Health Screening Research Articles

Evolutionary changes in metabolic dysfunction-associated steatotic liver disease and the risk of hepatocellular carcinoma: a nationwide cohort study.

To determine the association between evolutionary changes in metabolic dysfunction-associated steatotic liver disease (MASLD) status and the risk of hepatocellular carcinoma (HCC) in a nationwide population-based cohort. Information on study participants were derived from the Korea National Health Insurance Service database. The study population consisted of 5,080,410 participants who underwent two consecutive biennial health screenings between 2009 and 2012. All participants were followed up until HCC, death, or 31 December 2020. Association of evolutionary changes in MASLD status as assessed by fatty liver index and cardiometabolic risk factors, including persistent non-MASLD, resolved MASLD, incident MASLD, and persistent MASLD, with HCC risk was evaluated using the multivariable-adjusted Cox proportional hazards regression. Among the 5,080,410 participants with 39,910,331 person-years of follow-up, 4,801 participants developed HCC. The incidence of HCC in participants with resolved, incident, and persistent MASLD was approximately 2.2-, 2.3-, and 4.7-fold higher, respectively, than that in those with persistent non-MASLD among the Korean adult population. When stratifying the participants according to the evolutionary change in MASLD status, persistent (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 2.68-3.21; P<0.001), incident (aHR, 1.85; 95% CI, 1.63-2.10; P<0.001), and resolved MASLD (aHR, 1.33; 95% CI, 1.18-1.50; P<0.001) had an increased risk of HCC than that of persistent non-MASLD. The evolutionary changes in MASLD were associated with the differential risk of HCC independent of metabolic risk factors and concomitant medications, providing additional information on the risk of HCC stratification in patients with MASLD.

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening.

The government of Korea implemented a strategy of prevention and early diagnosis in high-risk groups to reduce the tuberculosis (TB) burden. This study aims to investigate the TB epidemiology and gap in understanding of TB prevalence among homeless individuals by analyzing active TB chest X-ray (CXR) screening results in Korea. The Korean National Tuberculosis Association conducted active TB screening with CXR for homeless groups from January 1 to December 31, 2021. Sputum acid fast bacilli smear and culture were performed for the subjects suggestive of TB on CXR. We performed a cross-sectional analysis of the data in comparison with the national health screening results from the general population. Among 17,713 homeless persons, 40 (0.23%), 3,077 (17.37%), and 79 (0.45%) were categorized as suggested TB, inactive TB, and observation required, respectively. Prevalence of suggested TB in the homeless was significantly higher (3-5 fold) than in the national general health screening based on age category (p < 0.005). Twenty-nine cases were confirmed as TB, yielding a prevalence of 164 cases per 100,000 individuals; 19 of these 29 cases showed inactive TB on CXR. Body mass index (p = 0.0478) and CXR result (p < 0.001) significantly correlated with confirmed TB based on multivariable analysis. Nutrition status and CXR results, especially that of inactive TB, should be considered in active TB screening of the homeless population, where TB prevalence is higher than the general population.

Team-based rehabilitation after mild traumatic brain injury – description of the clinical pathway

ABSTRACT Purpose Describe clinical practice, inter-disciplinary clinical pathway and core principles of care within a mild traumatic brain injury (mTBI) rehabilitation team. Methods An observational study examined inter-disciplinary practice, nested within an observational trial investigating team-based mTBI rehabilitation. Data were collected to describe clinical service over 12 months. Activity data quantified clinical sessions per participant, mode of service delivery and content of sessions using custom-designed codes. The clinical team gathered narrative data to confirm the inter-disciplinary clinical pathway and individual discipline practice. Results 168 participants entered the rehabilitation program during the 12 months. A single Allied Health Screening Assessment identified patient priorities. Occupational Therapy (OT) and Physiotherapy (PT) provided the majority of clinical sessions; the team also comprised Social Work, Rehabilitation Medicine, Speech Pathology and Clinical Psychology. Telehealth was the most common service delivery mode (54%). Median session numbers per participant ranged 1–4 for all disciplines; mean/maximum occasions of service were highest for PT (6.9/44) and OT (6.8/39). Conclusion A small proportion of participants received much higher number of sessions, consistent with intractable issues after mTBI. High attendance rates indicate the predominantly telehealth-delivered model was feasible. The clinical approach included early prioritizing of discipline input and follow-up after discharge.

Abstract SS03-06: Screening for Health Related Social Needs, and now what?

Abstract Screening cancer patients for health related social needs (HRSN) presents benefits and challenges for the patients as well as for the health care facilities. Who gets screened? How often? What are the results used for? What services can be provided? These are some of the issues that institutions face. At the same time patients can feel singled out, afraid to be honest thinking they would receive sub-optimal treatment, and have wrong expectations, among others. In this session we will address the importance of screening for HRSN such as transportation, housing, food security, and financial strain. Strategies to approach the patient and possible ways to address the needs will also be discussed. Citation Format: B. Segarra-Vazquez. Screening for Health Related Social Needs, and now what? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr SS03-06.

Development and Validation of Hospital Mental Health Screen to Detect Psychiatric Morbidity in Medically Ill Patients in India

Background: Psychiatric morbidities often go unnoticed in medically ill patients. It is essential to screen patients with medical morbidity so that they can be referred to psychiatrists for early interventions in general hospitals in India. There is a potential lacuna in terms of the availability of a scale that can aptly identify psychiatric symptoms in medically ill patients beyond depression or anxiety, especially in low-resource settings like India. Aim: The aim was to detect psychiatric morbidity in medically ill patients in India. Methodology: Items were generated using deductive and inductive approaches. Item-Content Validity Index (I-CVI) and Scale-Content Validity Index/Universal Agreement (S-CVI/UA) were computed by involving eight subject matter specialists. The tool was circulated to 397 medically ill patients for computing The exploratory factor analysis (EFA). Domain-wise reliability using Cronbach’s alpha was calculated for six factors. The concurrent criterion validity of the Hospital Mental Health Screen (HMHS) tool was calculated by the receiver operating curve (ROC) against the gold standard of any psychiatric morbidity diagnosed by two psychiatrists in 397 medically ill patients. We used IBM SPSS version 23. Results: Initially, 34 items were generated. At the I-CVI threshold of 79%, seven items were discarded. The S-CVI/UA of the scale was 85.1%. The Kaiser–Meier–Olkin Measure of Sampling Adequacy (KMO MSA) was found to be 0.916. At a factor loading threshold of 0.4 and an eigenvalue above 1, a six-factor structure was extracted using principal component analysis and varimax rotation. Domain-wise reliability was computed, which was between 0.657 and 0.840. The final tool consisted of 27 Likert items (0 = never to 4 = always). Using the ROC curve at the 19.5 threshold, 91.4% of the positive outcomes were correctly classified and 9.5% of the adverse outcomes were expected to be incorrectly identified by the HMHS screening tool. Conclusion: HMHS is a valid and reliable tool with good screening properties, designed especially for the Indian setting. This scale can assist in identifying psychiatric morbidity in medically ill patients in low-resource settings. There is further scope for performing confirmatory factor analysis (CFA) to reinforce the factor structure of HMHS.

Mental Health Screening: Recommendations from an Integrated Literature Review

Mental Health Screening: Recommendations from an Integrated Literature Review

Screening for serious mental illness in a correctional setting.

Serious mental illness (SMI) is more common among adults in correctional settings than in the general population. No standard exists for SMI screening across correctional settings; SMI therefore often goes undetected in these facilities. Placing individuals with unidentified SMI who are incarcerated in general population cells increases their risk for self-harming behaviors, suicide, and for being victims or perpetrators of exploitation and violence. This article describes a quantitative, descriptive study conducted to evaluate the use of the Brief Jail Mental Health Screen (BJMHS) tool to screen for possible SMI among individuals in a jail setting. A total of 89 individuals who were incarcerated in one jail setting were screened either with the facility's internally developed standard medical questionnaire (SMQ) or with the BJMHS. Findings showed that 28% screened positive for possible SMI using the BJMHS as compared with only 3% using the SMQ. The BJMHS flagged a higher number of possible instances of SMI than the jail's SMQ, potentially signifying its screening superiority. Identification of SMI leads to better care for individuals who are incarcerated, and it increases safety for the individual with SMI, the greater jail population, and jail staff. Findings from this study were shared with system leadership, which has replaced other screening tools with the BJMHS in at least 250 correctional facilities throughout the US.

Acceptability of digital vending machines to improve access to sexual and reproductive health in Brighton, UK: a qualitative analysis

IntroductionSexual health remains a public health priority and relies on widely available testing to enable prompt diagnosis and treatment. Technology-based approaches to distribute tests have potential to increase access and...

Results and methodology for classifying high risk pilots using CANFLY: A cognitive health screening tool for aviators

Cognitive health screening for aviators would assist in managing a shortage of experienced pilots. Extending pilot careers by optimizing their cognitive health would address both the number and quality of pilots available for airline and general aviation operations. The present work tested the validity of an online screening tool for pilots that measures aviation domain-relevant cognition. Sixty-five licensed pilots (18–80 years, M = 48.8, SD = 16.3) with varying levels of experience completed a 30-min online cognitive health screening tool for pilots. Risk status was determined via a novel metric using self-reported incidents. Machine learning algorithms identified the cognitive factors most useful in identifying pilots with increased risk for accidents and serious incidents. Support vector machines and boosted decision tree algorithms provided the most reliable and strongest classifications models of pilot risk. Findings support the use of this short online screening tool for highlighting performance issues with domain-relevant cognitive abilities based on the Dynamic Mental Model for pilots, such as situation awareness and prospective memory. Understanding personal cognitive challenges is the basis for customized skill maintenance designed to augment cognition for those interested in safely extending their piloting careers.

THRIVING IN MOTION – YOUTH MOVES: MOVEMENT FOR TRANS AND GENDER DIVERSE YOUNG FOLK

CASE SETTING Gender diverse young people have lower rates of exercise, and higher rates of mental and physical health challenges, perpetuated by a lack of trans-friendly physical activity providers and environments. Our collaborative project aimed to create and support community-based exercise opportunities for trans and gender diverse young people (15-25yrs) to increase participation and improve their physical and mental health outcomes. Alongside feasibility data from 18 months delivery, two case studies will be presented (23 yrs non-binary individual, presenting with disordered eating and exercise, neurodivergence and mental illness; 18yrs transfeminine presenting with neurodivergence and participation barriers). APPROACH AND TREATMENT Through targeted community collaboration with young people and multidisciplinary support services, a supportive and inclusive structured exercise program was created. Specifically, we delivered and evaluated the feasibility of the exercise program for gender diverse young people; and educated the wider exercise and health community on inclusive exercise practices. RESULTS Forty-six gender diverse young people participated across the delivery of 11 x 8-10 week programs in 5 Perth metro locations, totalling 4518 exercise therapy hours. On average 100% of participants reported a score higher than 3/5 for program enjoyment, 79% of participants reported a score higher than 3/5 for motivation to return. Participants on average increased weekly physical activity participation by 50% since commencing the program, and 100% of participants would recommend the program to other trans peers. REFLECTIONS/LEARNINGS In WA, the absence of exercise opportunities for gender diverse young people prompted our tailored program. We prioritized inclusivity, safety, and participant-specific needs. Our proactive approach included health screenings, upskilling staff, and encouraging a supportive environment. Listening to participant expectations, involving a Youth Advisory Group, and engaging a Youth Engagement Officer proved vital for program success. Our reflections incorporate the significance of tailored, inclusive programs and community involvement in fostering active, safe spaces.

Burden of undiagnosed depression among older adults in India: a population based study.

The study explored the levels and associated factors of undiagnosed depression among community-dwelling older Indian adults. It also identified the socio-demographic predictors of undiagnosed depression among the study population at national and state levels. The study employed data from the Longitudinal Ageing Study in India wave-I, 2017-18. Based on the data on depression from interviewee's self-reporting and measurement on Composite International Diagnostic Interview- Short Form (CIDI-SF) and Centre for Epidemiological Studies- Depression scale (CES-D) scales, we estimated undiagnosed depression among older adults (age 60+). We estimated multivariable binary logistic regressions to examine the socio-demographic and health-related predictors of undiagnosed depression among older adults. 8% (95% CI: 7.8-8.4) of the total older adults had undiagnosed depression on CIDI-SF scale and 5% (95% CI: 4.8-5.3) on the combined CIDI-SF and CES-D. Undiagnosed depression was higher among those who were widowed, worked in the past and currently not working, scheduled castes, higher educated and the richest. Lack of health insurance coverage, presence of any other physical or mental impairment, family history of Alzheimer's/Parkinson's disease/ psychotic disorder, lower self-rated health and poor life satisfaction were significant predictors of undiagnosed depression on both CIDI-SF and combined scales. To improve the health of older adults in India, targeted policy efforts integrating mental health screening, awareness campaigns and decentralization of mental healthcare to primary level is needed. Further research could explore the causal factors behind different levels of undiagnosed depression.

Sociodemographic, Lifestyle and Media Factors Associated with Health Screening: Evidence from Timor-Leste

Preventive medicine plays an important role in combating the surge in non-communicable diseases (NCDs). By using health screening, individuals can prevent and monitor the development of NCDs. This study aims to examine sociodemographic, lifestyle and media factors associated with the use of health screening (blood pressure and blood glucose tests) among adults in Timor-Leste. Data used in this study were derived from the Timor-Leste Demographic and Health Survey 2016. A total of 4,264 adults aged between 30 and 59 years were included in the bivariate probit analysis. Results showed that the use of health screening remained low in Timor-Leste. Males, rural dwellers, less-educated individuals, individuals who were in the poorer and poorest wealth quintiles, and unmarried individuals were less likely to use blood pressure test compared with females, urban dwellers, well-educated individuals, individuals who were in the richest wealth quantile and married individuals. Adults less likely to use blood glucose tests were less educated and unmarried. However, the use of health screening was not correlated with a respondent’s lifestyle behaviour and mass media exposure. In short, sociodemographic factors were associated with the use of health screening in Timor-Leste. Policymakers should consider designing intervention measures based on different sociodemographic groups.

Oral Health Status of Healthcare Workers in Ilembula/Tanzania during the COVID-19 Condition

The challenge of reduced dental treatment and education infrastructure in the Tanzanian highlands affects the oral health situation of both the general population and local healthcare workers. The aim of this study was to investigate the oral health status of healthcare workers at Ilembula Lutheran Hospital (ILH), Tanzania, during the COVID-19 pandemic. In total, 134 healthcare workers (62 women, 72 men; mean age 36.48 ± 9.56 years, range 19–59 years; median age 35.00 years) participated in this cross-sectional study, conducted from 12 February to 27 February. A dental examiner trained in oral health screening performed the oral health data collection. Data collection was performed by probability sampling using the Ilembula Data Collection Form—Oral Health (IDCF-Oral Health) questionnaire distributed in paper form. Ethical approval was obtained from the National Institute for Medical Research/Tanzania. The decayed, missing, and filled teeth (DMF/T) index proposed by the World Health Organization (WHO) was used with the associated caries measurement method and the simplified oral hygiene index (OHI-S). Details regarding edentulism, nutritional habits, and socio-economic factors were collected. Statistical analysis was performed using linear regression (α = 0.05). The average DMF-T index was 3.33 ± 0.82, with age, gender, meal frequency, and soft drink consumption significantly influencing the index. No evidence of dental plaque was detected in 43.3% of the participants. Of the participants, 32.8% required prosthetic treatment (Kennedy Class III), while 16.4% needed it for acute malocclusions. Oral hygiene products were used in 97% of cases. A total of 35.8% of the participants had an OHI-S score of up to 1.0, with (p &lt; 0.001) age and (p &lt; 0.001) sex having a significant influence on the index. The current oral health situation of healthcare workers at ILH shows a moderate need for restorative and prosthetic treatment in rural Tanzania. Despite the COVID-19 pandemic, there was no change in the need for dental treatment, which may be explained by the generally restricted access to dental healthcare in the investigated region. The development of an interdisciplinary oral health prophylaxis system could help to reduce the need for future treatments.

Healthcare Team Members’ Views on Social Determinants of Health Screening and Referral Practices in a Pediatric Emergency Department

Healthcare Team Members’ Views on Social Determinants of Health Screening and Referral Practices in a Pediatric Emergency Department

Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population

ObjectiveWhile hypertension is a well-recognized risk factor for non-alcoholic fatty liver disease (NAFLD), the specific roles of various common blood pressure measurements [diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), mean arterial pressure (MAP)] in detecting NAFLD and evaluating the associated risk in adults remain unclear.MethodsA retrospective analysis was conducted on 14,251 adult participants undergoing health screenings in the NAfld in the Gifu Area, Longitudinal Analysis project (NAGALA). Following the Z-transformation of the independent variables, we evaluated the relationships between the four blood pressure indices and NAFLD through multivariable logistic regression models. This analysis documented the odds ratio (OR) and 95% confidence interval (CI) for each standard deviation (SD) increase. Additionally, the effectiveness of these indices in identifying NAFLD was comparatively analyzed using receiver operating characteristic (ROC) curves.ResultsAfter adequately adjusting for confounders, all blood pressure indices except PP showed a positive correlation with NAFLD. For each SD increment, MAP had the strongest association with NAFLD compared to SBP and DBP. This finding was confirmed in populations without exercise habits, under 60 years of age, with normal blood pressure, and in non-obese groups. Furthermore, based on ROC analysis, MAP was found to have the highest accuracy in identifying NAFLD compared to the other three blood pressure indices.ConclusionAmong the four blood pressure indices evaluated, MAP demonstrates the greatest efficacy in identifying NAFLD and assessing its associated risk. These findings underscore the potential of MAP as the most promising blood pressure index for screening NAFLD.

Detection of Asymptomatic Sickle Cell Hemoglobin Carriers and Fetal Hemoglobin Regulating Genetic Variants in African Descendants from Oaxaca, Mexico

Sickle cell anemia has been classified as a noninfectious neglected tropical disease and, although not exclusively, affects African descendants more frequently. This study aimed to detect asymptomatic sickle cell hemoglobin carriers (HbAS) in marginalized and vulnerable populations during a public health screening in African descendants from Oaxaca, Mexico, and to validate an amplification refractory mutation system (ARMS)-PCR methodology to detect fetal-hemoglobin (HbF)-regulating genetic variants in BCL11A toward affordable routine association of single nucleotide variants (SNVs) with HbF concentrations. To this aim, hemoglobin variants were detected by acidic citrate agar and alkaline cellulose acetate electrophoreses. SNVs in the hemoglobin subunit beta gene (HBB) were identified by the β-globin mutation detection assay (β-GMDA) and ARMS-PCR, respectively, and validated by Sanger sequencing. The association between genotypes and HbF concentrations was evaluated using Spearman’s correlation coefficient. The results obtained during a directed screening in 140 self-identified African descendants revealed 42 HbS-carriers (30%), of which 39 showed normal total hemoglobin concentrations (92.8%), only 3 presented anemia (7.2%), and 9 showed quantifiable HbF concentration (21.4%). As validated by Sanger sequencing, the designed ARMS-PCR efficiently detected homozygous and heterozygous variants in BCL11A. In a cohort of 42 heterozygous (HbAS) and 27 healthy (HbAA) individuals from the same population, only one SNV (rs766432) showed statistically significant association with increasing HbF concentration, and two new unrelated homozygous silent variants were identified. This study reveals the need to raise coverage of HbS screening in vulnerable populations and shows a feasible low-cost ARMS-PCR methodology to determine the presence of SNVs in quantitative trait loci affecting HbF.

Education and health examination for the elderly

The elderly are one of the population groups that are vulnerable to various health problems. Proper education and health screenings can improve quality of life and prevent diseases that often occur in old age. This service activity aims to identify effective educational approaches and types of health checks that are important for the elderly. Service activities are carried out in the form of free examinations and health counseling to provide information and education about health for the elderly. For counseling activities using the lecture method and focus group discussion. Results show that an integrated educational approach, including information on healthy lifestyles, chronic disease management, and the importance of active socialisation, has a positive impact on elderly health knowledge and behaviours. risk of complications. It can be concluded that education and medical examination are two important aspects of caring for the elderly. An integrated, holistic educational approach can improve the elderly's health knowledge and behaviours, while regular health checkups can help detect health problems early and reduce the risk of complications.

A scoping review of academic and grey literature on migrant health research conducted in Scotland

BackgroundMigration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland.MethodsA scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation’s 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland.ResultsSeventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation’s strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication.ConclusionWhile research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.

Occupational Stress and Administrators’ Levels of Job Satisfaction in the University of Education, Winneba

The research assessed the effect of occupational stress on administrators’ levels of job satisfaction in the University of Education, Winneba (UEW). The study investigated the sources of occupational stress, job satisfaction determinants, and the effects of occupational stress on administrators' health, all of which were based on the demand control theory. The quantitative approach and descriptive survey design were used. The study randomly selected 110 participants from a population of 147 administrators at the University of Education, Winneba, using the sample size determination table. Data were collected from respondents using structured questionnaires, which were then processed with and coded IBM SPSS version 20. The data were analyzed with mean, standard deviation and regression. The study discovered that lack of promotion and resources, favouritism, inadequate staff, work obligations, red tape, immoderate administrative responsibilities, and occupational health issues were the major factors that account for occupational stress among staff. A weak and negative relationship was discovered between occupational stress and job satisfaction of staff. Thus, the study concluded that high levels of occupational stress resulted in lower job satisfaction. In order to improve job satisfaction levels of administrators at UEW, the study recommended that management should implement innovative measures such as flexible working hours, enhanced promotion based on merit, resource availability to facilitate work and remote working aimed at lowering the factors that contribute to occupational stress. Also, the University Health Directorate should occasionally run health screening to addressed health related issues among staff who are at risk.