Background: Mounting evidence indicates that hypertension leads to higher risk of cognitive decline and dementia. Hypertension is a highly heritable trait and a higher polygenic susceptibility to hypertension (PSH) is known to be associated with higher risk of dementia. We tested the hypothesis that a higher PSH leads to worse cognitive performance in middle-aged persons without dementia. Methods: We conducted a nested, cross-sectional, genetic study within the UK Biobank, a large population study that enrolled middle-aged Britons. Study participants with a history of dementia or stroke were excluded. We categorized participants as having low (<=20th percentile), intermediate (>20th and <80th percentile), or high (>=80th percentile) PSH according to results of 2 polygenic risk scores for systolic and diastolic blood pressure (BP), generated with genomic data on 732 genetic risk variants for these traits. Cognitive performance was evaluated via 5 simple tests: Pairs Memory, Reaction Time, Numeric Memory, Prospective Memory and Fluid Intelligence. A general cognitive ability score was calculated as the first principal component of a principal component analysis that included the results of these 5 tests. Primary analyses focused on Europeans and secondary analyses included all race/ethnic groups. Results: Out of 409,551 study participants of European ancestry with available genomic data, 42,080 (10.3%) completed all 5 tests. Multivariable regression models using systolic BP-related genetic variants indicated that, compared to study participants with low PSH, those with intermediate and high PSH had reductions of 3.9% (beta -0.039, SE 0.012) and 6.6% (beta -0.066, SE 0.014), respectively, in their general cognitive ability score (test for trend p <0.001). Secondary analyses including all race/ethnic groups (n=48,118) and using diastolic BP-related genetic variants yielded similar results (both instances, p<0.05). Analyses evaluating each cognitive test separately indicated that Reaction Time, Numeric Memory and Fluid Intelligence drove the association of PSH with the general cognitive ability score (all individual tests, p<0.05). Conclusions: Among non-demented, community-dwelling, middle-aged Britons, a higher PSH is associated with worse cognitive performance. These findings suggest the genetic predisposition to hypertension influence brain health in persons who have not yet developed dementia.

Background: While Community Needs Assessments (CNAs) are an important tool for Student-Run Clinics (SRCs) to understand local communities healthcare needs, few studies have evaluated CNAs and their impact on care provided at SRCs. Objective: Evaluate results from two CNAs of an SRC in East Parkside, Philadelphia to better comprehend (1) community awareness and opinions regarding the SRC and (2) local healthcare concerns and access. Methods: 58 and 105 East Parkside residents were surveyed in 2011 and 2015 respectively. The results were analyzed to quantify various health-related measures in the community. Results: Results showed high rates of hypertension, asthma, and diabetes. Rates of pap-smear and hypertension screening matched national averages while mammograms and colonoscopies were below national rates. Both CNAs showed that less than 40% of community members were aware of the clinic's existence. Conclusions: CNAs can provide valuable insights regarding local health needs which can inform future healthcare interventions.

Background: Free clinics, such as student-run clinics (SRCs), aim to improve healthcare for underserved populations. These populations, which include homeless individuals, low-income citizens, immigrants, and other marginalized groups, have different needs that can also vary by location. It is thus important that SRCs strive to know their patient populations. Needs assessments (NAs) are a tool to achieve this goal. To further develop NAs by SRCs, we sought to synthesize the state of published NAs by free clinics. This manuscript is meant to encourage these clinics to perform more NAs.Methods: We conducted a systematic review of manuscripts containing the concepts “student clinic” and “needs assessment”. We searched PubMed, Embase, Scopus, Web of Science, and Google Scholar. Manuscripts were included in the review if they 1) were peer-reviewed, 2) described a free-of-charge clinic, 3) performed a NA, and 4) the NA investigated needs or concerns of patients and/or the community. NAs were defined as an approach to gather information about a patient population with the goal of improving their healthcare. Results: The initial search yielded 94 manuscripts; 18 manuscripts met inclusion criteria and were retained for full examination. The NAs showed a plethora of different purposes, methodologies, and useful results. From the analysis, we also present suggestions for future NAs.Conclusions: The existing peer-reviewed and published NAs by student-run clinics show the immense utility and potential of this tool. There is ample opportunity to publish and expand more NAs.