Examination of the adult population

The concept of

The adult medical examination ( abbreviated to DVN ) has a more precise expanded name,).Speaking about the fact that the universal conduct of DVN among the population does not have its full coverage in one calendar year, and concerns only certain categories of adult citizens according to the order of the Ministry of Health of the Russian Federation( hereinafter - the Ministry of Health of Russia) dated 03.12.2012, No. 1006-n"On the approval of the procedure for the clinical examination of certain groups of adults".This circumstance is due to the fact that the implementation of the MFF requires a large financial cost.

Universal medical examination is a screening( from the English " screening" - a massive medical examination).

Purpose

The purpose of this set of measures in our domestic health care system is to identify and prevent the progression of various diseases in the population.

The MRE can be represented as preventive medical examinations, differing from the latter by a somewhat larger set of medical studies and consultations of doctors conducted at specially selected age periods in the population.

The term

Until 2013, the term " additional medical check-up " was used, but in the future in the Russian Federation, the entire population of the OGVN began to be in the mandatory medical insurance system.

Main goals and objectives

In the DVN screening, the main goals and objectives can be distinguished:

1. The earliest detection of diseases.
2. Accordingly, the beginning of treatment is timely.
3. The most favorable condition of the patient.
4. Decrease in the death rate among the population.

However, not all screening methods have unequivocal benefits! There may be adverse effects in the form of: erroneous diagnosis, overdiagnosis, false belief in the absence of disease.

On medical screening, you can also say that it happens:

1. mass, or universal, involving all persons of a certain surveyed category;
2. selective, or selective, for those at risk.

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Clinical examination in Russia

Clinical examination of adults

The DVN in Russia( persons aged 18 years and over) was established on the basis of the order of the Ministry of Health of Russia dated February 03, 2015 No. 36an "On approval of the procedure for clinical examination of certain adult groups".According to which citizens of the Russian Federation who have reached adulthood, if they wish, are entitled to free medical examinations from medical specialists and an instrumental medical examination at their place of residence.

Appendix No. 1 to Order No. 36an of the Ministry of Health of the Russian Federation of 03.02.2015 specifies the specialties of doctors, the set of surveys and their frequency.

The periodicity of the clinical examination is regulated as once every three years, starting at the age of 21 years, and so on, with the addition of a three-year interval, that is: 24 years, 27 years, 30, 33, 36, 39, 42, 45, 48,49, 51, 54, 57, 60, 63, 66, 69, 72, 75, 78, 81, 84, 87, 90, 93, 96, 99 years.

But there are some groups of citizens that are indicated in subparagraphs 1 to 3 of point 4 of the order, which is recommended annually for clinical examination, regardless of their age. These are:

• invalids and participants of the Great Patriotic War and invalids of military operations.
• persons, awarded with the sign "Resident of the besieged Leningrad".
• former under-age prisoners of concentration camps, ghettos, other places of forced detention created by the fascists and their allies during the Second World War.

A mandatory requirement for all these categories of citizens: disability should not occur as a result of their unlawful actions.

Medical examinations are conducted in medical organizations that participate in the implementation of the program of state guarantees of free medical care for citizens in the provision of primary health care.

Clinical examination as a preventive examination differs from dispensary observation, which is carried out by citizens who are on dispensary records with existing chronic diseases.

Clinical examination of children and adolescents

The medical examination of the children's population, i.e., citizens until the age of 18, is determined by Order No. 1346n of the Ministry of Health of the Russian Federation of December 21, 2012 "On the Procedure for Minors to undergo medical examinations, including admissionin educational institutions and in the period of training in them ".

The child population in Russia should undergo medical preventive examinations with the following regularity:

• Monthly - up to one year of life.
• Once in three months - in the second year.
• Once every six months in the third year.
• Annually from the age of three until reaching the age of eighteen.

Orders for arranging the implementation of the

1. . The order No. 1006н of December 3, 2012 approves the procedure for the prophylactic medical examination of the adult population, its scope( checklist of medical specialists, studies and other medical measures for men and women in certain age periods, diagnostic criteria of factorsrisk of developing chronic non-communicable diseases
2. Order No. 36an of 03.02.2015 updates the previous one( 1006n), specifies diagnostic examinations, a form of documentation, reporting.
3. Order No. 1346n of 21.12..2012, details the principles and procedure for undergoing medical examinations by minors, including when they enter and return to educational institutions.

• There are also Methodical Recommendations for the Conduct of the Mine Action Plan

The

Stages The basic principle of conducting medical examination of the population is its two-stage:

The first( first) stage of

It is based on the identification of all signs of chronic non-infectious diseases in citizens( i.e.ie, diseases of the circulatory system: coronary heart disease and cerebrovascular diseases, diabetes mellitus, malignant neoplasms, chronic lung diseases, increased intraocular pressure), risk factors for their development, as well as consumption of all narcotic and psychotropic drugs and funds without the appointment of a doctor.

The first stage ends with a reception at the local doctor-therapist, with a brief preventive counseling.

In cases of detection of a suspicion of having a chronic non-infectious disease, high and very high total cardiovascular risk, the district therapist reports this to the patient and directs him to the second stage of clinical examination.

The second( second) stage of

is the additional medical examination and further specification of the diagnosis, more in-depth prophylactic counseling, examination by specialists and a number of instrumental laboratory methods for testing at the indications specified at the first stage.

All citizens are divided into 3 large groups of health according to the final results of the OWS: relatively healthy( the first group of the state of health), then people with a high and very high total risk of developing cardiovascular diseases( the second group of health) and already sick people( the third group of health).

Control of

The organization of the implementation of the OWHN in a medical organization is controlled by the regional health committee, the Territorial Fund of the MLA and insurance medical organizations.

Examples of dispensary methods:

1. A positive result of a fecal occult blood test reveals internal intestinal bleeding, malignant neoplasms.
2. The Bek Depression scale is used to diagnose a depressive condition.
3. The alpha-fetoprotein test excludes fetal pathologies.
4. Tuberculin test( Mantoux reaction) reveals tuberculosis.
5. Radiography of the teeth is done to prevent caries.

Research in the period of clinical examination allows to diagnose malignant neoplasms at an early stage.

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I give an example of reliable screening tests:

1. Papanicolaou test is used to detect precancerous changes in cases of cervical cancer;
2. Identify breast cancer using the Mammography method.
3. The examination of a dermatologist makes it possible to recognize melanoma.
4. Colonoscopy is used to exclude colon cancer.

Screening medical equipment

The medical equipment used in screening diagnostics is often different from the clinical diagnostic equipment. After all, the purpose of screening is the detection of a disease in a clinically asymptomatic person, and not an examination of an already sick person, where it is necessary to analyze the nature and severity of the pathological process. Therefore, the screening equipment is less accurate than the diagnostic one.

Disadvantages and Benefits of Screening

Screening has, along with benefits, also drawbacks. The final decision on the appropriateness of screening is based on an intellectual analysis of these factors.

Advantages of

Screening makes it possible to identify diseases at their early, yet asymptomatic stages. And the cure for this becomes most effective.

Disadvantages of

The screening method like any other medical research is not perfect. Its results can be false-positive, false-negative, the existing disease may not be detected. In addition, screening costs very much financial resources;has undesirable effects of anxiety, discomfort, adverse effects of harmful chemicals and radioactive ionizing radiation on the human body;psychological discomfort in cases of particularly incurable diseases;stress and anxiety due to a false positive result( unnecessary additional research is often done here);a false sense of security excludes the timely diagnosis of dangerous diseases in persons with a false negative result.

Principles of screening

The need for population screening is caused by a number of issues of preventive measures. Despite the fact that some screening tests are unprofitable, nevertheless, the increase in the level of health among the population is observed as a result of mass screening surveys.

In 1968, WHO developed guidelines for defining screening principles, which to this day has not lost its force. It has such basic principles as:

1. Disease is an important medical problem.
2. Treatment of the disease should be carried out.
3. Availability of diagnosis and treatment of the disease.
4. There is a hidden period in the disease.
5. The research method for the disease should exist.
6. The method should be acceptable for the study.
7. The natural course of the disease must be adequately understood.
8. Policy coherence in the need for treatment.
9. Investments in case management should be balanced with total expenditure.
10. Continuous screening.