CHAPTER I

Introduction and Executive Sum mary

Dans AL, Morales DD for the Philippine Peiodic Healtb Examinations Stadlt Grorp

IN THIS SECTION

Health Screening as a Strategy for Preventive Medicine

Pitfalls of Screening and Other Preventive Medicine Strategies

Criteria for Screening
How the Guidelines were Developed

Executive Summary of Recommendations

I Introdwction and
E,xecutiue SummarSt
OOOII#@$&,i,1;8,

Health screening as a strategy for preventive Medicine

In the l'att half century, heahh care hat seen a najor thft in phik:ophltfrom curatiue
melirine to
preuentiuc medicine. Medical education has euolued, tonetiet
on preuenti)e"iedicine haue beenforned,
natiorul and international agenciet haue been set-up, and heahi budgetu haue
been reallocated - a// in
illpport of tbis inpottail.thzft in nedical thinking. In the procit, the concept of health care has
evaped the confnu of 'c/inics and horprtah, expanding into thi publit' arena, to'inc/'ude horrr, ,rhoo,/,
and the workplarc.

Thus far, four rnajor strategies have
been,used in the tapidly gtowing field of
preventive.medicine. These include 1)
health screening (doing tests for eady
detection of disease or risk factors for
disease),2) Iifestyle change (avoidance
unhealthy habits), 3) risk factor control
(treatment of factors that predispose to
disease), and 4) vaccinarion programs
(immunization against infectious
diseases). Health screening is often
referred to as the cornerstone of disease
prevention, and although it often ovedaps
with the latter three strategies, it is
main focus of this book. '
The World Health Organization
(1994) defines screening as the use of
presumptive methods to detect
unrecognized health risks or
asymptomatic disease in apparently
healthy individqals in order to permit
prevention and timely intervention. t.
Screening is performed to categorize
members of the general public into
those with higher or lower probability
of disease, with the former group
being utged to seek further medical
attention for definitive diagnosis and
treatfirent.3
: Sirfall*of Scrernit$ e*rd Otlier
"',P$rmntiw,,ltedicine,$ttategies
Just like in curative medicine, the
biggest pitfall in disease prevention is that
of things that ought to work do not always
do so. For example, some lifestyle
changes, such as salt restriction, have
failed to lead to appreciable changes in
the incidence of sftoke and coronary
disease in the general population. ' Most
dietary maneuvers, like high Ftber diet,
have not been proven effective in cancer
the prevention.' Risk factor control has
failed as well, and in sorle instances, has
even led to an increase in deaths. The
cholesterol lowedng drug clofibrate, for
example, was removed from the market
because a tial by the Wodd Health
Organization shovzed more deaths
among patients vrho teceived the
treatment..s
Even the strategy of screening
(executive check-ups) has had its failures.
Many tests,
such as the
electrocardiogram", have been found to
be inaccurate for detection of eady
coronaty disease. As a result, many
asymptbmatic patients wrongly
^te

,. Philippine Guidelines on periodic Heolth Exominotion: I

Effective Screening for Diseoses omong Apporenfly Heotthy iiriprnoi
I
I Introduction and
Executiue Summary
OOall#ffiffi,ri*,..
labeled as being "ill." Instead of
improving the quality of life of people,
this phenomenon of "false labeling"'has
been found to wreak havoc on the social,
psychological, physical and even financial
stability of unfortunate individuals.
Otherwise ptoductive people have been
denied insutance ot empioyment, or have
resigned from work because of
depression. Many times, the side effects
of scteening have been fat worse than the
effects of the diseases which
.we were
trying to prevent in the ltst place'
Futthermote, although treating eatly
disease may be cheapet and easiet, the
savings are often offset by the costs of
having to do the scteening tests on large
numbets of aPPatentlY healthY
indrviduals. For example, curative
sutgery fot a case of coronaqr attsty
disease (CAD) may cost half a million
pesosin the Philippines' In contrast,
pdmaty prevention of a single death
from cardiovascular disease may entail
tteating at least 143 patients fot high
cholesterol wrth a statin for 5 years't
Depending on the statin used, this may
cost as much as 20 mill-ion pesos. Indeed,
sometimes, pounds of Prevention
translate to just an ounce of cure.
Cdteria for Screening
Because health screening carries the
potential fc.,t harm, and because it can
lead to huge increments in unnecessary
public expenditures, critetia need to be
set on when scteening fot eatly disease
should be done. Many such criteda have
been developed, but most authors'''refet
to the ctiteria discussed belovz
I pnitiooine Guidelines on Periodic Heolth Exominolion:
I rtf"iriu" Screening for Diseoses omong Apporently Heolthy
1. Treatment fot the asymPtomatic
condition must have been
evaluated using well-designed
tandomized controlled trials that
observed effects on clinical
outcomes.
It is easy to comPrehend that if we
spend millions of Pesos to detect a
disease fot which thete is no effective
treatrent, then the act of screening
rvould have been rendeted futle.
What is difficult to decide is when to
consider a treatment effective. A
tteatment is usuallY considered
effective if it has undetgone thorough
evaluation 1n a randomlzed conttolled
tnal. In such a trial, patients with the
disease in question a.re randomlv
assigned to teceive either tl-ie new
Lreatrnenl or a comparison Lreaunent
(which can either be placebo or an oiC
standard thetaPy). If such :- u.,r
shows that patients do better on the
new treatment, then it is generailY
consideted effective. Such studies
could support a tecommendation to
screen fot disease. Flowevet, dre
study should show patients are doing
better not just biochemicallY
(e.g.cholesterol is lower),
physiologicalln (e.g. blood ptessure is
better), or anatomically (e.g' cotonaries
ate more o'ld"ly open). Doing bettet
should mean patients actually feel
better, ot live'longeg ftee ftom disease.
2. The burden of illness ftom the
asymptomatic condition must have
been measured accutatelY in
locally-conducted communitY-
based studies.
Filipinos
I Introdzction and
Executiue Sammary
OOOlSffiffi#F -i'.
Burden of illness refets to either
the prevalence of disease or its
impact on people's lives. If a disease
is very rare, or if it is inconsequential,
screening for it may not be a
worthwhile exercise. Studies on
burden of illness should be done in
the community-ar-large because
studies based in hospitals or clinics
tend to include patients with severe
illness, and tend to exaggerate the
true prevalence of the condition.
3. Accuracy of the screening test for
the asymptomatic condition must
have been evaluated in validation
studies done in the community.
All tests have two types of error
tates that should be minimized
before they can be accepted as
screening tests. A false positive error
refers to a positive test result in a
patient who does not really have
disease, while a false negative error
refers to a negative test result in a
patient who actually has the disease.
The hazards of false negative tests
are easy to understand - patients will
miss the chance for an early cure or
treatment. The hazards of false
positive tests, on the other hand, are
more difficult to appreciate. As
pointed out eadieq telling patients
they have an illness (when they
actually don't) can have physical and
psychological effects that are far
more severe than the disase itself.
Furthermore. false positive resrs
often lead to a battery of expensive
and unnecesary follow-up
ptocedutes.
Philippine Guidelines on Periodic Heollh Exominotion:
Effective Screening for Diseoses omong Apporenlly Heolthy Filipinos
Studies on the accuracy of
screening tests should be done in the
community-at-large because studies
based in hospitals and clinics may
tend to exaggerate accuracy. This is
because hospitalized patients tend to
have more advanced illnesses which
are, therefore, easiet to detect.
4. Cost effectivenessof thb screening
tesq as well as treatment for the
disease, should have been
evaluated Iocally in properly
conducted economic analyses.
Because effective screening tests
must be performed on almost every
healthy person, cost becomes a major
concem. If economic resources were
unlimited, then people could have any
test done. Unfotunately, resorrce
constraints exist rn all countdes - with
no excepd.on - and are felt at different
levels. At the public level, money spent
on sceening could draw resources
away from other health concems such
as treatment for tuberculosis and
diarhea. At 'the household level
money spent by a househol& on
screening could divert precious
resources from food, shelter and
education. Because- of this, for a
screening test to be acceptable, its cost
(plus subsequent tfeatment for the
disease detected) should be
commensu{ate to the disease or
complication that it is being prevented.
Studies that evaluate costs, dsks
and benefits of treatment are called
economic analyses. Such studies qeed
to be done locally because the costs of
I l
l
I 5l
I
ll
il
I
I Inlroduclion and
Execuliue Summary

OOOOOC€*& ,,.

health intenendons vary widely ftorn

ccjuntrv to countly. Thus, findings of Level 1 - Reconrmendation satisfies
an economic analysis done in the a1/the a6ove c riteria.
Uruted States should never be assumcd
Level 2 - Recommendation satisfies
to hold true in the Plilippines or an)r
#1, butnotall of #2, #3,and#1.
other countll, regardless of horv
thotoughly it rvas done. Level 3 - Recommendation satisFres
#2,#3, or#4, but not #1.
Using tirese standard criteria, many
Western countries have developed Level 4- Recommendation satishes
practice guidel-ines for periochc health none of the criteda.
examinations. The U.S. Preventive
Services Task Fotcc, for example,
conducted an extensive evaluation of Hoqrtke G*idelines srere ,

more than 200 tests that couid potentrally. Dweloped

be performed for eady disease detection
n
amongAmericans.
The Canadian Task Force on Periodic
Health Examination likewise formulated a
health screening pian consideted optimai
for Canadians. u A, can be gleaned from
drese criteda l-rowever, tests acceplable in
one country may not do so well in another
because of diffetences in disease
prevaience, and diffetences in the price and
availability of tests and treatments. Thus, it
has become necessary to formulate
recommendations on health screening for
l'ilipinos, using rhe sanre stringenr
standards used by our colleagues in
developed countrjes.
The decision to recommend or not to
recommend a test should consider the
inteqplay of the four factors above, rather
rhan a single one. Nevertheless, few
screening tesrs will satis$r all four cdteria.
To make the basis for the
recommendations explicit, each
recommendation in this book was graded
according to the following scale:
l'he guideLines were prepared by
designated Task Forces covering ren arcas
of interest as follows:
Task Force on Cardior.asculat Diseases
Task Force on Congenital and
Devclopmental Disorders
partral report)
Task Force on F{earing Disordets
Task Force on Infectious Diseases
Task Force on N{ental Disorders and
Substance r\buse
Task Force on IMetabolic, Nutritional
and Environmental Disorders
Task Force on IMusculoskeletal
Disordets
Task Force on Neoplastic Discases
Task Force on Prcnatal Disordets
Task Force or.r Vision Disorders
Within cacl-r Task _Forcc, the
recommendations were draftcd and
refined using standardrzed
ptinciples and a common protocol.
Each statelxent underr-..ent fout
phases of devclopment.

6l Philippine Guidelines on Periodic Heolth Exominotjon:

Effective Screening for Diseoses omong Apporenlly Heolthy Filipinos
I lntroduction ond
Execulive Summary
ooooo++ -
Phase 1 - Pteparation of the
Evidence-Based Draft
A technical reseatch committee
(TRC)of 4-5 membets was formed
in each Task Force. These
committees took charge of tracking.
retrieving and appraising existing
literatute regatding the scteening
tests used in theit held. They then
made the first draft of statements
known as the eufience-ba:ed draft - and
circulated it to the vadous Task Fotce.
members in preparation for the fitst
general meeting. This eady, each
statement was graded by the TRC
using the classification system
descdbedin the previous section.
2. Phase2- EnbancMeeting
The evidence-based dtaft vras
circulated orle week priot to ^
scheduled en banc meeting of all the
panelists. This allowed membets to
assess the tecommendations. It aiso
enabled them to look into atticles
that vzete not cited in the evidence-
based dtaft. En banc meetings of all
panelists in a Task Force were
conducted on an agreed date.
During this one to two-day
meeting, the panelists revised the
evidence-based dtaft, taking into
account not only the suPPorting
evidence but issues on feasibility,
resoutce limitations, value
judgment and experts' oPinions.
Votation was repeated until 7 5o/o ot
more agteed on a tecommendation,
at which point, a consensus 'was
Effeclive Screening for Diseoses omong Appolenlly Heolihy Filipinos
declared. The draft at this stage
was refetted to as the internediate
draft. This included all s.tatements-
regatdless of whether a consensus
was reached or not.
3. Phase 3 - Modified Delphi
Circulations
Issues not resolved by consensus
during tlte en ban; meetinq were
further discussed by
correspondence and voted on. The
votes were sent back to the TRC
who then took charge of counting
the votes as rvell as iummatizing the
commcnts and arguments. Delphi
circulations rvere carried out until a
consensus rvas reached, or until a
maximum of three citculations was
accomplished. Ut-rresolved issues
at the end of Phase 3 rvere labeled
untesolved, and wete included in
the third or penultimate draft.
4. Public Forurn
Fot each Task Fotce, the
culminating activity was a public
forum where stakeholders were
invited to review and comment on
tire various recommendations.
Invitations to the public forum
were sent to representatives of
health maintenance organizations
(llMOs), big corporarions,
hospitals, heads of related
societies, educational influentials
and the lay public. Written or otal
feedback was requested . After the
public forum, the;t'ina/ draft of the
guidelines was produced.
Philippine Guidelines on Periodic Heollh Exominofion: | -
I /
Introduction and
Execatiue Sannary

OOOt*&Wffi'q%-'+
ScreeningTests for Children
In sumrnarizing these extensive
sute Table E-t fot Childten - Screerung
^
rnade
d.liblruuott, the task forces by a tests that are tecommended
for the
was follovred
thut .u.h staterneflt seneralPo?ulatlon
as follows:
irr*^tY "f ?able'B'2 fot Children -
Evidence Scteerung
for selected
tests that are recommended
A) Burden of the Illness
B) AccuracY and ReliabilitY of the populatrons
Table B-3 fot Childten -
Scteerung
Test,
tests that cannot be recommended
C) AvailabilitY of Effective
being
Treatment for the illness 'i'"uir',s-+
routinelY
fot Children - Screqning
screened for, are aol recornmended
Issues and lests that
DJ Co.r.if..tilreness '
E,) R".o*-.,tdations of other
other
Scteening Tests for PregnantWomen
org".ri"rtiottt and -
iabl. b-t rot Ptegnant Womel ;
countlles' recommenoeo
Screening tests that are
an fo r the ge n ral PoPulation
e

For some recommendations'

Issues - i"ur. t-2 fot Pregnant Womel
uaati""^f section, F) Consensus recommendeo
,

concerns ared on Screening tests that are

*^li".r.,a"a, r"fl
"ttinglimitaflons' value fot nkctedPoPulations
feasibiliry resource i^bl. C-i iot Pregnant V/omen -
judgment and exPerts' opruons' Screening tests that cannol be
recommended routinelY
itble C-4 for Pregnant Womennot-.
Executive SummarY Scteening tests that are
recommended
In this executive summatyr we
have
screenlng
collated the various In addition, we have included
thtee
...o--"ndations in 15 tables: tablel o. irrr-t"li'ations recommended
fot adults
for Adults
--fuir" Tests
Screening
i-t rot Adults - Scrcening tests l- Table D-1 for adults' Immunizations
that ate recommended fot the general
,".orrr*""d ed fot the general
oooulation ooPulation
tests-
[t'ui. 'Fv2fotAdults - Screeningsehrted t^ff" D'2fot adults' lmmuntzabons
i;;*;.- rttom^"nded for ,*o*""a ed for Y ct e dPoPulationsle

oooulations
tests Table D-3 for adults' lmmuntzaflons
iJur" A-3 for Adults - Screening thatca n n o t b erecornmend
ed r o u ti n e 11
routine 11
n otberecornmend ed
lhatcan
teSts' Table D-4 for adults' Immunrzatrons
i"ir" A-4 fot Adults - Screening that cannot be recornmended
i^nl ar ea o/ rec ommende d'

nos
I E[,::R[.,:'"i::iffi tl:':::':ffixi
Firipr
ilil'ffi1;li"onhv
8
 Introduction and
1 Executiue Summary

OOaS#ffiffiW#r.
Finally, it must be pointed out that
In summarizing recommendations
these r..ommendations have been
of the various task forces, the steetrng
of
.o-*i,r"" has taken the libertYfew drafted for aPPatentlY healthY
in a in<lividuals. Atl Task Forces have
*nt i.g minot modifications
that a thotough history and
,tut"-"".rt.. These changes dealt with "-."-"a
ohvsicll examination will precede the
,;t"i"g and periodiciry' and *ti:,Iil: i"orr"., for tests' Detection oI anY
tne
whcn necessary' in order to slmpllty
All the lir"ur" from the history and physical
recommendations' .*u*i"rA"" should warrant additional
,".o--"ndations, in their otiginal ,.rt. ^rra ate beYond the scoPe of the
?orrn, ,r" available in the individual
present guidelines'
chaPters.

*gtll"''I;,;[,iliil; I
Philippine Guidelines on Periodic q
Diseoses omong Apporenlly
Heoli
Eff ective Screenin!'for
 Introduction and
1 Executiue Summarl

OOC##ffiffii's'E
tlr.at fie_c ommendedfotthe
TahleA-lfotMults' Scret E 60 yrs
20 -39 40 -49 50-59
-scnnnNtNc TESTS CONDITION
vts vfs vrs &qhove
Yearly Yearly Yearly
Ycariy
-.--ptt" r* n"dY Nless-[nJcx:
rn-
Wcight in kg /FIerght in
OR ObesitY
LIiP
ComPutc for Waist to
'Ratio:
'i)^i.t in-cm /
.ir.t*f"re'ce
c1n
I IiP circumfercncc 111

Yeer\' Yeer\' Yearlv

Ycarh
Flyoertcnson YcarIy YearlY
a ,,, "ltnlon BP Ycarll' Ycariy
Night birndncss,
Ily e cxamrnatron
llitot's sPot &
xcroPhth4!g4- Ymrh \'exiv Yearly
Ycarlt-
Smoking histotl Arql]gblgig- Ycerlv Yearlv
,.1 x1 P0tc0da1 Yearlv Yearlv
r Scdcntafl Iltcstv Even 2 Every 2
^f ,.tiuh
.....1 IJvery 2
ve2rs
(r( )l Dv shPidcmra vmf lraf s
\.uffin* lol.rl clrol( st s
Every 2
tivcry 2 Iivery 2
:
l)iebctcs caf s years
\rl of tllc f"llorvtttg: yeJrs .v

rirtls. tgs. 759

()(i'I"l lr{i(};
Yearlr- YearlY
()ml cetlccr
\risutl cxallt
mvitv
=---;
bYcfl-I Every2
(-olorecral ( \'(af s
liccrl occult ltlt 'r 'cl tcshtll;
Yearly Yearlv
( )uc:I1o11 )l) lr( 'lri11! nrobllnls
'' I T cering los - Yemly
'
\'lsual lflI
Yisual rctrttl with Sncllctr
Chrrt
_-----a-.1 Yearlv
.
p*diro" sitiq4";tal!- WO{n!n-
rl ch
Yeady Yearly
------:-
YearlY
YcrrlY
(]rtcrY iltl nLst ()r llrcSclrt
lJoncstic violclce
cffg!-- Yearly Yeady Yearly
, l.,rr r: stj c viol
lJrcast ca
Clinic, l brcest cxafl111atlon ,
ti
Scrccning mernmogJaPhl"
sal S?omen
.-"i1 ehl c
; Every 2 F.ver1'2
F,ve4'
oi i)l.slipidcmia vrs
JI*. g,.,^i ch ol c stc r
()ncc
I stcol(
llisk factt't asscsslncnt t()r
nstcoo(x()$ S*1-- lerance Test (O GTT) ; Fasting

ffi
To

dpiiitr2 t ;lt,,n,e ;':::;::2:l,f;:;'#:l[:t3:tGknse"*,*:','::' ortiiry. alrcholisn' dqaretle-smoking'

f ^t^{,'],:.,! irt;ltr,le loty ,i'etary rttldan. u,n'oi'iryri.ot
x* g;5/a.factors-t'or 0s/e0P0r0.tt't
.-
"
ii'ii 'l tit' uu'! ii'to'v ',.-"t,,r,c
oJ pteuiotrs '[ractures

Exorninoiion:
I pnitioo]ne Guidelines on Periodic Heollh
t"1';l;;;t;;"g ipporenttv Heolthv Filipinos
10 | rtteciiue Screening
I Introdaction and
E,xeculiue Sunmary

OO*#ffiffiffidiirirr

Table A-2 for Adults. Scteening tests that are (ecommended

.for selected populations
RISK FACTOR INTERVENTION FREQUENCY CONDIT'IONS
q.PFFNFI-I
Personal and Social Historv
1. Adults in thc Chcst x-ray Ycerlv A ctivc Tubcrculosis
occupational fI'13) disease
sctting
csp ecially
indu strral
workcrs ald
scli ool
tcach crs
I I calth carc (lhust x-rrv Yearly Activc Tubcrculosis
workcrs <li seasc
including N{alltoux test Yearly l,atent'I'ubcrculosis
hospital and in fcction
laboratory Ilcpatitis B sAntigen ()nce, then vaccination Ilcpatitis B
workcrs ftIbsAg) and Ar.rti- if n cces sary
Ilcpatitis B (anti-FIBs) if
never done and no prior

Anti-I1 cpatitis: A Virus ()nce, then vaccination I{cpatitis A

Immunogiobin G (anti- if necessary
IIAV IgG) enzvmc
immunoassav if ncvcr
done and no prior
vaccination
3. Caregivcrs of Gcncral Il calth Ilvcry 2 y ears I)epression, ar-rxicry
f aticnts with
(]ucstionnairc (see disorder &
chrolic ,\ppendix in Chaptcr 6) Pqt chosis
illncss, clrug
dcpcndencc
or mcntal
illness
4. Rctirees General II calth livcry 2 ycars l)cprcssion, anxictv
Questionnaire (scc disorder &
i\nnendix in Chaotcr 6).
5. 'I'ruck and 1 2lcad Fllectrocardiogram Ycrrly (Joronary heart
bus drivcrs, (ECCI) discase
se culitl
pcrsonncl &
nilo ts

6. l)olicr, IlcpatitisBsAntigcn ()ncc, thcn vaccination II epatitis B

FI cpatitis Ii (FIbv\g) and anti I{cpatitis ifnccessarv
{ircfightcrs, R (anti [IB$ tfncvcr done,
inmatcs, and no prior vaccination
studcnts
cllterillli
hcaltlr
pro fcs ston,
contacts of
pxticltrs witl.l

Philippine Guidelines on Periodic Heolth Exomincrlion:

Effective Screening for Diseoses omong Apporenlly Heolihv Filipinos t,,
Introduction and
Execatiue Sammary

ooc#ffiwffi
.fable A-2for Adults. Screening tests that u.. r""q-m"ttd"d fut s/:del fopfrdT
RISK FACTOR INTERVENTION

Anti-FI epatitis A Viru s Immunoglobin Oncc thm

7. Military Pcrsonnel,
vaccination i.f
rvorkets rvith Ci (Anti-FIAV Ig{i) en4'mc
necessafy
nonhumm Primates, immunoassaY if nevcr done md no
contacts of Patimts prior vaccinadon
.'ith I loatitis A I learing disorder
8. LixPosutc to Putc'fonc AudiometrY
occuPational
abnormal noise in
excess of 85
decibels for I hours
Active 'fubermlosis
9. Cortacs of gtims *'idr Chest x-tav
aairrc & Ptotr\ :rtirt Letmt'1'Ll disease
'lirkrurlodsclsa-r
Chlmr dra infection
History of Gtam stain for leucocytes, or direct
uflp(otected sex fluorcscmt anrigen pl. \ I detection
rvith multiPle tests of cerl'ical, urethral or pharvngeal
p21tners (mote than Gonorthea
1 partrcr during the
(lrr*.r"in md culrurts [rrr N
prcceding 6 Gonotdrca ofateas suspected trl havc
mondrs); bcen exposed (cen'ical, urethral, tectal

Partnets of Pcrsons N on-treponemai suologic tcsts u sng

with multiPle sex Venereal Discase Research Laboraton
paltners; men rvho A DRL) or R:Pid Plasmr Reagrn
have sex with men; (RPR7: if posirir q con6'm u tth
rrcponm'al prJlidum lr rm lgglurn an'n
i 2. Commercial scx assav (fPHA)
\ittu Human
workets Humm Immunodefi ciencY s
ImmunodcficiencY
ftl tV) ELI$\; if Pusinvc. confim
of Virus (HI\r)
13. Scxaal contacts usinsWestern Blot fWB)'
pctsons rvidr i-m"uno fl uorcsccnce assav (l FA)
Chlamydia, radioimmune PreciPitation assaY
()onorthea, SYPhilis (rvritten consent required)
HIV ilcpatitis C
And Hepatitis C Virus (IiCV)
(ELISA)
14. Serual contacts of
petsons rvith
Yeady;
15. Women who ue or ffitgtotg u"ctic acid
'isualization If normal for 2
who have been consrccuttve Cnical canccr
scxuallv active yrs, do every
Pap .sm"a, if it can be followed-up & donc 2-3yexs

Women < 25 who are
sexually active
Chlamvdia infection
6[--rtoi" for leucocytes, or direct
fluorcrccnt andgcn detection tests (DFA)
of cervical, urethral or pharyngeai fluid
specimens.

N gonorhea Yeuly Citnorrhca iqfection

6*ui. und.uiturcs for
16.Women< 25whore
sexua.lly active
of ueas suspected to have been exPosed
( cen'ical, urethral, rectal or pharyngeal
ras)

I prritiooine Guiclelines on Periodic Heolth Exorni'otion:

ornons Apporentlv Heollhv Filpnos
12 I H'J:ft."#Eli"g"i'-' oi';"t''
 'l
il

il

I Introduction and
Executiue Summary
oof sffi@ffi?i#b

Table A-2 for Adults. Screening tests that are recommended

ulations (Cnnt",
18. Close household Hepatitis Bs Antigen ({ bsAg) &
contacts anti - Flepatitis Bs (JBS) ifnever

Anti -llepatitis A virus (anti-

FIAV) IgG enzyme immunoassay
I 9. ridults rvho cherv Oral canccr
or smoke tobacco;
Adults rvho smoke Anv of the foilorving: Diabctes Mcllitus @M)
cigarettes; Fasting Biood Sugar (FIIS),
Random lllood Sugar S.BS), 75g

AnLlc Btachial Index (ABI; Pcriphctal Artetial Disease

Elcctrocardiogram (EC G) Ooronary Hcart Disease (CHD)

Oral cancct

21. Histor ofdrug ()nce, then

use vaccination i f

Anti-HAV IgCi enzymc

immunoassay ifner.er done and no

lI IV FIISA; if positive, confirm IIuman Immunodcfi cierrcv

using \X/estetn Blot (\Vll), Vitus (ll IV)
immunofluorescence assay (IFA or

22. Women with Any ofthe follou'ing: every 2 yeats

histoo ofdelivery Irlls, RBS, 75g O GT1 ; FC G; or
ofbabies latgc for IlCG*
gestational age

1. Family history of Fasting lipid profile

^^-t.,
C ardiovasculat
J)isease
Any of thc follorving: every 2 ycars
FBS, RBS, 75g OG'I'T; FCG; or

Familial Ankle brrchiel index (ABI) cvety 2 y ears Pelipheral Artcrial Disease
dy slipidemia

Any of the following: Diabctes Mellirus

FBS, RB.S, 75g OGTT; FCG; or
RCG*

5. Family history of Scrum uric acirl

: Family history of Intraocglar ptessure cveq 2 vears

Phvsical Exam

i Obesity Any ofthe following: Diabetes Mellitus

FBS, llRS, 759 OC}'IT; FCG; or

Severe myopia lntraocular pressure every 2 years

r=- :ingBhodSugar(FBS),RandonBkodSagar(RBS),759Oral GlzcoreToleranceTut(OGTT); Fa:ting

!!s4'C/acose (FCC); orRandon Capillar"y Glaron (RCG).

Philippine Guidelines on periodic Heol.ih Exominotion:

Effective Screening for Diseoses omong Apporenfly Heolthy Filipinos Irt
I
I Introdwction and
Executiue Summarl

OaOffiffiffiffi'#€i#i

Table A-2 fot Adults. Screening tests that are lecornrnerxl+d

fot selected populations (ConfA)
RISK FACTOR SCREENING TEST FREQUENCY clnmrrcnrs
sflf,nilEn
Combinatbn of Multiple
Aiclr Ercfnrc
L Two or more of the Lipid profile Every 2 years ol#*
lollowing:
a. Srnoking
b. Obesity
c. Post-
mcnnn*rcql

2. Two or more ofthe 1 2Jead electrocardiogram Yearly Cnybtdirc

following: (ECG)
a. Age >55 or
post-
menopausal
b. Smoking
c. Obes'ity
d. Family hisory
ofearly
cardiovascular
disease before
age 40 years
e. Familial
dyslipidemia
Especially ifthe
resul$ will influence
treatment decisions
(e.g., use ofaspirin or
lipidJowering agents
in asymptomatic
inrlivirlrrlc\
3. Smoker and age Ankle brachial index Every 2 yeas ftrlteral aterial
>55 weqrc rr RI\ fue

r+ I HllSi-x :,'J:;]ffi t? tl::: 3:#s'J ;ili[:l;t eo ,, h y F, p n o

i s
 I Itmdtction and
Er*vtitv Summary
ooa**€Fffii#4i$m
Table A-3 for Adults. Screening tests that cdnnot be tecommended routinely
POPUL{,TION INTERVENTION CONDITIONS
q.R FIfI\IItrT)
mntomaticA lult Pooulation
l. 20 years old and lloutine screening for clcvated intraocuiar Giaucoma
above pressure or eady glaucoma

Chest Xray Lung canccr

Urinalysis or dipstick screening Microscopic hematuria,

& Proteinuria

2. Aduits below 40years llepatitis Rs Antigcn ftIb.sAg) and anti- Ilepatitis B

old Ilepatitis B using enzyme immunoassay

3. Adults 40 ycars old l{outine comprchcnsive screening of adults (lataract, glaucoma

and above - to include c tract, age-reiated m2cular
-1"".^-" erral,ratinn
'1 ^*^^ ^' ^tinn "-.1
4. Adults 60 - 65 ycars Screening of dementia using clinical signs Dementia
old and above i.c., dcclining cognitive function and
problem s in performing instrumcntal
J"il.' "-ti.'itio"
Ultrasensitivc Thyroid Stimulating 1I'hvroid discase
H^,-^-p rl.cTj\
5. Institutionalized Anti-I{ epatitis A Virus lmmunoglobin Hepatitis A
patients, workers in (anti-IIAV IgG)
that institution and
clav care workers
6. Adults aged 40 or Chcst x-ray [,ung canccr
morewho smoke
7. Collepe student Chesf x-rav A -r;-a T"harnrl^ci c

B. Women of Rubclla titers Rubella

reproductive age who
are planning to get
nfemanf

:il
p

Philippine Guidelines on Periodic Heollh Exominolion:

Effeclive Screening for Diseoses omong Apporently Heolthy Filipinos t,,
I Introduction and
Executiue Summary

OOO&ffi@@t.lft: ',.

tests that are aof tecommended

Table A-4 for Adults' Screening

I pf itippine Guidelines on Periodtc Heolth Exominoiton:

Apporenilv Heolthv Filiptnos
L6 | rttectlve Screentng tot olt"-oi"t "tong
I Introduction and
Executiue Sammary

oot#ffi@@
are recommended
Table B-1for Children' Screening tests that
for the Senerdl Population
FREQUENCY CONDITIONS
POPUIATION INTERVENTION SCREENED
owth abnormalities
1. AII childr, (-ongenital adrcnal
2. Nconates 2 1 -hy droxylase defi cienq'
h.'ncrnlesia
r\s a Ncwborn Screen Ci6PD deficiencY
Flourescent sPot tcst
'fhyroid Stimulating
at 24 - 48 hrs of life Congenital
l..nothv roidisrn
IJormone
(lalactosemia
Clalactosemia tcst
Ycrrlv Visual disorder,
1. 2-5Yearsold Vison scrcenlng usrng
amblyopia or strabismus
Snellen chart or
stereoacuiw tcst 'lirhcrculosis
4 l-14 vears old
Deprcssion, anxietY
5. Adolcscent General Hcalth - Yearly
disorder & Pqrchosis
boys and girls Questionnaire
(10-19 vrs)
Ycerlv Domcstic violence
6. Adolescent Query for Past or Prcsent
grls (10-19 domestic violencc
vrs)

Table B-2for Children' Screening tests that

are

recommended for selected ulations

INTERVENTION FREQUENCY CONDITIONS
POPUTATION

'l'wo Oncc prefcrablY Congcnital

. High - infants
rzs,€ - ticrccl tcst permancnt scnsory
utilizir.rg cvokcd within 6 l-tonths
within 6 months of birth. & ncural hearing
from birth based cltolc<tu stic
loss
on: crnission s (I'l,O A t'1,)

r. History of then auditory

admission to thc Neonatal brainstem rcsPonses
Intcnsive Care Unit 0..l lCLf ) (r\11R.)

for 2 daYs or more

b. Syndromes known to causc
hearing loss (e.g. Usher's
syndrome. Waardenburgs
syndrome)
:. lirmily history ot
sens<try and
neural hearing
lo ss
d. Congenital infections (e g ,
toxoPlasmosis- rubella'
cvtotnegalovirus. herPes virus'
svphilis. bacterial meningitis)
e. Craniofacialabnormalities
(especiallY morPhologic
abnormalities ol the Pinna
& ear canal)
Ilepatitis C
HCV positrve mothers Anti-Hepatitis C

Philippine Guidelines on Pericdic Heolth

Exominolion:
EffectiveScreeningforDiseosesomongApporentlyHeolthyFilipino5
t,,
 Introduction and
Executiue Surnmary

oos#ffiffi#+
Table B-3 for Children. Screening tests that cdnnot be recommended routinely
POPUIATION INTERVENTION CO\DINO\S
SCREL\iED
A,
1. Neonates N{easurement of phenylalamne Phel:-::e: :'-:: ?KL''l
level on a dried spot specimen

2. Neonates & infants Univetsal heating scteening usrng I He-'-:-::: f '':ct:

within 6 months of evoked otoacoustic emrssion s
birth (EOA E) andf or arrdiron'
brainstem tesponses (ABR)

3. Infants at 6 months of

4. Older infants & Pre- Hearing screening ustng aucrlcr !{e:::: i=crce:
school childten (6 btainstem responses -r'BR . ,

mos.- 3 yrs of age) evoked otoacousuc sl:::i:c a- i

5. Age 2-3years, at age 5
years& every 1-2Years
thereafter
6. Adolescents age> 12
7. Schoo}-age childten
/F,()L\) or beharioral rner!:i
\risual examrnalton tor \-ls.l'al \-rsua-l irnpai-rment
acuity & ocular dtgrrnenr
Tanner stag'ing or sexual maru:r'r Delased pubern
raung as part of phv ucal
examinarion
Pure tone audiometrr- or Conducuve or sensoti- neutal
tvmoaflometfl' h lnss

B. School-age children Ivlass scteening chest x-raY Active TB disease

and college students
1.1t'r-i0 vrs. old)

Table B-4 fot children. Screening tests that cd.nnot be tecommended

Philippine Guidelines on Periodic Heolth Exominolion:

ffil rii.liiu" si,""ning for Diseoses omong Apporenily Heolthy Fitipinos
I Introduction and
Executiue Summary

OOO#.@ffiffiffi';i';ir,:'
Table C-l for Pregnant Women. Scteening tests that afe recommended
for the general populatioh
INTERVENTION FREQUENCY CONDITIONS
qCREENEr)
Ffis*nnr
T.asf Menstnra'l Period O,MP) At ieast once Measure sestational aEe
2. Tobacco or alcohol use or At least once Identifi high risk pregnarrcy
srrbsfance abuse
? Domestic ahrrse familv sfress At least once Identifv hieh risk Dresnancv
4. Environmental exposures at At least once Identi$' high risk pregnancy
home or at workolace
5. Ptevious poot pregnancy Once Identify high risk pregnancl
outcome, pretefm delivery,
fetal gtowth resttiction or
mal formation, placental
accidents, maternal
hemorhase
Pl1v inal F.vaminafion
t. Fundic height Every vrst Measure gestational age and
fetal orowth resttiction
2. Body Nlass Index @MI) Every visrt A ssess maternal nutrition
Weisht &E)/Heisht (m)
3. Fetal heart tones Every lrstt A ssess fetal comnromi se

4 Rlood nressufe Everv visit T{-rnerten <inn

T,ahoratorv Examination
1. Utine Culture and
Sensitivity (Jrine CS)
prefetably ot Utinaly sis
initiallv 6f CS not available)
First visit Asymptomatic bactetutia (if
urinaiysis is positive for pyuria,
infection should be confitmed
hrz CS hefore trertment)

2. Hemoslobin and hematocrit Once A

1 Rlood tvoe IABO) ( )nce Hemolvtic disease

4. 50g Glucose Challenge Test Once between 24'l' Gestational Diabetes Mell-itu s
tn ?Rth ..'cclr
5. Non-tteponemal serologic First visit Syphihs
tests using \IDRL or RPR; if
positive, confirm with
treponemal pallidum
hemagglutinatiofl assay
rTPHA)
6. Hepatitis B s Antigen (4bsAg) Once Hepatitis B
and Anti Hepatitis BS (Anti
HBS) at first prenatal visitif
nn nrinr rrcccinalinn

Philippine Guidelines on Periodic Heolth Exominoiion: I

Effeclive Screening ior Diseoses omong Apporenliy Heolihy Filipinos I 19
E

I Intrariu;ftor -i,:;
E,xenri t : J ;,,,;,,;,; -.

aolfllt'
Table C-2 for Pregnant Vomen. Screening tests that are
recommended for selected populations
CO\DITION INTERVENTION FREQUENCY CONDITIONS
SCREENED
egular mcnses Date of first notc of fctal C)nce I,leasure gestational
herut tones
Quickening Once l.leasure gestational
age
Ultrasound C)nce \{easure gcstational
2ge
hlgh-rlsk tor HIV IIuman Ycarlr Human
infection whlqh Immunodefi ciencl- Viru s immunodcficiency
include the following:
ftIn) EI-ISA; if positive, \-irus (lII\r)
a. History of confirm usingWestern
injectable Rlot (WB),
substance abuse
immuno fluoresccnce
b. History of sex
assay (IFA) or
with multiple
partners
radioimmune
c. Partners of precipitation assay
persons with
multiple sex
partners
d. Commercial sex
workers, sexual
contacts of
persons with
sexually
transmitted
diseases (STD)
e. Persons exposed

Table c-3 for Pregnant rwomen. screening tests that cannot

be recommended routinely

Table c-4 for Pregnant women. Screening tests that ate not recommended
INTERVENTION (-r\N]T!TTTr\
I{outine ultrasound Fetal abnormalities
Routine Clinical Pelvimetrv
Itoutine fetal movement corrnfinq A ssess fetal well-bcins
Urinary dipstick PreeclamDsia
Groun B Streotococcal screenino Group B StreDtococcal (GBS) infection
Vagnal pH Bacterial Varinosis
R.ubella titers Sr ihilin' t^ P
"h.lt.
Gram stain and cultures for N. Gonorrhca Gonococcal infection
Gram stain for leucocytes, or dircct fluoresccnt Chlamydia infection
antigm detection tesrs Q)FA) ofcervical, urethral
or oharvnseal fluid snecimm*
Human Immunodcficiency Virus (FIT\I scree. l luman Inlmunodcfi cieno' Virus G{ IV) in fecti on

Philippine Guidelines on Periodic Heollh Exominotion:

20', Effeclive Screening for Diseoses omong Apporenily Heolthy Filipinos
I Introduction and
Execatiue Summary
oot*&#6s'i.i1*#'
Table D-l for Adults. Immunizations recommended for the general population
POPIII-ATION IMMUNIZATIONS APPLICATIONS
1. Adults negative for Hepatitis A vaccination 2 doses ofinactivated
HepatitisA Virus IgG Hepatitis A vaccine given 6
after screening months apart
(0.6-12 months)
2. Child-bearing age if not Varicella vaccination 2 doses of live attenuated
pregnant and with no varicella vaccine (0, 4-Bweeks)
historo of immrrnifv
3. All persons> lByears Tetanus immuruzatron 3 doses oftetanus toxoid, first
old with unknown or 2 should be given 1 month
uncertain history of apart, and the 3'd dose, 6 12
completed primary months after the 1't dose with
seriesof immunization booster every l0years
dutins childhood
4. AII unvaccinated Tetanus immunization 2 doses oftetanus toxoid one
pregnant \romen of month apart, before delivery
those with uncertairl or ftom 2t"1 trimester onwxds
compieted history of
immunization
5. Pregnant women Hepatitis B vaccination 3 doses (0, 1,-2,4-6 months) of
negative for anti- plasma-detived or
Hepatitis BsAg recombinant H epatitis B
vaccine

Philippine Guidelihes on Periodic Heollh Exominotion: I

Effeclive Screening for Diseoses omong Apporently Heclihy Filipinos I ZI
I Introdartion and
Execaliue Summary

oos&@@ffi#
populations
Table D-2 for Adults' lmmunizations recommended fot selected

Influenza vaccination
ll H.t1,t*;orkers (i e physicians nurses' laboratory
'

\rancella vaccination if no 2 doses of live atteuuated

vaccine (0, 4-
history of imrnunitY 'aricella

Hepatitis A vaccinatron 2 doses ofinactivated

Hepatitis A vacciue given
6 nonths apaft

3 doses (0, l-2, 4-6

Hepatitis B vaccrnahotr
months) of Plasma-derived
or recornbinant HePatitis B

I dose annuallY of
InlhLenza vacclnahon
tt"tgGrnes and contacts with residents or parenteral influenza
t-E "plq"*f
Datients vaccine
and ottrer testdcr'es [or
, [li.ri.t*t ",assisted lir rrrg tacilities
persons in high-ri'k groups' Li,,l,-r;cf groups*
i., high-nsk orn,r)s
t. i:il; -t;;;;;i;"';;;; ** .openc's in
I .0 url of duck embryo
Pre-exposure rables
ffi reserrch lchoratories (PDEV) or 0 5 ml Vero
vaccination
7. V.t.rinutiun md arimal handlers cell (PVRV) rabies vaccine
i tllitli'i"i;t;;,o-tJdi'"'tlv i"uolved in taking care ofrabid IM: or 0.I ml lD 1br both
0atients Npesonday0 7ald2lot'
o [,"ii*".f.* srrch as bill collcclors doot-to-doot sajes
)8: booster every 3 Years tl

Persomel; etc uniibodv l"t"l i'atls below

Varicella vaccination' if no 2 doses of live attenuated

10.
-P;**king with children (teaclrers' day care varicella Yaccine (0' 4-
+
etnDlovg€s)* 8weeks)
;;,i;,i, i"'i,t.lilulronal seltings ti e rnrlitan !orerioncl
)+r.

' ;";;; ;";ane with pregrant^w*ornen' infants' AIDS pattents

'i;.
Hepatitis A vacclnatloll 2 doses ofinactivated
13. Militar1, Personnel Ilepatitis A vaccine giverr
i+ il".t"rt"ia *ntacts ofpatients with hepatitis A 6 months aPart

3 doses (0, l-2,4-6

Hepatitis B vaccination
15. Overseas wolkers rnonths) of Plasrra-derived
ii. p"r'... nt.nghters inrnales institultottalized persons or recoinbinant HePatitis B
ii iiuo.ntt the herlth profcssion vaccine
io c.niu.rs "nt.ring
ofpalre,rts with hepatititis B
i; ;:i;;;i,';;'oi"""a -'* rirh rnultiple panners {tnote thrn
..*., during the preceding 6 months)
^". rnen \\no nave
20 nnnla^ of p.^ont *rth rnultiple sex pmers:
sex with rnen
2.l. Comnercial sex workers
Hepatitis A & B HepatitisA-2dosesof
ilnj""ting u,rd non-irjecting illegal drug users vaccination inactivated llePatitis A
vaccine given 6 months
apalt
(0,6-12 rnonths)
Hepatitis B - 3 doses (0, l-
2. 4-6 rronths) of Plasrra-
derived or rccotnbinant

d (niliil dw//dt \ttu'/ ; O l)crvnt t' /tt

,'..ri. ),.t,.1,t,,,tt,,,, t.f t." nLv 4 l" t t ttiut-li li"L" r

Heorll" Exominoiion:
Philiooine Gurdelines on Period;c
for Diseoses omong ApporentlY HeolthY FiliPinos
22:l rfteciive Screening
I Introduclion and
Executiue Sammary

Oe€@@ffi&FPiiB

Table D-3 fot Adults. Immunizations that may or may not be recommended l

POPUIATION IMMUNIZATIONS APPLICATIONS

l. Adults> 60 ycms old Pneumococca] 1 dosc of23-valent
vaccinatior pn eumococcal poly saccharide

2. Adults> 50vcars old Influenza vaccination 1 dose annually ofparcnteral

inflrrmza vaccine
3. Travclcrs Influmza vaccination 1 dose annually of ptrmteral
it{lttttz.a vncnne
4. Persons( .{0 ycars old with no Ilepatitis B Ilepatitis B 3 doscs (0, 1-2,4{ months)
immunizadon vaccination of plasma<lcrived or
recombinant H cpatitis B
veccine
5. Pregnantwoman in 2nd or 3.d trimcsts of lnfluenza vac<inadon 1 dosc annually of parmteral
nfemrfl d influenza vaccine
6. Day cme workcrs Flepatitis A llcpatitisA-2doscsof
7. Workers in ilstitutionalized scttings veccination inactivated I Iepatitis A
vaccine g'ivan 6 months apart
(0, 6-12 months)

8. Persons confined in institutions (i.c. Ilepatitis A Flepatitis A - 2 closes of

cotrcctional bureau, homcs for thc eldcdy, vaccination inactivated FI epatitis A
etc.) lnflucnza vaccinetion vecdne;'ivm 6 months rprrt
(0, 6J 2 months)
influmza - 1 dose annually of
perenteral il fluenza vac<ine

Table D-4 for Adults. Immunizations that are not recommended.

No immunizations have been classified under this table.

Philipplne Guidelines on Periodic Heolth Exominotion: I

Effective Screening for Diseoses omong Apporenlly Heollhy Fitipinos I 23
I Introdaction and
Executiue Sammary

OOC#@Wffi'W-II;E '=,

References Dans Al. The value of exetcise

1. Sackett DL, Haynes RB, Tugwell P.
Clinical Epidemiology: A Basic
Science for Clinical
Boston: Little Btown and Co.;
1.991,.
2. Peters TJ, Wildschut HIJ, Weiner C.
Epidemiologic considerations in
scteening. In, Widschut HIJ,
Weiner C, Peters TJ, editbts. When
to Scteen in Obsetrics and
Gynecoiogy, London: WB
testing in screening for coronaty
artery disease. PhiJippine Journal of
Cardiology. 1.99 1 ; 20 (I): 609 - 617 .
Medicine.
7. ShepherdJ., Cobbe SM, Ford I,Isles
CG, Lorimar AR, Macfodane PW
Mcl(illop JH, Packard CJ, fot the
West of Scotland Cotonary
Prevention Study Gtoup. Ptevention
of coronary heatt disease with
prorastatin in men with
hlpercholes terolemia. N Engl J Med.
1.995;333:1301-1307 .

Saunders, L996.
8. Lee PR. U.S. Department of Health
3. Hooper L, Battlett C, Davey Smith G, and FIuman Setvices, Ptess
Ebtahim S. Reduced dietaty salt fot Confetence, Report of the U.S.
ptevention of cardiovascular disease Pteventive Services Task Force,
(Cochrane Review). In The Cochrane 1996.
Library, Issue 2, 2003- Oxfotd:
Update Softwate 9. Canadian Task Force on Preventive
Health Qare. The Canadian Guide
4. Asano TI! Mcleod RS. Dietary fibte to CLinical Pteventive Health Care,
for the prevention of colorectal Ottawa, Canada.l'997.
adenomas and carcinomas (Cochrane
Review).. In: The Cochrane Library, 10 Audet AM, Gteenfield S, trield M.
Issue 2, 2003. Oxfotd: UPdate Medical ptactice guidelines; cutrenl
Software. activities and future directions. Ann
Intetn Med I99 0 ;1.1.3:7 09 -7 1, 4.
5. \7H.O. cooperative trial on primary
prevention of ischaemic heart disease 11. Fink A, I{osecoff J, Chassin M,
using clof,rbtate to lower se.rum Brook RH. Consensus methods:
cholesterol: mortality follow-uP. characteristics and guidelines for
Repott of the Committee of Principal use. Am J Public Health
Investigators. Lancet. 1 980. 1984;7 4:979-983.

I pniliooine Guidelines on Periodic Heollh Exominotion:

24 | ftu.iiuu Screening for Diseoses omong Apporenlly Heolihy Filipinos