Objective To assess the impact of resilience, the ability to withstand and bounce back from adversity, on measures of well-being, self-reported stress, and mental health diagnoses. Methods This study was a cross-sectional survey of participants seen at an executive health practice at Mayo Clinic, Rochester, Minnesota, from January 2012 through September 2016. Participants completed an anonymous survey that included demographic information and 3 validated survey instruments—the 10-item Connor-Davidson Resilience Scale (CD-RISC), the 12-item Linear Analogue Self-Assessment Scale (LASA), and the 14-item Perceived Stress Scale (PSS). Self-reported history of mental health diagnoses was also collected. CD-RISC scores were used to stratify participants into lower (<30), medium (30–34), or higher (≥35) resilience categories. Participants’ LASA scores, PSS scores, and self-reported mental health diagnoses were compared among resilience categories. Results Of the 2,027 eligible participants, 1,954 met the study inclusion criteria as currently employed corporate-sponsored executive or business professionals (self-designated) who completed the CD-RISC survey. Most participants (62.5%) were aged 40 to 59 years. The majority were male (78.3%), white (95.3%), educated (86.2%), and in a committed relationship (89.7%). Among participants, 41.7% reported higher resilience, 34.3% had medium resilience, and 24.0% had lower resilience. The quality of life and overall LASA scores were positively associated with higher resilience ( P < .001). PSS scores and self-reported mental health diagnoses were negatively associated with higher resilience ( P < .001). These associations remained significant after adjusting for patient characteristics. Conclusions In this cross-sectional survey of a large cohort of corporative executives, the lower-resilience cohort had a 4-fold higher prevalence of depression and an almost 3-fold higher prevalence of anxiety compared with the higher-resilience cohort. High resilience was positively associated with well-being and negatively associated with perceived stress. Our findings suggest that higher resilience in the executive workplace environment is associated with better mental health, reduced stress, and greater well-being.

Objectives To determine whether autosomal dominant polycystic kidney disease (ADPKD) is associated with adverse fetal outcomes and maternal complications Methods We identified a cohort of 146 patients seen for pregnancy and cystic kidney disease at Mayo Clinic from 1975 to 2010. From this cohort, 54 patients met the ultrasound diagnostic criteria for ADPKD (ADPKD group), while the other 92 patients were diagnosed as “Simple Cyst” (control group). We compared the fetal and maternal outcomes of pregnancy and long-term maternal prognoses between these two groups. Results Overall, the fetal complication rates were similar between the ADPKD and control groups. Rates of spontaneous abortion (15.1% vs. 14%, P=.77) and premature birth (11.1% vs. 6.8%, P=.44) were comparable between groups, while the rate of fetal distress (3.4% vs. 0.7%, P<.01) was increased in the ADPKD group. The rate of preeclampsia in the patients with simple cysts (2%) was similar to that of the general population. In contrast, the pregnant ADPKD patients had higher risks for hypertension, proteinuria, edema, urinary tract infection, renal dysfunction, and preeclampsia during their pregnancies. Conclusion ADPKD is associated with increased maternal complications during pregnancy, but only has a slight potential of increased rates of fetal complications.

Clinical question:What is the best management approach for gynecomastia?Results:In most patients, surgical correction usually leads to immediate cosmetic and symptomatic improvement and is considered the best approach. In men who are being treated with antiandrogen therapies, pharmacological intervention with tamoxifen is the most effective approach, followed by radiotherapy.Implementation:Pitfalls to avoid when treating gynecomastia Failure to detect the very rare male breast cancerOverly aggressive early intervention or evaluationAppropriate medical interventionWhen to refer to specialist treatment

Objective To elucidate whether cardiorespiratory fitness (CRF) is protective or contributory to coronary artery disease plaque burden. Patients and Methods Study participants were working middle-aged men from the Mayo Clinic Executive Health Program who underwent coronary artery calcium (CAC) assessment and exercise treadmill testing for risk stratification. Data from January 1, 1995, through December 31, 2008, were considered. The CAC assessment score was used for lifelong plaque burden analysis; functional aerobic capacity (FAC) from treadmill testing was analyzed as 4 ranked categories of CRF. Known risk factors for cardiovascular disease, including family history, were also considered. Results In 2946 male patients in this retrospective, cross-sectional, observational study, known cardiovascular risk factor profiles and risk calculations tended to uniformly improve with increasing CRF, defined by the FAC level. Only the above-average group, or the third of 4 levels, was found consistently lower than other levels of FAC for CAC scores. The above-average group also had statistical significance after controlling for age, body mass index, and family history of coronary artery disease in a U-shaped distribution rather than the expected linear dose-response relationship. Plaque burden was significantly increased in patients with the highest FAC level ( P =.005) compared with the above-average group despite the observed maximal risk factor optimization in all known conventional cardiovascular risk factors. Conclusion For men, maximal CRF is associated with increased atherosclerosis, established with CAC scores. By comparison, average-to-moderate CRF appears to be cardioprotective regardless of either age or the influence of other contributing, recognized cardiac risk factors.

Adherence to recommended preventive services and immunizations in adults is suboptimal and often associated with socioeconomic status, race, and access to care. The aim of this study is to evaluate adherence in a cohort without these barriers to ascertain realistically optimal adherence rates and to examine remaining barriers among relatively advantaged individuals. Specifically, it employed a sample of 6889 patients presenting for executive health care from 2005 to 2009. Adherence varied across colorectal cancer screening (79%), mammography (89%), cervical cancer screening (91%), tetanus immunization (82%), and pneumococcal vaccination (62%). Multivariate logistic regressions revealed that age, education, alcohol use concerns, and being married were positively associated with adherence to certain services. Individuals without the usual barriers to care have variable, less-than-ideal rates of adherence to preventive services, which correlate with some health behaviors and demographics. Understanding the predictors of adherence may inform quality improvement processes aimed at optimizing disease prevention.

BackgroundThe benefits of a periodic health evaluation remain debatable. The incremental value added by such evaluations beyond the delivery of age appropriate screening and preventive medicine recommendations is unclear.MethodsWe retrospectively collected data on a cohort of consecutive patients presenting for their first episode of a comprehensive periodic health evaluation. We abstracted data on new diagnoses that were identified during this single episode of care and that were not trivial (i.e., required additional testing or intervention).ResultsThe cohort consisted of 491 patients. The rate of new diagnoses per this single episode of care was 0.9 diagnoses per patient. The majority of these diagnoses was not prompted by patients’ complaints (71%) and would not have been identified by screening guidelines (51%). Men (odds ratio 2.67; 95% CI, 1.76, 4.03) and those with multiple complaints at presentation (odds ratio 1.12; 95% CI, 1.05, 1.19) were more likely to receive a clinically relevant diagnosis at the conclusion of the visit. Age was not a predictor of receiving a diagnosis in this cohort.ConclusionThe first episode of a comprehensive periodic health evaluation may reveal numerous important diagnoses or risk factors that are not always identified through routine screening.

Stress and its attendant psychosocial and lifestyle variables have been associated with coronary artery disease (CAD), yet the contribution of socioeconomic status (SES) has not been addressed. The aim of this study is to determine if stress assessment is associated with CAD independent of SES, and is incremental to the Framingham Score. The study group consisted of 325 executive patients undergoing comprehensive health assessment. Stress was assessed utilizing the validated "Self-Rated Stress" (SRS) instrument. Coronary artery calcification (CAC) served to assess the degree of atherosclerosis, a CAD equivalent and risk assessment tool. The relationship between SRS and CAC was assessed, with adjustment by potential confounders. CAC was modeled by a variety of cut points (>0, ≥5, ≥100, ≥200) for the test of trend across stress levels per Mantel-Haenszel chi-square (1 df) with nonsignificant P values of 0.9960, 0.5242, 0.1692, 0.3233, respectively. A logistic regression model with SRS as a categorically ranked and continuous variable to predict binary outcome of calcification yielded P values of 0.2366 and 0.9644; this relationship, further adjusted by age, fruit and vegetable consumption, exercise, and education, yielded no statistically significant association. No improvement of fit was observed for the established Framingham Score to CAC relation utilizing SRS. The study concluded that SRS did not play a role in early CAD when focusing on a population in higher socioeconomic strata, and SRS did not add predictive value beyond patient age or calculated Framingham risk. Future studies should focus on additional validated instruments of stress to differentiate between subtypes of stress for varying SES strata.

Accurate prediction allows us to plan. This prediction capability has been made possible through the understanding of epidemiological principles of causation, while relying on statistical tools, or models, using an unbiased sample from a representative population in order to make an accurate claim. In the research work of Grau et al, an attempt had been undertaken to validate a prediction tool to estimate the disease burden, or risk, of coronary heart disease (CHD) should certain and known modifiable risk factors be altered given a public health initiative aimed at disease reduction.The risk factors identified include those that are non-modifiable (age, gender) and those that may be modified (smoking, hypertension, diabetes, blood pressure). These had been originally defined in the Framingham Heart Study with 10-year risk of CHD contingent on the role of each of these factors. Risk of disease had been determined via a multivariate regression analysis to derive this prediction tool. It had been an ambitious project, as Grau et al tried to identify common factors that impact CHD by following its development over a long period of time in a large group of study participants.Using this very same tool derived from a prospective cohort study, the authors attempt to devise a predictive risk algorithm using point prevalence of those risk factors.As an example, in table 3, scenario 2, the authors project that an improvement in the cardiovascular risk profile would decrease the number of CHD cases, the annual CHD incidence rates and the percentage of individuals at high risk. For example, the number of projected cases of CHD in men is predicted to fall from 627 197 to 581 591, a decrease of 45 606, should the lowest risk reduction target observed in the component studies of the DARIOS study be implemented nationwide by the year 2022. We believe this may be overly optimistic since it appears that the authors may not account for the possibility that an improvement in the risk profile does not mitigate the cumulative, prior years of exposure. Any intervention made at a community level, as informed by public policy, will certainly decrease the burden of major adverse events, but its ultimate impact will directly map to the duration of past exposure and duration of its future maintenance. Its effect will likely be most meaningful in the distant future rather than in the shorter term. The population of children born today into a community that has enacted these healthy changes would be the first to fully benefit from these changes in the modifiable risk factors known to cause CHD.Grau et al proceed to validate the application of the CASSANDRA risk model by comparing estimates of overall event rates projected from the model with the actual observed rates in the REGICOR population in two different time periods. Aside from the modest but statistically significant differences in these overall rate projections with the observed rates as evidenced by the CIs for the rate ratios that excluded 1.0, the more important issue is that they h...