april 20111 back to basics, 2011 population health: periodic health exam, epidemiology &...

1April 2011

Back to Basics, 2011 POPULATION HEALTH:

Periodic Health Exam,

Epidemiology & Community Medicine

Based on slides prepared by Dr. R. Spasoff

2April 2011

078-3 PERIODIC HEALTH EXAMINATION (1)

• Clinical Guidelines for primary and preventive care• Targeted and Evidence based• Objectives target common conditions for each age group• Use periodic health exam for health promotion/disease

prevention interventions.• Case-finding and screening for disease & risky behaviours

3April 2011

Classification of Recommendations

• A Good evidence to recommend• B Fair evidence to recommend• C Existing evidence is conflicting and

does not allow to make a recommendation for or against

• D Fair evidence to recommend against• E Good evidence to recommend against• I insufficient evidence to recommend

4April 2011

Elements

• Discussion• Physical exam• Tests • Therapy

5April 2011

Gen Pop- Discussion

• Dental Hygiene (community fluoridation, brushing , flossing) (A)

• Noise control, hearing protection (A)• Seatbelt use (B)• Injury prevention (bicycle helmets, smoke

detectors) (B)• Moderate physical activity (B)

6April 2011

Gen Pop- Discussion

• Avoid sun exposure and wear protective clothing (B)

• Problem drinking screening, counselling (B)

• Counselling to protect against STI’s (B)• Nutritional counselling on fat and

cholesterol (B)

7April 2011

Gen Pop- Physical Exam

• Clinical breast exam women age 50-69 (A)• Blood pressure measurement (B)• BMI measurement in obese adults (B)

8April 2011

Gen Pop- Tests

• Mutiphase screening with FOB test adults>50 q1-2 yrs (A)

• Sigmoidoscopy adults > 50 freq not established (B)

• Bone Mineral Density (1 major or 2 minor criteria)

9April 2011

10April 2011

The Canadian Task Force on Preventive Health Care concludesthat there is fair evidence to recommend screeningpostmenopausal women to prevent fragility fractures (no orlow trauma fractures) (grade B recommendation). Althoughthere is no direct evidence that screening reduces fractures,there is good evidence that screening is effective in identifyingpostmenopausal women with low bone mineral density andthat treating osteoporosis can reduce the risk of fractures inthis population (grade A recommendation).

11April 2011

Gen Pop- Tests

• Fasting lipid profile Controversial• Fasting glucose- hypertension and

hyperlipidemia• Mammography women 50-69 q1-2 yrs (A)• Sexually active women Pap Smear q1y x2,

then q3y if both normal

12

Gen Pop- Tests not Recommended

• PSA still has insufficient evidence to justify screening

• Syphilis tests should not be done routinely• Breast self exam (D)- fair evidence of no

benefit and good evidence of harm

April 2011

13April 2011

Gen Pop- Therapy

• Folic Acid supplementation women of child bearing age (A)

• Pharmacologic treatment of hypertension with diastolic BP>90 mm Hg

14April 2011

Special Pops- Smokers

• Counsel on smoking cessation• Nicotine replacement therapy (A)• Referral to smoking cessation program (B)• Dietary advice on leafy green vegetables

and fruits (B)

15April 2011

Special Pops- Pediatric

• Discussion– Home visits to high risk families (A)– Inquiry into developmental milestones (B)

• Physical– Repeated examination of hips hearing and eyes (A)– Serial heights weights and head circumference (B)– Visual acuity testing (>2 yrs) (B)

16April 2011

Special Pops- Pediatric

• Tests– Routine hemoglobin fir high risk populations

(sickle cell and thalassemia) (B)– Blood lead screening for high risk infants (B)

• Therapy– Immunization

17April 2011

Special Pops- Adolescents

• Counsel on sexual activity and contraceptive methods (B)

• Counsel to prevent smoking initiation (B)

18April 2011

Perimenopausal Women

• Counsel on osteporosis• Counsel on risks and benefits of hormone

replacement therapy (B)

Special Pops- adults>65

• Followup on caregiver concern of cognitive impairment (A)

• Multidisciplinary post-fall assessment (B)• Visual acuity (Snellen) (B)• Hearing impairment (B)

20

Special Pops- Familial

• First degree relative with melanoma– Full body skin exam (B)

• Familial Adenomatous Polyposis– Sigmoidoscopy and genetic testing (B)

• Heridtary non-polyposis colorectal cancer– Colonoscopy (B)

April 2011

21

Special Pops- Other

• Tb high risk– Mantoux testing (A)– INH chemoprophylaxis for close contacts and

recent convertors (B)

• STI high risk– Voluntary HIV antibody screening (A)– Gonrrhea screening (A)– Chlamydia screening (B)

April 2011