Periodical Health Care

Transcription

1 Periodical Health Care Associate Prof. Dr. Memet IŞIK Ataturk University Medical Faculty Department of Family Medicine Web: 1

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3 WHAT DO PRİMARY CARE PHYSİCİANS? Sağlık Bakımı Sağlığı iyileştirme Riskten koruma Risk azaltma Erken tanı Komplikasyon azaltma Primary Prevention Secondary Prevention Tertiary Prevention Individual Preventive Medicine! 3

4 WHAT DO PRİMARY CARE PHYSİCİANS? Health Care İmprove Health Prevent Risk Decrease Risk Early Diagnosis Decrease Complications Primary Prevention Secondary Prevention Tertiary Prevention Individual Preventive Medicine! 4

5 Prevention of What? 5

6 CAUSES OF DİSEASES(%) Ulaşım Genetik Çevre Davranış Access to care Genetic Environment Behaviors 6

7 İnsurance companies: Mortality decreases in persons how have regular check up! CHECK-UP (1921) Some diseases don t give a symptom, when they give symptoms to be diagnosed, there would not be enough time to treatment: the checkup era is over. Now its time of periodic health examination which changes according to age, exposure, gender, personal risks PERIODIC HEALTH EXAMINATION (1970) 7

8 The purpose of the periodic health examination is to evaluate health status, screen for risk factors and disease, and provide preventive counseling interventions in an age-appropriate manner. 8

9 The goal of screening and evaluation to prevent the onset of disease or the worsening of an existing disease. measurement of blood pressure to detect hypertension initiate treatment and prevent subsequent morbidity (e.g., stroke or renal failure) or mortality. to educate patients about behavioral patterns or environmental exposures that pose risks for future diseases. Counseling about smoking prevention and cessation to prevent lung cancer and emphysema, seat belt use to prevent motor-vehicle injuries, or modifying sexual practices to prevent the spread of sexually transmitted disease. 9

10 Does it work? In the United States Stroke (stroke) mortality has decreased by 50% since 1972 Early diagnosis and effective treatment of hypertension Cervical cancer mortality decreased by 80% neonatal screening Decrease in mental disfunction phenylketonuria screening Congenital hypothyroidism National Center for Health Statistics. 10

11 Vaccination and polio Polio eradication efforts began in 1989 in Turkey. Every year 6.5 million children are immunized Recent cases seen in ,8 1,6 1,4 1,2 1 0,8 0,6 0,4 0,2 0 Morbidite hızı(1/ ) Mortalite hızı(1/ ) Sağlık Bakanlığı, Polio morbidite ve mortalite hızları ,7 0,6 0,5 0,4 0,3 0,2 0,1 0

12 Daily Practice 30 year old woman visits your for a check-up. No history of any disease but she is concerned about breast cancer. Should you perform a breast examination? Should you teach breast self examination? Should you ask a mammography? How do you decide? 12

13 Effective Screening Criteria-1 1. Prevalence of the disease should be high PHE is not logical for the disease with a very low prevalence. - The incidence of osteogenesis imperfecta is : 1/10 000/year Medline Plus. Medical Encyclopedia. Osteogenesis imperfecta. 13

14 Effective Screening Criteria-2 For early diagnosis, there should be predictive risk factors or tests The reliability and the cost of the test should be known Tahmin ettirici risk faktörleri veya testler olmalı Testin güvenilirliği ve maliyeti bilinmeli - CRP: is cheep but no specific - Echocardiography : Sensitive and specific, but expensive 14

15 Which Screening Test? Take into account: Incidence Sensitivity (Duyarlık) Prevalence Morbidity of the disease Specificity (Özgüllük) PPV (Pozitif Tahmin) of the test Mortality NPV (Negatif Tahmin) 15

16 Basic Parameters Hasta (Prevalans) Sağlıklı (+) Test (-) Test Toplum-100 kişi Sensitivity (Duyarlık) Spesificity (Özgüllük) PPV NPV 16

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18 SENSİTİVİTY: ABİLİTY TO İDENTİFY POSİTİVE RESULTS. THE SENSİTİVİTY OF A TEST İS THE PROPORTİON OF PEOPLE WHO HAVE THE DİSEASE WHO TEST POSİTİVE FOR İT. IF A TEST HAS HİGH SENSİTİVİTY THEN A NEGATİVE RESULT WOULD SUGGEST THE ABSENCE OF DİSEASE. 18

19 Sensitivity Disease Present Absent Test Positive a b Negative c d Sensitivity 19

20 Specificity: The proportion of patients who do not have the disease who will test negative for it. Specificity = d b+d 20

21 Specificity Disease Present Absent Test Positive a b Negative c d 21

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23 POSİTİVE PREDİCTİVE VALUE Disease Present Absent Test Positive a b Negative c d PPV: Testte pozitif çıkanların gerçekten hasta olma ihtimali PPV= a a+b 23

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25 NEGATİVE PREDİCTİVE VALUE Disease Present Absent Test Positive a b Negative c d NPV: Test negatif çıkanların sağlıklı olma ihtimali NPV= d c+d 25

26 Relation between PPV and Prevalence pupulation = 100,000 Sensitivity = % 90 Specificity = % 90 Cancer Prevalence = % 1 Cancer Prevalence = % 0.1 Ca + Ca - test ,900 test ,100 PPV = % 8.3 Ca + Ca - Test ,990 test ,910 PPV = %

27 Effective Screening Criteria-3 Mortality and morbidity of the disease should be high Factors affecting morbidity and mortality of the apart from the disease type. - Age - Gender - Race- genetics - Geographic location - Living habits (culture) 27

28 Effective Screening Criteria 4. There should be an acceptable treatment It is nonsense to screen the incurable diseases Lung Ca? 5. There should be a prodromal period without symptoms. Şikayetlerin olmadığı bir erken dönem olmalı - AIDS - Syphilis? - Cervical cancer? - Breast cancer 28

29 Natural Course of a Disease biological start 2. early diagnosis is possible 3. clinical diagnosis 4. the result 29

30 An aggressive Cancer Beginning 6 ay Symptoms 1 yıl Death Beginning 2 year Symptoms Screening test performed once a year 4 year Death Less aggressive Cancer 30

31 BREAST CANCER Is an important disease for women The most common cancer in women. 30 thousand cases per year in Turkey. Symptoms can be detected before they occur Self-examination, physical examination, Mammography Cure is possible Surgery, Chemotherapy, Radiotherapy Benefit of treatment is greater than the discomfort 31

32 Periyodik Muayene Zararlı Olabilir mi? Asymptomatic person Screening Test normal Test abnormal True negative False negative True pozitive False pozitive Relieving Delay in diagnoses Treatment Anxiety The average error rate of a test : %5 Ian R. McWhinney. A Textbook of Family Medicine. Oxford University Press, USA

33 AKİF BEY 52-year-old... A company executive... Last week one of his colleagues hospitalized in the coronary care unit due to heart attack No complaints, but is concerned about. He wants to have a "check-up" to find out whether he has a heart disease. 33

34 AYNUR HANIM 34 y.o, teacher... Her mother died at the age of 55 due to breast ca. One of her friend adwised her to have an mammography. 34

35 KAMİL BEY 42 y.o., farmer. Smoking for 30 years. One of his friend who is also a havy smoker diagnosed as lung ca.. He wants to have a chest x ray.. 35

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38 Checkup chaos in our country -- Chest X-ray to scan lung diseases, --Urine test for screening urinary tract disorders, --ECG for screening CVD --Microfilm for tuberculosis screening, --PSA for prostate cancer screening, - Breast self-examination, for cancer breast cancer --Complete blood count for blood disease screening --Influenza vaccine for the prevention of influenza in healthy young people 38

39 How to Perform Periodic Health Examination? Although they are healthy, individuals are invited for a control by giving appointment at regular intervals. Service based on PHE criteria is provided to individual? - - Consultation - Vaccine - Home visit Examination - Prophylaxis - test (screening) 39

40 Suggestions in Our Country? For the year

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42 Suggestions for PHE Not to do 1. Pancreatic cancer screening in asymptomatic people 2. Bladder cancer screening in asymptomatic people 3. Peripheral arterial disease screening in asymptomatic people 4. Lung cancer screening in asymptomatic people 5. Thyroid cancer screening in asymptomatic people 6. Immune marker screening for type 1 diabetes in asymptomatic people 42

43 Suggestions for PHE 7. Genital HSV screening in asymptomatic people 8. Routine ECG screening in asymptomatic people 9. Routine urine examination in asymptomatic men 10. Routine urine examination in women (with the except of diabetic and homeless women) 11. Routine thyroid function tests (with the except of under sixty years of age and neonatal period) 12. Ovarian cancer screening in women who are not at risk 43

44 SUMMARY Which of the following is not an element of the periodic health examination? Consultancy Vaccination Examination Treatment of Diseases Home visits 44

45 Which one of the following are not taken into account in determining PHE suggestion rules? There should be an asymptomatic period of the disease for scanning. There should be an acceptable treatment for the disease Morbidity and mortality of the disease should be low The prevalence of the disease in the community should be high There should be predictive risk factors or tests for early diagnosis 45

46 In regard to PHE, which of the following is true for implementation? ECG screening for heart disease Complete blood count for the screening of blood diseases Chest radiography for scanning of lung diseases Measurement of weight and height in children in every application Making healthy checkup once a year to every individual 46