N-oleoyl alanine attenuates nicotine reward and spontaneous nicotine withdrawal in mice

BACKGROUND

As nicotine dependence represents a longstanding major public health issue, new nicotine cessation pharmacotherapies are needed. Administration of N-oleoyl glycine (OlGly), an endogenous lipid signaling molecule, prevents nicotine-induced conditioned place preference (CPP) through a peroxisome proliferator-activated receptor-alpha (PPARα) dependent mechanism, and also ameliorated withdrawal signs in nicotine-dependent mice. Pharmacological evidence suggests that the methylated analog of OlGly, N-oleoyl alanine (OlAla), has an increased duration of action and may offer translational benefit. Accordingly, OlAla was assessed in nicotine CPP and dependence assays as well as its pharmacokinetics compared to OlGly.

METHODS

ICR female and male mice were tested in nicotine-induced CPP with and without the PPARα antagonist GW6471. OlAla was also assessed in nicotine-dependent mice following removal of nicotine minipumps: somatic withdrawal signs, thermal hyper-nociception and altered affective behavior (i.e., light/dark box). Finally, plasma and brain were collected after administration of OlGly or OlAla and analyzed by high-performance liquid chromatography tandem mass spectrometry.

RESULTS

OlAla prevented nicotine-induced CPP, but this effect was not blocked by GW6471. OlAla attenuated somatic and affective nicotine withdrawal signs, but not thermal hyper-nociception in nicotine-dependent mice undergoing withdrawal. OlAla and OlGly showed similar time-courses in plasma and brain.

CONCLUSIONS

The observation that both molecules showed similar pharmacokinetics argues against the notion that OlAla offers increased metabolic stability. Moreover, while these structurally similar lipids show efficacy in mouse models of reward and dependence, they reduce nicotine reward through distinct mechanisms.

POS0690 SYSTEMATIC LITERATURE REVIEW: WHICH ROUTE AND DOSE OF CORTICOSTEROID IS MOST EFFECTIVE IN INDUCING REMISSION IN EARLY RHEUMATOID ARTHRITIS?

Background

Current NICE guidance for rheumatoid arthritis (RA) states that glucocorticoids may be used for bridging therapy and to rapidly decrease inflammation in acute flares1. However, a recommended route and dosage is not specified, and variation has been observed between individual departments as to whether or not steroids are administered2. Glucocorticoids are associated with adverse events that can be severe, leading to a strong recommendation by the American College of Rheumatology to avoid long term use3. It is therefore important to ascertain the efficacy of available routes and dosages of glucocorticoids to weigh against these risks.

Objectives

This review aimed to ascertain the optimum route and dose of corticosteroid for adults with early RA.

Methods

Papers included were full text, English language, randomised controlled trials that fulfilled the PICO criteria. The population was defined as adults with early RA with onset <2 years, the intervention corticosteroids of any route or dose, the comparator conventional DMARDs or placebo, and the primary outcome remission. Functional improvement and X ray progression were considered as secondary outcomes. MEDLINE, Embase, Web of Science and Cochrane Central were searched. Screening of results and extracted data was carried out by both reviewers. During data extraction, outcomes were rounded to timepoints of 3, 6 and 12 months, and steroid doses were stratified into low (up to 10mg/day prednisolone or equivalent), medium (15-30mg) and high (>30mg). Meta-analyses were carried out in RevMan 5.4 when 3 or more studies measured the same outcome at the same dose and route. A funnel plot was generated to check for publication bias.

Results

Three papers measured DAS28 remission rate at 1 year, comparing DMARDs only to DMARDs plus low dose oral steroids. The Forest plot for this meta-analysis is shown in Figure 1. As I2 = 0%, a fixed effect method was used. This shows an odds ratio (OR) of 1.73 (95% CI 1.25, 2.39) favouring low dose steroids in addition to DMARDs. Meta-analyses were also possible for HAQ at 1 year, and mean DAS28 at 1 year, comparing DMARDs alone to DMARDs plus low dose steroids. Both analyses favoured steroids; for HAQ scores the standardised mean difference (SMD) was -0.69 (95% CI -1.66, 0.29), and for DAS28 the SMD was -0.36 (95% CI -0.58, -0.15). At 3 and 6 months there was a lack of available data for meta-analyses.

Figure 1.

Forest plot showing the OR of DAS28 remission with low dose steroids and conventional DMARDs vs DMARDs only

Conclusion

At 1 year, remission and improvement in function appear more likely if low dose steroids are used. Due to a lack of available data, non-oral routes, higher doses and X ray progression could not be analysed. Studies were not designed to detect differences in adverse events. This highlights the need for further clinical research into steroid efficacy in early RA, as the meta-analyses suggest that glucocorticoids may be more effective in inducing remission in early disease than conventional DMARDs alone.

References

[1]National Institute for Health and Care Excellence. Rheumatoid arthritis in adults: management. https://www.nice.org.uk/guidance/ng100/chapter/Recommendations

[2]Yates et al. Rheumatology. 2020;59: 2035-42.

[3]Fraenkel et al. Arthritis Care & Research. 2021;73: 924-39.

Disclosure of Interests

None declared

Pharmacokinetics and central accumulation of delta-9-tetrahydrocannabinol (THC) and its bioactive metabolites are influenced by route of administration and sex in rats

Up to a third of North Americans report using cannabis in the prior month, most commonly through inhalation. Animal models that reflect human consumption are critical to study the impact of cannabis on brain and behaviour. Most animal studies to date utilize injection of delta-9-tetrahydrocannabinol (THC; primary psychoactive component of cannabis). THC injections produce markedly different physiological and behavioural effects than inhalation, likely due to distinctive pharmacokinetics. The current study directly examined if administration route (injection versus inhalation) alters metabolism and central accumulation of THC and metabolites over time. Adult male and female Sprague–Dawley rats received either an intraperitoneal injection or a 15-min session of inhaled exposure to THC. Blood and brains were collected at 15, 30, 60, 90 and 240-min post-exposure for analysis of THC and metabolites. Despite achieving comparable peak blood THC concentrations in both groups, our results indicate higher initial brain THC concentration following inhalation, whereas injection resulted in dramatically higher 11-OH-THC concentration, a potent THC metabolite, in blood and brain that increased over time. Our results provide evidence of different pharmacokinetic profiles following inhalation versus injection. Accordingly, administration route should be considered during data interpretation, and translational animal work should strongly consider using inhalation models.

Effects of inescapable stress on responses to social incentive stimuli and modulation by escitalopram

RATIONALE

Stress is a well-known risk factor for anhedonia, and its impacts on social reward functions may be mitigated by its controllability. Moreover, there are questions about the effectiveness of selective serotonin reuptake inhibitors (SSRIs) on improving social hedonic functioning deficits characteristic of major depression.

OBJECTIVES

The current study in male Sprague-Dawley rats investigated the effects of uncontrollable stress on responses to social incentive stimuli and possible modulation by the SSRI escitalopram (ESC).

METHODS

The effects of inescapable foot-shocks on preferential responses to a conspecific, and to a compartment that was previously paired with the presence of a conspecific, were assessed in a Y-apparatus in rats that received 0, 5, or 10 mg/kg ESC.

RESULTS

Although inescapable foot-shock exposure did not significantly alter the investigation of the conspecific, it did impair the response to the social-paired compartment and, importantly, this impairment was reversed by ESC.

CONCLUSION

These results indicate that psychophysical stress can negatively impact reactivity to learned social rewards and that SSRI administration can have positive therapeutic effects.

The public health community's use of social media for policy advocacy: a scoping review and suggestions to advance the field

OBJECTIVES

This study aimed to investigate the extent and key characteristics of academic research and scholarship on the public health community's use of social media for policy advocacy purposes. This will enable an evaluation of extant research and provide insight into directions for future research.

STUDY DESIGN

This study was a scoping review of academic literature.

METHODS

A scoping review of academic literature published between 1 January 2011 and 31 December 2020 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Boolean searches were conducted using a university library platform, which included databases, such as EBSCO host, Informit, Scopus, and ScienceDirect. Data were extracted using an a priori code frame, and publication, content, and disciplinary characteristics were analysed. The results of coding and screening comparison checks were within acceptable limits.

RESULTS

In total, 2672 works from around the world were identified and screened for inclusion. Twenty-two English language articles were included in the final analysis. The public health community's use of social media for policy advocacy purposes has largely been approached from a health perspective, despite research and scholarship about social media in communication and policy disciplines (among others). Reported research aims or questions emphasised functional rather than theoretical contributions. Most analysed works used empirical or case study-based methods and were produced by authors in Western geographies. Among the health issues discussed, tobacco and tobacco control were discussed most frequently. While recognising issues with social media, most publications framed social media as more of an opportunity than a problem.

CONCLUSIONS

The public health community's use of social media for policy advocacy purposes is an emerging field. There is considerable potential to expand scholarship and research in this field internationally, especially by integrating transdisciplinary knowledge and perspectives and by applying social media to foster policy change around identified global health challenges. Greater representation of authors from institutions in the Global South is also encouraged, as are applied and theoretical contributions.

Assessing the treatment of cannabidiolic acid methyl ester: a stable synthetic analogue of cannabidiolic acid on c-Fos and NeuN expression in the hypothalamus of rats

BACKGROUND

Cannabidiol (CBD), the non-psychotropic compound from Cannabis sativa, shows positive results on controlling several health disturbances; however, comparable data regarding additional chemical from C. sativa, such as cannabidiolic acid (CBDA), is scarce due to its instability. To address this limitation, a stable CBDA analogue, CBDA methyl ester (HU-580), was synthetized and showed CBDA-like effects. Recently, we described that HU-580 increased wakefulness and wake-related neurochemicals.

OBJECTIVE

To extend the comprehension of HU-580´s properties on waking, the c-Fos and NeuN expression in a wake-linked brain area, the hypothalamus was evaluated.

METHODS

c-Fos and NeuN expression in hypothalamic sections were analyzed after the injections of HU-580 (0.1 or 100 μg/kg, i.p.).

RESULTS

Systemic administrations of HU-580 increased c-Fos and neuronal nuclei (NeuN) expression in hypothalamic nuclei, including the dorsomedial hypothalamic nucleus dorsal part, dorsomedial hypothalamic nucleus compact part, and dorsomedial hypothalamic nucleus ventral part.

CONCLUSION

HU-580 increased c-Fos and NeuN immunoreactivity in hypothalamus nuclei suggesting that this drug might modulate the sleep-wake cycle by engaging the hypothalamus.

AB0298 PREGNANCY IN RHEUMATIC DISEASE: A REGION WIDE SURVEY OF CURRENT PRACTICE AMONGST CLINICIANS IN THE WESSEX MULTI-DISCIPLINARY CONNECTIVE TISSUE DISEASE NETWORK

Background:

Rheumatic diseases frequently affect females of child-bearing age, with implications for foetal and maternal outcomes.

Two-thirds (66%) of the women who died in the 2016-18 MBRRACE report were known to have pre-existing medical problems1. The NHS long-term plan supports creation of Maternal Medicine Networks to facilitate access to specialist care and advice in pregnancy.

Guidelines exist for use of disease modifying anti-rheumatic drugs (DMARDs) during pregnancy but other aspects of pregnancy related care in rheumatic disease remain less well defined. The Wessex wide connective tissue disease (CTD) network provides a multi-disciplinary forum to discuss cases, to obtain approval for high cost drugs, to compare practice in multiple hospitals but does not specifically discuss pregnancy related uncertainties.

Objectives:

To survey variations in clinical practice relating to rheumatic disease in pregnancy

Methods:

Following careful project planning with the tertiary referral centre obstetric lead consultant for maternal medicine, several areas of care were identified which were prone to local and individual variation. An anonymous online survey relating to these specific areas of pregnancy related care was circulated amongst members of the CTD network, including rheumatology consultants, rheumatology practitioners and specialist trainees.

Results:

16 responses were obtained across 7 hospital sites; 56% were from rheumatology consultants. 12/16 (75%) reported routinely offering contraceptive advice when prescribing DMARDs. Only 4/16 (25%) were aware of a specific pre-natal obstetric clinic available in their hospital. There was major variation in planned frequency of clinical review. 10/16 would increase frequency of review during pregnancy if a patient’s disease became active or unstable; 6/16 would aim to review patients approximately 3 monthly; 3/16 would not routinely increase frequency of review during pregnancy. Planned post-natal care was equally varied. 3/16 would routinely prescribe aspirin to all lupus women during pregnancy despite this being recommended for all women with SLE for prevention of pre-eclampsia2. Prescription of low molecular weight heparin was variable, and several responses were at odds with the current RCOG guidance on the subject3. 8/16 (50%) would prescribe corticosteroids judiciously in case of an acute disease flare.

Conclusion:

This survey has revealed significant variation in practice relating to rheumatic disease in pregnancy. Integrated care with colleagues from the regional referral centre for maternal medicine is required, in keeping with the recently published NICE guidance on the subject4. Adopting a hub and spoke model, with local centres working closely alongside a tertiary centre, will help optimise peri-partum care and outcome for patients with long-term rheumatic conditions.

References:

[1]Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) Saving Lives, Improving Mothers’ Care Maternal Report (December 2020). Available at https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2020/MBRRACE-UK_Maternal_Report_Dec_2020_v10.pdf [Accessed 28 January 2021]

[2]National Institute for Health and Care Excellence (2019) Hypertension in pregnancy: diagnosis and management (NICE guideline 133) Available at https://www.nice.org.uk/guidance/ng133 [Accessed 28 January 2021]

[3]Royal College of Obstetricians and Gynaecologists (2015) Reducing the risk of venous thromboembolism during pregnancy and the puerperium (Green-top Guideline Number 37a) Available at https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf [Accessed 5 January 2021]

[4]National Institute for Health and Care Excellence (2019) Intrapartum care for women with existing medical conditions or obstetric complications and their babies (NICE guideline 121) Available at https://www.nice.org.uk/guidance/ng121 [Accessed 5 January 2021]

Disclosure of Interests:

None declared

AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

Background:

The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.

Objectives:

To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.

Methods:

All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.

Results:

Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.

Conclusion:

Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.

References:

[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.

[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].

Disclosure of Interests:

None declared

AB0421 MANAGEMENT OF ULCERATION IN SYSTEMIC SCLEROSIS BY A SPECIALIST PODIATRY SERVICE; A CASE SERIES

Background:

Systemic sclerosis is a chronic disorder characterised by diffuse fibrosis and vascular abnormalities in the skin and major organs. Digital ulceration is a common complication, often resulting in patient disability. These ulcers can form through a variety of processes and management should be tailored according to aetiology. In Dorset, the specialist podiatry service has created a unique facility for optimal wound care in the setting of digital ulceration.

Objectives:

In this case series, we outline podiatric management of 4 common causes of digital ulceration in systemic sclerosis.

Methods:

Tissue ischaemia, infection, micro-trauma and calcinosis were identified as four major contributory factors resulting in ulceration or delayed wound healing. Four cases exemplifying management of each different contributory factor were identified and their case notes reviewed in order to extract clinically relevant data and images.

Results:

Case 1 illustrates treatment of ischaemic tissue injury to promote earlier healing, using careful wound care, debridement under local anaesthetic and low-level laser therapy.

Case 2 illustrates the importance of identifying repeated micro-trauma as a contributing factor to non-healing ulceration.

Case 3 demonstrates how surgical debridement or removal of the subcutaneous calcinosis in an outpatient setting can be a useful adjunct in encouraging ulcer healing.

Case 4 illustrates the complexity of correctly identifying infection in the setting of ulceration, with prompt management promoting wound healing.

Conclusion:

The pathophysiology of ischaemic tissue damage in scleroderma is complex and can reflect a broad range of vascular pathologies, often occurring concurrently1 including vasospasm, macrovascular disease and microvascular vasculopathy, leading to digital ulceration. Rapid identification of which processes are driving the ischaemia is critical in targeting therapy to the affected individual. A local podiatry service with expertise in management of tissue -related complications of systemic sclerosis is invaluable in promoting wound healing and preventing further complications.

References:

[1]Hughes M, Herrick A L. Digital ulcers in systemic sclerosis. Rheumatology 2017; 56(1):14-25.

Disclosure of Interests:

None declared

AB0409 INTRAVENOUS ILOPROST: A REGION WIDE SURVEY OF CURRENT PRESCRIBING AMONGST HOSPITALS IN THE WESSEX MULTI-DISCIPLINARY CONNECTIVE TISSUE DISEASE NETWORK

Background:

Digital ulceration in systemic sclerosis is a severe and disabling aspect of this complex, multi-system disease. Traditionally, intravenous (IV) iloprost has been prescribed to treat the problem. Alternative oral medications including sildenafil and bosentan are now readily available, although NHS clinical commissioning policy is yet to be updated to reflect changes in drug costs. Use of IV iloprost across Wessex was audited to review current practice across the region.

Objectives:

To compare use of IV iloprost across 7 different hospital rheumatology departments

Methods:

Data was collected across 7 different NHS hospital sites using rheumatology specific pharmacy records for high cost drug prescribing and a single uniform data collection proforma, which was then analysed by 1 person to ensure uniformity of results. Case notes were reviewed retrospectively to determine diagnosis, frequency and duration of iloprost treatment, if patients had been considered for sildenafil treatment (including if sildenafil was prescribed, any cautions or contra-indications to treatment, dose and any reason for discontinuation of treatment) and if patients had been considered for bosentan treatment and if it was prescribed.

Results:

45 patients were identified currently receiving IV iloprost. 32/45 (71%) had a diagnosis of systemic sclerosis, mixed connective tissue disease (CTD) or undifferentiated CTD (to be called scleroderma group). 13/45 had other miscellaneous diagnoses which had resulted in digital ulceration. These 13 patients were excluded from further analysis relating to sildenafil or bosentan prescribing as these medications were not indicated for other causes of digital ulceration. In the scleroderma group, 27/32 (84%) had been considered for sildenafil treatment. Of these, 8/27 started and discontinued due to intolerance and 17/27 remained on sildenafil. In the scleroderma group, 9/32 had been considered for bosentan treatment, and of these 7/9 remained on bosentan.

Conclusion:

The authors have identified that IV iloprost is still widely used for management of digital ulceration in rheumatology departments across seven different hospitals in Wessex. Most of this group of patients would likely be eligible for treatment with sildenafil or bosentan. Sildenafil intolerance is a challenge to management. Consideration of bosentan as a treatment option was limited in this group, and may be a cost-effective alternative to IV iloprost which would also eliminate the risk of infection associated with IV access in a potentially immunosuppressed group of patients.

Disclosure of Interests:

None declared

The pitch glide speech task lacks clinical utility to infer laryngeal lift during swallowing†

Purpose: To investigate the amount of laryngeal lift during the pitch glide speech task and during a bolus swallow.Method: Modified Barium Swallows (MBS) videos captured speech tasks and bolus trials. Using SwallowTail®, laryngeal elevation was measured by the amount of laryngeal lift from rest to its maximum excursion during each subject's pitch glide and 5 mL thin liquid, 20 mL thin liquid, and 15 mL puree trials. Paired t-tests, with Bonferroni correction, determined if there was a difference in laryngeal lift between the pitch glide and the bolus trials. Two methods were used to compare the methodology of measuring laryngeal lift.Result: Each subject's pitch glide was compared to their swallows. Laryngeal lift during the bolus swallow was greater than the lift during the pitch glide by an average of 1.10 cm, 1.38 cm, and 1.34 cm for 5 mL thin liquid, 20 mL thin liquid, and 15 mL puree, respectively. There was a significant difference in laryngeal lift between the pitch glide task and the 20 mL thin liquid, 5 mL thin liquid, and 15 mL puree swallows. Measurement tracking the posterior cricoid detected greater differences than the previous methodology using the hyoid.Conclusion: In this group of dysphagic patients, the larynx lifted significantly less during a pitch glide than during bolus swallows.

Effects on the post-translational modification of H3K4Me3, H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2 levels in cerebral cortex, hypothalamus and pons of rats after a systemic administration of cannabidiol: A Preliminary Study

BACKGROUND

Cannabidiol (CBD), a non-psychotropic constituent of Cannabis sativa, has shown therapeutic promises by modulating several pathological conditions, including pain, epilepsy autism, among others. However, the molecular mechanism of action of CBD remains unknown and recent data suggest the engagement on CBD´s effects of nuclear elements, such as histone activity.

AIM

This study assessed the changes on the post-translational modification (PTM) on the histones H3K4Me3, H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2 in several brain regions of rats after the administration of CBD (20mg/Kg/i.p.).

OBJECTIVE

To evaluate the effects on the PTM of histones H3K4Me3, H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2 levels in the cerebral cortex, hypothalamus and pons of CBD-treated rats.

METHOD

Ten adult rats were randomly assigned into 2 groups: Control or CBD (20mg/Kg/i.p). Animals were sacrificed after treatments and brains were collected for dissections of the cerebral cortex, hypothalamus and pons. Samples were analyzed for PTM on the histones H3K4Me3, H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2 levels by Western blot procedure.

RESULTS

CBD increased the PTM levels on the histones H3K4Me3, H3K9ac, and H3K27Me3 in the cerebral cortex whereas no significant differences were found in H3K9Me2 and H3K36Me2. In addition, in the hypothalamus, CBD decreased the contents of H3K9ac while no significant effects were observed in H3K4Me3, H3K9Me2, H3K27Me3, and H3K36Me2. Lastly, in the pons, CBD-treated rats showed a significant decline on the PTM levels of H3K4Me3 whereas no statistical differences were found in H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2.

CONCLUSION

The study showed that CBD induced differential effects in levels of PTM on the histones H3K4Me3, H3K9ac, H3K9Me2, H3K27Me3, and H3K36Me2 in several brain regions.

Industry funding of patient groups: a systematic review

Background

Patient groups play an important role in health care and policy. Concerns have been raised about the financial ties between the pharmaceutical industry and patient groups, because of potential threats to the groups' independence. We conducted a systematic review to synthesise studies that explored pharmaceutical or medical device industry funding of patient groups.

Methods

We searched Medline, Embase, Web of Science, Scopus and Google Scholar (from inception to January 2018). We included observational studies reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups which disclosed information about this funding; association between industry funding and organisational positions on health and policy issues. We carried out duplicate independent data extraction and assessed study quality.

Results

26 cross-sectional studies were included. Fifteen studies assessed the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). The proportion of patient groups which disclosed funding information on their websites was low (27% [95% CI: 24%-31%]). Few patient groups had formal policies governing corporate sponsorship (range from 2% (2/125) to 64% (175/274)). Among the few studies examining funding status versus organisational position, industry sponsored groups tend to hold positions consistent with sponsors' interests.

Conclusions

We found widespread indications of industry funding of patient groups. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Research on policy impact is still limited. Considering the important role that patient groups play in health, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.

Key messages

Industry funding of patient groups is common in high income countries. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Considering the important role that patient groups play in health care and policy, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

AB1357-HPR DESIGNING THE ROYAL COLLEGE OF NURSING COMPETENCY FRAMEWORK FOR RHEUMATOLOGY NURSES

Background:

The 1st Edition of the RCN Competency Framework for Rheumatology Nurse Specialists (RNS) will be published in March 2020. The role of the RNS is complex, and can include caring for children and young people. The importance of RNS’s was highlighted by the National Rheumatoid Arthritis Society (NRAS 2017). The British Society for Rheumatology (BSR) outlined the need for education, training supervision and work force development. Education for RNS isn’t currently centralized but is key to improving skills and developing workforce for the future. RNS are in short supply resulting in problems of access to services and delays in care (BSR 2019). In all 4 UK nations the titles of RNS and proficiency vary greatly (Titrate trial 2019) This is likely to have an impact on patient experience and outcomes. The European League Against Rheumatism (EULAR) developed recommendations for the role of the RNS which were recently updated (Beech et al, 2019). This framework maps all of these requirements.

Objectives:

This work supports the development of roles, improve access for patients and reduce. This document will act as a foundation for building sustainability and a more robust education and role development strategy. This work will strengthen rheumatology nursing and support all 4 UK nation’s issues regarding recruitment, retention, sustainability, succession planning and benchmarking. Dissemination is key and we will work hard with stakeholders to ensure centralization of a nationally adopted framework. This abstract submission will increase dissemination opportunities.

Methods:

Online data sources were searched for the most relevant and current evidence. Where research evidence wasn’t available, existing and new knowledge was utilised from a consensus of clinical expert and patient opinions, several rounds of discussions took place virtually and face to face. RCN Rheumatology Nurse Forum Workshop attendees in June 2019 also answered a questionnaire to elicit views and demographic information regarding roles.

Results:

The questionnaire results demonstrated 100% (n37) agreement with the development of the framework and that only 2 respondents had completed a competency process. 60% were RNS. Of these 52% (n13) were band 6, 47% (n9) were band 7, and 1% were band 8 consultant nurses. The questionnaire highlighted the need to develop the framework. Results were fed back to the working party to inform the domains to be included.

Conclusion:

Document will be at BSR 2020 having successfully submitted a session proposal and abstract. Evaluation will begin later in the year 6 to 12 months from launch. We will measure impact using a variety of methods including membership Facebook pages and the questionnaire at point of download request. We will measure where and how the competency is being used and adoption of the framework throughout the UK.

References:

[1]Beech B, Primdahl J, van Tubergen A, et al., (2019) 2019 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis.http://dx.doi.org/10.1136/annrheumdis-2019-215458 (accessed 13 December 2019). Benner, P (1984) From novice to expert, excellence

[2]British Society of Rheumatology (2019) State of Play, London: BSR. Available at: www. rheumatology.org.uk/Portals/0/Documents/ Policy/BSR_State_Of_Play_Scotland2018. pdf?ver=2019-03-11-094117-440 (accessed 13 December 2019).

[3]Martin N, Ibrahim F, Tom B, et al., (2017) Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomized controlled trial. Trials. 2017;18:591. doi.org/10.1186/s13063-017-2330-8.

Disclosure of Interests:

Polly Livermore: None declared, Diana Finney Speakers bureau: Nordic

Abbvie, Julie Begum: None declared, Ruth Wyllie: None declared, Trish Cornell Employee of: Consultant Nurse for Abbvie, Helen Smith: None declared, Lisa Howie: None declared, Louise Parker: None declared

Current concepts in the management of ankle arthritis

Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.

Determination of the Efficacy of Preservation of Non-Eye Area Water-Miscible Cosmetic and Toiletry Formulations: Collaborative Study

A collaborative study was conducted to test a method developed to distinguish between adequately and inadequately preserved cosmetic formulations. Nineteen laboratories participated in the study. Samples tested included shampoos, hair conditioners, oil-in-water emulsions, and water-in-oil-emulsions. Triplicate samples of 4 adequately preserved and 4 inadequately preserved cosmetic products were tested by each collaborative laboratory. Results showed that all inadequately preserved shampoo and conditioner samples failed to meet the acceptance criteria for adequately preserved formulations. Of the 51 preserved samples, 49 shampoos and 48 conditioners met the criteria for adequate preservation. All samples of inadequately preserved water-in-oil emulsions and oil-in-water emulsions failed to meet the acceptance criteria, whereas all adequately preserved emulsion formulations met the acceptance criteria.

Intra-Operative 3-Dimensional Imaging (O-arm) in Foot and Ankle Trauma Surgery: Report of 2 Cases and Review of the Literature

Background:

Intraoperative two-dimensional (2D) fluoroscopy is the standard imaging modality available to orthopaedic surgeons worldwide. It is well-accepted, however, multiplanar 3 dimensional (3D) CT scanning is superior to 2D imaging for visualising joint surfaces and is now a fundamental feature of the pre-operative planning of intra-articular fractures.

Objective:

We present two cases in which the use of 3D intraoperative imaging and the O-arm® (Medtronic, Minneapolis, USA) led to immediate intraoperative revision to optimise fixation and articular congruity. A review of the current literature is also provided.

Methods:

During the trial period of the O-arm at our major trauma centre, intra-operative imaging was used in the lower limb trauma setting. The O-arm was used intra-operatively in a comminuted pilon fracture and a displaced talus fracture. We recorded all the intra-operative events, including quality of reduction, implant positioning and operation time. Each patient was followed-up for 12 months post-operation and was finally assessed with x-rays and the AOFAS score.

Results:

In both the cases, either fracture reduction or the implant position/usage that was observed with 2D fluoroscopy was revised following a 3D intra-operative scan. No postoperative complications were noted and the healing process was uneventful. X-rays at the final follow-up were excellent and acceptable for the talus and pilon fracture, respectively, with corresponding clinical results and AOFAS score.

Conclusion:

Although frequently used in spinal surgery, to the best of our knowledge, the use of intra-operative 3D techniques in lower limb trauma is sparse and sporadically reported. We present our cases in which the most current innovative imaging techniques influenced intra-operative outcomes without compromising patient safety. We feel that this is a real example of how innovation can positively influence patient care.

A study of limbic brain derived neurotrophic factor gene expression in male Sprague-Dawley rats trained on a learned helplessness task

BACKGROUND

Brain derived neurotrophic factor (BDNF) has been linked to the etiology and pathology of Major Depressive Disorder (MDD). Here, the relationship between learned helplessness (LH), a cognitive/motivational state relevant to MDD, and BDNF mRNA in various limbic regions, was investigated.

METHODS

In Sprague-Dawley male rats, LH was induced by escape training, using a triadic design of stressor controllability involving exposure to no shocks (NS), escapable shocks (ES) or yoked inescapable shocks (IES). LH was subsequently assessed in an active avoidance task, and levels of BDNF mRNA in limbic brain regions were compared across the triad following testing.

RESULTS

Although the IES group displayed greater LH, BDNF mRNA levels were lower in the hippocampus and higher in the nucleus accumbens of both IES and ES groups. In contrast, BDNF mRNA in the basolateral amygdala was elevated only in rats exposed to IES.

CONCLUSION

These results suggest that the inability to control an aversive stimulus can lead to a LH behavioural phenotype that is associated with region-specific alterations of BDNF gene expression in limbic nuclei.

Acute continuous moderate-intensity exercise, but not low-volume high-intensity interval exercise, attenuates postprandial suppression of circulating osteocalcin in young overweight and obese adults

Bone remodeling markers (BRMs) are suppressed following the consumption of a meal. Our findings indicate that a single session of continuous moderate-intensity exercise, but not low-volume high-intensity interval exercise, performed 1 h after a meal attenuates the postprandial suppression of BRMs.

INTRODUCTION

Acute exercise transiently increases BRMs including osteocalcin (tOC) and the undercarboxylated form of osteocalcin (ucOC), a hormone that is implicated in glucose regulation. The effects of acute exercise and exercise-intensity on postprandial levels of tOC and ucOC are unknown.

METHODS

Twenty-seven adults that were overweight or obese (age 30 ± 1 years; BMI 30 ± 1 kg∙m^-2; mean ± SEM) were randomly allocated to perform a single session of low-volume high-intensity interval exercise (LV-HIIE; nine females, five males) or continuous moderate-intensity exercise (CMIE; eightfemales, five males) 1 h after consumption of a standard breakfast. Serum tOC, ucOC, and ucOC/tOC were measured at baseline, 1 h, and 3 h after breakfast consumption on a rest day (no exercise) and the exercise day (exercise 1 h after breakfast).

RESULTS

Compared to baseline, serum tOC and ucOC were suppressed 3 h after breakfast on the rest day (- 10 ± 1% and - 6 ± 2%, respectively; p < 0.05), whereas ucOC/tOC was elevated (2.5 ± 1%; p = 0.08). Compared to the rest day, CMIE attenuated the postprandial-induced suppression of tOC (rest day - 10 ± 2% versus CMIE - 5 ± 2%, p < 0.05) and ucOC (rest day - 6 ± 4% versus CMIE 11 ± 2%, p < 0.05), and increased postprandial ucOC/tOC (rest day 3 ± 2% versus CMIE 15 ± 1%, p < 0.05). In contrast, LV-HIIE did not alter postprandial tOC, ucOC, or ucOC/tOC (all p > 0.1).

CONCLUSIONS

Acute CMIE, but not LV-HIIE, attenuates the postprandial-induced suppression of tOC and ucOC. CMIE may be an effective tool to control the circulating levels of BRMs following meal consumption in overweight/obese adults.

N-Oleoyl-glycine reduces nicotine reward and withdrawal in mice

Cigarette smokers with brain damage involving the insular cortex display cessation of tobacco smoking, suggesting that this region may contribute to nicotine addiction. In the present study, we speculated that molecules in the insular cortex that are sensitive to experimental traumatic brain injury (TBI) in mice might provide leads to ameliorate nicotine addiction. Using targeted lipidomics, we found that TBI elicited substantial increases of a largely uncharacterized lipid, N-acyl-glycine, N-oleoyl-glycine (OlGly), in the insular cortex of mice. We then evaluated whether intraperitoneal administration of OlGly would alter withdrawal responses in nicotine-dependent mice as well as the rewarding effects of nicotine, as assessed in the conditioned place preference paradigm (CPP). Systemic administration of OlGly reduced mecamylamine-precipitated withdrawal responses in nicotine-dependent mice and prevented nicotine CPP. However, OlGly did not affect morphine CPP, demonstrating a degree of selectivity. Our respective in vitro and in vivo observations that OlGly activated peroxisome proliferator-activated receptor alpha (PPAR-α) and the PPAR-α antagonist GW6471 prevented the OlGly-induced reduction of nicotine CPP in mice suggests that this lipid acts as a functional PPAR-α agonist to attenuate nicotine reward. These findings raise the possibility that the long chain fatty acid amide OlGly may possess efficacy in treating nicotine addiction.

Atopic dermatitis and risk of hypertension, type 2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project

BACKGROUND

Atopic dermatitis (AD) has been associated with cardiovascular risk factors and diseases, but epidemiological studies to date have found conflicting results.

OBJECTIVES

To determine the associations of AD with hypertension, type 2 diabetes (T2D), myocardial infarction (MI) and stroke.

METHODS

We conducted a cross-sectional analysis of baseline data from the Canadian Partnership for Tomorrow Project, which includes Canadian residents aged 30-74 years living in British Columbia, Alberta, Ontario, Quebec and the Atlantic Provinces. We excluded participants with incomplete data on AD, hypertension, T2D, MI or stroke, who had type 1 or gestational diabetes or who developed any of the outcomes at an age prior to a diagnosis of AD. This left 259 119 participants in our analysis. We used logistic regression to calculate age- and sex-, and multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between AD and subsequent hypertension, T2D, MI and stroke.

RESULTS

AD was reported by 21 379 (8·4%) participants. In total, 52 787 cases of hypertension, 12 739 cases of T2D, 4390 cases of MI and 2235 cases of stroke were reported by participants at enrolment. In the multivariable-adjusted model, AD was associated with decreased odds of hypertension (OR 0·87, 95% CI 0·83-0·90), T2D (OR 0·78, 95% CI 0·71-0·84), MI (OR 0·87, 95% CI 0·75-1·00) and stroke (OR 0·79, 95% CI 0·66-0·95).

CONCLUSIONS

We did not find evidence of a positive association between AD and subsequent hypertension, T2D, MI or stroke; AD was inversely associated with these outcomes in our study. Given our findings and the conflicting literature, AD is likely not a major risk factor for cardiovascular disease.

Multifaceted interaction of bone, muscle, lifestyle interventions and metabolic and cardiovascular disease: role of osteocalcin

Undercarboxylated osteocalcin (ucOC) may play a role in glucose homeostasis and cardiometabolic health. This review examines the epidemiological and interventional evidence associating osteocalcin (OC) and ucOC with metabolic risk and cardiovascular disease. The complexity in assessing such correlations, due to the observational nature of human studies, is discussed. Several studies have reported that higher levels of ucOC and OC are correlated with lower fat mass and HbA1c. In addition, improved measures of glycaemic control via pharmacological and non-pharmacological (e.g. exercise or diet) interventions are often associated with increased circulating levels of OC and/or ucOC. There is also a relationship between lower circulating OC and ucOC and increased measures of vascular calcification and cardiovascular disease. However, not all studies have reported such relationship, some with contradictory findings. Equivocal findings may arise because of the observational nature of the studies and the inability to directly assess the relationship between OC and ucOC on glycaemic control and cardiovascular health in humans. Studying OC and ucOC in humans is further complicated due to numerous confounding factors such as sex differences, menopausal status, vitamin K status, physical activity level, body mass index, insulin sensitivity (normal/insulin resistance/T2DM), tissue-specific effects and renal function among others. Current observational and indirect interventional evidence appears to support a relationship between ucOC with metabolic and cardiovascular disease. There is also emerging evidence to suggest a direct role of ucOC in human metabolism. Further mechanistic studies are required to (a) clarify causality, (b) explore mechanisms involved and

Geostatistical modelling of arsenic in drinking water wells and related toenail arsenic concentrations across Nova Scotia, Canada

Arsenic is a naturally occurring class 1 human carcinogen that is widespread in private drinking water wells throughout the province of Nova Scotia in Canada. In this paper we explore the spatial variation in toenail arsenic concentrations (arsenic body burden) in Nova Scotia. We describe the regional distribution of arsenic concentrations in private well water supplies in the province, and evaluate the geological and environmental features associated with higher levels of arsenic in well water. We develop geostatistical process models to predict high toenail arsenic concentrations and high well water arsenic concentrations, which have utility for studies where no direct measurements of arsenic body burden or arsenic exposure are available. 892 men and women who participated in the Atlantic Partnership for Tomorrow's Health Project provided both drinking water and toenail clipping samples. Information on socio-demographic, lifestyle and health factors was obtained with a set of standardized questionnaires. Anthropometric indices and arsenic concentrations in drinking water and toenails were measured. In addition, data on arsenic concentrations in 10,498 private wells were provided by the Nova Scotia Department of Environment. We utilised stepwise multivariable logistic regression modelling to develop separate statistical models to: a) predict high toenail arsenic concentrations (defined as toenail arsenic levels ≥0.12 μg g(-1)) and b) predict high well water arsenic concentrations (defined as well water arsenic levels ≥5.0 μg L(-1)). We found that the geological and environmental information that predicted well water arsenic concentrations can also be used to accurately predict toenail arsenic concentrations. We conclude that geological and environmental factors contributing to arsenic contamination in well water are the major contributing influences on arsenic body burden among Nova Scotia residents. Further studies are warranted to assess appropriate intervention strategies for reducing arsenic body burden among human populations.

Updated investigations of cancer excesses in individuals born or resident in the vicinity of Sellafield and Dounreay

BACKGROUND

Earlier studies have shown raised risks of leukaemia and non-Hodgkin lymphoma in children, teenagers and young adults resident either at birth or diagnosis in Seascale. Some increases in cancer risk in these age groups have also been noted among those living around Dounreay. We aimed to update previous analyses relating to areas close to these nuclear installations by considering data from an additional 16 years of follow-up.

METHODS

Cross-sectional analyses compared cancer incidence rates for 1963-2006 among those aged 0-24 years at diagnosis living in geographically specified areas around either Sellafield or Dounreay with general population rates. Cancer incidence for the period 1971-2006 among the cohort of Cumbrian births between 1950 and 2006 was compared to national incidence for 1971-2006 using person-years analysis. Cancer among those born in the postcode sector closest to Dounreay was compared with that among those born in the three adjoining postcode sectors. Analyses considered both cancer overall and ICD-O-3 defined diagnostic subgroups including leukaemia, central nervous system tumours and other malignancies.

RESULTS

Apart from previously reported raised risks, no new significantly increased risks for cancer overall or any diagnostic subgroup were found among children or teenagers and young adults living around either nuclear installation. Individuals born close to the installations from 1950 to 2006 were not shown to be at any increased risk of cancer during the period 1971 to date.

CONCLUSIONS

Analysis of recent data suggests that children, teenagers and young adults currently living close to Sellafield and Dounreay are not at an increased risk of developing cancer. Equally, there is no evidence of any increased cancer risk later in life among those resident in these areas at birth.

Towards a better cannabis drug

This commentary discusses the importance of a new study entitled 'Cannabidiol attenuates deficits of visuo-spatial associative memory induced by Δ(9) -tetrahydrocannabinol' by Wright et al. from the Scripps Institute in La Jolla, California. The results in this study show that the non-psychoactive cannabis constituent cannabidiol opposes some, but not all, forms of behavioural and memory disruption caused by Δ(9) -tetrahydrocannabinol in male rhesus monkeys.

LINKED ARTICLE

This article is a commentary on the research paper by Wright et al., pp 1365-1373 of this issue. To view this paper visit http://dx.doi.org/10.1111/bph.12199.

Screw fixation of medial malleolar fractures: a cadaveric biomechanical study challenging the current AO philosophy

The AO Foundation advocates the use of partially threaded lag screws in the fixation of fractures of the medial malleolus. However, their threads often bypass the radiodense physeal scar of the distal tibia, possibly failing to obtain more secure purchase and better compression of the fracture. We therefore hypothesised that the partially threaded screws commonly used to fix a medial malleolar fracture often provide suboptimal compression as a result of bypassing the physeal scar, and proposed that better compression of the fracture may be achieved with shorter partially threaded screws or fully threaded screws whose threads engage the physeal scar. We analysed compression at the fracture site in human cadaver medial malleoli treated with either 30 mm or 45 mm long partially threaded screws or 45 mm fully threaded screws. The median compression at the fracture site achieved with 30 mm partially threaded screws (0.95 kg/cm(2) (interquartile range (IQR) 0.8 to 1.2) and 45 mm fully threaded screws (1.0 kg/cm(2) (IQR 0.7 to 2.8)) was significantly higher than that achieved with 45 mm partially threaded screws (0.6 kg/cm(2) (IQR 0.2 to 0.9)) (p = 0.04 and p < 0.001, respectively). The fully threaded screws and the 30mm partially threaded screws were seen to engage the physeal scar under an image intensifier in each case. The results support the use of 30 mm partially threaded or 45 mm fully threaded screws that engage the physeal scar rather than longer partially threaded screws that do not. A 45 mm fully threaded screw may in practice offer additional benefit over 30 mm partially threaded screws in increasing the thread count in the denser paraphyseal region.

Hydrogen peroxide production and free radical-mediated cell stress in Mycoplasma bovis pneumonia

Mycoplasma bovis causes chronic pneumonia and polyarthritis in feedlot cattle. M. bovis infects the lungs of most feedlot cattle, but the majority of calves never develop disease. Competing explanations are that some strains of M. bovis are more virulent than others or, alternatively, that calves require some other abnormality to be present in order for M. bovis to cause disease. We hypothesize that H2O2 production is an important virulence factor of M. bovis, causing oxidative injury to lung tissue. A second hypothesis is that isolates associated with caseonecrotic bronchopneumonia have an increased capacity for H2O2 production. Immunohistochemical markers of oxidative stress (4-hydroxynonenal, HN) and nitrative stress (3-nitrotyrosine, NT) were compared in lungs of calves with caseonecrotic bronchopneumonia characteristic of M. bovis infection, with other forms of bronchopneumonia or with non-inflamed lungs. HN and NT were identified in M. bovis pneumonia, mainly in foci of caseous necrosis. HN was not observed in inflamed non-necrotic tissue in lesions typical of pneumonic pasteurellosis. H2O2 production by M. bovis was identified, but the levels did not differ in isolates from calves with caseonecrotic bronchopneumonia compared with those with non-inflamed lungs or other forms of pneumonia. These findings provide evidence that oxidative and nitrative injury contribute to the formation of the caseonecrotic lesions that are characteristic of M. bovis pneumonia and that production of H2O2 by M. bovis may contribute to this oxidative injury.

Feasibility Analysis of an evidence-based positive prevention intervention for youth living with HIV/AIDS in Kinshasa, Democratic Republic of the Congo

We evaluated the feasibility of a Positive Prevention intervention adapted for youth living with HIV/AIDS (YLWH) ages 15-24 in Kinshasa, Democratic Republic of the Congo. We conducted in-depth interviews and focus group discussions with intervention facilitators and YLWH participants on the following four areas of a feasibility framework: acceptability, implementation, adaptation, and limited-efficacy. The adapted intervention was suitable, satisfying, and attractive to program facilitators and participants and able to be implemented effectively. It performed well with a new population and showed preliminary efficacy. However, we identified certain aspects of the intervention that must be addressed prior to wider implementation such as: (1) including more content on navigating marriage while living with HIV and disclosure; (2) adjusting intervention timing and session length; and (3) simplifying the more complicated content. An adapted evidencebased intervention was found to be feasible and lessons learned can be applied to YLWH in other low-resource settings.