Screening
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
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Objectives
• Describe the role of Periodic Health
Examination (PHE) in primary care
• Count three diseases with highest mortality
• Mention PHE guideline resources
• Explain the effective screening criteria used
in PHE
• Aware of the risks in PHE
• Aware of the importance of PHE and
preventive medicine in primary care.
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Iceberg phenomenon ?
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Diseased, diagnosed & controlled
2
Diagnosed, uncontrolled
3
Undiagnosed or wrongly
diagnosed disease
4
Risk factors for disease
5
Free of risk factors
Diagnosed
disease
Undiagnosed or
wrongly diagnosed
disease
3
The High mortality diseases in
Saudi Arabia
•
•
•
•
•
•
Symptoms /Signs ill defined ……
Diseases of CVS………………...
Injury / Poisoning……………….
Conditions perinatal period……..
Neoplasms………………………
Diseases of RS………………….
MOH- Saudi Arabia
24.64%
21.82%
18.31%
9.88%
4.55%
4.38%
Evidence Based Recommendations
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Screening
Screening involves the utilization of a
diagnostic procedure to check for the presence
of a disease prior to the manifestation of
clinical symptoms
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Goal of screening
The goal of screening and evaluation is to
prevent the onset of disease or the worsening
of an existing disease.
For example, measurement of blood pressure
is intended to detect hypertension so as to
initiate treatment and prevent subsequent
morbidity (e.g., stroke or renal failure) or mortality.
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World Health Organization — Principles of
Screening
The Wilson-Jungner Criteria. Public Health Paper 1968,
Geneva, WHO
• The condition should be an important health problem.
• There should be a treatment for the condition.
• Facilities for diagnosis and treatment should be available.
• There should be a latent stage of the disease.
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• There should be a test or examination for the condition.
• The test should be acceptable to the population.
• The natural history of the disease should be adequately
understood.
• There should be an agreed policy on who to treat.
• The total cost of finding a case should be economically
balanced in relation to medical expenditure as a whole.
• Case-finding should be a continuous process, not just a
"once and for all" project.
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Types of screening
•
•
•
•
Mass
Targeted
Multiple or Multiphasic
Case-finding or opportunistic
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Risk in Screening
• Adverse effects of screening procedure (e.g. Stress,
anxiety, radiation exposure, chemical exposure).
• Stress and anxiety caused by a “False Positive” screening
result.
• Unnecessary investigation and treatment of false positive
results.
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• Prolonging knowledge of an illness if
nothing can be done about it.
• A false sense of security caused by false
negatives, which may even delay final
diagnosis.
• Overuse/waste of medical resources.
• Unnecessary and uncomfortable procedures
looking for a disease that is unlikely
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Periodic Health Examination
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
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Importance of PHE
• Educate patients about behavioral patterns or
environmental exposures that pose risks for future
diseases.
• Examples include
– 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.
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Sources for information of PHE
1. AAFP recommended periodic-healthexaminationwww.aafp.org/fpr/970300fr/5.
html
2. Canadian Task Force on Preventive
medicine.www.ctfphc.org
3. NHS Screening. www.screening.nhs.uk
4. PHE.www.answers.com/topic/periodichealth-examination
5. PHE. www.enotes.com/public-healthencyclopedia/periodic-health-examination
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Screening / PHE programs in
Saudi Arabia
• Annual periodic health examination for all
diabetic and hypertensive patients registered
at PHC
• Cervical screening
• Breast cancer screening in some areas
• Pre-marital screening (genetic dis.,
infectious dis.)
• Well baby clinic
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Counseling
• Counseling during the periodic health
examination is also very important, for this is
where physicians recommend changes in
lifestyle that can affect future morbidity and
mortality
– Premarital
– Risky behaviours
• Smoking
– According to age group
– Healthy diet
– Exercise...
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Thanks
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