0367 Social Determinants of Black-White Disparities in the Work-Sleep Relationship by Occupational Class: A Sequential Mixed Methods Approach

Introduction

Although Black adults disproportionately work in lower-wage, lower-skilled jobs and experience short sleep (<7 hours), which has been shown to vary by employment industry and occupation, there is scant literature regarding the influence of the work-sleep relationship on racial/ethnic sleep disparities. Our prior quantitative research based on nationally-representative data revealed a novel finding that the prevalence of short sleep was generally highest at professional occupational classes among Black adults but was the least prevalent among their White counterparts.

Methods

To identify reasons for short sleep generally increasing with increasing professional occupations among blacks but decreasing among whites, we conducted a qualitative study using a sequential mixed methods design among Black and White workers across a range of industries and occupations. Occupations were classified as “professional” (e.g., doctors; lawyers) or “non-professional” (e.g., retail; food service). Race-matched trained facilitators conducted 36 focus groups that were homogenous in terms of race-sex/gender-occupational class and 63 one-on-one interviews (N=334 overall participants) using semi-structured interview guides. NVivo software was used to identify themes/patterns.

Results

Participants were a mean age of 41 ± 11 years, 42% were men, 58% had an annual income of ≥$50,000, and 57% were professionals. Black professionals overwhelmingly described less informational and emotional support as well as needing to “work twice as hard to get half as far” (i.e., John Henryism) compared to coworkers as potential explanations for work-sleep disparities. Both Black and White professionals identified longstanding social structures, interpersonal discrimination, income disparities, and familial or self-imposed pressures to succeed. White professional women frequently reported experiences with gender discrimination, which - they reported - may intersect with and amplify the effects of racial discrimination among Black women. Regardless of occupational class, Black men additionally described unique stressors (e.g., political climate; finances; police). White men frequently avoided discussing disparities, and the existence of disparities was often denied/questioned by non-professionals across race and sex/gender.

Conclusion

Our findings inform future research and interventions designed to illuminate and/or address sleep disparities emanating from the workplace.

Support

This work was funded by the Intramural Program at the National Institute of Environmental Health Sciences (Z1AES103325-01).

Survey of UK pet owners quantifying internal parasite infection risk and deworming recommendation implications

Background

Dogs and cats in the UK are exposed to many internal parasites which can pose risks to the health of both the pet and their owners. By understanding these endemic parasites and the risks they pose, we can assess the lifestyle of pets and recommend the correct deworming frequency. Studies identifying risk factors were discussed in the European Scientific Counsel Companion Animal Parasites (ESCCAP) guidelines. To this date, there has been very little information on how pet owners in the UK deworm their pets and if the protocols they follow align with ESCCAP recommendations. The objective of this study was to look at the current deworming protocols of UK cat and dog owners in conjunction with their lifestyle and risk.

Methods

An online survey was conducted in the UK targeting pet owners who own at least one dog and/or cat and were responsible for product purchase, the pet’s health care and veterinary visits. These survey results were analysed against the ESCCAP guidelines and each pet placed into a risk category. By comparing the current deworming frequency with that recommended for their risk category, the compliance of UK pet owners with ESCCAP recommendations was evaluated.

Results

A total of 500 dog owners and 500 cat owners completed surveys. Overall, the study found none of the pets fell into risk group A, with all pets meeting the risk level for at least deworming four times a year (risk group B and above). The majority of animals fell into the highest risk category D with 97% of dogs and 68% of cats. The average deworming per year in the UK was 3.1 for dogs and 3.1 cats, below the minimum recommended by ESCCAP.

Conclusions

For both felines and canines, the dosing frequencies are lower than recommended to both reduce zoonotic risk for reducing Toxocara spp. egg-shedding and improve pet health. This research highlights the need for improved education around dog and cat patient risk assessments and greater adherence to recommended deworming aligned with the ESCCAP guidelines.

Canine Leishmaniasis Control in the Context of One Health

Dogs are the main reservoir of Leishmania infantum and in some countries have been regularly culled as part of government policy to control visceral leishmaniasis. At the 13th Symposium of the Companion Vector-Borne Diseases World Forum in Windsor, UK, March 19–22, 2018, we consolidated a consensus statement regarding the usefulness of dog culling as a means of controlling visceral leishmaniasis. The statement highlighted the futility of culling infected dogs, whether healthy or sick, as a measure to control the domestic reservoir of L. infantum and reduce the risk for visceral leishmaniasis.

A Comparative Analysis of Physiotherapy for Stress Urinary Incontinence after Open or Robotic-Assisted Radical Prostatectomy

Purpose: We determined whether the patient-reported benefits of physiotherapy for stress urinary incontinence (SUI) symptoms differ significantly between men who have had open prostatectomy and those who have had robotic-assisted laparoscopic prostatectomy. Method: We conducted a retrospective analysis of data collected from the Rapid Access Clinic 4 offered by the Prostate Cancer Centre in Calgary, Alberta. Baseline characteristics were measured at the pre-surgery appointment, including demographics, health factors, and potential risk factors for SUI. Patient-reported SUI symptoms were measured pre- and post-surgery using the global score of the International Consultation on Incontinence Questionnaire-Urinary Incontinence. Results: Data from 56 men were included in the analysis, evenly split between the open and robotic sub-groups. At 3 months post-surgery, no statistically significant differences were found in the factors associated with incontinence between the two sub-groups. There was a statistically significant improvement in self-reported incontinence symptom severity from 3-month to 2-year follow-up for both sub-groups. Physiotherapy did not differentially affect either sub-group in a significant way. Conclusions: The self-reported benefits of physiotherapy for SUI symptoms did not differ significantly between the two types of prostatectomy surgery at 2 years post-surgery.

British Heart Rhythm Society Clinical Practice Guidelines on the Management of Patients Developing QT Prolongation on Antipsychotic Medication

The British Heart Rhythm Society’s Clinical Practice Guidelines on the Management of Patients Developing QT Prolongation on Antipsychotic Medication are written for heart rhythm consultants, primary care physicians, specialist registrars, nurses and physiologists who may be requested to review ECGs or advise on cases where antipsychotic-induced QT prolongation is suspected or proven. The guidance is adapted from the latest Maudsley Prescribing Guidelines in Psychiatry, published in 2018.

Voltage during atrial fibrillation is superior to voltage during sinus rhythm in localizing areas of delayed enhancement on magnetic resonance imaging: An assessment of the posterior left atrium in patients with persistent atrial fibrillation

Background

Bipolar electrogram voltage during sinus rhythm (V_SR) has been used as a surrogate for atrial fibrosis in guiding catheter ablation of persistent atrial fibrillation (AF), but the fixed rate and wavefront characteristics present during sinus rhythm may not accurately reflect underlying functional vulnerabilities responsible for AF maintenance.

Objective

The purpose of this study was determine whether, given adequate temporal sampling, the spatial distribution of mean AF voltage (V_mAF) better correlates with delayed-enhancement magnetic resonance imaging (MRI-DE)–detected atrial fibrosis than V_SR.

Methods

AF was mapped (8 seconds) during index ablation for persistent AF (20 patients) using a 20-pole catheter (660 ± 28 points/map). After cardioversion, V_SR was mapped (557 ± 326 points/map). Electroanatomic and MRI-DE maps were co-registered in 14 patients.

Results

The time course of V_mAF was assessed from 1–40 AF cycles (∼8 seconds) at 1113 locations. V_mAF stabilized with sampling >4 seconds (mean voltage error 0.05 mV). Paired point analysis of V_mAF from segments acquired 30 seconds apart (3667 sites; 15 patients) showed strong correlation (r = 0.95; P <.001). Delayed enhancement (DE) was assessed across the posterior left atrial (LA) wall, occupying 33% ± 13%. V_mAF distributions were (median [IQR]) 0.21 [0.14–0.35] mV in DE vs 0.52 [0.34–0.77] mV in non-DE regions. V_SR distributions were 1.34 [0.65–2.48] mV in DE vs 2.37 [1.27–3.97] mV in non-DE. V_mAF threshold of 0.35 mV yielded sensitivity of 75% and specificity of 79% in detecting MRI-DE compared with 63% and 67%, respectively, for V_SR (1.8-mV threshold)_.

Conclusion

The correlation between low-voltage and posterior LA MRI-DE is significantly improved when acquired during AF vs sinus rhythm. With adequate sampling, mean AF voltage is a reproducible marker reflecting the functional response to the underlying persistent AF substrate.

Pet travel disease risks

An ever-increasing number of pets, particularly dogs, are travelling from and back to the UK with their owners, in addition to new pets being brought in having been acquired outside the UK (often as ‘rescues’), and puppies bred outside the UK and imported legally or illegally. Such pet travel risks the importation of a variety of diseases that generally have not been present in the UK. Veterinary surgeons need to be aware of the risks associated with pet travel, and have a good understanding of these diseases. ESCCAP is an excellent source of information on parasites. To protect animal health, it is necessary to go well beyond the Pet Travel Scheme requirements. It is important to be able to provide owners with the best advice and preventative treatments to minimise the risks of pets acquiring parasitic, vector-borne and other diseases while travelling — for their benefit and for the longer-term health and welfare of the UK pet population, as well as the health of the human population. For any disease prevention or control programme to be effective, awareness and motivation must be raised, and for this, communication is key. It is vital to tailor the language used to match the audience in order for any message to be heard and accepted, and it is essential to remember the emotional attachment that people develop for animals they are ‘rescuing’.

The UK guidelines for management and surveillance of Tuberous Sclerosis Complex

BACKGROUND

The severity of Tuberous Sclerosis Complex (TSC) can vary among affected individuals. Complications of TSC can be life threatening, with significant impact on patients' quality of life. Management may vary dependent on treating physician, local and national policies, and funding. There are no current UK guidelines. We conducted a Delphi consensus process to reach agreed guidance for the management of patients with TSC in the UK.

METHODS

We performed a literature search and reviewed the 2012/13 international guideline for TSC management. Based on these, a Delphi questionnaire was formed. We invited 86 clinicians and medical researchers to complete an online survey in two rounds. All the people surveyed were based in the UK. Clinicians were identified through the regional TSC clinics, and researchers were identified through publications. In round one, 55 questions were asked. In round two, 18 questions were asked in order to obtain consensus on the outstanding points that had been contentious in round one. The data was analysed by a core committee and subcommittees, which consisted of UK experts in different aspects of TSC. The Tuberous Sclerosis Association was consulted.

RESULTS

About 51 TSC experts took part in this survey. Two rounds were required to achieve consensus. The responders were neurologists, nephrologists, psychiatrist, psychologists, oncologists, general paediatricians, dermatologist, urologists, radiologists, clinical geneticists, neurosurgeons, respiratory and neurodisability clinicians.

CONCLUSIONS

These new UK guidelines for the management and surveillance of TSC patients provide consensus guidance for delivery of best clinical care to individuals with TSC in the UK.

From Prostate Health to Overactive Bladder: Developing a Crosswalk for the IPSS to OAB-V8

OBJECTIVES

To develop a statistical model to facilitate the comparison of 2 common patient-reported outcome (PRO) instruments in male lower urinary tract symptoms.

METHODS

Two PROs used by urologists are the International Prostate Symptoms Severity (IPSS) and the Overactive Bladder-Validated 8 questions (OAB-V8). The former measures symptoms related to prostate cancer, the latter measures the severity of symptoms related to OAB. Ordinary least squares regression was used to develop 3 models for translating responses to the IPSS into OAB-V8 scores. The root mean square error was used to compare the models.

RESULTS

The sample consisted of 493 participants, ranging from 18 to 93 years of age. The recommended model included the individual responses to the IPSS' items and participants' age. Due to the low root mean square error (0.7606), indicating low variation and high precision, we can explain about 63% (R2 = 0.6260) relationship between IPSS and OAB-v8.

CONCLUSION

This study successfully modeled global OAB-V8 scores from IPSS responses. This model performed comparably well to others developed using similar methods.

Prevalence of feline lungworm Aelurostrongylus abstrusus in England

Infection of cats with lungworm Aelurostrongylus abstrusus has recently been documented in the UK. Here, we aimed to study the prevalence of A. abstrusus in fecal samples from cats across England. A total of 950 fecal samples were collected from cats together with information on their age, breed, gender, geographic region, lifestyle, and treatment history. A total of 17 (1.7%) cats were positive for A. abstrusus based on species-specific morphological features of the larvae isolated by Baermann's technique. There was no statistically significant difference in the proportion of positive samples between females (506; 53.2%) and males (444; 46.7%). Multiple regression analysis showed that prevalence of feline lungworm was significantly different across geographic regions: in comparison with East Midlands, some regions had shown significantly increased odds of A. abstrusus-positive samples (South East [odds ratio [OR] = 7.68; 95% confidence interval [CI] = 1.70 to 32.76; p = .01]; West Midlands [OR = 6.20; 95% CI = 1.21 to 26.84; p = .02]), while other regions had also increased odds although not statistically significant (Greater London [OR = 9.63; 95% CI = 0.43 to 84.05; p = .07]; North West [OR = 4.25; 95% CI = 0.59 to 20.89; p = .09]; South West [OR = 2.48; 95% CI = 0.12 to 17.64; p = .43]; and North East [OR = 1.88; 95% CI = 0.10 to 12.24; p = .57]). Keeping cats inside was protective against the risk of infection compared with those having outdoor access (OR = 0.09; 95% CI = 0.01 to 0.48; p = .02). On the other hand, age, breed, gender and deworming history did not have any significant effect on the likelihood of infection. Our data indicate that A. abstrusus is a parasite of potential significance in cats, in particular those from certain geographic regions in England. To reduce the spread of this parasite, an integrated feline lungworm control program needs to be implemented.

Treatment with nitric oxide in the neonatal intensive care unit is associated with increased risk of childhood cancer

AIM

This study aimed to determine whether neonatal intensive care therapies increase the risk of carcinogenesis in childhood.

METHODS

This study used population-based data on 1 072 957 infants born in New South Wales, Australia, between 2000 and 2011 and multivariate logistic regression to examine any associations between therapies used in the neonatal intensive care unit and diagnoses of cancer until mid 2012.

RESULTS

A total of 1126 of 1 072 957 (0.1%) children were diagnosed with cancer. Cancer risk was significantly increased by preterm birth (gestation <37 weeks; adjusted odds ratio (aOR) 1.3 (95% confidence interval: 1.0-1.6), birth weight ≥4 kg (aOR 1.4, 1.2-1.6) and caesarean delivery (aOR 1.2, 1.1-1.4). Extremely preterm (<28 weeks of gestation) infants were more likely to develop hepatic tumours (aOR 12.7, 3.3-48.3) than term infants. The only therapy used in the neonatal intensive care that was independently associated with an increased risk of cancer was nitric oxide (aOR 8.6, 4.3-17.4). Eight of the 790 (1%) infants treated with nitric oxide developed cancer (gestation range 30-41 weeks, age of cancer diagnosis: four months-five years).

CONCLUSION

Treatment with nitric oxide was associated with a higher risk of childhood cancer. These findings require further research.

Survey of European pet owners quantifying endoparasitic infection risk and implications for deworming recommendations

Background

Zoonotic endoparasites pose risks to pets and people. The European Scientific Counsel Companion Animal Parasites (ESCCAP) created risk groupings for dogs (A-D) and for cats (A-B), with the highest risk pets (Group D dogs and Group B cats) receiving the most frequent testing and/or deworming recommendations. Little information exists on current deworming behaviours across Europe, alignment to accepted guidelines and the percentage of dogs and cats falling into ESCCAP groups. The study objectives were to evaluate the reported infection-risk behaviours of dogs and cats and assesses whether deworming frequency reported by pet owners complied with recommended deworming frequencies.

Methods

A total of 5001 pet owners from five different countries (France, Germany, Spain, Sweden and the UK) were surveyed regarding endoparasite infection risk and the frequency of deworming of dogs and cats. For the purposes of this study, ESCCAP risk groups for cats (A-B) were converted into four risk groups (A-D) using the additional risk factors outlined in the ESCCAP guidelines. This allowed direct comparison between cats and dogs as well as grouped higher risk cats into the appropriate deworming frequency.

Results

The three most common risk factors identified for dogs were contact with: other dogs, snails or prey; children or the elderly; going off lead outside their own garden. 85–98% of all dogs had risks putting them into Group D, the highest risk group. The three most common risk factors identified for cats were: hunting; catching prey; contact with children or the elderly. Using these revised groups, 33–68% of cats were in Group D. Despite the majority of dogs and cats falling into a risk category where ESCCAP recommends monthly deworming, dogs and cats averaged 2.3 and 2.2 dewormings per year, respectively. This frequency was less than the four times a year dosing frequency demonstrated to be required to reduce zoonotic Toxocara spp. ova shedding.

Conclusions

Overall, 93% of dogs and 54% of cats fell into Group D, the highest risk group. Deworming frequencies were considerably less than recommended by ESCCAP or required to both reduce zoonotic risk and improve pet health. Improved treatment compliance is needed.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3149-1) contains supplementary material, which is available to authorized users.

Survey-based pilot study into the chosen therapy and prophylaxis used by UK primary care veterinary surgeons against canine angiostrongylosis

Canine Angiostrongylosis (CA), a gastropod-borne parasitic infection caused by the metastrongyloid nematode Angiostrongylus vasorum, is an important cause of significant morbidity to domestic dogs across the UK as well as in other European countries. This study aimed to ascertain the frequency at which particular drugs were used by primary care practitioners in the UK for therapy against and prophylaxis for CA. Primary care veterinary clinicians were surveyed using an online questionnaire and face-to-face or telephone interviews. Eighty-six veterinary surgeons responded. The majority of practices (n = 52) included lungworm in their standard anthelmintic protocols; moxidectin was the most common drug used for prophylaxis (n = 71). Fenbendazole was the most frequently selected drug, by 45% of vets, for treatment of confirmed cases of CA despite it being unlicensed for this purpose in the UK and the absence of a clear treatment protocol. The results of this pilot study provide an initial insight into the approach taken by primary care practitioners in their approach to CA. This provides an important starting point for future studies investigating the decision-making for CA amongst UK veterinary surgeons, particularly to clarify whether in a larger cohort an unlicensed drug remains the treatment of choice. The absence of a clear protocol for fenbendazole means that treatment of dogs affected by CA may be suboptimal, increasing the risk of morbidity and mortality.

Panoptes: web-based exploration of large scale genome variation data

Motivation

The size and complexity of modern large-scale genome variation studies demand novel approaches for exploring and sharing the data. In order to unlock the potential of these data for a broad audience of scientists with various areas of expertise, a unified exploration framework is required that is accessible, coherent and user-friendly.

Results

Panoptes is an open-source software framework for collaborative visual exploration of large-scale genome variation data and associated metadata in a web browser. It relies on technology choices that allow it to operate in near real-time on very large datasets. It can be used to browse rich, hybrid content in a coherent way, and offers interactive visual analytics approaches to assist the exploration. We illustrate its application using genome variation data of Anopheles gambiae, Plasmodium falciparum and Plasmodium vivax.

Availability and implementation

Freely available at https://github.com/cggh/panoptes, under the GNU Affero General Public License.

Contact

paul.vauterin@gmail.com.

A four year epidemiological and chemotherapy survey of babesiosis and theileriosis, and tick vectors in sheep, cattle and goats in Dehgolan, Iran

Babesia and Theileria are two protozoa belonging to the phylum Apicomplexa, which result in babesiosis and theileriosis in different hosts, cause considerable problems in domestic animals and as a consequence economic losses. These two diseases are transmitted by ticks. This survey was carried out due to the lack of studies and information regarding tick vectors and Theileria and Babesia species in the Dehgolan area of Iran, which is a center of agriculture and animal holding industry. This study was conducted during a four-year period, between 2012 and 2016. Infection with Theileria and Babesia was observed throughout the year while in contrast to cattle and sheep, infection with Babesia in goats was not observed between December and February. Infection with Babesia and Theileria reached the highest peak in July and this was more considerable for Theileria in cattle and sheep with a prevalence of 37–47% and 46–79%, respectively. The infection rate in goats for both diseases was 20%. The results in this study showed that Imidocarb Diproprionate and Buparvaquone are effective treatments for Babesia and Theileria, respectively. In this survey, the ticks of Rhipicephalus spp. and Hyalomma anatolicum had the highest infection rate with Babesia and Theileria, respectively. Considering the significant relationship between the prevalence of Theileria and Babesia with tick infection in this study and other studies, more studies on climate changes and tick vector prevalence are necessary.