sample.
- mammogram: 50-74y
- STDs :Chlamydia/gonorrhea/ syphilis/ HIV
- Colon ca: >=50 yrs
Fecal occult blood Q 1y
Flexible sigmoidoscopy Q 5ys
Colonoscopy Q 10 yrs
- DEXA : >>>>>>> as USPSTF
USPSTF
National guideline 2015
Colon ca. screening (A) -2016
* age 50-75 years
- FOBT every 1 year
- Flexible sigmoidoscopy every 5ys
- CT colonography
- Colonoscopy every 10 yrs
Osteoporosis screening (B) - 2012
*women >= 65 years
* <65 + high fracture risk( 10 yrs # risk)
Using DEXA of hip & lumber spine / minimum of
2 years to measure a change in BMD

32. (18 – 60 years) - Chemoprophylaxis (medication)
-Folic acid :
* 0.4 – 0.8 mg (pregnant / planning )
* 4mg/day if high risk for NTD
( DM, epileptic, previous baby NTD )
- ASA:
81 mg od
M 45 , F 55 yrs ( upto 79 years)
-VitD
USPSTF
National guideline 2015
Aspirin :(B) 2016
adults aged 50 - 59 years who have
> =10% 10-year CVR
not at increased risk for bleeding,
have a life expectancy of at least 10 yrs
and are willing to take low-dose aspirin
daily for at least 10 years.
The USPSTF recommends initiating low-
dose aspirin for the primary prevention
of CVD and colorectal cancer

33. (18 – 60 years) - Chemoprophylaxis (immunization)
- Catch up vaccine :
MMR
- infl. ,Tdap/Td, pcv13, MCV, Hib, PPSV23, HAV,
HBV, varicella
USPSTF
National guideline 2015
Refer to CDC

34. (18 – 60 years) - Chemoprophylaxis (immunization)

36. 1- counseling
2- Screening :
- physical examination
- Investigation
3- Chemoprophylaxis :
- immunization.
- Medication.
1- Definition / aim .
2- Content of PHE.
3- Guidelines .
4- National checklist
5- MCQ
6- PHE records
7- References.
< 6 years
6-17 years
18-60 years
> 60 years

37. ( > 60 years) - Counseling
- Smoking state & cessation
- Alcohol abuse
- Depression screening
- Diet
- Fall assessment & physical activity :
RISK ASSESSMENT :
1- Hx of fall
2- mobility problem
3- poor performance on timed Get-Up-&-Go test
USPSTF
National guideline 2015
Falls prevention in older adults:
(B)- 2012
*exercise or
*physical therapy and
*vitamin D supplementation
to prevent falls in community-dwelling
adults > = 65 years who are at
increased risk for falls.

38. ( > 60 years) - Screening (examination)
- BMI
- BP
Q 2ys if <=120/80
Q1 y if 120-130/80-89
USPSTF
National guideline 2015

39. ( > 60 years) - screening (investigation)
- FBS/HbA1c/RBS :
Start 45yrs Q 3 yrs , all adult BMI>=25 with risk factors
- Fasting lipid profile
F>=45 , M>=35 yrs Q5yrs OR Q 1 y if with CVR factors
- Pap Smear: on 21 yrs
- mammogram: 50-74y
- Colon ca: >=50 yrs
- DEXA : risk OP Q 1-2 ys
- Abdominal ultrasound :
M 65-75 ys
who ever smoked to R/o AAA (abd.Aortic Aneurysm)
USPSTF
National guideline 2015
Abdominal Aortic Aneurysm: (B)-2014
65-75 yrs old man who ever smoked.
>>> one-time screening for AAA by
ultrasonography.
>>>Women 65-75 years :
no recommendation (I)

40. ( > 60 years) - Chemoprophylaxis (medication)
- ASA:
81 mg od
M 45 , F 55 yrs
( up to 79 years )
-VitD
800 iu od
USPSTF
National guideline 2015
Aspirin :(B) 2016
adults aged 50 - 59 years who have
> =10% 10-year CVR
Statin :(B) 2016
Statin preventive medication:
Low-moderate dose statin for :
1- adults ages 40–75 years with no
history of CVD ( ischemic stroke/ CAD )
2- > = 1 CVD risk factors
3- calculated 10-year CVD event risk of
> = 10%

41. ( > 60 years) - Chemoprophylaxis (immunization)
- infl. ,Tdap/Td, pcv13, MCV, MMR, PPSV23, HAV,
HBV, varicella , Zoster
USPSTF
National guideline 2015
Refer to CDC

42. References

43. Thank you