Health Care Screening Research Articles

Catchii: Empowering literature review screening in healthcare.

A systematic review is a type of literature review that aims to collect and analyse all available evidence from the literature on a particular topic. The process of screening and identifying eligible articles from the vast amounts of literature is a time-consuming task. Specialised software has been developed to aid in the screening process and save significant time and labour. However, the most suitable software tools that are available often come with a cost or only offer either a limited or a trial version for free. In this paper, we report the release of a new software application, Catchii, which contains all the important features of a systematic review screening application while being completely free. It supports a user at different stages of screening, from detecting duplicates to creating the final flowchart for a publication. Catchii is designed to provide a good user experience and streamline the screening process through its clean and user-friendly interface on both computers and mobile devices. All in all, Catchii is a valuable addition to the current selection of systematic review screening applications. It enables researchers without financial resources to access features found in the best paid tools, while also diminishing costs for those who have previously relied on paid applications. Catchii is available at https://catchii.org.

Community-Based Diabetes Awareness Strategy With Detection and Intervention: The Mobile Diabetes Education Center.

To prevent diabetes and increase equitable access to health care screenings, Touro University California has created and implemented a community outreach program called the Mobile Diabetes Education Center (MOBEC). This program is a joint effort that also involves Sutter Health, the California Department of Public Health, Kaiser Permanente, the Solano County Department of Public Health, and community-based organizations, focusing on advancing health equity in Solano County's at-risk populations. This article reports on the services and initial successes of MOBEC. With its strong community collaboration, MOBEC has helped to raise awareness of diabetes and ensure access to much-needed health screenings and education. This model can potentially be used as a blueprint for similar efforts nationwide to address the health care needs of medically underserved communities.

Correction for Self-Selection in Breast Cancer Screening. Comment on Dibden et al. Worldwide Review and Meta-Analysis of Cohort Studies Measuring the Effect of Mammography Screening Programmes on Incidence-Based Breast Cancer Mortality. Cancers 2020, 12, 976.

Observational studies of cancer screening are subject to bias associated with the self-selection of screening participants for whom the underlying probability of cancer death may be different from those who do not participate. Dibden et al. reviewed data on mortality reduction from 27 observational studies of mammography screening expressed in terms of relative risk for women who were screened versus not screened. Results were given, both unadjusted and after application of a correction for self-selection. The correction was based on a constant (1.17)-the ratio of risks of death in screening non-attenders versus those not invited, derived from a Swedish study. For some of the studies this correction had a large effect in diminishing the measured mortality benefit associated with screening. In particular, application to The Pan-Canadian Study of Mammography Screening, a study whose authors had previously tested for and found no evidence of self-selection bias, caused the estimated benefit to decrease from 40% to 10%. The appropriateness of applying a correction based on a constant to a population whose healthcare environment and screening participation rates are very different from those from which it was derived is questionable.

An Intersectional Approach to Examining Breast Cancer Screening among Subpopulations of Black Women in the United States.

This study examines breast cancer screening behavior among subpopulations of Black women in the United States. Binary logistic regression was used to analyze breast cancer screening among a nationally-representative sample (n = 9,783) of Black women-US-born, non-US-born Caribbean, and non-US-born African-from the 2011-2017 National Health Interview Survey dataset. Non-US-born African Black women were less likely to have breast cancer screening, compared to US-born Black women. Among non-US-born Black women, non-US-born Caribbean Black women were more likely to have had breast cancer screening. Differential healthcare access associated with nativity differences among Black women can be informing their breast cancer screening behaviors. Efforts to improve breast cancer outcomes among Black women can benefit from interventions that account for differential access to healthcare and breast cancer screening behaviors among subgroups of Black women.

Predictive Framework Development for User-Friendly On-Site Glucose Detection.

This study explores a smartphone-based spot detection framework for glucose in a rapid, simple, and affordable paper-based analytical device (PAD), which employs machine-learning algorithms to estimate various glucose concentrations. Herein, two different detection mixtures were chosen with chitosan (C) and without chitosan (WC) for the color change analysis. Being a biopolymer, chitosan improves the analytical performance of PADs when used with a chromogenic agent. Moreover, the influence of the illumination conditions and camera optics on the professed color of glucose strips was observed by choosing various illumination conditions and different smartphones. Hence, this study focuses on developing a framework for smartphone-based simple and user-friendly spot-based glucose detection (with a concentration range of 10-40 mM) at any illumination conditions and in any direction of illumination. Additionally, the combination of color spaces and machine-learning algorithms was applied for the signal enhancement. It was observed that the machine learning classifiers, cubic support vector machine (SVM) and narrow neutral network show higher accuracy for the WC samples, which are 92.7 and 92.3%, respectively. The samples with chitosan show higher accuracy for the linear discriminant and quadratic SVM classifiers, which are 94.1 and 93.9%, respectively. Simultaneously, cubic SVM shows ∼93% accuracy for both cases. In order to assess the performance of the devices, a blind test was also conducted. This study demonstrates the potential of the developed system for initial disease screening at the user end. By incorporating machine learning techniques, the platform can provide reliable and accurate results, thus paving the way for estimating the accuracy of the results for improved initial healthcare screening and diagnosis of any disease.

Perspectives of patients undergoing neoadjuvant chemotherapy for breast cancer during the COVID-19 pandemic.

The COVID-19 pandemic resulted in a lapse in routine health care and cancer screenings for many individuals. This study sought to improve our understanding of the impact of the COVID-19 pandemic on women being treated for breast cancer, both in general, and specifically related to their diagnosis. Semi-structured interviews were conducted between August 2021 and February 2022 with women who were receiving neoadjuvant chemotherapy for early-stage breast cancer at the Stefanie Spielman Comprehensive Breast Center in Columbus, Ohio. Interviews were recorded and transcribed verbatim. Transcripts were coded using deductive dominant thematic analysis and inductive coding that allowed for categorization of data as well as identification of emergent themes. Data collected from our 19 interviews revealed that the COVID-19 pandemic posed important challenges for breast cancer patients including fear of COVID-19 infection and feelings of isolation. Most interviewees noted they had been vaccinated against COVID-19 because of a desire to protect themselves and others from getting sick. Some women also expressed concerns about having delayed their screening mammograms due to the pandemic. Several patients described unexpected positive aspects of the pandemic such as being able to spend more time with family and having the ability to continue working because of the option to work from home during their cancer treatment. Our findings provide important insight about the impact of COVID-19 on breast cancer patients. We highlight the positives that have been reported because of the pandemic, as well as the need to address delayed breast cancer screening.

Preventive Healthcare Screening Completion Among Midlife and Older Adults With Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities (IDD) face several barriers to healthcare, making them less likely to receive numerous routine preventive health screenings. Preventive healthcare is a critical aspect to maintaining health and wellness, particularly for people with complex health needs. This study examines individual- and state-level factors associated with mammogram and colonoscopy screenings in mid- and later-life foradults with IDD receiving state services. Multilevel logistic regression models analyzed data from the 2012-2013 and 2018-2019 waves of the National Core Indicators In-Person Survey (NCI-IPS). Results indicated that factors such as age, living situation, transportation access, and community involvement were associated with completion of both preventive screenings. Medicaid expansion was associated with a significantly greater likelihood of completing a colonoscopy screening only among younger persons in the sample (i.e., in their 50s). These findings may have implications for completion of preventive health screenings for adults with IDD.

Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study

ObjectivesTo describe chronic kidney disease (CKD) regarding treatment rates, comorbidities, usage of CKD International Classification of Diseases (ICD) diagnosis, mortality, hospitalisation, evaluate healthcare utilisation and screening for CKD in relation...

Colon cancer epidemiology, race and socioeconomic status: Comparing trends in counties served by an urban hospital in Newark, NJ with overall NJ-state and nation-wide patterns

PurposeDisparities in colorectal cancer (CRC) trends are linked with socioeconomic status (SES) and race. To better understand the colon cancer trends at our medical center, this study characterizes the racial and socioeconomic profile of the population served by our center to identify modifiable risk factors amenable to interventions. MethodsColon cancer data from our center as well as New Jersey (NJ) and United States (US) were obtained from National Cancer Database. Demographic data on race and SES for NJ counties were obtained from public databases that sourced data from the American Community Survey and the US census. We compared the odds of being diagnosed with early-onset and late-stage colon cancer (III or IV), respectively in NJ and US, across different racial groups. We also quantified the association between Social Vulnerability Index (SVI) and age-adjusted CRC mortality in NJ counties, with and without accounting for the racial composition of each county. ResultsIn 2015, our center recorded higher proportions of late-stage and early-onset colon cancer diagnoses compared to all hospitals in NJ and US. Trends for stage and patient age at diagnosis of colon cancer for NJ and the US (2010–2019) showed that Black, Hispanic, and Asian/Pacific Islander individuals had greater odds of being diagnosed with early-onset (age<50) and late-stage colon cancer (Stage III/IV) when compared to White population. NJ counties served by our center showed an overrepresentation of either Black or Hispanic-Latino populations and reported significant disadvantage in SES. For NJ counties, each 25 percentile increase in social vulnerability was associated with 1.04 times the rate of age-adjusted colorectal cancer death (95 % CI: 1.00–1.07). ConclusionPublic data on race and SES of the target population can help identify areas of social disparities at the county-level to guide targeted interventions such as improving healthcare access and screening rates.

A Validation Study of Mental Health Monitoring Through a Mobile Application.

Face-to-face evaluation is the most important in psychiatric evaluation, but smart healthcare, including non-face-to-face evaluation, can be beneficial considering the situation in which face-to-face evaluation is limited or the preventive aspect of mental illness. In this paper, we aimed to check whether mental health screening tests have the same significance as paper-based tests even when collected through mobile applications. A smart mental healthcare screening test was conducted on the 1,327 community subjects. We measured two indicators of depression (Patient Health Questionnaire 9-item scale, PHQ-9) and anxiety (Generalized Anxiety Disorder 7-item scale, GAD-7) to check mental health conditions. The average Cronbach's alpha value of the PHQ-9 questionnaire was good at 0.870. As a result of PHQ-9's principal component analysis, one component with an eigenvalue of 1 or more was identified, which is suitable to be described as a single factor. The average Cronbach's alpha value of the GAD-7 was 0.919. The structural validity of the GAD-7 was confirmed through principal component analysis. Our results show that PHQ-9 and GAD-7 scales performed through mobile applications can have the same meaning as paper-based tests. Surveys using a tablet PC, or smartphone application can monitor residents' mental health and accumulate data. Based on these data, smart mental health management can check the mental health of residents and treat mental illness in connection with medical services.

Investigating the Correlation Among Personality Traits, Familial Functioning, and Suicidal Thoughts Among University Students: A Descriptive Correlational Study

Objectives: Suicide is a serious public health problem, especially among students as active members of the community. The present study aimed to determine the correlation among personality characteristics, family functioning, and suicidal ideation in students of Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2018. Materials and Methods: The population of this descriptive correlational study included all 675 students of Shahid Beheshti University of Medical Sciences, from whom 244 students were selected using stratified random sampling. The required data was collected using four questionnaires, including demographic characteristics, personality traits, family functioning, and Beck Scale for Suicidal Ideation (BSSI). To analyze data, we used multiple linear regression and the Statistical Package for the Social Sciences (SPSS, version 22). Results: Examination of personality traits suggested that the correlation between psychosis and suicidal thoughts was positive and significant (P&lt;0.05). The correlation coefficients between the components of extraversion-introversion, agreeability, and responsibility and suicidal ideation were negative and significant (P&lt;0.05). There was also a positive and significant relationship between all components of family functioning and suicidal ideation (P&lt;0.05). Conclusions: Effective steps can be taken to prevent suicide among students through providing optimal psychological healthcare and periodic screening of students in terms of suicidal thoughts and mental disorders.

Tick tock on the stomach clock: Factors affecting time to diagnosis of gastric adenocarcinoma at an urban cancer center with a large East Asian patient population.

e18508 Background: Gastric cancer is the fifth most common cancer in the world and disproportionately affects the East Asian population. Various factors contribute to this disparity such as genetics and environmental exposure. Given that language barriers can contribute to reduced quality of healthcare delivery, screening rates, and patient safety, it is important to assess the impact of language on the diagnosis of gastric cancer. Tufts Medical Center’s proximity to Boston’s Chinatown make our patient population unique for analysis of these factors. Here we present a single-institution experience of the factors affecting gastric adenocarcinoma time to diagnosis. Methods: We used ICD-10 codes to retrospectively identify patients at Tufts Medical Center with a diagnosis of gastric cancer between January 2011 and December 2021. We excluded patients that did not have a diagnosis of gastric adenocarcinoma or lacked adequate clinical documentation. We recorded demographic, clinical, and treatment characteristics including race (White, Asian, or other), primary language (English, Asian or other), presenting symptoms, enrollment in hospice, and interpreter status (certified, non-certified, none, or not applicable). Certified interpreters included professional medical services for in-person, video, or phone interpreters. Non-certified interpreters included family members, physicians fluent in the language, or others. We assessed the impact of these on the time between initial presentation to the healthcare system and eventual diagnosis of gastric cancer. Results: 80 patients were included in the analysis. Mean days to diagnosis by race were as follows: White (40), Asian (43), other (25), p = 0.20. Mean days to diagnosis based on language were as follows: English (40), Asian (43), other (6), p = 0.07. Mean days to diagnosis based on interpreter status were as follows: certified (19), non-certified (13), none (73), NA (40) (p = 0.05). When pairwise comparison was done, there was no difference between certified and non-certified interpreter (p = 0.40). There was no difference between certified interpreter and no interpreter (p = 0.06). There was a statistically significant difference between non-certified interpreter and no interpreter (p = 0.04). Presenting symptoms and eventual enrollment in hospice did not significantly impact time to diagnosis. Conclusions: We saw a shorter time from initial presentation to diagnosis of gastric adenocarcinoma in non-English speaking patients who used an interpreter at the initial visit compared to those who did not. One should always consider interpreter availability as an important part of reducing health disparities.

Changes in alcohol consumption reported on routine healthcare screenings are associated with changes in depression symptoms.

The Alcohol Use Disorders Identification Test-Consumption version (AUDIT-C) has been robustly validated as a point-in-time screen for unhealthy alcohol use, but less is known about the significance of changes in AUDIT-C scores from routine screenings over time. Unhealthy alcohol use and depression commonly co-occur, and changes in drinking often co-occur with changes in depression symptoms. We assess the associations between changes in AUDIT-C scores and changes in depression symptoms reported on brief screens completed in routine care. The study sample included 198,335 primary care patients who completed two AUDIT-C screens 11 to 24 months apart and the Patient Health Questionnaire-2 (PHQ-2) depression screen on the same day as each AUDIT-C. Both screening measures were completed as part of routine care within a large health system in Washington state. AUDIT-C scores were categorized to reflect five drinking levels at both time points, resulting in 25 subgroups with different change patterns. For each of the 25 subgroups, within-group changes in the prevalence of positive PHQ-2 depression screens were characterized using risk ratios (RRs) and McNemar's tests. Patient subgroups with increases in AUDIT-C risk categories generally experienced increases in the prevalence of positive depression screens (RRs ranging from 0.95 to 2.00). Patient subgroups with decreases in AUDIT-C risk categories generally experienced decreases in the prevalence of positive depression screens (RRs ranging from 0.52 to 1.01). Patient subgroups that did not have changes in AUDIT-C risk categories experienced little or no change in the prevalence of positive depression screens (RRs ranging from 0.98 to 1.15). As hypothesized, changes in alcohol consumption reported on AUDIT-C screens completed in routine care were associated with changes in depression screening results. Results support the validity and clinical utility of monitoring changes in AUDIT-C scores over time as a meaningful measure of changes in drinking.

Barriers and facilitators to cognitive impairment screening among older adults with diabetes mellitus and hypertension by primary healthcare providers in rural Uganda.

The burden of non-communicable diseases and cognitive impairment exhibit a linear rise in sub-Saharan Africa due to the increase in life expectancy. Non-communicable diseases like diabetes mellitus and hypertension increase the risk for cognitive impairment. To improve our understanding of the underpinnings of the cognitive impairment screening, this study explored the barriers and facilitators of routine cognitive impairment screening in a primary healthcare setting guided by the Capacity, Opportunity, Motivation Behavioral change (COM-B) model. This was a descriptive qualitative study with primary healthcare providers who provide care to older adults with diabetes mellitus and hypertension at three primary healthcare centers in Mbarara district southwestern Uganda. In-depth interviews were conducted using a semi structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework approach along the COM-B components. Each COM-B component factors were categorized as barriers and facilitators. We conducted 20 in-depth interviews with clinical officers, enrolled nurses, and a psychiatric nurse. The questions were guided by the Capacity, Opportunity and Motivation Behavioral change (COM-B) framework to identify barriers and facilitators to cognitive impairment screening. The factors that negatively affected the screening were considered as barriers, while the positive as facilitators. Capacity related barriers to cognitive impairment screening included chronic understaffing, primary healthcare provider non-involvement, lack of training/skills, lack of knowledge and awareness in screening, absence of caretakers, lack of patient awareness of cognitive problems; while facilitators were staff recruitment, primary healthcare provider involvement, and specialized training. Opportunity related barriers to screening included patient overload, infrastructure shortage, and time constraints. Motivation related barriers included lack of screening guidance and policy, while the facilitators were availability of mentorship programs for primary healthcare providers. Integrating cognitive impairment screening in primary health care requires engagement of relevant stakeholders with the focus on addressing implementation challenges through capacity development. Timely cognitive impairment screening at the first point of care initiates a cascade of interventions for timely enrollment into care, thus arresting the progress of cognitive impairment that leads to dementia.

Review of linear and nonlinear models in breath analysis by Cyranose 320

Analysis of volatile organic compounds (VOCs) in breath specimens has potential for point of care (POC) screening due to ease of sample collection. While the electronic nose (e-nose) is a standard VOC measure across a wide range of industries, it has not been adopted for POC screening in healthcare. One limitation of the e-nose is the absence of mathematical models of data analysis that yield easily interpreted findings at POC. The purposes of this review were to (1) examine the sensitivity/specificity results from studies that analyzed breath smellprints using the Cyranose 320, a widely used commercial e-nose, and (2) determine whether linear or nonlinear mathematical models are superior for analyzing Cyranose 320 breath smellprints. This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses using keywords related to e-nose and breath. Twenty-two articles met the eligibility criteria. Two studies used a linear model while the rest used nonlinear models. The two studies that used a linear model had a smaller range for mean of sensitivity and higher mean (71.0%–96.0%; M = 83.5%) compared to the studies that used nonlinear models (46.9%–100%; M = 77.0%). Additionally, studies that used linear models had a smaller range for mean of specificity and higher mean (83.0%–91.5%; M = 87.2%) compared to studies that used nonlinear models (56.9%–94.0%; M = 76.9%). Linear models achieved smaller ranges for means of sensitivity and specificity compared to nonlinear models supporting additional investigations of their use for POC testing. Because our findings were derived from studies of heterogenous medical conditions, it is not known if they generalize to specific diagnoses.

(118) Pilot Survey Study Evaluating Sexual Healthcare Delivery and Provider Habits for Pregnant Patients

Abstract Introduction Female sexual dysfunction affects many women throughout their lives and is associated with medical, psychological, and quality-of-life issues. Studies show an increased prevalence of sexual dysfunction in pregnancy, particularly in the third trimester. However, limited empirical data on sexual dysfunction in American pregnant women exist, and there is a lack of recommendations for intrapartum sexual healthcare screening. It is difficult to find concise screening resources to aid in detection and management. Studies have found that healthcare providers may not inquire about a patient’s difficulty due to known barriers, including a lack of knowledge and training. Objective This pilot survey study aims to assess current provider patterns and modalities surrounding screening patients for sexual dysfunction in pregnancy through a direct questionnaire. Methods This pilot study is an IRB-approved, observational cross-sectional survey conducted via REDCAP. The anonymous questionnaire contains approximately 20 items, including questions regarding provider demographics and screening practices. We identified perinatal care providers, including Physicians, Advanced Practice Nurses (APNs), and Certified Nurse Midwives (CNMs), through Doximity. The data is largely quantitative and includes some qualitative responses to open-ended questions that are not powered. Descriptive summary statistics are reported overall and stratified by provider background. Results 25 perinatal care providers completed the survey; 15 (60%) physicians and 10 (40%) APNs and CNMs. Male providers represented 8% (n=2) of responses. 16 (64%) providers reported that they regularly screen for sexual dysfunction in pregnant patients. Of those 16 providers, the age range most represented was the 41-50 age range (n=7, 43.75%), and they consisted of 10 (62.5%) physicians and 6 (37.5%) APNs or CNMs. Of the providers who regularly screen, 7 (43.75%) selected that the most important time to screen was in the postpartum period and 4 (25%) selected the initial obstetric visit. Physicians reported asking both patients and their partners about sexual dysfunction in pregnancy “almost always” (n=1, 6.25%), “sometimes” (n=4, 25%), “almost never” (n=6, 37.5%), or “never” (n=4, 25%). APNs and CNMs reported asking both partners about sexual dysfunction in pregnancy “sometimes” (n=3, 33.3%), “almost never” (n=3, 33.3%), or “never” (n=4, 44%). Qualitative data revealed these barriers to regularly screening for sexual dysfunction in pregnancy: a lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Conclusions Approximately two-thirds (64%) of providers support screening for sexual dysfunction in pregnancy. A similar proportion of physicians (66%) and APNs/CNMs (60%) reported that they regularly screen for sexual dysfunction in pregnancy. Of the providers who regularly screen, providers selected that the most important time to screen is postpartum (43.75%) followed by the initial obstetric visit (25%). In general, providers report screening via open-ended questions or questionnaires. Some providers who support, but do not regularly screen detailed these specific barriers to screening: lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Disclosure No

IMPACT OF VISUAL MODALITIES IN MULTIMODAL PERSONALITY AND AFFECTIVE COMPUTING

Abstract. Personality and affective computing techniques play a significant role for better understanding of human’s behavior and intentions. Such techniques can be applied in practice in recommendation systems, healthcare, education, and job applicant screening. In this paper, we propose a novel multimodal approach to personality traits assessment that leverages affective features of human’s voice and face, as well as recent advances in the deep learning. We present a new mid-level modality fusion strategy that is based on a cross-modal attention mechanism with summarizing functionals. In contrast to other state-of-the-art approaches, we not only analyze a visual scene, but specifically process human’s upper body (selfie) and a scene background. Our experiments show that the Extroversion personality trait is better estimated by fusing visual scene, face, and audio (voice) modalities, while the Conscientiousness and Agreeableness traits are better assessed by fusing face, selfie, and audio modalities. Furthermore, our results show that utilizing the selfie modality outperforms the visual scene modality by more than 1% in terms of the Concordance Correlation Coefficient. Additionally, our approach based on processing three modalities (selfie, face, and audio) is on-par with other known state-of-the-art approaches that employ at least four modalities on the test set of the ChaLearn First Impressions V2 corpus.

Exploring the associations between auditory hallucinations and psychopathological experiences in 10,933 patient narratives: moving beyond diagnostic categories and surveys

BackgroundPrevious research suggests that auditory hallucinations are prevalent within both the clinical and general populations. Yet, we know little about how these phenomena are associated with other psychopathology symptoms and experiences. The current study aids investigations towards preventing, predicting and more effectively responding to such distressing occurrences. There have been substantial efforts in the literature to propose models of auditory hallucination and attempts to verify them. However, many of these studies used survey methods that restrict the person’s responses to a set of pre-defined criteria or experiences and do not allow exploration of potential important other symptoms beyond them. This is the first study to explore the correlates of auditory hallucination using a qualitative dataset consisting of unrestricted responses of patients about their lived experiences with mental illness.MethodThe study used a dataset consisting of 10,933 narratives from patients diagnosed with mental illnesses. For analysis, the study used correlation on the text-based data. This approach is an alternative to the knowledge-based approach where experts manually read the narratives and infer the rules and relationships from the dataset.ResultThis study found at least 8 correlates of auditory hallucination (small correlation coefficients), with the unusual ones being “pain.” The study also found that auditory hallucinations were independent of obsessive thoughts and compulsive behaviours, and dissociation, in contrast with the literature.ConclusionThis study presents an innovative approach to explore the possible associations between symptoms without the restrictions of (or outside the confines of) traditional diagnostic categories. The study exemplified this by finding the correlates of auditory hallucination. However, any other symptom or experience of interest can be studied similarly. Potential future directions of these findings are discussed in the context of mental healthcare screening and treatment.

A Survey of Personal Health Habits, Wellness, and Burnout in Practicing Orthopaedic Surgeons—Are We Taking Care of Ourselves?

The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

Multiple morbidity across the lifespan in people with Down syndrome or intellectual disabilities: a population-based cohort study using electronic health records

The Down syndrome phenotype is well established, but our understanding of its morbidity patterns is limited. We comprehensively estimated the risk of multiple morbidity across the lifespan in people with Down syndrome compared with the general population and controls with other forms of intellectual disability. In this matched population-based cohort-study design, we used electronic health-record data from the UK Clinical Practice Research Datalink (CRPD) from Jan 1, 1990, to June 29, 2020. We aimed to explore the pattern of morbidities throughout the lifespan of people with Down syndrome compared with people with other intellectual disabilities and the general population, to identify syndrome-specific health conditions and their age-related incidence. We estimated incidence rates per 1000 person-years and incidence rate ratios (IRRs) for 32 common morbidities. Hierarchical clustering was used to identify groups of associated conditions using prevalence data. Between Jan 1, 1990, and June 29, 2020, a total of 10 204 people with Down syndrome, 39 814 controls, and 69 150 people with intellectual disabilities were included. Compared with controls, people with Down syndrome had increased risk of dementia (IRR 94·7, 95% CI 69·9-128·4), hypothyroidism (IRR 10·6, 9·6-11·8), epilepsy (IRR 9·7, 8·5-10·9), and haematological malignancy (IRR 4·7, 3·4-6·3), whereas asthma (IRR 0·88, 0·79-0·98), cancer (solid tumour IRR 0·75, 0·62-0·89), ischaemic heart disease (IRR 0·65, 0·51-0·85), and particularly hypertension (IRR 0·26, 0·22-0·32) were less frequent in people with Down syndrome than in controls. Compared to people with intellectual disabilities, risk of dementia (IRR 16·60, 14·23-19·37), hypothyroidism (IRR 7·22, 6·62-7·88), obstructive sleep apnoea (IRR 4·45, 3·72-5·31), and haematological malignancy (IRR 3·44, 2·58-4·59) were higher in people with Down syndrome, with reduced rates for a third of conditions, including new onset of dental inflammation (IRR 0·88, 0·78-0·99), asthma (IRR 0·82, 0·73-0·91), cancer (solid tumour IRR 0·78, 0·65-0·93), sleep disorder (IRR 0·74, 0·68-0·80), hypercholesterolaemia (IRR 0·69, 0·60-0·80), diabetes (IRR 0·59, 0·52-0·66), mood disorder (IRR 0·55, 0·50-0·60), glaucoma (IRR 0·47, 0·29-0·78), and anxiety disorder (IRR 0·43, 0·38-0·48). Morbidities in Down syndrome could be categorised on age-related incidence trajectories, and their prevalence clustered into typical syndromic conditions, cardiovascular diseases, autoimmune disorders, and mental health conditions. Multiple morbidity in Down syndrome shows distinct patterns of age-related incidence trajectories and clustering that differ from those found in the general population and in people with other intellectual disabilities, with implications for provision and timing of health-care screening, prevention, and treatment for people with Down syndrome. The European Union's Horizon 2020 Research and Innovation Programme, the Jérôme Lejeune Foundation, the Alzheimer's Society, the Medical Research Council, the Academy of Medical Sciences, the Wellcome Trust, and William Harvey Research Limited.