Corporate Health Screening

Transcription

1 Corporate Health Screening What should I look out for? Presented by: Dr Wee Wei Keong Director Health for Life Programme

2 WHAT IS HEALTH SCREENING? Tests/procedures carried out to detect a condition/disease Example include blood and urine tests, X-rays etc Conducted at regular intervals May be targeted at particular groups It is NOT diagnostic and may require CONFIRMATION

3 WHEN & WHAT TO SCREEN? WHO recommends: Condition is an important health problem (high prevalence) Natural history of disease is understood Recognisable latent or early symptomatic stage Suitable and acceptable screening test (Sensitive? Specific? Good PPV? Reliable?) Accepted treatment and useful intervention available Cost-effective method Case-finding should be a continuing process

4 THE PLAIN HEALTH FACTS

5 MAJOR KILLERS IN SINGAPORE (2006) Cancer 28.5% Coronary Heart Disease 18.5% Pneumonia 13.7% Cerebrovascular Disease 8.9% Accidents, Poisoning & Violence 6.3%

6 MAJOR KILLERS IN SINGAPORE (2006) Other Heart Diseases 4.3% Diabetes 3.3% Chronic Obstructive Lung Disease 3.3% Urinary Tract Infections 2.0% Nephritis, Nephrotic Syndrome 1.7% & Nephrosis

7 TOP 5 CANCERS IN WOMEN Breast Colorectum Lung Ovaries Cervix

8 TOP 5 CANCERS IN MEN Lung Colorectum Liver Stomach Prostate

9 RISK FACTORS FOR HYPERTENSION Obesity High Cholesterol/Fat Intake High Salt Intake High Alcohol Intake Diabetes Smoking Excessive Stress Family History

10 MAJOR RISK FACTORS FOR DIABETES Obesity Lack of Exercise Unbalanced Diet Family History Diabetes in Pregnancy

11 MAJOR RISK FACTORS FOR CORONARY HEART DISEASE Hypertension Diabetes Smoking Hyperlipidemia Family History Age Sex Obesity Lack of Exercise (sedentary) Excessive Stress Menopause

12 MAJOR RISK FACTORS FOR STROKE Age 55 years and above Hypertension Diabetes Coronary Heart Disease Smokers High Cholesterol/Fat Intake High Alcohol Intake Excessive Stress Obesity High Blood Cholesterol

13 Diabetes Family History Age MAJOR RISK FACTORS FOR ATHEROSCLEROSIS Male Hypertension Hyperlipidemia Atherosclerosis Menopause Stress Diet Smoking Obesity Sedentary Lifestyle

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15 IMPORTANT FINDINGS (NHS 2004) 1 in 5 adult Singaporeans have high blood cholesterol 1 in 8 of adult Singaporeans are daily smokers

16 IMPORTANT FINDINGS (NHS 2004) 1 in 3 adult Singaporeans are either overweight or obese (includes 6.9% or 1 in 14 who are obese) 1 in 4 adult Singaporeans exercise regularly

17 IMPORTANT FINDINGS (NHS 2004) 1 in 4 adult Singaporeans have hypertension (39.7% or 4 in 10 don t know) Some 1 in 12 adult Singaporeans have diabetes (49.4% or almost half don t know)

18 IMPORTANT FINDINGS (NHS 1998) Only 1 in 4 adult Singaporean Women do monthly Breast Self Examination (BSE) 40% of adult Singaporean Women have never done BSE before

19 IMPORTANT FINDINGS (NHS 2004) About 1 in 3 (29.9%) Singaporean Women, aged years, have never had a Pap Smear done before

20 IMPORTANT FINDINGS (NHS 2004) Ever had Mammography: years: 47.5% years: 56.2% years: 50.5%

21 WHY SCREEN? To promote health and prevent disease To detect latent diseases To detect Risk Factors To do something about them!

22 What types of Health Screening should we do? Why? How often?

23 CLINICAL PRACTICE GUIDELINES ON HEALTH SCREENING

24 BLOOD PRESSURE To screen for hypertension FOR WHOM? Adults (aged 21 years and above) Once every 2 years (even if desirable readings) Pregnant women should be checked

25 BLOOD PRESSURE HOW FREQUENTLY? Annually or more frequently (if High Normal / Have Risk Factors) Opportunistic screening at every visit to doctor OTHER POINTS TO NOTE: Emphasis on Lifestyle Modification

26 FASTING BLOOD GLUCOSE To screen for diabetes mellitus (OGTT also suitable) FOR WHOM? Adults (from age 40 years or from age 30 years if Risk Factors present) Once every 3 years (even if normal results)

27 FASTING BLOOD GLUCOSE HOW FREQUENTLY? Annually or more frequently (if Risk Factors or IGT or IFG) OTHER POINTS TO NOTE: Opportunistic screening by doctor (for High Risk Individuals)

28 FULL FASTING LIPID PROFILE To screen for dyslipidemia (a major Coronary Risk Factor) To focus on blood LDL cholesterol, HDL cholesterol & Triglycerides FOR WHOM? Adults (from age 40 years) Adult with Coronary Risk Factors (from age 30 years)

29 FULL FASTING LIPID PROFILE FOR WHOM? Patients with history of CHD, PVD, hypertension, stroke & diabetes Patients with IFG or IGT Patients with a history of familial hyperlipidemia HOW FREQUENTLY? Once every 3 years (if normal results) Opportunistic screening by doctor (High Risk Persons)

30 BODY MASS INDEX (BMI) & WAIST CIRCUMFERENCE To screen for obesity FOR WHOM? All Adults (from age 18 years) HOW FREQUENTLY? Once a year (even if normal results) Opportunistic screening by doctor (if High Risk)

31 VISUAL ACUITY (SNELLEN S S CHART) To screen for visual problems (especially in elderly) FOR WHOM? All Adults (from age 65 years) HOW FREQUENTLY? Frequency is discretionary Opportunistic screening by doctor

32 SCREENING MAMMOGRAPHY For breast cancer FOR WHOM & HOW FREQUENTLY? Annually for normal risk, asymptomatic women, aged years 2-yearly for normal risk, asymptomatic women, aged years 70 years and above: Discretionary (2-yearly)

33 SCREENING MAMMOGRAPHY OTHER POINTS TO NOTE: Women on HRT: Annually, up to 5 years after stopping HRT Annually if BRCA Gene Carriers or with strong family history (5 years before age of onset in youngest family member, with monthly BSE, 6-monthly CBE and ultrasound)

34 SCREENING MAMMOGRAPHY OTHER POINTS TO NOTE: Annually for the remnant or other breast in women with past history of breast cancer (follow doctor s advice) Women with silicone or paraffin oil injections (futile except for MRI in selected cases)

35 BREAST SELF EXAMINATION No evidence of mortality benefit but BSE still recommended from age 30 years onwards as it improves women s awareness of their breasts (do it 1 week to 10 days after period)

36 For cervical cancer PAP SMEARS FOR WHOM & HOW FREQUENTLY? All women who ever had sexual intercourse (test by 25 years of age) Frequency is at least once every 3 years (until age 65 years if all previous smears negative) HIV positive women should be screened more frequently (e.g. yearly)

37 URINE DIPSTICK For kidney disease (and diseases of the urinary tract) FOR WHOM & HOW FREQUENTLY? Test opportunistically for any healthy asymptomatic individual Test annually if more than 50 years old or has history of hypertension, diabetes, smoking or family history of kidney disease

38 FOBT & COLONOSCOPY For colorectal cancer FOR WHOM & HOW FREQUENTLY? All asymptomatic individuals aged 50 years and older (annual FOBT or flexible sigmoidoscopy 5-yearly or colonoscopy 10-yearly) Positive FOBT results should be followed up by colonoscopy (or barium enema if not technically possible)

39 SCREENING COLONOSCOPY OTHER POINTS TO NOTE: Colonoscopy every 10 years if there is positive family history of 1 first-degree relative having it after 45 years. Start 10 years before the age of the youngest afflicted relative or at age 50 years, whichever is earlier.

40 SCREENING COLONOSCOPY OTHER POINTS TO NOTE: Colonoscopy every 3 years if there is positive family history of at least 1 first-degree relative having it before 45 years or at least 2 firstdegree relatives having it (any age). Start 10 years before the age of the youngest afflicted relative.

41 SCREENING COLONOSCOPY OTHER POINTS TO NOTE: Colonoscopy 1 year after polypectomy in individuals with past history of polyps showing high-risk features Colonoscopy 3 years after polypectomy in individuals with past history of polyps showing absence of high-risk features Colonoscopy 1 year after resection in patients with known past history of colorectal cancer (assuming total imaging was achieved pre-surgery)

42 HEALTH SCREENING (Basic Principles) Choose evidence-based and good practice screening tests/procedures which are adequately sensitive and specific for a targeted population Screen for conditions that have a high prevalence and for which something can be done Ensure there is adequate follow-up and intervention Post-screening

43 Health Screening must be followed by Post-screening Intervention and Care if a Workplace Health Promotion Programme is to be effective

44 WHAT IS POST-SCREENING SCREENING INTERVENTION? Intervene: to become involved in a situation in order to improve or help it Programmes that intervene to change results (health status)

45 WHEN? After screening (biometric measurements) - BMI, BP, blood sugar, blood cholesterol - More motivated to change After lifestyle survey (questionnaire) - Family history - Eating, exercise, smoking habits, coping with stress - Know their own risk

46 WHO? Healthy Those with no risk factors Not So Healthy Those with disease (e.g. diabetes, hypertension, heart disease) Apparently Healthy Those with risk factors (e.g. smoking, sedentary, overweight, stressed, family history) but do not have disease

47 WHY? Aim: Primary health education educate the healthy to prevent them from being at risk of diseases Secondary health education educate those at risk to prevent them from getting diseases Tertiary health education educate those with diseases from getting complications and deteriorating in their condition (patient education)

48 What Benefits? Motivation Why? What Barriers? Pre-contemplation Contemplation Awareness Self-Efficacy How? Preparation Knowledge Action Change Attitude Maintenance Change Practice Change Behaviour Corporate Culture Culture & Environmental Support

49 MOTIVATION/SELF-EFFICACY EFFICACY MATRIX Self-Efficacy High Low Can but don t want to Can t & don t want to Can & want to Can t but want to Sweet Spot Low Motivation High

50 Thank You!