Research following trauma in minority ethnic and faith communities: lessons from a study of the psychosocial sequelae of the Christchurch mosque terror attacks

Recruiting participants for research from highly traumatised ethnic and faith communities requires a participatory and trauma-informed approach that considers logistic barriers, as well as trauma-related and culture-specific issues. Active community engagement through every stage of the project and employing community members in research roles can help build trust, identify and mitigate concerns early, prevent re-traumatization, and ensure that findings will be of value to the community. Some of these research challenges are discussed in the context of the Christchurch mosque terror attacks. These insights may be helpful for researchers and clinicians working in similarly challenging environments.

Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention

STUDY DESIGN

Descriptive.

OBJECTIVES

The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred.

METHODS

The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided.

RESULTS

A detailed intervention manual has been developed to help standardise the delivery of the intervention.

CONCLUSIONS

This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.

Efficacy and safety of a vitamin-mineral intervention for symptoms of anxiety and depression in adults: A randomised placebo-controlled trial "NoMAD"

BACKGROUND

Anxiety and depression are increasingly burdening society. We investigated whether micronutrients (vitamins and minerals), improve anxiety and depression symptoms in an adult community setting.

METHODS

Participants (n = 150) describing functionally-impairing symptoms of anxiety/depression randomly received micronutrients or placebo for 10 weeks. Primary outcome measures were Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder Scale-7 (GAD-7), and Clinical Global Impression-Improvement scale (CGII). They were monitored online with regular phone contact with a clinical psychologist.

RESULTS

Linear mixed-effects modelling showed significant improvements in both groups, with the micronutrient group improving significantly more quickly on both the PHQ-9 (t = -2.17, p = 0.03) and the GAD-7 (t = -2.23, p = 0.03). Subsequent models with covariates showed that participant characteristics moderated time-by-group interactions; micronutrients provided fastest improvement relative to placebo for younger participants, those from lower socioeconomic groups and those who had previously tried psychiatric medication. On the CGII, there were no group differences at end-point ((F1,148) = 1.36, p = 0.25, d = 0.19, 95 % CI [-0.13 to 0.51]), with 49 % of the micronutrient and 44 % of the placebo groups being identified responders. Participants on micronutrients had significantly increased bowel motions compared with placebo. There was no increased suicidal ideation, no serious adverse events and the blind was adequately maintained. Drop out was low at 8.7 %.

LIMITATIONS

The improvement under placebo and lack of formal diagnoses limit generalizability.

CONCLUSIONS

Despite limited clinician contact, all participants improved significantly, though improvements were faster with micronutrients. Participants in some subgroups demonstrated a lower response to placebo, identifying where micronutrients may offer greatest potential as an intervention.

Single-cell RNA sequencing captures patient-level heterogeneity and associated molecular phenotypes in breast cancer pleural effusions

BACKGROUND

Malignant pleural effusions (MPEs) are a common complication of advanced cancers, particularly those adjacent to the pleura, such as lung and breast cancer. The pathophysiology of MPE formation remains poorly understood, and although MPEs are routinely used for the diagnosis of breast cancer patients, their composition and biology are poorly understood. It is difficult to distinguish invading malignant cells from resident mesothelial cells and to identify the directionality of interactions between these populations in the pleura. There is a need to characterize the phenotypic diversity of breast cancer cell populations in the pleural microenvironment, and investigate how this varies across patients.

METHODS

Here, we used single-cell RNA-sequencing to study the heterogeneity of 10 MPEs from seven metastatic breast cancer patients, including three Miltenyi-enriched samples using a negative selection approach. This dataset of almost 65 000 cells was analysed using integrative approaches to compare heterogeneous cell populations and phenotypes.

RESULTS

We identified substantial inter-patient heterogeneity in the composition of cell types (including malignant, mesothelial and immune cell populations), in expression of subtype-specific gene signatures and in copy number aberration patterns, that captured variability across breast cancer cell populations. Within individual MPEs, we distinguished mesothelial cell populations from malignant cells using key markers, the presence of breast cancer subtype expression patterns and copy number aberration patterns. We also identified pleural mesothelial cells expressing a cancer-associated fibroblast-like transcriptomic program that may support cancer growth.

CONCLUSIONS

Our dataset presents the first unbiased assessment of breast cancer-associated MPEs at a single cell resolution, providing the community with a valuable resource for the study of MPEs. Our work highlights the molecular and cellular diversity captured in MPEs and motivates the potential use of these clinically relevant biopsies in the development of targeted therapeutics for patients with advanced breast cancer.

UNITE Project: understanding neurocognitive impairment after trauma exposure-study protocol of an observational study in Christchurch, New Zealand

INTRODUCTION

Our previous research has demonstrated significant cognitive effects of earthquake exposure 2-3 years following the Canterbury earthquake sequence of 2011. Such impairment has major implications for a population trying to recover, and to rebuild, a devastated city. This study aims to examine psychological, cognitive and biological factors that may contribute to subjective cognitive difficulties in a large group of individuals exposed to the Canterbury earthquake sequence.

METHODS AND ANALYSIS

Two-hundred earthquake-exposed participants from an existing large cohort study (Christchurch Health and Development Study, CHDS) will be recruited. Inclusion is based on results of online screening of the CHDS cohort, using the Cognitive Failures Questionnaire. Individuals scoring the highest (n=100) and lowest (n=100), representing the highest and lowest levels of subjective cognitive impairment, are selected. Exclusions are: psychotic/bipolar disorders, serious substance/alcohol dependence, chronic medical conditions, pregnancy and previous serious head injury. Participants will undergo a half-day assessment including clinician-rated interviews, self-report measures, objective and subjective cognitive assessments, blood sample collection and physical measurements. The primary analysis will compare cognitive, psychological and biological measures in 'high' and 'low' subjective cognitive impairment groups. The study will have power (p<0.05, α=0.8) to show a difference between groups of 0.4 SD on any variable.

ETHICS AND DISSEMINATION

Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. The online screening component of the study received ethical approval on 1 April 2021 (16/STH/188, PAF 7), and the main study (subsequent to screening) received approval on 16 August 2021 (Northern A 21/NTA/68). All participants provide written informed consent. Findings will be disseminated initially to the CHDS cohort members, the wider Canterbury community, and then by publication in scientific journals and conference presentations.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT05090046).

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans: Special patient groups and surgical aspects

This article explores the management of snakebite to vulnerable patient groups, namely children and pregnant women as well as providing detail on the current best practice when caring for venom ophthalmia and surgical wounds resulting from snakebite. Finally, the optimal free-to-use medical record for accurate documentation of snakebite incidents is provided for use by South African practitioners.

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans

Snake bite management is largely driven by expert opinion and consensus, however there are a few large retrospective studies and RCT's that have improved the quality of medical guidance currently available. South African snakes are different in the venomous potential and it behooves the hospital provider and the average medical practitioner to know the current best practice concepts concerning assessment, treatment and antivenom use. The recent SASS meeting in July 2022 provided an update and national consensus from which this Hospital Care document is derived.

The COVID Psychosocial Impacts Scale: A Reliable and Valid Tool to Examine the Psychosocial Impacts of the COVID-19 Pandemic

This paper reports on the development and validation of the COVID Psychosocial Impacts Scale (CPIS), a self-report measure that comprehensively examines both positive and negative psychosocial impacts from the COVID-19 pandemic. This is the first part of the program of work in which the CPIS was administered and compared with a measure of psychological distress (Kessler Psychological Distress Scale, K-10) and wellbeing (World Health Organization Well-Being Index, WHO-5). The data were obtained online in 2020 and 2022 at two distinct time points to capture different exposures to the pandemic in the New Zealand population to a non-representative sample of 663 and 687 adults, respectively. Two hundred seventy-one participants took part in both surveys. Findings indicate a unidimensional structure within CPIS subscales and inter-relatedness among CPIS stress-related subscales. The scatter plots and correlation matrix indicate CPIS having a positive moderate correlation with K10 and a negative moderate correlation with WHO-5, indicative of construct validity. The paper outlines contextual factors surrounding CPIS development and makes suggestions for future iterations of CPIS. Further work will examine its psychometric properties across cultures.

Examining the psychosocial impacts of the COVID-19 pandemic: an international cross-sectional study protocol

INTRODUCTION

The COVID-19 pandemic exposed people to significant and prolonged stress. The psychosocial impacts of the pandemic have been well recognised and reported in high-income countries (HICs) but it is important to understand the unique challenges posed by COVID-19 in low- and middle-income countries (LMICs) where limited international comparisons have been undertaken. This protocol was therefore devised to study the psychosocial impacts of the COVID-19 pandemic in seven LMICs using scales that had been designed for or translated for this purpose.

METHODS AND ANALYSIS

This cross-sectional study uses an online survey to administer a novel COVID Psychosocial Impacts Scale (CPIS) alongside established measures of psychological distress, post-traumatic stress, well-being and post-traumatic growth in the appropriate language. Participants will include adults aged 18 years and above, recruited from Indonesia, Iraq, Iran, Malaysia, Pakistan, Somalia and Turkey, with a pragmatic target sample size of 500 in each country.Data will be analysed descriptively on sociodemographic and study variables. In addition, CPIS will be analysed psychometrically (for reliability and validity) to assess the suitability of use in a given context. Finally, within-subjects and between-subjects analyses will be carried out using multi-level mixed-effect models to examine associations between key sociodemographic and study variables.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Human Ethics Committee, University of Otago, New Zealand (Ref. No. 21/102). In addition, international collaborators obtained local authorisation or ethical approval in their respective host universities before data collection commenced.Participants will give informed consent before taking part. Data will be collected and stored securely on the University of Otago, New Zealand Qualtrics platform using an auto-generated non-identifiable letter-number string. Data will be available on reasonable request. Findings will be disseminated by publications in scientific journals and/or conference presentations.

TRIAL REGISTRATION NUMBER

NCT05052333.

Feasibility study of brief Group Transdiagnostic Cognitive Behavioural Treatment delivered via Zoom for anxiety and depression in primary care

AIM

To report the feasibility of delivering and the effectiveness of brief Group Transdiagnostic Cognitive Behavioural Therapy (TCBT) via Zoom for anxiety and/or depression in primary care.

METHODS

Participants were eligible for this open-label study if their primary care clinician recommended brief psychological intervention for clinically diagnosed anxiety and/or depression. Group TCBT included an individual assessment followed by four x 2-hour manualised therapy sessions. Primary outcome measures assessed recruitment, adherence to treatment and reliable recovery measured using the PHQ-9 and GAD-7.

RESULTS

Twenty-two participants received TCBT over three groups. Recruitment and adherence to TCBT met feasibility thresholds for delivering group TCBT via Zoom. Improvements in the PHQ-9, GAD-7 and reliable recovery were present 3 and 6 months following treatment commencement.

CONCLUSION

Brief TCBT delivered using Zoom is a feasible treatment for anxiety and depression diagnosed in primary care. Definitive RCTs are required to provide confirmatory evidence of efficacy for brief group TCBT in this setting.

The association of body mass index and odds of type 2 diabetes mellitus varies by race/ethnicity

OBJECTIVE

This study aimed to examine the association between body mass index (BMI; weight [kilogram]/height² [meter]) and type 2 diabetes mellitus (T2DM) among the largest three largest racial/ethnic groups in the United States.

METHODS

We compiled 10 waves of the continuous National Health and Nutrition Examination Survey from 1999-2000 through 2017-2018. Participants (N = 45,514) were those who had data on BMI, HbA_1c, and demographics. We estimated associations between BMI and prediabetes/T2DM odds for Black, Latine, and White participants.

RESULTS

BMI was associated with 10% higher odds of prediabetes/T2DM vs. having normal HbA_1c levels (odds ratio = 1.10, 95% confidence interval = 1.10-1.11) for Latine and White individuals. However, the association between BMI and prediabetes/T2DM was significantly weaker among Black individuals. When focusing on T2DM prevalence, the association with BMI for Black participants was even weaker (odds ratio = 0.97, 95% confidence interval = 0.95-0.98).

CONCLUSIONS

The unstable associations between BMI and T2DM across race indicate that BMI has received unwarranted focus as a prime predictor of T2DM. Relying on BMI introduces bias in T2DM risk estimations especially in Black individuals. Focusing on BMI places the onus on individuals to change and increases weight stigma, which can worsen health outcomes. Instead, policymakers should focus on social determinants of T2DM and its concomitant racial/ethnic disparities.

The long-term impacts of the Canterbury earthquakes on the mental health of the Christchurch Health and Development Study cohort

OBJECTIVE

Long-term studies following disasters are rare. It is important to quantify long-term effects of disasters to determine impacts on populations over time. We therefore aim to report the long-term associations between exposure to the Canterbury earthquakes and common mental disorders, taking into account potential confounding factors.

METHODS

The Christchurch Health and Development Study is a 40-year longitudinal study of a birth cohort of New Zealand children (635 males and 630 females). The Christchurch Health and Development Study includes 884 participants with data on earthquake exposure and mental health outcomes at ages 34 and 40 years. Rates of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders were measured categorically and using an expanded definition that included sub-syndromal symptoms. The current impact of the earthquakes is reported using 12-month prevalence data 7 years after the earthquakes. The cumulative impact of the earthquakes over the 7 years since onset is also reported.

RESULTS

There was a linear trend towards increasing rates of disorder with increasing exposure to the earthquakes. After adjusting for covariates, the 12-month prevalence of anxiety disorder symptoms was significantly increased (p = 0.003). The earthquakes were also associated with cumulative increases in symptoms of post-traumatic stress disorder (p < 0.001), anxiety disorder (p = 0.016), nicotine dependence (p = 0.012), and the total number of disorders (p = 0.039).

CONCLUSION

The Canterbury earthquakes were associated with persistent increases in Anxiety Disorder symptoms 7 years after their onset. The earthquakes were also associated with cumulative increases in symptoms of common psychiatric disorders. The magnitude of these effects is small, may no longer be clinically significant and has decreased over time.

Pathways to post-traumatic growth and post-traumatic stress following the Canterbury earthquakes in a cohort of 40-year-olds

OBJECTIVE

To report on post-traumatic growth and post-traumatic stress following the Canterbury earthquakes and to quantify the relationships between exposure to the earthquakes, post-traumatic growth and post-traumatic stress.

METHOD

The Christchurch Health and Development Study is a longitudinal birth cohort study of New Zealanders aged 40 years at the time of latest assessment in 2017. A total of 455 participants were exposed to the Canterbury earthquakes and assessed in 2012 and 2017. Post-traumatic growth was measured in 2017 using the Post-traumatic Growth Inventory. Earthquake-related post-traumatic stress was measured in 2012 using post-traumatic stress disorder items from the Diagnostic Interview Schedule. Post-traumatic growth and post-traumatic stress were modelled using measures of earthquake impact and subjective measures of earthquake consequences (peri-traumatic stress and disruption distress).

RESULTS

There was an indirect relationship between earthquake impact and post-traumatic growth. This was mediated via disruption distress. There was also an indirect relationship between earthquake impact and post-traumatic stress. This was mediated via peri-traumatic stress and disruption distress. Post-traumatic growth and post-traumatic stress were not significantly related.

CONCLUSIONS

Measurement of post-traumatic growth and post-traumatic stress is required for a holistic understanding of disaster consequences. Subjective assessment of distress following disasters is required to predict their psychological effects.

Psychological distress, loneliness, alcohol use and suicidality in New Zealanders with mental illness during a strict COVID-19 lockdown

INTRODUCTION

People with pre-existing mental health conditions may have been disproportionally impacted by the COVID-19 pandemic and associated public health restrictions. In this study, we compared psychological outcomes, experiences and sources of stress over the pandemic lockdown in New Zealanders with and without a previous diagnosis of mental illness.

METHODS

Two online surveys were conducted in New Zealand over the level 4 lockdown in April 2020 measuring psychological distress, anxiety, well-being, suicidality, alcohol use and subjective experiences. They included 3389 participants, of whom 18.4% reported having been previously diagnosed with a mental illness.

RESULTS

During the lockdown, people previously diagnosed with a mental illness had about twice the risk of reporting moderate-high levels of psychological distress (K10 ⩾ 12), at least moderate levels of anxiety (GAD-7 ⩾ 10) and poor well-being (WHO-5 ⩽ 12). They reported increased alcohol use and were about four times as likely to have experienced suicidal thoughts with 3% reporting having made a suicide attempt over the lockdown period. They reported less satisfaction with, and poorer relationships with people in their 'bubble', reduced social contacts and greater loneliness. They also reported higher levels of health and financial concerns.

CONCLUSION

During the COVID-19 lockdown in New Zealand, people with a previous diagnosis of a mental illness were at increased risk of detrimental psychological outcomes. This highlights the importance of recognising this and the challenges people face in pandemics.

Examining the long-term cognitive effects of exposure to the Canterbury earthquakes in a resilient cohort

BACKGROUND

Although most people do not develop mental health disorders after exposure to traumatic events, they may experience subtle changes in cognitive functioning. We previously reported that 2-3 years after the Canterbury earthquake sequence, a group of trauma-exposed people, who identified as resilient, performed less well on tests of spatial memory, had increased accuracy identifying facial emotions and misclassified neutral facial expressions to threat-related emotions, compared with non-exposed controls.

AIMS

The current study aimed to examine the long-term cognitive effects of exposure to the earthquakes in this resilient group, compared with a matched non-exposed control group.

METHOD

At 8-9 years after the Canterbury earthquake sequence, 57 earthquake-exposed resilient (69% female, mean age 56.8 years) and 60 non-exposed individuals (63% female, mean age 55.7 years) completed a cognitive testing battery that assessed verbal and visuospatial learning and memory, executive functioning, psychomotor speed, sustained attention and social cognition.

RESULTS

With the exception of a measure of working memory (Digit Span Forward), no significant differences were found in performance between the earthquake-exposed resilient and non-exposed groups on the cognitive tasks. Examination of changes in cognitive functioning over time in a subset (55%) of the original earthquake-exposed resilient group found improvement in visuospatial performance and slowing of reaction times to negative emotions.

CONCLUSIONS

These findings offer preliminary evidence to suggest that changes in cognitive functioning and emotion processing in earthquake-exposed resilient people may be state-dependent and related to exposure to continued threat in the environment, which improves when the threat resolves.

Thriving in a pandemic: Determinants of excellent wellbeing among New Zealanders during the 2020 COVID-19 lockdown; a cross-sectional survey

Objective

The COVID-19 pandemic and associated restrictions are associated with adverse psychological impacts but an assessment of positive wellbeing is required to understand the overall impacts of the pandemic.

Methods

The NZ Lockdown Psychological Distress Survey is an on-line cross-sectional survey of 3487 New Zealanders undertaken during a strict lockdown for COVID-19. The lockdown extended from 25 March 2020 to 28 April 2020 and the survey was undertaken between 15 April 2020 and 27 April 2020. The survey measured excellent wellbeing categorised by a WHO-Five Well-being Index (WHO-5) score ≥22. The survey also contained demographic and pre-lockdown questions, subjective and objective lockdown experiences, and questions on alcohol use. The proportion of participants with excellent wellbeing is reported with multivariate analysis examining the relative importance of individual factors associated with excellent wellbeing.

Results

Approximately 9% of the overall sample (303 participants) reported excellent wellbeing during the New Zealand lockdown. In the multivariable analysis, excellent wellbeing status was positively associated with increasing age (p<0.001), male gender (p = 0.044), Māori and Asian ethnicity (p = 0.008), and lower levels of education (certificate/diploma level qualification or less) (p<0.001). Excellent wellbeing was negatively associated with smoking (p = 0.001), poor physical (p<0.001) and mental health (p = 0.002), and previous trauma (p = 0.033).

Conclusion

Nine percent of New Zealanders reported excellent wellbeing during severe COVID-19 pandemic restrictions. Demographic and broader health factors predicted excellent wellbeing status. An understanding of these factors may help to enhance wellbeing during any future lockdowns.

Abiraterone decanoate (PRL-02): Pharmacology of a single intramuscular (IM) depot injection compared to oral abiraterone acetate (AA) in intact male rats

160

Background: Oral AA is a standard of care for metastatic prostate cancer. The recommended daily AA 1000 mg dose produces high peak and low trough plasma concentrations that are associated with safety issues (e.g., hepatotoxicity) and inadequate efficacy, respectively. PRL-02 is a novel abiraterone prodrug undergoing evaluation in patients with advanced prostate cancer (NCT04729114). In chemically-castrate monkeys, single doses of PRL-02 suppressed androgens for 14 weeks at much lower plasma exposures than AA (Moore et al, ASCO GU 2021). The present study in intact male rats evaluated the systemic exposures and activity of PRL-02 compared to daily oral AA at 7 and/or 14 days post-treatment start. Methods: Sexually mature male rats (n=4 per timepoint) were administered a single IM dose of PRL-02 (90 mg/kg), daily AA (90 mg/kg) or IM/oral vehicle (VEH). Biological samples were collected on Day 7 (PRL-02/VEH; 0h) or Day 14 (PRL-02/AA/VEH; 2, 6 and 24h) post-dosing. Drug and androgen concentrations were determined by LC-MS/MS. Testicular CYP17 hydroxylase activity was measured ex vivo on Day 14. Results: The Day 14 plasma exposure from abiraterone was greater from AA (5.6 - 210 ng/mL) than from PRL-02 (1.15 – 1.37 ng/mL). However, for Day 14 tissue exposures (AUC0-24) from ‘total abiraterone equivalents’ (TAE; concentration of free abiraterone plus abiraterone from prodrug) were greater from PRL-02 in adrenal, testes, lymph node and bone target tissues than from oral AA; exposures from AA were only greater in non-target tissues such as liver and brain (Table). There was no measurable Day 14 CYP17 hydroxylase activity in testes following PRL-02 or AA dosing; inhibition appeared irreversible from PRL-02 and AA. Compared to VEH, a single IM dose of PRL-02 resulted in 81% and 75% reductions in plasma testosterone (T) on Days 7 and 14 post-dose, and an 80% reduction in testicular T on Day 14. Daily AA resulted in a 98% reduction in plasma T after 14 days. Conclusions: Single-dose IM PRL-02 blocked testicular CYP17 enzyme activity as effectively as daily AA in intact male rats and produced a durable large reduction in plasma T. The pharmacological activity, tissue and plasma distribution of TAE from IM PRL-02 in the rat model, along with results from prior monkey model studies, suggest the potential for a greater therapeutic index than from daily oral AA and support the ongoing evaluation of IM PRL-02 in patients with advanced prostate cancer.[Table: see text]

Psychosocial impacts on the Christchurch Muslim community following the 15 March terrorist attacks: a mixed-methods study protocol

INTRODUCTION

On 15 March 2019, a white supremacist gunman opened fire in two mosques in Christchurch, New Zealand, during Friday prayers, killing 51 people and injuring 40. The event was witnessed by at least 250 survivors and also live streamed on social media, leading to widespread and repeated exposure within the community. It is expected that survivors, families and community members will be at increased risk of developing mental disorders due to the scale and violence of these attacks.This protocol describes the first phase of a proposed longitudinal study to screen and assess the long-term impacts of the terrorist attack on members of the Christchurch Muslim community, to determine clinical need and facilitate access to appropriate interventions and to gain insights into working with such a traumatised, ethnically diverse population. It has been developed in close collaboration with members of that community.

METHODS AND ANALYSIS

A mixed-method design is described, combining self-report measures with a clinician-administered diagnostic interview. Participants include Christchurch Muslims aged 18 years and over, with a target sample size of n=200. Analyses will determine prevalence of major mental disorders, while regression analyses will model the relationship between pre-event features, trauma exposure and mental disorders. A small number of participants, stratified by exposure type, will also take part in a qualitative interview in English. All study information and self-report measures are provided in translations based on the ethnolinguistic composition of the group and are available in paper and online versions.

ETHICS AND DISSEMINATION

Ethical approval was granted by the New Zealand Health and Disability Ethics Committee 19/NTA/147. All participants provide informed consent, either written or online via REDCap software. The study is registered with the Australian New Zealand Clinical Trials Registry. Findings will be disseminated initially to the impacted community, then by publication in scientific journals, presentations and to government agencies.

TRIAL REGISTRATION NUMBER

ACTRN12620000909921.

Characterizing the Heterogeneity of Small Extracellular Vesicle Populations in Multiple Cancer Types via an Ultrasensitive Chip

Identifying small extracellular vesicle (sEV) subpopulations based on their different molecular signatures could potentially reveal the functional roles in physiology and pathology. However, it is a challenge to achieve this aim due to the nano-sized dimensions of sEVs, low quantities of biological cargo each sEV carries, and our incomplete knowledge of identifying features capable of separating heterogeneous sEV subpopulations. Here, a sensitive, multiplexed, and nano-mixing-enhanced sEV subpopulation characterization platform (ESCP) is proposed to precisely determine the sEV phenotypic heterogeneity and understand the role of sEV heterogeneity in cancer progression and metastasis. The ESCP utilizes spatially patterned anti-tetraspanin-functionalized micro-arrays for sEV subpopulation sorting and nanobarcode-based surface-enhanced Raman spectroscopy for multiplexed read-outs. An ESCP has been used for investigating sEV phenotypic heterogeneity in terms of canonical sEV tetraspanin molecules and cancer-associated protein biomarkers in both cancer cell line models and cancer patient samples. Our data explicitly demonstrate the selective enrichment of tetraspanins and cancer-associated protein biomarkers, in particular sEV subpopulations. Therefore, it is believed that the ESCP could enable the evaluation and broader application of sEV subpopulations as potential diagnostic disease biomarkers.

Protocol for a mixed-method cohort study investigating the prevalence and impact of obsessive-compulsive disorder (OCD) in chronic pain rehabilitation

INTRODUCTION

While there is considerable and growing research in the individual fields of obsessive-compulsive disorder (OCD) and chronic pain, focused research into their potential association remains limited. By exploring this potential association, better theoretical understanding of and better therapeutic approaches to chronic pain management could be developed. The study's aim is to explore the prevalence and impact of obsessions-compulsions on the experience and rehabilitation of chronic pain among individuals attending different branches of a New Zealand pain service.

METHODS AND ANALYSIS

This is a cohort study using well-validated questionnaires and semistructured interviews. Participants will be recruited through community pain services from a private rehabilitation-focused company with branches across New Zealand. Participants will complete an OCD screening measure (Obsessive-Compulsive Inventory-Revised (OCI-R)). These results will be used to compare results from the specialist pain services benchmarking electronic Persistent Pain Outcomes Collaboration measure sets, at both participant intake and completion of each Pain Service Programme. Prevalence rates of OCD caseness from the OCI-R will be estimated with 95% CI. Generalised linear regression models will be used to explore differences in pain baseline and outcome factors between those with high and low obsessive-compulsive symptoms. Semistructured interviews, assessed through interpretative phenomenological analysis (IPA), will be used to provide information on lived experiences of individuals with comorbid chronic pain and OCD. This will be supported through the administration of an Obsessive Beliefs Questionnaire 44.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Health and Disability Ethics Committee (HDEC20/CEN/82). Study results will be disseminated at professional conferences and in peer-reviewed journals. A lay summary of findings will be provided to requesting participants or through attendance at a local hui (gathering).

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12621000758808).

Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and 'other' essential workers during the COVID-19 lockdown

OBJECTIVES

To compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 'other' essential workers) with that of workers in nonessential work roles.

DESIGN

Online cross-sectional survey.

SETTING

Conducted in New Zealand over level 4 lockdown in April/May 2020.

PARTICIPANTS

Findings from employed participants (2495) are included in this report; 381 healthcare workers, 649 'other' essential workers and 1465 nonessential workers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ² tests.

RESULTS

After controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in 'other' essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and 'other' essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants' own health and 33% about other people's health.

CONCLUSIONS

During the pandemic lockdown, essential workers (those in healthcare and those providing 'other' essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.

Learning from previous disasters: Potential pitfalls of epidemiological psychosocial research in the COVID-19 environment

It is critical to understand the psychosocial impacts of the COVID-19 pandemic on populations around the world. In this article, we highlight the key challenges associated with epidemiological psychosocial research in a disaster context and reflect on lessons learned from firsthand experience over the last decade in Christchurch, New Zealand, following the 2010/2011 Canterbury earthquakes and 2019 Mosque attacks. We make recommendations for study design to improve the quality of research evaluating the impacts of the COVID-19 pandemic, the inclusion of positive outcome measures and the need to evaluate a range of cultural contexts. We hope that highlighting these areas will improve research and result in a better understanding of the psychosocial impacts of the pandemic.

Evaluation of the All Right? Campaign for tangata whaiora/mental health service users in Canterbury, New Zealand

All Right? is a wellbeing campaign developed in response to the devastating Canterbury earthquakes of 2010 and 2011. Vulnerable groups post-disaster include people with a prior history of or unresolved mental illness. This research focussed on the reach and impact of All Right? specifically for tangata whaiora/mental health service users. Evaluation objectives were primarily focussed on assessing the extent which mental health service users engaged with All Right? and to determine the impact of this interaction. Both qualitative and quantitative methods were used to gather data. Findings indicated that mental health service users responded to All Right? to a greater extent than the general target population, e.g. about one-third (37%) of respondents to a population based Christchurch survey agreed that they had done activities as a result of what they had seen or heard of the All Right? campaign compared with approximately two-thirds (68%) of respondents to the mental health service users' survey. One of the key factors facilitating mental health service users' engagement with All Right? appears to be that the campaign was directed at whole-of-population level, therefore engagement was not defined by being a mental health service user. Engagement was also likely to be facilitated by the campaigns perceived impact of reducing mental illness-related stigma. This research concluded that population-wide wellbeing campaigns in the post-disaster context, when done well, can positively impact the wellbeing of the overall population, including mental health service users.

Broad spectrum micronutrient formulas for the treatment of symptoms of depression, stress, and/or anxiety: a systematic review

Introduction: Vitamin and mineral nutritional supplements are becoming increasingly popular as alternative treatments for anxiety and depression, as issues such as side effects from medication, failure to respond to psychotherapy and workforce limitations pose barriers for successful treatment.Areas covered: This review covered double-blind, randomized controlled trials (DBRCTs) testing formulas including at least four vitamins and/or minerals used for the treatment of symptoms of anxiety, stress, or depression in adults not currently taking medication for psychiatric difficulties.Expert opinion: The majority of the 23 trials reviewed were conducted on people without psychological difficulties, limiting the generalizability of the results in people with diagnosed mood and anxiety difficulties. Sixteen studies demonstrated positive effects for symptoms of anxiety, depression, or stress. Micronutrient supplementation in healthy nonclinical adults has limited benefits for mood and anxiety symptoms, although may convey some subtle general improvements. The evidence for adults with physical or mental ill health is more positive although limited by small samples and variability in nutrients studied. Broad-spectrum nutrient products may be more effective than a selected few. While an effect of micronutrients cannot be dismissed, the variability of the studies makes it extremely challenging to identify specific treatment benefits.

Silver linings of the COVID-19 lockdown in New Zealand

The COVID-19 pandemic has caused significant disruption, distress, and loss of life around the world. While negative health, economic, and social consequences are being extensively studied, there has been less research on the resilience and post-traumatic growth that people show in the face of adversity. We investigated New Zealanders’ experiences of benefit-finding during the COVID-19 pandemic and analysed qualitative responses to a survey examining mental well-being during the New Zealand lockdown. A total of 1175 of 2010 eligible participants responded to an open-ended question probing ‘silver linings’ (i.e., positive aspects) they may have experienced during this period. We analysed these qualitative responses using a thematic analysis approach. Two thirds of participants identified silver linings from the lockdown and we developed two overarching themes: Surviving (coping well, meeting basic needs, and maintaining health) and thriving (self-development, reflection, and growth). Assessing positive as well as negative consequences of the pandemic provides more nuanced insights into the impact that New Zealand’s response had on mental well-being.

Recruitment and retention of participants in longitudinal studies after a natural disaster

Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents' barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.

Abiraterone decanoate (AD): Potent and long-acting activity of a novel intramuscular (IM) abiraterone prodrug depot in a castrate monkey model

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Background: Oral abiraterone acetate (AA) is a standard of care for castration-resistant (CRPC) and castration-sensitive prostate cancer (CSPC). Due to poor oral bioavailability, the recommended AA dose is 1,000 mg (4 x 250mg) once-daily on an empty stomach. The daily oral regimen produces high peak plasma concentrations that may be associated with safety issues (e.g., hepatotoxicity) and low trough concentrations that may be associated with inadequate CYP17 inhibition. AD is one of a series of novel abiraterone prodrugs that were designed to provide a controlled release of abiraterone and long-acting CYP17 inhibition with IM delivery. Following successful preclinical pilot studies, AD was further developed into a clinically acceptable formulation (PRL-02) and its PK/PD characteristics were evaluated and compared to oral AA in a castrate monkey pharmacology model in support of future clinical development. Methods: Sexually mature male cynomolgus monkeys underwent chemical castration using Lupron depot. Plasma samples were analyzed for prodrug, abiraterone and steroid concentrations following a single oral AA dose (5, 15 or 45 mg/kg) and a single IM AD injection (10, 30 or 100 mg/kg) (n=3/dose group). The combined activity of IM AD plus glucocorticoid replacement (single 0.5 mg/kg IM dexamethasone (DEX) dose or weekly doses of 1.29 mg/kg IM methylprednisolone acetate (MPA)) was also evaluated. AD, abiraterone and adrenal steroid levels were evaluated by LC-MS/MS. Results: Chemical castration resulted in a plasma testosterone (T) decrease of 72% from intact. T was further reduced to sub-castrate levels by both AA and AD (98.6% and 99.7% maximum decrease from castrate baseline, respectively). All dose levels of AD were highly effective in reducing plasma T yet led to abiraterone plasma concentrations (Cmax, AUC, Cmin) that were much less than those associated with steady-state clinical levels from oral AA. Sustained T suppression was observed following all single AD IM doses for 14 weeks, the last timepoint tested.The addition of a glucocorticoid replacement (DEX or MPA) starting at week 9 further reduced T in all AD groups. Conclusions: Single-dose IM AD suppressed T to the same or greater extent than single-dose oral AA in castrate monkeys, while providing much lower abiraterone exposures than the oral acetate prodrug. As such, IM AD may offer an improved risk-benefit profile due to the consistently lower abiraterone levels. The durable, profound T reductions provided by all AD doses are consistent with a 3-month clinical regimen that can be given in conjunction with Lupron. IM AD may thus offer patients with CSPC and CRPC a more convenient, safe and effective alternative than daily oral AA.

What should every dental health professional know about electronic cigarettes?

Electronic cigarettes (E-cigarettes) have become increasingly popular around the world. Currently, dental professionals' knowledge and attitudes are varied with many clinicians unclear regarding the impact of E-cigarette products on the oral and general health of their patients. With developing social and health-related challenges, advice of dental and medical associations and other regulatory bodies on E-cigarette use is changing. Growing evidence demonstrating the risks of E-cigarette usage has prompted a review of legislation in the United Kingdom (UK), United States of America (USA), Australia and Canada to include the sale and availability of E-cigarettes, particularly those containing nicotine. Further consideration within the scientific and public health community is being given to assessing demographic usage patterns particularly uptake by non-smokers and adolescents, efficacy as a cessation tool, the impact of vapour on bystanders and direct injuries via explosions as well as emerging lung injuries. This article aims to provide a summary of the most up to date evidence relating to E-cigarette use, the latest position of dental associations and the oral health implications of E-cigarettes compared to conventional smoking. The article also aims to collate this information in order to provide dental clinicians with guidance on how to advise patients, specifically in answering common questions posed regarding E-cigarette use.

Important marine areas for the conservation of northern rockhopper penguins within the Tristan da Cunha Exclusive Economic Zone

The designation of Marine Protected Areas has become an important approach to conserving marine ecosystems that relies on robust information on the spatial distribution of biodiversity. We used GPS tracking data to identify marine Important Bird and Biodiversity Areas (IBAs) for the Endangered northern rockhopper penguin Eudyptes moseleyi within the Exclusive Economic Zone (EEZ) of Tristan da Cunha in the South Atlantic. Penguins were tracked throughout their breeding season from 3 of the 4 main islands in the Tristan da Cunha group. Foraging trips remained largely within the EEZ, with the exception of those from Gough Island during the incubation stage. We found substantial variability in trip duration and foraging range among breeding stages and islands, consistent use of areas among years and spatial segregation of the areas used by neighbouring islands. For colonies with no or insufficient tracking data, we defined marine IBAs based on the mean maximum foraging range and merged the areas identified to propose IBAs around the Tristan da Cunha archipelago and Gough Island. The 2 proposed marine IBAs encompass 2% of Tristan da Cunha’s EEZ, and are used by all northern rockhopper penguins breeding in the Tristan da Cunha group, representing ~90% of the global population. Currently, one of the main threats to northern rockhopper penguins within the Tristan da Cunha EEZ is marine pollution from shipping, and the risk of this would be reduced by declaring waters within 50 nautical miles of the coast as ‘areas to be avoided’.

Disparities in Opioid Pain Management for Long Bone Fractures

An expanding body of evidence has established that racial disparities exist in the US healthcare system, manifesting in poorer health outcomes for members of the non-white population. This study examines whether disparities exist in the type of analgesia ordered for long bone fractures and the time to medication administration in a community teaching hospital serving a large Hispanic population. We reviewed de-identified data of 115 patients from the emergency department of a community Level II Trauma Center in central Florida with diagnosed long bone fractures and examined the clinical and demographic variables associated with the type of analgesic administered and factors associated with delays in medication administration. We found that women reported higher pain scores than men, but there was no difference in the type of pain medication administered. There was no difference in pain scores between white and non-white patients; however, white patients were more likely to receive opiates for their long bone fractures compared with non-white patients (70 vs 50%, p < 0.0001). Opioid pain medications were prescribed significantly more often to adult and elderly patients compared with pediatric patients who were more likely to receive acetaminophen compared with both other patient groups (p < 0.001). In summary, we found that pain score was not associated with the class of pain medication administered, but that race and age were. This study questions the utility of the pain score for acute injuries and raises concerns about the role of physician bias in analgesia administration.

42 Screening for Atrial Fibrillation in Housebound Individuals: An Evaluation of the Use of the AliveCor Kardia Device

Background

The Croydon Rapid Response service is a multidisciplinary team providing admission avoidance support for people at crisis in their own homes or care homes. This population includes many living with frailty, the majority of whom are housebound.

Introduction

Atrial fibrillation (AF) is common, and often asymptomatic, and a significant risk factor for developing an ischaemic stroke. There is an ambition across health systems to improve identification of people with AF to better manage their risk of stroke. Screening is often performed using ECG readings typically performed in healthcare settings such as GP surgeries or hospitals.

The Croydon Rapid Response Team were provided with 10 AliveCor Kardia devices as part of a programme funded by the Health Innovation Network, with the aim to screen for AF aiming in traditionally hard-to-reach populations such as those people who are, through ill health or poor mobility, unable to leave their own home.

Methods

Activity use of the AliveCor Kardia devices were collated from centralised activity data based on the device serial numbers. Data collected were reviewed over a 12 month period. After 12 months use a survey was performed of clinician’s views on the devices.

Results

Over a 12 month period (March 2018 – February 2019) 389 recordings were performed across all Kardia devices. One device was lost within 1 month of the roll-out. Of the 389 recordings performed, possible AF was identified in 56 cases (14% of those screened). Survey results were received from 6 clinicians. 1 clinician used the device everyday in their practice. 2 staff members report using it 1-2/week, 3 staff members report using it 1-2/month.100% of respondents described the device as easy to use and helpful in clinical practice.100% of respondents agreed that they were clear how to manage a positive result.None of the respondents described increased workload due to the device and screening programme.

Conclusions

The AliveCor Kardia device is an acceptable and effective tool to aid detection of AF in housebound individuals seen by the Rapid Response team. The scheme should be considered for extension to other community teams, and further diagnostic equipment such as 12 lead ECG should be considered to complete the pathway.

97 Complexity In Croydon

Introduction

The Complex Care Support Team (CCST) are a newly-formed, integrated service, caring for Croydon residents when existing services decide additional multidisciplinary team input is required.

There is no single definition of healthcare complexity. Most cases encountered by the team have involved many different services and professionals. The team have found that by forging relationships and co-ordinating care across organisational boundaries, some of the “complexities” can be mitigated. We aim to develop our understanding of the needs of this population and the underlying drivers for complexity in Croydon.

Methods

The records on EMIS, CERNER and ePJS were reviewed from the inaugural two months of the service, for:Rockwood Frailty ScoreNumber of medicationsNumber of long-term conditionsED attendances or admissions to hospital over the preceding year.

After team discussion on every case, underlying causes of complexity were assigned to four groups: medical, psychological, social and systems failure.

Results

Of the 57 people accepted by CCST over 2 months, 39 required reviewing in person. 5 records were not completed, so 34 cases were included for evaluation. The age range of this cohort was 49-92, with 17 male and 17 female. Results revealed significant frailty, multimorbidity and polypharmacy. 91% had two or more underlying drivers for complexity, with the largest underlying driver being systems failure, in 85% of cases.

Conclusions

This work improves our understanding of the needs of the population deemed the most “complex” in Croydon. The likelihood of multiple underlying drivers for complexity was high, highlighting how complex health issues are likely to span both professional and organisational boundaries. This can in itself be a significant underlying driver for complexity, illustrated here as “systems failure”. In developing current and future services, this work reinforces the vital benefits of multidisciplinary and cross-organisational working currently occurring in CCST.

82 Virtual Reality Home Visit Simulation: Pilot Study

Introduction

There are multiple drivers to move healthcare into community settings, including people’s own homes. Traditional healthcare training, particularly medical training, is largely hospital-based, and hospital-based models of care. Few professions have explicit training in how best to assess an individual at home, and the additional elements to examine when visiting an induvial in their own home. To meet this training need Croydon Health Services were successful in a bid for funding to develop training to meet this gap. With this funding, a programme was developed and after attempts at simulation home visits in the simulation centre, a virtual reality (VR) home visit scenario was devised and filmed in the community using a professional actor to simulate a housebound individual. The recording was then professionally edited by a specialist VR team to maximise its effectiveness including interactive educational elements.

Methods

A pilot study examining the acceptability of the virtual reality home visit scenario was designed. A user group of medical staff with limited community experience participated in undertaking the virtual reality scenarios, delivered via Samsung Note 8 devices combined with Samsung Gear VR headsets. Feedback was received from participants by standardised paper-based surveys.

Results

7 responses were obtained. 100% of respondents described the scenario as easy to use, as well as agreeing that the same experience could not be gained from watching a standard video of the same scenario. 100% of respondents felt that the on-screen information was helpful.

Feedback on areas for improvement suggested a desire for greater interactivity of other aspects of home assessment, and a desire to improve interactivity with the simulated patient, including history taking.

Conclusions

Virtual reality home visit simulations are an acceptable and effective tool to introduce new concepts to staff. Further development should aim to maximise interactivity in the scenario and explore options for greater interaction with the simulated patient. Further role out of the virtual reality is planned for local and regional training sessions.

Intermittent low dose carbon monoxide inhalation does not influence glucose regulation in overweight adults: a randomized controlled crossover trial

NEW FINDINGS

What is the central question of this study? Low dose carbon monoxide (CO) inhalation plays a role in regulating proteins involved in glucose metabolism; does low dose CO improve glucose and insulin responses to an oral glucose tolerance test in overweight adults? What is the main finding and its importance? Five days of intermittent CO inhalation does not alter the glucose or insulin responses to ingestion of a glucose bolus in overweight adults. Low dose CO is utilized in various physiological assessment procedures; these findings allow researchers and clinicians to utilize these procedures without concern of altering glucose metabolism.

ABSTRACT

Low dose carbon monoxide (CO) inhalation upregulates several proteins important for glucose metabolism. Such changes could be clinically significant and may be relevant to those who use CO as a research tool. We hypothesized that low dose CO inhalation would improve glucose and insulin responses to an oral glucose bolus in overweight humans. Eleven young adults (5 men, 6 women; body mass index: 25-35 kg m^-2 ) were included in this randomized, placebo-controlled, single-blinded crossover study. Following screening, participants completed two 7-day protocols with a 4-week washout. Twenty-four hours prior to and following five consecutive days of either once daily CO (men: 1.2 ml (kg body mass)^-1 ; women: 1.0 ml (kg body mass)^-1 ) or placebo (room air) inhalation, participants underwent oral glucose tolerance tests (OGTT). For key outcome variables, there were no significant main effects or interactions across condition or time point (mean ± SD), including fasting glucose (mg dl^-1 : pre-placebo: 85.2 ± 10.1; post-placebo: 82.9 ± 10.6; pre-CO: 83.6 ± 7.7; post-CO: 84.0 ± 9.0), 2 h post glucose (mg dl^-1 : pre-placebo: 100.9 ± 20.0; post-placebo: 98.7 ± 13.1; pre-CO: 94.2 ± 23.2; post-CO: 94.4 ± 14.9), or the Matsuda index (pre-placebo: 16.1 ± 11.5; post-placebo: 20.3 ± 24.7; pre-CO: 15.6 ± 15.3; post-CO: 17.5 ± 16.8). In conclusion, 5 days of low dose CO administration did not influence glucose and insulin responses to an OGTT in overweight adults. Low dose CO inhalation is utilized in a variety of physiological assessment procedures; these findings allow researchers to utilize these procedures without concern of altering glucose metabolism.

The impact of the Canterbury earthquakes on dispensing for older person's mental health

OBJECTIVE

To evaluate the impact of the Canterbury earthquakes on the mental health of older people by examining dispensing patterns of psychotropic medication.

METHOD

Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics, and sedative/hypnotics are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) (n = 67 760 at study onset) and the rest of New Zealand (n = 469 055 at study onset). We compared older age dispensing data between 2008 and 2018 for Canterbury DHB with older age dispensing data nationally in order to assess the impact of the Canterbury earthquakes on the mental health of older persons.

RESULTS

Older age residents of Canterbury are dispensed antidepressants, antipsychotics, and anxiolytics at higher rates than national comparators, but this finding predated the onset of the earthquakes. Short-term increases in anxiolytic and sedative/hypnotic dispensing occurred for the month following the February 2011 earthquake. No other short- or longer-term increases in dispensing of psychiatric medication were present.

CONCLUSION

The February 2011 Canterbury earthquake caused a short-term increase in dispensing of anxiolytics and sedative/hypnotics. No longer-term effects on dispensing were observed. This suggests that older persons sought assistance for insomnia and anxiety in the aftermath of the most devastating earthquake, but longer-term rates of clinically significant anxiety and depression for older persons did not increase as a consequence of the earthquakes sequence.

Abstract PD9-05: The importance of the metastatic biopsy: Clinical and translational relevance in a real world series of patients with metastatic breast cancer

Background

Metastatic breast cancer (MBC) is a heterogeneous disease, whose clinical course and prognosis may be unpredictable, creating significant uncertainty for patients and their families. Heterogeneity is breast cancer subtypes is now well recognized as a potential reason for treatment resistance. Sampling metastatic sites at the point of diagnosis or upon progression, when safe, is recommended to better guide therapy.

Purpose

This study evaluated patients currently undergoing treatment for MBC in the clinic to determine the clinical and translational significance of a metastatic sample.

Methods

Patients currently undergoing treatment for MBC at the Olivia Newton John Centre were identified. Data was collected on patient demographics, clinicopathological information, treatment and duration of response. Translational research tissue was collected, with consent, for DNA and RNA analysis.

Results

Between January 2017 and May 2018 111 patients were identified. The mean age of MBC diagnosis was 60 years (range 30-87), with a mean follow up time of 2.4 years (range 0.8-16). Fifteen patients died during the study period. Sixty-seven (60%) patients were initially treated for early breast cancer (EBC), with a median disease free interval (DFI) 4.7 years. Half (51%) these patients relapsed after five years.

At MBC diagnosis, multiple sites of disease were identified including bone, visceral, brain, nodal and skin/chest wall disease. Bone only disease was common (25%), whereas brain disease was rare overall (9%). Metastatic tissue was collected in 67 (60%) patients, where up to four different sites were biopsied. The most commonly biopsied site was bone (n=21), followed by soft tissue (n=20), chest wall/skin disease (n=12), liver (n=9), lung (n=8) and brain (n=8). Serous disease was collected in 16 patients, including pleural, pericardial, ascitic and cerebrospinal fluid.

Based on the EBC subtype (n=67), 70% had luminal disease, 19% had Her2 positive disease and 7% had TNBC. However, based on a metastatic biopsy (n=67), only 61% of patients had luminal disease, 21% had HER2 positive, and 18% had TNBC. Paired EBC and MBC samples were available in 48 patients, with significant change in breast cancer subtype demonstrated in 12 of these patients (25%). The most common change was a loss in ER staining, which included 6 patients from ER positive, HER2 negative to TNBC and three patients who became ER negative but remained HER2 positive. Molecular profiling was performed thus far on 8 samples at the single cell and bulk level. These results highlight a large level of inter- and intra-tumoral heterogeneity, and may result in a better understanding of the molecular pathways specifically deregulated in patients at the point of progression.

Conclusion

In this single institution series of patients with MBC, over half of the cohort underwent at least one metastatic biopsy. Strikingly, a quarter of patients demonstrated a change in their breast cancer subtype, which directly guided subsequent therapy. Metastatic tissue can provide vital information to inform treatment decisions, which may be guided by translational laboratories having access to fresh tissue at the point of metastatic diagnosis or disease progression.

Citation Format: Yeo B, Molinaro T, Merino D, Berthelet J, Pouliot N, Fang C, Bell C, Anderson R. The importance of the metastatic biopsy: Clinical and translational relevance in a real world series of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-05.

The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group

Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care. This study analyzed 484 surveys received from clinicians collecting demographic, virological, and reproductive health data along with perceived barriers to linkage and retention in care. Most women (67%) were estimated to have been linked into care within 28 days of diagnosis. For women who were not linked into care for more than 28 days, the most commonly reason cited was fear of disclosure to others, followed by fear of disclosure to their partner. The main reasons given for non-retention in care were related to transport, carer responsibilities, financial pressure, health beliefs and concern about stigma or disclosure.

Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience

OBJECTIVE

To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy.

DESIGN

Retrospective cohort study.

SETTING

Four cancer/genetics centres in Scotland.

POPULATION

Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria).

METHODS

Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria.

MAIN OUTCOME MEASURES

Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations.

RESULTS

Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%.

CONCLUSIONS

Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate.

TWEETABLE ABSTRACT

BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.

First nations people's perspectives on barriers and supports for enhancing HPV vaccination: Foundations for sustainable, community-driven strategies

OBJECTIVE

In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities.

METHODS

Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vaccine. A 2017 community gathering was convened to engage First Nations community members, health directors, and health services researchers in dialogue around unique barriers and supports to HPV vaccination in Alberta. Voices of community Elders, parents, health directors, and cancer survivors (n=24) are presented as qualitative evidence to help inform intervention design.

RESULTS

Key findings from discussions indicate barriers to HPV vaccination include resource constraints and service infrastructure gaps, historical mistrust in healthcare systems, impacts of changing modes of communication, and community sensitivities regarding sexual health promotion. Supports were identified as strengthened inter-generational relationships in communities.

CONCLUSIONS AND FUTURE DIRECTION

Ongoing dialogue and co-development of community-based strategies to increase HPV vaccine uptake are required. The identification of possible barriers to HPV vaccination in a Canadian Indigenous population contributes to limited global literature on this subject and may inform researchers and policy makers who work with Indigenous populations in other regions.