The sustainability of exercise following colorectal surgery: A qualitative study of participants in the PREPARE-ABC trial

OBJECTIVE

This study aimed to explore perceptions regarding the sustainability of exercise following participation in a pre- and post-colorectal surgery exercise intervention trial (PREPARE-ABC).

DESIGN

Qualitative interview study. Data were analysed using framework analysis and independently coded by two researchers.

SETTING

Six United Kingdom National Health Service Trusts.

PARTICIPANTS

Eighteen interviews (hospital-based exercise n = 9, home-based exercise n = 3, standard care n = 6) were conducted with patients 12-15 months after being randomised in the trial, after their 12 month appointment.

INTERVENTION

Individuals who participated in one of two exercise intervention groups (hospital-supervised or home-supported exercise) or a standard care control group of the PREPARE-ABC trial were invited to interview.

RESULTS

The exercise interventions were reported to influence participants' recovery and future sustainability of exercise behaviour change. Several participants continued to engage in exercise over a year after their surgery. Reasons for this included being engaged with exercise prior to diagnosis, psychological benefits of exercise and wanting to be engaged with something to help recovery. Perceptions about the sustainability of active lifestyles were influenced by confidence to engage in structured exercise or physical activity and beliefs about its potential to promote future wellness.

CONCLUSIONS

Sustainability varies among individuals and early assessment of physical activity engagement could be beneficial. Physical activity interventions immediately following surgery may be important for future engagement.

Helping Others Facilitates Well-Being for Indigenous Peoples Living With HIV/AIDS in Canada

Research has found that helping others facilitates well-being for Indigenous peoples living with HIV and AIDS, but limited research exists that investigates the mechanism(s) underlying this relationship. Indigenous perspectives posit that helping others facilitates well-being through the development of an individual's spiritual, physical, emotional, and mental aspects (four aspects). Similarly, self-determination theory posits that helping others facilitates well-being by satisfying basic psychological needs. In the present study, we examined if helping others facilitates well-being through the fulfillment of the spiritual, physical, emotional, and mental aspects among Indigenous peoples living with HIV and AIDS. We used a convergent parallel mixed methods design, coupled with a community-engaged approach grounded in the United Nations Greater Involvement of People Living with HIV and AIDS principles and Indigenous and decolonizing research methodologies. Survey (n = 117) and interview data (n = 9) collected by an Indigenous-led HIV/AIDS organization in Canada were employed to examine the relationship between helping, the four aspects, and well-being. Participants were primarily First Nations leaders and mentors who live with HIV/AIDS, with some Métis and Inuit. A parallel multiple mediation model and reflexive thematic analysis were used to analyze the relationship between helping, the four aspects, and well-being. Mixed-methods findings support the idea that helping others promotes well-being by fulfilling the emotional and mental aspects. Qualitative findings demonstrated this relationship for all four aspects. This research may facilitate the development of programs to support Indigenous peoples living with HIV/AIDS well-being and contribute to the literature on integrating Indigenous perspectives and methodologies within psychological research.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

A198 THE LONG-TERM IMPACT OF ENVIRONMENTAL EXPOSURES ON HOST HEALTH AND THE RISK FACTORS OF CROHN'S DISEASE

Background

Several environmental factors are associated with Crohn’s disease (CD) in large case-control studies; however, it is not clear how these factors maybe be influenced by age of exposure and if they are related to alterations in pre-disease biological markers of CD risk.

Purpose

To investigate the association between environmental factors in different age groups with future risk of CD onset and assess their relation to other pre-disease biomarkers.

Method

We used an environmental risk assessment questionnaire (ERA) to collect information from healthy first-degree relatives(FDR) of CD enrolled in the CCC-GEM project. ERA was a multi-item questionnaire querying 69 questions under 7 section headings: background, cultural/ethnic, smoking history, medical history, family history, environmental history and pet history. For the environmental and pet sections, current and historical (<1, 2-4, 5-15 years old) data was captured at the time of recruitment. We used Cox proportional hazard models to identify exposures associated with future CD onset. Next, we used regression models to identify the relationship of exposures with biological factors associated with CD risk previously identified by our group i.e.: i) intestinal permeability using urinary fractional excretion of lactulose to mannitol ratio (LMR) with LMR≥0.025 defined as abnormal; ii) subclinical inflammation using fecal calprotectin (FCP) with FCP≥100µg/g; and iii) fecal microbiome composition and diversity using 16S rDNA sequencing. Two-sided p<0.05 (or false discovery rate corrected p<0.05) were considered significant.

Result(s)

A total of 4289 FDRs were recruited, 47% were male, median recruitment age was 17.0 years[6-35]. After a median follow-up of 5.6-years (IQR=3.42-8.67), 86 FDRs developed CD. Living with a dog between age 5-15 (Hazard Ratio (HR)=0.61; 95% confidence interval (CI)=0.39-0.95), and a large family size (>3) in the first year of life (HR=0.41; 95% CI=0.22-0.89) were protective against CD onset. Conversely, having a bird at time of survey (HR=2.84; CI=1.37-5.90), and having a sibling with CD (HR=2.07; 95% CI=1.18-3.63) were risk factors for CD onset. We found that owning a dog between age of 5-15 (Odd Ratio(OR)=0.77, 95% CI=0.65-0.90) was significantly associated with LMR, nine taxa bacterial and higher chao1 diversity index. Having a bird at time of survey was significantly associated with FCP (OR=2.04, 95% CI=1.33-3.11). There was no association between large family size and having a CD sibling with gut microbiome, FCP or LMR.

Conclusion(s)

The study identified four environmental factors associated with future development of CD. Among them, exposure to dogs during early life was protective against CD onset and might be explained by its association with normal gut permeability and microbiome. We also identified that having a bird at recruitment increased risk of CD onset which might be mediated by an increase in subclinical inflammation.

Submitted on behalf of the CCC-GEM consortium

Disclosure of Interest

None Declared

A39 HEALTHY FIRST-DEGREE RELATIVES FROM MULTIPLEX FAMILIES VERSUS SIMPLEX HARBOR A HIGHER RISK OF DEVELOPING CROHN'S DISEASE AND ARE ASSOCIATED WITH SUBCLINICAL INFLAMMATION AND ALTERED MICROBIOME COMPOSITION

Background

Healthy individuals within families with multiple affected members (multiplex families) with Crohn’s disease (CD) have a notably high risk of developing CD. No large prospective pre-disease cohort has assessed differences in preclinical intestinal inflammation, permeability, fecal microbiome, and genetics in healthy at-risk subjects from multiplex families.

Purpose

We aimed to assess differences in subclinical gut inflammation, genetic risk, gut barrier function, and fecal microbiota composition between first-degree relatives (FDRs) from families with 2 or more affected members (multiplex) and families with only one affected member (simplex). Also, we aimed to assess the risk of future CD onset in subjects from multiplex versus simplex families.

Method

We utilized the GEM Project cohort of healthy FDRs of CD patients. Subclinical gut inflammation was assessed using fecal calprotectin (FCP) at recruitment. Gut barrier function was assessed using the lactulose-to-mannitol ratio (LMR). For assessment of the CD-related genetic risk, CD-polygenic risk scores (CD-PRS) were calculated. Microbiome composition was assessed by sequencing fecal 16S ribosomal RNA. Generalized estimating equations logistic regression and LEfSe (PMID: 21702898) were used to assess the associations between multiplex status and different outcomes. A Cox proportional hazards model was used to assess time-related risk of future onset of CD.

Result(s)

4385 subjects were included. Median age was 17 [IQR 12-24] years, 52.9% were female, 69.4% were siblings and 30.6% were offspring. 4052 (92.4%) and 333 (7.6 %) were simplex and multiplex subjects, respectively. After adjusting for age, sex, family size, and relation to proband, multiplex status was significantly associated with higher baseline FCP (p=0.038), but was not associated with either baseline LMR or CD-PRS (p=0.19 and p=0.33, respectively).

We found no significant differences in alpha diversity (Shannon index) (p=0.57) between simplex and multiplex subjects. Beta diversity analysis assessed by the Bray-Curtis dissimilarity index did not reveal significant differences (R2=3e-04, p=0.607). The genera Eisenbergiella, Eggerthellaceae uncultured, and Morganella, were significantly more abundant in multiplex subjects, whereas Lachnospira, Sutterella, Lachnospiraceae_NK4A136_group, and Lachnospiraceae_UCG_004 less abundant.

The risk of CD onset was significantly higher in multiplex subjects. In multivariable analysis, multiplex status at recruitment was associated with increased risk of CD onset (adjusted HR 3.41, 95% CI 1.70-6.87, p=0.00055), after adjusting for demographics, FCP, LMR, and CD-PRS.

Conclusion(s)

Multiplex status compared to simplex is associated with a 3.4-fold increased risk of CD onset, a higher FCP, and fecal bacterial composition. A comprehensive assessment of environmental factors that increase CD risk in multiplex families remains to be elucidated in future studies.

Disclosure of Interest

None Declared

Future Exploration of the Outer Heliosphere and Very Local Interstellar Medium by Interstellar Probe

A detailed overview of the knowledge gaps in our understanding of the heliospheric interaction with the largely unexplored Very Local Interstellar Medium (VLISM) are provided along with predictions of with the scientific discoveries that await. The new measurements required to make progress in this expanding frontier of space physics are discussed and include in-situ plasma and pick-up ion measurements throughout the heliosheath, direct sampling of the VLISM properties such as elemental and isotopic composition, densities, flows, and temperatures of neutral gas, dust and plasma, and remote energetic neutral atom (ENA) and Lyman-alpha (LYA) imaging from vantage points that can uniquely discern the heliospheric shape and bring new information on the interaction with interstellar hydrogen. The implementation of a pragmatic Interstellar Probe mission with a nominal design life to reach 375 Astronomical Units (au) with likely operation out to 550 au are reported as a result of a 4-year NASA funded mission study.

Sexuality in ADHD: empirical data concerning hypersexual and paraphilic fantasies and behaviors in adults with ADHD

Introduction

ADHD is a neurodevelopmental disorder displaying inattention, hyperactivity, and impulsivity as core symptoms. It can affect several areas of life including sexual health. Clinicians have often made assumptions concerning the bound of specific ADHD symptoms affecting sexual desire by increasing its frequency and intensity. Yet, there is still a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. A recent literature review could show that some individuals who suffer from ADHD report about hypersexual and paraphilic fantasies and behaviors, but as far as we know, no clear empirical data has emerged supporting the idea that hypersexuality and paraphilias are more frequent in individuals with ADHD.

Objectives

The present investigation aimed to compare several sexuality related aspects between individuals with and without ADHD.

Methods

Therefore, we designed an extensive online survey based on established questionnaires, such as the Hypersexual Behavior Inventory (HBI). The survey was implemented in a outpatient sample, ADHD specific fora as well as other general online channels.

Results

In total, N = 238 individuals participated in the survey (n = 160 with ADHD). Thereby, individuals with ADHD reported significantly more often about a wide range of hypersexual fantasies and behaviors in comparison to individuals without ADHD. Furthermore, individuals with ADHD reported significantly more often about paraphilic fantasies and behaviors including fetishistic and sadistic sexual fantasies. No differences were found concerning other paraphilias. Further results regarding other facets of sexuality, such as sexual orientation, are to be presented and discussed.

Conclusions

The present study contributes to closing the knowledge gap regarding sexuality in individuals with an ADHD.

Disclosure

No significant relationships.

A176 UTILITY OF MACHINE LEARNING FOR SERUM METABOLOMIC DATA ANALYSIS IN PEDIATRIC CROHN DISEASE

Background

The pathogenesis of pCD remains poorly understood, but evidence suggests roles for genetics, environment, immune response, and gut microbes. Microbial changes can contribute to chronic inflammation and correlate with disease severity. Metabolomics reflects interactions between host immune and gut microbial function by quantifying compounds in biological samples. Therefore, metabolomics provides a unique opportunity to gain insight into pCD pathogenesis.

Aims

To correlate disease severity, metabolites, and clinical data by applying machine learning algorithms in pediatric Crohn Disease (pCD).

Methods

ImageKids is a multicenter, prospective, cohort observational study, conducted to develop magnetic resonance enterography (MRE) indices for pCD. Paired serum specimens were collected at study initiation (Visit One; V1) and completion (Visit Four; V4; 18 months) for 120 pCD patients. Serum from patients with representative clinical scenarios and paired samples was analyzed at The Metabolomics Innovation Centre (TMIC; University of Alberta) and 131 metabolites were identified. Metabolites were analyzed via Unsupervised (U.ML) and Supervised (S.ML) Machine Learning algorithms based on Scikit-learn library in Python. Principal Component Analysis (PCA) was used to identify the variation pattern of the patients’ metabolome. Classifiers and regression algorithms were trained to assess correlation with disease activity.

Results

Results were available for the 56 paired samples. U.ML demonstrated distinct metabolome profiles with V1 clustering mainly attributed to aspartic acid, glutamic acid, and kynurenine. V4 clustering was mainly attributed to spermidine, spermine, total dimethylarginine. Furthermore, demographics was found as an important environmental factor driving distinct patterns of the metabolomics profile.

After training different classifiers and regressors with S. ML algorithms, metabolome data were correlated with disease severity (defined by C-reactive protein and fecal calprotectin). Isoleucine, p-hydroxyhippuric acid, and putrescine were the top three compounds associated with disease severity. The accuracy of our classification models was of 80% and the coefficient of determination of our regression models was 0.5

Conclusions

Metabolomic analysis can provide insight into disease pathogenesis and help predict disease severity among pCD patients. The correlation between metabolomics and disease severity might allow a better understanding of changes in host-microbe interactions and introduce new diagnostic or therapeutic options.

Funding Agencies

CIHR

A238 ALTERED GUT MICROBIOME COMPOSITION AND FUNCTION ARE ASSOCIATED WITH GUT BARRIER DYSFUNCTION IN HEALTHY RELATIVES OF CROHN’S DISEASE PATIENTS

Background

The gut microbiome may play a role in gut barrier homeostasis including epithelial barrier function, but data are scarce and limited to animal studies

Aims

To assess if alterations in gut microbiome are associated with gut barrier function

Methods

We utilized the Genetic Environmental Microbial (CCC GEM) cohort of healthy first-degree relatives (FDRs) of Crohn’s disease (CD) patients. Gut barrier function was assessed using the ratio of urinary fractional excretion of lactulose to mannitol (LMR). Stool bacterial DNA was extracted and sequenced for the V4 hypervariable region of the 16S rRNA gene using MiSeq and processed using QIIME2. Microbial functions were imputed using PICRUSt2. The cohort was divided into a North American discovery cohort (n=2,472) and non-North American external validation cohort (n=655). LMR>0.025 was defined as abnormal. LMR-microbiome associations were assessed using multivariable regression model and Random Forest (RF) classifier algorithm. q<0.05 was considered significant when multiple tests were performed

Results

The median age of the entire cohort was 17.0 years [IQR 12.0; 24.0], 52.6% were females and 25.4% had LMR>0.025. In the discovery cohort, subjects with LMR>0.025 had markedly reduced alpha diversity (Chao1 index, estimate= -0.0037, p=4.0e-04) and altered beta diversity (Bray-Curtis dissimilarity index, PERMANOVA: pseudo-F statistic = 2.99, p=1.0e-03). We identified eight bacterial genera and 52 microbial pathways associated with LMR>0.025 (q<0.05). Four genera (decreased Adlercreutzia [odds ratio(OR)=0.74, 95% confidence interval (CI) 0.6–0.91], Clostridia-UCG-014 [OR=0.71, 95%CI 0.59–0.86], and Clostridium-sensu-stricto-1 [OR=0.75, 95%CI 0.61–0.92] and increased Colidextribacter [OR=1.65, 95%CI 1.2–2.26]) and eight pathways (including decreased biosynthesis of glutamate [OR=0.4, 95%CI 0.21–0.74], tryptophan [OR=0.06, 95%CI 0.01–0.27] and threonine [OR=0.038, 95%CI 0.003–0.41]) were replicated. Bacterial community composition was associated with gut barrier homeostasis as defined by the RF analysis (p= 1.4e-6)

Conclusions

Gut microbiome community and pathways are associated with gut barrier function. These findings may identify potential microbial targets to modulate barrier function

Submitted on behalf of the CCC-GEM Consortium

Funding Agencies

CCC, CIHRCrohn’s and Colitis Canada Genetics Environment Microbial (CCC-GEM) III; The Leona M. and Harry B. Helmsley Charitable Trust; Kenneth Croitoru is the recipient of the Canada Research Chair in Inflammatory Bowel Diseases

A42 HETEROGENEITY IN EFFICACY AND SAFETY ENDPOINTS FOR PEDIATRIC CLINICAL TRIALS IN INFLAMMATORY BOWEL DISEASE: A NEED FOR HARMONIZATION

NOT PUBLISHED AT AUTHOR’S REQUEST

Funding Agencies: None

A236 ASSOCIATION OF STOOL METABOLOMIC PROFILE AND MICROBIOME COMPOSITION RISK SCORE WITH FUTURE ONSET OF CROHN’S DISEASE

Background

Microbial composition-based risk score (MRS) was recently developed and validated to predict future risk of developing Crohn’s disease (CD) among healthy first-degree relatives (FDR) of CD patients. We hypothesized that stool metabolomic profiles, some of which are linked to the gut microbiome, are associated with future risk of CD.

Aims

To assess the association of stool metabolomic profile with onset of CD and to determine the correlation between stool metabolites and the MRS

Methods

Healthy FDR of CD patients were recruited as part of the nested case-control cohort of the CCC-GEM Project. Healthy FDRs who later developed CD (n=56) were matched approximately 1:1 by age, sex, follow-up duration, and geographical location with control FDRs remaining healthy (n=66). Stool metabolomics were assessed using the Metabolon’s DiscoveryHD4™ platform, and the stool microbiome characterised by 16s rDNA amplicon sequencing. We fitted a multivariable conditional logistic regression model on the disease status as a function of individual stool metabolites. We additionally performed Spearman correlation between each stool metabolite and the MRS.

Results

Among 1,029 stool metabolites that were analyzed, 79 were associated with future risk of CD (p&lt;0.05); however, none remained significant after multiple testing correction (FDR correction). Considering the exploratory nature of this study with limited sample size, we focused on the top seven metabolites associated with CD onset (p&lt;0.01). Of these, two stool metabolites (dimethylglycine, methylmyristate) were associated with increased risk of CD onset while five (cytosine, guanine, cytidine, hydroxyglutarate, nervonate) were associated with decreased risk of developing CD. The two metabolites positively associated with CD onset were positively correlated with the MRS, while the five metabolites negatively associated with CD onset, were negatively correlated with the MRS. Meanwhile, 24 stool metabolites had significant correlation with MRS (FDR-corrected p&lt;0.2). Among those, a total of four stool metabolites (cytosine, guanine, methymyristate, cytidine) overlapped with the top seven stool metabolites associated with CD onset.

Conclusions

Stool metabolite profiles may predict future risk of CD. A subset of these metabolites have significant correlation with the MRS with consistent direction of effect. This may suggest that stool metabolites mediate the putative effect of the gut microbiome on CD risk. Further validation in the full GEM cohort is warranted.

Funding Agencies

CCC, CIHRThe Leona M. and Harry B. Helmsley Charitable Trust; Kenneth Croitoru is the recipient of the Canada Research Chair in Inflammatory Bowel Diseases; Sun-Ho Lee is a recipient of the Imagine/ CIHR/CAG Fellowship Award; Sun-Ho Lee, Juan Antonio Raygoza Garay, and Williams Turpin are recipients of fellowship awards from the Department of Medicine, Mount Sinai Hospital, Toronto, Canada.

Mitral annular dysjunction in surgical mitral valve prolapse

Funding Acknowledgements

Type of funding sources: None.

Introduction

Mitral valve prolapse (MVP) affects 3% of the population and is the leading indication for mitral valve surgery.[1] Mitral annular disjunction (MAD) is a structural abnormality commonly seen in patients with MVP.[2] MAD is defined as an abnormal separation (&gt;5mm) between the left atrial wall-mitral valve junction and the left ventricle myocardium,[2] associated with hypermobility and myxomatous degeneration of the mitral valve leaflets.[3]  There is a paucity of literature regarding MAD, however evidence is growing that it may be associated with ventricular arrhythmia and sudden cardiac death.[3] We examined the prevalence, imaging characteristics and clinical associations of MAD among patients who have undergone mitral valve surgery for MVP.

Methods

Single centre cohort study of consecutive patients undergoing mitral valve surgery for MVP over a 3-year period. Patient baseline characteristics, echocardiographic parameters, surgical outcomes, frequency of arrhythmic events and 3-year cardiac and all-cause mortality were recorded.  Single site data was obtained from a prospective Australia-wide cardiac surgery registry, as well as retrospective analysis of holter-monitor reports, device interrogation and review of medical records. Transthoracic echocardiogram images were re-examined, and parameters re-measured by a qualified examiner.

Results

Among 73 patients with surgical MVP, 20 patients had MAD (27.4%). The median MAD length was 8.1 (IQR 6.8-11.8) mm. The most severely affected patient had a disjunction length of 28 mm. MAD was associated with younger age at surgery (60 vs 66, P = 0.005), female sex (40.0% vs 22.6%, P = 0.138), bileaflet MVP (50% vs 10.6%, P = 0.004) and less cardiovascular comorbidities, including hypertension (25.0% vs 57.7%, P = 0.013) and hypercholesterolaemia (30.0% vs 61.5%, P = 0.016). Patients with MAD had greater mitral valve leaflet lengths, mitral annular diameters, and high-velocity systolic signal on tissue doppler of the mitral valve annulus (pickelhaube sign). Three patients in the MAD positive group had an arrhythmic event (VF or VT) at 3 years compared to one in the MAD negative group. There was no significant difference in 3-year cardiac or all-cause mortality between groups.

Conclusion

MAD is a common anatomical abnormality in patients with surgical MVP, and is easily detected on transthoracic echocardiography. It is associated with younger age at surgery, female sex, bileaflet MVP, increased leaflet length and annulus diameter. There was a signal towards increased arrhythmic events in patients with MAD despite younger age and less cardiovascular risk factors. Large longitudinal studies are needed to further assess the association of MAD with arrhythmic events to help guild appropriate investigation and risk stratification of these patients. Abstract Figure. MAD on Parasternal Long axis view  Abstract Figure. Pickelhaube sign

Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report

BACKGROUND

Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice.

OBJECTIVES

The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research.

METHODS

An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland.

RESULTS/CONCLUSIONS

We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

POS1206 SEROPREVALENCE OF SARS-CoV-2 ANTIBODIES IN AUTOIMMUNE INFLAMMATORY RHEUMATOLOGIC PATIENTS

Background:

Immune responses in AIIRD patients may be reduced and influenced by immunosuppressive treatments[1].The effect of immunosuppression on the mounting of SARS-CoV-2 antibodies in AIIRD is not clear.

Objectives:

To assess the prevalence of SARS-CoV-2 antibodies in AIIRD patients and to define clinical factors affecting this prevalence.

Methods:

Consecutive consenting AIIRD patients from the Rheumatologic department in Tel Aviv Medical Center participated in the study.

Patients answered a questionnaire and were tested for SARS-CoV-2 antibodies. A two stage antibody testing was done in order to increase specificity.

Results:

The study included 560 AIIRD patients (229 RA, 149 PsA, 84 SLE, 55 vasculitidies, 40 SpA, 3 other CTD), of them 26 patients were found to have SARS-CoV-2 IgG antibodies (4.6%) (Table 1). This was more than double than a previous prevalence in the same clinic population studied after the first wave of the pandemic in Israel, which was 2.07% (accepted for publication).

A lower rate of immunosuppression was found for positive SARS-CoV-2 IgG patients compared to negative serology patients (Table 1, p=0.009). There was also a trend for the subgroup of patients on biologic DMARDS (26.92% vs. 47% respectively, p=0.06).

Positive SARS-CoV-2 PCR test was reported and confirmed in 36 patients, of them 14 (38.89%) had negative serology. Patients who did not have antibodies had numerically more than double rates of glucocorticoids and bDMARDs treatment. The time between positive PCR test to positive serology test was significantly shorter (mean±standart deviation 75.57±40.44 days) than the time between positive PCR to negative serology test (130.79±86.47 (p=0.04) (Table 1 and Figure 1) suggesting a fading of the antibody response with time.

Conclusion:

The prevalence of SARS-CoV-2 IgG was 4.6% in a population of AIIRD patients from a single tertiary medical center in Israel. SARS-CoV-2 seroprevalence tended to be low among AIIRD patients on immunosuppressive treatment, including in patients with a confirmed history of positive SARS-CoV-2 PCR, similar to other studies [3].

As in individuals without AIIRD, the mounting of SARS-CoV-2 IgG seems to fade with time.

Larger studies are needed to confirm the potential effect of immunosuppression on the antibody response in AIIRDs.

Table 1.

Demographic and clinical characteristics of patients with negative and positive SARS-CoV-2 IgG, and in the subgroup with positive SARS-CoV-2 PCR test

Total population (n=560)Positive PCR population (n=36)Negative IgG(n=534)Positive IgG(n=26)PNegative IgG(n=14)Positive IgG(n=22)PFemale n (%)360 (67.42)22 (84.62)0.0810 (71.43)18 (81.82)0.68Age median (95% CI)57 (54.95-57.58)52.5 (46.55-58.6)0.2342 (35.46-53.11)52.5 (47.62-60.65)0.06No. of comorbiditiesmean±STD (95%CI)0.88±1.15 (0.78-0.98)0.92±1.2 (0.44-1.41)0.860.79±1.12 (0.14-1.43)0.96±1.3 (0.4-1.51)0.68AIIRD treatments n(%)Total immunosuppression401 (75.09)13 (50)0.00911 (78.57)12 (54.54)0.175GC113 (21.16)3 (11.54)0.325 (35.71)3 (13.64)0.32csDMARDS257 (48.13)13 (50)17 (50)13 (59.09)0.73bDMARDS251 (47)7 (26.92)0.069 (64.29)7 (31.82)0.09Anti CD-2036 (6.74)00.41 (7.14)00.39

SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; IgG, immunoglobulin G; PCR, polymerase chain reaction; n, number; 95%CI, 95% confidence interval; GC, glucocorticoids; csDMARDS, conventional synthetic disease modifying antirheumatic drugs; bDMARDS, biologic disease modifying antirheumatic drugs.

References:

[1]V. Furer et al., “Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients wit,” RMD Open, vol. 5, no. 2, p. e001041, Sep. 2019.

[2]D. Simon et al., “Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion,” Nat. Commun., vol. 11, no. 1, pp. 1–7, 2020.

Acknowledgements:

This study was performed in collaboration with the Israeli Ministry of Health.

Disclosure of Interests:

None declared.

An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study

Background

This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions.

Methods

Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R.

Results

About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34).

Conclusions

There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.

Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study

Community-based screening and treatment of women aged 70-85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK.

INTRODUCTION

The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70-85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study.

METHODS

A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP.

RESULTS

Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm.

CONCLUSIONS

This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.