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Wellness Wise

The Wellness Guide to Preventive Care

A recent government study showed that more than half of all Americans do not receive many of the important preventive services they need—that is, immunizations, screening tests for early detection of disease, and education about healthy habits and injury prevention. Why not?

How about that annual physical?

It used to seem simple: people were advised to undergo a standardized annual or biannual "complete physical." But in the 1980s, at the request of the government, an independent committee of physicians known as the U.S. Preventive Services Task Force reviewed all evidence and evaluated the benefits and drawbacks of common screening tests and came up with recommendations. (A similar group, the Canadian Task Force on Preventive Health Care, does the same work in Canada.) That head-to-toe physical exam has now been discarded for seemingly healthy people, since it yields too few benefits for its cost. Over the long run, it doesn't pay off in terms of better health and longer life.

Some tests that used to be routinely done, such as chest X-rays, electrocardiograms (EKGs), urine tests, and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not general "screening" tests and are not done routinely in everyone (and as such are not covered in this article).

The U.S. and Canadian Task Forces continue to update and re-evaluate their advice, reviewing thousands of studies every year and consulting hundreds of scientific reviewers.

Blood pressure measurement (to detect hypertension)
Who needs: All adults.
How often: Once every 2 years for those with normal blood pressure.
Comments: More frequent monitoring for those with readings of greater than 130/85 or higher—consult your doctor.

Cholesterol measurement
Who needs: All adults.
How often: Once every 5 years. More often if total or LDL ("bad") cholesterol is high, HDL ("good") is low, and/or you have risk factors.
Comments: Those at high risk for heart disease need medical advice about life-style changes and possibly drug therapy—consult your doctor.

Pap smear (for early detection of cervical cancer)
Who needs: All women with a cervix, starting at age 18, or earlier if sexually active.
How often: If 3 annual tests are normal, then once every 3 years. More often if you smoke or have multiple sex partners or other risk factors.
Comments: Some experts advise that woman who have never had an abnormal result can stop being screened after age 65—consult your doctor.

Breast cancer screening (mammography)
Who needs: All women 50 and over; those 40-49 should discuss risk factors with a doctor.
How often: Annually. Medicare reimburses for it.
Comments: Clinical breast exams are also important—consult your doctor.

Colonoscopy screening (fecal occult blood test, sigmoidoscopy, colonoscopy)
Who needs: Everyone 50 and over; earlier for those at high risk.
How often: Occult blood test annually; sigmoidoscopy every 5 years or colonoscopy every 10 years.
Comments: Digital rectal exam and X-ray with barium enema may also be done. Medicare now pays for colonoscopy—consult your doctor.

Prostate cancer screening (prostate specific antigen, or PSA, test; and digital rectal exam, or DRE)
Who needs: African Americans and men with family history, DRE and PSA starting at age 40. For others, DRE, and possibly PSA, starting at 50.
How often: DRE annually; PSA on professional advice.
Comments: Usefulness of PSA screening for all men remains controversial—consult your doctor.

Diabetes screening (fasting blood glucose test)
Who needs: Everyone 45 and older; earlier for those at high risk.
How often: Every 3 years.
Comments: African Americans, Hispanics, Asians, Native Americans, obese people, and those with a strong family history need more frequent screening, starting at age 30—consult your doctor.

Thyroid disease screening
Who needs: Women 50 and over; those with high cholesterol or family history of thyroid disease.
How often: On professional advice.
Comments: Routine screening remains controversial. Talk to your doctor about risk factors.

Chlamydia screening
Who needs: Women 25 and younger, if sexually active.
How often: Annually, or more often.
Comments: Men and women of any age who are at risk for STDs (chlamydia, gonorrhea, syphilis, and HIV) should be tested—consult your doctor.

Glaucoma screening
Who needs: People at high risk: those over 65, very nearsighted, or diabetic; blacks over 40; those with sleep apnea or family history of glaucoma.
How often: On professional advice of eye specialist.
Comments: Many eye specialists advise screening all adults every 3-5 years, starting at age 39—consult your doctor.

Dental checkup
Who needs: All adults.
How often: Every 6 months, or on professional advice.
Comments: Should include cleaning and exam for oral cancer—consult your doctor.

Tetanus/diphtheria booster
Who needs: All adults.
How often: Every 10 years.
Comments: People over 50 are least likely to be adequately immunized—consult your doctor.

Influenza vaccine
Who needs: Everyone 50 and over, people with lung or heart disease or cancer, and others at high risk.
How often: Annually, in autumn.
Comments: Even healthy younger adults can benefit and should consider getting the shot—consult your doctor.

Pneumococcal vaccine
Who needs: Everyone 65 and over, and others at high risk for complications.
How often: At least once.
Comments: Effective against most strains of pneumococcal pneumonia; lasts at least 5-10 years—consult your doctor.

Rubella vaccine
Who needs: All women of childbearing age.
How often: Once.
Comments: Avoid during pregnancy—consult your doctor.

Hepatitis B vaccine
Who needs: All young adults, as well as adults at high risk.
How often: On professional advice.
Comments: All newborns should be vaccinated—consult your doctor.

Chickenpox vaccine
Who needs: Anyone who has never had chickenpox.
How often: Once. But above age 13 it requires two shots.
Comments: Not recommended for pregnant women or those with compromised immunity—consult your doctor.

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Effective September 1, 2008, the University of Texas System will expand your Wellness Preventive Health Services benefit to include colonoscopy coverage under the UT SELECT Preventive Care Program package. This means that a colonoscopy performed by an in- network physician at an in- network facility will now be available at no cost to you.

The University of Texas System- “Living Well: Make it a Priority” Worksite Health & Wellness program was established in 2007 to encourage all employees, retirees and dependents to reach their full potential and maintain the productivity necessary to meet the challenges of work and life. Our goal in providing a variety of programs, tools and resources is to enable you to take charge of your health and to develop your own personal wellness program utilizing all programs and services available through both UT System Institutions and our plan vendors. Read more about the new colonoscopy coverage.

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