Americans Are a Bit Fuzzy About Physical Checkups

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.

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 [5]: 1941-1946)

Study Finds Caffeine May Stiffen Artery, Cause Cardiovascular Disease

Caffeine is the most widely used drug in the world, but studies focusing on its health effects have been conflicting. Scientists are now taking a closer look at very specific ways in which the body responds to caffeine. For the first time, researchers in Athens have shown in two studies that coffee appears to cause a major artery to stiffen, which increases risk of cardiovascular disease. The research was presented last week at the annual meeting of the American Society of Hypertension in New York.

In one study, 10 people with hypertension that was controlled by medication abstained from coffee for 12 hours and then took a capsule containing either the caffeine equivalent of two to three cups of coffee or a placebo. On another occasion, they were given the placebo capsule.

Researchers then measured the stiffness of the subjects’ aorta, the main blood vessel that carries blood from within the heart to the arteries. The measurements showed that aortic stiffness increased 30 minutes after the subjects took the caffeine capsules, peaked one hour afterward, and began a slow return to its starting point after three hours. The speed of blood flow through the arteries also increased, as did blood pressure. A separate but similar study of 10 healthy people who took a capsule with the equivalent of one cup of coffee also showed an increase in aortic stiffness.

The short-term effects of caffeine were slight but significant. Researchers note that increasing aortic stiffness and speed of blood flow repeatedly for months or years could lead to degeneration of the blood vessels. “We are not saying that everyone should abstain from coffee, but people with heart failure or hypertension should be more cautious,” says Dr. Charalambos Vlachopoulos, director of hypertension at the Henry Dunant Hospital in Athens. He also reminds people that caffeine is not limited to coffee but is in certain sodas and teas.

Drinking Tea Strengthens Bones and Does a Body Good

People who drink several cups of tea a day may be getting more caffeine than they should, but other ingredients in the tea may be strengthening their bones. Of the 4,000 chemical compounds in tea, researchers suspect that the combination of fluoride and flavonoids, including phytoestrogen, may prevent bone loss in men and women.

But results of three major studies of tea and bone mass have not all shown a connection between tea-drinking and prevention of bone loss. Researchers in Taiwan were troubled by the fact that only white patients who drank black tea were studied. So the National Cheng Kung University team designed a study to examine more than 1,000 Chinese men and women who drank three different types of tea. The researchers also took into account many different factors that could have an effect on bone density, including age, sex, obesity, physical activity, smoking, coffee consumption and calcium supplements. About half the men and women were tea drinkers, some for as long as 10 years or more, and 91% drank green tea.

The results indicate that many years of tea drinking may be best for bones. Those who consumed tea habitually for six to 10 years had greater bone density in the lumbar spine than those who didn’t drink tea regularly for that long a time. There was no significant difference between the group who drank tea for less than five years and those who were not tea drinkers. (Archives of Internal Medicine 2002;162: 1001-1006.)

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Dianne Partie Lange can be reached by e-mail at DianneLange@cs.com.