Obesity and adverse childhood experiences in relation to stress during the COVID-19 pandemic: an analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

People with obesity are at increased risk of chronic stress, and this may have been exacerbated during the COVID-19 pandemic. Adverse childhood experiences (ACE) are also associated with both obesity and stress, and may modify risk of stress among people with obesity. The objectives of this study were to evaluate the associations between obesity, ACEs, and stress during the pandemic, and to determine if the association between obesity and stress was modified by ACEs.

METHODS

A longitudinal study was conducted among adults aged 50-96 years (n = 23,972) from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study. Obesity and ACEs were collected pre-pandemic (2015-2018), and stress was measured at COVID-19 Exit Survey (Sept-Dec 2020). We used logistic, Poisson, and negative binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the associations between obesity, ACEs, and stress outcomes during the pandemic. Interaction by ACEs was evaluated on the additive and multiplicative scales.

RESULTS

People with obesity were more likely to experience an increase in overall stressors (class III obesity vs. healthy weight RR = 1.19; 95% CI: 1.12-1.27) as well as increased health related stressors (class III obesity vs. healthy weight RR: 1.25; 95% CI: 1.12-1.39) but did not perceive the consequences of the pandemic as negative. ACEs were also associated an increase in overall stressors (4-8 ACEs vs. none RR = 1.38; 95% CI: 1.33-1.44) and being more likely to perceive the pandemic as negative (4-8 ACEs vs. none RR = 1.32; 95% CI: 1.19-1.47). The association between obesity and stress was not modified by ACEs.

CONCLUSIONS

Increased stress during the first year of the COVID-19 pandemic was observed among people with obesity or ACEs. The long-term outcomes of stress during the pandemic need to be determined.

Emotion socialization parenting interventions targeting emotional competence in young children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children.

METHODS

Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months.

RESULTS

Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged.

CONCLUSIONS

Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.

Positive Parenting and Early Childhood Cognition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This review examines the effectiveness of positive parenting interventions aimed at improving sensitivity, responsiveness, and/or non-harsh discipline on children's early cognitive skills, in four meta-analyses addressing general mental abilities, language, executive functioning, and pre-academics. The objectives are to assess the magnitude of intervention effectiveness and identify moderators of effectiveness. We include randomized controlled trials of interventions targeting positive parenting to improve cognition in children < 6 years. Studies that include children with neurodevelopmental and/or hearing disorders were excluded. MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses (October 2021) and citation chaining identified relevant records. Five reviewers completed screening/assessments, extraction, and risk of bias. Pooled analysis in Comprehensive Meta-Analysis (Version 3) used random effects modeling, with moderation via Q-statistics and meta-regression. Positive parenting interventions led to significant improvements in mental abilities (g = 0.46, N = 5746; k = 33) and language (g = 0.25, N = 6428; k = 30). Effect sizes were smaller and nonsignificant for executive functioning (g = 0.07, N = 3628; k = 14) and pre-academics (g = 0.16, N = 2365; k = 7). Robust moderators emerged for language and cognition. For cognition, studies with higher risk of bias scores yielded larger intervention effects. For language, studies with younger children had larger effect sizes. Studies mitigated selection and detection bias, though greater transparency of reporting is needed. Interventions that promote parental sensitivity, responsiveness, and non-harsh discipline improve early mental abilities and language. Studies examining executive functioning and pre-academics are needed to examine moderators of intervention effectiveness. Trial registration Systematic review PROSPERO registration. CRD42020222143.

Phase II study of TAS-OX (TAS-102 and oxaliplatin) plus bevacizumab for late-line colorectal cancer

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Background: TAS-102 (trifluridine/tipiracil) is a novel oral antimetabolite for late line metastatic colorectal cancer (CRC) approved in 2018. Many patients are treated early in their course with oxaliplatin (OX), particularly adjuvant, and may benefit from re-treatment. In this trial we combine the typical late line use of TAS with OX (BEV [bevacizumab] added at investigator discretion) with goal of improved response. Methods: Eligibility included measurable CRC previously treated with all approved drugs per TAS package insert (irinotecan, oxaliplatin, 5FU, anti-VEGF, anti-EGF) as appropriate, PS = 0-1, labs within usual range, neuropathy < grade 2, ability to take oral meds, appropriate contraception. If no contraindication to BEV, this could be added at patient. TAS was dosed at 35 mg/m2 days 1-5 with OX 85/m2 d1 every 14 days (and BEV 5 mg/kg, if given). All supportive care was allowed including growth factors. Results: 47 patients (pts, median age 55) were enrolled in a Simon mini-max design, including 45% female, 21% black, 11% Asian, 11% Hispanic and 5% mixed. 26 pts received BEV. For the first 40 pts, 385 cycles were given (mean = 7 cycles, median 8) with 18 pts (45%) requiring dose reductions (1 dose reduction = 9 pts, 2 = 6, 3 = 3), and 9 receiving (peg)/filgrastim. Toxicities leading to SAEs included gr 3 heme (2), heart failure, abd pain/n/v (6), sepsis (2), urinary (4); and related gr 3 included one gr 3 vomiting and one gr 3 neutropenia. Independently reviewed RECIST Response (N = 32) included PR 2(6%), SD 23 (72%), PD 7 (22%). Mean TTP was 4.5 m (median 4, range 1 – 18) with 9 (28%) pts more than 6 months. Conclusions: In patients with late-line CRC and candidates for TAS (trifluridine/tipiracil), treatment with TAS plus OX is both well tolerated and active. RR is higher than single agent and 78% (95% CI, 60-91%) of patients had stable disease or response, with 60% receiving 8 or more cycles. Randomized trials comparing to single agent TAS are warranted in this setting. Clinical trial information: NCT04294264 .

Clinical significance of intermittent absent end-diastolic flow of the umbilical artery in fetal growth restriction

BACKGROUND

Fetal growth restriction can result from a variety of maternal, fetal, and placental conditions. Umbilical artery Doppler assesses the impedance to blood flow along the fetal component of the placental unit. An abnormal umbilical artery waveform reflects the presence of placental insufficiency and can help differentiate a growth-restricted fetus from the constitutionally small, thus guiding further management. The presence of persistently absent end-diastolic flow and reversed end-diastolic flow is an indication for inpatient antenatal surveillance and preterm delivery. There is no consensus on the optimal management of intermittent absent end-diastolic flow owing to a lack of data to support the ideal delivery timing for growth-restricted fetuses with this finding.

OBJECTIVE

This study aimed to estimate the risks of adverse perinatal outcomes among growth-restricted pregnancies with persistently elevated, intermittently absent, and persistently absent end-diastolic flow. Fetal growth restriction is a common condition that is associated with an increased risk of fetal morbidity and mortality. Intermittently absent umbilical artery end-diastolic flow may be identified among pregnancies with fetal growth restriction. The fetal risks associated with persistently absent end-diastolic flow have been described. However, the risks associated with intermittent absent end-diastolic flow are not as well-known.

STUDY DESIGN

We performed a retrospective cohort study including nonanomalous, singleton, growth-restricted pregnancies that received umbilical artery Doppler assessment at our institution from 2009 to 2020. Fetuses were classified into the following 3 categories: elevated umbilical artery Doppler, intermittent absent end-diastolic flow, and persistently absent end-diastolic flow. The Doppler categories were classified by the most severe in the pregnancy. The primary outcome was a composite of neonatal morbidity.

RESULTS

Total 233 fetuses met the criteria. Of which 78 (33.0%) had elevated umbilical artery Doppler waveforms, 37 (16.0%) had intermittent absent end-diastolic flow, and 119 (51.0%) had absent end-diastolic flow. The composite outcome was statistically different between the groups, occurring in 16.9% with elevated umbilical artery Doppler waveforms (13/77), 35.1% (12/39) with intermittent absent end-diastolic flow, and 56.3% (65/127) with absent end-diastolic flow (P<.001). The odds ratio for the composite outcome was significantly increased in absent end-diastolic flow (odds ratio, 6.15; 95% confidence interval, 3.14-12.80) and was not significantly increased for intermittently absent end-diastolic flow (odds ratio, 2.46; 95% confidence interval, 0.98-6.19) when compared with elevated umbilical artery Doppler waveforms. When adjusted for gestational age at delivery and antenatal steroids, no difference was seen in the primary outcome for intermittent absent end-diastolic flow (adjusted odds ratio, 0.73; 95% confidence interval, 0.20-2.68) and absent end-diastolic flow (adjusted odds ratio, 1.44; 95% confidence interval, 0.51-4.07).

CONCLUSION

Among growth-restricted pregnancies, intermittent absent end-diastolic flow is associated with a similar rate of composite neonatal morbidity as persistently elevated Doppler waveforms. In addition, there is no difference in composite neonatal morbidity between the 3 groups when corrected for gestational age at delivery and antenatal steroid administration. These similar outcomes should be considered when creating an antenatal surveillance plan and discussing the potential for outpatient management.

The association between adverse childhood experiences and epigenetic age acceleration in the Canadian longitudinal study on aging (CLSA)

Research examining the association between exposure to a wide range of adverse childhood experiences (ACEs) and accelerated biological aging in older adults is limited. The purpose of this study was to examine the association of ACEs, both as a cumulative score and individual forms of adversity, with epigenetic age acceleration assessed using the DNA methylation (DNAm) GrimAge and DNAm PhenoAge epigenetic clocks in middle and older-aged adults. This cross-sectional study analyzed baseline and first follow-up data on 1445 participants aged 45-85 years from the Canadian Longitudinal Study on Aging (CLSA) who provided blood samples for DNAm analysis. ACEs were assessed using a validated self-reported questionnaire. Epigenetic age acceleration was estimated by regressing each epigenetic clock estimate on chronological age. Cumulative ACEs score was associated with higher DNAm GrimAge acceleration (β: 0.07; 95% CI: 0.02, 0.11) after adjusting for covariates. Childhood exposure to parental separation or divorce (β: 0.06; 95% CI: 0.00, 0.11) and emotional abuse (β: 0.06; 95% CI: 0.00, 0.12) were associated with higher DNAm GrimAge acceleration after adjusting for other adversities and covariates. There was no statistical association between ACEs and DNAm PhenoAge acceleration. Early life adversity may become biologically embedded and lead to premature biological aging, in relation to DNAm GrimAge, which estimates risk of mortality. Strategies that increase awareness of ACEs and promote healthy child development are needed to prevent ACEs.

Stressors and symptoms associated with a history of adverse childhood experiences among older adolescents and young adults during the COVID-19 pandemic in Manitoba, Canada

INTRODUCTION

The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic.

METHODS

Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression.

RESULTS

A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults.

CONCLUSION

Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group.

Associations between psychological distress and hair cortisol during pregnancy and the early postpartum: A meta-analysis

Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [- 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.

Income precarity and child and parent weight change during the COVID-19 pandemic: a cross-sectional analysis of the Ontario Parent Survey

OBJECTIVES

To describe child and parent weight change during the pandemic, overall and by income precarity.

DESIGN

A cross-sectional online survey was conducted.

SETTING

Caregivers of children 0-17 years of age living in Ontario, Canada, during the COVID-19 pandemic from May 2021 to July 2021.

PARTICIPANTS

A convenience sample of parents (n=9099) with children (n=9667) living in Ontario were identified through crowdsourcing.

PRIMARY OUTCOME MEASURE

Parents recalled, for themselves and their child, whether they lost weight, gained weight or remained the same over the past year. OR and 95% CI were estimated using multinomial logistic regression for the association between income precarity variables and weight loss or gain, adjusted for age, gender and ethnicity.

RESULTS

Overall, 5.5% of children lost weight and 20.2% gained weight. Among adolescents, 11.1% lost weight and 27.1% gained weight. For parents, 17.1% reported weight loss and 57.7% reported weight gain. Parent weight change was strongly associated with child weight change. Income precarity measures, including job loss by both parents (OR=7.81, 95% CI 5.16 to 11.83) and disruption to household food supply (OR=6.05, 95% CI 4.77 to 7.68), were strongly associated with child weight loss. Similarly, job loss by both parents (OR=2.03, 95% CI 1.37 to 3.03) and disruption to household food supply (OR=2.99, 95% CI 2.52 to 3.54) were associated with child weight gain.

CONCLUSIONS

Weight changes during the COVID-19 pandemic were widespread and income precarity was strongly associated with weight loss and weight gain in children and parents. Further research is needed to investigate the health outcomes related to weight change during the pandemic, especially for youth, and the impacts of income precarity.

Maternal sensitivity moderates the association between maternal history of childhood maltreatment and child executive function

BACKGROUND

Experiences of childhood maltreatment are associated with a variety of negative outcomes throughout individuals' lives as well as disadvantaged cognitive and socioemotional development among their offspring. The mechanisms through which some children show resilience against the intergenerational transmission of risk, however, are less well understood.

OBJECTIVE

The current study focuses on a proximal parental factor that plays a central role in children's early cognitive development - maternal sensitivity - and examines whether it moderates the association between maternal history of childhood maltreatment and child executive function (EF).

PARTICIPANTS AND SETTING

Data were collected from a community sample of 139 mothers and their infants (51 % female) recruited from urban areas in Ontario, Canada.

METHODS

Maternal maltreatment history was assessed via self-report at child age 3 months. Maternal sensitivity was assessed observationally at child age 8 months, and child executive function was assessed using performance-based measures at child age 3 years. Hypotheses were tested through multiple regression models.

RESULTS

In the current sample, maternal maltreatment history was not associated with child EF on average. However, results were consistent with a moderation model, indicating that maternal maltreatment history was associated with lower levels of child EF only when mothers were relatively insensitive.

CONCLUSIONS

The findings indicate the importance of considering sensitive parenting practices as a protective factor for children's cognitive development in the context of more distal risk factors such as mothers' history of childhood maltreatment.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.

Artificial intelligence-guided, single-lead EKG may be a game-changer for symptom-to-balloon time reduction in ST-elevated myocardial infarction

Background

Over decades, efforts to shave off life-saving minutes from ST-Elevated Myocardial Infarction (STEMI) care centred on reducing door-to-needle and door-to-balloon times. We firmly believe that symptom-to-balloon time should prove a better focus to this end. Challenges come with this goal as it heavily relies on a patient's perception and initiative to seek care, which we deem intelligent and wearable Artificial Intelligence (AI)-driven Single Lead EKG technologies as an attractive solution in modern-day cardiology.

Purpose

To provide an accurate, accessible, and cost-effective AI-driven Single Lead STEMI detection algorithm that can be embedded into wearable devices and employed in a self-administered fashion.

Methods

Database: EKG records from Mexico, Colombia, Argentina, and Brazil from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10[s] length with a sampling frequency of 500 Hz, including the following balanced classes: angiographically confirmed and unconfirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding those mentioned above). Cardiologists manually checked the label of each record to ensure precision. Pre-processing: We discard the first and last 250 samples as they may contain a standardisation pulse. The study applied a digital low pass filter of order 5 with a frequency cut-off of 35 Hz. The mean was subtracted from each Lead. Classification: The determined classes were “STEMI” (Including STEMI in different locations of the myocardium – anterior, inferior, and lateral); and “Not-STEMI” (Combination of randomly sample, branch blocks, non-specific ST-T changes, and abnormal records – 25% of each). Training and Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. A different model was trained and tested for each Lead, using the central 4,500 samples of the records. The last dense layer outputs a probability for each report of being STEMI or Not-STEMI. Lead V2 showed the best overall results. The model was further tested through the same methodology using the best Lead with a subset of the previous data, excluding the unconfirmed STEMI EKG records (Total 7,230 12-lead EKG records for Confirmed Only STEMI dataset). Performance metrics were reported for each experiment and compared.

Results

Combined STEMI data: Accuracy: 91.2%; Sensitivity: 89.6%; Specificity: 92.9%. Confirmed STEMI Only dataset: Accuracy: 92.4%; Sensitivity: 93.4%; Specificity: 91.4% (Figure 1).

Conclusion

By assiduously improving the quality of the model's input, we continue to assess our algorithm's performance and reliability for future clinical validation as a potential remote monitoring and early STEMI detection device.

Funding Acknowledgement

Type of funding sources: None.

Type III collagen formation is significantly associated with risk of outcome in HFpEF patients but loses its significant association with underlying AF

Introduction

Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, associated with high morbidity and mortality. Atrial fibrillation (AF) has been associated with structural remodelling and fibrosis and can coexist with HFpEF. Type III collagen is the second most abundant collagen in the heart wall and has been associated with cardiac fibrosis. It has been previously shown that type III collagen formation, measured by PRO-C3, is prognostic for all-cause mortality in HFpEF.

Purpose

In this study, we aimed at investigating if the prognostic power of PRO-C3 in relation to all-cause mortality would be affected by underlying AF in HFpEF patients.

Methods

The analysis included 166 individuals with hypertensive HFpEF. The patients were classified in three groups according to NYHA classification, 43.2% in NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. A previous history of AF was present in 53.4% of the patients. Cardiac function was assessed by echocardiography and standard clinical measures. Type III collagen formation was evaluated by means of ELISA with the biomarker PRO-C3, which targets the released N-terminal pro-peptide of type III collagen.

Results

Levels of PRO-C3 were significantly elevated in HFpEF patients with AF (p=0.0063). PRO-C3 was significantly predictive of all-cause mortality in HFpEF patients (AUC=0.643, p=0.0053), but lost its significant association when factoring in AF (AUC=0.581, p=0.235). There was an increased risk of all-cause mortality (p=0.0089) but not statistically significant differences in HFpEF patients with AF (p=0.178) with increasing tertiles of PRO-C3.

Conclusions

Type III collagen formation as measured by PRO-C3, was increased in patients with HFpEF and previously diagnosed AF. However, while PRO-C3 can be predictive of all-cause mortality in HFpEF patients, it lacks predicting ability when AF is considered. The presented data suggest a potential role of increased type III collagen formation in HFpEF patients with adverse outcomes, which is consistent with the presence of increased fibrosis, and can potentially be used as a tool of risk stratification.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Nordic Bioscience A/S

Performance metrics of AI-enhanced single lead EKG maintained after entry of organised clustered data

Background

Our experience in creating innovative Artificial Intelligence-guided single lead EKG methodologies for ST-Elevation Myocardial Infarction (STEMI) detection within complex EKG records has been previously validated.

Purpose

By expanding the intricate variables of our previously tested algorithm input, we seek to further improve our STEMI detecting tool.

Methods

11,567 12-lead EKG records (10-s length, 500 Hz sample frequency) derived from the Latin America Telemedicine Infarct Network database from April 2014 to December 2019. From these records, we included the following balanced classes: angiographically confirmed and unconfirmed STEMI (divided by wall affected), branch blocks, non-specific ST-T changes, normal, and abnormal (Remaining 200+ CPT codes). Cardiologist annotations ensured precision (Ground truth). Determined classes were “STEMI” and “Not-STEMI”. A 1-D Convolutional Neural Network model was trained and tested for each lead with dataset proportions of 90/10, respectively. The last dense layer outputs a probability for each record being STEMI/Not-STEMI. The analysis also included performance metrics and false-negative reports.

Results

Overall, the most promising Single lead for STEMI detection was V2 (91.2% Accuracy, 89.6% Sensitivity, and 92.9% Specificity). 55% of false negatives were inferior wall STEMI (Table 1).

Conclusion

Appreciable progress of our new methodology compared to our previous experiences in AI-guided Single Lead for STEMI detection, especially for lead V2. By performing a thorough analysis of false-negative reports, we aspire to identify potential areas of STEMI detection weakness which will become the focus of future ventures.

Funding Acknowledgement

Type of funding sources: None.

No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence

Background

The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations.

Purpose

To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols.

Methods

The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample.

Results

This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1).

Conclusions

The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease.

Funding Acknowledgement

Type of funding sources: None.

Intensive care unit-acquired weakness: From molecular mechanisms to its impact in COVID-2019

Intensive Care Unit-Acquired Weakness (ICU-AW) is a generalized and symmetric neuromuscular dysfunction associated with critical illness and its treatments. Its incidence is approximately 80% in intensive care unit patients, and it manifests as critical illness polyneuropathy, critical illness myopathy, and muscle atrophy. Intensive care unit patients can lose an elevated percentage of their muscle mass in the first days after admission, producing short- and long-term sequelae that affect patients’ quality of life, physical health, and mental health. In 2019, the world was faced with coronavirus disease 2019 (COVID-19), caused by the acute respiratory syndrome coronavirus 2. COVID-19 produces severe respiratory disorders, such as acute respiratory distress syndrome, which increases the risk of developing ICU-AW. COVID-19 patients treated in intensive care units have shown early diffuse and symmetrical muscle weakness, polyneuropathy, and myalgia, coinciding with the clinical presentation of ICU-AW. Besides, these patients require prolonged intensive care unit stays, invasive mechanical ventilation, and intensive care unit pharmacological therapy, which are risk factors for ICU-AW. Thus, the purposes of this review are to discuss the features of ICU-AW and its effects on skeletal muscle. Further, we will describe the mechanisms involved in the probable development of ICU-AW in severe COVID-19 patients.

Associations between exposure to adverse childhood experiences and biological aging: Evidence from the Canadian Longitudinal Study on Aging

People exposed to adverse childhood experiences (ACEs) suffer from an increased risk of chronic disease and shorter lifespan. These individuals also tend to exhibit accelerated reproductive development and show signs of advanced cellular aging as early as childhood. These observations suggest that ACEs may accelerate biological processes of aging through direct or indirect mechanisms; however, few population-based studies have data to test this hypothesis. We analysed ACEs and biological aging data from the Canadian Longitudinal Study on Aging (CLSA; n = 23,354 adults aged 45-85) and used the BioAge R package to compute three indices of biological aging from blood-chemistry and organ-function data: Klemera-Doubal method (KDM) biological age, phenotypic age (PA), and homeostatic dysregulation (HD). Adults with ACEs tended to be biologically older than those with no ACEs, although the observed effect-sizes were small (Cohen's d<0.15), with the exception of neglect (d=0.35 for KDM and PA). Associations were similar for men and women and tended to be smaller for older as compared to midlife participants. Subtypes of ACEs perceived as being more severe (e.g., being pushed or kicked, experiencing forced sexual activity, witnessing physical violence) and more frequent and diverse exposures were associated with relatively larger effect-sizes. These findings support the hypothesis that ACEs contribute to accelerated biological aging, although replication is needed in studies with access to prospective records of ACEs and cellular-level measurements of biological aging. Furthermore, future work to better understand the degree to which associations between ACEs and biological aging are moderated by specific life-course pathways, and mediated by lifestyle and socioeconomic factors is warranted.

Molecular characterization of thioester-containing proteins in Biomphalaria glabrata and their differential gene expression upon Schistosoma mansoni exposure

Schistosomiasis is a disease caused by trematode parasites of the genus Schistosoma that affects approximately 200 million people worldwide. Schistosomiasis has been a persistent problem in endemic areas as there is no vaccine available, currently used anti-helmintic medications do not prevent reinfection, and most concerning, drug resistance has been documented in laboratory and field isolates. Thus, alternative approaches to curtail this human disease are warranted. Understanding the immunobiology of the obligate intermediate host of these parasites, which include the freshwater snail Biomphalaria glabrata, may facilitate the development of novel methods to stop or reduce transmission to humans. Molecules from the thioester-containing protein (TEP) superfamily have been shown to be involved in immunological functions in many animals including corals and humans. In this study we identified, characterized, and compared TEP transcripts and their expression upon S. mansoni exposure in resistant and susceptible strains of B. glabrata snails. Results showed the expression of 11 unique TEPs in B. glabrata snails. These transcripts present high sequence identity at the nucleotide and putative amino acid levels between susceptible and resistant strains. Further analysis revealed differences in several TEPs’ constitutive expression levels between resistant and susceptible snail strains, with C3-1, C3-3, and CD109 having higher constitutive expression levels in the resistant (BS90) strain, whereas C3-2 and TEP-1 showed higher constitutive expression levels in the susceptible (NMRI) strain. Furthermore, TEP-specific response to S. mansoni miracidia exposure reiterated their differential expression, with resistant snails upregulating the expression of both TEP-4 and TEP-3 at 2 h and 48 h post-exposure, respectively. Further understanding the diverse TEP genes and their functions in invertebrate animal vectors will not only expand our knowledge in regard to this ancient family of immune proteins, but also offer the opportunity to identify novel molecular targets that could aid in the efforts to develop control methods to reduce schistosomiasis transmission.

Prenatal distress, access to services, and birth outcomes during the COVID-19 pandemic: Findings from a longitudinal study

BACKGROUND/AIMS

During the COVID-19 pandemic, pregnant people have experienced disruptions to prenatal care, as well elevated rates of mental health problems and distress. The current longitudinal study aims to understand how different forms of prenatal distress (mental health problems, COVID-19 stressful experiences, and access to prenatal services) impact infant birth outcomes during the pandemic.

METHODS

Participants were 265 pregnant individuals from Ontario, Canada. Maternal depression, pregnancy-related anxiety, COVID-related stressors (i.e., financial difficulties, social isolation), and disruptions to prenatal and health services were assessed during pregnancy. Delivery experiences and birth outcomes were assessed in the early postpartum period. Associations between pregnancy stressors and birth outcomes were assessed using path analyses.

RESULTS

Participants reported experiencing substantial changes to their prenatal care due to COVID-19; 23.0 % had prenatal appointments cancelled, 47.9 % had difficulty accessing prenatal classes, and 60.8 % reported changes to their birth plans. Results of path analyses showed a unique effect of pregnancy-related anxiety during the pandemic on lower birth weight, younger gestational age at birth, and more infant birth problems. Further, multi-group path analysis revealed these effects were more pronounced in male infants.

CONCLUSIONS

Findings demonstrate that pregnant individuals in Ontario, Canada have experienced considerable disruptions to services during pregnancy. In addition, pregnancy-related anxiety was uniquely linked to elevated risk for adverse birth outcomes, which more heavily impacted male infants. These findings underscore the need for additional mental health support and access to services for pregnant people and their infants, to reduce long-term adverse maternal and fetal health outcomes.

Mental Health Help-Seeking in Parents and Trajectories of Depressive and Anxiety Symptoms: Lessons Learned From the Ontario Parent Survey During the COVID-19 Pandemic

Tracking parents’ mental health symptoms and understanding barriers to seeking professional help are critical for determining policies and services to support families’ well-being. The COVID-19 pandemic has posed enormous challenges to parents’ mental health and the access to professional help, and there are important public health lessons that must be learned from the past 2 years’ experiences to inform future mental health responses to social- and family-level stressful events. This study examines the trajectories of parents’ depressive and anxiety symptoms over a year during the pandemic as related to their mental health help-seeking. Data were collected from a sample of parents residing in Ontario, Canada at baseline (May–June, 2020; Wave 1) and again 1 year later (Wave 2; referred to as W1 and W2 below). Parents (n = 2,439; Mage = 39.47, SD = 6.65; 95.0% females) reported their depressive and anxiety symptoms at both waves. Mental health help-seeking, including self-reported contact with professional help and perceived unmet mental health needs, was measured at W2. Parents were classified into four groups by mental health help-seeking. Inconsistent seekers and non-seeking needers, both reporting perceived unmet needs for professional help, showed greater increases in depressive and anxiety symptoms, whereas parents with no need or needs met showed smaller increases in depressive symptoms and decreases in anxiety symptoms. Belief in self-reliance and time constraints were the leading reasons for not seeking help. These findings suggest that over a year into the pandemic, parents with perceived unmet mental health needs were at greater risk for worsening depressive and anxiety symptoms. Recognizing the demands for mental health services when families experience chronic stressors and targeting the identified barriers may promote family well-being during and beyond this pandemic.

POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE

Background

The goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.

Objectives

To describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).

Methods

We evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.

Results

Overall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.

Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).

Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).

Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).

Conclusion

A high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.

References

[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).

[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.

[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.

[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.

[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032

Disclosure of Interests

Rosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant

POS0438 IDENTIFICATION OF ANTI-CYTOKINE AUTOANTIBODIES WITH POTENTIAL TO PREDICT FLARE IN RHEUMATOID ARTHRITIS PATIENTS UNDERGOING BIOLOGICAL THERAPIES: A DISCOVERY STUDY

Background

The presence of anti-cytokine autoantibodies (ACAAs) seems to be a physiologic mechanism to control the immune response and regulate cytokine activity. Biological therapies also regulate cytokine activities and have greatly improved the quality of life of RA patients. However, alteration of the cytokine network by the use of these treatments may lead to a disbalance in the regulatory system of ACAAs. We hypothesize the ACAAs network may influence the course of immune response in RA patients and may be useful to predict the therapy efficacy.

Objectives

We aimed to explore the potential of circulating ACAAs to predict flare in a cohort of RA patients treated with biological therapy.

Methods

We employed sera at baseline from 194 RA patients of the clinical trial OPTIBIO1 (A Coruña), whose primary endpoint is to evaluate the usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologics. These patients were treated with TNF inhibitors (Etanercept, N=47; Infliximab, N=12; Adalimumab, N=35; Certolizumab (CTZ), N=17; Golimumab, N=5), Tocilizumab (TCZ, N=60) and Abatacept (ABA, N=18). Patients were in clinical remission (DAS 28 <2.6 or SDAI <5 or ACR/EULAR 2011 criteria) at least from 6 months. Patients were followed during a minimum period of one year and maximum period of 3 years. Flare was considered when remission criteria were not fulfilled. The bead-based antigen array MILLIPLEX MAP Human Cytokine Autoantibody Magnetic Bead Panel was used for the simultaneous detection and quantification in sera of anti-BAFF, anti-G-CSF, anti-IFNβ, anti-IFNγ, anti-IL-1α, anti-IL-6, anti-IL-8, anti-IL-10, anti-IL-12 (p40), anti-IL-15, anti-IL-17A, anti-IL-17F, anti-IL-18, anti-IL-22, and anti-TNFα. Non-parametrical tests, ROC curves and logistic regressions were performed for the statistical data analysis using SPSS. P-value < 0.05 was considered statistically significant.

Results

The levels of anti-17A and anti-IL-1α were increased in the sera from patients who suffered a flare during the follow-up period (N= 76), compared to those who remained in remission (N= 118), showing an area under the curve (AUC) of 0.586 and 0.594, respectively. Segregating by treatment, the levels of anti-17A were specifically increased in those relapsing patients under CTZ (N=6), ABA (N=12) and TCZ (N=20) treatment. The AUC of anti-17A within these three therapies was 0.867, 0.903 and 0.682, respectively. Logistic regression analysis also associated the levels of anti-17A with the risk of suffering a flare in TCZ-treated patients (OR=1.11; p=0.015, for 100 MFI increase). In addition, the TCZ-treated patients who suffered a flare also showed higher levels of anti-IL17F, anti-IL-1α, and anti-IL-18 compared to those that remained in remission, showing AUCs of 0.689, 0.657 and 0.698, respectively. Anti-IL-18 was also associated with the risk of flare in these patients (OR=1.65; p=0.028, for 100 MFI increase). The presence of these three ACAAs was also higher in the TCZ-treated patients who suffered a flare compared to those in remission.

Conclusion

Although further validation of our results is needed, we present a ground-breaking study showing the potential of anti-IL17A, anti-IL-1α, and anti-IL18 to predict flare in RA patients under biological therapies.

References

[1]Bejerano C, et al. Clinical evaluation usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologic therapies. The Optibio Study. Arthritis Rheumatol. 2016; 68 (suppl 10): 649.

Table 1.

Table showing a summary of the results. CI: confidence interval

• Treatments• ACAAs• AUC (CI 95%; p)Allanti-IL17A0.586 (0.504-0.668; 0.044)anti-IL-1α0.594 (0.512-0.676; 0.028)CTZanti-IL17A0.867 (0.675,1.000; 0.017)ABAanti-IL17A0.903 (0.761-1.000; 0.007)TCZanti-IL-1α0.657 (0.494-0.820; 0.049)anti-IL-17F0.689 (0.551-0.827; 0.018)anti-IL17A0.682 (0.528-0.835; 0.023)anti-IL180.698 (0.545-0.850; 0.013)

Disclosure of Interests

None declared.