Annual Health Assessments Research Articles

Ethnicity and the Prevalence of Polycystic Ovary Syndrome: The Eastern Siberia PCOS Epidemiology and Phenotype Study.

Previous studies have shown that the prevalence of polycystic ovary syndrome (PCOS) may vary according to race/ethnicity, although few studies have assessed women of different ethnicities who live in similar geographic and socio-economic conditions. To determine the prevalence of PCOS in an unselected multiethnic population of premenopausal women. A multicenter prospective cross-sectional study. The main regional employers of Irkutsk Region and the Buryat Republic, Russia. During 2016-19, 1398 premenopausal women underwent a history and physical exam, pelvic ultrasound, and testing during a mandatory annual employment-related health assessment. PCOS prevalence, overall and by ethnicity in a large medically unbiased population, including Caucasian (White), Mongolic or Asian (Buryat), and mixed ethnicity individuals, living in similar geographic and socio-economic conditions for centuries. PCOS was diagnosed in 165/1134 (14.5%) women who had a complete evaluation for PCOS. Based on the probabilities for PCOS by clinical presentation observed in the cohort of women who had a complete evaluation we also estimated the weight-adjusted prevalence of PCOS in 264 women with an incomplete evaluation: 46.2 or 17.5%. Consequently, the total prevalence of PCOS in the population was 15.1%, higher among Caucasians and women of Mixed ethnicity compared to Asians (16.0% and 21.8% vs. 10.8%, pz <0.05). We observed a 15.1% prevalence of PCOS in our medically unbiased population of premenopausal women. In this population of Siberian premenopausal women of Caucasian, Asian and Mixed ethnicity living in similar geographic and socio-economic conditions, the prevalence was higher in Caucasian or Mixed than Asian women. These data highlight the need to assess carefully ethnic-dependent differences in the frequency and clinical manifestation of PCOS.

Prediction of adolescent weight status by machine learning: a population-based study

BackgroundAdolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors.MethodsA population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors’ importance was assessed using Shapley values.Results442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts.ConclusionsThe machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.

Determination of pulmonary vessel alteration in Chinese male smokers by quantitative computed tomography measurements: a retrospective study.

The blood volume of intraparenchymal vessels is reported to be increased in smokers. However, the blood volume can be affected by many confounders besides tobacco exposure. This study aimed to investigate the association between cigarette smoking and pulmonary blood volume after adjusting the related factors in a large cohort of Chinese males. In this retrospective study, male participants admitted to the First Affiliated Hospital of Xi'an Jiaotong University for annual health assessment between February 2017 and February 2018 were enrolled. All subjects underwent non-contrast chest computed tomography (CT) scans, and 152 subjects underwent a review CT scan 2-3 years later. A three-dimensional approach was employed to segment the lung and intrapulmonary vessels and quantitative CT (QCT) measurements, including lung volume (LV), intrapulmonary vessel volume (IPVV), low-attenuation area <-950 Hounsfield unit (LAA-950 and LAA-950%), and mean lung density (MLD). Linear regression was used to estimate the association between IPVV and the smoking index (SI). A paired t-test was used to compare the QCT parameters between the initial and follow-up CT scans. A total of 656 male participants were enrolled and classified into three subgroups: non-smokers (n=311), current smokers (n=267), and former smokers (n=78). The IPVV of current smokers (134.62±23.96 vs. 120.76±25.52 mL) and former smokers (130.79±25.13 vs. 120.76±25.52 mL) were significantly larger than that of non-smokers (P<0.05). A higher SI was associated with greater IPVV [non-standardized coefficient: 0.167, 95% confidence interval (CI): 0.086-0.248]. For current smokers, the IPVV of the follow-up scan significantly increased compared to its baseline scan (135.49±28.60 vs. 129.73±29.75 mL, t=-2.326, P=0.02), but for the non-smokers and former smokers, the IPVV of the follow-up scan did not increase or decrease compared to the baseline scan (P>0.05). Pulmonary vascular volumes detectable on non-contrast CT are associated with cigarette exposure, and smoking cessation may prevent pulmonary vasculature remodeling.

Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review.

People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.

A retrospective study on the immobilisation of five captive primate species at Uganda Wildlife Conservation Education Centre, Uganda

AbstractThis retrospective study examined data from 108 primates consisting of 41 olive baboons (Papio anubis), 30 colobus monkeys (Colobus guereza), six debrazza monkeys (Cercopithecus neglectus), 26 red‐tailed monkeys (Cercopithecus ascanius), and five ruwenzori colobus monkeys (Colobus angolensis ruwenzorii). These primates underwent annual health assessments, involving the administration of an initial intramuscular dose ketamine (5 mg/kg) plus medetomidine (0.05 mg/kg). Additional intramuscular top‐ups of ketamine (5 mg/kg) plus medetomidine (0.05 mg/kg) were given as needed. Monitoring started when the animals were placed on the examination table in dorsal recumbency and continued until their return to the enclosures. During this period, various physiological parameters, such as heart rate (beats per minute), respiration rate (breaths per minute), peripheral oxygen saturation (SpO2, %) and rectal temperature (°C), were recorded at random intervals. To reverse immobilisation, atipamezole was administered intramuscularly at five times the medetomidine dose. Additionally, the study measured various induction and recovery times.

Identifying and providing management support for people at risk of frailty in general practice.

Background: Frailty, associated with increasing age and characterised by diminished strength and function, often remains undetected. Presentations of frailty often occur when a seemingly minor event results in a significant health crisis and unnecessary hospital admission, with substantial associated health care costs. Evidence suggests that targeted therapies may decrease the negative outcomes associated with being frail. In Australia frailty affects up to 25% of people aged ≥70 yet a standardised assessment of frailty amongst patients attending general practice is not routine. The FRAIL Scale, developed and validated internationally as a screening tool, requires five simple questions relating to fatigue, resistance, ambulation, illnesses, and weight loss to be answered to identify risk of frailty. &#x0D; Method: Audit of 282 patients aged ≥75 years who had completed annual health assessments in ten Australian general practices, found only 2% had been assessed for all five FRAIL Scale components. &#x0D; Outcome: To facilitate use of the FRAIL scale a FRAIL Scale App has been developed which can be built into the General Practice clinical support system. Our pilot study is investigating the 1) feasibility and adoption of the App by general practices recruited from two Australian regions (North Sydney/Brisbane South); 2) access to resources/referral options in the community to support identified need; 3) acceptability to providers/patients/carers of the risk of frailty assessment and management approach. The App has been adopted by 17 general practices recruited from the two regions and is an efficient and effective method to identify risk of frailty and provide management suggestions.&#x0D; Implications: This study is providing an understanding of the services required in the community to support those who are pre-frail/at risk of frailty. A reduced burden to the hospital system, improved health outcomes and quality of life for older people who are at risk or living with frailty are potential benefits of an effective tool used routinely in general practice. &#x0D; &#x0D; &#x0D; &#x0D; Key messages:&#x0D; 1.Risk of frailty is not being routinely assessed in general practice&#x0D; 2.The Frail scale tool can be easily incorporated into the practice workflow.&#x0D; 3.Risk of frailty management resources and services are required to support the implementation. &#x0D;

Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation.

In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.

Baseline Urinalysis of the Fully Marine, Herbivorous Dugong (Dugong dugon)

The dugong (Dugong dugon) is a fully marine mammal that grazes in nearshore seagrass meadows and whose health is vulnerable to human coastal activities. This study establishes urine baseline ranges for apparently healthy dugongs that can be used as health biomarkers. Voluntary urine samples (uncontaminated by seawater) were collected from 71 wild-caught dugongs in Moreton Bay, Australia, that were held out of water during an annual health assessment from 2008 to 2022. Urine was analysed for qualitative characteristics (colour, turbidity, odour), biochemistry through reactive urinalysis test strips, urine specific gravity (USG) by refractometer, electrolytes by flame photometry, sediment by microscopy, and bacterial culture. Urine of dugongs was typically pale yellow, clear to slightly cloudy, and mildly odorous. Urine was usually slightly alkaline (mean pH 8), and USG was low (mean 1.018). Urinalysis from dipstick indicated consistently negative readings for the presence of glucose, urobilinogen, bilirubin, ketones, and nitrites. Urinary protein was detected in 85% of sampled dugongs. Haemolysed red blood cells were recorded in &gt; 85% of urine samples; microscopy indicated light haematuria (intact red blood cells) in 16% of samples. Seven percent of dugongs had detectable levels of leukocytes suggesting the possibility of mild urinary tract infection. Urinary sediment containing epithelial cells, keratinaceous debris, calcium carbonate crystalluria, and rare struvite crystals were typical. Light to moderate levels of bacteria were present in urine samples, with variable mixed growths, including Halomonas aquamarina, Pseudomonas stutzeri, Photobacterium damselae, Psychrobacter spp., and Staphylococcus aureus. Spermatozoa were present in the urine of 32% of the sexually mature males. Physical characteristics and chemistry of dugong urine showed some similarities to those of manatees and other herbivores. These baseline urinalysis data for healthy wild dugongs in a single population are valuable benchmarks against which dugongs of variable health status (including compromised dugongs) and from other localities may be compared.

Cardiometabolic Risk Increased in Working-Aged Adults During the COVID-19 Pandemic.

Background: Public health measures necessary to mitigate the spread of coronavirus disease 2019 (COVID-19) impacted lifestyles and health practices. This multiyear cohort analysis of U.S. working-aged adults aims to evaluate the impact of the COVID-19 pandemic on metabolic syndrome and explores contributing factors. Methods: This longitudinal study (n = 19,543) evaluated year-to-year changes in metabolic syndrome and cardiometabolic risk factors through employer-sponsored annual health assessment before and during the COVID-19 pandemic using logistic mixed-effects model. Results: From prepandemic to pandemic (2019 to 2020), prevalence of metabolic syndrome increased by 3.5% for men and 3.0% for women, across all ethnic groups. This change was mainly driven by increased fasting glucose (7.3%) and blood pressure (5.2%). The increased risk of metabolic syndrome was more likely to occur in individuals with an elevated body mass index (BMI) combined with insufficient sleep or physical activity. Conclusions: Cardiometabolic risk increased during the COVID-19 pandemic compared with before the pandemic in a working-aged adult population, more so for those with a high BMI, unhealthy sleep, and low physical activity practices. Given this observation, identification of risk and intervention (including lifestyle and medical) is increasingly necessary to reduce the cardiovascular and metabolic risk, and improve working-aged population health.

Will a fee-for-service payment for a young people’s health assessment in general practice increase the detection of health risk behaviours and health conditions? Protocol for a cluster randomised controlled trial (RAd Health Trial)

IntroductionAdolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual...

1291-P: Participants in Annual Workplace Health Evaluation Program Had Lower Risk for Developing Diabetes

Background: We asked whether the risk of developing diabetes would be reduced in individuals who participated in annual employer-sponsored workplace health evaluations compared to those not participating in the program. Methods: We studied a cohort of all employees with 5 years of administrative claims data (2017-2021) and no diabetes-related pharmacy claims in the baseline year (2017). The health evaluation group was defined as individuals who participated in annual workplace health assessments for 5 consecutive years. The non-health evaluation group did not participate in workplace assessments in any year. The association between health evaluation status and incident diabetes was assessed in Cox regression models that adjusted for variables that differed between the 2 groups at baseline (Table). Incidence of diabetes was defined as any diabetes-related pharmacy claims during follow-up (2018 to 2021). Results: Of 9,021 participants, 67.8% were female; mean baseline age (standard deviation) was 46.1 (10.4) years. After adjustment (Table footnote), annual workplace health evaluation participants (n=7,957) had a 33% lower in risk of developing diabetes compared to the non-health evaluation group (n=1,064) (Table). Conclusions: Individuals participating in annual health evaluations in a workplace setting had lower risk of developing diabetes than non-participants. Disclosure C.H.Tong: None. M.Jalandoni-bustamante: Employee; Quest Diagnostics. M.S.Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C.E.Birse: Employee; Quest Diagnostics.

1286-P: Hyperinsulinemia Is Common in Individuals with Normoglycemia in a Nationwide Working-Age Population

Introduction: Hyperinsulinemia is associated with future diabetes and cardiovascular disease. However, fasting insulin (FI) levels are rarely assessed in individuals with normoglycemia. To investigate the potential magnitude of undiagnosed hyperinsulinemia (FI &amp;gt;16 uIU/mL), we assessed the prevalence of hyperinsulinemia in individuals with normoglycemia (fasting glucose [FG] 70 to &amp;lt;100 mg/dL) in a nation-wide study of working-age individuals without diabetes. Methods: The study included employees and spouses who participated in an annual health assessment program at Quest Diagnostics (October 2020 to February 2021). Those with diabetes, with FG &amp;lt;70 or ≥100 mg/dL, or with missing data were excluded. FI was measured by a mass-spectrometry assay standardized for the peptide content of WHO reference materials. Results: Participants included 23,339 individuals (68% women) with normoglycemia (FG ≥70 or &amp;lt;100 mg/dL) and median age of 43 years (IQR 34 to 53). Hyperinsulinemia was observed in 7% (n =1,546) of participants. Of these, 1,064 individuals also participated in the health assessment program in a subsequent year and 46% (n =490) of them had persistent hyperinsulinemia. Obesity (BMI ≥30 kg/m2) was more common (83% vs. 71%) in those with persistent hyperinsulinemia than in those without (P &amp;lt;0.001) and they had lower HDL-C levels (45 vs 47 mg/dL, P &amp;lt;0.001) Age, sex, and triglyceride levels did not differ between those with and without persistent hyperinsulinemia (all P &amp;gt;0.05). Of the 490 individuals with persistent hyperinsulinemia, 76% (n =373) had persistent normoglycemia. Conclusion: In a large population of working-age individuals, hyperinsulinemia was found in about 1 in 15 individuals with normoglycemia. Those with persistent hyperinsulinemia in a subsequent year were more likely to have obesity and lower HDL-C levels, and about 1 in 5 were no longer normoglycemic. Measurement of FI levels may have value in even apparently metabolically normal individuals. Disclosure J.Z.Louie: Employee; Quest Diagnostics. D.Shiffman: Consultant; Quest Diagnostics, Employee; Quest Diagnostics. J.B.Meigs: Consultant; Quest Diagnostics. M.J.Mcphaul: Employee; Quest Diagnostics.

Health Outcomes of Children Living in Out-of-Home Care in Metropolitan Western Australia: A Sequential Mixed-Methods Study—A Protocol Paper

The research protocol described aims to examine and establish the health outcomes of children and young people living in Out-of-Home Care (OOHC) in Perth, Western Australia (WA) from the perspective of the care recipients and service providers. A Study Advisory Panel (SAP) will be established comprised of Aboriginal Elders (because of the over-representation of Aboriginal children in OOHC), health professionals and other relevant stakeholders to help co-design all phases of the study. Mixed methods will be used in data collection and analysis. In the quantitative phase, it is proposed to collect retrospective data from three WA Department of Communities (DOC) districts. The data proposed to be collected includes: the number of children who received initial and annual health assessments, the health needs identified, and interventions put in place to address these needs. The qualitative phase will consist of interviews with service recipients (young people who have exited OOHC and Carers), health service providers (Community Health Nurses, School Nurses, General Practitioners and Paediatricians) and OOHC Case Workers. The research will provide an overview of the current health needs of children and young people in OOHC in WA and the perspectives of these young people, their Carers and service providers on current processes for accessing healthcare. It is anticipated that the study will provide valuable evidence for quality improvement in health service delivery to better meet the health needs of children and young people in OOHC.

A Bayesian network model for predicting cardiovascular risk

Background and ObjectiveCardiovascular diseases are the leading death cause in Europe and entail large treatment costs. Cardiovascular risk prediction is crucial for the management and control of cardiovascular diseases. Based on a Bayesian network built from a large population database and expert judgment, this work studies interrelations between cardiovascular risk factors, emphasizing the predictive assessment of medical conditions, and providing a computational tool to explore and hypothesize such interrelations. MethodsWe implement a Bayesian network model that considers modifiable and non-modifiable cardiovascular risk factors as well as related medical conditions. Both the structure and the probability tables in the underlying model are built using a large dataset collected from annual work health assessments as well as expert information, with uncertainty characterized through posterior distributions. ResultsThe implemented model allows for making inferences and predictions about cardiovascular risk factors. The model can be utilized as a decision- support tool to suggest diagnosis, treatment, policy, and research hypothesis. The work is complemented with a free software implementing the model for practitioners’ use. ConclusionsOur implementation of the Bayesian network model facilitates answering public health, policy, diagnosis, and research questions concerning cardiovascular risk factors.

Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis.

In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16-29years in Aboriginal Community Controlled Health Services between 2018 and 2020. Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. Of the 13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20-24years (OR 1.2, 95% CI 1.1-1.4) and 25-29years (OR 1.1, 95% CI 1.0-1.2) compared to 16-19years and patients residing in very remote (OR 4.2, 95% CI 3.7-4.8), remote (OR 2.4, 95% CI 2.1-2.8), and regional areas (OR 2.5, 95% CI 2.2-2.8) compared to metropolitan areas. There was no association with patient sex. Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women.

Association between hearing loss and development of dementia using formal behavioural audiometric testing within the Mayo Clinic Study of Aging (MCSA): a prospective population-based study

Hearing loss has been identified as a potential major modifiable risk factor for developing dementia. This study examined associations between formal behavioural pure-tone and speech audiometry assessed by an audiologist with development of dementia in the Mayo Clinic Study of Aging (MCSA). The MCSA is a prospective population-based study examining the incidence, prevalence, and risk factors of mild cognitive impairment and dementia in Olmsted County, Minnesota, USA. Participants undergo clinical examinations with neuropsychological testing at enrolment and every 15 months. Participants were 50 years or older at enrolment between Nov 29, 2004, and Dec 23, 2019, who underwent formal behavioural audiometric evaluation by an audiologist due to concerns about hearing loss or as a part of annual comprehensive health assessments. Associations of pure-tone average (PTA) and word recognition scores (WRS) with the development of dementia were evaluated using Cox proportional hazards regression with age as the timescale, and associations with changes in cognitive testing scores over time were evaluated using linear mixed-effects models. Among 1200 eligible participants, the mean age at enrolment was 79 years (SD 9), 593 (49%) were men, and 207 developed dementia during a mean of 7·0 years (SD 3·7) of follow-up. After adjusting for sex, years of education, smoking status, diabetes, hypertension, apolipoprotein E ε4 carriership, and hearing rehabilitation (defined as hearing aid or cochlear implant use), neither PTA (hazard ratio [HR] per 10-decibels hearing level increase of 0·99 (95% CI 0·89-1·12; p=0·91) nor WRS (HR per 10% decrease of 0·98, 95% CI 0·89-1 ·07; p=0·65) was significantly associated with the development of dementia. However, both PTA and WRS were significantly associated with poorer performance in cognitive testing over time: participants with a PTA higher than 25 decibels hearing level or a WRS lower than 100% had significantly worse declines in cognitive testing scores. Informant-based hearing difficulties assessed by the participant's study partner were significantly associated with the development of dementia (HR 1·95, 95% CI 1·45-2·62; p<0·0001). In this prospective population-based study, subjective informant-based hearing difficulties were associated with development of dementia, whereas objective measures on formal behavioural audiometry were predictive of poorer performance on cognitive testing over time but not the development of dementia. Other factors related to central processing might potentiate the effects of peripheral hearing loss detected on behavioural audiometric testing. National Institute of Health, the Alexander Family Alzheimer's Disease Research Professorship of the Mayo Clinic, the GHR Foundation, the Mayo Foundation for Medical Education and Research, the Liston Award, the Schuler Foundation, the Rochester Epidemiology Project medical records linkage system, and the National Institute on Aging.

Comparative analysis of the health status of military police officers and firefighters: a cross-sectional study in the State of Paraná, Brazil

ObjectivesTo evaluate the health-condition of military police officers and firefighters. To identify risk factors for not being medically ready for duty.DesignCross-sectional study.SettingData were extracted from medical records during annual periodic...

Work-up for Incidentally Detected NAFLD: How Far is It Worth?

Mishra S, Bhujade H, Butt AS, et al. Work-up for Incidentally Detected NAFLD: How Far is It Worth? Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S26-S36.

965-P: Factors Associated with Poor Glycemic Control in Persons with Type 2 Diabetes and Employer-Based Health Care Coverage

Lack of healthcare insurance is an important factor for poor glycemic control in persons with diabetes. However, a large proportion of insured people also have inadequate glycemic control. This study was conducted to assess factors associated with poor glycemic control in persons with type 2 diabetics (T2D) who received full healthcare coverage through their employer.The study included employees and spouses with T2D who participated in an annual health assessment in 20 and had medical coverage ≥12 consecutive months prior to the assessment. T2D was defined from ICD codes in claims, self-reported physician diagnosis, or having fasting glucose &amp;gt; 125 mg/dL or HbA1C &amp;gt; 6.4%. A stepwise multinomial logistic regression model was used to assess associations of healthcare engagement, diet, smoking and socioeconomic status with glycemic control. The 2,981 participants included 16% (n=484) with HbA1C &amp;gt; 8.5% and 27% (n=800) with HbA1C 7 to 8.5%. We found that HbA1C &amp;gt; 8.5% was associated with age, sex, years since last physical exam, number of complications, number of medications, and physical activity. The regression model results are shown in the figure. We conclude that poor glycemic control is common among persons with T2D despite good healthcare coverage. We identified factors associated with poor glycemic control in this population that may help design strategies to improve glycemic control. Disclosure C.M.Rowland: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. J.Z.Louie: None. D.Shiffman: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. R.Garg: None. E.Bernal-mizrachi: None. M.J.Mcphaul: Employee; Quest Diagnostics.

The Nevada peripheral artery disease screening effort in a Medicare Advantage population and subsequent mortality and major adverse cardiovascular event risk

BackgroundContemporary estimates of undetected asymptomatic lower extremity peripheral artery disease (PAD) in the community and its association with adverse outcomes in the population are lacking. We investigated the long-term association between previously undetected PAD and subsequent all-cause mortality and major adverse cardiovascular events (MACE) for Medicare Advantage beneficiaries aged ≥65 years in a large metropolitan area characterized by concentrations of atherosclerotic risk factors and a more vulnerable socioeconomic risk profile. MethodsData were derived from the patients’ electronic medical records and linked with claims outcomes data for 13,971 Medicare Advantage beneficiaries aged ≥65 years who had undergone PAD screening in 2016 as a part of their routine annual health assessment in the greater Las Vegas, Nevada, metropolitan area. PAD screening was performed with their primary care provider using volume plethysmography system methods. The association between PAD screening status and 1- and 3-year all-cause mortality and MACE rates was documented. ResultsThe cohort had a mean age of 75.3 ± 6.6 years, and 57.7% were women. Of the 13,768 patients, 4351 (31.6%) had had a positive PAD screening result. Almost 60% had had a lower socioeconomic income level, with 15.1% living under the poverty level. The risk estimates associated with a positive vs negative PAD screening result for both all-cause mortality and MACE were as follows: unadjusted hazard ratio (HR) for mortality, 2.17 (95% confidence interval [CI], 1.79-2.63) and unadjusted HR for MACE, 2.00 (95% CI, 1.15-3.49) at 1 year and unadjusted HR for mortality, 2.04 (95% CI, 1.84-2.26) and unadjusted HR for MACE, 1.67 (95% CI, 1.37-2.02) at 3 years. After multivariable adjustment, all associations persisted (P < .001), with HRs ranging from 1.41 to 1.69, except for that for 1-year MACE (similar risk estimate but P = .09). ConclusionsA positive screening result for previously undetected lower extremity PAD was independently associated with short- and long-term increased risks of mortality and MACE for individuals aged ≥65 years living in a large, metropolitan area.