Health Screening Guidelines
Many diseases are preventable , early detection of a disease is more cost-effective than treating the disease itself. In other words prevention is better than care.
The historical reduction in morbidity and mortality from screening tests is impressive.
For e.g.:
• The incidence of invasive cervical cancer has decreased dramatically since the introduction of Pap smear screening.
• The age adjusted mortality from stroker has decreased 50% since 1972, in Part related to earlier detection and treatment of hypertension.
Objectives:
• To learn the basic concepts and to understand the importance of Health Screening.
• To be able to formulate a preventive health care plan for a patient based on the patients age and risk factors through:
i - Primary Prevention: Prevent the development of diseases.
ii - Secondary prevention: Identify and treat symptomatic person with risk factors or pre-clinical disease. e.g. Pap smear, blood pressure screening
iii - Tertiary Prevention: Management of clinical illness to prevent complications e.g. Insulin therapy in diabetes Cholesterol management in coronary artery disease.
What is Health Screening?
It is a periodic evaluation of the body system to determine an individual's health status. It consists of various procedures which the doctors use to assess the well being of an individual.
The benefits of health screening:
1 One body is a dynamic constantly changing living being. Therefore Periodic health screening allows early detection of diseases Previously unknown to the individual. These may include heart disease; high BP (hypertension), Diabetes Mellitus and cancer, which are the leading cause of death in developed countries and often have no symptoms until advanced stages when treatment may be too late.
2 Promote health consciousness among patients.
3 It includes Individualized Counseling on the following issues:
- Diet: studies have shown that a diet high in fruits and vegetables can reduce the heart disease. Intensive counseling can be delivered by nutritionist or dietitians.
- Obesity: Health risk of being overweight. Exercise and physical activity importance.
- Alcohol and other Drug Abuse: Alcohol abuse is a major cause of chronic liver disease and cirrhosis.
- Dental Care: Patient should be counseled to visit a dental care provider on regular basis.
- Sexually Transmitted Diseases: All adolescent and adult patients should be advised of risk factors of Human Immunodeficiency Virus (HIV) infection and other Sexually Transmitted Diseases (STD) and counseled appropriately about effective measures to reduce the risk of infection.
- Smoking: Counseling on regular basis to stop smoking is recommended for all persons who smoke or use tobacco. Prescription Smoking Cessation aids should be offered for selected patients.
- Visual Impairment:
- Depression: Patients should be counseled to assure accurate diagnosis, effective treatments and follow-up.
- Injury Prevention: Parents of small children should be counseled on measures to reduce the risk of unintentional household and recreational injuries. Patients who use alcohol or illicit drugs should be warned against engaging in potentially dangerous activities while intoxicated.
- Unintended Pregnancy: Counseling about effective contraceptive methods is recommended for all women and men at risk for unintended pregnancy, and should also receive information about Prevention of Sexually Transmitted Diseases (STD).
- Risk of Skin Cancer with excessive exposure to the sun.
- Treatment option for menopausal women: Regular Health Screening is important to a woman's health at her menopause, as they are before. Some women still mistakenly believe that because they no longer menstruate, screening for mammogram and PAP smears are no longer needed. Patients should be counseled and complete information should be given.
• Polypharmacy or the overuse of medication.
• Benefits and limitation of Self Breast Examination (BSE): There is insufficient evidence to recommend for or against routine CBE or BSE alone.
• Counseling for stress management and limiting risk of occupational and environmental hazards.
4 Health Education: There are number of ways to render health education. Use a combination of methods, group classes, audiovisual aid, written material and community resources.
• Involve other health professionals such as dietitians, patient educator and nurses.
- Risk of smoking and alcohol/drug abuse
- Nutrition and exercise
- Testicular self examination, current screening recommendations
- High risk sexual behavior; efficacy of common method of contraception.
- Breast self examination
- Safety and injury prevention
- Post-menopausal hormone replacement therapy.
- Adequate calcium intake
- The risks, benefits, methods and recommendations for immunizing adults against Hepatitis B, Influenza, Pneumococcal Infection, Tetanus, Diptheria, Mumps, Measles
- Daily calorie, fat, carbohydrate, protein, mineral and vitamin requirements.
5 Health screening provides wide range of services with lower cost comprehensive packages, with the information that need to lead a healthier lifestyle.
Who should go for health screening?
All adults should go for health screening. It is particularly recommended for those with a family history of serious illness, those above 40 years of age and those with high risk of developing significant disease due to diet, lifestyle, nature of work, environment or other circumstances.
How often should one go for health screening?
Below 40 years old – once every 2 years or when necessary.
Above 40 years old – annually
What does health screening includes?
The basic health screening program should include the following:
• Full Physical Exam: This is an examination of major body systems.
• Height and weight: calculate body mass index (BMI)
• Blood Pressure: measure every visit. Recommended every 2 years above age 18. More frequently if borderline high or high blood pressure is indicated or if you have a family history.
• Pulse reading
• Review of medical history: this is a review of your previous medical illness, family medical history, present medical symptoms and medications.
• Hearing Test: Review on yearly basis, to determine hearing loss or assess need for hearing aid.
• Vision Examination: Specialized tests that evaluate vision loss or other eye conditions, such as glaucoma or macular degeneration.
• Age 45 and older – annually.
• Skin Examination: Visual inspection of skin for abnormal or pre-cancerous conditions.
• Every 3 years between ages 20-40 Yearly for women ages 40 and older.
• Spirometry which test lungs functions.
• Cervical cancer screening by:
- PAP Smear: Regular PAP smear screening is recommended every one to 3 years in all women with a cervix who are or have been sexully active or who are 21 years of age or older.
• Colorectal Cancer Screening: Faecal occult blood test (FOBT) age 50, and annually thereafter colonoscopy every 10 years, flexible sigmoidoscopy and double contrast barium enema every 5 years.
• Chalmydia Screening: All sexually active women age 25 and younger.
• Breast Cancer Screening: Mammogram every one to two years for ages 40 and from ages 40-49, every year above 50.
• Obesity Screen: Body mass index every one to three years
• Laboratory Tests: These are usually blood and urine tests that reveal diseases and internal status not easily detected by physical examination.
• Blood Screening: This will be tailored to the individual, however the basic profiles will be:
- Full blood count
- Renal function
- Liver function
- Cholesterol/body fats
- Prostate test over 40 years
- Thyroid function
- Blood sugar
• ECG (Resting test and ECG) to test the heart system, rate, and other abnormalities.
• Urine Analysis
• Chest X-ray
• Osteoporosis: Bone mineral density age 65 and over, every 2 years.
• Immunization schedule:
- Influenza - Annually at age 50 and above, younger if you have COPD.
- Pneumococcal - Once at age 65 or above, younger if you have COPD or other conditions that put you at high risk.
- TD Booster (Teatanus/Dptheria) – Every 10 years for adults Rubella – for childbearing age.
Why do people have a Health Screening? Health screening is a comprehensive assessment of health and well being, not only does it highlight any problem areas, but it also enables to practice preventive medicine.