The annual physical exam may be history, but many Americans don't know it. Although the U.S. Preventive Services Task Force hasn't recommended that healthy people get checkups since about 1979, a recent survey in Denver, San Diego and Boston found about two-thirds of people still believe that an annual head-to-toe exam is necessary.
Not only were those surveyed wrong about checkups, they also mistakenly believed certain tests that no medical group recommends were needed; and they ignored others that authorities say are needed. In short, people seem to be confused about what screening tests they need and when. It doesn't help, write the researchers, that doctors still use the words "annual checkup" in conversations with patients.
For The Record
Los Angeles Times Thursday June 06, 2002 Home Edition Main News Part A Page 2 National Desk 8 inches; 316 words Type of Material: Correction
Journal citation--In the Health section on May 27, an item in the Capsules column, about needle biopsies of nodules, contained an incorrect citation to the Journal of Clinical Endocrinology & Metabolism. The correct citation is 87 : 1941-1946.
For The Record
Los Angeles Times Monday June 10, 2002 Home Edition Health Part S Page 3 Features Desk 1 inches; 40 words Type of Material: Correction
Incorrect citation--An item in the Capsules column on May 27, about needle biopsies of nodules, contained an incorrect citation to the Journal of Clinical Endocrinology & Metabolism. The correct citation is 87 : 1941-1946.
In Denver, where the first phase of the survey was done, more than 90% of the 603 people questioned expected a blood pressure measurement, a heart and lung exam, and, for men, a prostate exam with their physical. But of all those procedures, only a blood pressure measurement is recommended by the task force. Those surveyed also felt their blood should be tested for various substances like thyroid (hormone) and hemoglobin. The task force only recommends cholesterol testing.
The 600 respondents in the other cities answered slightly different questionnaires. They didn't want as many tests as the Denver group, but their expectations were similar regarding the need for an annual checkup. Dr. Christine Laine, senior deputy editor of the Annals of Internal Medicine and author of an editorial accompanying the study, says research has not yet demonstrated that patients who have annual physicals are more likely to get recommended tests or adopt healthy behaviors than people who don't get regular checkups. (Annals of Internal Medicine 2002:136: 652-659)
Unhappy Marriages Can Be Hazardous to One's Health
A bad marriage makes the heart grow thicker, probably because the stress causes blood pressure to climb. Now researchers have reanalyzed the data that originally showed unhappy married men have high blood pressure and zeroed in on some specific attributes of marriage that make a difference.
Satisfaction and cohesion, which are measures of marital support, seem to be most important in terms of blood pressure in the 103 patients studied, says Brian Baker, associate professor of psychiatry at the University of Toronto, who presented his findings last week in New York at the annual meeting of the American Society of Hypertension. The size of the left ventricle of the heart increased 6.2% on average in the 72 subjects who had weak scores in marital support. "Satisfaction means people are satisfied and committed in their relationship. It's a quality of marriage concept," explains Baker. "Cohesion is a quantity of life. It's the amount of time the couple spends together." Job strain was more difficult to measure because about half the people had changed their jobs over the course of three years. A larger study of people with stable jobs over a long period is needed. "We think that double exposure--a bad job and a bad marriage--will tell us more," says Baker.
With More Nodules Being Detected, Spotlight Falls on Needle Biopsy
Physicians are bracing themselves for an epidemic of small thyroid growths. Why? Use of imaging technology, such as MRIs and CT scans, as a diagnostic tool in medicine is growing and these tests are turning up nodules that otherwise would have gone unnoticed. Once accidentally detected, the nodules can't be ignored because a small percentage are malignant.
When tumors are large enough, a needle biopsy is often the next diagnostic step. Considering the increasing numbers of people with the nodules and the low likelihood of cancer, however, the cost of this invasive test could be enormous. This dilemma has doctors searching for guidelines on who should get a needle biopsy and who should be reexamined in six to 12 months. Now an Italian study of 402 people with thyroid nodules--31 of whom turned out to have cancer--has yielded some suggestions.
All the patients in the study had both ultrasound and needle biopsies, and by comparing the results, the researchers found that the image of the nodule created by sound waves was useful in predicting malignancy. They report that features on the ultrasound--such as irregular or blurred edges or tiny calcifications--pointed to cancer, indicating that the nodule should be biopsied. "This is a touch controversial, but it's an interesting study of a large number of patients in which they found a significant number of hidden cancers ... by looking at the three characteristics on ultrasound," says Dr. Leonard Wartofsky, a professor of medicine at Georgetown University. (The Journal of Clinical Endocrinology & Metabolism 85 : 1941-1946)
Study Finds Caffeine May Stiffen Artery, Cause Cardiovascular Disease