A101 VIRTUAL MINDFULNESS-BASED STRESS REDUCTION FOR ADULTS WITH INFLAMMATORY BOWEL DISEASE: FEASIBILITY TRIAL PRELIMINARY RESULTS

Background

Patients with Inflammatory Bowel Disease (IBD) often suffer from high levels of anxiety and depression. Despite high rates of mental health comorbidity, a low proportion of patients receive psychiatric referrals and treatment. In Canada, provincial health care plans cover psychiatric services, making them affordable for patients and making referral efficient for gastroenterologists. Psychiatrist-led virtually-delivered Mindfulness-Based Stress Reduction (MBSR) has been associated with reducing feelings of stress, anxiety, and depression in several high-quality randomized control trials. It also reduces cost and travel requirements for patients, both which have been identified as barriers to accessing mental health treatment.

Purpose

To assess the feasibility of online-delivered MBSR for IBD patients, with feasibility outcomes defined as recruitment success, and attendance, adherence, and attrition of participating patients.

Method

Eligible participants were adult IBD patients aged 18-65 attending gastroenterology clinics in Edmonton, Alberta who self-identified as being anxious or depressed and/or were referred by their gastroenterologist. A research coordinator contacted eligible patients who expressed interest in participating after completing an assessment of symptoms and a semi-structured interview with a psychiatrist. The MBSR protocol was an 8-week group-based intervention aimed at giving participants tools to cope with stress effectively. Participants attended 8 weekly sessions lasting 2.5 hours/week and a one-time weekend session lasting 5 hours. They were also asked to practice every night for 45-60 minutes. Completion of the program required attendance of at least 6 of 8 weekly sessions and the weekend session. Two groups, led by the same team of qualified psychiatrists, started MBSR, with sessions occurring in the evening via Zoom.

Result(s)

Of the 64 patients referred to the study, 16 (25%) agreed to participate. Reasons for declining to participate are shown in Table 1, with 80% indicating they were too busy. Of the 16 patients enrolled, the median age was 36 (range: 18-55), 10 identified as female (62.5%) and 8 had Crohn’s Disease (50%). Attendance, adherence, and attrition data from the first group of 7 participants were recorded. Only 3 (42.8%) successfully completed the program. The participants that completed the program had an attendance rate of 100% and practiced 6 nights a week for an average of 25 minutes a night. A second group with 9 participants is currently ongoing.

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Conclusion(s)

Although interest in a cost-free, virtual stress management resource was relatively high, willingness to enroll in MBSR specifically, was low, largely due to the time commitment. Follow-up interviews with those who enrolled and did not enroll in the intervention are underway to highlight the benefits and barriers to MBSR.

Disclosure of Interest

None Declared

Maternal smoking during pregnancy: Trends and determinants in the conception to community study

BACKGROUND

Despite earlier declines, maternal smoking during pregnancy continues to be a public health problem. We examined trends and factors associated with maternal smoking during and between pregnancy over six years.

METHODS

Participants were 27 532 pregnant women in Tasmanian public hospitals whose smoking status was gathered by midwives during perinatal care between July 2008 and June 2014. Generalized linear modeling was used to examine the trends in prevalence of maternal smoking over time and factors associated with change in smoking status both within and between pregnancies.

RESULTS

Smoking during pregnancy decreased from 25.9% in 2008 to 16.4% in 2014 (57.9% decline). Multivariable regression analysis suggested that maternal alcohol consumption during pregnancy, living in a highly socioeconomically disadvantaged area, and being an Aboriginal or Torres Strait Islander significantly increased the risk of maternal smoking during pregnancy. Being older, married, or in a de facto relationship, and intending to breastfeed were associated with reduced risk of smoking during pregnancy. Between index (first birth recorded in data set) and last pregnancy, 35.1% of smokers quit, but 5.1% of nonsmokers started smoking. Only 8.1% of mothers who smoked during the first half of pregnancy quit by the second half.

CONCLUSIONS

Maternal smoking during pregnancy is decreasing. To sustain the decline, preventive efforts must address the role of social determinants of health (eg, mothers who drink alcohol, live in highly disadvantaged areas, are younger and single) among women who smoke during pregnancy.

Maternal Smoking in Pregnancy and Child's Hospital Use up to 5 Years of Age in a Data Linkage Birth Cohort

OBJECTIVES

To examine if exposure to maternal smoking during pregnancy is associated with emergency department (ED) presentation and admission through the ED in children up to 5 years after birth.

METHODS

Antenatal records of all children up to 5 years of age who were born in Tasmania, Australia, between July 2008 and June 2014 were linked to health service use (ED presentations and hospital admissions). Negative binomial regression was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) at ≤1 year and ≤5 years for ED presentations and admissions to the hospital through the ED for any reason and by 9 major disease categories for children exposed versus children not exposed to maternal smoking during pregnancy. Models were adjusted for sex, socioeconomic position, maternal age at birth, and region of residence. Presentations and admissions for poisoning and injuries were used as a negative control.

RESULTS

Among 36 630 infants, 21% were exposed to maternal smoking during pregnancy. Exposed children had a 26% higher rate of presentation to the ED (IRR_adjusted 1.26; 95% CI 1.23-1.29) and a 45% higher rate of admission (IRR_adjusted 1.45; 95% CI 1.39-1.51) at up to 5 years of age. Compared with the negative control, higher presentation and admission rates were evident in respiratory; eyes, ears, nose, and throat; psychosocial; and infectious disease categories.

CONCLUSIONS

Higher health care service use was observed in children exposed to maternal smoking during pregnancy for a range of conditions associated with exposure to smoking. The findings reinforce the need to reduce smoking among people in their childbearing years.

IgM ANCA in healthy individuals and in patients with ANCA-associated vasculitis

Low levels of IgM auto-antibodies have been reported in health and disease. IgM anti-neutrophil cytoplasmic antibodies (ANCA) have been reported in patients with ANCA-associated vasculitis (AAV). We sought to investigate if healthy individuals may have IgM ANCA in their sera. The first aim of the study was to determine whether IgM ANCA was present in healthy individuals and in patients with ANCA-associated vasculitis. The second aim was to determine what happens to IgM ANCA levels over time. The third aim was to determine whether bacterial infections affected IgM ANCA levels in non-AAV patients. Sera from healthy individuals and patients with AAV were tested for IgM ANCA by immunofluorescence on fixed neutrophils, immunoprecipitation, Western blot and ELISA. Peripheral blood mononuclear cells were isolated and tested by ELISpot for circulating IgM ANCA B cells. To determine whether infection affected IgM ANCA levels, we studied non-AAV patients with bacterial endocarditis or Staphylococcus aureus bacteraemia and measured IgM ANCA levels over time. IgM ANCA is detectable in both healthy individuals and patients with AAV and the titres decreased with increasing age. Circulating IgM ANCA B cells were identified by ELISpot. In the presence of infection, we could not find a significant change in IgM ANCA levels. We report the presence of low-level specific IgM ANCA in the sera of healthy individuals and in patients with ANCA-associated vasculitis. Bacterial infection did not affect the level of IgM ANCA in this small study.

Roof cavity dust as an exposure proxy for extreme air pollution events

Understanding exposure to air pollution during extreme events such as fire emergencies is critical for assessing their potential health impacts. However, air pollution emergencies often affect places without a network of air quality monitoring and characterising exposure retrospectively is methodologically challenging due to the complex behaviour of smoke and other air pollutants. Here we test the potential of roof cavity (attic) dust to act as a robust household-level exposure proxy, using a major air pollution event associated with a coal mine fire in the Latrobe Valley, Australia, as an illustrative study. To assess the relationship between roof cavity dust composition and mine fire exposure, we analysed the elemental and polycyclic aromatic hydrocarbon composition of roof cavity dust (<150μm) from 39 homes along a gradient of exposure to the mine fire plume. These homes were grouped into 12 zones along this exposure gradient: eight zones across Morwell, where mine fire impacts were greatest, and four in other Latrobe Valley towns at increasing distance from the fire. We identified two elements-barium and magnesium-as 'chemical markers' that show a clear and theoretically grounded relationship with the brown coal mine fire plume exposure. This relationship is robust to the influence of plausible confounders and contrasts with other, non-mine fire related elements, which showed distinct and varied distributional patterns. We conclude that targeted components of roof cavity dust can be a useful empirical marker of household exposure to severe air pollution events and their use could support epidemiological studies by providing spatially-resolved exposure estimates post-event.

Exposure to air pollution during the first 1000 days of life and subsequent health service and medication usage in children

BACKGROUND

Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited.

OBJECTIVES

We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM_2.5) from coal mine fire emissions and the frequencies of general practitioner attendances and dispensations of prescribed asthma inhalers, steroid skin creams, and antibiotics during the first year of life; 2. infant exposure and those outcomes during the year following the fire.

METHODS

All participants were recruited from the Latrobe Valley of Victoria, Australia. Participants' 24-h average and hourly peak mine fire-specific PM_2.5 exposures from 09/02/2014 to 31/03/2014 were estimated using chemical transport modelling. Outcome data were obtained from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme from each child's birth to 31/12/2016. We used negative binomial and logistic regression models to independently assess risks of the outcomes associated with every 10 and 100 μg m^-3 increase in average or peak PM_2.5 exposure, respectively, while adjusting for potential confounders.

RESULTS

We included 286 of 311 children whose parents consented to be linked, comprising 77 with no exposure, 88 with intrauterine exposure and 121 with exposure in infancy. 10- and 100- μg m^-3 increases in average and peak PM_2.5 exposure during infancy were associated with greater incidence of antibiotics being dispensed during the year following the fire: the adjusted incidence rate ratios were 1.24 (95% CI 1.02, 1.50, p = 0.036) and 1.14 (1.00, 1.31, p = 0.048) respectively. No other significant associations were observed.

CONCLUSION

Exposure to coal mine fire emissions during infancy was associated with increased dispensing of antibiotics. This could reflect increased childhood infections or increased prescriptions of antibiotics in the year following the fire.

Potential tenfold drug overdoses on a neonatal unit

Nearly one third of intravenous drug prescriptions on a neonatal unit were for doses less than one tenth of a single drug vial. Tenfold drug errors in prescribing are well documented and with the continued use of vials containing adult size doses, great potential exists for serious administration errors.

Testing methods for mitigation of tree dieback in Tasmanian dry eucalypt forests and woodlands

Dieback of eucalypts is a widespread phenomenon in subhumid eastern Australian vegetation remnants. It has been shown to have a multifactorial etiology, including drought, vertebrate and invertebrate predation and stock impacts. At three dieback sites in subhumid Tasmania experimental plots were established in the period 1996?1998 to test the single and interactive effects of possum exclusion, watering and stock exclusion on the health of trees, and to determine the influence of fencing on soil bulk density and eucalypt regeneration. At two sites the exclusion of possums mitigated dieback over the two year measurement period, although at one site the trees continued to deteriorate. At the third site there was no impact of any of the treatments, and changes in health over the experimental period related to tree size, indicating a self-thinning process. Soil penetration resistance decreased in the fenced treatment at all sites, and eucalypt regeneration was encouraged by fencing at two sites. Although the results of the experiment are not consistent with moisture deficiencies as a causal factor in dieback, this may relate either to a lack of severe drought during the measurement period, which followed a decade of such drought, or to the magnitude and/or application method of the watering. The results of the experiment indicate that, at some sites, the exclusion of possums will improve tree health, and that the exclusion of stock can improve tree regeneration and soil conditions.