1. Saudi Diploma in Family Medicine / 24 1 Dr. Zekeriya Aktürk Preventive Medicine and Periodic Health Examinations in Primary Care

2. Saudi Diploma in Family Medicine / 24 2 Aim-Objectives At the end of this presentation the participants will be; –Able to describe the role of PHE in primary care –Able to count three diseases with highest mortality –Able to define PHE –Able to explain the effective screening criteria used in PHE –Aware of the risks in PHE –Able to describe current clinical preventive service recommendations for family practice –Aware of the importance of PHE and preventive medicine in primary care.

3. Saudi Diploma in Family Medicine / 24 3 What are primary care physicians doing? Health Care Health promotion Risk prevention Risk reduction Early diagnosis Complication reduction Personal Preventive Medicine! Primary Prevention Secondary Prevention Tertiary Prevention

4. Saudi Diploma in Family Medicine / 24 4 Prevention of what?

5. Saudi Diploma in Family Medicine / 24 5 Reasons of diseases (%)

6. Saudi Diploma in Family Medicine / 24 6 Insurance companies: “Mortality decreases in persons undergoing regular health checks!” CHECK-UP (1921) PERIODIC HEALTH EXAM was introduced. (1970) Some diseases don’t have enough clues at the beginning, and when able to diagnose there was no time for treatment: check-up gone. Changing by personal factors such as age, exposure, sex, and risk

7. Saudi Diploma in Family Medicine / 24 7 Definition Evaluation of apparently health individuals in certain time periods, using a number of standard procedures such as counseling, physical examination, immunization, and laboratory investigations is called Periodic Health Examination.

8. Saudi Diploma in Family Medicine / 24 8 Does it work? USA: Mortality from stroke has decreased by 50% since 1972 –Early diagnosis and treatment of hypertension Mortality from cervix cancer decreased by 80% Neonatal screening –Decrease in mental retardation Phenylketonuria screening Congenital hypothyroidism National Center for Health Statistics. http://www.cdc.gov/nchs/r&d/ndi/ndi.htm

9. Saudi Diploma in Family Medicine / 24 9 Immunization and Polio Polio eradication in Turkey Every year 6.5 million children are immunized Last case seen in 1998 Turkish MoH, polio morbidity and mortality rates. http://www.saglik.gov.tr/extras/istatistikler/temel2000/97.htm

10. Saudi Diploma in Family Medicine / 24 10 Think of your daily life A 30-year old woman applies to your office. She has no history of disease but afraid of becoming breast cancer. –Should you perform a breast exam? –Should you teach her breast self exam? –Should you order a mammography? How do you decide?

11. Saudi Diploma in Family Medicine / 24 11 1.Prevalence of the disease should be high No sense to screen diseases with low prevalance. - Osteogenesis imperfecta: incidence 1/10 000/year Effective screening criteria Medline Plus. Medical Encyclopedia. Osteogenesis imperfecta. http://www.nlm.nih.gov/medlineplus/ency/article/001573.htm

12. Saudi Diploma in Family Medicine / 24 12 2. Predictive risk factors or tests should be present The safety and cost of the test should be known - CRP: Cheap but not specific - Echocardiograpy: sensitive and specific but expensive Effective screening criteria

13. Saudi Diploma in Family Medicine / 24 13 10 4 6 80 Diseased (Prevalence) Healthy Specifity Sensitivity PPVNPV (+) Test(-) Test Basic Parameters Population-100 persons

14. Saudi Diploma in Family Medicine / 24 14 3. Morbidity and mortality should be high Factors related with morbidity and mortality (beyond the disease itself) : Effective screening criteria - Age - Sex - Race - Gegraphical area - Life style (culture)

15. Saudi Diploma in Family Medicine / 24 15

16. Saudi Diploma in Family Medicine / 24 16 0-18 months Perinatal causes Congenital anomalies 7-12 years Accidents other than motor vehicle Motor vehicle accidents 19-39 years Motor vehicle accidents Suicide 65 years and older Heart diseases Cerebrovascular diseases Mortality according to age groups

17. Saudi Diploma in Family Medicine / 24 17 4.There should be an acceptable treatment No sense to srean untreatable diseases - Lung cancer (?) 5.There should be a prodromal period without complains - AIDS - Syphilis - Cervix cancer - Breast cancer Effective screening criteria

18. Saudi Diploma in Family Medicine / 24 18 4 year Beginning Symptoms DEATH 2 year 1 year6 mo Aggressive cancer The same cancer but less aggressive Screening once a year The natural course of diseases

19. Saudi Diploma in Family Medicine / 24 19 Let’s come back to our example: patient with breast cancer It’s an important disease for women –Worldwide 719000 new cases/year. (1/1000) Morbidity/mortality It can be recognized without symptoms –Mammography Curable –Surgery, Chemotherapy, Radiotherapy The value of treatment is more than its adverse effects

20. Saudi Diploma in Family Medicine / 24 20 Can periodic health examination be harmful? Asymptomatic person Screening Test normal True negative Reassurance False negative Delay in diagnosis Test abnormal True positive Treatment False positive Anxiety The average error rate of a test: %5 Ian R. McWhinney. A Textbook of Family Medicine. Oxford University Press, USA 1997.

21. Saudi Diploma in Family Medicine / 24 21 Chest x-ray to screen lung diseases, Urinanalysis to screen urinary diseases, ECG, Microfilm to screen Tbc, PSA to screen prostate cancer, Self exam to screen breast cancer, CBC, Influenza immunization for healthy adolescents The Check-up Chaos

22. Saudi Diploma in Family Medicine / 24 22 How is PHE performed? Healthy individuals Counseling Immunization Home visit Prophylaxis Physical exam Laboratory test

23. Saudi Diploma in Family Medicine / 24 23 Any Guidelines for KSA?

24. Saudi Diploma in Family Medicine / 24 24