bluuebunny/crossref_metadata_2025 huggingface dataset:
P869 Prevalence of Depression and Anxiety before and during the COVID-19 Pandemic in Puerto Ricans with Inflammatory Bowel Disease
Authors: Rivera Roman J G , López-Marte P , Vallejo-Tagle G , Hernández-Torres J , Torres E A , Viñas-Joy G
Published: January 2023

Background

A higher rate of anxiety and depression is present in patients with inflammatory bowel disease (IBD). The COVID-19 pandemic has negatively impacted mental health in the general population. This study aims to compare the prevalence of depression and anxiety in patients with IBD during the pre-pandemic period and the pandemic period, and to explore trends in patients' specific IBD-related needs during the pandemic era.

Methods

Data was collected from subjects with IBD in two different timepoints: 2016 and 2021-2022. Self-administered questionnaires were given to adults with confirmed IBD attending an academic IBD Clinic. Data collected included demographic information, Patient Health Questionnaire-9 (PHQ-9) for major depressive disorder (MDD), General Anxiety Disorder-7 (GAD-7) questionnaire and subject’s need for referrals to other services such as nutrition, pain management, mental health services. Scores of 10 or more in the GAD-7 or PHQ-9 indicate need for professional evaluation. Statistical analysis was performed using R Studio v.4.2.1. This study is approved by the UPR MSC-IRB.

Results

Two hundred-fifty-two questionnaires were collected in 2016 and 196 during the 2021-22 pandemic period. The majority of subjects were male (54.6%) and had Crohn’s disease (69.9%). Mean ± SD age was 40.2 ± 14.6. In the PHQ-9, 33.7% (n=91) during 2016, and 16.33% (n=32) during 2021-22 screened positive for MDD. For the GAD-7, 30.7% (n=83) during 2016, and 12.76% (n=25) during 2021-22 screened positive for generalized anxiety disorder (GAD). Sex and age differences were not detected for MDD and GAD screening, with exception for age differences in MDD during 2021-2022. The most frequent needs for referrals during 2021-2022 were nutrition evaluation (n = 74), access to IBD education (n = 73), psychology services (n = 71) and participation in research for IBD studies (n = 66)

Conclusion

The frequency of depression and anxiety in Puerto Ricans with IBD during the pandemic period was lower than pre-pandemic. Possible factors related to this include active use of telemedicine providing regular follow-up, integrated psychological support as part of the regular clinic services, and access to information regarding COVID-19 and IBD.
P877 Risk of gastric cancer among patients with incident ulcerative colitis: A nationwide population based study
Authors: Kim H S , Kim H , Kim K
Published: January 2023

Background

Few studies have investigated the risk of gastric cancer (GC) in ulcerative colitis (UC), with inconsistent results. This study assessed GC risk in patients with newly diagnosed UC.

Methods

Using claims data of the Korean National Health Insurance (NHI) from January 2006 to December 2015, we identified incident UC patients. UC was defined using the International Classification of Diseases-10 codes and UC-specific prescriptions. Age and sex-matched non-UC individuals during the same period were randomly selected as controls from the NHI database. Hazard ratios (HRs), adjusted for covariates, were calculated using multivariate Cox proportional-hazards regression.

Results

From 2006 to 2015, 30,546 patients diagnosed with UC and 88,829 matched non-UC individuals were included. GC developed in 77 (0.25%) UC and 383 (0.43%) non-UC individuals. The HR for GC in UC patients was 0.60 (95%CI: 0.47–0.77) compared to non-UC individuals. When stratified according to age and sex, the HR for late-onset UC (≥40 years) was 0.63 (95%CI: 0.49–0.80) compared to non-UC for the same age, and the HR of male UC patients was 0.55 (95%CI: 0.33– 0.89), compared to non-UC men. Among UC patients, the HR for age ≥40 years was 23.37 (95%CI: 6.38–85.64).

Conclusion

UC patients had a decreased GC risk compared to non-UC individuals. In particular, UC patients aged ≥40 years and male UC patients had a decreased risk of GC compared to non-UC individuals. However, among UC patients, late-onset UC (≥40 years) had a higher risk of GC than early-onset UC.
P882 Regional differences in biologic and surgical treatment of inflammatory bowel disease in Norway 2011–2019
Authors: Anisdahl K , Lirhus S S , Medhus A W , Moum B , Melberg H O , Høivik M L
Published: January 2023

Background

We have previously reported regional differences in biologic and surgical treatment for inflammatory bowel disease (IBD) patients diagnosed 2010–2012. In this study, our aim was to explore whether regional differences in the use of biologics and surgery were consistent over time.

Methods

We performed a nationwide, observational study using linked data from the Norwegian Patient Registry (NPR) and the Norwegian Prescription Database (Nor-PD). Incident cases were defined as ≥2 IBD diagnosis codes in the NPR, or ≥1 IBD diagnosis code in the NPR and ≥2 IBD prescriptions in the NorPD. Kaplan-Meier estimates were used to calculate time from diagnosis to first biologic and/or major surgical event. The log-rank test was used to test for statistical significance. Patients were stratified by health region affiliation (Northern [NR], Central [CR], Western [WR] and South-Eastern [SER]), and grouped as Cohort I (2011–2014) or Cohort II (2015–2019) depending on year of diagnosis.

Results

We included 7306 patients with Crohn’s disease (CD) and 13688 patients with ulcerative colitis (UC). Results are shown in Figure 1 (CD) and Figure 2 (UC). All cumulative incidences (%) reported below are measured five years after diagnosis.

CD patients:

In Cohort I, SER had the highest (40%) and CR had the lowest (35%) cumulative incidence of patients starting biologics (p=0.02). In Cohort II, WR had the highest cumulative incidence (53%), and differed significantly from NR and SER (p≤0.04).

In Cohort I, there were large regional differences in surgical treatment. NR had lower use of surgery (11%) than all other regions (p≤0.03). In Cohort II, the proportion undergoing surgery had decreased in all regions, except in NR (14%). The use of surgery was lowest in SER (12%), and differed significantly from CR and WR (p≤0.03).

UC patients:

In Cohort I, SER had the highest cumulative incidence of patients starting biologics (18%), and differed significantly from CR and WR (p≤0.01). In Cohort II, the use of biologics was lower in CR (20%) when compared to all other regions (p≤0.01), while differences between the three other regions were non-significant.

CR had the largest proportion of patients undergoing surgery in both Cohort I (8%) and Cohort II (7%), and differed significantly from all other regions in Cohort I (p≤0.05), and SER and WR (p<0.01) in Cohort II. Differences between the three other regions were non-significant.

Conclusion

The study revealed important, sustained regional differences in the use of both biologics and surgery, especially for UC. Pursuing whether geographical treatment variation impacts outcome will aid in ensuring equal access to best clinical care.
P886 Clinical course and therapeutic management 5 years after diagnosis, in a cohort of Spanish patients with Crohn′s disease diagnosed in the 21st century
Authors: De Castro Parga M L , Dagraza M , Hernández V , García-Morales N , Pineda J R , Rodriguez-Prada I
Published: January 2023

Background

There are now serious doubts about the validity of the classical understanding of the natural history of Crohn′s disease (CD), as it is mainly based on retrospective studies that used old phenotypic classifications and that were carried out in a period of time when there were no biological drugs and little use of immunosuppressants. We aimed to evaluate the natural disease course 5 years after diagnosis of a cohort of CD patients diagnosed in the 21 st century in the North-West of Spain,

Methods

We performed an epidemiological, descriptive, prospective, incident cohort, population-based study. Patients diagnosed with Crohn's disease between 2010 and 2011 in Vigo healthcare area, belonging to the Epi-IBD study (formerly EpiCom) were followed up until December 31, 2016. Their electronic medical records were reviewed, and changes in location and behaviour CD phenotypic patterns, treatments received, as well as the presence of outbreaks with and without hospitalisation and the need for surgery were recorded.

Results

Between 2010 and 2011, 91 patients were diagnosed with CD, but only 75 of them were followed up until 2016. At 5 years, 20% CD patients had changed location and 34.7% their behaviour. Patients with ileal L1 or colonic L2 involvement at diagnosis maintained initial CD location more frequently (94.3% and 82.4%, respectively), but 31.6% ileocolonic L3 decreased location to L1 (15.8%) or L2 (15.8%) (p<0.05). (Figure 1). Even more, patterns B3 at diagnosis greatly modified during follow-up: 22.2% changed to B1, 44.4% to B2 and 22.2% to B2-B3 (p<0.05 for B1 and B2). (Figure 2 ). Initial location L1 was associated with stenosing pattern at 5 years follow-up (p<0.05), and both phenotypes (L1 and B2) with need for surgery (p<0.05).

Five years after diagnosis 54.7% of CD patients had received 5-ASA, 64% local corticosteroids, 74.7% systemic corticosteroids, 77.3% immunosuppressants, 33.3% biologics, and 20% surgery. At that time 48% had suffered an outbreak and 49.3% needed to be hospitalized. There were differences between the initial phenotypic pattern and use of biologics in the first year of follow up (55.6% of patients with B3 (p<0.05 compared to B1 and B2) and 100% B2-B3 required this therapy compared to 20% of B2 and 18% B1, with no differences at 5 years.

Conclusion

Natural history of Crohn′s disease in the 2010-2011 Vigo cohort showed an improvement in their behaviour and location 5.years after diagnosis, with a decrease in penetrating behaviour and ileocolonic location. This fact could be explained by and early and high use of biologics drugs in the more aggressive phenotypes.
P901 A genetic analysis of familial aggregation in Inflammatory Bowel Disease multiplex families
Authors: Jans D , Lee H S , Ferrante M , Vermeire S , Cleynen I
Published: January 2023

Background

Relatives of patients with inflammatory bowel disease (IBD) have a higher risk to develop IBD than the general population. In some families, even a remarkably high prevalence of disease is found. Here, we aim to determine the role of the known IBD risk loci in familial aggregation of disease, as well as to study if there are common variants specific to familial IBD.

Methods

Imputed immunochip genotypes of 55 families [157 Crohn’s disease (CD), 29 ulcerative colitis (UC) and 138 unaffected relatives] that have at least three affected, first-degree relatives were used. A sporadic dataset (1705 CD, 917 UC, 873 controls) was used for comparison. For each individual, a polygenic risk score (PRS) was calculated with PRSice based on the IBD summary statistics of de Lange et al (2017), a p-value threshold ≤0.01 and MAF≥0.01. The mean PRS of all relatives of one family is denoted the familial PRS. Family-based association analyses were performed with SAIGE. The significance threshold for association used was p<1e-4.

Results

As a group, unaffected relatives have a lower PRS than affected relatives (p=1.36e-5, β(se)=-0.60(0.14)), but still higher than unrelated controls (p=2.07e-4, β(se)=0.39(0.11))(fig 1). Twenty-four families have a familial PRS that is higher than the mean PRS of sporadic cases, and seven families have a familial PRS that is lower than the mean PRS of unrelated controls, the low PRS families (fig 2A). In most families, the affected members have a higher mean PRS than the unaffected members (fig 2B). This relationship however is sometimes reversed, especially in the low PRS families. SAIGE found nine variants to be associated with familial IBD (fig 3A, table 1). Two independently associated variants, rs2241130 in IL1RL2 (p=1.19 e-5, β(se)=1.21(0.28)) and rs144641193 in IL1RL1 (p=8.23e-5, β(se)=1.29(0.33)) reside in a known IBD locus (IL18RAP). Some other identified variants were also located in genes previously implicated in IBD, either through GWAS [rs72781786 in PRKCQ (p=2.93e-5, β(se)= -0.95(0.23))], or via functional studies (rs2242601 in EPHA1 and rs2272766 in CTSB). A restricted analysis of the low PRS families identified only one significant variant: rs11579543, located between RPE65 and DEPDC1 (p=6.12e-5, β(se)=-2.71(0.68))(fig 3B, table 1).

Conclusion

Our analysis indicates that common risk variants play an important role in familial aggregation of disease in many multiplex families. Some families however have a very low polygenic risk, indicating shared environmental factors might be relatively more important, or genetic factors not captured by the score, e.g. rare variants, may have contributed. Also, a few loci are specifically implicated in familial IBD, some related to the immune system, e.g. CLECL1 and CD69.
P915 Uncovering the role of Archaea in the pathogenesis of Inflammatory bowel disease
Authors: Singh P , Murugesan S , Kumar M , Saadaoui M , Elhag D A , Hendaus M A , Ibrahim N , Al-Mudhaka F , AbuHazima K , Akobeng A , Elawad M , Al Khodor S
Published: January 2023

Background

Microbial dysbiosis is a major factor that contributes to the course of Inflammatory Bowel Disease (IBD), a complex class of relapsing-remitting chronic inflammatory diseases. The body's overall homeostasis is significantly influenced by the human microbiota, which is a diverse population of bacteria, viruses, fungi, protists, and archaea. Recent research shows that archaea can affect both health and disease, by directly interacting with the host as well as other members of the microbial community. Although the role of bacteria, viruses, and fungi has already been studied, the archaeome remains the under-discovered part of the gut microbiota, especially in the context of IBD.

Methods

In this study, we profiled the gut archaea using archaeal 16S rRNA gene region in a cohort of pediatric patients with different forms of IBD including Ulcerative colitis (UC), Crohn’s disease (CD), unclassified IBD (IBDU) and healthy controls. We determined the compositional, diversity, and taxonomic alterations of archaea in pediatric patients with IBD and compared to healthy controls.

Results

Euryarchaeota, and Crenarchaeota, were the major archaeal phyla identified in our samples, other minor phyla identified were Halobacterota and Thermoplasmatota. At the genus level, Methanobrevibacter and Methanosphaera were the most abundant archaea, respectively. Overall, we did not observe any significant difference in the archeal alpha diversity within the various groups. There was however a significant difference between the overall community structure of the archaea between controls and IBD patients (p<0.05).

Conclusion

A thorough understanding of the role played by the archaea during the pathogenesis of IBD may open the door to the identification of new processes and, ultimately, the development of creative therapeutic targets that can complement the currently used treatments for IBD patients.
P923 The pre-treatment gut microbiome at adult IBD inception: Initial signals from the Birmingham inception cohort
Authors: Rimmer P , Cheesbrough J , Iqbal A , Sharma N , Iqbal T , Quraishi N
Published: January 2023

Background

Gut microbiome disruption and ‘dysbiosis’ is an established characteristic of IBD. The lack of treatment naïve and prospective longitudinal microbiome data makes it challenging to separate the influence of potential confounders. We present our preliminary microbiota analysis from a treatment naïve cohort of IBD patients seen in our rapid-access integrated clinical and research IBD inception clinic.

Methods

Stool collected in DNA Genotek OM-200 kits is brought to the first face to face pre-diagnosis outpatient review, alongside faecal calprotectin (FCAL). Metadata is collected prospectively with repeat samples collected longitudinally. Healthy controls were recruited separately. Stool microbial DNA was extracted with subsequent 16S rRNA PCR and sequencing. Diversity analysis and taxonomic classifications were performed in line with the QIIME2 workflow. Taxa with linear discriminant analysis (LDA) >2 at a P<0.05 were considered significant on LDA effect size (LEfSe) analysis. Correlation was evaluated with Kendall’s Tau coefficient.

Results

Across sites, our clinics have seen 609 patients, with 256 enrolled in active research. We have banked 200 pre-treatment OM-200 stool samples from this cohort, with a further 45 samples from follow up visits. Of the first 49 samples sequenced, 31 were diagnosed with IBD (UC=18; CD=13). An independent cohort of 18 healthy controls were used for comparison. Median FCAL in the IBD cohort was 915ug/g (IQR 1499ug/g). Microbial composition in the IBD patients as assessed by Bray-Curtis distance matrix was significantly different compared to healthy controls (P<0.001). Alpha diversity (Shannon diversity index) was significantly lower in the IBD cohort when compared to healthy controls (P=0.01, Figure 1).

These differences in alpha and beta diversity were also observed with IBD subtypes (P<0.01). Patients with IBD had significantly lower relative abundance of multiple taxa belonging to the families Clostridiaceae, Lachnospiraceae, and Coriobacteriaceae and genus Ruminococcus, Butyricicoccus, Bifidobacterium, Blautia and Dorea, as displayed in Figure 2. The genuses Fusobacterium, Peptostreptococcus and Subdoligranulum positively correlated with FCAL levels whilst the genus Lachnobacterium negatively correlated (both P<0.05).

Conclusion

We present our preliminary index analysis of microbiome data in a unique treatment naïve IBD cohort. Our ongoing prospective longitudinal collection of clinical, microbial, immunological and metabolomic datasets will facilitate understanding of potential baseline prognostic indicators, predictive biomarkers for treatment response and relationship with disease activity. A further large batch of samples are submitted for sequencing and additional insights will follow.
P925 Deep functional assessment of the colonic mucosa-associated microbiota in Crohn’s disease and health identifies pro- and anti- inflammatory secretomes and associated bacterial consortia. The ENIGMA study
Authors: Teh J J , Kang S , Zhang J , Hu J , Hamilton A L , Wilson-O’Brien A , Trakman G L , Lin W , Ching J , Sung J J Y , Yu J , Ng S C , Kamm M A , Morrison M
Published: January 2023

Background

Gut microbial dysbiosis and dysregulated host immune responses are key factors implicated in Crohn’s disease pathogenesis. However, the nexus between the mucosa-associated microbiota (MAM) and epithelial cell immune response(s) remains poorly understood. Here, we used in vitro cultures of LS174T human epithelial cells to examine the inflammatory tenor of the secretomes from colonic MAM recovered from healthy and Crohn’s disease subjects in Hong Kong (where Crohn’s disease incidence is low but increasing) and Australia (globally high incidence).

Methods

Biopsies from healthy (21 HKG, 20 AUS) and Crohn’s disease (30 HKG, 29 AUS) subjects were collected from the right colon and the MAM propagated from tissue using a habitat simulating medium. After 24h of growth, cultures were centrifuged, and the supernatant (secretome) fraction filter sterilised. For the immune assays, the LS174T cell line was transfected with recombinant lentivirus to provide an NF-κB:luc (luciferase) reporter gene fusion (Cellomics Technology, MD, USA) and aliquots used to inoculate 96-well microtiter plates and cultured for 24 h under standard conditions. Cultures were then challenged for 4 hours with 0.1 vol of a MAM secretome. Luc-bioluminescence was measured as a marker of NF-κB transcriptional activity from the individual wells and normalised to the reporter gene response from cells challenged with sterile, uninoculated bacterial medium.

Results

Across the 100 MAM secretomes tested, the median score for NF-ĸB activation was 104.4% relative to the medium control, suggesting most of the secretomes possessed a net neutral effect, with the 1st and 4th quartiles deemed stimulatory (>126% baseline activity) and suppressive (<92% baseline activity), respectively. There was no significant relationship found between a secretome’s inflammatory score and its corresponding α-diversity metric, nor was there any distinct clustering of the secretomes according to country of origin and/or case-control groups. However, the relative abundances of Roseburia spp. and Clostridium innocuum were significantly enriched in those consortia producing immunostimulatory secretomes. In contrast, the relative abundances of Erysipelatoclostridium ramosum, Ruminococcus gnavus, Parabacteroides distasonis, Blautia sp. CAG257 and Bacteroides xylanisolvens were enriched, and that of Coprococcus comes depleted, in those microbial consortia producing immunosuppressive secretomes.

Conclusion

Specific bacterial taxa drive the functional signature of the colonic MAM secretome in an immunostimulatory or suppressive direction.

The ENIGMA study is supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust
N01 Using Item Response Theory to improve the efficiency of the Crohn and Colitis Knowledge score for patients with Inflammatory Bowel Disease
Authors: Comoretto R , Azzolina D , Monaco E , Martinato M
Published: January 2023

Background

Patient knowledge varies widely in inflammatory bowel disease (IBD), but knowledge of the disease and its management is essential for patients with chronic disorders and can improve health-related quality of life, coping ability, self-care skills, and adherence and can positively impact several outcomes including disease activity and direct and indirect costs. To assess patients’ knowledge is available the Crohn’s and Colitis Knowledge Score (CCKNOW), but can be biased by subjects’ abilities, attitudes, or other latent traits not considered in its validation process. The purpose of this study was to reassess the index developed for measuring IBD patients’ knowledge using the Item Response Theory (IRT).

Methods

IBD patients with a recent (<18 months) diagnosis, stable therapy, and no previous IBD-related surgery have been asked to answer the 30 items described in the validation of the CCKNOW questionnaire. Measures of between-item relationships (scalability) and unidimensionality (single major trait) were estimated prior to applying a 2-PL logistic IRT model across all 30 items. To evaluate a questionnaire with improved item information, low discriminatory items were removed by order of discrimination value, with the lowest discriminating item<1.7 removed before the 2-PL model was re-estimated with the remaining items. The process was then repeated twice to remove poorly discriminating and inefficient scaling items. The difficulty parameters have also been estimated in the 2-PL logistic IRT model. Cronbach’s alpha (α) was used as a guide to measuring whole-scale reliability.

Results

49 patients (17 females, 21 Crohn’s Disease) were enrolled, with a median (IQR) age of 37 (29-47) years, a median disease duration of 334 (212-426) days and a median number of outpatients visit performed of 1 (1-3). Only 6 subjects involved in the study were graduated; the median level of health-related quality of life (S-IBDQ) was 47,7 (30,3-60,9). About 50% of subjects in both groups were in disease remission. Based on discrimination ability, item number 4, 10, 11, 22, 29, and 30 could be excluded because demonstrated a discrimination ability below 1.7. The Cronbach’s alpha for the 24 items questionnaire indicates a suitable internal consistency (α = 0.84). Based on difficulty parameters, the most difficult items were the 25th and 14th, and the easiest were the 19th and 21st.

Conclusion

This is the first study systematically to interrogate a commonly used index for patients’ IBD knowledge, using robust psychometric and statistical methodologies. IRT is a valid and robust psychometric methodology, which may be used to analyse patient questionnaires. The revised CCKNOW questionnaire provides optimum trait information.
N14 The satisfaction of IBD patients’ nursing care in biological therapy. Observational study
Authors: Napolitano D , Cocchieri A , Orgiana N , Fanali C , Poscia A , Schiavoni E , Bernabei T , Amatucci V , Turchini L , Durini E , Strazzeri M , Laterza L , Lopetuso L R , Mora V , Papa A , Pugliese D , Gasbarrini A , Scaldaferri F
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) management requires a multidisciplinary team, in which nurses have a pivotal role. Although patient care is the main focus of all clinical actions, satisfaction with healthcare professionals is an aspect of growing importance that has been related to positive clinical outcomes. In this setting, evaluating the satisfaction of the nursing provided could be a pivotal component for the satisfaction of the patient, particularly in the IBD unit, where patients in intravenous (iv) biological therapy spend a major amount of time compared to non-complicated acute hospitalization. The aim of the study is to measure the overall quality of nursing care perceived by IBD patients receiving biological therapy. Furthermore, the opinion of loyal and non-loyal patients was measured at the IBD center as a secondary objective

Methods

Cross-sectional observational study to assess nursing satisfaction through the Newcastel Satisfaction Nursing Scale (NSNS). The instrument consists of two separate scales: the Scale of Nursing Care Experiences ("A") and the Scale of Nursing Satisfaction ("B"). The patient who is followed by the center, at the time of administering the questionnaire, for a period of more than 12 months, will be considered in the arm long follow-up while all patients treated at the center for a period ranging from 0 to 12 months, in those short follow-up. The study protocol was approved by the Ethics Committee.

Results

Two hundred and thirty-four in biological therapy, questionnaires were administered, of these, with an excellent response rate, 200 (86.2%). The result was an overall level of satisfaction compared to the first scale "A", equal to 88.4%, while for the second scale "B" the total result was 90.7%. By analyzing the satisfaction of nursing care received, differentiating the patient between short and long follow-up, the results seem to confirm how the patient in the long follow-up positively affects satisfaction, significantly in the first scale "A" 90.5% vs 82.9% p = 0.0002 and in the second scale "B" 92.5% vs 86% p = 0.0001. The lowest average satisfaction scores were recorded in the doctor-nurse ratio and in the communicative aspects, while the highest scores are related to the empathic components and professional competence of nursing.

Conclusion

In conclusion, the level of satisfaction of patients in biological therapy is high and this seems to increase significantly with time and with patient loyalty to the center (Fig. 1). Further research projects could aim to fill gaps in knowledge and validate scales of assessment of nursing skills in the field of IBD, including by structuring studies with a control cohort.
N24 At Home Calprotectin a United Kingdom Patient Perspectives and Tertiary Center Experience
Authors: Avery P , Adio J , Cornford R , Younge L
Published: January 2023

Background

Home faecal calprotectin tests (HFCT) have been available for some years with slow uptake to use in the UK. During the Sars-Cov-2 pandemic use increased as it allowed a measure of disease activity when lab testing in some areas ceased. In a United Kingdom tertiary referral IBD unit, CalproSmart was introduced in 2020. We analysed completion rates of HFCT and the barriers and enablers patients experienced in its use.

Methods

Data from the CalproSmart portal was analysed. Total patients registered was compared against the number that had completed a test. Age, sex and return rates per annum as well as local or out of area patients were included.

All patients who enrolled to receive a HFCT were sent an anonymous online questionnaire using MS Forms. Descriptive statistics were used to analysis the results with a thematic analysis of free form text answers.

Results

A total of N=304 patients were enrolled on the CalproSmart portal over a three-year period from October 2020 until July 2021. HFCT was completed by 118 (39%) of these patients. Completion was highest in 2020 78% of patients who enrolled on the system completed a HFCT. There was a slight trend towards females being more likely to complete at 23% versus 16% of males. There was no sign of age as a determinant to completion. Of the 118 patients who completed the HFCT 84 (71%) were out of local area patients and 34 (29%) local patients.

There were 54 (17%) questionnaires returned. All but 4 (7%) respondents had attempted or completed the HFCT. When asked why they wanted to try a HFCT 39 (72%) patients indicated not having to go to hospital/GP as their primary reason with getting an instant result 29 (54%) and seeing your own result 27 (50%) coming in next. 13 (24%) cited more disease control as a reason to try the test. People found the test mostly easy to use but when comparing overall happiness with the HFCT kits 9 people reported they were somewhat unhappy or unhappy. People were either happy or unhappy with the HFC test usability is a theme that is generated as a barrier and a facilitator for some (see figure 1). When asked which they would prefer to do in future CalproSmart at home or bring your sample to either your GP or hospital n=45 (83%) preferred HFCT.

Figure 1 Q 12 Overall how happy were you with CalproSmart home calprotectin kit? Free text answer comparison

Conclusion

During the pandemic HFCT were popular and out of area patients were more likely to complete the kits. Despite the low return rates those that chose to complete HFCT were in most of cases happy to continue HFCT. With, attention to patient selection and enhanced training on the HFCT there is a case for the continued use in services that have altered significantly since the pandemic.
N27 Living well with IBD; An online survey from the UK
Authors: Radford S , Sawyer R
Published: January 2023

Background

Chronic disease, such as inflammatory bowel disease (IBD), is a major cause of health problems in the U.K. Finding ways to best serve chronically ill patients is amongst the most important challenges facing the health care system. In order to better understand how to best support patients with IBD we need to understand what is important to them. The aim of this survey was to investigate the opinions and experiences of people living with IBD in relation to what they think are the most important factors of living with IBD and what it meant to live well with IBD.

Methods

An online survey, using Microsoft forms was created. Participants of any age or gender who were living with IBD were invited to take part via invitations and advertisements through social media (Twitter). There were three questions asked with free text responses to enable us to gather in depth data relating to personal experiences.

Results

45 responses were collected anonymously via the online survey. Symptom burden was reported by 42 participants to be the most impactful aspect of living with IBD, impacting on work, education, social and leisure activities as well as sex and intimacy. Whilst 26 participants reported that ‘living well’ with IBD was to achieve complete symptom resolution, more participants spoke about having manageable symptoms without fluctuation. Achieving a ‘normal’ level of daily activity was important to participants.

Conclusion

This survey found that most patients focus on symptom resolution or better symptoms management when considering living well with IBD. Patients report that the most impactful aspect of IBD is managing symptoms alongside other daily tasks such as work, education, social and leisure activities. Further exploration in order to better understand the magnitude of symptom resolution that would be acceptable or preferable for people living with IBD is warranted.
The plateauing of cognitive ability among top earners
Authors: Keuschnigg Marc , van de Rijt Arnout , Bol Thijs
Published: January 2023

Are the best-paying jobs with the highest prestige done by individuals of great intelligence? Past studies find job success to increase with cognitive ability, but do not examine how, conversely, ability varies with job success. Stratification theories suggest that social background and cumulative advantage dominate cognitive ability as determinants of high occupational success. This leads us to hypothesize that among the relatively successful, average ability is concave in income and prestige. We draw on Swedish register data containing measures of cognitive ability and labour-market success for 59,000 men who took a compulsory military conscription test. Strikingly, we find that the relationship between ability and wage is strong overall, yet above €60,000 per year ability plateaus at a modest level of +1 standard deviation. The top 1 per cent even score slightly worse on cognitive ability than those in the income strata right below them. We observe a similar but less pronounced plateauing of ability at high occupational prestige.
Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage
Authors: Saenz Joseph L , Milani Sadaf Arefi , Mejía-Arango Silvia
Published: January 2023

Objectives

Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico.

Methods

Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression.

Results

Among those in the lowest quartile of expected cognition, a more internal LOC (β = 0.32 [men] and β = 0.44 [women]) and conscientious personality (β = 0.39 [men] and β = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender.

Discussion

Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.
School lunchboxes as an opportunity for health and environmental considerations: a scoping review
Authors: Lalchandani Neha Kishan , Poirier Brianna , Crabb Shona , Miller Caroline , Hume Clare
Published: January 2023

Very little research has focussed on children’s school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children’s lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes—particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children’s health and sustainability behaviour, and mobilizing their pro-environmental agency.
Mixed method evaluation of a clinic waiting room–based health education program in the Dominican Republic
Authors: Cohen S , Halpern M , Stonbraker S
Published: January 2023

Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room–based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees’ change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room–based education talks improve knowledge and provide suggestions for similar interventions.
A qualitative exploration of stakeholder perspectives on the implementation of a whole school approach to mental health and emotional well-being in Wales
Authors: Brown R , Van Godwin J , Edwards A , Burdon M , Moore G
Published: January 2023

Early intervention to support mental health and well-being of school-aged children may be of significant benefit in preventing escalation of mental health problems in later life. While there are limitations to current understanding of the best ways for schools to support mental well-being, a whole school approach (WSA), involving all those who are part of the school system in creating and sustaining a supportive environment where health is prioritized, may be effective. This research explored stakeholder views of this approach, as part of a contract commissioned by the Welsh Government to conduct an evaluability assessment of a WSA. Semistructured focus groups and interviews were completed with stakeholders from the health and education sectors, as well as parents, to explore how a WSA may operate in a Welsh context and barriers and facilitators to potential implementation and outcomes. Findings suggest that existing pressures on schools may impact implementation of a WSA, with school staff already time poor and many staff experiencing their own mental well-being challenges. Implementation may be supported by clear guidance at local and national levels, funding for staff time and training and stakeholder involvement at all stages. Long-term monitoring and evaluation are also needed to understand system changes.
SCN1A: bioinformatically informed revised boundaries for promoter and enhancer regions
Authors: Pagni Susanna , Custodio Helena Martins , Frankish Adam , Mudge Jonathan M , Mills James D , Sisodiya Sanjay M
Published: January 2023

Pathogenic variations in the sodium voltage-gated channel alpha subunit 1 (SCN1A) gene are responsible for multiple epilepsy phenotypes, including Dravet syndrome, febrile seizures (FS) and genetic epilepsy with FS plus. Phenotypic heterogeneity is a hallmark of SCN1A-related epilepsies, the causes of which are yet to be clarified. Genetic variation in the non-coding regulatory regions of SCN1A could be one potential causal factor. However, a comprehensive understanding of the SCN1A regulatory landscape is currently lacking. Here, we summarized the current state of knowledge of SCN1A regulation, providing details on its promoter and enhancer regions. We then integrated currently available data on SCN1A promoters by extracting information related to the SCN1A locus from genome-wide repositories and clearly defined the promoter and enhancer regions of SCN1A. Further, we explored the cellular specificity of differential SCN1A promoter usage. We also reviewed and integrated the available human brain-derived enhancer databases and mouse-derived data to provide a comprehensive computationally developed summary of SCN1A brain-active enhancers. By querying genome-wide data repositories, extracting SCN1A-specific data and integrating the different types of independent evidence, we created a comprehensive catalogue that better defines the regulatory landscape of SCN1A, which could be used to explore the role of SCN1A regulatory regions in disease.
Is evidence of effectiveness a driver for clinical decision support selection? A qualitative descriptive study of senior hospital staff
Authors: Baysari Melissa T , Van Dort Bethany A , Stanceski Kristian , Hargreaves Andrew , Zheng Wu Yi , Moran Maria , Day Richard , Li Ling , Westbrook Johanna , Hilmer Sarah
Published: January 2023

Limited research has focused on understanding if and how evidence of health information technology (HIT) effectiveness drives the selection and implementation of technologies in practice. This study aimed to explore the views of senior hospital staff on the role evidence plays in the selection and implementation of HIT, with a particular focus on clinical decision support (CDS) alerts in electronic medication management systems. A qualitative descriptive design was used. Twenty senior hospital staff from six Australian hospitals in New South Wales and Queensland took part in a semistructured interview. Interviews were audio-recorded and transcribed, and a general inductive content analysis approach was used to identify themes. Participants acknowledged the importance of an evidence base, but reported that selection of CDS alerts, and HIT more broadly, was rarely underpinned by evidence that technologies improve patient care. Instead, investments in technologies were guided by the expectation that benefits will be achieved, bolstered by vendor assurances, and a perception that implementation of HIT is unavoidable. Postponing implementation of a technology until an evidence base is available was not always feasible. Although some technologies were seen as not requiring an evidence base, stakeholders viewed evidence as extremely valuable for informing decisions about selection of CDS alerts. In the absence of evidence, evaluation or monitoring of technologies postimplementation is critical, particularly to identify new errors or risks associated with HIT implementation and use. Increased transparency from vendors, with technology evaluation outcomes made directly available to healthcare organizations, may result in less reliance on logic, intuition, and vendor assertions and more evidence-based selection of HIT.
Implementing a screening algorithm for early recognition of sepsis in hospitalized children: a quality improvement project
Authors: Feinstein Yael , Kogan Slava , Dreiher Jacob , Noham Ayelet , Harosh Shimrat , Lecht Jenia , Sror Tzipi , Cohen Nurit , Bar-Yosef Eileen , Hershkowitz Eli , Lazar Isaac , Schonmann Yochai , Greenberg David , Danino Dana
Published: January 2023

Sepsis is a leading cause of mortality in children. Utilizing a screening tool for early recognition of sepsis is recommended. Our centre had no screening tool for sepsis nor a standardized protocol for sepsis management. In December 2020, a screening algorithm for sepsis was implemented. The algorithm consisted of vital signs measurements in children with an abnormal body temperature, a pop-up alert, nurse’s and physician’s evaluation, and activation of a workup protocol. The project’s primary aim was to increase vital signs measurement rates in hospitalized children with abnormal body temperature from 40% to >90% within 6 months, by 1 June 2021, and sustain until 31 December 2021. Adherence to the algorithm and performance were monitored during 2021, and the outcomes were compared to the preceding 5 years and a control ward. The alert identified 324 children and 596 febrile episodes. Vital signs measurement adherence increased from 42.7% to >90% in 2 months. A nurse evaluated 86.4% of episodes, and a physician evaluated 83.0% of these. Paediatric intensive care unit (PICU) admission rates were lower in the intervention period vs. the pre-intervention period vs. the control ward (4.6% vs. 5.6% vs. 6.0%, respectively); the median PICU length of stay was shorter in the intervention vs. the control ward [2.0 (IQR 1, 4) vs. 5.5 (IQR 2, 7), respectively]. These differences were not statistically significant. During the intervention period, the adherence to vital signs measurements reached the goal of >90%. The alert system prompted an evaluation by caregivers and management according to the protocol. Further monitoring is needed to improve outcomes.
Sequential Sampling Plans for Thrips (Thysanoptera: Thripidae) in Soybean Crops With Insecticide Applications Using Tractor or Airplane
Authors: Neves Daniel Victor Chaves , Lopes Mayara Cristina , Pereira Poliana Silvestre , Reis Kayo Heberth de Brito , Picanço Mayara Moledo , Costa Thiago Leandro , Peluzio Joenes Mucci , Sarmento Renato Almeida , Picanço Marcelo Coutinho
Published: January 2023

Sampling plans are an essential part of integrated pest management programs. Sequential sampling plans enable rapid and low-cost assessment of pest densities. Thrips are emerging pests in soybean crops, and the main method used in pest control is chemical. In soybean crops, insecticides are applied mainly using tractors or airplanes. Thus, this work aimed to determine sequential sampling plans for thrips in soybean crops with insecticide applications using a tractor or airplane. Data were collected in 56 soybean fields, and each field was 20 ha. Sampling plans were determined and validated. The lower (m0) and upper (m1) limits of the sequential sampling plans were: m0 = 1.72 and m1 = 3.43 (by tractor applications) and, m0 = 2.27 and m1 = 4.53 thrips. sample−1 (by airplane applications). The slope (S) and the lower (h0) and upper (h1) intercepts of the sequential sampling plans were: S = 2.42, h0 = −5.79, and h1 = 5.79 (by tractor applications) and, S = 3.19, h0 = −6.83, and h1 = 6.83 (by airplane applications). Sequential sampling plans allowed for correct decisions to be made in all situations using a maximum of 10 samples. The sequential plan reduced the sampling effort by over 87% compared to conventional sampling plans. Therefore, these control decision-making systems have proven feasible and advantageous for implementing integrated pest management programs for controlling thrips species in soybean crops.