Aktif Dinleme - Iletisim Kursu, Kirikkale - Ocak 2005

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Preventive Medicine and Periodic Health
Examinations in Primary Care
Dr. Zekeriya Aktürk
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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.

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What are primary care physicians doing?
Tertiary Prevention
Primary Prevention
Secondary Prevention
Personal Preventive Medicine!
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Prevention of what?
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Reasons of diseases ()
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Insurance companies Mortality decreases in
persons undergoing regular health checks!
CHECK-UP (1921)
Some diseases dont 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
PERIODIC HEALTH EXAM was introduced. (1970)
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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.
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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/rd/ndi/ndi.htm
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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/teme
l2000/97.htm
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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?

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Effective screening criteria

1. Prevalence of the disease should be highNo sense
   to screen diseases with low prevalance.-
   Osteogenesis imperfecta incidence 1/10 000/year

Medline Plus. Medical Encyclopedia. Osteogenesis
imperfecta. http//www.nlm.nih.gov/medlineplus/en
cy/article/001573.htm
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Effective screening criteria
2. Predictive risk factors or tests should be
presentThe safety and cost of the test should be
known- CRP Cheap but not specific -
Echocardiograpy sensitive and specific but
expensive
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Basic Parameters
Population-100 persons
() Test
(-) Test
Diseased (Prevalence)
Sensitivity
10 4 6 80
Specifity
Healthy
PPV
NPV
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Effective screening criteria
3. Morbidity and mortality should be highFactors
related with morbidity and mortality (beyond the
disease itself)
- Age- Sex- Race- Gegraphical area- Life
style (culture)
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Mortality according to age groups

• 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

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Effective screening criteria

• There should be an acceptable treatmentNo sense
  to srean untreatable diseases- Lung cancer (?)
• 5. There should be a prodromal period without
  complains- AIDS- Syphilis- Cervix cancer-
  Breast cancer

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The natural course of diseases
Aggressive cancer
1 year
6 mo
Beginning
Symptoms
DEATH
Screening once a year
4 year
2 year
Symptoms
DEATH
Beginning
The same cancer but less aggressive
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Lets come back to our example patient with
breast cancer

• Its 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

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Can periodic health examination be harmful?
The average error rate of a test 5
Ian R. McWhinney. A Textbook of Family Medicine.
Oxford University Press, USA 1997.
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The Check-up Chaos

• 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

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How is PHE performed?

• Healthy individuals
• Counseling
• Immunization
• Home visit
• Prophylaxis
• Physical exam
• Laboratory test

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Any Guidelines for KSA?
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