Annual Health Assessments Research Articles

Abstract 9610: High Levels of Myeloperoxidase Are Similar Across ASCVD Risk Groups and Are Associated with Markers of Liver Fibrosis and Kidney Function in a Workforce Population

Background: High blood levels of free myeloperoxidase (MPO) identify patients at risk for cardiovascular disease. We investigated levels of MPO according to 10-year ASCVD risk and the association between high MPO and markers of liver fibrosis and kidney disease. Methods: The study included participants in employer-sponsored annual health assessment (August 2020 to March 2021, n=33,984, 63% women, median age 47, IQR 36 to 56). Age and sex adjusted logistic models assessed the association between high MPO and non-alcoholic fatty liver disease (NAFLD) fibrosis score, liver Fibrosis-4 (FIB4) score, and estimated glomerular filtration rate (eGFR), stratified by 10-year ASCVD risk groups. Results: High MPO (>540 pmol/L) was found in 3% (n =925), 4% (n=184), and 5% (n =63) of the low (<7.5%), intermediate (7.5% to 20%), and high (>20% or prevalent disease) ASCVD risk groups, respectively. High MPO (>540 vs. ≤540 pmol/L) was associated with high NAFLD fibrosis score (>0.676 vs. <-1.455): OR = 4.7, 95%CI 3.5 to 6.2, high FIB4 score (>3.25 vs. ≤3.25): OR =3.4, 95%CI 1.8 to 6.4 and low eGFR (<60 vs. ≥60 mL/min/1.73m 2 ): OR =1.8, 95%CI 1.4 to 2.4. The associations varied according to ASCVD risk (Figure). In the high ASCVD risk group, MPO was not associated with either NAFLD fibrosis score, FIB4 score, or eGFR (P ≥0.2 for all) and the risk differed according to ASCVD risk group (>20% vs. ≤20%) for NAFLD fibrosis score (P int =0.03) and eGFR (P int =0.01). Conclusion: The fraction of those with high MPO did not appreciably differ across ASCVD risk groups and most participants with high MPO levels in this workforce population were in the low ASCVD risk group. This observation is consistent with the hypothesis that subjects in the high ASCVD risk group are more likely to be receiving preventive therapies, whereas guidelines dictate that those in moderate and low risk groups may not. Investigating the association of MPO levels in ASCVD risk groups according to preventive therapy intensity is warranted.

Annual biological variation and personalized reference intervals of clinical chemistry and hematology analytes.

A large number of people undergo annual health checkup but accurate laboratory criterion for evaluating their health status is limited. The present study determined annual biological variation (BV) and derived parameters of common laboratory analytes in order to accurately evaluate the test results of the annual healthcare population. A total of 43 healthy individuals who had regular healthcare once a year for six consecutive years, were enrolled using physical, electrocardiogram, ultrasonography and laboratory. The annual BV data and derived parameters, such as reference change value (RCV) and index of individuality (II) were calculated and compared with weekly data. We used annual BV and homeostatic set point to calculate personalized reference intervals (RIper) which were compared with population-based reference intervals (RIpop). We have established the annual within-subject BV (CVI), RCV, II, RIper of 24 commonly used clinical chemistry and hematology analytes for healthy individuals. Among the 18 comparable measurands, CVI estimates of annual data for 11 measurands were significantly higher than the weekly data. Approximately 50% measurands of II were <0.6, the utility of their RIpop were limited. The distribution range of RIper for most measurands only copied small part of RIpop with reference range index for 8 measurands <0.5. Compared with weekly BV, for annual healthcare individuals, annual BV and related parameters can provide more accurate evaluation of laboratory results. RIper based on long-term BV data is very valuable for "personalized" diagnosis on annual health assessments.

Setting standards in sensory analysis

Setting standards in sensory analysis

MO803THE UTILITY OF BONE HEALTH INDEX SDS SCORES IN MEASURING BONE DENSITY IN CHILDREN WITH END STAGE KIDNEY DISEASE

Abstract Background and Aims Decreased bone mineral density (BMD) is well recognised in patients on dialysis. Lower DXA-BMD predicts incident fractures in patients with CKD 3a-5D. However while bone age (BA) Xrays are routinely performed to assess delays in bone age and density, DXA scans are not available widely. We compared the utility of bone density findings using automated measurements performed on routine BA Xrays and DXA scans. Method In our tertiary paediatric renal unit, patients on renal replacement therapy are reviewed within a joint dialysis/endocrine clinic by an nephrologist and endocrinologist,with annual radiological bone health assessment using hand and wrist Xray using Bone Xpert™ software. This automates assessment of BMD on hand Xrays, correcting for delays in bone age and calculates bone health index standard deviation score (BHI-SDS) using measurements of cortical thickness and mineralisation of metacarpal bones. In any patient with abnormal BMD on BA Xray or uncontrolled hyperparathyroidism, DXA was performed (measured as whole body (minus head) and in lumbar spine (L1–L4)). DXA-BMD Z scores were automatically calculated using normative data. A review of the results obtained was performed to compare these investigations of bone mineralisation status in our paediatric dialysis patients. Results 14 patients with ESRD on renal replacement therapy had both BHI-SDS and DXA BMD Z scores measured. Median chronological age was 12.6 years at DXA densitometry (range 5.1-16.3 years) with median BA of 11.5 years (range 4.4-14.8 years). All patients where BA Xray was performed had evidence of renal osteodystrophy radiographically. Median BHI-SDS was -1.2 (range -3.56 to 1.5). Median lumbar spine Z-score was -0.5 (range-3.6-2.9) and median WBMH Z-score was -1.2 (range -2.6-1.5). Pearson correlation coefficients with BHI-SDS were 0.77 and 0.8 respectively. Only 4/15 (27%) who had DXA performed had reported low BMD. Only one had objectively measured loss of vertebral height on vertebral fracture assessment. However there were two patients with undiagnosed scoliosis and one patient with an anterior wedge shaped fracture identified on DXA. These patients were referred for orthopaedic management. Conclusion The utility of BHI- SDS to measure bone density in paediatric patients with ESRD has not been reported. There appears to be good correlation between BHI SDS scores and DXA scan Z score measurements in paediatric patients with ESRD on renal replacement therapy. The advantages of using BHI SDS is that it is less expensive, more easily performed, more widely available and takes into account the delay in bone age often found in these children. BHI-SDS is a measure derived from assessment of the peripheral skeleton, in contrast to DXA, which measures bone health in the total skeleton or spine. BHI-SDS appears to be a useful initial measure to quantify bone density in patients with radiological changes consistent with renal osteodystrophy in the peripheral skeleton. However all children with low BHI-SDS should proceed to DXA scan as this may detect spinal abnormalities in addition.

Low dose CT detected interstitial lung abnormalities in a population with low asbestos exposure.

The use of low dose CT (LDCT) chest is becoming more widespread in occupationally exposed populations. There is a knowledge gap as to heterogeneity in severity and the natural course of asbestosis after low levels of exposure. This study reports the characteristics of LDCT-detected interstitial lung abnormalities (ILA). The Asbestos Review Program offers annual LDCT, health assessments, and pulmonary function tests to an asbestos-exposed cohort. Asbestosis was defined using the Helsinki Consensus statement and the presence of ILA defined using a protocol for occupational CT reports. At least two of three pulmonary function tests: forced expiratory volume in 1 s (FEV1 );​ forced vital capacity (FVC); and diffusion capacity for carbon monoxide (DLco) were required for analysis of physiological decline. From 1513 cases, radiological ILA was present in 485 (32%). The cohort was 83.5% male with a median age of 68.3 years and a median (IQR) asbestos exposure of 0.7 (0.09-2.32) fiber/ml-year. A mixed occupation, mixed asbestos fiber cohort comprised the majority of the cohort (65.8%). Of those with ILA, 40 (8.2%) had an FVC decline of ≥10% and 30 (6.2%) had a DLco decline of ≥15% per year. Time since first exposure, increasing tobacco exposure and reported dyspnea were independently associated with the presence of ILA. In this population with relatively low asbestos exposure, LDCT-detected ILA that fits criteria for asbestosis is common, but physiological decline is not. This mild chronic stable phenotype of asbestos-associated ILA contrasts with the traditionally accepted views that asbestosis requires high exposures.

Validation of a three-item Fatigue Severity Scale for patients with substance use disorder: a cohort study from Norway for the period 2016\u20132020

BackgroundLittle attention has been paid to customising fatigue questionnaires for patients with Substance Use Disorders (SUDs). The present study aims to validate and shorten the nine-item Fatigue Severity Scale (FSS-9) and Visual Analogue Fatigue Scale (VAFS) for use with this population.MethodsWe used data from a nested cohort with annual health assessments with responses on the FSS-9 and VAFS. During the period 2016–2020, 917 health assessments were collected from 655 patients with SUD in Bergen and Stavanger, Norway. A total of 225 patients answered the health assessment at least twice. We defined baseline as the first annual health assessment when the health assessments were sorted chronologically per patient. We checked for internal consistency, and we used longitudinal confirmatory factor analysis (CFA) and linear mixed model (LMM) analysis to validate and shorten the FSS-9 and VAFS.ResultsThe internal consistency of the FSS-9 was excellent with a Cronbach’s α of 0.94 at baseline and 0.93 at the second annual health assessment. When shortening the FSS-9 to a three-item FSS (FSS-3, items 5–7), the Cronbach’s α was 0.87 at baseline and 0.84 at the second health assessment. The internal consistency was not affected when the VAFS was added to the FSS-3 and the FSS-9. The longitudinal CFA model showed a well-fitting model for the FSS-3 (χ2 = 13.33, degree of freedom = 8, P = 0.101). The LMM analysis showed equal linear changes at the individual level for the FSS-3 (slope: 0.00, P > 0.05) and FSS-9 (slope: 0.01, P > 0.05) between the health assessments.ConclusionThe FSS-9 could be shortened to the FSS-3 with high validity and reliability for patients with SUDs and the addition of VAFS did not provide much added variability.

Variation in biochemistry test results between annual wellness visits in apparently healthy Golden Retrievers.

BackgroundAnnual wellness testing is widely recommended for apparently healthy dogs, but there is little data to assist with distinguishing normal variation from clinically important changes.ObjectivesTo define variability in biochemistry analytes between annual wellness tests in healthy Golden Retrievers.AnimalsFour hundred thirty‐four Golden Retrievers undergoing annual health assessments by their primary care veterinarians as part of a prospective cohort study.MethodsChanges in 23 biochemistry analytes were calculated between year 1 and year 2 health checks for 196 dogs classified as healthy for ≥3 consecutive years. Using a direct nonparametric method, annual change intervals were constructed to define normal variability. A validation cohort of 238 dogs without a diagnosis of systemic disease for ≥3 consecutive years were compared with the reference and annual change intervals, and the proportions of dogs outside annual change intervals and a population‐based reference interval were compared by using a McNemar test.ResultsAnnual change intervals were calculated based on 190 dogs after outlier removal. For all 23 analytes, >90% of dogs in the validation cohort were within the annual change interval. There were no significant differences in the classification by reference versus annual change intervals.Conclusions and Clinical ImportanceThe annual change intervals met performance requirements for classification of dogs that did not develop systemic disease in the year following wellness testing as normal.

Nematode epibionts on skin of the Florida manatee, Trichechus manatus latirostris

A survey for the presence of nematodes on the skin of the native Florida manatee, Trichechus manatus latirostris from Crystal River, Florida was conducted during annual manatee health assessments. A putative isolate of Cutidiplogaster manati (Diplogastridae) and two other nematodes belonging to the same family were recovered from mid-dorsal tail skin-scrapings from all sampled winter-collected healthy wild adult manatees during two successive years (2018–2019). Qualitative abundance estimates of these three species of diplogastrid nematodes suggest that an average wild Florida manatee adult might possess between 30,000 and 120,000 nematodes on its tail dorsum and that the entire body dorsum including the tail might possess 160,000–640,000 nematodes in roughly equal ratios. Attempts to culture these nematodes on a variety of different culture media were unsuccessful but examination of the mouth (stomatal) morphology suggests specialized feeding on microbes such as diatoms or predation on other nematodes. No skin lesions were observed during the 2018–2019 samplings suggesting that under normal conditions these nematodes are highly specialized free-living epibionts of the skin that are tightly bound to this niche and horizontally transferred between individual manatees in an analogous fashion to human skin mites (Demodex folliculorum and D. brevis). Molecular phylogenetic inferences using sequences of near full length SSU and D2–D3 expansion segments of LSU rRNA genes revealed a putative new morphospecies in Cutidiplogaster sister to C. manati that was monophyletic with several named Mononchoides species, and another putative new morphospecies that formed a clade with several undescribed species similar in appearance to Mononchoides as well as Tylopharyx, Eudiplogasterium, Paroigolaimella and Sachsia.

Recent trends in health assessments for older Australians.

Non-Indigenous older Australians (aged 75+ years) are encouraged to undertake an annual health assessment (75+HA) to identify overlooked medical conditions, holistically assess the management of current chronic conditions and highlight potential risk factors for poor health. Uptake in the 2000s has been previously reported to be slowly increasing, but still very low. This study aimed to identify the uptake of 75+HA between 2011 and 2019, comparing State and National trends over a 9-year period. The uptake of Medicare Items 701, 703, 705 and 707 between 2011 and 2019 was analysed. These results were incorporated with Australian Demographics data to present rate ratios by State and age groups. An increasing number of 75+HAs were performed between 2011 and 2019, and the 75+HAs performed were increasing in duration. Overall, the 75+HA uptake was still generally low, at approximately one-third of the eligible population; however, despite the low uptake, age-standardised figures showed upward trends. The 75+HA rate in the 85+ year group has now overtaken their younger (aged 75-84 years) counterparts. There were also clear variations between States. Given the low rates, strategies to improve uptake should be targeted so all eligible Australians receive an annual Medicare Benefits Schedule (MBS)-funded 75+HA.

Impact of clinical and sociodemographic factors on fatigue among patients with substance use disorder: a cohort study from Norway for the period 2016\u20132020

BackgroundThe impact of clinical and sociodemographic factors on fatigue remains unknown among patients with substance use disorders (SUD). This study aims to evaluate fatigue among patients with SUD using a nine-item fatigue severity scale (FSS-9) and identify the impact that clinical and sociodemographic factors – such as injecting substance use, chronic infectious diseases, liver fibrosis, opioid agonist therapy (OAT), debt difficulties, and housing situation – have on fatigue.MethodsWe used data from a cohort of patients with SUD in Norway with annual health assessments surveying FSS-9 and some clinical and sociodemographic factors. A total of 915 FSS-9 measurements were collected from 654 patients during the period 2016–2020. We defined baseline as the first annual health assessment when the health assessments were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyse whether the clinical and sociodemographic factors affected the FSS-9 sum score, presented with beta coefficients (β) with 95% confidence intervals (CI).ResultsThe mean sum score of the FSS-9 was 43 (standard deviation: 16) at baseline. Females compared with males (adjusted mean difference of FSS-9 sum score: 4.1, 95% CI: 1.3–7.0), having debt difficulties compared with having no debt difficulties (2.9;0.4–5.3), and frequent use of benzodiazepines (5.7;3.0–8.4) or amphetamines (-5.0;-8.0– -2.0) compared to less frequent or no use of these substances changed the FSS-9 baseline sum score. The other clinical and sociodemographic factors did not predict any clinically relevant change in the FSS-9 sum score from baseline to the following health assessments.ConclusionPatients with SUD suffer from high levels of fatigue. Female patients, patients with debt difficulties, and those with extensive use of benzodiazepines are at particular risk of being fatigued. This should be taken into consideration when planning health services.

Abstract 13178: Attainment of LDL-C Goals is Associated With Measures of Patient Engagement With Their Healthcare Providers

Introduction: Achieving optimal levels of low density lipoprotein cholesterol (LDL-C) reduces risk of cardiovascular events. We have found substantial gaps in LDL-C goal attainment in employees and spouses with an employer-sponsored medical plan. Understanding how patients’ engagement with healthcare providers affects LDL-C goal attainment may inform gap-closure programs. Methods: The study was drawn from 35,276 participants in an annual health assessment program offered by nation-wide clinical diagnostic provider to employees and spouses between September 2017 and June 2018. We excluded those with &lt;1 consecutive year of employer- sponsored health plan and those younger than 40 or older than 75. The analysis was further limited to 7,363 participants who would benefit from LDL-C management according to the AHA/ACC definition of patient-management groups. The association between attaining LDL-C goal and education, socioeconomic status, and self-reported measures of engagement with healthcare providers was assessed in age, sex, and ethnicity adjusted logistic regression models. Results: Attaining LDL-C goal was more likely in those with a personal physician than in those without (OR =2.25, 95%CI, 1.70 to 2.99, P &lt;0.0001). Similarly, greater confidence in selecting a physician, talking with a physician, or understanding medical benefits, as well as a more recent physical exam and a greater number of medications were associated with greater odds of attaining LDL-C goal ( Figure, all P values &lt;0.0001). Socioeconomic status and education levels were not associated with attaining LDL-C goals ( P &gt;0.05). Conclusion: Confidence in interaction with healthcare providers (understanding benefits, selecting a physician, and talking with a physician) was associated with LDL-C goal attainment in those with an employer-sponsored health plan. Improving patients’ confidence in their ability to interact with healthcare providers may improve LDL-C goal attainment.

Amplifying feedback loop between growth and wood anatomical characteristics of Fraxinus excelsior explains size-related susceptibility to ash dieback.

Since the 1990s the invasive fungus Hymenoscyphus fraxineus has caused severe crown dieback and high mortality rates in Fraxinus excelsior in Europe. In addition to a strong genetic control of tolerance to the fungus, previous studies have found landscape heterogeneity to be an additional driver of variability in the severity of dieback symptoms. However, apart from climatic conditions related to heat and humidity influencing fungal infection success, the mechanistic understanding of why smaller or slower-growing trees are more susceptible to dieback remains less well understood. Here, we analyzed three stands in Switzerland with a unique setting of 8years of data availability of intra-annual diameter growth and annual crown health assessments. We complemented this by ring width and quantitative wood anatomical measurements extending back before the monitoring started to investigate if wood anatomical adjustments can help better explain the size-related dieback phenomenon. We found that slower-growing trees or trees with smaller crowns already before the arrival of the fungus were more susceptible to dieback and mortality. Defoliation directly reduced growth as well as maximum earlywood vessel size, and the positive relationship between vessel size and growth rate caused a positive feedback amplifying and accelerating crown dieback. Measured non-structural carbohydrate (NSC) concentrations in the outermost five rings did not significantly vary between healthy and weakened trees, which translate into large differences in absolute available amount of NSCs. Thus, we hypothesize that a lack of NSCs (mainly sugars) leads to lower turgor pressure and smaller earlywood vessels in the following year. This might impede efficient water transport and photosynthesis, and be responsible for stronger symptoms of dieback and higher mortality rates in smaller and slower-growing trees.

Five-year Survival Rate of Bonded Dental Restorations in Frail Older Adults

Frail older adults residing in long-term care (LTC) facilities are among the most vulnerable to dental caries due to poor oral hygiene (OH), medication-related salivary hypofunction, carbohydrate-rich diets, and limited access to dental care. Providing dental restorations for LTC patients is challenging, and there are few studies investigating the longevity of restorations in this cohort. Multiple restorative materials have been used to restore tooth anatomy as well as address caries prevention using fluoride-based materials. This study examined the longevity of bonded direct restorations placed in LTC patients. Specifically, we examined whether a difference in survival exists between resin composite (RC) and glass ionomer cement (GIC) direct restorations in frail older adults residing in LTC. Tooth-colored restorations placed in LTC patients between 2007 and 2012, within the University of British Columbia Geriatric Dentistry Program, were followed annually up to 5 y or until they incurred an event (i.e., re-restoration or tooth extraction) or the patient was lost to follow-up or deceased. Restoration status was documented within the Clinical Oral Disorder in Elders (CODE) Index annual oral health assessments. Mixed-effect logistic regression was calculated to determine hazard ratios, address within-patient correlation, and measure the effect size of multiple covariates. A total of 3,201 dental restorations placed in 846 LTC patients were followed. This cohort of patients had a mean age of 86 y and high levels of oral and systemic disease. Over half were wheelchair bound and had compromised ability to perform OH. The overall 5-y survival rate was 60.3%, and there was no statistically significant difference in survival between RC and GIC. Tooth-colored restorations had reasonable longevity in LTC patients and had comparable survival to restorations placed in functionally independent, community-dwelling geriatric populations. No difference between RC and GIC was found with regards to restoration longevity in this population. Direct restorations provided to frail older adults residing in LTC have reasonable longevity and should be expected to survive for the remainder of the patient's life. As no detectable difference exists in survival rates between RC and GIC, operators should select appropriate restorative materials based on clinical conditions, patient factors, physical properties, and personal preference.

Visual impairment among Aboriginal and Torres Strait Islander patients attending an Australian Indigenous primary health service: a cross-sectional study.

This cross-sectional study aimed to identify the period prevalence of visual impairment (VI) and blindness among Aboriginal and Torres Strait Islander people attending an Indigenous urban primary healthcare service, eye care practitioner referrals for those with VI and any opportunities to improve care delivery. Visual acuity (VA) examinations, using a Snellen chart, are performed as part of routine annual health assessments offered to children and adults. This study included patients aged ≥5 years (n=1442) who had a health assessment conducted between 1 January 2015 and 31 December 2016 and provided consent for the use of their health assessment information for research. Of patients with available data, 2.4% (33/1374) experienced VI, defined as presenting VA worse than 6/12 to 6/60 in the better-seeing eye. VI was more common in those aged ≥60 years (14/136; 10.3%) and was significantly associated with increasing age (P<0.001). No patients experienced blindness, defined as presenting VA worse than 6/60 in the better-seeing eye. All patients with VI were aged ≥16 years. Nine (27%) of the 33 patients with VI in the better-seeing eye were referred to an optometrist or an ophthalmologist. The low period prevalence of VI and no blindness in this study are positive findings. The findings also indicate that routine VA testing of older adults, especially those aged ≥60 years, should be conducted to avoid missing those not having an annual health assessment.

Albumin and Hemoglobin Trajectories and Incident Disabling Dementia in Community-Dwelling Older Japanese

Background: Serum albumin and hemoglobin levels are independently associated with subsequent cognitive deterioration in older adults. This prospective study used repeated measures analysis to identify aging trajectories in serum albumin and hemoglobin levels and investigated if these trajectories were associated with incident disabling dementia among community-dwelling older Japanese. Methods: A total of 2,005 adults aged 65–90 years participated in annual geriatric health assessments during the period from June 2002 through July 2017; the total number of observations was 9,330. A review of a municipal database of the Japanese public long-term care insurance system identified 1,999 of 2,005 adults without dementia at baseline, 278 (13.9%) of whom developed disabling dementia during the follow-up period (June 2002 through December 2017). Results: We identified three trajectory patterns (high, moderate, and low) for serum albumin and hemoglobin levels for the age period 65 through 90 years. After controlling for potential confounders, participants with moderate and low trajectories for serum albumin level had hazard ratios of 1.27 (95% confidence interval 0.94–1.72) and 2.07 (1.37–3.11), respectively, for the development of incident disabling dementia, with the high trajectory group as reference. The respective hazard ratios for hemoglobin level were 1.31 (0.93–1.85) and 1.58 (1.04–2.40), respectively. Conclusion: Dementia risk was higher for individuals with low trajectories for serum albumin and hemoglobin levels. This finding highlights the importance of interventions that improve nutritional status and control relevant diseases in middle-aged and older adults with low serum albumin and hemoglobin levels.

Awareness and acceptability of population-based screening for pathogenic BRCA variants: Do race and ethnicity matter?

ObjectiveTo evaluate awareness and acceptability of population-based BRCA testing among an unselected population of women presenting for annual gynecologic health assessment, with secondary objective to determine if a racial disparity exists in acceptability and awareness of this screening strategy. MethodsWomen presenting for routine gynecologic care in an outpatient setting of a single academic institution were anonymously surveyed. Survey collected age, self-identified race and ethnicity, education level, personal and family history of breast and/or ovarian cancer (BOC), awareness and interest, and willingness to pay out of pocket for testing. Responses were compared with bivariate and multivariate analysis. ResultsInterest in testing was expressed in 150 of 301 (45.1%) of participants. Women with a family history of BOC were more likely to be interested in testing than those without (OR = 1.9 (1.0–3.6)). Interest in testing was associated willingness to pay (OR = 3.3 (1.7–6.4)). Higher education level was associated with awareness of testing (OR = 9.9 (2.0–49.7)). Interest in testing was similar between racial groups, but awareness and willingness to pay for testing were higher among White women. Multivariate analysis with adjustment for education level confirmed that Black and Hispanic women were less likely to have awareness of genetic testing compared to White women and non-Hispanic Women, respectively (OR = 0.11 (0.05–0.3); OR = 0.10 (0.01–0.8)). ConclusionsInterest in genetic testing among women in the general population is high. Despite interest, awareness of BRCA is poor among Black and Hispanic women even when adjusting for education level.

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

Safeguarding Trainee Health: A Call for an Annual Opt-Out Mental Health Screening

Back to table of contents Previous article Next article CommentaryFull AccessSafeguarding Trainee Health: A Call for an Annual Opt-Out Mental Health ScreeningPeriel Shapiro, M.D., Seth Barishansky, B.A.Periel ShapiroSearch for more papers by this author, M.D., Seth BarishanskySearch for more papers by this author, B.A.Published Online:6 Jun 2019https://doi.org/10.1176/appi.ajp-rj.2019.140603AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail There is an alarmingly high prevalence of depression among medical trainees. A 2016 meta-analysis of data from 122,356 medical students found that nearly a third were depressed (1). Another meta-analysis of data from 17,560 residents, published in 2015, found a similarly high rate of depression, with a prevalence estimate of 28.8% (2).In 2017, the Accreditation Council for Graduate Medical Education (ACGME) instituted a requirement that training programs provide a "confidential, affordable mental health assessment" (3). In fulfilling the ACGME mandate, many institutions offer access to university counseling centers or community providers for a mental health evaluation.Institutions that rely on self-referral to establish access to care are likely to miss many individuals in need. In one survey of house staff at Northwestern University, 110 residents and fellows felt that they would benefit from mental health care (4). Yet fewer than half of those trainees sought an evaluation. In another survey of 183 medical students at Yale University, 24.5% reported increased mental health needs during medical school, but fewer than half of those students increased their help-seeking behaviors (5). Many trainees may not self-refer because of stigma, manifesting as a fear of appearing weak or of facing professional consequences if discovered seeking care. Time and cost are also cited as barriers; programs may require that trainees seek an evaluation during their free time and pay out of pocket for services (4, 5).An annual opt-out mental health screening, included among other annual health care interventions, may mitigate issues associated with a self-referral system. By providing access to a no-cost evaluation in the same location and contiguous with workday time slots appointed for general health care needs, such as the influenza vaccine and tuberculin test, trainees will not have to sacrifice their limited personal time and funds in order to obtain an evaluation. An annual evaluation for every trainee would frame mental health care as a routine matter of health maintenance for all future physicians. A positive screen in the mainstreaming context of routine health maintenance may spur trainees to accept help before a crisis occurs.Mental health is a prerequisite for optimal medical training. An annual mental health assessment for trainees, embedded among well-established trainee health care requirements, would serve both to minimize the barriers associated with a self-referral system and to reduce the stigma associated with mental health care.Dr. Shapiro is a first-year psychiatry resident, and Mr. Barishansky is a fourth-year medical student, at Robert Wood Johnson Medical School, Rutgers University, New Brunswick, N.J.

Acceptability and knowledge of universal screening for pathogenic BRCA mutations, does race matter?

Objective: To evaluate acceptability and knowledge of population-based, universal BRCA testing (UBT) among women presenting for annual gynecologic health assessment, and to determine whether a racial disparity exists in acceptability and knowledge of UBT.

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.