Health Checks
- Pros and cons to Health Checks
Pros and cons to Health Checks
Please Note: Health checks for any health condition are never 100% effective and a negative result does not necessarily mean you are free of that health condition (106). Health checks refers to the application of a specific test for conditions even if they have no obvious signs or symptoms (97). Some conditions may not display early signs and symptoms, however if the condition is detected in early stages treatment tends to be more successful (106). The health check is not necessarily used to diagnose a condition, rather to determine if further investigations need to be done (106). The potential benefits of a health check for different conditions must outweigh any potential harms that may result. There must be strong evidence from research that a health check is effective in reducing the burden of relevant health conditions (82). For this reason it is important to talk to with your general practitioner to identify what health checks are relevant for you.
General practitioners see 86% of all Australians every year, so they have a great opportunity to encourage patients to take greater responsibility for their health and also test them for potential health conditions (97). The service log book provided on this site is simply a tool to prompt you to ask your general practitioner about tests for health conditions that may be relevant to you. Please be aware that health checks are not necessarily a once off event, they may be done on a continual basis, say annually. The initial test can be used as a baseline measurement and following tests to assess changes to the known baseline. The downloadable service log book and community forum initiated personal surveys provide you with an opportunity to keep record of your results and track them over an extended period of time.
For health checks to be effective there needs to be a ‘window of opportunity’ where it is possible to detect the disease before it reaches an advanced stage (106). Fortunately many health conditions develop gradually, so early detection, treatment and lifestyle interventions can achieve positive results (106). It must be noted that some conditions do develop rapidly and may progress to advanced stages even between health check 1 to health check 2 (106). Regular health checks simply increase the likelihood of identifying a health condition in early stages of development where treatment can be much more effective (106).
There are two elements to health checks - Health test sensitivity and specificity that you need to be aware of:
- Sensitivity refers to the ability of the test to correctly identify people who have disease. Sometimes a test with poor sensitivity will wrongly identify people as being free of the health condition when they weren’t (false negative). This can result in delays in diagnosis and receiving treatment. It may also develop a false sense of security, becoming oblivious to signs and symptoms (106).
- Specificity describes the ability of the test to correctly identify people who do not have the disease. A test with poor specificity will result in a high rate of healthy people incorrectly testing positive, leading to more unnecessary invasive diagnostic testing (false positive). Patients may have to undergo further testing that is uncomfortable, expensive and in some cases potentially harmful. There may be psychological consequences such as anxiety for both the patient and their family (106).
Assessments of Relevance?
The following assessments are detailed in the ‘service log book’ and also feature below. The log book spreads the assessments over 48 weeks, prompting you to perform the basic screen tests or speak to your health professional for the more advanced assessments.
- Body Mass Index (BMI)
- Height Measurement (cm)
- Waist - Hip Ratio
- Waist Girth (cm)
- Advanced Optional Assessments
- Digital Rectal Examination (DRE)
- Faecal Occult Blood Test (FOBT)
- Prostate Specific Antigen (PSA)
- Vision Check using Snellen Chart
- Whispered Voice out of Field of View Test
- Diphtheria & Tetanus (dT)
- Pneumococcal Polysaccharide (PPV)
Body Dimension & Health Assessments
Body Mass Index (BMI)
BMI is a number that is based on a person's weight and height. It can be used to identify people at risk for some health problems. Higher BMI values indicate greater weight per unit of height. The score is valid but it does have some limitations, as it may overestimate body fat in those of higher muscular build. It can also potentially underestimate body fat in older persons and others who have lost muscle mass (88).
Height Measurement (cm)
1. Please remove your shoes for an accurate measurement.
2. Place your back flat against the wall with your head placed in the Frankfort plain (chin slightly dropped placing head in natural position rather than against the wall)
3. Place a levelled ruler on top of the head to determine a point on the wall equivalent to your height.
4. Once determined measure with measuring tape and obtain a value to the nearest 10th of a centimeter.
Weight Measurement (kg)
Please remove shoes, excess clothing and heavy accessories for an accurate measurement, then step onto scales and limit movement. Try to use the same scales throughout the study and make sure the batteries are relatively new.
Waist - Hip Ratio
The waist to hip ratio is a measurement to assess whether you are in a healthy weight range. It also tells us whether you are storing your fat around your hips or your waist. The location of fat storage can be linked to health risks. The waist to hip ratio is calculated by dividing your waist girth measurement in centimeters by your hip girth measurement in centimeters.
Waist Girth (cm)
Waist girth can indicate your risk of developing health conditions
1. Please do not perform this measurement over clothing; otherwise it will affect the result.
2. You should stand with your arms by your side, feet together and relax your abdomen.
3. Identify the narrowest part of the torso and then place the tape around horizontally ensuring that it is not on an angle.
4. Confirm the girth after a normal expiration, or “breathe-out”.
Hip Girth (cm)
Hip girth can indicate physical activity levels and risk of developing conditions, as those who are more physically active (even if overweight) tend to have more muscle in this region rather than body fat.
1. Ideally this measurement would be taken in your underwear.
2. Place your feet together then have someone identify the most protruding point of the gluteal (backside) muscles.
3. Once identified place the measuring tape horizontally and level around the hips.
4. It is recommended that the gluteals are tensed during this measurement (95).
Blood Pressure
Blood Pressure assessments should be performed by a health professional unless you have been trained to self-analyse blood pressure. The health professional will use a sphygmomanometer, which has the ability to assess pressure on the arteries as the heart is pumping. You will receive two readings systolic and diastolic eg. 120/80. Systolic represents the pressure exerted on the arteries whilst the heart is contracting. Diastolic represents the pressure on the arteries whilst the heart is relaxed. You may have to do this assessment a couple of times to get a true representation of your ‘normal’ blood pressure, as sometimes people get nervous (white coat fever) about the assessment and subconsciously increase their blood pressure.
Prior to blood pressure assessment avoid: Physical activity, Smoking and Caffeine (25)
Heart Rate (radial)
1. This assessment represents the amount of times the heart beats per minute.
2. Find the bony process on the inside of the wrist.
3. Keep two fingers in line with the bony process and lay them flat across the first quarter of the wrist (palm up).
4. Apply pressure until you feel the pulse.
5. Ignore the first pulse and count the rest thereafter for 15 seconds.
6. Once you have obtained a figure multiply it by four to determine your heart rate per minute.
Self Check Assessments
ABCDE Skin Check
Screen you body for lesions (sunspots) identifying new ones or changed ones. Lesions that are asymmetrical (not uniform in shape), have an irregular border, variation in colour or have a red halo and are elevated more than 6mm can be possible melanomas (97). If the lesion is ‘the ugly duckling’ then it may require further examination (97). Men have a high risk of developing melanomas on their back so have someone screen your back for you. This assessment is recommended to be performed every four weeks throughout the program. By doing this assessment regularly you will be more familiar with your skin lesions and more capable of identifying changes in them. If you identify any abnormalities please refer to your general practitioner for further examination.
1. Asymmetry
2. Border
3. Colour
4. Diameter
5. Elevation
Or ‘ugly duckling’(97)
See Cancer Council Skin Check Information here.
Advanced Optional Assessments
Bone Density – DXA
A DXA (Dual-energy X-ray Absorptiometry) scan is capable of diagnosing Osteoporosis and Osteopenia. It is a short, painless scan that measures the density (strength) of your bones, usually at the hip and spine. The result from this test is called a T-score. The scan involves only low radiation levels (93). If over the course of the program you note a loss in height by more than 0.5cm it may warrant further investigation (97). Please refer to your general practitioner to talk about the benefits of a DXA scan for you.
Digital Rectal Examination (DRE)
The Prostate Cancer Foundation of Australia (PCFA) recommends all men from 50 years (40 years of age if there is a family history of prostate cancer) to talk to their doctor about having a DRE test (16). The DRE examination is done to check for abnormalities with the prostate gland (16). During the examination, a health professional gently puts a lubricated, gloved finger of one hand into the rectum. He or she may use the other hand to press on the lower belly or pelvic area. It is entirely your decision to have the DRE test performed, so speak to your general practitioner about being tested. PCFA recommends both the DRE and PSA blood test be done annually.
Faecal Occult Blood Test (FOBT)
The FOBT test detects small amounts of blood in your bowel motion that may be leaking from a cancerous growths. It is recommended that you have the test performed at least every two years once over 50, however if you have a family history you should consider having the assessment performed once over 40 years of age. The test requires three samples which can be done in the comfort of your own home. Kits can be ordered through www.bowelcanceraustralia.org or organized through your general practitioner. Free bowel cancer screening tests are being offered to Australians turning 50, 55 or 65 between 1 January 2008 and 31 December 2010. Participants with a positive FOBT will be advised to discuss the result with their doctor, who will generally refer them for further investigations, usually a colonoscopy (32). It is entirely your decision to have the FOBT test performed, you can either speak to your general practitioner or visit www.bowelcanceraustralia.org to find out more about the assessment and to see if you would benefit from it.
Fasting Blood Glucose
Your blood glucose levels are checked after fasting for 12-14 hours. You can only drink water during this time, and have to avoid all other food and beverages. This test is an indicator of your likelihood of developing diabetes (26). It is entirely your decision to have the fasting blood glucose test performed, so speak to your general practitioner about the assessment if you feel you would benefit from it.
Fasting Blood Lipids
Your blood lipids are checked after fasting for 12-14 hours. You can only drink water during this time and have to avoid all other food and beverages (26). This test is an indicator of developing cardiovascular disease(s) (61). It is entirely your decision to have the fasting blood lipid test performed, so speak to your general practitioner about the assessment if you feel you would benefit from it.
Prostate Specific Antigen (PSA)
Early detection is the key to enabling better outcomes and potential cure of prostate cancer. Accordingly, PCFA recommends that men at 50 with no family history of prostate cancer, and men at 40 with a family history, should seek voluntary annual assessments in the form of a Prostate Specific Antigen (PSA) blood test together with a Digital Rectal Examination (DRE). For more info see the PCFA Policy on PSA and DRE. The PSA test involves a blood sample being taken and analysed, looking for a known marker linked with prostate cancer. It is entirely your decision to have the PSA test performed, so speak to your general practitioner about the assessments to see if you could benefit from it. Please note that Medicare will cover one free PSA test, per male, per annum.
Testosterone Levels
Your testosterone levels can be measured through a blood test. Men’s testosterone levels gradually decrease with age and this can sometimes lead to a testosterone deficiency (13). It can be helpful to have baseline records of your testosterone levels. It is entirely your decision to screen your testosterone levels, so speak to your general practitioner about the assessment if you feel you would benefit from it.
Urinary Analysis
Urinalysis is an analysis of a urine sample, which can provide evidence of diseases, even some that have not developed noticeable signs or symptoms (86). Urinalysis is often utilised to diagnose a urinary tract or kidney infection, evaluate causes of kidney failure and to screen for progression of some chronic conditions such as diabetes and high blood pressure (86). About 10-15ml of urine midstream is collected for the analysis (86). It is recommended to have a urinalysis every 1-5 years depending on your risk factors (97). It is entirely your decision to have the urinalysis test performed, so speak to your general practitioner about the assessment if you feel you would benefit from it.
Vision Check using Snellen Chart
It is recommended to have your eyes checked once a year once you turn 65 (97). The Snellen chart will require you to look at a chart, cover one eye and read out the letters. Decreased vision can increase the risk of falls (97). Certain chronic health conditions, such as diabetes can have impact on vision so this assessment can help monitor this (97).
Whispered Voice out of Field of View Test
It is recommended to have your hearing checked once a year after the age of 65. It simply involves a specialist asking a question out of your field of view and monitoring if there is any response (97).
Optional Immunisation
Diphtheria & Tetanus (dT)
All adults who reach the age of 50 and have not received a booster dose of a tetanus-containing vaccine in the previous 10 years should be given dT or dTpa vaccine (40). dTpa is preferred, if not given previously, as it provides additional protection against pertussis, or whooping cough (40). If you are in this category, or haven’t had a dT booster for 10 years, please ask your general practitioner about it.
Hepatitis A & B
Those who travel internationally, are drug users or have sexual intercourse with other men are at a higher risk of contracting Hepatitis A and/or B (40). If you fall into any of these categories and haven’t had a Hepatitis A and B vaccine then please ask your general practitioner about it.
Influenza
An annual Influenza vaccine has been shown to reduce hospitalisations from pneumonia by about half in adults over 65 (40). A yearly influenza vaccine is recommended for Aboriginal and Torres Strait Islander people over 45 years of age (40). Please ask your general practitioner about the influenza vaccine and how it could benefit you.
Pneumococcal Polysaccharide (PPV)
All people aged over 65 years, and Aboriginal and Torres Strait Islander people over 45 years of age should receive the PPV vaccine every five years (40). If you are in this category and haven’t had the PPV vaccine then please ask your general practitioner about how it could benefit you.
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